s not theirs. The application of legal ules generally makes this impossible. The real question is: What will come losest to giving the child the environnent that his parents, by reason of their efusal or inability to get along together, are taking away from him?

Instead of answering this question, our courts are often called upon to decide as between father and mother whether the pot or the kettle is black and to enter a judgment for the welfare of the child accordingly. The right

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for 3 weeks with one parent and 1 week with the other; the school months with mother and the summer months with father, or vice versa. Six months with one parent and 6 months with the other is not at all unusual. During his entire childhood the child of divorce becomes the subject of a struggle between parents for his affections. Under such circumstances, we have nothing but a legalized method of promoting abnormal emotional development. The poor kids never get the chance to develop any

answer for the child can be reached only through objective investigation, not through the application of set rules or some compromise whereby each parent gets a part of what both selfishly want. First in the normal, natural development of a child is a sense of security, the feeling of belonging some place. The child who is the center of a dispute between parents seldom has this, and if he has it, our courts may unwittingly take it away from him.

The opinions of our courts concerning custody are full of statements that the welfare of the child is foremost, that children are not chattels, and so forth. But it seems that we then proceed to take care of the personal desires of the parents.

No sense of security

Court orders, instead of permitting the children to grow up normally, call

sense of security and they belong no place at all.

In the next place, even though parents are at odds, the real interests of the child suffer when the natural sense of respect and admiration for either parent is impaired. The parents themselves contribute to this before the matter ever gets into the hands of lawyers. Instead of keeping the children. as far from the battle as possible, the parents permit them and often encourage them to enter into it. In many instances, they are present during the taking of evidence and quite often, under the influence of one of the parents, a child himself testifies. If the child is over a given age, though so young in development as to have no mature judgment, the court is supposed to listen to his expressed wish, though the place that he wants to stay may be merely the place where he is assured

of the most luxuries and the least discipline.

In many cases, after being subjected to the tirades of each parent, the child gets the idea of not belonging any place at all, thinks that neither parent wants him, or is fit to have him, and develops a sense of loneliness that will be a handicap to his normal emotional development and a plague to his entire adult existence. Sometimes he is shoved into some school where the authorities have no knowledge of his background, and before long they find that he is a

runaway.

Another thing is that children need to feel that a single authority exists to which they are subject. Where we have divided custody, rights of visitation, and so forth, the child not only does not have this feeling, but cannot get it. In many instances each parent, when with the child, not only attempts to alienate him from the other but curries favor with the child so that he will want to come back again. The child is in the middle, and if this is the best that can be done for him, the chances are that he might be better off without either parent.

These are but three of the many principles, violation of which prevents the child of divorce from growing into a normal, well-adjusted adult. They illustrate how we are abusing the children of divorce instead of helping them. If the child of divorce is to be like other children, we must not permit him to be placed in abnormal situations if we can possibly avoid it. Of course, we do not violate the interests of children purposely. Lawyers and courts simply know no better and cannot be expected to know without the assistance of the kind of special and technical advice that is indispensable if an intelligent conclusion is to be reached.

Court needs technical advice

Lawyers differ in opinions of legal matters, and doctors differ in the diagnosis and treatment of illness. Nevertheless, an intelligent man in trouble does not go to the barber shop for his legal advice, and a sick man who wants to get well does not go to a witch doctor. Why then should we continue to give only lip service to child welfare, about which we, as lawyers, know nothing, and permit our courts to enter or

ders affecting the entire future of children without any proper advice on the subject whatsoever?

Many a lawyer feels that he has fulfilled his professional obligations if he acts as if he were the parent he represents, and it is the service of such members of the profession that sometimes seem most in demand. Voluminous and expensive records are developed which cannot possibly serve the real interests of any child and which never give the court any intelligent guidance.

Our court of appeals has commented on this on several occasions, and in a recent case, in permitting a mother to take her children to another State for permanent residence, gave as justification for this the elimination of the stench with which the divorce action had been surrounded. However little our courts may know of child welfare, and they can be expected to know but little, they know, and properly, that these performances do not and cannot serve the real interests of child.

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An honest and intelligent approach to the problem is for the legislature to prescribe a procedure that will make it possible for courts to obtain special service and advice.

In our cities it is becoming more and more common for informed and socially responsible lawyers to send parents to

competent child psychiatrists. In this manner an intelligent and expert disinterested opinion for the benefit of the child is obtained. A reputable doctor of psychiatry renders professional service for the sole benefit of the child.

If a decision on custody is ultimately necessary, the court can have the benefit of sound advice from a competent source before acting, since the doctor, having made an objective approach and being competent in his special field, makes an able witness for the child. Expert assistance of this sort may sometimes lead to the discovery of the real reason why parents are unable to get along together. The cause may occasionally be eliminated, and reconciliation accomplished. Children are always better off with both parents if they have a conftented, responsible home, and any other arrangement, even such as is made upon the basis of the most expert advice, is, at best, nothing more than a substitute.

In these days, expert advice is becoming more and more difficult to get. The impetus given psychiatry by the war has made it virtually impossible to get into the office of a first-class practitioner-for they are all too few-short of an appointment made many weeks in advance.

According to information given the

State Judicial Council of Kentuck some of our circuit judges are havin investigations made by child-welfa workers where such workers are ava able. This is believed to be a sour practice, and during the writer's serv as circuit judge he did likewise.

Quite often a court feels that he making Solomon's choice, and few real ize the tremendous responsibility of th circuit judge who in making a sing decision may well affect the entire lif of a child. For example, what is or to do in the following instance?

Rightly or wrongly, the custody of child of very tender years whose parentwere divorced had been awarded to the father. The mother was married whe very young, had had no real girlhoo and had been unhappy with her hus! band. The pattern is familiar. Th husband later boarded the child wit a childless couple. Subsequently the mother remarried and was happily ad justed, her new husband was willin." and anxious to assume the obligations. a father toward the child, and the mat ter was reopened. The father had alremarried, and the couple who had th child were desirous of keeping him All were financially able to assume the responsibility, and there was no mora question involved to cloud the issue.

How is it possible for anyone to believe that a court can act intelligently in such a situation without some sort of special advice? Even experts do not welcome this kind of problem, yet th entire future of a bright little boy may hang on how successfully the probler is met. Such a problem, involving a boy 5 years of age, was presented in the Mason Circuit Court in 1945. Not only is this not a legal problem; it is a problem that lawyers cannot even argue intelligently. The court in this instance. who happened to be the author, did not hesitate to take the problem at his own expense to the best child psychiatrist he could find. Whatever the result of such a case, even if it was handled exactly right, it should have no value as a legal precedent. The answer in the next case may be entirely different, and so legal precedence as such is of little or no value.

It is terrifying enough to make decisions in these matters even when fortified with the most expert advice available, but when we realize that our cir

cuit courts are, for lack of any other way, feeling their way around in the clark, it makes one wonder how long we are to continue grinding out children of divorce by the hundreds, children who may be headed for early delinquency and, perhaps, doomed to be handicapped and emotionally unstable in adulthood.

This is the situation. We can do but one of two things. Either we must shut our eyes and let nature take its course or we must attempt to meet the situation as intelligently as we can. We cannot have psychiatrists to advise all our courts. In no more than a handful of communities is there available this kind of special advice, and, though meeting the problem adequately requires the application of this specialized branch of medical and social science, there is no practical way to obtain it except in a few cases.

Some have suggested that the court appoint a guardian ad litem (to act for the child in the case). This is an excellent idea, since it gives to the child his natural social right, independent representation at court. However, no matter how good the guardian ad litem may be, he needs competent advice if he is to represent his client or clients capably. The only kind of advice that can be of real value to the child and the court is that based on information ob

tained through an objective investigation by a competent person trained in the delicate social science of child welfare.

Job for child-welfare division

The child-welfare division of the department of welfare of my State has been criticized because of the delay in handling cases. These delays are due to the severe shortage of trained childwelfare workers, a situation which should be remedied gradually as trained personnel become more available. Since many children of broken homes end up as delinquents and ultimately become the reponsibility of the child-welfare division anyhow, it seems reasonable to believe that many delinquencies might be avoided if the agency could enter the picture in its early stages before the child's problem becomes acute.

It is believed by many, and certainly it is reasonable belief,, that no court

order which in any way affects a child should be entered without an objective investigation by a person trained in child welfare. Certainly this is the least we should provide.

When a child is to be adopted, the law of Kentucky makes the department adoption proceedings. The reason for of welfare a necessary party to the this legislation, of course, is to assure the child of as good a home and as good an opportunity to develop normally as is possible under the circumstances.

The same reason exists in custody procedures in divorce cases even though the other parties involved happen to be the parents.

What is best for the children?

After parents separate, a child will have new adjustments to make and it is most important that they be made successfully. This cannot be achieved through "show cause" orders, producing children in open court, and so forth. The results of objective investigations should be a part of the case record, and the opinion of the child-welfare worker should be prima facie evidence of what is best for the children involved.

Anyone with any experience with parents at war with each other knows that often an effort to obtain custody of

a child is merely a matter of spite to keep the other parent from getting anything. People want their friends. and the public to know that they won. They want everyone to feel that whatever the trouble might have been it was the other party's fault.

When a court has a record such as suggested, he can act intelligently in the interests of the children. Otherwise he can do nothing more than grope in the dark, wishing that he had some sort of Divine help; and, because he hasn't, he often creates more problems than he solves.

Since these problems are of social character and are problems of social welfare, they demand a new approach. A person trained in child welfare can be of invaluable aid in assisting the parent, or other person who may have. the custody of the child, so that he can more easily adjust to the new environ

ment.

Furthermore, once an order is made it should not be forgotten by the court. The child-welfare worker should maintain adequate contact with the case and be ready to recommend to the court such changes as may be required in the interests of the child. A guardian ad litem to represent the children, fortified by a witness who is educated and trained to know at least some of the answers to the delicate problems involved should enable our courts to act. in a far more intelligent manner.

It is by no means implied that these ideas offer a ready cure for the bad situation described. As long as there are divorces and children of divorce the problem will always be with us. However, if the challenge of a bad situation, so close to the legal profession, is to be intelligently met, the circumstances must be faced as they are, not as we should like them to be. To meet the challenge with any degree of success, methods must be applied which give some promise of actually solving the problem. It is common knowledge that it has not been successfully met. heretofore, and certainly it deserves unselfish, objective thinking. The end to be attained for the ever-growing number of our children of divorce is worth far more than whatever effort is involved.

Reprints available in about 5 weeks

LILLIAN JEFFERS

Maternal and Child-Health Consultant Nurse Louisiana State Department of Health

Public-health nursing and institutional nursing were equally represented at the pediatric-nursing conference held May 26-30, 1947, at New Orleans, under the sponsorship of the Division of Maternal and Child Health of Louisiana's State Department of Health and the Department of Nursing Education of the Louisiana State University School of Medicine.

The conference was led by Dr. Milton J. E. Senn, New York Hospital and Cornell University, and Mrs. Margaret Adams, R. N., Columbia University.

Some discussions were led by Dr. Henry Barnett, Cornell University; Dr. James Q. Haralambie, Cornell University and New York Hospital; and Dr. Myron E. Wegman, Louisiana State University School of Medicine.

Mrs. Adams told the conference that to work constructively with children, a nurse must first try to understand herself and to find out whether or not she really likes children. A nurse who does not like children cannot pretend. Children understand from the way the nurse talks or touches them whether her attitude is sympathetic.

Lack of time and pressure of work are frequently given as the reason for omitting the little kindnesses that children need in order to feel secure, said Mrs. Adams. But, she added, it does not take any extra time to call a child

by his given name or to greet him and tell him good-bye. When a nurse takes a child to the operating room no extra time is necessary to introduce him to the nurse in that room and to tell him that she, his ward nurse, will be waiting for him when he returns to his room. After a painful treatment given to a very young child, the nurse, with no loss of time, may cuddle him in her arms to comfort him, perhaps while talking with the physician about the treatment. No extra time is necessary for the nurse to hold an infant in her arms, instead of her lap, while feeding him.

Discussing premature infants, Dr. Barnett said that although only about 1 out of every 20 newborn infants is premature, practically half of all neonatal deaths are attributable to prematurity.

Measures to combat the high death rate for premature infants must be taken during pregnancy, to prolong the period of gestation, said Dr. Barnett, and also during delivery and the postpartum period.

The essentials of good care of premature infants, whether in the home or in the hospital, are based on extensive clinical experience and knowledge of certain physiological handicaps of premature infants, Dr. Barnett went on. Such care must include provisions for control of body temperature; prevention of infections; skilled medical and nursing supervision; proper feeding; preparedness for immediate emer

gencies; and preparation of the family for discharge of the infant from th hospital and follow-up in the home.

Dr. Senn reminded the conferenc that pediatrics is sometimes called specialty dealing with diseases of chi dren, but, he said, this is too narrow a definition. The pediatrician is interested in diseases, but he considers sickness an incident in the life of a child more important is the child's health. And most of the time the pediatrician is dealing with a child who is well.

on.

The pediatrician must have an understanding of the well child before he can treat the sick child, Dr. Senn went He must know the child's parents. his brothers and sisters, and others in the family; the family environment: and people outside the family in the immediate community.

Dr. Senn pointed out that anyone who deals with children--the physician. the nurse, the jurist, the social worker. the teacher-is confronted with a mass of problems that seem insoluble. Delinquency, broken homes, increased divorce rates, and so forth, are of concern not only to social workers and the clergy, but also to physicians and

nurses.

We must understand, said Dr. Senn, that growth and development is a process that is going on constantly from conception to death. Age should not be a barrier to growth and development, and ! parents should grow and develop while rearing their children. The kind of parents a child has plays an important part in determining what kind of an individual that child will be, said Dr. Senn.

The regular pattern of growth and development is not a straight line, Dr. Senn continued. There are periods when the child seems to stand still or to go backward. He seems to be holding on to the past. He knows what he has, but is afraid of the future. After this seeming standstill, the child may go rapidly ahead.

Although growth and development proceed irregularly, there is an interrelationship between the physical, emotional, social, and intellectual spheres, according to Dr. Senn. That the nurse should have a philosophy for her approach to child care and behavior is more important than just getting necessary information regarding it.

opportunity to examine her baby. Let her count his fingers and toes. Give the baby to her for feeding as early as possible. The feeling that the mother has of "giving the baby of myself" (breast being self) can't be emphasized too much.

Caring for the baby must be gratify

ing to mother and child, Dr. Senn maintained. The baby eats not only to take in food but also to suck. He wants to do a lot of sucking, and to use his mouth for a long time. If a self-demand feeding system is used with a baby from the beginning, he will put himself on schedule by the fourth to the sixth week.

When we try to keep a young infant on a clock schedule, we are imposing on him something he perhaps does not want at the time and we might thus

Dr. Senn pointed out that to obtain maximum development of an individual's potentiality, we must begin with gestation. Thus the antepartum experiences of the mother are important. The mother whose diet is inadequate may have a damaged offspring. A communicable disease, especially LOUISE JAMES German measles, occurring early in pregnancy may injure the fetus.

Emotional development must also be considered during the antepartum period, said Dr. Senn. The mother has certain feelings about her pregnancy, about the baby who will be born. Mother and father both have questions. Prospective parents need opportunity to talk over with the doctor what is on their minds.

Examination of the mother during the antepartum period should be more than a physical examination, Dr. Senn went on. She should be given time to ask questions. Every question, even if it seems foolish, should be answered. The doctor should identify himself with the patient and look at her questions through her eyes.

The time to consider infant feeding, Dr. Senn told the conference, is in the antepartum period. Changes in the mother's breasts cause her to think about whether or not she should breastfeed her baby. The doctor should talk with the mother about what breastfeeding is, how to do it, and its advantages.

Just as soon as possible after the birth of the baby, give the baby to the mother, said Dr. Senn. The physical contact of holding her own child gives her the feeling that she is a mother. Give her the

bring about a feeding problem in the baby early in the newborn period.

Every child in his normal growth and development has certain periods that are focal points in his life, went on Dr. Senn. These are, in general, the antepartum period; birth; the newborn period; weaning from the breast and

bottle; the time when solid food is begun; toilet training; the arrival of a new baby in the family; and the beginning of school.

What is crucial in the development of a human being, in the opinion of Dr. Senn, is that he be accepted by his family, be loved by his parents, be a part of the family unit. Physical care is important, but emotional development

more so.

Maternal and Child-Health Consultant Nurse Arkansas State Board of Health

Interest in the whole field of pediatrics has been greatly stimulated in Arkansas by the recent State-wide survey made by the American Academy of Pediatrics.

Arkansas, a rural State, with more than 600,000 children under 15 years of age (1940 census) has only 1,396 physicians, of whom only 9 are pediatricians; 3 of these are members of the Academy.

The only children's hospital in the State is in Little Rock. Few hospitals have beds for Negro children, although Negroes comprise about one-fourth of the State's total population. Overcrowding in hospitals is general. Nurses are scarce, and most hospitals with pediatric departments are forced to place in responsible positions nurses who have had no preparation beyond basic training as a nurse.

Feeling the need for a program of pediatric-nursing education, the State Board of Health planned an institute on pediatric nursing and held it the first week in March 1947, in cooperation with the Crippled Children's Division of the State Department of Public Welfare, the State Nurses' Association, and the State League of Nursing

Education. Dr. Francis F. Schwentker and Helen Schnetzer, both of Johns Hopkins Hospital, were guest speakers.

Eligibility to attend was restricted to graduate nurses employed as instructors in schools of nursing; those engaged in pediatric nursing, either in hospitals or on private duty; and public-health nurses especially engaged in maternal and child-health services, such as well-child conferences, school programs, and bedside nursing.

Some of the topics on the program were: Nutritional problems in Arkansas; medical problems in nutrition; feeding the infant and child; infectious diseases; the practical care of the infectious patient; respiratory diseases; abdominal diseases; rheumatic fever and nursing problems in this and other long illnesses; endocrine disorders and the psychological problems of the endocrine patient; congenital anomalies; and accidents.

Throughout the entire conference the leaders pointed out the importance of care for all children as an integral part of community services. Both emphasized the rights of children to a happy family life and the importance of recognizing their personal needs, whether the child is sick or well.

Films and slides were used effectively. Demonstration materials included incubators and other equipment for the