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3. Maternity hospitals, or maternity wards in general hospitals, sufficient to provide care in all complicated cases and for all women wishing hospital care; free or partpayment obstetrical care to be provided in every necessitous case at home or in a hospital.

4. All midwives to be required by law to show adequate training, and to be licensed and supervised.

5. Adequate income to allow the mother to remain in the home through the nursing period.

6. Education of general public as to problems presented by maternal and infant mortality and their solution.



1. Complete birth registration by adequate legislation requiring reporting within three days after birth.

2. Prevention of infantile blindness by making and enforcing adequate laws for treatment of eyes of every infant at birth and supervision of all positive cases.

3. Sufficient number of children's health centers to give health instruction under medical supervision for all infants and children not under care of private physician, and to give instruction in breast feeding and in care and feeding of children to mothers;, at least once a month throughout first year, and at regular intervals throughout preschool age. This center to include a nutrition and a dental clinic.

4. Children's health center to provide or to cooperate with sufficient number of public-health nurses to make home visits to all infants and children of preschool age Deeding care-one public-health nurse for average general population of 2,000. Visits to the home are for the purpose of instructing the mother in

(a) Value of breast feeding.
(6) Technic of nursing.
(c) Technic of bath, sleep, clothing, ventilation, and general care of the baby,

with demonstrations.
(d) Preparation and technic of artificial feeding.
(e) Dietary essentials and selection of food for the infant and for older children.

(5) Prevention of disease in children. 5. Dental clinics; eye, ear, nose, and throat clinics; venereal and other clinics for the treatment of defects and disease.

6. Children's hospitals, or beds in general hospitals, or provision for medical and nursing care at home, sufficient to care for all sick infants and young children.

7. State licensing and supervision of all child-caring institutions, or homes in which infants or young children are cared for.

8. General educational work in prevention of communicable disease and in hygiene and feeding of infants and young children.


1. Proper location, construction, hygiene, ventilation, and sanitation of schoolhouse; adequate room space-no overcrowding.

2. Adequate playground and recreational facilities, physical training, and supervised recreation.

3. Adequate space and equipment for school medical work and available laboratory service.

4. Full-time school nurse to give instruction in personal hygiene and diet, to make home visits to advise and instruct mothers in principles of hygiene, nutrition, and selection of family diet, and to take children to clinics with permission of parents.

5. Part-time physician with one full-time nurse for not more than 2,000 children; if physician is not available, one school nurse for every 1,000 children; or full-time physician with two full-time nurses for 4,000 children for(a) Complete standardized basic physical examinations once a year, with

determination of weight and height at beginning and end of each school

year; monthly weighing wherever possible. (6) Continuous health record for each child to be kept on file with other records

of the pupil. This should be a continuation of the preschool health

record which should accompany the child to school. (c) Special examinations to be made of children referred by teacher or nurse. (d) Supervision to control communicable disease. (e) Recommendation of treatment for all remediable defects, diseases, deform

ities, and cases of malnutrition. (5) Follow-up work by nurse to see that physician's recommendations are

carried out. 6. Available clinics for dentistry, nose, throat, eye, ear, skin, and orthopedic work; and for free vaccination against smallpox.

7. Open-air classes with rest periods and supplementary feedings for pretuberculous and certain tuberculous children, and children with grave malnutrition. Special classes for children needing some form of special instruction due to physical or mental defect.

8. Nutrition classes for physically subnormal children, and the maintenance of midmorning lunch or hot noonday meal when necessary.

9. Examination by specialist of all atypical or retarded children.

10. Education of school child in health habits, including hygiene and care of young children.

11. General educational work in health and hygiene, including education of parent and teacher, to secure full cooperation in health program.


1. Complete standardized basic physical examination by physician, including weight and height, at least once a year, and recommendation for necessary treatment to be given at children's health center, school, or other available agency.

2. Clinics for treatment of defect and disease.
3. Supervision and instruction to insure-

(a) Ample diet, with special attention to growth-producing foods.
(6) Sufficient sleep and rest and fresh air.
(c) Adequate and suitable clothing.
(d) Proper exercise for physical development.

(e) Knowledge of sex hygiene and reproduction. 4. Full-time education compulsory to at least 16 years of age, adapted to meet the needs and interest of the adolescent mind, with vocational guidance and training.

5. Clean, ample recreational opportunities to meet social needs, with supervision of commercial amusements.

6. Legal protection from exploitation, vice, drug habits, etc.




General statement. The conclusions of the White House Conference of 1909 on the Care of Dependent Children are reaffirmed in all essentials. They have been guides for communities and States in reshaping their plans for children in need of special care. They are recommended for consideration to all communities whose standards do not as yet conform to them, so that they may be translated into practice in the various States.

The fundamental rights of childhood are normal home life, opportunities for education, recreation, vocational preparation for life, and moral, religious, and physical development in harmony with American ideals and the educational and spiritual agencies by which these rights of the child are normally safeguarded.

Upon the state devolves the ultimate responsibility for children who are in need of special care by reason of unfortunate home conditions, physical or mental handicap, or delinquency. Particular legislation is required to insure for such children the nearest possible approach to normal development.

Adequate income.—Home life which is, in the words of the conclusions of the White House conference, “the highest and finest product of civilization,” can not be provided except upon the basis of an adequate income for each family.

Assistance to mothers. The policy of assistance to mothers who are competent to. care for their own children is now well established. It is generally recognized that the amount provided should be sufficient to enable the mother to maintain her children suitably in her own home, without resorting to such outside employment as will necessitate leaving her children without proper care and oversight; but in many States the allowances are still entirely inadequate to secure this result under present living costs. The amount required can be determined only by careful and competent case study, which must be renewed from time to time to meet changing conditions.

State supervision.-A State board of charities or a similar supervisory body should be responsible for the regular inspection and licensing of every institution, agency or association, incorporated or otherwise, which receives or cares for mothers with children or children who suffer from physical or mental handicaps, or who are delinquent, dependent, or without suitable parental care, and should have authority to revoke such licenses for cause and to prescribe forms of registration and report. This State agency should maintain such supervision and visitation of children in institutions and children placed in family homes as will insure their proper care, training, and protection. The incorporation of private organizations caring for children should be required, and should be subject to the approval of the State Board of Charities or similar body. State supervision should be conceived and exercised in harmony with democratic ideals which invite and encourage the service of efficient, altruistic forces of society in the common welfare.

Removal of children from their homes.—Unless unusual conditions exist, the child's welfare is best promoted by keeping him in his own home. No child should be permanently removed from his home unless it is impossible so to reconstruct family conditions or build and supplement family resources as to make the home safe for the child, or so to supervise the child as to make his continuance in the home safe for the community. In case of removal separation should not continue beyond the period of reconstruction.

Home care.—The aim of all provision for children who must be removed from their own homes should be to secure for each child home life as nearly normal as possible, to safeguard his health, and to insure for him the fundamental rights of childhood. To a much larger degree than at present, family homes may be used to advantago in the care of such children.

Principles governing child placing.–Before a child is placed in other than a temporary foster home, adequate consideration should be given to his health, Dientality, character, and family history and circumstances. Arrangements should be made for correcting remediable physical defects and disease.

Complete records of the child are necessary to a proper understanding of his heredity and personality and of his development and progress while under the care of the agency.

Particular consideration should be given to children who are difficult to place and who require provision adapted to their peculiar needs.

Careful and wise investigation of foster homes is prerequisite to the placing of children. Adequate standards should be required of the foster families as to character, intelligence, experience, training, income, environment, sympathetic attitude, and their ability to give the child proper moral and spiritual training. When practicable children should be placed in families of the same religious faith as the parents or the last surviving parent.

A complete record should be kept of each foster home, giving the information on which approval was based. The records should show the agency's contacts with the family from time to time, inc.icating the care given the child intrusted to it. In this way special abilities in the families will be developed and conserved for children.

Supervision of children placed in foster homes should include adequate visits by properly qualified and well-trained visitors, who should exercise watchfulness over the child's health, education, and moral and spiritual development. Periodic physical examinations should be made. Supervision of children in boarding homes should also involve the careful training of the foster parents in their task. Supervision should not be made a substitute for the responsibilities which properly rest with the foster family. The transfer of the legal guardianship of a child should not be permitted save with the consent of a properly designated State department or a court of proper jurisdiction.

In all cases involving the legal adoption of children, the court should make a full inquiry into all the facts through its own visitor or through some other unbiased agency, before awarding the child's custody.

Children in institutions.---The stay of children in institutions for dependents should be as brief as possible. The condition of all children in such institutions should be carefully studied at frequent intervals, in order to determine whether they should be restored to their own homes, placed in foster homes, or transferred to institutions better suited to their needs. While they do remain in institutions, their condition should approximate as nearly as possible that of normal family life as to health, recreation, schooling, and spiritual, aesthetic, civic, and vocational training.

Care of children born out of wedlock.—The child born out of wedlock constitutes a very serious problem, and for this reason special safeguards should be provided.

Save for unusual reasons both parents should be held responsible for the child during his minority and especially should the responsibility of the father be emphasized.

Care of the child by his mother is highly desirable, particularly during the nursing months.

No parent of a child born out of wedlock should be permitted to surrender the child outside his own family, save with the consent of a properly designated State department or a court of proper jurisdiction.

Each State should make suitable provision of a humane character for establishing paternity and guaranteeing to children born out of wedlock the rights naturally belonging to children born in wedlock. The fathers of such children should be under the same financial responsibilities and the same legal liabilities toward their children as other fathers. The administration of the courts with reference to such cases should be so regulated as not only to protect the legal rights of the mother and child, but also to avoid unnecessary publicity and humiliation.

The treatment of the unmarried mother and her child should include the best medical supervision and should be so directed as to afford the widest opportunity for wholesome, normal life.

Care of physically defective children. Special care and educational opportunities for deaf, blind, and crippled children should be provided in the public educational system, local or State.

Mental hygiene and care of mentally defective children.—The value of the first seven years of childhood from the point of health, education, and morals and formative habits can not be overestimated. Throughout childhood attention should be given to the mental hygiene of the child-the care of the instincts, emotions, and general personality and of environmental conditions. Special attention should be given to the need for training teachers and social workers in mental hygiene principles.

Each State should assume the responsibility for thorough study of the school and general population for the purpose of securing data concerning the extent of feeble mindedness and subnormality.

Adequate provision should be made for such mentally defective children as require institutional care. Special schools or classes with qualified teachers and adequate equipment should be provided by educational authorities for such defective children as may be properly cared for outside of institutions. The State should provide for the supervision and after-care of feeble-minded persons at large in the community, especially those paroled from institutions. Custodial care in institutions for feebleminded children should not be resorted to until after due consideration of the possibility of adjustment within the community.

Juvenile courts.-Every locality should have available a court organization providing for separate hearings of children's cases; a special method of detention for children, entirely apart from adult offenders; adequate investigation for every case; provision for supervision or probation by trained officers, such officers in girls' cases to be women; and a system for recording and filing social as well as legal information.

In dealing with children the procedure should be under chancery jurisdiction, and juvenile records should not stand as criminal records against the children.

Whenever possible such administrative duties as child placing and relief should not be required of the juvenile court, but should be administered by agencies organized for that purpose.

Thorough case study should invariably be made. Provision for mental and physical examinations should be available.

The juvenile victims of sex offenses are without adequate protection against unnecessary publicity and further corruption in our courts. To safeguard them the jurisdiction of the juvenile court should be extended to deal with adult sex offenders against children, and all safeguards of that court be accorded to their victims, or if these cases are dealt with in other courts, the facts revealed in the juvenile court should be made available, and special precautions should be taken for the protection of the children as here suggested.

Rural social work.-Work for children needing special care has been neglected in rural parts of the country. Social conditions in rural communities are often as acute as in urban communities. The principles of child care as enumerated above are applicable to rural needs. Agencies for rural service should be enco

couraged, and should be adapted to the peculiar needs of rural communities. The county is usually the best administrative unit.

Scientific information. There is urgent need of a more adequate body of scientific literature dealing with principles and practice in the children's field of social work, and the meeting of this need is a responsibility resting on those so engaged. Careful interpretation and analysis of methods and results of care and the publishing of these findings must precede the correcting of many present evils in practice. Boards of directors, trustees, and managers should particularly consider participation in the preparation of such a body of facts and experience as being a vital part of the work of their staff members.

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