The past half century has witnessed unprecedented changes in the field of pediatrics. As a basis for exploring the future, we briefly review the past, the demography of the pediatric patient and physician populations, and our present environment, all of which impact on the future.
During the first 30 years of this century, the major causes of morbidity and mortality in infants and children were infectious and nutritional diseases.1 Specific drug therapy for infections was nonexistent, and meningitis had a 75% to 100% fatality rate. Various forms of streptococcal disease, such as empyema, meningitis, mastoiditis, and erysipelas, were rampant. Clean milk, nutrition, diarrhea, and the epidemiology of disease dominated medical thinking. Pediatricians began showing an interest in preventive medicine and child behavior. They also began prescribing complex formulas and vitamins and frequently recommended rigid feeding schedules for infants. Significant strides were made in the understanding of nutritional and