Harold Coe Stuart and MCH colleagues

The measure of a healthy life

“Your child is in the 80th percentile for height and 75th for weight.”

Nearly every parent of an infant or young child in the U.S. and many other parts of the world has heard words similar to those at his or her child’s well-baby visits and annual physicals. But few know the genesis of the charts that doctors use to assess their children’s progress toward normal health milestones—a 1930s project undertaken at Harvard School of Public Health.

The brainchild of pediatrician-researcher Harold Coe Stuart, the Longitudinal Studies of Child Health and Development marked a new approach to pediatric public health. It was concerned with the manifestations of health, not simply sickness, and it replaced a focus on individual care with ongoing developmental research. To this end, Stuart—who headed the School’s Department of Child Hygiene, later known as the Department of Maternal and Child Health—followed a group of 324 children in Boston’s predominantly Irish middle-class Roxbury neighborhood from before birth through adulthood, starting in 1930. The project was holistic and intensely cross-disciplinary—involving social workers, public health nurses, anthropologists, dentists, psychologists, psychiatrists, and pediatricians—a reflection of Stuart’s conviction that children’s health involved the interplay of physical, emotional, social, and cultural factors.

No comprehensive study of normal child growth had ever taken place before. “Pediatricians interested in research have been so preoccupied with the study of disease that they have not contributed as much as might have been anticipated to studies of normal development,” Stuart wrote. “It is surprising how little is really known about the effects of disease on growth, in view of the attention given to sick children.” He advocated that physicians, school health programs, and parents take regular measurements of a child’s height, weight, chest circumference, hip-width, and girth, stressing that diversion from a normal growth pattern might be a tip-off to underlying disease. And presaging more recent social trends, Stuart interviewed fathers and encouraged them to be part of the child’s upbringing.

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