As one of the early practitioners of the "New Pediatrics," first talked about in the 1950s, I have been asked to give some of my reflections on recent developments in pediatric practice which Silver and Ott describe in the paper under review.

The satisfactions of long-term care of children and their families have been extolled frequently and are very real to those of us who have pursued this type of practice. The failures of too large a number of youngsters under our care to reach satisfactory adjustment in adult society offer frustrations equally real and even more poignant. The gnawing doubt that anything we have done is responsible for the good results is alleviated somewhat by our feeling that factors beyond our control are the cause of the failures.

Despite all the testimonials from patients and their families to our skill in helping, and the opposing and rather more vocal diatribes of others against the "permissiveness" allegedly fostered by Benjamin Spock, I sometimes ask myself: Has the output of 80% of my time in many years of pediatric practice really made use of the large input in time and effort by school, hospital, and individual? It is clear that the skills learned during training years have been a boon to the 20% of patients who required expert care in diagnoses, treatment, and preventive pediatrics. But what about that other 80%?

From comments in periodicals by dissatisfied pediatricians, from the large number of young and not so young practitioners who year by year give up the "New Pediatrics," and from annoyances expressed with the demands made by and material returns available from pediatric practice, I assume that many of my colleagues have found the balance of frustrations weighing heavily against the satisfactions.

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