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A Tribute to Dr. Noboru Kobayashi

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Dr. Noboru Kobayashi, the founder of CRN, passed away at the end of last year at the age of 92.
This would usually be an occasion for mourning, however, I believe that it is more fitting to reflect on Dr. Kobayashi's life and achievements.

Dr. Kobayashi's Achievements and Vision

Dr. Kobayashi, an advocate of Child Science, was the founder of the Japanese Society of Child Science and Child Research Net (CRN). He had an exceptional personal history, having experienced the end of World War II as a student at the Imperial Japanese Naval Academy and later going on to study at The University of Tokyo, Faculty of Medicine. When the atomic bomb was dropped on Hiroshima, Dr. Kobayashi was undergoing training on the island of Etajima. He once told me about how he had passed through Hiroshima soon after atomic bombing on his way back to Tokyo with younger students from his school.

After graduating from The University of Tokyo, Faculty of Medicine, he became a faculty member of the school of pediatrics, but soon after, took part in a pediatric residency training program in Cincinnati, Ohio in the United States at a time when it was still unusual to study abroad.

This was a period when studying abroad in postwar America was not yet common, and although a number of his classmates at medical school applied, when the opportunity arose, many declined out of a sense of unease and anxiety. In the end, Dr. Kobayashi was one of only two students to actually study abroad. This fact reveals his ambitious and progressive spirit at a young age. He gained further experience at the Great Ormond Street Hospital, a children's hospital in London. After returning to the Department of Pediatrics at the University of Tokyo Hospital, he assumed the position of Chairman of the International Pediatric Association and became a leading figure internationally in the field of pediatrics. Through this impressive career, he expanded and deepened his understanding of pediatrics and children around the world.

Dr. Kobayashi left his position as professor of pediatrics at the University of Tokyo before reaching retirement age to become Director of the National Children's Hospital, now known as the National Center for Child Health and Development. There he took action to bring pediatric medical care up to par with prevailing global currents. This included establishing school classes in the hospital at a time when this was still unusual; providing lodging for parents of children who were hospitalized long-term (Ronald McDonald House); and creating a national network of children suffering from intractable diseases. His achievements include establishing the Japanese Society of Baby Science and the Japanese Society of Child Science and introducing the new perspective of "Child Science."

I later visited Dr. Kobayashi when he was living in comfortable retirement, and although he had accomplished so much, he said to me "I wonder if I have done something, even just a little, to help the world." I was touched by Dr. Kobayashi's open and natural expression of concern.

At a time when society had not yet fully grasped the usefulness of the internet, Dr. Kobayashi was among the first to understand its potential. He founded Child Research Net (CRN) as a hub for the communication and exchange of interdisciplinary knowledge regarding children, a clear testament to his forward-looking vision. In 1996, the year that Dr. Kobayashi retired from the National Children's Hospital, CRN was established with the support of Soichiro Fukutake, then president of Benesse Corporation.

CRN's activities also included cooperating with early childhood education scholars and specialists in China to hold conferences in both countries on a reciprocal basis as a forum for the free exchange of information, and this marked the beginning of an exchange program on Child Science in East Asia. This program has since grown and is currently active in Southeast Asia as Child Research Network Asia.

Dr. Kobayashi's Words

Here I would like to reflect on Dr. Kobayashi's farsighted views and consider some of the terms that he often used to express them.

Interdisciplinary

Today the term "interdisciplinary" has become a rather common word, but Dr. Kobayashi asserted the significance of interdisciplinary studies early on. In English, the term refers to collaboration and exchange across disciplinary boundaries, and for Dr. Kobayashi, it meant studies of children that were not confined within the framework of a particular specialty, but rather undertaken through collaborative research extending beyond disciplinary boundaries. He noted that the academic fields that studied children, such as medicine, education, developmental psychology, neuroscience, and sociology, were separated into different areas with different historical backgrounds, and wishing to study these conditions from an interdisciplinary approach, he established two associations: the Japanese Society of Baby Science and the Japanese Society of Child Science.

In contrast, academic organizations at that time, however, were each engaged in setting up separate systems for the certification of different medical specialists and organizations, and thereby promoted specialization. In this sense, Dr. Kobayashi's idea was a novel one that ran counter to this trend toward further specialization.

Ensuring a center for interdisciplinary academic inquiry also means providing a space where researchers from different fields with their individual methods of inquiry can come together and exchange ideas. Dr. Kobayashi made scrupulous efforts to see that the Japanese Society of Child Science would indeed be such a space. Study sessions and conferences were held and specialists from a wide range of fields, including medicine, education, developmental psychology, neuroscience, and sociology were invited to speak.

After the Japanese Society of Child Science got off to a good start, I once proposed that we should actively appeal to pediatricians, doctors like Dr. Kobayashi and myself, to increase membership, but Dr. Kobayashi replied that "We should not allow it to become an organization totally run by physicians."

"Children are our future."

Among his many adages, this one was especially well-known: Children are our future. It can also be found on the CRN home page.

The meaning that is compressed in this saying is very broad and escapes simple explanation. It tells us not to forget that we adults are now making the decisions that will determine the world that children today will have to live in tomorrow. It is a word of caution, reminding us that we justify this by saying that we are doing it for the benefit of children when in fact, we don't really understand their true feelings at all. It also harbors a sharp criticism of the paternalistic point of view and practices often seen in child-raising, discipline, and education.

I would say that Dr. Kobayashi did not attempt to introduce Child Science within existing academic societies because he sensed the paternalistic point of view that prevailed there.

Child-caring Design
The Japanese Society of Child Science was established, and during discussions to define its mission, Dr. Kobayashi proposed the concept of "Child-caring Design." His idea was that the goal of the Japanese Society of Child Science should not simply be discussion, but also taking action to change the structure of child care.

There is one unfortunate incident that may have been the impetus for the concept of "Child-caring Design." In 2004, a fatal accident occurred when a six-year old child was caught in an automatic revolving door. It underscored the need for child-caring design to reform the current situation in which building construction conforms to adult standards and insufficient consideration is given to the behavior and viewpoint of children.

It is a known fact that accidents, both indoors and outdoors including traffic accidents, are the leading cause of death among children in Japan, and although various measures have been taken, they remain insufficient. The fact that accidents are the leading cause of death among children today indicates that child-caring design has not been thoroughly implemented.

Child-caring design is most needed in child care facilities and kindergartens where preschool children spend their time, but it is not enough to focus solely on the safety of children. Facilities should be constructed so that it is possible for the staff to view the activities of all children and ensure their safety, but observation will indicate that there are children who like to play in areas outside the viewing range of child care workers. Exploratory behavior such as crawling into narrow spaces can be avoided in structures built with a good overall view that "is convenient for adults." Child-caring design involves solving the difficult equation of both providing a place for free and creative play and ensuring the safety of children.

"Joie de vivre"

"Joie de vivre" was a word that Dr. Kobayashi liked to use. I felt that Dr. Kobayashi considered his mission to be not only curing children of illness, but also enhancing their quality of life (QOL). He established The Support Network for Nanbyo Children of Japan, a non-profit organization that is committed to raising the quality of life of children with chronic and incurable diseases, and also served as director of the Children's Rainbow Center, which dedicated to research on child abuse. These efforts indicate that he viewed his work as not only curing illness.

In the activities of the Support Network for Nanbyo Children of Japan to improve the quality of life of children, the rather bleak term "quality of life" is not translated as such into Japanese. Instead, it is expressed as the "brilliance or the sparkle of life," a choice that clearly reflects the nuance of "joie de vivre."

The Mission of Child Research Network (CRN)

Here I have referred to Dr. Kobayashi's views that led to the establishment of Child Science and the Japanese Society of Child Science because they are central to the discussion and understanding of the mission of CRN.

As mentioned earlier, Dr. Kobayashi served as Chairman of the International Pediatric Association (IPA), and when I participated in the International Pediatric Association (IPA) Congress held in Panama last year, I felt that I understood the reason for his view that the work of a pediatrician should not be limited to treating childhood diseases.

Practicing as a pediatrician in Japan, one is apt to think that the primary mission of a pediatrician is to cure illness in children. This is quite obvious if you take part in a pediatrics conference in Japan because nearly all the research presented will concern the causes of illness and treatment. Of course, research is also presented on child health and preventing illness, but this is predicated on the existence of a peaceful society free of conflict, war, or starvation. As expected, research on illness was also presented at the IPA Congress in Panama, but the majority of presentations focused on war, starvation, poverty, and child abuse.

Gender issues, which are rarely discussed at conferences on pediatric medicine and psychology in Japan, were also a notable subject. In many countries today, girls do not have the same educational opportunities as boys, and this results in marriage and childbirth at a young age. At the IPA Congress in Panama, one important theme was teenage pregnancy and childbirth. In simple terms, teenage pregnancy might be considered an issue to be addressed by gynecologists, but at the IPA Congress, it is presented as an important one for pediatricians. Not only does teenage pregnancy among young women who have not yet received sufficient education result in a high rate of premature births, but it is associated with child-raising in an unsuitable environment, and as a result, has an unfavorable effect on the health and development of the next generation of children. It is necessary for pediatricians to be concerned about and approach issues such as the gender gap in education and teenage pregnancy, which are outside the area of narrowly defined pediatrics.

Poverty and the Health and Development of Children

An enormous amount of research is conducted annually to study factors that promote the health and development of children. All of these studies invariably include a question on the annual income of the child's household. I have also conducted international comparative surveys regarding the effect of the living environment of children on their quality of life, and in the questionnaire, ask parents to include their household income. Although the questionnaires are anonymous, a number of respondents hesitate to disclose their annual income because it is private information, and this is said to result in a low response rate. The reason for including it on the questionnaire is that household income has an influence on nearly every indicator concerning child health and development, and unless annual income is taken into account and the data adjusted accordingly, accurate statistical analysis is not possible.

Compared with children from high-income households, children from low-income households score lower in the areas of health and development as well as scholastic achievement. In order to identify the effects of living environment factors other than annual income on such indicators, it is necessary to add annual income data.

To put it another way, the goal of "improving and eliminating poverty conditions," which leads to improved child health and development, will become the task of pediatricians and educational specialists. This means that pediatricians and educators will no longer be able to confine themselves to narrow fields, but must engage in interdisciplinary activities. At the IPA Congress, discussions dealt not only with eliminating gender discrimination, but also projects to reduce the number of households living in poverty, and these will become standard concerns for pediatricians.

As Chairman of the IPA, Dr. Kobayashi, dissatisfied with existing scholarship on pediatrics and children's health, advocated Child Science and established the Japanese Society of Child Science as well as CRN. For Dr. Kobayashi, these were necessary steps—things that clearly needed to be done.

CRN's mission is to carry on Dr. Kobayashi's aspirations, to develop and realize them even further, and to work to resolve the many issues that affect the lives of children today.

Profile

sakakihara_2013.jpg Yoichi Sakakihara
M.D., Ph.D., Professor Emeritus, Ochanomizu University; Director of Child Research Net, Executive Advisor of Benesse Educational Research and Development Institute (BERD), President of Japanese Society of Child Science. Specializes in pediatric neurology, developmental neurology, in particular, treatment of Attention Deficit Hyperactivity Disorder (ADHD), Asperger's syndrome and other developmental disorders, and neuroscience. Born in 1951. Graduated from the Faculty of Medicine, the University of Tokyo in 1976 and taught as an instructor in the Department of the Pediatrics before working with Ochanomizu University.
Comment

Such a lovely and heartfelt tribute, thank you, Dr. Sakakihara. Dr. Kobayashi's insights and passion for children's welfare are needed now more than ever.

I also remember his humility and generous spirit. He reminded me of what Fred Rogers, also being remembered in the US through recent films, once said: "The child is in me still. And sometimes not so still." Thank you for keeping Dr. Kobayashi's spirit alive.


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