Dr. Jacalyn Blackwell-White vividly remembers the baby boy and his 16-year-old mother. He was born weighing a healthy 6 pounds, but was hospitalized before he was 8 weeks old for failure to gain weight properly.
"In the hospital, he ate greedily," she said. "It proved that he hadn't gotten adequate calories at home."
Dr. Blackwell-White calls this one of her success stories because the baby didn't die. After he was released from the hospital, he and his young mother moved to his grandmother's house where he received better care, she said.
While none of her infant patients have died since she began practicing in Baltimore in 1987, Dr. Blackwell-White is keenly aware of the city's infant mortality rate for black babies, which rivals that of some Third World countries.
In Baltimore in 1988, the latest year for which figures are available, for every 1,000 black babies born, more than 20 died before reaching their first birthday. That's more than double the national rate of 10 deaths per 1,000 births for all races, and it's higher than the 17.6 rate for blacks nationally. Baltimore has the third highest infant death rate among major cities, with 18 of every 1,000 live births resulting in deaths, according to a report released this month by the Children's Defense Fund.
Such statistics place Baltimore's black pediatricians on the front line in the war against infant deaths because they come in contact with young teen mothers and their children. A key factor in infant deaths is low-weight babies, and teen mothers are more likely to give birth to underweight infants.
But, even so, black pediatricians see only a small percentage of those considered high-risk mothers. These are girls and women "in the cracks" of society, homeless, drug addicted, mired in poverty, said Dr. William A. Bryant, a pediatrician who has practiced in the city for 13 years and has his office in Northwood, near Morgan State University.
Such mothers generally receive little or no prenatal care from obstetricians, and don't take their children to pediatricians for well-baby visits, he said.
Black pediatricians applaud such programs as the Baltimore Project, a pilot program partly financed by the city that is designed to find mothers considered at high risk and get proper health care and social services for them and their babies.
"We have been out there fighting infant mortality," said Dr. Bryant, speaking of black doctors. "But there are not enough of us" to solve such a huge problem.
While they may not be able to solve it, black pediatricians try to chip away at it in many ways, including speaking frankly with their teen-age patients about sex, sexually transmitted diseases and the need to avoid pregnancy.
Once a teen-ager becomes pregnant, she generally is referred to an obstetrician for prenatal care and doesn't see her pediatrician again until after the child's birth.
However, one West Baltimore pediatrician insists on seeing his pregnant teen patients for regular visits throughout their pregnancy to help ensure the birth of healthy babies.
Dr. Shirley R. Clinton, a pediatrician for more than 30 years who practices out of the Garwyn Medical Center that he helped found in 1979, says teens and their mothers usually heed his instructions because they have trusted his advice in the past.
"I want to make sure they are getting the proper diet, rest and care," he said. "It doesn't matter if she's going to the obstetrician, I'm the one who's going to take care of that baby when it gets here."
Dr. Clinton said the only thing worse than the high rate of infant deaths in Baltimore are the deaths associated with the illegal drug trade.
"They both are preventable deaths," he said.
Dr. Blackwell-White tries to reduce the infant mortality figures by working a couple of days a week at a downtown clinic for low-income people. In addition to her work there, she has a private practice in Randallstown, and is an on-call emergency room physician for Sinai Hospital.
Her work at the clinic with young mothers sometimes makes her feel like a parent, teacher, social worker and psychologist rather than just a doctor, she said.
"We lecture so much that we probably wear their ears out. That's the hope, that you change some lives."
Black doctors fight infant mortality