Elizabeth Ann is a timid, sickly little girl who lives with her Aunt Frances and her Great-Aunt Harriet.

When Great-Aunt Harriet becomes ill, poor little Elizabeth Ann is sent to live with the much-feared Putney cousins, whom, as Great-Aunt Harriet said "Such lack of sympathy, such perfect indifference to the sacred sensitiveness of child-life, such a starving of the child-heart ... No, I shall never forget it!

They had chores to do ... as though they had been hired men!" But to the Putney cousins in Vermont Elizabeth Ann has to go. And there, with her Uncle Henry, Aunt Abigail and Cousin Ann, she grows strong and well and happy and, most importantly, learns to think for herself, and truly becomes Understood Betsy. (summary Kymm Zuckert)