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112
ROYAL COLLEGE OF ST. KATHARINE, POPLAR.
Report of the Senior Medical Officer for the year ended
31st December, 1925.
The opportunities for conference between those engaged in infant
welfare work, the increasing literature and numerous official reports
on the subject are steadily helping to define both the scope of the work
and the problems it presents. Some of the less obvious clinical features
are only beginning to crystallise out from the mass of routine work which
is concerned largely with the feeding, clothing and general management
of the early days of life. One such feature, for example, is special
liability of the infant to catarrhal infections; another, the recognition
of the baby who from birth is the prey to nervous unrest; a third, the
detection of the earliest signs of incipient rickets.
A group of cases which cause us no little anxiety and some dissatisfaction
can be singled out in a review of each year's work. It consists
of children who, after making good progress for about the first eight
months of life, tend to drop below the normal standard of growth and
at 18 months or 2 years of age do not by any means fulfil their early
promise. The decline starts, it will be noticed, at or about the start
of the weaning period, and one suspects therefore that the substitution
of a mixed diet for some of the milk is not accurately adapted to the
child's physical needs. Undoubtedly there are great opportunities for
error here. A good mixed diet is more difficult to prescribe accurately
than a milk diet. The ingredients are difficult to measure while their
preparation is dependent on the mother's judgment and skill in cookery.
Infants will often establish a perverse and troublesome preference for
some particular foodstuff, notably farinaceous foods, and they are sometimes
indulged rather than carefully trained to take balanced diet. The
appearance of headsweating during sleep in a child about 10 months
old often coincides with the habit of eating freely of bread, potato,
biscuits, rice and chocolate. It can be observed, at the same time, the
child's vitality is declining. Whereas, at six or seven months of age,
when milk fed, he was actively clambering over his mother reaching for
anything that attracted his attention at the clinic, essentially full of
life and obviously enjoying it, he has become lethargic, sits stilt instead
of standing up and is said to be getting fretful and wants to be nursed.
Dietetic instruction at this stage should be careful and explicit as
regards total amount of food, number of meals, balance of foodstuffs