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138
Royal College of St. Katharine.
Report of the Senior Medical Officer.
The Diet of the Infant at the Age of Weaning.
The chart which accompanies these notes records the weight of a
healthy first-born baby during its first two years of life.
The curve almost divides itself into three sections. The first extends
from birth to nine months, during which time the weight rises steadily.
The second extends from nine months to a year and eight months, and
in this period no progress is made. In the third a sharp recovery
occurs, but is checked just before the end of the year.
During the first nine months the baby was practically free from
illness. It was fed at the breast for six and a half months and then
transferred to cow's milk as the mother was losing weight. Small
amounts of solid food were recommended at this age but were not readily
taken. There were a few mild catarrhal infections during these first
months, and arrows on the chart mark where they occur. They had but
slight effect on the rate of growth. In the latter part of the year, and
in the second year it will be seen that they interfere greatly with progress.
They were, also, clinically much more severe illnesses; thus at fourteen
months the child was ill for three weeks with otitis media and bronchitis.
During the second period, and while no growth is recorded, the child's
general health declined steadily. Appetite was capricious and food
refusal was a constant source of anxiety to the parents. With any
attempt to advance the diet, or even to modify it to the state of health
at a particular stage, some symptom, such as retching, vomiting, flatulence
or disordered stools was reported. Bad sleeping habits, with long
periods of crying and wakefulness at night, were added difficulties. The
appearance of the baby at eighteen months of age was in striking contrast
with that at any time during the first nine months; it was now undersized
and pallid, with poorly-developed muscles and little subcutaneous
fat. There were no clinical signs of rickets; iron was prescribed, but
was said to provoke vomiting.
At the age of a year and eight months the baby was removed from its
home and placed in the charge of trained nurses on a controlled diet,
under a regime which included several hours a day out of doors. For the
first fortnight after the change a most stubborn refusal of food was
encountered and the ordeal by hunger was necessary to overcome it.