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139
That much of the vomiting was self-induced was clear, for the child could
do it at will, and its satisfaction at the return of a meal which had taken
half-an-hour to coax down was quite unmistakable. Once this was given
up and meals were taken regularly with other children a rapid gain in
weight followed. It was clear there was a normal power of digesting
a wide range of food. In fourteen weeks 5lbs. of weight was added, at
which point the child was returned to its home. It was able to walk
for the first time and was in greatly improved condition.
This failure, after about eight months of age, to maintain the steady
rate of growth seen during the milk-feeding period, is so common among
children attending the infant clinics that it is selected for brief discussion.
In the instance just described the halt is, perhaps, too marked and
prolonged to be taken as quite typical; and the delay certainly owed
something to the neurotic habits which the child developed. Nevertheless,
it will serve to illustrate features common to many others.
The early progress certainly denotes a perfect harmony between food
and physiological requirements. There are two usual explanations given
for the slightness of the reaction to infection at this age, some attributing
it to an immunity derived from the mother and prolonged by breastfeeding,
others considering that it denotes merely an adequate supply of
suitable food. The well-known immunity to measles during the first six
months or more is brought forward in support of the first view; its
opponents claim that infants fed on suitable preparations of artificial
milk show equally good and uninterrupted progress. Whichever is
correct, a decline in growth commonly occurs at about the same age in
both breast- and bottle-fed—that is in the last quarter of the year, the
stage at which some food other than milk must be added if good
nutrition is to be maintained. It seems fair to argue that the test of
whether the additions are suitable and the amount of milk still enough
is closely reflected in the rate of gain. Resistance to illness must remain
an open question, though by analogy with rickets its dependence on
proper food is probably close. Taking the test of weight alone, of how
many can we say it is satisfactorily passed? An impartial review of a
large number of charts and of the notes referring to the children, leaves
the impression that failure at this stage is very common. It is difficult
to avoid the conclusion that this period of transitional feeding marks a
crucial stage in child welfare, so often does a decline in general health
set in—a decline which is certainly not made good by the age of five in
many instances.