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23
Dr. Cicely Peake reports as follows in regard to the south.western division:—
Clinics are held about eight times a month. They are spread over three area.centres at
(a) Stoekwell.gardens, (b) St. George's dispensary, Blackfriars, and (c) Shillington.street school,
Battersea. This arrangement avoids as much journeying as possible for mothers and children,
saves their money and time, and enables them to attend a place that is probably already known
to them, and not therefore too formidable.
In the earlier groups of malnourished children referred to the centres, "problem cases"
predominated over those due to poverty, but among the later cases it has been found that the
underlying cause is more often an economic one. Incidentally, almost every sort of problem
arises among them.
Many of the children have relatives who have been, or are, of a "thin kind"; and a history
of anxiety, over.work, poor feeding and ill.health during the mother's pregnancy is common;
twin pregnancies, prematurity and small birth.weight are also factors. Children at the end of
large families tend to malnutrition. It is very conducive to bad nutrition to be the youngest
child of a large poor family with the eldest under fourteen years of age. A large proportion of
income goes on food, and clothes have to be found. The money left for rent will not pay for
suitable accommodation. The children go to swell the numbers in one or two rooms of a full
house, and may have to live in a basement. There is then lack of daylight, fresh air and
the quiet that they need even more than the better.off. It is also unfortunate to be the youngest
of a family where money is earned by the older children and the family circumstances are flourishing.
The problem of the only child is then seen in the youngest, who becomes a malnutrition
case through too much spoiling and too many halfpennies for sweets.
Loss or ill.health of one or both parents and absence from home of the mother are all important.
Irregularity of the father's employment, whether in a building trade, road.making, dock
labour or street selling, means that there will be periods of absence or loss of income. The family
has to live on credit and buy at top prices.
Nearly all the mothers are making an effort to do well by their children. They are grateful
for advice, very interested in nutrition and willing to co.operate. They need education. They
believe that meat is bad for children, and that a little flavouring of it in a stew is what they need.
Milk, in their view, is only a pleasant drink, good for infants and not necessary for children who
can eat with the family. Plain Empire or Dutch cheese by the pound is not so good a bargain,
they think, as an expensive kind in silver paper wrappings. There is a very common notion
that a little of the water in which greens have been boiled is a good substitute for the greens
themselves. They believe that fruit and vegetables are not necessary if the bowels are regular, but
insist that a weekly purge should always be given. There is a strange prejudice against the
white of an egg, and a child who asks for the yolk to be cooked solid must be refused.
Mothers are willing to agree that the children's lack of appetite for breakfast may be due to
their own example, and they promise to co.operate about this, as well as in trying to make meals
as regular and attractive as possible.
A reasonable bedtime is impossible to arrange for badly overcrowded families, and nearly
always difficult for any poor family in a crowded district. Noises and lights and other children
playing outside keep the younger ones awake.
The word "nutrition" still raises animosity in the minds of some parents. They think
it suggests that they starve the children. There is trouble with a superior type of parent, having
a superior and "linear" type of child, who is too tall for his or her weight though otherwise in
very good health. Usually the child is growing very rapidly. It is wise to watch such children
and keep up their intake of protective foods, for it is among them that active rickets, causing
changes in the chest wall, has been seen to develop in five cases (girls) this winter after they had
begun attending the centre.
The provision of milk for school children is a great help towards satisfactory nutrition. But
if the child is sick once after its milk—and nearly all children are sick occasionally—or if it once
finds its milk unattractive, the arrangement for milk in school is quietly stopped "because it
doesn't suit him." The loss of milk meals when the children are absent from school is unfortunate.
Official milk schemes have helped in a few cases and outside agencies have also been useful, e.g.,
one child was allowed to go and drink its milk daily at a local Invalid Children's Aid Association
office and charitable funds provided holiday milk that was delivered daily for certain children
as ordered from a local shop. It will be a great boon when official schemes cover all cases and
milk is available in the holidays, etc., for all who are ordered official milk.*
Convalescence, residential open.air day schools and open.air classes are all exceedingly
useful for children attending nutrition centres. Hopping or visits to relations are not as a rule
satisfactory. It is the regular routine and feeding and the atmosphere of quiet security that
the children need. They often gain four or five pounds in weight in a stay of as many weeks.
The progress of the children is greatly dependent on the nurse.in.charge and the care organiser
who initiates and maintains contact. It is impossible to over.emphasise the value of their work.
* An account of the experimental arrangement for giving milk in the holidays is given on p. 59