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formed of giving the child rest during the day, there seemed to be an inclination
to prolong this habit unduly and at the expense of the night sleep. The fact that
children of the age of 3 to 4 years, were found to receive an average total of 13½
hours' sleep, and at the age of 4 years, an average of 12 hours' sleep per day, compared
with an average of only 10 hours at the age of 2 years, bears out this observation.
In the case of the younger children the loss of at least four hours' necessary
sleep per day might be enough to account for the greater incidence of nervous
conditions and 'temper' found at this age.
Deformities.—Deformities were not found to be sufficiently serious to warrant
much remark. Most of the cases noted were minor rachitic deformities of the
chest that might be expected to improve with better nutrition and hygienic treatment.
Deformities of knees and feet were fairly common, but in many cases were
due to excessive weight or to unsuitable, and particularly too short, shoes rather
than to manifest rickets. Where such deformity was obvious, advice was given
on walking, simple exercises and the correction of shoes, while a few cases were
referred for plastic operation, or for massage and remedial treatment at the Invalid
Children's Aid Association's Clinic.
Numbers per Session.—The number of cases examined per session was not
large, 8 to 10 being found to be about as many as could be managed with the full
examination described, and allowing also some time for talk with the parent. After
the first few sessions, for which appointments were not necessarily kept, the
attendances generally were steady, and parents showed a willingness to avail
themselves of the services provided, and to return for further conferences on request
or when new symptoms became evident.
Percentage Requiring Treatment.—The percentage of children referred for
treatment, including dental treatment, was 35.
Conclusions.—In conclusion, the purposes served by the Toddlers' Clinic
may perhaps be said to have evolved as follows:—
(1) As a purely inspection clinic providing information as to general physique
and fitness of children at the ages chosen for examination.
(2) As a means of providing a certain amount of general instruction in
matters of diet, hygiene and management that prevent or lessen illness.
(3) As a clearing house for the treatment of established defects, cases being
referred to suitable centres, private practitioners, convalescent homes
and hospitals, and to different types of clinics.
(4) As a place of observation for minor conditions of ill-health or physical
defect not yet requiring treatment.
(5) As a means of bringing under notice certain cases of abnormality, often
unsuspected or ill-defined, for which suitable provision, short of treatment,
must be made, and the parent guided as to management.