RESULTS OF THE SELF-SELECTION OF DIETS BY YOUNG CHILDREN.

Abstract

25 m A EIA SOITO ORA Sp.13 served at each meal according to a fixed schedule. Each article, even salt, was served in a separate dish, salt not being added to any, nor was milk poured over the cereal. All portions were weighed or measured before serving and the remains weighed or measured on the return of the tray to the diet kitchen. Food was not offered to the infant either directly or by suggestion. The nurses' orders were to sit quietly by, spoon in hand, and make no motion. When, and only when, the infant reached for or pointed to a dish might she take up a spoonful and, if he opened his mouth for it, put it in. She might not comment on what he took or did not take, point to or in any way attract his attention to any food, or refuse him any for which he reached. He might eat with his fingers or in any way he could without comment on or correction of his manners. The tray was to be taken away when he had definitely stopped eating, which was usually after from twenty to twenty-five minutes. The results of this six-year study of self-selection of diet by young children from the time of weaning on may, for the purpose of this discussion,-be conveniently grouped under three heads: (1) The results in terms of health and nutrition of the fifteen children; (2) the adequacy of the self-chosen diets as judged by nutritional laws and standards; (3) the contributions made by the study to our understanding of appetite and how it functions. Like the lives of the happy, the annals of the healthy and vigorous make little exciting news. There were no failures of infants to manage their own diets; all had hearty appetites; all throve. Constipation was unknown among them and laxatives were never used or needed. Except in the presence of parenteral infection, there was no vomiting or diarrhaea. Colds were usually of the mild three-day type without complications of any kind. There were a few case of tonsillitis but no serious illness among the children in the six years. Curiously enough, the only epidemic disease to visit the nursery was acute glandular fever of Pfeiffer with which all the children in the nursery came down like ninepins on the same day. During this, epidemic when temperatures of 103 to 1050 F. prevailed, as with colds, etc., trays were served as usual, the children continuing to select their own food from the regular list. This led to the interesting observation that just as loss of appetite often precedes by twenty-fou'r to forty-eight hours every other dis-coverable sign and symptom of acute infection, so return of appetite precedes by twelve to twenty-four hours all other signs of convalescence, occurring when fever is still high and enabling the observer to correctly predict its fall. This eating of a hearty meal when fever is still high is often not in evidence when children are put on restricted diets during such illness, but the correct-ness of the observation has been amply confirmed in the Children's Memorial Hospital where a modification of the self-selective method of feeding prevails. During convalescence unusually large amounts of raw beef, carrots and beets were eaten. The demand for increased amounts of raw beef and carrots can be easily accounted for but we are still curious about that for beets, and inclined to wonder whether they may furnish an anti-anaemic substance (iron?) from the fact that beets were eaten by all in much larger quantities in the first six months or year after weaning than ever again save after colds and acute glandular fever. Some of the infants were in rather poor condition when taken for the experiment. Four were poorly nourished and underweight; five had rickets. Two of these five had only roentgeno-logical signs of rickets, and one mild clinical rickets as well, while the other two were typical textbook cases. The first infant received for the study was one of the two with severe rickets, and, bound by a promise to do nothing or leave nothing undone to his detriment, we put a small glass of cod liver oil on his tray for him to take if he chose. This he did irregularly and in varying amounts until his blood calcium and phosphorus became normal and x-ray films showed his rickets to be healed, after which he did not take it again. He had taken just over two ounces in all. No other of the 15 children had any cod liver oil, viosterol, treatment by ultraviolet rays or other dietary adjuvants at any time during the study, and all four of the other cases of rickets were healed in approximately the same length of time as was the first. Regardless , however, of their condition when received , within a reasonable time the nutrition of all, checked as it was at regular and frequent intervals by physical examinations, urine analyses, blood counts, haemoglobin estimations and roent-genograms of bones, came up to the standard of optimal so far as could be discovered by examinations .