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14 The Health Bulletin October, 192] PINCHEIO FACIAL EXPRESSION MOUTH BREATH1M6 FLAT CHEST ROUND SHOULDERS AN6EL . WIN65 PROTUBERAMT ABDOMEH SWAY BACK KNOCK KNEE5 FLAT FEET TYPICAL posture of malnutrition (so-called Vatigue" posture)
£i : Odoher, 1927 The Health BuLLETI:^: 15 child to run about half sick, \Yith a badly lacerated throat, and perhaps a moderate temperature indicating the depleted condition that follows any such operation as this. If such care is not taken, the results are quite likely to be exactly the reverse of what has been hoped for ; and instead of iniprovement. increased underweight and even more serious fatigue may supervene, from which the child will not recover for many months. Another cause of malnutrition may be an undetected and uncorrected eye strain. This may be due to either farsightedness, near-sightedness, or that distortion of the shape of the eye-ball itself known as astigmatism. If allowed to continue without correction, headache, retardation in school, and marked malnutrition, with any conceivable nervous symptom or symptoms, may develop. Other physical causes are such wasting diseases as diabetes, tuberculosis, or syphilis, that produce malnutrition. Sometimes the cause is found to be some form of heart trouble. Such defects can only be discovered by a complete, careful examination by a physician. Wherever their removal is possible, this should be accomplished. If such removal, and consequent cure, are found to be impossible of accomplishment, then at least such palliative treatment should be given as will do the utmost to minimize the bad effects of the physical defect that is at the bottom of the trouble. Among the causes found in the second group, faulty health habits, we need only run over in review the habits of any family of children that we know fairly intimately, in order to find a promising start for our list ! Late hours, over-indulgence in moving-pictures with their eyestrain, poor ventilation, and unwholesome emotional stimulation, reading of trashy fiction and depraved newspaper sex and crime "news," as well as the overhearing of adult conversations not thoroughly understood but none the less harmful and suggestive in their implications and innuendoes,—all these rank high among the faulty health habits that are producing malnutrition among our children. We parents are confirmed and hardened offenders in this matter of discussing subjects that should be tabu, before our children ; and trusting to a stupidity that we would be the first to deny were others to assume it, to protect them from ideas that we should never have allowed them to entertain, had we given the subject the serious thought that it deserves. In the third class of causes, faulty food habits, high place must be assigned to overindulgence in candies, drug store drinks, and sugar in inordinate amounts at the table. Eating at the wrong time, between meals instead of at meals, is a close second. Still another contender for first place is the over-centering of parental interest in what the child eats, what he will not eat, and why he will not eat it, with a consequent exaggeration of his sense of his own importance, and his power to upset his elders' peace of mind by his food idiosyncrasies. As this question, and the proper way to deal with it, has been considered at some length in an earlier article, "Refusal to Eat," in Children, the Magazine for Parents, January, 1927, it need not be gone into further at this time. The fourth class, emotional strain, embraces two great sub-divisions, each of which deserves a volume,—namely, Home Strain and School Strain. As both are considered elsewhere (The Nervous Child, Putnams, 1927), they need only be mentioned here. What about the cure for malnutrition is in the vast majority of cases curable, else its consideration would be futile in the Bulletin. The effort at bringing about a cure must be twofold : first, the removal of the causative factors and second the building up of the child by increased rest, increased food, and decreased or elimination of the factors contributing to his fatigue. The removal of the causative factors is self-explanatory—the very discovery of the cause should indicate the need for its removal before a permanent cure can be accomplished. As to the second phase of the cure, this is also self-evident—though it is not nearly so easy to accomplish, by convincing the parents of its necessity, as is the first. It consists in the following regimen (a) The institution of five meals a day by the addition of two extra meals,
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