The relationship between physical growth and change in mental development on the Griffiths mental development scales was investigated in 127 stunted Jamaican children over a 2-year period. The role of nutritional supplementation in this relationship was examined. There were no consistent associations between changes in weight-for-height or head circumference and developmental change. Height gain over 2 years was significantly associated with change in mental age, and locomotor and hearing and speech subscale scores. Height gain in the first year predicted change in mental age, and hearing and speech in the second year. Some of the effect of supplementation on development was shared with linear growth. Therefore, nutrition probably explains part of the relationship between growth and development. However, supplementation also had effects on development independent of growth. The benefits of supplementation on development and the extent to which they were shared with growth varied among the subscales.
The unusual complication of acute hiatal hernia with oesophageal rupture following transthoracic oesophagomyotomy is described in 2 cases. Inadvertent disruption and widening of the oesophageal hiatus at the time of surgery coupled with increased intragastric and intra-abdominal pressure were the probable causes. The hiatus should be carefully inspected on completion of the myotomy and anatomical restoration performed if necessary in order to avoid this complication. Urgent surgical intervention, gastric fundal serosal patch repair and intravenous alimentation proved successful in the management of these patients.
Taitz and King suggest that the existence of 'speech delay' may be offered as evidence of serious deprivation in care proceedings.' We feel that the relations between language development, deprivation, and child abuse are more complex than Taitz and King imply. (1) 'Speech delay' is an imprecise term. Does it refer to poor articulation, limited vocabulary, immature syntax, inadequate social use of language, or poor comprehension? When is 'delay' significant? Speech therapists report 'delay' at varying levels on language testing, from less than-1 to-2 standard deviations from the mean. (2) There is wide variation in the rate of language acquisition even among normal children growing up in stable families,2 and a substantial part of this variation is determined by genetic and constitutional factors.3 (3) Although much has been written in a descriptive sense about early language acquisition, little is known about the minimum environmental requirements for this process. There is, however, a strong body of opinion that language acquisition is a very robust function and the variance attributable to different levels of 'stimulation' may be quite small.4 (4) 'Speech delay' is a symptom calling for differential diagnosis. Some children with delayed speech development turn out to have a true language disorder, but the differential diagnosis from 'simple' speech delay can be very difficult in a young child.
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