A Practical Application of Some Lessons of the Self-Selection of Diet Study to the Feeding of Children in Hospitals

Abstract

In April, 1931, a new way of serving meals to children in hospitals was instituted in the orthopedic ward of the Children's Memorial Hospital of Chicago. From the first day it pleased both children and nursing staff ; it quickly won the cordial support of the dietitian and her staff, and, after a year's experience with the method in this ward, meals are now similarly served in the cardiac ward and in the ward for convalescents.The advantages of the new serving method have been evident in :(1) The opportunity it affords of serving a more varied diet and allowing for individual choice in foods without increase of cost.(2) Better appetites and more enjoyment of food by the children.(3) Lessened nursing time and labor spent in serving meals.(4) Lessened waste of food.The orthopedic ward is a thirty-one bed unit composed of three main rooms, with small rooms for isolation and for recovery after operation, and, during the year (April 1, 1931, to April 1, 1932) had an average daily occupancy of 27.8. Its patients are about equally divided in numbers between children having a tuberculous or other infec¬ tious disease of bone or joint, about one third of whom have fever, and well children with deformities, congenital or acquired. The patient turn-over is relatively rapid, as surgical procedures (fusion operations) have largely superseded expectant treatment or complete dependence on casts in scoliosis and in tuberculosis of the spine or joints, and also because every effort is made, compatible with the patient's best interests, to avoid long drawn-out hospitalization of the children by their early discharge to a suitable institution, if not to their own homes. Thus, an admission rate of slightly more than five per week and an average hospitalization of five and one-half weeks bracket this ward with the medical and surgical wards from the point of view of "activity," while in the course of each week more than one fifth of the children in the ward, on the average, undergo anesthesia for some surgical procedure or other. Many require more than one operation for the

Dietary self-selection by animals.

“…In other studies, Davis (1928Davis ( , 1933Davis ( , 1934Davis ( , 1939 maintained older children up to 4ŷ ears on a self-selection regime. At no time during this period was any effort made to control the children's intake of the 30 unseasoned and unmixed foods that were used.…”

The experimental analysis of appetite.

“…It is well established that animals, including the human infant, if given a free choice among the components of an adequate diet, select proportions of fat, protein, carbohydrate, minerals, vitamins, and water, which lead to normal growth and to the maintenance of health. The studies of Evvard (22), Osborne and Mendel (44), Mitchell and Mendel (41), Davis (15,16,17,18,19), Harlow (29), and Richter and collaborators (1,47,48,49,50,51,52,53,54,55,56,57) are the better known works substantiating this principle. It is obvious, of course, that, before standard synthetic diets were ever heard of, wild animals somehow managed to locate foods, select, and so far as possible balance their diets from the edibilia of forest and plain.…”

Development of food acceptance patterns.

“…Such pioneering research illustrates the bidirectional nature of influence that can occur in the feeding context: The social context of feeding influences food acceptance patterns, and the affective tone of the feeding experience can, in turn, influence the child's socioemotional development and the quality of the parent-child relationship. Davis's (1928Davis's ( , 1933Davis's ( , 1935Davis's ( , 1939 and Duncker's (1938) research focused on contextual factors influencing food acceptance, especially the role of experience and the social affective context. In contrast, the research of Ainsworth and Bell (1969) and Bruch (1973) emphasized the influence of early feeding experience on the child's socioemotional and physical development.…”

“…Lipsitt, 1963), but the focus of this work was not on feeding per se. Historically, research on infant and child feeding includes the early work of Clara Davis on dietary self-selection during infancy and early childhood (Davis, 1928(Davis, , 1933(Davis, , 1935(Davis, , 1939), Duncker's (1938) intriguing research on social influence and food preferences, Ainsworth and Bell's (1969) investigation of mother-infant feeding patterns and child outcomes, and Bruch's (1973) study of the family dynamics of childhood obesity and eating disorders.…”

“…Such pioneering research illustrates the bidirectional nature of influence that can occur in the feeding context: The social context of feeding influences food acceptance patterns, and the affective tone of the feeding experience can, in turn, influence the child's socioemotional development and the quality of the parent-child relationship. Davis's (1928Davis's ( , 1933Davis's ( , 1935Davis's ( , 1939 This document is copyrighted by the American Psychological Association or one of its allied publishers.…”