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CONTRIBUTIONS FROM THE FIELD OF CHILD DEVELOPMENT * JUNE 28, I94I Miss Mary Sweeny (Merrill-Palmer School3: On a study of changes in family food habits by Merrill-Palmer staff. Included only protective foods listed in Govt. Bull. Eat the Right Food. Submitted to faculty of Merrill- Palmer School, Merrill-Palmer students, an evening class of students at Wayne University, Merrill-Palmer parents, parents of WPA nursery school. Asked: I) if adults had changed habits; 2) conscious change; 3) frequency increased or decreased; 4) why changed. Changes: M-P staff, 4070; M-P students, 2I~o-36~o; Wayne U., 509fo; M-P parents, (f) 50.5%o, (m) 4470; WPA parents, 32.89fo. Reasons: education (highest all groups); medical advice; change in environment; change in taste and ways of preparation; reducing; professional connections; social reasons. Media by which reached: articles, lectures, classes, profession, noteworthy few radio and no adver- tising. Actual changes: (men M-P) grapefruit and dark bread; also oranges, white bread, cheese, cereals; same for M-P women; (WPA parents) high in protective foods, especially milk, cereal, oranges, grapefruit, decrease in sweets; (no occupation group) milk, grapefruit, oranges, meat, cheese, vege- tables, fish. In dealing with data did not separate favorable from unfavorable changes, but it could be done. Question of whether people really not influ- enced by radio, or just did not mention because of lack of prestige. Did not deal with any factors of environment or background such as income, nation- ality, etc. Dr. George D. Stoddard (State University of Iowa): Read abstracts from four researches, selected from bibliography of 30-40 titles on changes in food habits of young children. ~) K. Dunker: "Experimental Modification on Children's Food Preferences through Social Suggestion" in Journal of Abnormal and Social Psychology, ~938, 3. Conclusion: There is a tendency to learn to like what is accepted, but liking or disliking always subject to social suggestion. Control group of children made free choices of some foods; same children in pairs chose-choices of second child of pair showed solo due to social influence-younger (if more than ~§ years) followed older unless older an adult where might get respect barrier. Story telling experiment showed children liked (relatively) unpleasant hero food better than (rela- tively) pleasant hero poison; influence tended to survive original situation though gradual tapering off took place. 2) D. McCarthy: "Children's F~eed- ing Problems in Relation to the Food Aversions in the Family," in Child Development, ~g35, 6. Conclusions: Food aversions of family members associated with 3570 of children's food aversions; problem group had more similar aversions than non-problem group and also had more peculiar or unique aversions. Higher percentage of identical food aversions among title. * See minutes of Committee on Food Habits conference of June 28, :94~, under same ~49
I 50 The Problem: of cha77gi;7g Food Habits siblings than between children and parents of same group. 3) T. F. Vance: "Food Selections of Nursery School Children," in Child Development' eggs, 3. Forty-four children, 25 observations each, choice of meat or eggs, ~ vege- tables, sandwich. Meat, apples, sandwiches, fish, eggs ranked labial:; vegetables low; creamed foods low. Single items preferred to combinations. Taste factor, (emotional) conditioning and mechanical difficulties rank high in reasons for choices. Similar study comparing city with rural children showed different accepted foods for each group but all preferred white and dark bread, milk, custard, carrots, peas, and beans; most disliked common vegetables; rural children had better appetites. 4) G. M. Borgeson (Teachers' College disserta- tion) on observations done in WPA nursery school showed that factors involved in getting children to eat included: watchful neglect; pleasing at- mosphere; social conversation; small portions; paired liked-dislil~ed foods; matter of fact attitude to refusals; good adult example. Dr. Arnold Gesell (Clinic of Child Development, New Haven Hospital): On studies of development of young babies under elastic conditions of self- regulated feeding. Organism taken as point of departure; organism and cul- tural factors united in concept of development. Babies in homes; mothers charted feeding, waking, sleeping periods over long time. Found self-regula- tory fluctuation in all three factors; interpreted as effortful attempts of organ- ism to accomplish increasingly mature adjustments. Range of fluctuation varies with infant; those with low variation fit best the usual fixed schedules. Self-demand schedules satisfy infant physically and emotionally; sense of security essential to mental health. Expresses democratic approach to prob- lem. Emphasis on meals changes with age: o-3 months night meal; 3-6 months breakfast; 6-~8 months noon meal; ~-3 years night meals; 4-5, 6-~ breakfast. Waves of appetite and allergies affected by maturity {actors. Pos- ture important. Dr. R. Benedict cited examples from primitive cultures show- ing agreement with Dr. Gesell's findings; pointed out association between nursing and sense of security. Dr. Gesell emphasized same point in relation to self-selection. Dr. Stoddard question of foods chosen; must be good foods. Asked how much choice given infants. Dr. Gesell said not much ex- periment on this but also emphasized good foods; referred to Clara Davis chapter in Vol. I of Brennemann's Practice of Pediatrics. Dr. W. L. Warner asked how all this was related to improving of general food habits. After some discussion Dr. Gesell pointed out that the habits formed in first five Years are vital; at present child participation in family meals (normal way j has declined. But diets are better. Getting enough choices of food to all people a problem of technology. Wrong feeding in early period creates a continu- ing cultural difficulty. Therefore must emphasize prevention rather than re-education of adults; must set up ways of living in homes which will give organisms best chance to thrive from beginning.* *Gesell, Arnold, and Ilg, Frances L. Feeding behavior of infants: A pediatric ap- proach to the mental hygiene of early life. Philadelphia, Lippincott, ~939. Gesell, Arnold, and Ilg, Frances L., in collaboration with Learned, Janet, and Ames Louise B. Infant and child in the culture of today: The guidance of development in home and nursery school. New York, Harper, ~943. ~
Contributions front Child Development 151 Dr.. C. A. ~Idrich (Children's Memorial Hospital, Chicago, Ill.~: In the newborn, cultural changes have made little difference in their inherent abili- ties developed over the whole period of human evolution. Importance of selective behavior related to question of habits; habits are based on satis- factions things we like to debut in children are a more reflex sort of ~ 1 · Tt ~ · . ~ · . · ~ , · ~ · 1 - 1 · ~ · , 1 behavior. Habits can be positively or negatively inclined ~t against real satisfaction cannot be good habits. Therefore appetite must be allowed free range in selection. Animal experiments and studies of children's choices show ability to make necessary choices for balanced diet. Selection of good foods show children will normally not select nutritionally forbidden foods (sugar, etc.~. Dr. Young of University of Illinois has theory taste buds may register deficits and so aid selection. Babies need few different things to eat (as few as 6-7 kinds even to 4 years). Growth determines time children will accept new kinds of foods (semi-solids physically difficult before 4 months). But must not limit diet to what we now know is good may find more foods later. Dr. Seay asked whether program should first stress right foods of economic conditions. Dr. ~Idrich: Information not enough; thwarted appe- tites lead to problems; must help all the time to develop right habits from beginning. Research in Toronto on effect of protective foods given to preg- nant mothers shows correct feeding (costing $200) will cut infant mortality. Miss F. Stern: How are mothers induced to follow good program? Dr. ~1- drich: By getting mothers to see' child growth and development and to under- stand that pediatrician and mother only provide favorable environment. Demonstrate time for changes in diet by development of child itself. Mrs. Sideline Heiney ~ National Child Research Center, Washington, D. C.~: In work with pre-school children (70-8;o a year) one difficulty is analyzing likes and dislikes and giving right amount of cooperation in feed- ing problems. Some children have established dislikes; others suddenly change likes (especially ' after 4 years). One group disliked vegetables; decided to allow complete free choice; after 3 weeks discussed minimums with them and within ~! weeks got cooperation in eating rejected foods. Method also suc- cessful with 5 year olds; not with 3 year olds. Selection must be guided by some set minimum. Dr. Aldrich pointed out necessary differences when work is therapeutic rather than (as his) preventive. Dr. Stoddard said both points of view necessary; task of Committees to find what influences on food habits prevail in modern culture. Dr. C. E. Gnthe said object of both Committees so to integrate human animal with opportunities that we will get best results. Dr. Benedict said important to find ways of working from beginning' but also to,correct bad existing developments. Dr. Id rich: Of course, but ought to make use of findings of science. Dr. Gesell: But human organism itself ought to be center of gravity for all work. DO. Miriam E. Lowenberg (Iowa State College): Interested to discover why children in Dr. Vance's study rejected vegetables. Experimented with effects of changed methods of preparation; found children rejected strong tasting vegetables (onions for one); textures also important- object to stringy or dry foods, gummy and starchy foods. If prepared to have mild taste and with good texture children would eat. No comparative studies on ~. .
I52 The Problem of Changing Food Habits effect of fancily eating habits, but think they play part. In making changes important to begin with what child likes, only small portions of disliked foods; no forcing. Discarding the cooking water may cause a loss of nutritive value but felt it more important first to develop a taste for food itself. Dr. Mary V. Gutteridge (Formerly, Merrill-Palmer School)*: On rela- tive value of two methods of conducting lunch procedure. Two groups of children, 8 in each, ate in separate rooms. In first, children served selves; in second were served but allowed to choose second servings. Observed by 6 graduate students estimate of food; amount eaten by each child each item; amount left uneaten; time taken to eat; child's behavior and conversation. In computing found three major variables: individual differences (average of top child more than twice amount of bottom child); differences on five days of week (Tuesday lowest, then Wednesday, Thursday, Monday, Friday); week to week differences (general increase due to outdoor play as spring advanced). Found mean amount consumed by self service exceeded that by control group. May point to cause of difficulties with small child in keeping him on a strictly regulated meal schedule. Are hoping to carry experiment out where can check all meals taken in a day. Excerpts from letter by Dr. Willard Olson (University of Michigan): Ex- presses doubt habit approach gets at some roots of problem; verbal expres- sion of attitude seems to have relationship to organismic status of child (center of gravity of a series of measurements) in relation to chronological age. Attention should be given to affective and emotional aspects of food consumption; recognize relationships to growth of child as a whole. Dr. Benedict: Above experiment too limited to allow one to draw cultural conclusions; ought to have experiment using children of different cultural backgrounds.. Dr. Stoddard: Food only one means of expressing resistances in nursery school ages. Ought to carry out studies of 2, 3, 4 year olds to higher age ranges. Must also consider economic selective factor in orphan- age where poorly fed, children eat everything offered. Dr. E. Waring: Loyalty strong in children of nursery school age. Can set up contract joint goal with adult and so accomplish necessary task (eating). Miss Agnes Larson (City Supervisor of Home Economics, St. Paul, Minn.~: The object of our nutrition work in the City of St. Paul is to locate undernourished children, overcome malnutrition, prevent further deficiency through dietary measures; correct through medical procedures. Much of the work was carried on in the school in order to reach all pupils and through them their parents. Work was also carried on in the individual hones. - - 1 ~ ~ ~ ~ ~ ~ ~ Monthly classes were held for parents at school, and classroom instruction was given to the children in school by their own classroom teacher. Feed- ing and care only effective if accompanied by corrective measures. Problem of 500 Mexican families on very limited diet-which~children accept; show no interest in other food until placed in nutrition clinic or influenced through home visitation. Conduct lunch services in schools; also nutrition clinics; nutrition classes for parents, for children; home visitation Work. Made ser * There was no opportunity for Dr. Gutteridge to review the summary of her remarks before the publication of this current report.
Contributions front Child De7~elop~ent ~53 vey of influence of nutrition clinics on food and health habits of undernour- ished children. Using as controls 40 children front two schools. Observa- tions and ~neasuren~ents by students of nutrition at University through home visitation; contacts with social worker, teachers, physician. Must have home cooperation to succeed. Must also Set children to cooperate willingly. Eco- nomic status of fancily influential (larger the family on low income, worse the situation). Glade thorough tests of children at beginning of experiment. Allowed children to follow own wishes in eating lunch when started; within four weeks almost all dislikes disappeared, table manners improved, appetite improved. Improvement in rate of eating, play, sleep, behavior at mealtime, and nervousness in over 40~ of cases Moliere formerly had difficulties. De- gree of excitability and evidence of colds reduced. Scholarship improvement in 53%0; attentiveness in Who; posture in 6670. Reduction in mean percen- tage underweight from judo to 77. Right kind of illustrative material very necessary to put program across; prepare simple pamphlets for children. teachers, parents so that lessons can be followed through at school and home. No technical words. Can get going with foreign groups by praising what they have already done and go on from there adding new things rather ~ ~ ~ v than making abrupt changes. Outstanding defects in children revere anemia, defective teeth, tonsils, ear conditions, cardiac diseases; 3 ~ ~ had defects that had to be corrected before building up; 80%0 lied low hemoglobins. Dr. R. Wilder: What success with foreign groups ? bliss Larson: Italians and Mexicans problem, but get very good cooperation. Have six diet centers in city taking care of 300-400 families; 300 children eating at centers at noon. Since each family averages 5 people, work with all reaches large population- mostly foreign. Get commodities from Office of Food Distribution which is supplemented by funds for food obtained through local agencies. Dr. Ethel B. Waring (Cornell University): Fancily Life Department stresses personality aspects of food habits. A study of lo best eaters-lo poorest eaters seemed to show that "good eating is an aspect of development in that the more advanced organism seetns more likely to be a good feeder." Feeding not only organisn~'s effort to satisfy hunger, but also effort to satisfy social end 'affectional needs. Necessary to have people learn principles of guidance rather than merely practices, so they can apply the principles in either situation. Result of film material shown in Farm and Home Week as experiment indicated parents liked to see parents learning and succeeding in guiding their children's eating better than hearing lectures about it. Pre- pared bulletins on children with food dislikes showing how these were over- come idea to give principles for parents to folIo-1v: what parent did, when she did it, and related what with why. Tried to put over idea of relationship between parent and child that principle will fall down if based on unwhole- some relationship. Three categories of action: child and adult with joint effort and purposes; efforts opposed; efforts unrelated or independent. Under these categories illustrated if and when social pressure (adult step in) de- sirable. Plan small 4 page pamphlets simply written. Try to help parents feel less strain, more confidence. Give minimum first serving in school and advocate it for home if child gets this amount into him, parent can rest
1 -4 The Pro bleats of Chair Food Habits easy about whatever else is chosen. A study of method in influencing food habits of low income families instruction given in home visiting seas effective. Follow-up showed improvement persisted. Remainder of programs devoted to educational progrcz~ns and their orientation. 71~Iiss Sne Taylor (Federal Security Agency' Department of Agriculture): Federal Security Agency is the action agency set up in the United States Department of Agriculture to help low income farm families who are unable to secure a loan from any other lending agency; it has given rehabilitation aid to some 900,000 families. Tl~e method is one of loans based on farm and home operating plans, supplemented with education in the necessary prac- tices. It is a "supervised credit" program. Federal Security Agency farm and home supervisors visit farms and homes of borrower families to discuss their problems, analyze their resources, and develop with each family a farm and home plan which will include: ~) production of adequate food for the family, ~) feed for livestock, 3) diversified farm enterprises for cash income, 4) farm and home operating budgets, 5) improved farm and home practices wl~icl~ will lead to an improved level of living for the family and greater financial security. Malting home-grown food available has been the greatest single factor in im- proving food habits which have resulted in improved health of Federal Security Agency borrower families. This has been accomplished by planning with the families for adequate home production and giving them financial assistance and round-the-year, on-the-farm advice. Subsistence production of milk has increased from an annual go gallons per family before their acceptance on the Federal Security Agency program to 488 gallons; canned fruits and vegetables from 5~ quarts to 242 quarts; meat from 85 pounds to 447 pounds; and the average family has had an increase of about 88 dozen eggs. Planning is based on individual family needs. Planning the food supply begins with the amounts and types of food the family should use each day and the amount they will need for a year. The next step is planning how much the family will use and what they will produce. Planning for home production is very complete. It includes the number of subsistence live- stock, their feed, care, and management; an adequate supply of vegetables and fruits for use fresh, for canning, drying, and storing; and the necessary equipment and materials for production, such as good quality seed, insecti- cides, fencing for gardens, pressure cookers, jars for canning, and proper storage facilities. Cooperative purchasing of fad and home equipment and machinery is encouraged among families who are not able to own it individually. Proper tenure arrangements are important to an adequate home-grown food supply Federal Security Agency assists the landlord and tenant to draw up a lease that will encourage food production as well as cash crops. Assured occupancy for three to five years with written tenure agreements, recognizing the family's need for producing their own food, has led to more adequate gardens and more subsistence livestock on rented farms. Actual teaching of improved practices has resulted not only in production of more food but also in better variety, better quality, and better use of food. For example, some people do ,
Contributions from Child Development ~55 not want milk because they never had milk of good quality, some do not like carrots because they never learned how to serve them. Care of food, how to plan, cook, and serve palatable meals has been an important part of teaching Federal Security Agency's families. In teach- ing, the demonstration method has been stressed and it has been found impor- tant to have the men and women of the families together in both den~onstra- tion and discussions. Farm and home tours to observe good practices have proven very effective. All nutrition has been taught in very simple terms, materials from United States Department of Agriculture and the Colleges of Agriculture and from other sources having suitable material have been adapted for use with low income farm families. Perhaps the outstanding ~ ~ ~ ~ ~ · . A result ot increased come production ot loon by r eceral Security Agency families has been improved health. The change in morale as evidenced by the increased participation in community activities goes to show the over-all effect of improved level of living. Dr. Norman L eon (T Old ( Food Distribution Administration ): Surplus Marketing Administration operation of Food Stamp Program, School Lunch Program, Low Cost Milk Programs, direct purchase and distribution of commodities to needy families; the Cotton Stamp Program; and, with AAA, the use of cotton stamps to reduce cotton acreage and increase home produc- tion of food. Little value in teaching unless people can take advantage of ~ . - ~ . · . . . .. .- . . . education. People In need of getter civets must nave resources. Currently 4,ooo,ooo people getting about $2.35 per month on Food Stamp Program for food; about 6,ooo,ooo receiving commodities directly through welfare departments in states; 4,750,ooo children getting some commodities through school free lunch program- lunches made up in whole or in part of these commodities; about 500,000 people getting milk under low cost milk program; about z8~,ooo school children getting penny milk. These programs provide a tangible basis for community effort toward education in food values. Can link program to something, definite in which whole community can participate. Blue stamps, issued after purchase of orange stamps, insure that surplus foods do not merely supplant others. School lunch programs insure increase in total food consumption, but too many children will get nothing in summer because schools closed. Agriculture has undertaken expansion program toward areas of greatest food needs; some on surplus list are those we do not produce enough of. Need an agricultural program based on nutritional lines; would make sense. Replace export markets. Need 2070 more milk; loom more leafy green and yellow vegetables; 70%0 more tomatoes and citrus fruits; ~5~ more butter; 35~70 more eggs. Food Stamp Program and lunch program concerned with over-all agricultural problem help both farmer and consumer. Study in Dayton, Ohio, by Bureau of Human Nutrition and Home Economics indicates increase in vitamin content of diet and practi- cally all nutrients; still lack of calcium. Farm program means translating vitamins, etc., into commodities for consumption. Now about to stress increased consumption of fresh vegetables. Dr. Fai.h Billiards (Department of Labor): Bureau of Labor Statistics in ~9~8 studied food expenditures in cities throughout the United States. The sample covered families of employed clerical workers and employed
I 56 The Problems of Cha,~gi~g Food Habits wage earner families with at least one child under sixteen. Ire 1936 made new study of 35 of Close same cities including wider family sampling. In- creased use of some foods such as fresh fruits arid vegetables and milk shows effects of greater availability, campaigns of use of foods; but also indicates strong attachments to special kinds of diets carrying over the whole period to Bitten localities. This latter point important ire planning educational pro- grams and use of surpluses, etc. Miss Frances Stern (Food Clinic of The Boston Dispensary, Boston, iNIass.~: The Food Clinic came into being about ~5 years ago, to serve the needs of the out-patient for scientific food guidance as an aid to successful medical treatment. The Food Clinic of The Boston Dispensary now has about 7000 visits annually, by ~500 patients. All patients are referred by the staff physicians. In the Food Clinic the dietician plans the dietary regime on the basis of laboratory and medical findings and recommendations, and on her understand- ing of the patient and the economic, social, mental, and emotional factors in his life, gained front the medical record and from the nutritional history which she takes in conference with the patient. Teaching the patient is essential to successful food treatment. To under- stand why he should adhere faithfully to his diet, the patient must know why certain foods are prescribed for him. So the dietician helps hint to under- stand that foods contain substances or constituents like those of which the body is composed, how these food constituents aid in upbuilding and main- tainir~g health, growth, and vigor, and why the foods in his diet will serve his special needs. Other members of the patient's family are brought into this teaching program, to obtain their understanding and cooperation. The Food Clinic is constantly developing materials to lately interpret these principles of nutrition not only to patients, but to the students who receive instruction in the Food Clinic in the practice of dietetics and to all who teach in the interests of public health. In the Clinic, where the patients represent 30 nationalities, such materials help to overcome difficulties in understanding the spoken word. The exhibit proves to be a most interesting and helpful means of teaching the essentials of nutrition that every one should know. The book "Applied Dietetics," which describes the principles, procedures, and methods of food treatment in the Food Clinic, with many tables to help in the computation and evaluation of diets, normal and therapeutic, is forth- coming in a new edition. The Department of Health Education, affiliated with the Food Clinic of The Boston Dispensary, has developed methods and materials for teaching patients while they await treatment. The book, "How to Teach Nutrition to Children," * is the outcome of this work. Its purpose is to teach the food constituents, how they serve body needs, and what their food sources are. Special mention should be made also of a chart "Feed Your Body to Protect Health" which also carries out this philosophy of teaching, and of a color film, "Fun in Food," which is based on the book referred to above. The * Pfaffman, Mary, and Stern, Frances. How to teach nutrition to children. New York Barrows, ~94~. 2~4 p. (Formerly published under title, "Food and your body.")
Contributions from Child Development ~57 chart can be obtained from The Food Clinic of The Boston Dispensary, and the film from Films Inc., 330 West 42nd Street, New York City. The Food Clinic extends its teaching program to the community though the food clinic established in the Young Women's Christian Association, the nutrition and health education department in the Burroughs Newsboys Foundation, through special meetings held with mothers in the Dispensary, and to many parts of the world through its publications, students, and visitors. Miss Grace M. Henderson (Adult Homemaking Education, Cornell Uni- versity): Have we, who are interested in food habits, responsibility beyond selling an improved diet? May we not actually best achieve that end if we at the same time lead families and groups of families in the further develop- ment of the at least equally important ability to think, to plan, to experiment, and to evaluate, in relation to their other needs? We can get people to taste new foods, to exchange recipes, and to want to eat them. We can help home- makers become skillful in preparing them. We can sometimes work with stores and others to make foods available. But families have to consider food in relation to other wants and must choose among them. They need to con- sider costs, relative importance of other needs, and the money and material that is available. Helping them continually to improve this ability and disposi- tion to choose, plan, and decide carefully is our opportunity while working for better health. Family willingness and ability to think independently is basic to a vigorous democracy; as is good food. Many nutritionists are teach- ing for both purposes. They meet with families and groups of families who discuss not only the relation of food and food elements to health problems, but costs in relation to family incomes and to their other needs. Professional teachers are supplemented by and cooperate with lay leaders in attacking fancily and community health problems. It takes time, but families recognize theblesirability of the slower approach. They want to think, experiment, and evaluate as a family group, in this and other vital daily problems. Good food habits and health then result, and with them, thoughtful management, under- standing, ongoing community programs of education and cooperation, and increasingly able local leadership; in short healthful and able democratic communities. Miss Dorothy Bovee (American Red Cross, Washington, D. C. ): Ink hence of Education of Food Habits in the Mulberry Area in New York. Staff Nutri- tionist at Mulberry Health Center Little Italy. Selected ~35 families at random out of Dig; divided into 3 groups: ~) control, 2) to 7 public nurses, 3) special education group. First made survey of entire family situation; special emphasis on food eaten by children (using 5 point rating scale). Did 9 months intensive educational work on group 3. Patient close contact with parents, children; had to establish motivation, etc. Brought out importance of individual teaching, especially for foreign families. At end of g months again gave children status (with rating scale) and found considerable improve- ment in families of group 3. Found it unwise to change diet; better to get people to re-establish old good habits and then help make readjustments in terms of present situation. Reprints of study available at Milbank Memorial Fund.
