Posts tagged ‘paediatrics’

Jul 17

Children’s Food

I’m writing this post while listening to this week’s podcast of BBC Radio 4’s Food Programme. The episode is about nine year-old food writer Martha Payne, whose blog about the dinners served at her school became the cause of a strange and troubling controversy a month ago.

Martha uses her blog, NeverSeconds, to review the food she eats at school. As Jay Rayner points out, although she may criticise – rightly – much of which the school provides for lunch, NeverSeconds is not intended as a kind of school dinners hatchet job. She rates her meals according to a Food-o-Meter, taking into account how healthy, but also how delicious, they are.

As her blog has grown in popularity, children from all over the world have contributed photographs and reviews, and it’s partly this which makes Never Seconds so wonderful: it’s a space in which children can discuss and debate food.

NeverSeconds came to wider – global – notice when the Argyll and Bute Council tried to shut it down in June, after the Daily Record published an article featuring Martha cooking with the chef Nick Nairn, headlined ‘Time to fire the dinner ladies.’ The blog’s honest descriptions and pictures of some of the food served to schoolchildren can’t have pleased councillors either.

As Private Eye (no. 1317) makes the point, the council’s bizarre – and futile – attempts to silence a blog probably had as much to do with internal politicking and minor corruption as anything else, but the furore which erupted after the ban also said a great deal about attitudes towards food and children.

What is really scandalous about the blog is that it reveals how bad – how unhealthy, how heavily processed – school meals can be. When Jamie Oliver launched a campaign in 2005 to improve the quality of school dinners in the UK, his most shocking revelations were not, I think, that children were being fed Turkey Twizzlers and chips for lunch, but, rather, that the British government is willing to spend so little on what children eat at school. Last year, the state spent an average of 67p per primary school pupil per meal, per day. This rose to 88p for those in high school.

Michael Gove has recently announced another inquiry into the quality of school meals – this time headed up by the altogether posher-than-Jamie Henry Dimbleby, the founder of the Leon chain of restaurants, who also seems to spend the odd holiday with the Education Secretary in Marrakech. It’s a tough life.

But as Sheila Dillon comments during this episode of the Food Programme:

Martha Payne, a nine year-old who seems to understand better than many adults, that dinner ladies, or even individual school kitchens, are not the source of the school dinner problem. It has far deeper roots.

When did it become acceptable to serve schoolchildren junk food for lunch? The way we feed children tells us a great deal about how we conceptualise childhood. Or, put another way, what we define as ‘children’s food’ says as much about our attitudes towards food as it does about children.

The idea that children should be fed separately to adults has a relatively long pedigree. The Victorians argued that children – and women – should be fed bland, carbohydrate-heavy meals to prevent their delicate digestive systems from being exerted. Fruit, meat, spices, and fresh vegetables should be eaten only in strict moderation.

There is, of course, a disconnect between what experts – medical professionals, childrearing specialists – recommend, and what people actually eat. In the late nineteenth-century Cape Colony, for instance, the pupils at an elite girls’ school near Cape Town were fed a diet rich in red meat and fresh fruit and vegetables.

But the belief that children’s bodies are delicate and potentially vulnerable to disruption was an indicator of shifts in thinking about childhood during the mid and late nineteenth century. The notion that children need to be protected – from work, hunger, poverty, and exploitation and abuse from adults – emerged at around the same time. As children were to be shielded from potential danger, so they were to eat food which, it was believed, was ideally suited to digestive systems more susceptible to upset and illness than those of adults.

But as scientists became interested in the relationship between food and health – in nutrition, in other words – towards the end of the 1800s, paediatricians, demographers, and others concerned about high rates of child mortality during the early twentieth century began to look more closely at what children were being fed. For instance, in the 1920s and 1930s, scientists in Britain and the United States drew a connection between the consumption of unhealthy or diseased food – particularly rotten milk – and high rates of diarrhoea, then almost always fatal, among children in these countries.

They were also interested in what should constitute a healthy diet for a child. As childhood became increasingly medicalised in the early twentieth century – as pregnancy, infancy, and childhood became seen as periods of development which should be overseen and monitored by medical professionals – so children’s diets became the purview of doctors as well. As RJ Blackman, the Honorary Surgeon to the Viceroy of India (no, me neither), wrote in 1925:

Food, though it is no panacea for the multitudinous ills of mankind, can do much, both to make or mar the human body. This is particularly so with the young growing child. All the material from which his body is developed has to come from the food he eats. Seeing that he doubles or trebles his weight in the first year of life, and increases it twenty-fold by the time he reaches adult stature, it will be seen that food has much to accomplish. Naturally, if the food be poor, the growth and physique will be poor; and if good, the results will be good.

Informed by recent research into dietetics, doctors advised parents to feed their children varied diets which included as much fresh, vitamin-containing produce as possible. In a popular guide to feeding young children, The Nursery Cook Book (1929), the former nurse Mrs K. Jameson noted:

Many years ago, I knew a child who was taken ill at the age of eight years, and it was thought that one of her lungs was affected. She was taken to a children’s specialist in London. He could find nothing radically wrong, but wrote out a diet sheet. By following this…the child became well in a month or two. This shows how greatly the health is influenced by diet.

This diet, she believed, should be designed along scientific principles:

Since starting to write this book I have come across an excellent book on vitamins called ‘Food and Health’ (Professor Plimmer), and I have found it very helpful. I have endeavoured to arrange the meals to contain the necessary vitamins, as shown in the diagram of ‘A Square Meal’ at the beginning of the book.

Indeed, she went on to explain that children who were properly fed would never need medicine.

In 1925, advising mothers on how to wean their babies in the periodical Child Welfare, Dr J. Alexander Mitchell, the Secretary for Public Health in the Union of South Africa, counselled against boiling foodstuffs for too long as it ‘destroys most of the vitamins.’ He argued that children’s diets ‘should include a good proportion of proteins or fleshy foods and fats’, as well as plenty of fruit, fresh vegetables, milk, and ‘porridge…eggs, meat, juice, soups’.

What is so striking about the diets described by Mitchell, Jameson, and others is how similar they were to what adults would have eaten. Children were to eat the same as their parents, but in smaller quantities and in different proportions. For example, some doctors counselled again children being allowed coffee, while others believed that they should limit their intake of rich foods.

So what is the origin of the idea that children should be cajoled into eating healthily by making food ‘fun’? Mrs Jameson’s recipes might have cute names – she calls a baked apple ‘Mr Brownie with his coat on’ – but they’re the same food as would be served to adults. Now, our idea of ‘children’s food’ differs from that of the 1920s and 1930s. When we think of children’s food, we imagine sweets, soft white sandwich bread, pizza, hotdogs, and brightly coloured and oddly shaped foodstuffs designed to appeal to children.

As Steven Mintz argues in his excellent history of American childhood, Huck’s Raft (2004), the 1950s and 1960s were child-oriented decades. Not only were there more children as a result of the post-war baby boom, but with the growing prosperity of late twentieth-century America, more money was spent on children than ever before. Families tended to be smaller, and increasing pocket money transformed children into mini-consumers.

Children either bought, or had their parents buy for them, a range of consumer goods aimed at them: from clothes and toys, to ‘child-oriented convenience foods… – “Sugar Frosted Flakes (introduced in 1951), Sugar Smacks (in 1953), Tater Tots (in 1958), and Jiffy Pop, the stovetop popcorn (also in 1958).’

The same period witnessed a shift in attitudes towards childrearing. Families became increasingly child-centred, with meals and routines designed around the needs of children, rather than parents. In many ways, this was a reaction against the orthodoxies of the pre-War period, which tended to emphasise raising children to be obedient, well-behaved, and self-disciplined.

So the definition of children’s food changed again. For the parents of Baby Boomers, food was made to be appealing to children. Fussiness was to be accommodated and negotiated, rather than ignored. And children’s desire for food products advertised on television was to be indulged.

I am exaggerating to make a point – in the US and the UK children during the 1960s and 1970s certainly ate less junk than they do now, and this new understanding of children’s food emerged in different ways and at different times in other parts of the world – but this change represented a bonanza for the burgeoning food industry. Although the industry’s attempts to advertise to children are coming under greater scrutiny and regulation (and rightly so), it does have a vested interest in encouraging children and their parents to believe that that is what constitutes good food for children.

I think that it’s partly this shift in thinking about children’s relationship with food – that they should eat only that which they find appealing, and that children will only eat food which is ‘fun’, brightly coloured, oddly shaped, and not particularly tasty – that allowed for the tolerance of such poor school food for so long in Britain.

Martha’s blog is a powerful corrective to this: she, her classmates, and contributors all have strong opinions about what they eat, and they like a huge variety of food – some of it sweets, but most of it is pretty healthy. The irony is that in – apparently – pandering to what children are supposed to like, politicians and policy makers seem to find listening to what a child has to say, fairly difficult. If we’re to persuade children to eat well, then not only should we encourage them to talk and to think about food, but we need to listen to what they have to say about it.

Breast is Best?

On a cold morning in early December last year, I found myself sitting in the Highgate Literary and Scientific Institution in London, looking at pages and pages of breasts.

Pausing occasionally to wonder at the collection of life choices which had led to this moment, I scanned these black and white photographs of lactating women from the 1920s and 1930s, attempting to understand the set of criteria according to which they were categorised into ‘good’ and ‘bad’ breasts.

The pictures were taken and kept by the Mothercraft Training Centre in London, and were intended for nurses and other healthcare practitioners working with mothers and young babies. Informed by the programme of scientific childrearing developed by the New Zealand doctor Truby King during the first decade of the twentieth century, the Centre’s staff promoted breastfeeding as the best way of providing babies with adequate nutrition.

In King’s view, breastfeeding needed to be approached scientifically. Mothers should not feed on demand but, rather, according to a strict schedule, depending on the age of the infant. This feeding by the clock was a technique aimed as much at mothers as it was at shaping obedient and self-reliant babies and young children.

Like other specialists in the relatively new field of paediatrics, King believed that mothers were irrational and emotional, and inclined to follow what he characterised as the unscientific and unsanitary advice provided by their female relatives. By breastfeeding in King’s ‘scientific’ manner, mothers could learn to be rational creatures.

In King’s view, not only were there right and wrong ways of breastfeeding, but also good and bad breasts. The photographs in the Mothercraft Training Centre’s collection were meant to help nurses identify the link between the shape of women’s breasts and the ways they would feed their babies.

I was reminded of these photographs this week by the most recent cover of Time magazine, which features 26 year-old Jamie Lynn Grumet breastfeeding her son. She is young, slim, and wears a skimpy top, and her child is a sturdy three year-old.

The debate which erupted around the cover focussed on the age of the boy: wasn’t it weird, asked some, for a mother to be feeding so old a child? The picture – deliberately, I think – provoked this controversy by upsetting contemporary notions of what nurturing motherhood should look like.

But what interested me is that Time chose this particular photograph for its cover. The edition’s focus is not, in fact, on breastfeeding. It’s about a popular childrearing guide The Baby Book (1992) written by William Sears, which advocates that mothers and babies remain as close together as possible for as long as possible. Kate Pickert explains:

While the concept sounds simple, the practicalities of attachment parenting ask a great deal of mothers. The three basic tenets are breast-feeding (sometimes into toddlerhood), co-sleeping (inviting babies into the parental bed or pulling a bassinet alongside it) and ‘baby wearing,’ in which infants are literally attached to their mothers via slings. Attachment-parenting dogma also says that every baby’s whimper is a plea for help and that no infant should ever be left to cry.

Hilariously lampooned by Maggie Gyllenhaal in Away We Go, attachment parenting has been the subject of extensive and frequently ferocious debate. Breastfeeding, though, is only one feature of this particular mode of parenting. So why the cover on Time? It’s partly because photographs of breastfeeding women still – depressingly – provoke argument. As Jill Lepore writes, there’s a long history of banning magazines which print pictures of breastfeeding women:

Like its historical antecedents – a centrefold in a 1938 issue of Life called ‘The Birth of a Baby,’ and another, in 1965, called ‘The Drama of Life’ – it has gotten a great deal of attention. Sales have been brisk. Interest has been prurient. Outrage is all the rage.

Life’s ‘Birth of a Baby’ issue was banned all over the country (but not before selling seventeen million copies). Overnight, Gallup conducted a nationwide poll, asking: ‘In your opinion, do these pictures violate the law against publication of material which is obscene, filthy or indecent?’ (Twenty-four per cent of respondents said yes; seventy-six per cent no.) A generation later, the photographs on the 1965 cover, ‘The Drama of Life’ were shipped into outer space on board the Voyager (but not before selling eight million copies in four days). Each gave rise to criticism, some of it quite wonderful. The week after Life published ‘The Birth of a Baby,’ The New Yorker published a parody, called ‘The Birth of an Adult,’ written by EB White. ‘The Birth of an Adult is presented with no particular regard for good taste,’ White wrote. ‘The editors feel that adults are so rare, no question of taste is involved.’

‘Respectable’ news magazines often print photographs of women with semi-covered breasts. If these usually sexualised images of women are tolerated, why do pictures of breastfeeding women provoke such disgust? Given that the World Health Organisation and many governments advise mothers to breastfeed their babies exclusively for the first six months of life, it seems strange that breastfeeding women should be regarded as a kind of social embarrassment.

Indeed, Facebook’s decision to treat photographs of women breastfeeding as pornography, and women’s experiences of being forced out of public spaces when breastfeeding, seem to suggest that the issue is connected to how women’s bodies are understood socially.

Our bodies are socially and culturally constructed. As South Africa has seen over the past fortnight, the portrayal of the President’s penis in Brett Murray’s painting ‘The Spear’ has provoked outrage partly because it defies taboos around nudity in some South African communities and is seen as being part of a long history of white exploitation of black bodies.

Depictions of breastfeeding women are relatively common in art before the early twentieth century. These were meant to celebrate women as mothers – in a role which most believed celebrated women’s God-given and ‘natural’ role on earth. The photographs of lactating breasts in the Mothercraft Training Centre collection were intended for medical purposes – as were the pictures of breastfeeding mothers in mothercraft publications. I wonder if it’s possible to link the worldwide decline in breastfeeding during the 1940s and 1950s to the decreasing tolerance for the portrayal of breastfeeding women in popular publications? As breasts have become increasingly sexualised in advertising and the media, has this accompanied a discomfort with the idea that they can also be used to nourish and to nurture?

Although decades apart, there are similarities between the attitudes which informed mothercraft and those behind the Time cover: that women’s bodies are not their own to control. The Time cover suggests, firstly, that breastfeeding in public is not only worthy of comment, but also freakish – that it should be done within the secluded confines of the home. And, secondly, it implies that when women are in charge of raising their children, they behave irrationally: that they embrace ‘gurus’ and are ‘driven to extremes’. There is nothing on this cover to suggest that this mother chose – calmly and carefully – to feed and to care for her child in this way.

Milking It

This week the committee organising the 2012 Olympics in London caused widespread anger when it announced that breastfeeding mothers would have to buy an extra ticket to bring their babies into sports venues. Some venues have a few discounted tickets for children, but others don’t. One commentator posted on Mumsnet

that while she and her husband were lucky enough to get tickets to an equestrian event in August, organisers had told her there are no children’s tickets so she will have to pay £95 for a three-month old in a sling.

Those who can’t afford an extra ticket, or who lose out in the next round of ticket allocation, are advised to stay away. Unsurprisingly, Britain’s Equality and Human Rights Commission has suggested that this is potentially a case of ‘indirect sex discrimination’ because it will affect considerably more women than men.

This situation is ridiculous in so many ways. What angers me the most is that the Olympic committee took this decision in a country where the National Health Service advises that babies be breastfed exclusively for the first six months of life. The members of the committee seem either to think that women shouldn’t breastfeed in public – an irritating view about which I am going to be extraordinarily rude at some stage – or that mothers with babies have no desire to attend public events.

In the midst of the uproar, The Ecologist tweeted an article which it had published six years ago about the debate over whether women should breast- or bottle-feed their babies. It’s an argument that parents, doctors, and policy makers have been holding since at least the beginning of the twentieth century, and it’s to the credit of Pat Thomas that her piece provides a good overview of shifting attitudes towards infant feeding over the course of the past hundred years or so.

But it’s also a problematic piece of writing, and one which demonstrates particularly well why so many mothers feel bullied about how they decide to feed their babies. Thomas makes no attempt to hide her view that all mothers should breastfeed their children. She begins with a terrifying list of statistics:

The health consequences – twice the risk of dying in the first six weeks of life, five times the risk of gastroenteritis, twice the risk of developing eczema and diabetes and up to eight times the risk of developing lymphatic cancer – are staggering. With UK formula manufacturers spending around £20 per baby promoting this ‘baby junk food’, compared to the paltry 14 pence per baby the government spends promoting breastfeeding, can we ever hope to reverse the trend?

I’d love to know where she found these figures – particularly given her opening statement that women have breastfed for ‘nearly half a million years’. (How does she know this? Why the coy, qualifying ‘nearly’?) Thomas is, though, correct to point to the compelling evidence that breastfed babies tend to be healthier than those who are fed on formula, and that breastfed children may do better at school and have stronger immune systems. Also, there is a direct and proven link between the use of baby formula and high child mortality rates in the developing world.

She blames the slow decline of breastfeeding over the course of the twentieth century on the medicalization of childcare, and on the advertising strategies employed by formula companies – most notoriously Nestle. I have little to add to her second point, other that, broadly, I agree with her. The International Code of Marketing of Breastmilk Substitutes, a response to the Nestle Boycott of the late seventies, needs to be properly implemented. But her argument about the medicalization of women’s experiences of childbirth and childrearing is not entirely correct. She quotes Mary Renfrew from the Mother and Infant Research Unit at the University of York:

‘If you look at medical textbooks from the early part of the 20th century, you’ll find many quotes about making breastfeeding scientific and exact, and it’s out of these that you can see things beginning to fall apart.’ This falling apart, says Renfrew, is largely due to the fear and mistrust that science had of the natural process of breastfeeding.

In particular, the fact that a mother can put a baby on the breast and do something else while breastfeeding, and have the baby naturally come off the breast when it’s had enough, was seen as disorderly and inexact. The medical/scientific model replaced this natural situation with precise measurements – for instance, how many millilitres of milk a baby should ideally have at each sitting – which skewed the natural balance between mother and baby, and established bottlefeeding as a biological norm.

During the early years of twentieth century, global concern about high rates of child mortality animated a child welfare movement which aimed to improve the conditions in which children were raised. In Europe, North America, Australia, New Zealand, and parts of Africa and Latin America, medical professionals held up rational and scientific methods of feeding and caring for babies as the best means of eradicating the ‘ignorant’ practises which, many believed, caused babies to die. This new emphasis on hygiene, speedy medical intervention, and regular monitoring of babies’ development and health at clinics and hospitals did lower rates of morbidity – as did declining fertility rates, the control of infectious disease, economic prosperity, and increased attendance of school.

Doctors and specialists in the relatively new field of paediatrics were particularly interested in how babies were fed. Contrary to what Thomas suggests, the nineteenth-century orthodoxy that breastfeeding was the healthiest and best option for both mothers and babies lasted well into the 1940s. Innovations in artificial formulas provided mothers who couldn’t breastfeed – for whatever reason – with good alternatives, and doctors did recommend them. There were anxieties that malnourished mothers’ milk would not feed babies sufficiently, and doctors recommended ‘top ups’ with formula or other liquid.

The real difference between nineteenth- and twentieth-century attitudes towards breastfeeding was that it was increasingly controlled and patrolled by trained professionals. As Renfrew notes, mothers were told how much milk their babies needed at each feed, and there was a lot of debate in medical journals and in other professional forums about how and when babies should be fed.

The set of guidelines formulated by the incredibly influential, New Zealand-based Dr Truby King emphasised the importance of routine in feeding. King’s mothercraft movement – which established clinics and training centres around the British Empire during the first half of the twentieth century – taught mothers to feed ‘by the clock’. At five months, a baby was to be fed only five times per day – and at the same time every day – while one month-old babies had an extra, sixth feed.

Like many childcare professionals of the period, King believed that feeding on demand was not only unhealthy – it placed babies at risk of under- or overfeeding – but it was morally and intellectually damaging too. Babies who understood that crying would cause them to be fed would become spoilt, lazy children and adults. Indeed, this points to the infant welfare movement’s more general preoccupation with mothers and motherhood. As the interests of the state were seen, increasingly, as being linked to the proper rearing and education of children, the role of the mother grew in importance. King called his centres ‘shrines to motherhood’, for instance.

But the naturally fussy, over-cautious, and credulous mother was not to be trusted to follow her own instincts: authorities and professionals, who tended to be male, were to provide her with rational, scientific advice on raising her baby. It’s difficult to gauge mothers’ response to the information aimed at them. In her study of mothers in the United States in the 1920s and 1930s, Julia Grant concludes that mothers did heed childcare professionals, but modified their advice according to the views and experiences of their peers. Similarly, mothers in New Zealand took what they wanted from King’s pamphlets on childrearing.

Equally, mothercraft clinics and breastfeeding advice days were well attended by mothers and babies. Several mothercraft centres all over the world also included a dietetic wing, where nursing mothers could stay for up to a fortnight, learning how to breastfeed their babies. There, they would be taught how to breastfeed by the clock, and how to cope with mastitis and painful breasts and nipples. Wonderfully, hospital fees were means tested, so poor mothers could attend for free.

Throughout its existence, the Cape Town dietetic hospital never had an empty waiting list, and similar units in Britain, Australia, and New Zealand were as enthusiastically supported by women. Mothercraft seems to have been at its most successful when mothers could choose how and when they wanted to its advice and services.

While it’s true that the medicalization of breastfeeding transformed this act into a ‘science’ which needed to be re-taught to mothers – that it became possible to inform a mother that she was breastfeeding incorrectly – and that this was underpinned by misogynistic and eugenicist ideas around childhood, motherhood, and the nation, it is as true that mothers did respond positively to the advice provided by mothercraft and other organisations. Clearly, mothers wanted more advice about how to feed their babies – and that they altered it to suit their conditions and needs.

It’s for this reason that I think that Thomas is doing mothers a disservice. Encouraging more women to breastfeed needs to respect the fact that women’s choices about how to feed their babies are influenced by a variety of factors and considerations. Thomas – and other breastfeeding evangelicals – seems to buy into the same discourse of maternal irresponsibility as childcare professionals did in the early twentieth century: the belief that women somehow don’t really understand what’s best for their babies, and must be properly educated. Even if her – and others’ – motives are progressive and well-meaning, they still fail to take mothers seriously.

Posts tagged ‘paediatrics’

Children’s Food

Breast is Best?

Milking It

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