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Perspective on the paper by Lucas et al(see 120)
It has long been known that poor growth in infancy is associated with high morbidity and mortality in childhood. The earliest systematic records of infant mortality collated by the registrar general ascribed “debility” and “atrophy” as the principal causes of death in early life and the knowledge that undernourished babies were likely to grow up into fragile adults was one of the driving forces behind the provision of public welfare services for mothers and children.1 So great was the concern for the future of the newborn that a parliamentary commission surveyed the physical status of babies and school children across Great Britain in the early years of the past century.2 Growth charts, essential tools for such surveys, had been pioneered in clinics aimed at detecting and managing babies and children who failed to thrive,3 largely as a consequence of infectious diseases and poor feeding. Their widespread use was crucial to the success of public child health initiatives, which served to highlight the connection between domestic and social conditions, including parenting and child health.
Although there remains a strong correlation between poverty and short stature, the fortunes of children are now immeasurably better than they were a hundred years ago. Nevertheless, growth is still used routinely to assess child health and development, and parents inevitably still attach great importance to it. Lucas et al4 in their systematic review of lay perceptions about infant size and growth, found that parents emphasise the importance of normality in growth. However, judging from the selected quotations presented, parents also strongly link quality of parenting and sufficiency of nutrition to growth, and experience great anxiety and a sense of diminished worth …