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Paediatric nutrition as a new subspecialty: is the time right?
  1. MRC Childhood Nutrition Research Centre
  2. Institute of Child Health
  3. 30 Guilford Street
  4. London WC1N 1EH

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    Scientific interest in nutrition in early life preceded the formal development of paediatrics. Building on biochemical studies of the 18th century,1 Franz Simon underpinned a rational, scientific basis for infant feeding with his landmark work in 1838,2 when the word ‘paediatrics’ had not even entered the English language.3 This was 20 years before the first chair of paediatrics in the US and a century before paediatric chairs were created in Britain (1930s). By then, the field of paediatric nutrition had already passed many major milestones,4 for instance the scientific understanding that led to prevention and treatment of infantile scurvy and rickets.5 6 In 1940 the editors of Holt’s Diseases of Infancy and Childhood (11th edition) stated ‘Nutrition in its broadest sense is the most important branch of paediatrics’.7 Given the extraordinary scientific effort and interest over the past two centuries, it is paradoxical that nutrition has never emerged as an independent paediatric specialty, when other areas of much more recent focus have done so.

    Why should this be so? Firstly, the intensive interest in nutrition largely solved the earlier concerns. With the exception of iron deficiency anaemia, primary nutritional deficiency diseases are now uncommon in the West. Secondly, other specialties have evolved partly from the need to master specialised techniques (for example cardiac catheterisation); yet, until recently there have been few such techniques in clinical nutrition. Thirdly, medical specialties have been based traditionally on organ systems, a categorisation into which a broad, multidisciplinary subject like nutrition does not fit. Consequently, nutrition has been fragmented and subsumed piecemeal into other fields—enteral nutrition into gastroenterology, intravenous feeding into surgery, growth into endocrinology and so forth.

    However, there has now been a significant shift in thinking about nutrition from a preoccupation with meeting nutrient needs to a …

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