A Country Doctor Reads: January 13, 2019

The Making of the Picky Eater – The Wall Street Journal

Picky eaters are said to be a newish phenomenon among children. An article in The Wall Street Journal gives some interesting history, from children being fed scraps to medically suggested bland diets to letting children eat whatever they wanted:

Doc­tors scram­bled to find so­lu­tions. One of the most widely noted re­sponses came from the Cana­dian pe­di­a­tri­cian Clara Davis, who con­ducted a se­ries of ex­per­i-ments in the 1920s and ’30s to see what would hap­pen if small chil­dren, in­clud­ing ba­bies, were al­lowed to pick their own foods. For her study, Davis was able to round up 15 in­fants from in­di­gent teenage moms or wid­ows and su­per­vise all of their eat­ing for pe­ri­ods rang­ing from six months to 4½ years, ac­cord­ing to ar­ti­cles she pub­lished in 1928 and 1939 in the Cana­dian Med­ical As­so­ci­a­tion Jour­nal and a 2006 re-ex­am­i­na­tion of her work in the same pub­li­ca­tion.

The chil­dren were al­lowed to choose among 34 items, in­clud­ing milk, fruit, veg­eta­bles, whole grains and beef, both raw and cooked. They made some rather ec­cen­tric choices, in­clud­ing fist­fuls of salt, and most were ap­par­ently fond of brains and bone mar­row. Some-times they ate lit­tle, and some­times more than an adult (no­tably, six hard-boiled eggs on top of a full meal, or five ba­nanas in a sin­gle sit­ting). The tiny sub­jects var­ied widely in their self-cho­sen menus, but the idio­syn­crasies evened out over time, and each child, Davis re­ported, ended up eat­ing a bal­anced and com­plete diet.

Sickly and scrawny at the start of the study, they be­came healthy and well-nour­ished, she wrote, sup­port­ing a con­cept that was be­com­ing known at the time as body wis­dom. “For every diet dif­fered from every other diet, fif­teen dif­fer­ent pat­terns of taste be­ing pre­sented, and not one diet was the pre­dom­i­nantly ce­real and milk diet with smaller sup­ple­ments of fruit, eggs and meat that is com­monly thought proper for this age,” she wrote. “They achieved the goal, but by widely var­i­ous means, as Heaven may pre­sum­ably be reached by dif­fer­ent roads.”

https://www.wsj.com/articles/the-making-of-the-picky-eater-11547222243?emailToken=80100119fadefc742677f724403aa150cbvUY9r2u42phXe/xLqWogESDE2LVV9s63YhE1cBAjC76RZ3aiqGOnAdmPVYJfP2d8RZyN8IAkeUG6dOlgjOuw%3D%3D&reflink=article_email_share

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1626509/

The Grace of Denial – The New England Journal of Medicine

This week’s “Perspective” essay is by a physician who has sympathy for patients and families who fail to accept a terrible disease diagnosis until well after it should have been obvious. Dr. Heather Sher insisted and believed her father had Lyme Disease instead of Amyotrophic Lateral Sclerosis.

So yes, I am familiar with denial. When I see patients who cannot face the prospect of a terrible diagnosis, I understand their delay, their reluctance, their trepidation on a deep level — a level that perhaps only someone who has witnessed a loved one’s slow demise from a terminal illness can appreciate. In the face of a diagnosis for which there is no effective treatment and no cure, our denial allowed my family 6 months of relative peace before things became unbearable. We had a few extra months with my father without the constant awareness that his death was imminent. My medical inexperience, clouded clinical judgment, and desperate desire for more time with my dad extended our denial of medical reality for longer than is typical.

Today, when I hear detached descriptions of patients who’ve waited too long to address a devastating illness, I understand. “Denial helps us to pace our feelings of grief,” Elisabeth Kübler-Ross explained. “There is a grace in denial. It is nature’s way of letting in only as much as we can handle.”

https://www.nejm.org/doi/full/10.1056/NEJMp1810685

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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