Environmental stress and the underprivileged child

Clinical examination of 123 ex‐patients who had been admitted to hospital with kwashiorkor ten years earlier revealed that approximately half had reached normal Boston percentiles for weight and height. Those most undersized at the outset remained so thereafter. There was no significant difference between ex‐patients and sibling controls in anthropometric measurements or biochemical findings. Growth attainment correlated with a Multiple Social Score. Intellectual assessment showed no significant difference in Full Scale Intelligence Score between ex‐patients and controls. Late onset ex‐patients and controls, however, had lower scores than their counterparts of early onset. In certain sub‐tests, moreover, the late onset ex‐patients performed less well than their own controls, suggesting emotional interference and failure to concentrate. A concept is formulated of kwashiorkor as only one of the manifestations of the stress which a disturbed ecology projects on children in developing countries. It will not, therefore, be eradicated by the provision of food supplements.