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JAMA 100 Years Ago
November 19, 2008


JAMA. 2008;300(19):2317. doi:10.1001/jama.2008.579

Considerable discussion—not a little thing being sensational—has appeared recently in the newspapers on the question of underfed school children, mainly aroused by the reports of sanitary inspectors that large numbers go breakfastless to school. The first remedy that occurs to many zealous social reformers is to supply free meals, the assumption being that the conditions are due to poverty. Without doubt, in a great city, there are always some children who go hungry to school, on account of actual lack of food; in this country, however, we believe they are few and far between. Such should be cared for by the proper charitable agencies, and not through the school. Looking at the subject from a purely medical point of view, poverty is not the cause in more than an extremely small minority of the cases of those who go breakfastless. Every physician is aware of the capricious morning appetites of children who are physically below grade from any one of numerous causes, and this is especially likely to be the case with those living in the urban slums and crowded tenement districts. Any dispensary physician or visiting nurse will testify to this fact. In a recently issued edition of a work on the British poor,1 the author says that a large proportion of the children, if asked why they had no breakfast, would say it was because they did not want it, or often, in case of the younger children, because their mothers could not make them take any. The cause in many cases lies further back than the mere lack of food, which is often plentiful enough; it is generally the unhygienic customs and conditions of the poorer classes that are the real cause. It is not in the poor alone, moreover, that we observe these irregular appetites; they are common enough in the children of the comparatively well-to-do, but the condition appears in a more aggravated form in a bad hygienic environment. The practices of giving children stimulants, such as strong coffee and tea, the heavy evening meals and meals at irregular hours, sleeping in crowded ill-ventilated rooms, etc., are all active factors in producing capricious appetites, and they should all be taken into account when seeking a remedy. There would be little use in spending public money for free meals for children who did not want to eat in the early morning.