Providing for the Child in Health and in Crisis1 (1962)

The subject is a wide one. I propose therefore to select certain features that can be stated easily and that can be put forward as significant, noting in particular those aspects of this general question that belong to the present age.

1. When we think of providing for health we nowadays think in terms of mental health. It is the emotional development of the child that concerns us, and the laying down of the foundations of a lifetime of mental health. The reason for this is that in paediatrics the developments on the physical side have been so great that we know where we are. There is bodily development that takes place, given good heredity, as a result of good food and good physical conditions. We understand the meaning of the words ‘good food’, and deficiency diseases are now rare. Also, when starvation or poor housing conditions are a feature, we have a social conscience, and we know what to do. In Great Britain this has crystallized out into the welfare state, which with all its drawbacks and the new problems it creates makes us rather pleased as well as annoyed when we pay heavy taxes.

In considering this subject, then, let us take it for granted either that the children we refer to are as healthy physically as modern physical prophylaxis and therapy can ensure; or else that any physical disease that is present is under paediatric control, and that our aim is to study the mental health of the child with that illness. For simplicity's sake we start with the mental health of the physically healthy child.

Of course, if a child suffers from anorexia nervosa the starvation that results is not to be attributed to physical neglect. If there is a so-called ‘problem family’, then it is not the local authority that can be wholly blamed for the slum conditions in which a child is being brought up. Physical care is affected by the child's or the parents' ability to receive care, and we see that all around the edge of the area that we call physical care there is