Foreword

I treasure my copy of the 7th edition of Nelson’s Textbook of Pediatrics (1959), not least because the index contains the following entry on page 1419: “Birds, for the, pp 1 to 1413”. Pages 1 to 1413 is the entire book up to the index! This entry apparently was inserted by Dr. Nelson’s daughter, who did the indexing for this volume, and it appears only in the first printing of this edition. However, I also treasure the 7th edition because reading it reminds me of how far pediatrics has come in the last half-century. Infant feeding gets 20 pages of attention in 1959, the 3rd paragraph of which begins with these words: “The majority of feeding difficulties of the first few years of life are the result of abnormal and unpleasant child-parent relationships, most of which are avoidable.”1 Nearly all of the chapter that follows is devoted to a discussion of breast and formula feeding and suggestions for transitioning to solid foods; with only 3 pages devoted to feeding problems (which include constipation and diarrhea) and no information at all on feeding premature infants and infants with special needs.

My, how times have changed, at least in the world of infant feeding. Much of the change has been driven by increased survival of low birth weight infants and infants with complex congenital abnormalities. In 1959, mortality for infants born at less than 1000 g was around 90%; now, nearly 90% of these infants survive. Statistics are similar for infants with complex congenital disorders. Greater survival of fragile children has led to a far higher incidence of feeding disorders. A quick internet search resulted in nearly 1000 hits for “feeding teams” in children’s hospitals—I will hazard a guess that even if Google had been available in 1959, there would have been no infant feeding teams to be found.

In this issue of Current Problems in Pediatric and Adolescent Health Care, John Udall and his colleagues provide a series of discussions of the many issues around feeding difficulties in infants, starting by describing the development and physiology of infant feeding. This is followed by practical information on the behavioral management of feeding disorders, and ending with a discussion of feeding issues in the disabled child. The information here will be useful to both generalists and specialists, and will help us to competently identify and manage feeding problems, and to refer the right patients to all of those feeding teams!