will certainly not
learn this particular action. But the fault as a rule lies deeper. The
child who cannot feed himself cannot be taught until fingers and brain
have been developed in the thousand activities of his daily routine,
by which he acquires general dexterity. A child who is still too young
to feed himself is learning the dexterity which is necessary as a
preliminary in every action of the day. If he can carry the tablecloth
and the cups and saucers to the tea-table, imitating in everything the
action of his nurse, it will be strange if he does not also imitate
her in the central scene, the actual eating of the food. If, on the
other hand, he is waited upon hand and foot, if he is restrained and
confined, sitting too much passively, now in his perambulator, now in
his high chair, now on his nurse's lap, his imitative faculties and
his tactile dexterity alike remain undeveloped. The child who is slow
in learning to feed himself shows his backward development in every
movement of his body. One may note especially the stiff,
"expressionless" hands, indicating a general neuro-muscular defect. I
have seen many children of eighteen months or two years of age in whom
the movements necessary for efficient mastication and swallowing had
failed to develop satisfactorily. In some a pure sucking movement
persisted, so that when, for example, a morsel of bread or rusk was
put in the child's mouth, it would be held there for many minutes and
submitted only to suction with cheeks and tongue. Attempts to swallow
in such a case are so incoordinate that they give rise frequently to
violent fits of choking, which distress the child and produce
resistance and struggling, while at the same time they alarm the
mother or nurse so much that further attempts to encourage the taking
of solid food are hastily and for a long time abandoned. In this
helpless condition the other factors which tend to develop what we
have called negativism have full play. The want of imitation and the
lack of dexterity is not the sole or perhaps the main cause of the
child's refusal of food and of the apparent want of appetite, but it
is the cause of the failure to learn to feed himself, which places
him in a condition which is peculiarly favourable to the operation of
other factors. If only we can teach the child to feed himself, the
difficulties of the situation become much less formidable.

The first of the factors which encourage the persistent refusal