Views & Reviews Medical Classics

The Normal Child

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2436 (Published 11 April 2012) Cite this as: BMJ 2012;344:e2436
  1. Ian Johnston, specialty doctor in community paediatrics, Croydon Health Services NHS Trust, Croydon CR9 2RS
  1. ibj1{at}btinternet.com

Variation in humanity is so great that it is sometimes challenging to tell the normal from the pathological. This distinction is critical in paediatrics, where variation in children’s growth, physical appearance, behaviour, and emotional development can be enormous without amounting to disease. Recognition of the normal child is an acquired skill; one that is fraught with the dangers of overinvestigation and of the failure to reassure parents. Ronald Illingworth’s The Normal Child, a landmark in the paediatric literature, saved countless doctors—specialist and non-specialist—from the perils of misdiagnosing normality in children.

Illingworth, who was professor of child health at Sheffield University, published the book in 1953. His central thesis was that a thorough knowledge of the normal is an essential basis for knowledge of the abnormal. Lack of knowledge of the normal, he felt, was harmful to the child, parents, and family. As a concept it is still valid today, with much medical teaching emphasising disease and illness rather than health. His literary style was clear and simple and tinged with a forthrightness and sense of humour that came from a lifetime’s experience. The child was ever foremost in his thoughts. He instinctively understood the anxiety that parents experience when their worries are unanswered, or unnecessary worry is created by failing to recognise the normal.

Illingworth’s delivery can be wryly tongue in cheek: “Most undescended testes are due to cold hands.” But this is invariably followed by the practical: “It is said that the most satisfactory way of examining the testes is with the boy squatting, with the knees apart and the hands on the knees for support.” His pictures of behavioural conditions are models of clarity and precision. The description of a ruminating baby is typical of his style: “The baby hollows his tongue, clamps the jaws, strains, arches the back with the mouth open and holds the head back. He contracts the abdominal muscles and may make sucking movements of the tongue, bringing milk up.” With sharp observation it culminates: “He shows satisfaction at his achievement, obviously enjoying it.” Illingworth had an eye for detail.

His advice is ever simple and to the point. On circumcision, a controversy of the time, he says, “The child is the only one who matters in this regard. If there is no particular reason from his point of view for doing the operation, it is unjustified.” He was a counterweight to his contemporary Benjamin Spock, whose populist opinion he quotes only to dismiss.

The 10th and final edition was written when Illingworth was 81, and was published posthumously. His highly personal style failed to survive the advent of evidence based medicine. The Normal Child, however, stands as a monograph written by a master paediatrician of great humanity that contains timeless descriptions of infant and childhood behaviour and conditions. Today’s evidence based paediatric literature might have succeeded Illingworth’s book, but it will never replace it.

Notes

Cite this as: BMJ 2012;344:e2436

Footnotes

  • The Normal Child

  • A book by Ronald S Illingworth

  • First published 1953

  • Competing interests: None declared.

  • Provenance and peer review: Not commissioned; not externally peer reviewed.

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