In early childhood the difficulty of the refusal of food often passes or diminishes when the child learns to feed himself with precision and certainty.  To teach him to do so, it is not wise to devote all our attention to making him adept at this particular task.  The fault is that the brain centres which control the movements of hands, mouth, and tongue have not been developed, because his activities in all directions have not been encouraged.  It is much less trouble for a nurse to feed a little child than to teach him to feed himself, and if he is not given daily opportunities of practice he 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.