To see the twins, Jimmy and Wayne Grant, together — on one of our home visits — is to understand something of what the paediatric term ‘failure to thrive’ means. Jimmy is a chubby, rose-cheeked boisterous two-year old. He appears to be a happy, mischievous boy, running, playing, talking and laughing. He comes to his mother for help and comfort and cuddles up to her spontaneously. He responds readily to her attention and affection. She smiles at him, picks him up, sits him on her lap, plays with him, answers his questions, watches his movements, warns him when he is in danger.

On the edge of the room, like a stranger, stands Wayne — posture rigid, staring fixedly at us. He isasad, lethargic looking child, very small and extremely thin. His pale face throws into relief the dark shadows under his eyes. He remains in one spot, as if at attention; by now he is gazing unswervingly at his mother. She takes no notice of him. When asked to call Wayne over to her she looks in his direction; as she does so her face hardens and her eyes are angry. She addresses him with a dry command; when he hestitates she shouts at him.