The Care and Feeding of Children Part 10

_In pa.s.sing from Formula V of the First Series to Formula I of the Third Series the proportion of fat is at first reduced. Is this necessary or important?_

No; it only happens to come so in simplifying the calculation. It may be avoided by taking off at first the upper 13 ounces as top-milk and using 7 ounces of this in a 20-ounce mixture, in place of Formula I; and by using for the next increase the upper 15 ounces as top-milk, taking of this 8 ounces in a 20-ounce mixture in place of Formula II.

Then should follow Formula III.

_What further addition may be made to the food of the later months?_

Usually about the sixth or seventh month, farinaceous food in the form of gruel may be added, this taking the place of part of the water and part of the sugar.

_What changes may be made in the food when the infant has reached the age of ten or eleven months?_

The proteids may be still further increased, and the sugar and the lime-water reduced until plain milk is given.

_How may this best be done?_

At first one feeding a day of plain milk and barley gruel may be given; later, two feedings; then three feedings, etc. Let us suppose an infant to be taking such a modified milk as Formula IV or V (page 76), six feedings a day. The plain milk diluted only with barley gruel would at first replace one of these feedings; then two, three, four, etc., these changes being made at intervals of about two weeks. The proportions of the milk and barley gruel should at first be about 5-1/2 ounces milk, 2-1/2 ounces barley; later, 6 ounces milk, 3 ounces barley; still later, 7 ounces milk, 2 ounces barley, until finally plain milk is given to drink and the cereals given separately with a spoon. This is reached with most infants at fourteen or fifteen months; with many at twelve or thirteen months. Other forms of farinaceous food may of course be used in the place of the barley, and in the same proportions.

With some infants the addition of a pinch of bicarbonate of soda may be advantageously made to each milk-feeding when the lime-water is omitted, but with most this is unnecessary.

If the infant strongly objects to the taste of the milk when the milk sugar has been omitted, a small quant.i.ty (one fourth to one half teaspoonful) of granulated sugar may for a time be added to each feeding, then gradually reduced.

GENERAL RULES FOR GUIDANCE IN THE USE OF THE FORMULAS GIVEN

It should again be emphasized that these formulas are not intended for sick children nor for those suffering from any marked symptoms of indigestion. For such infants special rules are given later.

_What should be the guide in deciding upon a formula with which to begin for a child who is to be artificially fed?_

The age and the weight are of some importance, but the best guide is the condition of the child's digestive organs. One should always begin with a weak formula, particularly, (1) with an infant previously breast fed; (2) with one just weaned, as a child who has never had cow's milk must at first have weaker proportions than the age and the weight would seem to indicate; (3) with infants whose power of digestion is unknown. If the first formula tried is weaker than the child can digest, the food can be strengthened every three or four days until it is found what the child is able to take. On the contrary, if the food is made too strong at first, an attack of indigestion will probably follow.

_How should the food be increased in strength?_

The first essential is that it be done very gradually; abruptly increasing the food usually causes a disturbance of digestion.

It is never wise to advance more rapidly in strengthening the food than from one formula to the next one in any of the series given; with many infants it is better to make the steps of increase only half as great as those indicated (page 72).

_How rapidly should the food be increased in quant.i.ty?_

The increase should not be more than a quarter of an ounce in each feeding; or from one and a half to two ounces in a day.

_When should the food be increased?_

In the early weeks an increase may be necessary every few days; in the later months sometimes the same formula may be continued for two or three months. It is, however, impossible to give a definite rule as to time. One cannot say with any child that an increase is to be made every week or every two weeks. A much better guide are the conditions present.

The signs indicating that the food should be increased are, that the infant is not satisfied, not gaining in weight, but is digesting well, i.e., not vomiting, and having good stools. One should not increase the food, however, so long as the child seems perfectly satisfied and is gaining from four to six ounces a week, even though both the quant.i.ty and the strength of the food are considerably below the average; nor should the food be increased if the child is gaining from eight to ten ounces a week, even if he seems somewhat hungry. The appet.i.te is not always a safe guide to follow.

_How can one know whether the strength or the quant.i.ty of the food should be increased?_

In the early weeks it is well first to increase the strength of the food, the next time to increase the quant.i.ty, then the strength again, etc. After the fourth or fifth month, the quant.i.ty, chiefly, should be increased.

_If a slight disturbance or discomfort occurs after the food has been strengthened, is it best to go back to the weaker formula or to persist with the new one?_

Symptoms of minor discomfort are seen for a day or two with many infants after an ordinary increase in food; but in most cases an infant soon becomes accustomed to the stronger food and is able to digest it. If, however, the symptoms of disturbance are marked, one should promptly go back to the weaker formula. The next increase should be a smaller one.

_Should one be disturbed if for the first two or three weeks of artificial feeding the gain in weight is very slight or even if there is none?_

Not as a rule. If the infant does not lose weight, is perfectly comfortable, sleeps most of the time, and does not suffer from any symptoms of indigestion, such as colic, vomiting, etc., one may be sure that all is going well and that the infant is becoming used to his new food. As the child's appet.i.te improves and his digestion is stronger, the food may be increased every few days and very soon the gain in weight will come and will then be continuous. If, however, the scales are watched too closely and, because there is only a slight gain in weight or none at all, the food is rapidly increased, an acute disturbance of digestion is pretty certain to follow.

_Is not constipation likely to occur if the child is on a very weak food?_

It is very often seen and is due simply to the small amount of residue in the intestine. Under these circ.u.mstances, if the bowels move once every day, one should not be disturbed even when the movements are small and somewhat dry. As the food is gradually strengthened, this constipation soon pa.s.ses off; while if injections, suppositories, or cathartics are used to produce freer movements, the functions of the bowels are likely to be disturbed.

_Under what circ.u.mstances should the food be reduced?_

Whenever the child becomes ill from any cause whatever, or whenever any marked symptoms of indigestion arise.

_How may this be done?_

If the disturbance is only a moderate one and the food has been made up for the day, one third may be poured off from the top of each bottle just before it is given, and this quant.i.ty of food replaced by the same amount of boiled water.

If the disturbance is more severe, the food should be immediately diluted by at least one half and at the same time the quant.i.ty given should be reduced.

For a severe acute attack of indigestion the regular food should be omitted altogether and only water given until the doctor has been called.

_If the food has been reduced for a disturbance of digestion, how should one return to the original formula?_

While the reduction of the food should be immediate and considerable, the increase should be very gradual. After a serious attack of acute indigestion, when beginning with milk again, it should not be made more than one fifth the original strength, and from ten days to two weeks should pa.s.s before the child is brought back to his original food, which should be done very gradually. It is surprising how long a time is required with young infants before they completely recover from an attack of acute indigestion, even though it did not seem to be very severe. The second disturbance always comes from a slighter cause than the first one.

THE ADDITION OF OTHER FOODS TO MILK

_How long should modified milk be continued without the addition of other food?_

This depends upon circ.u.mstances; usually, for about six months; but if the infant is thriving satisfactorily the milk may be used alone for ten or eleven months; with some infants who have especial difficulty in digesting cow's milk, it is advisable to begin the use of other food at three or four months or even from the outset.

_What is the first thing to be used with milk?_

Farinaceous food in some form, usually as a gruel.

_How are these gruels made?_

They may be made directly from the grains or from some of the prepared flours (page 149). The flours are usually to be preferred as being more simple of preparation.

_How should they be used in making the food?_

They should be cooked separately, rather than with the milk; when the food is mixed, they take the place of a portion of the water in the formulas given on pages 70 and 71.

_How much of the gruel should be used?_

If it is prepared as recommended on page 149, it may make according to circ.u.mstances from one sixth to one half the total quant.i.ty of food.