The Care and Feeding of Children Part 11

_Which of the farinaceous foods are to be preferred?_

Those most used are barley, oatmeal, arrowroot, and farina. There is not much difference in their nutritive value; oatmeal gruel is somewhat more laxative.

_What value do these substances possess as infant foods?_

Some of the starch is digested and absorbed; but the chief value of gruels is believed to be that when added to milk they render the curd more easily digested by preventing it from coagulating in the stomach in large tough ma.s.ses. This is certainly true with many infants, but there are others who are not at all benefited, and not a few young infants whose digestion is made distinctly worse by the use of farinaceous food, particularly when employed in considerable quant.i.ty.

The addition of gruels to milk for all infants is not to be recommended.

_What further additions may be made to the diet of healthy infants during the first year?_

Beef juice, the white of egg, and orange juice.

_How and when may beef juice be used?_

With infants who are strong and thriving satisfactorily it may be begun at ten or eleven months; two teaspoonfuls may be given daily, diluted with the same quant.i.ty of water, fifteen minutes before the midday feeding; in two weeks the quant.i.ty may be doubled; and in four weeks six teaspoonfuls may be given. The maximum quant.i.ty at one year should not be more than two or three tablespoonfuls.

With delicate infants who are pale and anaemic, beef juice is more important, and it may often be wisely begun at five or six months in half the quant.i.ties mentioned.

_When should white of egg be used?_

Under the same conditions as beef juice, particularly with infants who have difficulty in digesting the proteins (curd) of milk. At six months half the white of one egg may be given at one time, and soon after this the entire white of one egg. The best in manner of cooking is the "coddled", egg (see page 151).

_When should orange juice be begun?_

Usually about the eleventh or twelfth month; it should be given about one hour before the feeding; two teaspoonfuls at first, then one tablespoonful at a time, and later three or four tablespoonfuls. It is particularly useful when there is constipation. It should always be strained, and care should be taken that it is sweet and fresh.

OVERFEEDING

_What is meant by overfeeding?_

Giving an infant too much food; either too much at one time or too frequently. Overfeeding is sometimes practised during the day, but is chiefly done at night.

_Is not an infant's natural desire for food a proper guide as to the quant.i.ty given?_

The appet.i.te of a perfectly normal infant usually is; but overeating is a habit gradually acquired and may continue until twice as much food as is proper is taken in the twenty-four hours. This habit is most frequently seen in infants whose digestion is not quite normal; because of the temporary relief from discomfort experienced by taking food into the stomach, they often appear to be hungry the greater part of the time, especially at night.

_What are the causes of overfeeding?_

The most common one is the habit of watching the weight too closely, and the conviction on the part of the mother or nurse that because a child is not so large nor gaining so rapidly as some other infant of the same age, more food or stronger food should be given.

_What harm results from overfeeding?_

All food taken in excess of what a child can digest becomes a burden to him. The food lies in the stomach or bowels undigested, ferments, and causes wind and colic. When overfeeding is longer continued, serious disturbances of digestion are soon produced. The infant is restless, fretful, constantly uncomfortable, sleeps badly, and stops gaining and may even lose in weight. Such symptoms may lead to the mistaken conclusion that too little food is given, and it is accordingly increased, when it should be diminished. One of the results of long-continued overfeeding is dilatation or stretching of the stomach.

_What should guide one as to the quant.i.ty of food to be given to any infant??_

(1) The size of the infant's stomach at the different months; (2) the amount of milk which the healthy nursing infant gets; (3) the quant.i.ties with which most children do best. The table of quant.i.ties and intervals of feeding, on page 108, gives the average figures derived from these sources. It is seldom wise to go beyond the limits there stated; nor should one insist upon giving any fixed amount if it is clearly more than the child wants or can be made to take except by continued coaxing.

LOSS OF APPEt.i.tE

_What is to be done when without any other signs of illness a child's appet.i.te gradually fails?_

This is often the result of a long period of overfeeding or the use of milk too rich in fat. If in all other respects the child seems well and simply does not want his food, it should be offered at regular hours, but not more frequently; on no account should he be coaxed, much less forced, to eat, even though he takes only one half or one third the usual quant.i.ty. The intervals between feedings should not be shortened but rather lengthened. Often, with a child a year old, it is necessary to reduce the number of feedings to four or even three in twenty-four hours. Water, however, may be offered at more frequent intervals. The food should be weakened rather than strengthened. No greater mistake can be made than, because so little is taken, coaxing or forcing food at short intervals through fear lest the child may lose weight.

THE CHANGES IN THE FOOD REQUIRED BY SPECIAL SYMPTOMS OR CONDITIONS

Infants with weak digestion and those suffering from various forms of indigestion have often especial trouble in digesting the fat of milk.

To meet the needs of such there is required a series of formulas in which the fat is lower than in those already given.

These formulas are obtained from plain milk.

_Fourth Series_

_Formulas from Plain Milk (containing 4-per-cent Fat)_

--------------------------------------------------------- I. II. III. IV. V. VI. VII. VIII.

Plain milk 5oz. 6oz. 7oz. 8oz. 9oz. 10oz 12oz. 14oz.

Milk sugar 1 " 1 " 1 " 1 " 3/4 " 3/4 " 1/2 " 1/2 "

Lime-water. 1 " 1 " 1 " 1 " 1 " 1 " 1 " 1 "

Boiled water 14 " 13 " 12 " 7 " 6 " 5 " 2 " 0 "

Barley gruel 0 " 0 " 0 " 4 " 4 " 4 " 5 " 5 "

--------------------------------------------------------- 20 20 20 20 20 20 20 20 oz. oz. oz. oz. oz. oz. oz. oz.

When larger quant.i.ties than 20 ounces are required they are calculated in the same manner as described on page 73 in speaking of 10-per-cent milk.

The approximate composition of the formulas of the Fourth Series expressed in percentages is as follows:

---------------------------------------- FORMULA. Fat. Sugar. Proteids.

---------------------------------------- I. 1.00 6.00 0.90 II. 1.20 6.00 1.00 III. 1.40 6.50 1.20 IV. 1.60 6.50 1.40 V. 1.80 6.00 1.60 VI. 2.00 6.00 1.80 VII. 2.40 5.50 2.10 VIII. 2.80 5.50 2.50 ----------------------------------------

_Why is it that an infant so often vomits some of its food within a few moments after finis.h.i.+ng its bottle?_

Usually because the quant.i.ty is too large. Sometimes it is due to the fact that the food is taken too rapidly, from too large a hole in the nipple. It may be due to too tight clothing, or to moving the child about in such a way as to press upon the stomach.

_What are the princ.i.p.al causes of, and the changes in the food required by habitual vomiting, regurgitation, or spitting up of small quant.i.ties of food between feedings, often repeated many times a day?_

This is always a symptom of gastric indigestion, and a most troublesome one. In such conditions the fat and often the sugar also should be reduced and the lime-water increased.

Formulas made from rich top-milk or milk and cream are to be avoided.

Those made from 7-per-cent milk are less likely to be the cause of trouble than those from 10-per-cent milk; but if the symptoms are at all severe it is better to use instead of these the formulas of the Fourth Series derived from plain milk.

Reduction in the sugar may be made by adding only one half ounce of milk sugar to each twenty ounces of the food; in severe cases the sugar may be omitted altogether.