The Care and Feeding of Children - L. Emmett Holt (chrysanthemum read aloud .TXT) 📗

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 quantity?

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 quantity 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 appetite is not always a safe guide to follow.

How can one know whether the strength or the quantity 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 quantity, then the strength again, etc. After the fourth or fifth month, the quantity, 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 appetite 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 circumstances, 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 passes 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 circumstances 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 quantity 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 quantity 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 pass 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 circumstances; 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 circumstances from one sixth to one half the total quantity of food.

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 masses. 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 quantity. 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 quantity of water, fifteen minutes before the midday feeding; in two weeks the quantity may be doubled; and in four weeks six teaspoonfuls may be given. The maximum quantity at one year should not be more than two or three tablespoonfuls.

With delicate infants who are pale and anæmic, beef juice is more important, and it may often be wisely begun at five or six months in half the quantities 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 quantity given?

The appetite 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 quantity 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 quantities with which most children do best. The table of quantities 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 APPETITE

What is to be done when without any other signs of illness a child's appetite 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