The Parents' Review

A Monthly Magazine of Home-Training and Culture

Feeding of Children.

(Continued from page 805.)

[Dr Charles Graham Havell, M.D. (1858-1941) practised in Felixstowe, Suffolk. He married Cicely May Ridpath in 1892. His only child, the artist Joyce Havell, was about 9 years old when this article was written.]

From eighteen months to two years, the child is gradually completing his first outfit of teeth, a sure indication from Nature that more liberty can be taken with his food. There are few more important lessons to be learnt than that of the unwisdom of not allowing the gradually developing digestive organs the fullest exercise of their growing power consistent with safety. The sweet simplicity of the predigested foods so abundantly used in childhood is a fertile source of all sorts of developmental errors. Because a child's stomach is a delicate organ easily thrown out of gear, therefore you should spare it by the habitual use of easily digestible or predigested food, is a fallacy constantly fallen into. Nature has a remedy, speedy and efficacious, for an over-tried stomach, and an occasional expression of her protest will hurt nobody. A very acute observer, Dr. Henry Campbell, recently writing on this point, throws out the suggestion that the universal prevalence of adenoid growths may be due partly to the failure to supply children with material for mastication. His chain of reasoning is a little too technical to cite here, but it depends upon the fact that the proper exercise of the jaws encourages the circulation through the blood and lymph channels, and tends to prevent the narrow jaws and high arched palates so usually associated with adenoids.

We begin, therefore, not later than eighteen months to give more solid kinds of food. The breakfast from this age onwards is too often a monotonous daily portion of bread and milk. This dish constitutes an admirable arrangement of food elements and it is pleasant to take. It is, however, of the utmost importance that a distaste for milk foods should not be created, and a constant change of the farinaceous [starchy] basis of the meal not only secures this, but adds a speculative element--so dear to the child's mind--to a meal which often lacks variety. Almost any of the farina class which can be made into a pudding make capital breakfast dishes, served in a bowl like porridge. For instance, semolina, vermicelli, corn-flour, hominy, Frame Food, Nutron, sago, rice, all come under this head; for slightly older children the claims of macaroni must not be forgotten, as it contains a considerable amount of gluten.

Dinner also assumes the character of a square meal. Meat or fish may be given daily in the forms of puree, lightly cooked and cut up finely, or pounded in a warm mortar.

With the complete eruption of the teeth at the end of the second year, the digestive equipment of the child may be said to be complete. It possesses the mechanical power for disintegrating and the chemical agents for the conversion of all kinds of food.

Its dietetic history from this time onwards is a gradual emancipation from restriction. The only guides necessary are the observance of the proper proportion of the food elements, that is to say, that the proteids, fats and carbohydrates must bear their proper relation; that the anti-scorbutic [preventing scurvy] element in fresh milk, fruit and vegetables, must always find place in the menu; that the food should be properly cooked and served, and properly eaten. With regard to quantity, if a reliable person is always present at meal-time to see that the food is eaten leisurely and properly masticated, there is little fear that the child will eat too much. [Goodhart, Diseases of Children, p. 35.] A calculation has been made that a child under two requires one-third the amount of food of a man at moderate work, while a half of the man's allowance would be required by a child of from six to nine.

PERIOD III.

The chief share of the regulation of the dietary of the child in our last period will come into the domain of the school master or mistress. Whatever reproach could be in time past, or can still be, levelled at our public schools, it is certain that the minutest care, amounting almost to fastidiousness, has been devoted to every detail of the dietetic and hygienic management of that essentially modern institution, the preparatory school. The girls of the family are, however, at home until a later age, and are often, I fear, not so well cared for as their brothers. The question of diet of children of school age has been well worked out by Dr. Clement Dukes, of Rugby School, and to his book [Essentials of School Diet, Rivingtons] I can refer those interested in the matter. From it I have abstracted much of the following information. The following principles should be arrived at:--

I. The meals should be so equitably divided that in no part of the day shall the body be stinted in its supply.

II. That the main food supply shall take place in the early part of the day, at breakfast and at the mid-day meal, when the organs are most vigorous and food most required for work. Also that food of a stimulating character should not be supplied in the evening.

III. That there shall be time to eat the meal and for thorough mastication, the slow eaters being rather encouraged in their habit than worried. Nothing can ensure this except the personal supervision of the parent or schoolmaster.

IV. That as most carelessness is usually displayed in those important elements the vegetables and fats, the greatest care should be taken to see that they are properly cooked and served by the carver.

V. That no alcohol should be given in any form or at any time except as a remedy in sickness.

In our consideration of the early periods we tried to estimate the exact amount of the various food stuffs required. Let us try and follow the same course here. Food in the adolescent period is required to supply the loss incidental to wear and tear, which is far more active at that time than at any other, and to provide material for the purpose of growth.

Besides these demands it must be remembered that children are often doing at this period mental work which, if attempted on insufficient food, leads to various forms of neurosis.

It has been calculated that the amount of nitrogen eliminated from the body in a state of repose is a 1 1/8 grains for each pound of body weight. We are thus able to get exact data of the amount of albuminous food required in a state of rest, to prevent actual loss of nutrition. By adding calculated amounts to make up for exercise and growth, we can estimate theoretically the requirements. According to Dr Clement Dukes, who has already been referred to, at boy under fourteen years of age requires weekly:--

Table 1

Header 1	Starches	Bread Oatmeal	90 ounces
Carbohydrates	Sugar Fat	Fat Butter	16 " 2.5 " 8.0 "
Proteids	Milk Soup Meat Fish Cheese		200 " 20 " 64 " 10 " 2 "

This estimate provides about nine ounces of cooked meat per day inclusive of bone, and including also such things as potted meat and sausages supplied at breakfast. As this would represent 3/4lb. of uncooked meat a day, it seems to me a pretty liberal allowance. It would appear to me desirable, if only for reasons of economy and variety, to derive a portion of the proteid element from oatmeal, peameal or lentils. The meat ration should be divided between breakfast and dinner, none being given except in the form of soup for tea or supper. A good deal of controversy has been expended over the question of making the principal evening meal a tea or a supper. Dr. Dukes strongly opposes a supper as unwise, because it sends a boy or girl to bed with undigested food in the stomach, engendering thereby restless sleep, talking, walking and dreams, and because it is accountable for certain physical sensations in the young which are better avoided. On the other hand, there is the objection that if tea is made the important meal it is undesirable that a fast of 13 or 14 hours should be imposed on a rapidly growing child.

I would suggest that the question should be determined by the season of the year. In winter the active exercise must be taken in the afternoon, and after football or hockey the child is quite ready for a substantial meal by teatime, while it seems a pity to curtail the long summer evening most suitable for exercise by a formal meal. Such a tea would have as its staple dish eggs, fish or potted meat; the drink should be milk, tea or cocoa; and bread, butter, jam, marmalade, treacle or honey. The addition of such green vegetables, like the cresses, which can be eaten uncooked, as are in season are most desirable.

If a light tea be given, supplemented by a supper, it should be remembered that many people, children as well as adults, have a difficulty in digesting milk at night. In such cases a soup thickened with a farinaceous food, or porridge and treacle, are suitable.

I should like to conclude with a few general observations on the errors into which all parents are liable to fall in the feeding and management of their children. Let me emphasize the fact that it is not merely ignorance which is responsible for these mistakes. I am inclined to think that the well-meaning and over-anxious parent commits almost as many as the careless and ignorant. Let me insist again upon the importance of looking to nature as the supreme guide, and to urge that each step taken outside the path indicated by nature leads in an arithmetical progression to evils of far-reaching consequence.

For instance, depriving an infant of its natural sustenance is one such step. It entails, even if a natural food like cow's milk is substituted, dangers of indigestion and consequently of malnutrition, dangers of infectious disease, dangers of tubercular disease. But if instead of substituting fresh milk from animal sources a main reliance is placed upon an artificially prepared food, not one but two steps out of nature's pathway are taken and more than twofold peril incurred. The result will very likely be the chain of evils coming under the head of rickets, the consequence of which may affect the whole future of the child, tending to permanent deformity and impoverishment.

Let me give two instances which came under my notice on one summer day in Felixstowe of the error into which a thoroughly well-meaning parent may fall. In both cases the patient was a baby in convulsions. The first was in charge of a trained nurse; the appointments of the nursery were as perfect and up-to-date as thought could make them. The baby was a fragile, almost transparent little creature of three months, in an extreme degree of emaciation, weighing five or six pounds. I found it was fed on humanized milk, and to my great delight I found it was not bought in cases from London, but prepared at home. I almost began to think that here at least was a case where contributory negligence could not be charged. I asked the nurse to show me how she prepared the food. She brought out her battery of implements, and to my astonishment I found that instead of abstracting only a portion of the curd from the milk she removed the whole of it! The poor little mite had been fed from its birth without a particle of proteid, its sole nutriment was whey and such fat as in the milk of a dairyman possessed. The fits were solely due to the extreme debility induced by such a diet, and after the mistake was remedied in two or three weeks the child was comparatively well and bonny.

The second instance was in every way a contrast to the first. A baby of six months, rolling in fat, and as plethoric as a little alderman. His diet was pure milk, as much as he liked to take. I asked the mother to give me a definite idea of the quantity he consumed. She said, "I don't know exactly; I give half a pint in the bottle and he has about ten bottles a day. I take half a gallon a day for him, and he generally gets through it!" A lenten penance was imposed on the young profligate and he had no more fits.

Among older children one frequently hears from mothers and nurses as an excuse for a most unwholesome scheme of diet the plea that the child does not, and never did, "like" milk, and that he will not take milk or farinaceous food of any kind.

I am willing to admit that there are a small number of children to whom from the earliest age cow's milk is almost impossible of digestion and consequently repugnant. A certain number have a like difficulty with regard to farinaceous food. But I am equally certain that in the great majority of these cases the principle has been adopted from the earliest age of common sense. It is quite sufficient for some parents, and nearly all nurses, for a child to "like" a thing (provided the granting of it does not interfere with their temporary ease) for his whim to be granted. Naturally the children at breakfast, scenting the aroma of a dish of kidneys or sausages their parents are eating, will push away the bowl of milk before them and suggest in a sweet and insinuating way their preference for the parents' food. So it gradually comes about that all meal-time the children are trotting about from one compliant parent to the other, who, swearing they will ne'er consent, give way every time. The rest is easy. I am quite sure this is the evolution in nine cases out of ten of the child to whom milk is impossible and farinaceous food anathema. To what lengths it may go is almost incredible. I have seen a puny little urchin of six sitting at table d'hôte with its parents, going through the menu with them, helping itself to their wines and sipping liqueur afterwards, with their smiling misapprobation. And going out into the street to relieve my feelings the first group I met was a toddler of four, linked hand in hand with his parents, puffing away at a four inch cigar!

Although this extreme instance was only introduced to point a moral, there is no doubt that minor faults of the same character are only too common. Indeed mothers and nurses, particularly nurses, sometimes appear to derive a secret gratification in the narration of their children's idiosyncrasies as regards food, and are full of terror as to what will happen to their susceptible stomachs when subjected to the rough-and-tumble of a school. In reality a well-ordered school is the surest cure of such cases, partly because the children's minds are diverted to things a little higher than their stomachs, partly because simple wholesome food is given under the constant supervision of ripe experience.

If one lesson is impressed upon a medical mind dealing with the alimentary defects and errors of childhood more prominently than another, it is an inherent tendency to physiological wrong-doing on the part of the child. I would urge that the proper attitude of the parent where a child is obviously falling away from a standard of health is not the giving of so-called tonics, or the greasy and sticky compounds of the children's medicine cupboard, but the putting to one's self the question, "How am I transgressing Nature's methods, Nature's laws?" To such an enquiry she will never turn a deaf ear. She is ever willing to meet you half way; nay, like the Father to the Prodigal, she will run to greet, even while they are yet a great way off, those who turn to her for guidance and counsel in singleness and sincerity of purpose.

Typed by happi, Mar. 2021; Proofread by LNL, Apr. 2021