L. Emmett Holt

“ Examples of bad methods of feeding are, coaxing or forcing to eat, rapid eating with insufficient mastication eating between meals, allowing a child to have his own way in selecting his food, as when he lives largely upon a single article of diet. Things to be considered under the head of improper food are, indulgence in sweets, desserts, etc., the use of imperfectly cooked foods, especially cereals and vegetables, and of raw or stale fruits. ”

“ Those are therefore to be preferred the use of which develops the child's imagination, and with which he can be taught to amuse himself. For boys nothing can surpass blocks, toy soldiers, balls, engines, and cars; and for girls, dolls and housekeeping sets. The complicated mechanical toys now so much in vogue give only a momentary pleasure, and as soon as the wonder at their operation has worn off, they have lost interest for the child except that which he gets in breaking them to see how the thing worked. ”

“ Young children should not be allowed to play with their food, nor should the habit be formed of amusing or diverting them while eating, because by these means more food is taken.
Older children should not be permitted to make an entire meal of one thing, no matter how proper this may be.
Children, who are allowed to have their own way in matters of eating are very likely to be badly trained in other respects; while those who have been properly trained in matters of eating can usually be easily trained to do anything else that is important. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ How should a baby be put to sleep?
The room should be darkened and quiet, the child's hunger satisfied, and the child made generally comfortable and laid in its crib while awake.
Is rocking necessary?
By no means. It is a habit easily acquired, but hard to break, and a very useless and sometimes injurious one. The same may be said of sucking a rubber nipple, or "pacifier," and all other devices for putting children to sleep. ”

“ Older children often become so attached to the bottle that only with the greatest difficulty can they be made to give it up. Frequently they will refuse all solid food, and will take nothing except from the bottle so long as it is given, and when finally at three or four years, it is taken away, they will not touch milk during the rest of their childhood. The difficulty is here that children form the "bottle habit." This habit is troublesome, unnecessary, and should by all means be prevented. An exclusive diet of milk for children of two or three years often results in anæmia and malnutrition. ”

“ Should a child sleep in the same bed with its mother or nurse?
Under no circumstances, if this can possibly be avoided. Very young infants have often been smothered by their mothers, by overlying during sleep. If the infant sleeps with the mother, there is always the temptation to frequent nursing at night, which is injurious to both mother and child. Older children also should, if possible, have separate beds; many contagious diseases and bad habits are contracted by children sleeping together. ”

“ As large a room as possible should be selected—one that is well ventilated, and always one in which the sun shines at some part of the day, as it should be remembered that an average child spends here at least three fourths of its time during the first year. The nursery should have dark shades at the windows, but no extra hangings or curtains; about the baby's crib nothing but what can be washed should be allowed. The air should be kept as fresh and as pure as possible. There should be no plumbing no drying of napkins or clothes, no cooking of food, and no gas burning at night. ”

“ Children should not be continually urged to eat if they are disinclined to do so at their regular hours of feeding, or if the appetite is habitually poor, and under no circumstances should a child be forced to eat.
5. Indigestible food should never be given to tempt the appetite when the ordinary simple food is refused? food should not be allowed between meals because it is refused at meal-time. ”

“ If there is any important article of a simple diet such as milk, meat, cereals, or vegetables, which a child habitually refuses, this should always be given first at the meal and other food withheld until it is disposed of. Children so readily form habits of eating only certain things and refusing others that such an inclination should be checked early. ”

“ With a large, strong child, having a good digestion one should use the First Series. With a smaller, less vigorous child, whose digestion is not so good, or with one who does not do well upon the First Series, the Second Series should be used.
Why is it necessary to make the food so weak at first?
Because the infant's stomach is intended to digest breast milk, not cow's milk; but if we begin with a very weak cow's milk the stomach can be gradually trained to digest it. If we began with a strong milk the digestion might be seriously upset. ”

“ How should the infant be held during dressing and undressing?
Nothing is more awkward than to attempt to dress a young baby in a sitting posture. It should lie upon the nurse's lap until quite old enough to sit alone, the clothing being drawn over the child's feet, not slipped over the head. ”

“ What points should guide one in selecting toys and playthings for an infant?
The instinct in a baby to put everything into the mouth is so strong that nothing should be given that cannot be safely treated in this way. Hence one should choose things which are smooth, those which can be easily washed, and those which cannot be swallowed. ”

“ Measles and chicken-pox are very contagious, and very few children who have not had them can come near a person suffering from either disease without taking it. Whooping-cough is almost as contagious as measles, and for young babies even more so. A very close exposure is not necessary in the case of either of these diseases, and whooping-cough can undoubtedly be contracted in the open air. Scarlet fever and diphtheria are much less contagious; for both of these a pretty close exposure is necessary.
How long should a child with any of these diseases be kept away from other children? ”

“ As quiet peaceful sleep is a sign of perfect health, disorders of sleep may be produced by almost anything which is wrong with the child.
1. Habitual disturbance of sleep in infants is most frequently associated with the food or feeding. It may be from the discomfort of chronic indigestion due to improper food. In bottle-fed infants it is often the result of overfeeding; in those who are nursed it is often due to hunger. A common cause is frequent night feeding; an infant who is fed three or four times during the night is almost invariably a bad sleeper. ”

“ Sterilizing milk does not improve its digestibility but rather the contrary. Sterilized milk should be modified for infant feeding in the same way as milk which has not been heated.
Is milk in any way injured by heating to 212° F. for an hour?
There is abundant evidence that milk is rendered less digestible by such heating; also that it is more constipating, and that for some children its nutritive properties are interfered with, so that it may cause scurvy; this, however, is not seen unless it is continued as the sole food for a long period. ”

“ 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. ”

“ In the vast majority of cases it is so, but only by faithfully observing for a long period the rules for simple feeding laid down elsewhere. One of the greatest' difficulties in the way of recovery is that parents and nurses are unwilling to follow a restricted diet long enough to secure a complete cure, or to change radically their methods of feeding, but expect the child to recover by simply taking medicine. ”

“ This is a much more difficult matter than the treatment of acute indigestion, for, as it is usually the result of the prolonged use of improper food or of an improper method of feeding, a cure can be accomplished only by a discovery and removal of the cause. ”

“ If the vomiting occurs some time after nursing and is repeated, it is a sign of indigestion; often because the milk is too rich in fat. The intervals between nursings should then be lengthened; the breast milk may be diluted by giving one or two tablespoonfuls of plain boiled water, lime-water, or barley-water, five or ten minutes before nursing; the mother should eat less hearty food, especially less meat.
What should be done if the infant has frequent or habitual colic? ”

“ 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. ”

“ They are of no value in older children, rewards being much more efficacious. In all cases one should give a child plenty of milk and water early in the day, but no fluids after 4 P.M., the supper being always of solid or semi-solid food. The child should be taken up regularly at ten o'clock or thereabouts. It often happens that the formation or continuance of the habit is due to the child being in poor general condition, to some irritation in the urine, or in the genital organs. Unless the simple means mentioned are successful the child should be placed under the charge of a physician. ”

“ How long should the thermometer be left in place to take the temperature?
Two minutes in the rectum, and five minutes in the groin.
Is the temperature of a young child a good guide as to the severity of its symptoms in illness?
As a rule it is. A temperature of 100° to 102° F. commonly means a mild illness, and one of 104° F. or over a serious one. The duration of the fever is, however, even more important than the height of the temperature. It should be remembered that in all young children slight causes often produce a high temperature which lasts for a few hours ”

“ 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. ”

“ A large infant with a strong digestion will bear a rather rapid increase and may be able to take V by the time it is three or four weeks old. A child with a feeble digestion must go much slower and may not reach V before it is three or four months old.
It is important with all children that the increase in the food be made very gradually. It may be best with many infants to increase the milk by only half an ounce in twenty ounces of food, instead of one ounce at a time as indicated in the tables. ”

“ That the chest shall be covered with soft flannel, the limbs well protected but not confined, and the abdomen supported by a broad flannel band, which should be snug but not too tight. It is important that the clothing should fit the body. If it is too tight it interferes with the free movements of the chest in breathing, and by pressing upon the stomach sometimes causes the infant to vomit soon after swallowing its food. If the clothing is too loose it is soon thrown into deep folds or bunches, which cause much discomfort. ”

“ The formulas given in this book are chiefly calculated on the basis of a good average milk which contains about 4 per cent fat. Many persons have the idea that the richer the milk, the more rapidly the child will gain in weight, and hence the superiority of such milk for infant feeding. While it is true that some children taking a very rich milk may, for a time, gain rapidly in weight, yet sooner or later, serious disturbances of digestion are nearly always produced. ”

“ Condensed milk is not to be recommended as a permanent food where good fresh cow's milk can be obtained.
What are the objections to its use?
It is very low in fat and proteids, and high in sugar. This accounts for its easy digestibility, and also explains why children reared upon it often gain very rapidly in weight, yet have as a rule but little resistance. They are very prone to develop rickets and sometimes scurvy.
Are the proprietary infant foods open to the same objections as condensed milk? ”

“ Often the amount of ice is so small, and the bottles so far away, that the temperature of the milk is never below 60° or 65° F. To be really effective a refrigerator should have a temperature where the milk is placed of not over 50° F. The temperature should be tested with the nursery thermometer from time to time to ascertain what results are being obtained. Spoiled milk owing to a faulty refrigerator is to be blamed for many attacks of acute illness among infants. Next to the feeding-bottles it is the one thing in the nursery which should receive the closest attention. ”

“ One serious objection to allowing young children highly seasoned food, entrees, jellies, pastry, sweets, etc., even in such small amounts as not to upset the digestion, is that children thus indulged soon lose appetite for the simple food which previously was taken with relish. ”