THE DIET OF OLDER CHILDREN (FOURTH TO TENTH YEAR)
Throughout this period the largest meal should always be in the middle
of the day, and a light supper given, very much like that described
for the third year. During the first half of this period, milk may be
allowed once either between breakfast and dinner or dinner and supper;
no other eating between meals should be permitted, but water should be
allowed freely.
MILK AND CREAM
_What part of the diet should milk form during childhood?_
It should form a very important part up to the tenth year; nothing can
take its place. There are comparatively few children who cannot take
and digest milk if it is properly fed.
_Why is milk so advantageous?_
Because no food that we possess has so high a nutritive value as milk,
for the amount of work required of the organs of digestion. It is,
therefore, peculiarly adapted to the diet of the child.
_What are the essential points in the use of milk?_
It should be clean and fresh, but not too rich. It is a mistake to
select for any children the rich milk of a Jersey herd and use it as
though it were an ordinary milk. For children who have difficulty in
digesting milk, it should be somewhat diluted, i.e., one part of water
to four parts of milk, or salt or bicarbonate of soda should be added.
It is also important not to give milk at meals when fruits, especially
sour fruits, are allowed.
_How much milk may advantageously be given?_
The average child with good digestion should take from one and one
half pints to one quart of milk daily, this including not only what
the child drinks but what is served upon cereals and in other ways. It
is seldom wise to allow a child to take as much as two quarts daily,
as a more mixed diet for most children is better.
_To what extent may cream be used?_
Older children do not require so large a proportion of fat in their
food as do infants, and the use of cream, especially very rich cream,
often results in disturbances of digestion. The use of too much or too
rich cream is a common cause of the coated tongue, foul breath and
pale gray stools, often called "biliousness."
_Is not cream useful in overcoming the constipation of children?_
With infants it is valuable to a certain point, but with older
children only to a limited degree, and if such symptoms as those above
described are present, cream should not be given.
EGGS
_To what extent may eggs be used in the diet of this period?_
They form a most valuable food. It is essential that they should be
fresh and only slightly cooked, soft boiled, poached or coddled; fried
eggs should never be given and all omelets are objectionable.
_Which is more digestible, the white or yolk of the egg?_
For the great majority of children, the white of the egg. This forms
one of the most digestible proteids we possess, and can be used, even
in the latter part of the first year, with advantage.
_Is it not true that eggs often cause "biliousness"?_
Very seldom, if fed as above advised. This is an old prejudice but has
little basis in fact.
_How often may eggs be given?_
Most children from four to ten years old will take one egg for
breakfast and another for supper for an indefinite period with relish
and benefit. There are, however, some few who have a peculiar
idiosyncrasy as regards eggs and cannot take them at all.
MEAT AND FISH
_What meats may be given to young children?_
The best are beefsteak, mutton-chop, roast beef, roast lamb, broiled
chicken and certain delicate fish, such as shad or bass.
_What are the important points to be considered in giving meat to
children?_
Most meats should be rare and either scraped or very finely divided,
as no child can be trusted to chew meat properly. Meats are best
broiled or roasted, but should not be fried.
_How often should meat be given?_
At this period, only once a day, at the mid-day meal.
_Is not the excessive nervousness of many modern children due to the
giving of meat, or at least aggravated by its use?_
There is little ground for such a belief, unless an excessive amount
of meat is given. Certainly cutting off meat from the diet of nervous
children seldom produces any striking benefit.
_What meats should be forbidden to young children?_
Ham, bacon, sausage, pork, liver, kidney, game and all dried and
salted meats, also cod, mackerel and halibut; all of these are best
withheld until the child has passed the tenth year.
_Are not gravies beneficial and nutritious?_
The beef juice, or so-called "platter gravy," from a roast is
exceedingly nutritious and desirable, but many of the thickened
gravies are much less digestible and are too often given in excess;
only a small quantity should be allowed. They should not form an
important part of the meal.
VEGETABLES
_What vegetables may be used at this period?_
White potatoes may be given first. These should preferably be baked or
boiled and mashed, but never fried. They should be served with beef
juice or with cream rather than with butter.
Of the green vegetables, the best are peas, spinach, asparagus tips,
string beans, stewed celery, young beets, or carrots, and squash.
Baked sweet potato, turnips, boiled onions and cauliflower, all well
cooked, may be given after the sixth or seventh year in moderate
amount.
The principal trouble in the digestion of vegetables is due to
imperfect cooking. It is, in fact, almost impossible to cook them too
much; they should also be very finely mashed. They form a valuable
addition to the diet after three years, although the amount at first
given should be small, one or two teaspoonfuls. They greatly aid in
securing regularity of the bowels. Because small particles are seen in
the stools, it is not to be inferred that they are causing disturbance
and should, therefore, be stopped, but only that they should be more
thoroughly cooked and more finely divided before being given.
_Is it safe to use canned vegetables for children?_
Many of the best brands of canned vegetables are quite safe and some,
such as peas and asparagus, can be used with advantage. They are
frequently better than stale green vegetables often sold in the
markets.
_What vegetables should not be given to young children?_
None of those which are eaten raw, such as celery, radishes, onions,
cucumbers, tomatoes or lettuce. Certain others, even when well cooked,
should not be allowed; as corn, lima beans, cabbage, egg plant. None
of these should be given until a child has passed the age of ten
years.
_Are vegetable salads to be given?_
As a rule salads of all kinds should be omitted until a child has
passed the tenth year. Salads are difficult to digest and a cause of
much disturbance in children of all ages.
CEREALS
_What are the most important points in selecting and preparing
cereals?_
The important things are that they are properly cooked and not used in
excess. The ready-to-serve cereals should never be chosen for
children, nor should a child, because he is fond of cereals, be
allowed to make his entire meal of them, taking two or three
saucerfuls at a feeding.
Many of the partially cooked preparations of oatmeal and wheat are
excellent, but should be cooked for a much longer time than is stated
upon the package, usually three or four times as long. Digestibility
is chiefly a matter of proper cooking. Most of the grains,--oatmeal,
hominy, rice, wheaten grits,--require at least three hours' cooking in
a double boiler in order to be easily digested. The prepared
flours,--corn starch, arrowroot, barley,--should be cooked at least
twenty minutes. I know of no preparation in the modern market which
requires no cooking, which is to be recommended for children.
_How are cereals to be given?_
Usually with milk or a mixture of milk and cream; always with an
abundance of salt and with very little or no sugar, one half
teaspoonful on a saucerful of cereal should be the limit.
Cereals should not be served with syrups or butter and sugar.
BROTHS AND SOUPS
_What broths and soups are to be recommended?_
Meat broths are generally to be preferred to vegetable broths,--mutton
or chicken being usually most liked by children. Nearly all plain
broths may be given. Those thickened with rice, barley or corn starch
form a useful variety, especially with the addition of milk.
Vegetable purees of peas, spinach, celery or asparagus may be used for
children over seven years old. Tomato soup should not be given to
young children.
BREAD, CRACKERS AND CAKES
_What forms of breadstuffs are best suited to young children?_
Fresh bread should not be given, but stale bread cut thin and freshly
dried in the oven until it is crisp is very useful, also zwieback, the
unsweetened being preferred. Oatmeal, graham or gluten crackers and
the Huntley and Palmer breakfast biscuits, stale rolls, or corn bread
which has been split and toasted or dried till crisp, form a
sufficient variety for most children.
_What breadstuffs should be forbidden?_
All hot breads, all fresh rolls, all buckwheat and other griddle
cakes, all fresh sweet cakes, especially those covered with icing and
those containing dried fruits. A stale lady-finger or piece of sponge
cake is about as far in the matter of cakes as it is wise to go with
children up to seven or eight years old.
DESSERTS
_What desserts may be given to young children?_
Mistakes are more often made here than in any other part of the
child's diet. Up to six or seven years, only junket, plain rice
pudding without raisins, plain custard and, not more than once a week,
a small amount of ice cream.
_What should be especially forbidden?_
All pies, tarts and pastry of every description, jam, syrups and
preserved fruits; nuts, candy and dried fruits.
_Does "a little" do any harm?_
Yes, in that it develops a taste for this sort of food, after which
plainer food is taken with less relish. Besides the "little" is very
apt soon to become a good deal.
_Does not the child's instinctive craving for sweets indicate his need
of them?_
That a child likes or craves sweets is the usual excuse of an
indulgent parent. Every child likes his own way, but that is no reason
why he should not be trained to obedience and self-control; a child's
fondness for sweets can hardly be considered a normal instinct. As a
matter of fact, supported by everyday experience, no causes are
productive of more disorders of digestion than the free indulgence in
desserts and sweets by young children. It is a constantly increasing
tendency, not easily controlled as a child grows older; and in early
childhood, the only safe rule is to give none at all.
FRUITS
_Are fruits an essential or important part of the diet?_
They are a very important part and should be begun in infancy. They
are particularly useful for the effect they have upon the bowels. It
is important that they should be selected with care and given with
much discretion, especially in cities. In the country where fruit is
absolutely fresh, a somewhat greater latitude may be allowed than is
given below.
_What fruits may safely be given to children up to five years old?_
As a general rule, only cooked fruits and the juices of fresh fruits.
_What fruit juices may be used?_
That from sweet oranges is the best, but the fresh juice of grape
fruit, peaches, strawberries and raspberries may also be used.
_What stewed fruits may be given?_
Stewed or baked apples, prunes, pears, peaches and apricots.
_What raw fruits are to be particularly avoided with young children?_
The pulp of oranges or grape fruit, also cherries, berries, bananas
and pineapple.
_What precautions should be emphasized regarding the use of fruits?_
That they should be used with greater care in hot weather and with
children who are prone to attacks of intestinal indigestion.
_What symptoms indicate that fruits should be avoided?_
A tendency to looseness of the bowels with the discharge of mucus, or
frequent attacks of abdominal pain or stomach ache.
_Is there any special choice of meals at which fruit should be given?_
The fruit juice given early in the morning, upon an empty stomach,
works more actively upon the bowels than if it is given later in the
day.
It is not, as a rule, wise to give cream or milk with sour fruits.
Usually the fruit is best given at the mid-day meal, as a dessert, at
a time when no milk is taken. It is in all cases important that the
quantity of fruit should be moderate.
_What besides water and milk should a child be allowed to drink and
what should be forbidden?_
Tea, coffee, wine, beer and cider in all quantities and in all forms
should be forbidden to young children below puberty. Cocoa which is
made very weak, i.e., almost all milk, is often useful as a hot drink.
Lemonade, soda-water, etc., should if possible be deferred until the
tenth year. A free indulgence in things of this kind should never be
permitted with children of seven or eight years.
INDIGESTION IN OLDER CHILDREN
_What are the different ways in which indigestion shows itself in
children?_
First, in acute disturbances which last for a few days only; and,
secondly, in chronic disturbances which may continue for weeks or
months.
_Which of the two forms of indigestion is more likely to impair
seriously the health of the child?_
Chronic indigestion; for since the cause is not recognized it often
goes on for months and even years unchecked.
_What are the symptoms of acute indigestion?_
These are familiar and easily recognized. They are vomiting, pain,
undigested movements from the bowels, often fever and considerable
prostration.
Such attacks are usually traceable to their proper cause, the removal
of which is followed by prompt recovery.
_What are the common causes of acute indigestion?_
This is frequently due to overeating, to indulgence in some special
article of improper food, or to eating heartily when overtired. Acute
indigestion often marks the beginning of some acute general illness.
_How should acute indigestion be managed?_
One should bear in mind that for the time being the digestive organs
have stopped work altogether. The important thing, therefore, is to
clear out from the intestines all undigested food by some active
cathartic, such as castor oil. The stomach has usually emptied itself
by vomiting. All food should be stopped for from twelve to thirty-six
hours, according to the severity of the attack, only water being
given.
_At the end of this time is it safe to begin with the former diet?_
No; for such a procedure is almost certain to cause another attack of
indigestion. At first only broth, thin gruel, very greatly diluted
milk, or whey should be given. The diet may be very slowly but
gradually increased as the child's appetite and digestion improve, but
in most cases a week or ten days should elapse before the full diet is
resumed.
_What are the symptoms of chronic indigestion?_
These, although familiar, are not so easily distinguished and are very
often attributed to the wrong cause. There are usually general
symptoms such as indisposition, disturbed sleep, grinding of the
teeth, fretfulness, languor, loss of weight and anæmia. There are
besides local symptoms: flatulence, abdominal pain, abdominal
distention, constipation, or looseness of the bowels with mucus in the
stools, foul breath, coated tongue, loss of appetite, or an abnormal
capricious appetite. Such symptoms are often wrongly ascribed to
intestinal worms.
_What are the common causes of chronic indigestion?_
This is generally the result of a bad system of feeding, either the
prolonged use of improper food or of improper methods of feeding.
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.
_Is it not true that a diet or a special article of food which does
not make a child ill is proof that such a diet or such a food is
proper for a child?_
By no means; with many people the only guide In feeding children is
that the article in question did not make the children sick, therefore
it is allowable. This is a very bad principle. A better one is to
adopt such a diet as will nourish the child's body with the least
possible tax upon his digestive organs; in other words, to exclude
articles which experience has shown to be injurious to most children.
_How should chronic indigestion be managed?_
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.
_Is chronic indigestion curable?_
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.
_For how long a period is it necessary to continue very careful
feeding?_
In any case it must be done for several months; with most children for
two or three years; with some, throughout childhood, for with them the
slightest deviation from established rules is sure to provoke a
relapse.
_Is not medicine useful?_
It is undoubtedly of assistance for the relief of some symptoms, but
the essential thing is proper feeding, without which nothing permanent
can be accomplished.
GENERAL RULES TO BE OBSERVED IN FEEDING
Bad habits of eating are readily acquired but difficult to break.
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.
Learning to eat proper things in a proper way forms therefore a large
part of a child's early education. If careful training in these
matters is begun at the outset and continued, the results will well
repay the time and effort required.
Whether the child feeds himself or is fed by the nurse, the following
rules should be observed:
1. Food at regular hours only; nothing between meals.
2. Plenty of time should be taken. On no account should the child bolt
his food.
3. The child must be taught to chew his food. Yet no matter how much
pains are taken in this respect, mastication is very imperfectly done
by all children; hence up to the seventh year at least, all meats
should be very finely cut, all vegetables mashed to a pulp, and all
grains cooked very soft.
4. 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.
6. 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.
7. 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.
8. If an infant refuses its food altogether, or takes less than usual,
the food should be examined to see if this is right. Then the mouth
should be inspected to see if it is sore. If neither of these things
is the cause, the food should be taken away and not offered again
until the next feeding time comes.
9. In any acute illness the amount of food should be much reduced and
the food made more dilute than usual. If there is fever, no solid food
should be given. If the child is already upon a milk diet, this should
be diluted, and in some cases partially peptonized.
10. In very hot weather the same rules hold, to give less food,
particularly less solid food, and more water.
FOOD FORMULAS
_Beef Juice._--One pound of rare round steak, cut thick, slightly
broiled, and the juice pressed out by a lemon-squeezer, or, better, a
meat-press. From two to four ounces of juice can generally be
obtained. This, seasoned with salt, may be given cold, or warmed by
placing the cup which holds it in warm water. It should not be heated
sufficiently to coagulate the albumin which is in solution, and which
then appears as flakes of meat floating in the fluid.
_Beef Juice by the Cold Process._--One pound of finely chopped round
steak, six ounces of cold water, a pinch of salt; place in a covered
jar and stand on ice or in a cold place, five or six hours or
overnight. It is well to shake occasionally. This is now strained and
all the juice squeezed out by placing the meat in coarse muslin and
twisting it very hard. It is then seasoned and fed like the above.
Beef juice so made is not quite as palatable as that prepared from
broiled steak, but it is even more nutritious, and is more economical,
as fully twice as much juice, can be obtained from a given quantity of
meat. Beef juice prepared in either of these ways is greatly to be
preferred to the beef extracts sold.
_Mutton Broth._--One pound of finely chopped lean mutton, including
some of the bone, one pint cold water, pinch of salt. Cook for three
hours over a slow fire down to half a pint, adding water if necessary;
strain through muslin, and when cold carefully remove the fat, adding
more salt if required. It may be fed warm, or cold in the form of a
jelly.
A very nutritious and delicious broth is made by thickening this with
cornstarch or arrowroot, cooking for ten minutes and then adding three
ounces of milk, or one ounce and a half of thin cream, to a half pint
of broth.
_Chicken, Veal, and Beef Broths._--These are made and used in
precisely the same manner as mutton broth.
_Meat Pulp._--A rare piece of round or sirloin steak, the outer part
having been cut away, is scraped or shredded with a knife; one
teaspoonful to one tablespoonful may be given, well salted, to a child
of eighteen months. Scraping is much better than cutting the meat
fine.
For this on a large scale, as in institutions, a Hamburg-steak cutter
may be employed.
_Junket, or Curds and Whey._--One pint of fresh cow's milk, warmed;
pinch of salt; a teaspoonful of granulated sugar; add two teaspoonfuls
of Fairchild's essence of pepsin, or liquid rennet, or one junket
tablet dissolved in water; stir for a moment, and then allow it to
stand at the temperature of the room for twenty minutes, or until
firmly coagulated; place in the ice box until thoroughly cold. For
older children this may be seasoned with grated nutmeg.
_Whey._--The coagulated milk prepared as above is broken up with a
fork and the whey strained off through muslin. It is best given cold.
If some stimulant is desired, sherry wine in the proportion of one
part to twelve, or brandy one part to twenty-four, may be added. Whey
is useful in many cases of acute indigestion.
_Barley Jelly from the Grains._--Three tablespoonfuls of pearl barley;
soak overnight, then place this in one quart of fresh water; add pinch
of salt, and cook in double boiler steadily for four hours down to one
pint, adding water from time to time; strain through muslin. When cold
this makes a rather thick jelly. If a thinner gruel (barley water) is
desired, one half the quantity of barley should be used.
_Oat, Wheat, or Rice Jelly._--These are prepared from oatmeal, wheaten
grits, and rice grains in the same manner as the barley jelly.
_Barley Jelly from the Flour._--Either Robinson's patent barley or
prepared barley flour of the Health Food Company may be used. One
rounded tablespoonful of the flour, thoroughly blended with a little
cold water, is added, stirring, to one pint of boiling water
containing a pinch of salt; cook for twenty minutes in a double
boiler, and strain. This makes a jelly of about the consistency of
that made from the grains as above. It is essentially the same in
composition, and much less trouble to prepare. A thinner gruel (barley
water) is made by using half the quantity of flour.
When this is to be mixed with milk, it is well to add the milk to the
barley gruel before removing from the fire, and stir two or three
minutes, or until the milk has nearly reached the boiling point, when
it should be removed and bottled.
_Oat or Wheat Jelly from the Flour._--These are made from the prepared
oat flour of the Health Food Company or Hubbell's prepared wheat
flour. They are used like the barley.
_Imperial Granum._--This is prepared and used in precisely the same
way as the barley flour above mentioned, the gruel being mixed with
milk before it is removed from the fire.
_Albumin Water._--The white of one fresh egg; half a pint of cold
water; pinch of salt; teaspoonful of brandy. This should be shaken
thoroughly and fed cold either with a spoon or from a bottle. It is
useful in cases of vomiting, and can sometimes be retained by a very
irritable stomach.
_Lime-water._--One heaping teaspoonful of slaked lime; one quart
boiled or distilled water; place in a corked bottle and shake
thoroughly two or three times during the first hour. The lime should
then be allowed to settle, and after twenty-four hours the upper clear
fluid carefully poured or siphoned off for use.
_Dried Bread._--Either stale or fresh bread may be used; it is cut in
thin slices and placed in the oven, with the door open, and quickly
dried until it is crisp, but not browned. It is in many respects
preferable to crackers for little children.
_Coddled Egg._--A fresh egg, shell on, is placed in boiling water
which is immediately after removed from the fire. The egg then cooks
slowly in the water, which gradually cools, for seven or eight
minutes, when the white should be about the consistency of jelly. For
a delicate digestion the white only should be given, with salt; it can
be easily separated from the yolk.