The Feeding of Children
( Originally Published 1921 )
The principles of the correct feeding of children are in some ways quite different from the laws of feeding the adult. These distinctions are based chiefly on the fact that the children grow while adults do not.
This fact of growth is exceedingly important and must in no wise be overlooked. It is a general law of life that the primary business of the young creature is to grow. In some species the growing period is distinctly marked off from the period of maturity. In bees, for in-stance, the young larvae is fed on "bee-bread" made from the pollen of the flowers, and rich in protein. When the larva-- of the bee goes through the transformation stage and comes out as an adult insect, it ceases entirely to eat its former food; in fact, it is incapable of doing so. The adult bee lives on honey, which is almost wholly a fuel food. In the case of some insects whose adult life is briefer, no food whatever is taken in the adult period.
In the higher animals no such sharp distinction marks off the period of growth from that of maturity, but to a certain extent the nutritional laws which more sharply divide these periods in insect life apply to the higher species.
In addition to the growth factor there are certain other differences between childhood and maturity; the body of a child, being smaller, the heat lost by radiation of the surface is greater in proportion to the weight of the body. The pulse in childhood is more rapid and the speed of the general physiological activities is greater. These facts, together with the fact of growth, necessitate that the child consume more food in proportion to its weight than the adult—in fact—this rate of food consumption according to weight is for a young child three times as great as the adult's.
A further distinction between childhood and maturity, and a distinction that is exaggerated 'by civilized conditions, is that the child is physically more active—in fact, the normal, healthy child, given proper facilities for play, prefers to be physically active during all its waking hours. But the civilized adult, because of the development in his mental life, the routine of his business, and the restrictions of clothing, housing and customs, ceases this varied activity, and per-forms his physical toil and even his artificial play at stated hours and set times. Often he ceases to play altogether, and muscular activity ceases to be essential to his labors. Under these conditions the civilized adult is usually over-fed and under-exercised—hence the main burden of this book, as far as the eating habits of the adult are concerned, is to caution against over-eating and find ways to prevent obesity.
With the child, when normal physical activity is permitted and encouraged, obesity is more rare. Because of the child's activity and its greater food needs, over-eating, while it does occur among children, is not so prevalent as among adults. On the other hand under-eating, which is rare among adults, at least those who are prosperous and have food available, is much more likely to occur among growing children.
Because of their smaller bodies, more physiological activities and greater food needs, children require food more frequently than adults. The conventional three meals a day often rep-resent too frequent eating for the adult, though it is usually ideal for the child. A child should never be allowed to piece between meals, though moderate quantity of acid fruit can with benefit usually be given at any time desired, and his meal program intelligently adapted to his needs.
Children are frequently under-nourished. Among the poorer classes this may be caused by an insufficient quantity of food. But among both poor and prosperous children are frequently under-nourished because of an improper quality of food. As with adults so with children: they may eat plenty and still be under-fed. Moreover, they may be fat and still be under-fed with those elements essential to health, vitality and proper growth.
Most alarming facts have recently been brought to light in regard to this question of the proper nourishment of children. Malnutrition and under-nourishment are the most serious conditions that can affect a growing child, and this crime against childhood is one of the most serious things that can affect human society. For the child it means the stunting of growth, impairment of health and lessened resistance to disease and particularly encourages a predisposition to tuberculosis. In America to-day every seventh child dies before the end of the first year, and two of the remaining six die before reaching maturity—and America is the best fed nation is the world. In some of the poorer districts in our large cities as high as seventy per cent of children' are found to be suffering from malnutrition. Not so many were actually underfed as improperly fed. Even in the most fashionable schools in well-to-do neighborhoods forty per cent of the children have been found suffering from malnutrition, yet all these children had more than enough food placed before them three times a day, but the food was not of the proper quality, or the children did not eat enough because they were pampered, under-exercised or their appetites ruined by improper food indulgence.
Discussing the food problem of the adult we showed that to prescribe the exact amount of food was foolish, and that the proper way to judge how much one should eat was by observation of the weight, or, more accurately, the condition of the body. It is equally foolish to pre-scribe the exact amount of food for children. With the child as with the adult, the condition of the body is a necessary criterion in determining whether the child is properly nourished or not, but with the child there is one additional factor that should be considered, and that is the rate of growth.
In the case of adults I refrain from giving tables of ideal heights and weights, because I believe that the careful study of the physique is a better method from which to arrive at a proper conception of the weight of the body.
In the case of children I believe that tables will be valuable. Once maturity is reached there should be little change in body weight, but the child constantly growing should be ever changing the body weight; hence the need of knowing what this rate of change should be.
I will first give a table showing the average rate of growth or normal increase of weight in pounds during each year of growth—of course, the figures can be computed for shorter time periods.
NORMAL RATE OF GROWTH FOR CHILDREN
The rate of growth is the most important of all factors in determining the nutrition of children. If this increase of weight were always that of vital active tissue no further figures would be needed, but children can get fat and during such fattening periods they would appear to be properly nourished when they were really not growing; likewise, if past accumulations of fat were being lost, children might seem to be ceasing to grow when in reality they were growing all right. Be-cause of these facts it is desirable also to have at hand a table giving both heights and weights in relation to age. For this purpose I am using tables published in the PHYSICAL CULTURE MAGAZINE and furnished by the New York City Department of Health.
The figures in these tables are average figures determined from the weighing and measuring large groups of children. 'Some children may, of course, grow more rapidly. The average is rarely the ideal. However, rapidity in the physical growth of a child is not necessarily an advantage. The most highly developed races reach their maturity more slowly than do the inferior races; in fact, one of the greatest distinctions between man and other kindred species is his slower rate of growth. This has come about during the period of man's evolution due to the development of his greater brain power. The brain grows slowly and the process of acquiring the vast amount of knowledge and experience needed by a civilized man requires time. The reaching of physical maturity before the period of mental maturity is not an ad-vantage, but may prove a serious disadvantage in life. Hence the standard of average rates of growth may be considered as approximately ideal rates; any falling below this standard is a serious matter that should be at once corrected, but there is no occasion for attempting to stimulate growth at an excessive rate as one might do in the feeding of young farm stock.
You have already learned from the discussion of the chemical nature of foods that protein is the material of growth, and that protein foods vary in quality, those from milk and eggs being the best proteins for human nutrition.
Returning to the subject of the nature of growth foods and the importance of protein in the child's diet, I will call your attention to the fact that it is the quality of protein which needs attention rather than the quantity. Mother's milk is not as rich in protein as the milk of the cow because the young human does not grow as rapidly as the calf. There is no more protein in proportion to other elements
STANDARDS OF NUTRITION AND GROWTH
The chief standards by which nutrition and growth are estimated are three:
1. The relation of weight to height. 2. The annual gain )n weight and height. 3. The general appearance of the child. All school children should be weighed at least every three months—September, December, March and June are the best months. Those who are much below the normal should be weighed at least once every month; better every week. The height should be taken twice a year, at six months' interval; September and March are the best months, each being the beginning of the periods of most rapid growth. The relation of weight to height is the one which is of most value in determining condition. This relation is but little affected by race or country. These tables were prepared by Dr. Thomas D. Wood, of the Child Health Organization.
The most common blunder to be found in writings upon the nutrition of children is this over-emphasis upon the quantity of protein; this frequently leads to the introduction of meat in the child's diet, from which it should either be omitted entirely or used most sparingly. The proper quality and quantity of protein is vital, otherwise no growth can occur, but the unnatural efforts to build the whole diet around protein foods is a grievous mistake.
This blunder of the excessive-use of proteins in the child's diet is due to a little knowledge but an incomplete understanding of food science. Much more frequent are the blunders due to utter ignorance; they include not only the over-use of meat, but the over-use of denatured cereal foods, sugar, pastries and, above all, candies and confections. Such dietetic errors result in the food deficiency which I have already discussed at length in other chapters of this book. But in the case of children an insufficient diet is more dangerous because of the necessity of growth, and also because the smaller body and more rapid vital processes of the child render it less capable of storing up the essential food elements for periods when they are absent from the diet.
The child needs a variety of natural foods; it tires quickly of monotonous and prescribed diets. A child is usually told to eat what is set before him—hence if the child does not like the food set before him he does not eat enough, or makes up the deficiency in quantity by a raid on the jam pots or a trip to the candy store. A child has the right to say something regarding the selection and preparation of his food; many parents will resent this statement, on the ground that the child's ignorance renders him incapable of deciding such a matter. But a parent should remember that a - child's appetite is guided largely by instinct which is controlled entirely, if the child be normal, by the needs of its body. Therefore, the child's own appetite should guide the parent as to its needs. The parent should by all means select the child's food and try to train him in his dislikes and Iikes if his appetite seems abnormal, but the child's instinctive desire should guide in the matter—it should not be forced to eat food that is distasteful. Too often he will go hungry if you insist on his eating food he does not like. One can err either by acceding to the child's acquired taste for a few deficient foods, or by attempting to force the child to eat foods for which he has no appetite. The problem is one that requires tact and patience as well as intelligence. The solution may usually be found in the use of menus that offer a goodly number of natural and wholesome foods, a sufficient proportion of which the child has learned to eat with relish.
There are a few foods, of course, which are so basically important that they cannot be omitted from the diet. First among these is milk and the simple rule is that every child should have as much as it desires of whole milk; it is his chief dependence for the growth protein, the calcium for bone formation and the protective vitamines, though be sure to remember that milk is not needed with full hearty meals in which a large variety of wholesome food has been furnished. Use milk only with "light" meals, composed preferably of sweet fruits.
The leafy vegetables arc riot so important to the child as they are to the adult; they should not however be neglected in the child's diet. The practice of giving children well cooked spinach as soon as they are able to masticate it well has been widely adopted and with excellent results in the case of such children being below their normal nutritive condition. The spinach should be steamed rather than cooked since it loses less mineral salts in steaming. Feeding spinach juice may be begun at the age of one year if the child is not thriving. A tablespoonful a day may be given at this age and the amount may be gradually increased if the child learns to like it. Oranges or other acid fruit should be given daily.
Tender salads with simple dressings should be added to the diet. Cooked greens, especially cooked cabbage, are not so digestible and should come later, though raw cabbage can be especially commended.
Fruit, as well as vegetables should be plentifully used in the child's diet. Prune pulp and apple sauce may be added at quite an early age. As soon as the child has learned to chew his food carefully the sweet fruits, preferably raisins, may be freely given him and should be used to replace the store candies. Nuts which require very thorough mastication, and are not so easy of digestion, should be added to the diet gr aduly, from the fifth to the tenth year.
The chief reliance for much of the fuel foods for the child must necessarily be the natural cereals, but they should not be used to the exclusion of fruits and vegetables.
In the feeding of children the first thought to keep in mind is the necessity of confining the meals to three per day. By all means avoid the baneful practice of "piecing" between meals. That is one of the principal causes of children's ailments. The stomach is supposed to have its regular rest and when it starts to digest it should be allowed to continue the process with-out having additional food introduced in the "middle" of the digestive process.
There is only one exception to this rule, and that refers to acid fruits. Acid fruits like oranges, apples, pears, pineapples, peaches, etc., can be taken at most any time when the child desires them, in moderate quantities. The desire for these fruits, shortly after a meal, frequently indicates the need of additional acid to help digest the meal. Therefore you can safely follow the instincts of a child in its desire for acid fruits, though I cannot emphasize too strongly the necessity of avoiding all other food between meals.
The habit of giving children candies, cakes and delicacies of various kinds between meals should be most strongly condemned. A child cannot possibly maintain health where the "piecing" habit is adhered to unless he possesses extraordinary vital vigor. If parents would definitely understand that by feeding children between meals they are more liable to contract measles, diphtheria, scarlet fever and many other serious diseases, they will perhaps best realize the danger of eating between meals.
As soon as a child arrives at an age when he depends upon solid food, three meals a day should be sufficient for him and at such meals a child's appetite can usually be depended upon as far as quantity is concerned. A child can be allowed to satisfy its appetite at each of these meals with plain, wholesome food only.
The appetite should not be "tickled" and a child should not be encouraged to eat beyond its appetite. Many parents are inclined to worry if a child seems to lose its appetite. This should cause no concern whatsoever, for if the dictates of the stomach are adhered to, it will come back to its "feed" within a reasonable time.
One of my usual practices, when a child loses its appetite for a few days, is to feed nothing but acid fruit for a day or two. After this, as a rule, a child will keenly enjoy solid foods.
A still better plan in many cases, after a child has seemed to have lost its appetite for a few days, is to put the child on an exclusive milk diet, giving it nothing but whole, sweet milk. In this case, a child should be given milk about every hour during the day and allowed to take whatever it may desire at this time. If occasionally the period is stretched to one and a half or two hours, this will be satisfactory. In fact, there is no necessity of adhering rigidly to the every hour idea throughout the entire day. The child can be allowed to take as much milk as it may desire under these circumstances, though it should be allowed nothing else except acid fruit in connection therewith. No other food of any kind should be given with this diet.
Many parents are impressed with the idea that a child cannot be thoroughly nourished on milk. This is a serious mistake as milk with no other food will nourish a child indefinitely. In fact, a rest now and then for the stomach from solid food, with a milk diet, is usually valuable to a child, and adults can also be benefited by a similar regime.
I have known many instances where children have been able to gain weight and strength from a milk diet. In fact, in many instances in which a child does not seem to grow satisfactorily, if a milk diet is given for three or four days, about twice a month, there will usually be a very material gain resulting therefrom.
The diets presented herewith are merely suggestions. They can be varied in accordance with the needs.
DIET FROM THE TIME THE CHILD IS WEANED UP TO ABOUT TWO YEARS OF AGE
Breakfast Half or whole orange or some other acid fruit that is enjoyed.
Whenever the bowels are very loose this acid fruit should not be used. When constipated part of the white pulp of an orange, prunes or raisins are advised.
Choice of the following cereals: crumbles, hominy, rice, oatmeal, corn-meal.
The cereal can be served as a drink by making it into a very thin gruel, though it should be made with milk and eaten with a spoon like soup. It can be sweetened with brown sugar, if desired, though honey or raisins make a much more satisfactory sweetening.
Choice of any one of the following foods:
Vegetable soup. One egg prepared in any manner, frying exccpted. Chopped beef, as in a Salisbury steak, if meat is desired.
With any one of the above foods you can add graham bread, zwieback or whole wheat crackers and baked, boiled or mashed potatoes, with rice.
A dessert can be made of rice, farina, tapioca, custard, etc.
Corn-meal and milk or some other cereal that might be palatable. If a child is very active and is hungry, one egg can be added.
Whole wheat bread, corn bread or zwieback.
If a child does not seem to be thoroughly nourished on a diet of this kind, a glass of milk could be given before retiring and one hour before each meal, if there is a desire for it.
DIET TWO TO SIX YEARS
Acid fruit as may be desired.
Choice of cereals. Crumbles, shredded wheat, cornflakes, oatmeal, corn-meal, etc.
Rich cream soup of some sort, made of vegetables. Beans, peas, barley, etc.
Eggs cooked as desired. Meat, fish or chicken if meat is desired. Chopped beef (top of round steak) is usually the most wholesome and most nourishing kind of meat.
Choice of any vegetable that is especially palatable. Potatoes, carrots, onions, spinach, asparagus, etc.
A dessert can be made of any plain pudding like unpolished rice ; custard, blane-mange or pies can be used made with whole wheat crust.
Candy can be allowed for dessert occasionally or raisins, prunes, dates or any sweet fruit will be more satisfactory.
Soup if desired.
Eggs prepared in any way that may be appetizing. Cereal pudding of some sort,—rice, farina, corn-meal, etc., or stewed fruit.
DIET FOR SIX YEARS AND OVER
Raw acid fruits as desired or stewed fruits. Choice of cereals, shredded wheat, crumbles, oatmeal, corn-meal, etc. Served with raisins, dates, figs or other sweet fruit instead of sugar.
Any kind of nourishing, appetizing soup. Eggs prepared in any appetizing manner. Fish or chicken or meat, if meat is desired. All vegetables in season.
Salads are especially important in a child's diet. as it becomes less active muscularly. Lettuce, tomatoes, cabbage and all sorts of green "stuff" can be made into palatable salads.
Desserts can consist of puddings or pies which can be made with whole wheat crust, or cakes containing a small amount of whole wheat flour or bran.
Stewed fruit or custard.
Baked apples or other stewed fruit.
Eggs in any form desired.
Vegetables with whole wheat bread and butter. Milk or cocoa and some light dessert, if desired.