One of the most important factors in the well-being of any individual is right feeding in childhood, especially in early childhood. One of the chief causes of sickness and death among young children is their wrong feeding. A conservative estimate would be two thousand ill on any one day from this cause. Further, wrong feeding weakens the system so the child is much more susceptible to infectious diseases.

Not only the general health of the individual but also the quality of the teeth, the efficiency of the digestive system, the desire for stimulants, the stability of the nervous system, the quality of mental activity, power of will, strength of character, the happiness or misery of everyday living, are profoundly affected by the foods and régime of feeding during childhood.

The intelligence of the mother or the nurse, the grandmother, the father, and the friend has far more to do with the right feeding of children than does the amount of the family income. The child in the wealthy home is quite as liable to be wrongly fed as the child in the poor home. It is possible to buy enough of the right kinds of nourishing foods for a very small sum.

To feed a child so as to produce one hundred per cent. efficiency in his health to-day and fifty years from to-day should be the ambition of every one who has the care of that child,—not merely to keep him from death or present illness. This is not an easy matter, nor to be learned in a day or a month. It requires careful and earnest study of food composition, food values, the physiology of digestion, dietetics, cooking; and then patience, thoroughness, and practicability to put this knowledge into use three to five times a day, seven days in the week, every week in the year.

The Fundamental Principles of Feeding

Cleanliness and Purity. The following standards are necessary to meet these requirements.

1. Unadulterated foods. Foods unwholesome because of adulteration include:

a. Canned goods preserved with benzoate of soda or other artificial preservative

b. Candies, jams, pickles, containing coal-tar dyes and other adulterants

c. Sulphur-bleached dried fruits and molasses

d. Bakery goods made with preserved eggs, milk, and other adulterants

2. Protection from dust, dirt, and insects. Dry foods, such as bread, crackers, dates, figs should be kept wrapped in moisture-proof paper. Butter, bakery goods, and dried fruits not so wrapped should be kept under glass. Fruits and vegetables should be kept within doors, protected from dogs and cats. Milk, which is most easily contaminated, should be produced in a clean dairy, by clean workers, kept covered constantly, protected from animals, in a cool place.

3. Preparation under sanitary conditions. Bakeries and other food factories and kitchens should be scrupulously clean, with abundance of fresh air and sunlight. All persons handling food should be free from any contagious disease, with clean hands and garments. This factor is even more important than freedom from adulteration.

It is easily possible to-day to ascertain what products meet the pure food requirements. By careful purchasing, and the preparation and serving of food at home by healthy individuals, with intelligent attention to sanitation, these essential requirements of hygiene can be most completely assured.

Regularity. Meals should be served promptly at regular hours, and no food taken between meals. If food is taken irregularly, rhythm is disturbed, the digestive fluids are not ready and cannot act efficiently. If food is taken while undigested food remains in the stomach, the work of digestion must begin over again, as the fluids secreted in the early stage of digestion are different from those in the last stages. Thus the food previously taken is kept in the stomach too long; it ferments, too much acid is produced, sour stomach results, the stomach is irritated, the glands are overworked and become exhausted, and the consequence is poor digestion. To do its best work, the stomach requires rest between feedings.

During sleep, the activity of the digestive tract is very slow. Solid food taken less than an hour or two before bedtime is not well digested and is likely to remain in the stomach and ferment; the pressure produces disturbed sleep and “bad dreams”; the stomach is not ready for digesting breakfast; the individual wakens tired, without appetite, and possibly with headache or nausea. Babies, having only milk, can be fed at bedtime. With children two to six years, an hour should intervene between the light supper and sleep; with older children, from two to four hours.

If a child is regularly hungry between meals, the cause may be (a) insufficient quantity at meals; (b) diet not well balanced—frequently insufficient mineral foods; (c) eating too rapidly so that food is not well chewed and therefore not assimilated; (d) too long intervals between meals. If occasionally hungry between meals, light food requiring little digestion should be given, such as fruit juice, ripe fruit, dates, figs, or a glass of milk. Cake, cookies, candies, or other hearty foods upset digestion.

Simplicity. This applies both to the variety served at one meal, to the method of preparation, and to the serving. A maximum of five or six food items at one meal is sufficient, and is more easily digested than a greater number. Foods simply cooked require less work of the digestive organs than do more complex mixtures; at the same time they cultivate simple tastes, with their contentment.

Cheerfulness. Good cheer is the best of appetizers. Professor Pawlow has discovered that the amount and the efficiency of the gastric juice are affected by the anticipation and enjoyment of food, and that the gastric juice thus poured out at the beginning of a meal, which he has called the “appetite juice”, is the most powerful and active. Happiness and laughter (but not silliness or horseplay) should therefore be encouraged at meals.

A child should not be fed when excited, angry, cross, crying, unhappy, or overtired. Under emotional stress no gastric or intestinal juices are formed, and food cannot be digested. When a child is very tired, the system is too exhausted to do the work of digestion, and nitrogenous foods (such as meat or eggs) taken then are positively harmful, as they only decay. If at mealtime a child is cross simply because he is hungry, feeding will help put him in a happy mood, conducive to digestion. Otherwise, it is better to give only a small quantity of easily digested food, such as fruit juice, thin gruel, vegetable broth, toast, milk.

Sufficiency. This applies to the total quantity of energy and fuel foods, or what is technically called caloric sufficiency; and to the quantity and proportions of each of the food elements, technically called a balanced ration. Careful studies of dietetic needs have been made within the last ten years, and the approximate needs and conditions for different ages are now so well defined that adequate feeding need no longer be mere guess-work.

Caloric Sufficiency. A calorie is the measure of a unit of heat as an inch is a measure of a unit of space. One calorie[18] of heat is the amount that will raise the temperature of a pint of water 4° Fahrenheit. The amount of a given food, as of bread, that would furnish this much of heat when digested in the body is a one-calorie portion of bread,—¹/₁₀ ounce, or a half-inch cube. The total caloric requirement depends upon the amount of bodily heat and muscular energy needed by an individual. This will depend upon the individual’s (1) weight, (2) age, (3) occupation, (4) health, (5) climate. The amount of outdoor life, clothing, the temperament, height, and personal idiosyncrasies will require individual variations from the average.

Daily Energy Requirements During Growth.

Part of this energy is needed to carry on the vital processes, such as circulation, secretion, digestion; during the waking hours, energy is needed for every muscular action, such as walking, dressing, talking, exercising.

Proportions of Food Elements. To furnish what is termed a “balanced ration”, the protein, carbohydrate, and fat should each constitute, in the total calories for the day, approximately the following proportions: protein 10 to 15 per cent., carbohydrate 50 to 60 per cent., fat 25 to 35 per cent. To some extent the fat and carbohydrate are interchangeable, but a great excess of fat or carbohydrate produces indigestion, and great insufficiency of fat starves the nerves. Each gram (about ¹/₂₈ ounce) of protein or carbohydrate furnishes four calories of heat; each gram of fat furnishes nine calories. Without sufficient protein, the child will not increase in growth. An excess of protein is no less injurious, as it cannot be stored in the body, but must be eliminated. Especially injurious is an excess of proteins containing purin-bodies, which produce urea and uric acid, thereby causing forms of kidney disease, gout, and rheumatisms. Excess of food, combined with sluggish elimination, produces putrefaction and fermentation in the intestine, resulting in auto-intoxication from the poisonous gases and chemicals, thereby inducing irritability, nervousness, languor, low resistance to germ diseases, colds.

In childhood and maternity a purin-free diet and one least likely to produce auto-intoxication is especially important.

A sufficient proportion of minerals is no less essential to life and health, although these are needed in minute quantities. Research in physiological chemistry has only recently discovered the vital significance of minerals. The quantities needed in childhood are not yet exactly known. Not only the bones and teeth but each cell and fluid requires mineral matter. The digestion and assimilation of food, the absorption of oxygen and the elimination of carbonic acid gas by the blood, the normal action of the heart, the generation of energy, the sensitiveness and reaction of the nerves, are all dependent upon the mineral supply in the system. There are no less than twelve, the principal ones being calcium, phosphorus, iron, soda, potash, sulphur. Calcium (lime) is especially needed for bones and teeth, phosphorus for growth and for nerve cells, iron for red blood corpuscles, soda for elimination of carbonic acid gas. The daily requirements for a man are:

Lime .7 gram; Phosphorus 2.75 grams; Iron .015 gram.

The allowance for a child should probably approximate this, and growing children probably need more of lime and phosphorus.

Minerals supplied to the body in vegetable and animal tissues or fluids have in some way been vitalized and made organic, so they are readily assimilated by the system. Mineral matter as dug from the earth and purchased at the drugstore is inorganic and is not assimilated either so thoroughly or readily.

Vitamines are equally essential in the food. These are subtle organic substances, as yet little understood, but necessary for perfect assimilation. Cooking, especially at a high temperature or for a long period, usually diminishes the vitamines in foods. This is one special objection to boiled, condensed, and powdered milk, patent baby foods, canned vegetables, canned, dried and salted meats. Children kept exclusively on such foods and boiled water do not thrive. Such a diet produces scurvy. Some fresh, uncooked food, such as raw milk, uncooked fruit or fruit juices, uncooked vegetables, is needed every day.

Laxative elements are also essential. These are (a) cellulose, found in the husk of whole wheat, and the fibers of vegetables and fruits; (b) water, found in milk, vegetables, and fresh or stewed fruits; (c) oil, found in cream, olive oil, and fatty nuts; (d) sugars, found in honey, molasses, dried fruits; (e) vegetable acids, found in fruits.

Hard foods, requiring work of the jaws, are needed every day, especially from nine months to seven years of age, while the first and second teeth are coming. Hard foods exercise and develop the jaws and teeth, and promote a good circulation through the jaws, mouth, and nose. They may be supplied by a chicken or chop bone wiped free of the cooked meat, or after nine months by hard crust, hard toast, zwieback, or educator crackers, given at one or two meals every day. Soft, mushy foods as a steady diet are injurious, not only because they fail to supply the needed exercise and circulation, but also because they cling to the teeth, and by fermenting produce their early decay.

Foods containing growth-producing principles are needed daily. Little is yet known of this factor. Some foods that, according to their chemical composition, would be considered valuable for growth, have been found on experimentation to be lacking in growth-producing properties; among these are corn, bacon, gelatine. Other foods have marked growth-producing results, and among these are milk, butter, eggs, whole wheat.

Foods Permissible for Children at Different Ages. Add each new food gradually, beginning with a mere taste and observing whether it agrees. Eggs, especially white, should be added cautiously, and discontinued if they cause swelling, indigestion, or diarrhea. Raw fruits must be selected with great care, neither overripe nor underripe, nor swallowed in lumps; they are prohibited in diarrhea.

10 months:

• Milk
• Oatmeal or whole wheat jelly
• Rice or barley jelly
• Zwieback, hard toast
• Strained spinach
• Prune juice, prune pulp
• Orange juice, strained, diluted
• Gelatine

12 to 15 months, add:

• Baked potato
• Junket
• Egg yolk hard-boiled, grated
• Coddled egg (½)
• ½ egg (raw) beaten in milk
• Vegetable broth with purée of potato, carrot, or spinach
• Stale whole wheat bread
• Wheatsworth crackers
• Olive oil
• Cottonseed oil
• White grape juice
• Chicken bone or chop bone, cooked, meat scraped and wiped off

15 to 18 months, add:

• Rice boiled or steamed (cooked 3 to 6 hours)
• Oatmeal gruel (cooked 6 to 12 hours)
• Butter
• Baked apple (pulp)
• Date pulp
• Custards

18 to 24 months, add:

• Purée (strained) of fresh peas, dried peas, celery, onions, corn
• Hominy (ground) cooked 12 hours
• Tapioca thoroughly cooked
• Scraped raw apple
• Ripe raw peach
• Strained honey
• Stewed dried peaches, mashed

2 to 3 years, add:

• Young tender peas or lima beans, mashed
• Asparagus tips, stringless beans, chopped fine
• Tender carrots, beets, celery, minced fine
• Mashed potatoes
• Whole wheat breakfast cereal, corn meal, corn bread, bran muffins, macaroni
• Poached egg
• Stewed pear, mashed
• Stewed chopped figs
• Apple sauce
• Oatmeal crackers
• Purple grape juice

3 to 4 years, add:

• Vegetables, diced
• Sweet potatoes, mashed
• Raw, grated carrots
• Cornflakes
• Shredded wheat
• Seedless grape pulp
• Grape fruit
• Ground almonds, pecans, filberts

4 to 6 years, add:

• Purée of dried beans, lentils
• Heart of tender celery (raw or stewed)
• Minced, tender lettuce
• Stewed tomatoes
• Stewed apricots, strawberries
• Whole cooked prunes
• Whole dates, figs (sterilized)
• Ripe banana, scraped and mashed, or cooked (occasionally)
• Peppermints
• Ice cream
• Gingerbread
• Sponge cake, molasses or sugar cookie

6 to 8 years, add:

• Eggs scrambled or omelet
• American cheese (cooked)
• Cottage cheese
• Oysters (cooked)
• Lentils, dried Lima beans
• Raw tomatoes, cress
• Peanut butter
• Seedless raisins, chopped
• Simple preserves, marmalade, jam
• Raw pears, strawberries, raspberries
• Cantaloupe, watermelon
• Simple layer or loaf cake

Foods Injurious to Children. Never to be given under twelve years of age; not advised for any age.

Stimulants: Coffee, tea, beer, wine. These furnish no food value but stimulate the heart and leave serious poisons that injure kidneys, liver, stomach, and nerves.

Condiments: Pepper, mustard, catsup, vinegar, pickles, horseradish. These are irritating to the delicate lining of the stomach; they overstimulate the appetite; they have no food value. Excess of acids extracts needed mineral from the body.

Meats: Pork roast or chops, ham, sausages, canned or dried meats and fish, corned beef, sweetbreads, kidneys, game. All are difficult of digestion.

Pastry: Pie, tarts, dumplings, cream puffs. The combination of fat and starch makes these difficult of digestion.

Rich Foods: Rich cake, puddings, sauces, preserves, and conserves. Excess of sugar or fat overtaxes the digestion and also spoils the appetite for simple, wholesome foods.

Fried Foods: Fried meat, potatoes, eggs; fritters, doughnuts, waffles, pancakes, French toast. Fat so combined with starch or protein delays, even prevents, digestion. Starch requires longer cooking than is possible in frying.

Fresh Baked (less than twenty-four hours old): Bread, rolls, muffins, cake. Rolls or muffins may be served warm by re-heating in oven. Fresh bread or cake forms a sticky mass, very difficult for the digestive juices to dissolve or penetrate.

Not permissible for children under six years:

All difficult of digestion.

• Popcorn
• Soda water
• Ice cream cones
• Peanuts
• Baked beans
• Rusks
• Grocery cookies
• Cucumbers
• Cabbage
• Whole nuts
• Cherries
• Berries

(Some physicians also exclude all cake, candy, ice cream, jam.)

Illnesses Produced by Wrong Feeding. Illness may be due to one of several causes. Wrong feeding is one fundamental cause of ill health and a direct cause of many forms of illness. An excess or deficiency of any one of the food elements, wrong combinations of foods, wrong habits of feeding, lack of cleanliness or purity, improper cooking, may all produce illness.

The general ill health and low vitality from wrong feeding may be due to:

While the exact relation between wrong feeding and some of the specific forms of illness is still a moot question, some of the probabilities now tentatively held by many physicians may be indicated in a general way, as in the following table:

Digestion. In the process of digestion, foods are not broken down into simple chemical elements, as nitrogen, hydrogen, oxygen, but into simpler yet still very complex compounds, as organic minerals (lime, phosphorus, soda), simpler sugars, fatty acids, emulsions, soaps; and the proteins into their many forms of amino-acids and (if these are inherent) purins and uric acid. Soluble minerals, simple sugars, and many drugs are quickly absorbed from the stomach directly into the circulation. Water passes into the small intestine in five to twenty minutes. The solid portions of mother’s milk complete their stomach digestion in about two hours, cow’s milk and other easily digested foods in two and a half to three hours, under favorable conditions. Digestion is continued in the small intestine, where about four hours are required for further digestion; the soluble portion is absorbed into the circulation, and the indigestible remainder, with waste cell material and bile, passes into the large intestine. There the journey is very irregular and slow, requiring from ten to twenty hours. The longer the delay, the greater the fermentation and putrefaction, and the accumulation of putrefactive bacteria and poisonous gases; the poisons, which are constantly being absorbed into the system, produce auto-intoxication. About half the solid waste is bacteria and waste cell tissue.

Food Composition. Every one who is responsible for the feeding of children should be thoroughly acquainted with the different food substances and the composition and value of common foods. For practical purposes of dietetics, foods are analyzed into their content of protein, carbohydrate, fat, mineral, cellulose, water. Some foods contain only one or two of these elements; other foods contain them all.

1. Protein foods are those that contain nitrogen; their special use is to build new body cells (for growth) and to replace waste of tissue; they also furnish energy. Proteins differ in value according to the number and the kinds of amino-acids in their composition.

Foods containing high percentage of protein:

Eggs
Milk
Cheese
Cereals
Almonds
Peanuts
Peas
Beans
Lentils
Fish
Lean meat

2. Carbohydrates (sugars and starches) furnish bodily heat and muscular energy.

Foods containing high percentage of starch:

Potatoes
Rice
Cereals
Tapioca
Macaroni
Farina

Foods containing high percentage of sugar:

Sweet fruits
Dried fruits
Beets
Carrots
Honey
Maple Syrup
Molasses
Barley sugar
Cane sugar

Starch digestion begins in the mouth by the action of the saliva and is completed in the intestines. Starches are changed to a form of sugar. Excess of carbohydrates is stored in the liver or as fat through the body.

3. Fats furnish energy and heat.

Foods containing high percentage of fat:

Cream
Butter
Egg yolk
Olive oil
Cottonseed oil
Nuts (except chestnuts)
Meat fats

4. Minerals are found in grains, in fruit, green vegetables, milk, eggs, meat.

Calcium and phosphorus are furnished in high percentage by:

Grape juice
Orange juice
Rhubarb
Maple sap
Milk

Calcium, phosphorus, and iron are all supplied in high percentage in:

Spinach
Celery
Peas
Lima beans
String beans
Apples
Prunes
Peaches
Pears
Dates, raisins
Whole wheat
Whole cereals
Egg yolk
Lean meat (except calcium)

While milk contains only a low percentage of iron, it furnishes a high proportion of the day’s supply in children’s diet, because of the total quantity used.

Valuable mineral material in many fruits and vegetables is just beneath the skin. It is dissolved into the water if these foods are boiled. The mineral matter is conserved by baking, or stewing, or steaming, by cooking without paring, or by using the water in which they are boiled.

The mineral matter is in the germ and the husks of grains. Refined foods, such as white flour and sugar, polished or puffed rice, processed barley and corn meal, cream of wheat, cornstarch, sago, from which the husk has been removed, have been robbed of their mineral matter. The whole ground grains and brown sugar retain the minerals.

5. Water, a necessary part of all tissues, constitutes about sixty per cent. of the body weight. It promotes circulation of the blood and other internal fluids, dissolves poisons, aids elimination of waste through urine, feces, and perspiration. Water is best taken half an hour before meals, and at the close. If taken with the meal, it should be only after food in the mouth has been swallowed, that it may not interfere with the action of the saliva upon the food. Ice in water makes it too cold for the stomach, and unless artificial, is apt to contain dangerous impurities. Water should be sipped, warmed in the mouth before being swallowed, and not more than one glass taken at a time. Water is supplied in:

Milk
Cocoa
Broths
Fruit juices
Fruits
Green vegetables

Water constitutes about 65 per cent. of meats, 80 per cent. of fish, 90 per cent. of fresh fruits and vegetables.

6. Cellulose. The indigestible cellulose and fibers in food furnish a bulk of waste which stimulates the intestines to muscular action. Supplied in:

Whole wheat
Whole cereals
Prunes, dates
Figs, raisins
Fibrous vegetables as celery, spinach, onions, carrots, beets, peas, beans
Skins of apples, pears

Cellulose is lacking in concentrated foods, as cheese, nuts, sugar, butter; refined foods, as white flour, cream of wheat, cornstarch; in liquid foods.

Laxative Foods:

Figs
Dates
Prunes
Orange
Apple
Raisins
Peach
Plum
Rhubarb
Grapes
Whole wheat cereals
Whole wheat bread
Whole wheat crackers
Corn meal
Bran muffins
Peanut butter
Pecan nuts
Gingerbread
Molasses
Honey
Onions
Spinach
Olive oil
Cottonseed oil

Purin Bodies in Common Foods. Purin bodies are found in some protein foods. Purins are uric-acid forming. The poisons of purins are believed to be productive of gout, rheumatism, migraine and periodic headaches, bilious attacks, catarrhs, neurasthenia, and general ill-health of an indefinite nature.

Acid-forming and Alkali-forming Foods. The blood contains some acids and some alkalies. For physical efficiency, the balance should be slightly alkaline. In the process of digestion minerals are oxidized into their chemical constituents of acids or alkalies. An excess of acid interferes with the normal alkalinity of the blood and secretions, prevents the normal absorption of oxygen and elimination of carbonic acid gas by the blood, hinders the work of the white blood corpuscles, irritates the nerves, lowering, therefore, the resistance and vitality, and irritates the kidneys. In the dietary, care should be taken to include alkali as Well as acid-forming foods.

The Question of Meat. Some authorities on dietetics now advise against giving meat in early childhood. Wiley and Mendel advise waiting until about four years, Sherman and Lorand until about eight.

The following objections are made to meat in children’s diet:

(1) It has a high percentage of purin bodies, which the child’s organism is less fitted to dispose of.

(2) It is acid-forming to a high degree.

(3) “Meat proteins are much more susceptible to putrefaction in the intestine, giving rise to absorption of putrefactive products which are more or less injurious (producing ‘auto-intoxication’) than are the proteins of most other foods.”[21]

(4) It is stimulating to the flow of gastric juice, especially the extractives, which are found particularly in meat juices, meat broths, beef tea. As an acid-forming food it is stimulating, and easily irritating, to the nerves, and therefore is disadvantageous with nervous children, or when the nervous system is yet highly sensitive, as it is in early childhood.

(5) Carnivorous animals, such as the cat and the dog, do not permit their young to have meat until the teeth are developed. Meat given experimentally to young kittens produced convulsions.

(6) It is an expensive form of protein. Beef juice contains chiefly the stimulating extractives, and a slight quantity of iron.

(7) Protein in milk, selected vegetables, and (usually) eggs, is more easily digested; and iron can be supplied by selected vegetables and fruits.

The following table gives approximately the comparative value of a 100-calorie portion of beef juice (requiring 3½ pounds of lean beef) and an equal bulk of milk.

The meat at twenty-two cents a pound costs seventy-seven cents; the milk at ten cents a quart costs five cents. One pound of meat will give little more than one fourth of this food value; one ordinary serving (2 ounces) only 3 per cent. of the above values.

Physicians, on the other hand, more often advise meat, especially for the iron and the stimulation to digestion.

The Question of Sugar. Sugar is a concentrated form of fuel food. Children need much of fuel foods, but this can be given in the form of fats and starches as well as sugar. Sweet easily spoils the appetite for plain, more wholesome foods, and gives a sense of sufficiency before the needs of the body have been satisfied. Children whose taste has been spoiled by sweetened food are more likely to show a distaste for wholesome vegetables. Sugar taken between meals or in excess at meals is irritating to the sensitive lining of the stomach. Sugar excess causes fermentation in the stomach and intestines, overtaxes the liver, reduces the normal alkalinity of the blood, produces nausea, headache, biliousness, irritability, nervousness. It injures the teeth by causing mouth acidity, which produces tooth decay, and by causing distaste for simple lime-containing foods. The peevishness and irritability of children after an overdose of candy is very likely due to the indigestion and the hyperacidity of the blood, which irritates the nerves.

Cane sugar and candy lack the mineral matter found with sugar in the natural syrups, fruits, and vegetables. The necessary amount (and it is small) of sugar should therefore be given to young children in the form of fruits, at the close of the midday meal. It is advantageous to the child’s efficiency and contentment not to have candy or ice cream under four years of age, and he will thrive without them until ten years. When allowed, they should be given only in slight amount as a dessert at the close of dinner, and not between meals.