Chapter 3

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.