THE FEEDING OF HEALTHY CHILDREN.
What has been said in the theoretical part about the feeding and the metabolism of the child after the first year of life will give us an indication of the difficulties which we meet in practice, and which will be the greater as three obstacles have to be considered against which we are more or less powerless. As stated above, our directions may fail to be carried out owing to the poverty of the parents. and in the large fami lies of the poor it will frequently be impossible to provide the diet we have to prescribe. The lath' "proles" means a family of many children and from this word proletariat is formed. But even in families a little higher in the social scale, or rather in better circumstances, it is fre quently difficult to feed a family sufficiently, and the physician must therefore always consider the pecuniary circumstances of his clients, and he must never forget that in a large majority of his patients he must try to provide the necessary diet at the least expense. We must always avoid prescribing anything which might be done more cheaply and it really is less difficult to get. up a cheap menu for a child than for an adult.
The next. obstacle and one that is equally hard to surmount is the parental or, better, the maternal ignorance, and this is by no means con fined to any social stratum and is just as frequent among the rich as it is in the middle and lower classes, and it. will be so until scientific feeding is made part of the teaching and training of our girls.
In trying to regulate a child's diet we will meet with two forms of maternal stupidity, first in that it is very difficult. to elicit by question ing what and how much a child gets to eat and frequently we have to waste much time in listening to the oft repeated statement that the child eats "nothing" and only careful inquiry will reveal to us of what this "nothing" consists, and we will also frequently find that the child knows more than its parents and that it instinctively resists their foolish at tempts at stuffing it. We must, therefore, in determining how a little patient ha's been fed so far, always insist on details as to kind, amount and preparation of the diet, and as stated before, it is by no means easy really to learn how the child was fed and we frequently feel the need of a clever attorney to elicit all the facts.
We also find that it is by no means easy to make mothers adhere strictly to our on IVI'S and the more exact we are in giving them our instructions as to time, kind, amount and preparation of food and drink.
and the less we leave to the women themselves. so much greater will be our success. It is often advisable to write down our dietetic direc tions in the form of a prescription and to give them to the mother, and we will thus enhance their importance and avoid confusion. Notwith standing this we will frequently meet. with failure owing to the fact that mother, grandmother, nurse or any other important member of the family declares that this Or that is too heavy or not nourishing enough or too much or too little, and simply change our diet list In no other part of our daily practice do Ive need more firmness in resenting meddling and interference with our orders.
Usually the child itself has to serve as an excuse; it did not want this or that, or it wanted something else. or it was still hungry, etc. We will easily understand that suggestion plays an important r6le in this, though We IIlust realize -and this leads us to the third diiiicultv—that individual differences have to be considered in children the same as in adults, and that by adhering stubbornly to any fixed diet we \\•111 never succeed with children.
Dyes in small children we frequently find that their tastes are quite developed and that we must individualize, though the physician must never be guided by ev'iv whim on the child's part especially as it is frequently just this capriciousness in eating or in refusing its food which is the pathological factor, and our will power must overcome the will of the child and our suggestive powers must over-rule those of the child's surroundings. Nobody, however, who knows anything of children will deny that we will never he able to overcome certain of their likes and dislikes of foods; we must consider idiosyncrasies and it is frequently part of our duty to find out if we have to deal with an innate psychical or physical aversion to certain foods or simply with whims and naughti ness. Careful observation and treatment in a hospital aid materially in this. and in no other branch of pediatrics does treatment in a hospital or sanitarium give better results than in these cases where we have to regulate the diet, and we will here frequently succeed in the shortest time where we had failed at home. We must naturally insist that the children arc not accompanied by their mother or own nurse, as otherwise we will lack one of our most important psychical influences.