We have been considering hitherto the food materials suited to an infant during the first stage of life which terminates at nine months. This epoch is marked by the eruption of the first tooth, which is supposed to indicate the time for weaning.
In the case of breast-fed children the ordinary time to commence weaning is at the age of eight or nine months. At the same time if the mother has plenty of milk and is healthy, and if the infant is thriving and satisfied, there is no harm in continuing the process until the child is twelve months old. Under certain conditions it may be advisable to do so, for example in the middle of the hot season, when it is so difficult to obtain fresh pure cows' milk. Also if there have been serious feeding difficulties in the earlier stages of the nursing, the weaning may be deferred as it will probably be a time of further difficulties which the infant will be better able to meet later on.
If it has been decided on medical grounds that weaning is advisable it should not be deferred because "the baby won't take anything but the breast." This is purely a figment of the maternal imagination, and history does not relate any example of a healthy infant committing suicide by refusing bottle food. The weaning process should be carried out gradually and may be spread over three weeks or a month, so as to accustom the infant and its digestive organs to the change of food. Cows' milk, in one of the modifications described, should be given. A mixture of milk, cream, and malt extract will be found suitable, diluted with an equal amount of plain water or barley-water to begin with. The time selected for the first bottle should be one when a healthy appetite is present, increased perhaps by an added feeling of hunger from a longer fast than usual. The infant will then be less critical about the change of nourishment and feeding apparatus. In some cases a considerable amount of patience and perseverance will be called for. After weaning other foods may be added as in the case of bottle-fed babies.
The bottle-fed baby has no weaning process to pass through at this age. By some it is held that before the age of nine months an infant should have some farinaceous food in addition to cows' milk, but as a rule this is neither necessary nor desirable in the case of healthy infants. In some cases such food may be ordered medically, as for example in the presence of indigestion or constipation. Cows' milk supplies all the physiological requirements of an infant up to the age of nine months. For the following three months no other food is absolutely necessary, but the digestive organs are now capable of dealing with carbo-hydrate material in some other form than sugar alone. The great change at this age is the addition of other carbo-hydrate material to the diet, but this is to supplement and not to replace cows' milk. While both the quality and the quantity of the added carbo-hydrate are important, the chief danger lies in the latter. The tendency of mothers and nurses is to increase the amount of carbo-hydrate too rapidly, in the belief that the more it takes the stronger will the child be. Thus the digestive organs may be overtaxed and the tissues may be loaded with an excessive amount of carbohydrate material.
The cereals in common use at this stage are wheat, barley, and oats. Oatmeal porridge, although largely used in Scotland, seems to be regarded with distrust in England. It is considered to be "heating" - a somewhat vague term - and to be responsible for the production of spots on the skin. The real drawback to its use is that it requires prolonged boiling to be thoroughly digestible and this may explain its unpopularity in certain quarters. The question of easy and rapid preparation is an important one in many households and largely determines the nature of the food to be used. As a first addition to the diet, we may begin with one of the good proprietary foods for infants, in which the starch has been converted, e.g. Mellin's, or Savory and Moore's, or Benger's. When this is tolerated, we may change to wheat flour or prepared barley, or bread, or bread jelly prepared according to Dr. Cheadle's formula, or milk pudding.
The preparation of wheat flour, according to Dr. Eustace Smith, is as follows : A covered earthenware jar filled with the flour is put in a slow oven. From time to time it is removed, and the contents stirred up from the bottom and sides so as to prevent the formation of hard lumps. When thoroughly baked the flour forms a soft greyish-coloured powder. For each meal one teaspoonful of the prepared flour is rubbed up with a table-spoonful of cold milk into a smooth paste. A second spoonful of cold milk is then added, and the rubbing is repeated until the mixture has the appearance of a perfectly smooth cream. A quarter of a pint of hot milk or milk and water is then poured upon the mixture, to the accompaniment of brisk stirring, and the food is ready for use. It may be sweetened with extract of malt instead of sugar.
Prepared barley is cooked as follows : A tablespoonful of the ground barley is added to a pint of cold water and the mixture slowly boiled down to half a pint. Of this a dessertspoonful may be added to 6 oz. of milk for a meal. It is preferably sweetened with malt extract. It will be noted that barley-water as a diluent of milk for infants is different from the above and is not used for its nutritive properties.
Bread and milk is prepared as follows : A slice of stale bread without crust is soaked in a basin of cold water for two hours; the water is then poured off, the bread is beaten up, and over it is poured a quarter of a pint of boiling milk. This may be sweetened with sugar or malt extract.