The alterations in the diet at this period are as regards the quantity rather than the quality of the food materials. The active exercises which characterize a child at this age call for an increased amount of carbo-hydrates and of proteins, in other words of energyproducing and muscle-forming material. The meals should be three in number and no feeding between meals should be encouraged. At the same time if the child is really hungry, a piece of dry bread or biscuit with an apple may be given occasionally. It is a parent's duty to satisfy the appetite of the child, not to try and coax it with sweets and strongly flavoured delicacies.
Milk should still be an important part of the diet, either plain or in puddings or with cocoa. Tea and coffee should be deferred until the latter part of this period, and then should only be used as a flavouring to the milk. Eggs and butter and cream should also form a regular part of the diet.
The proteins of meat are very digestible and very appetizing but must not be given in excess owing to their stimulating properties. A little minced or finely cut beef or mutton may be given every second or third day. Fish in the form of boiled or steamed sole, whiting, haddock, herring, or cod is more suitable. Chicken, rabbit, calf's head, and game which is tender but not high, will be found to be palatable and to lend a sufficient amount of variety in the diet. Meat soups should not be made strong. A small amount of meat stock may be used as flavouring to make vegetable soups with carrots, turnips, rice, cabbage, potatoes, etc. For a few years these may be given after straining, but later all the vegetables present in the soup may be taken. Beef essences, meat juices, and prepared concentrated foods are not required by children in health. The training in mastication should be perseveringly continued by the use of some hard articles of food. Until this is learned it may be necessary to give meat in a pounded, minced, or shredded form. The habit of bolting the food, acquired from the fluid diet of infancy, must be checked, and a slow methodical habit of eating should be acquired early in life.
Bread forms a most important element in the diet. The amount of bread and butter or jam that an active four year old child will consume at a meal is astonishing. Care must be taken, however, that the butter or jam is not the element which makes the bread go down. White or brown bread may be used and it should be at least twenty-four hours old. It may be plain, or toasted. All plain biscuits are also to be allowed, sweetened ones being regarded as an occasional luxury.
All the cereals are useful. Porridge, oatmeal or hominy, with milk, syrup, or sugar. Farinaceous puddings of all kinds. If well cooked, puddings are readily taken by children.
Of fresh vegetables the potato is the most popular, and in fact it is the only one which young children do not tire of. Potatoes may be given plain boiled, or mashed, or fried. Cauliflower, cabbage, spinach, asparagus, tomatoes, and peas may be given. All tinned vegetables are to be avoided.
The natural demand of the organism for sugar must be fully satisfied, and it is better to do so by the use of sugar in the food than by the artificial products of the manufacturer, which are often taken in excess apart from meals. Puddings and stewed fruit can be suitably sweetened. Honey, syrup, and jam can be taken with bread, biscuits, and puddings. At the same time it is not advisable to ruin the taste for plain foods by oversweeten-ing a number of the dishes.
Fruits contain a considerable amount of sugar in a very assimilable form. They also contain certain elements which are of especial importance in maintaining a healthy condition of the blood. Grapes, oranges, apples, bananas, pears, cherries and plums are suitable. They should form part of the regular diet of the child, so that some fruit is taken every day. In hot weather it will be found useful to reduce the amount of the more substantial elements of the diet and to increase the amount of the fruit and vegetables. Special care must be taken to ensure that the fruit is in proper condition, i.e. neither unripe nor too ripe, as unwholesome fruit disturbs the alimentary tract most seriously. Tinned fruits should not be used as a sufficiency of fresh fruit is always obtainable.