A dietary suitable for different ages may be drawn up as follows : -
Cows' milk which has been brought to the boil, and slightly sweetened and salted (1-1 1/2 pints daily).
Half a teaspoonful of butter, or two to three teaspoonfuls of cream may be given three to four times a day in the milk. Cod-liver oil.
Two meals in the day may consist of (1) porridge made with milk, or (2) any plain milk pudding, or (3) boiled bread and milk.
The child should be fed every three hours by day and only once during the night (10 p.m. to 7 a.m.).
The milk may be increased to two pints a day. In addition there may be given an ounce of cream, or the yolk of one egg, or bacon fat, daily. Bread and butter are allowed, the former in strictly moderate amount. Cod-liver oil.
In addition to the above, boiled fish, chicken, mutton, biscuits, and green vegetables are allowed. The quantity of milk must be lessened when other foods are added, but the fatty material must be in sufficient amount. Cod-liver oil.
Cod-liver oil holds a prominent place in the dietetic treatment of rickets from its being one of the most convenient forms of giving fat. In one or other form it is usually taken readily by the youngest rachitic subjects, and is easily digested. While it is really to be regarded as a food, it appeals also to the lay mind from the fact that it is sold in medicine bottles. The variety of preparations on the market show that all differences in taste have been consulted. The oil may be given either in the crude form, or in the refined preparation which is commonly sold. As a rule, a good emulsion is to be preferred, as being more palatable, and therefore probably more digestible. The following is the preparation in use at the Children's Hospital, Padding-ton Green.
Sodii Hypoph., Calcii Hypoph. .....
Olei Morrhuse .........
Olei Cassiae .........
Aquam destill. ad ....... .
This emulsion contains 50 per cent of cod-liver oil, and the dose is from 1-2 drachms three times a day. The great advantage about cod-liver oil as a fat is that it can be obtained of reliable quality at a moderate price. Yolk of egg is also an admirable fatty substance, but eggs are frequently expensive and of doubtful freshness. It is not advisable to give a rickety baby the yolks of "cooking eggs" or of eggs which have been preserved for six months. When the freshness of the egg is beyond suspicion, there is no better fatty food for the youngest rickety infant. The yolk may be given raw and mixed in the milk, or may be lightly boiled.