Feeding Intervals

Long intervals between feedings are indicated here still more strongly than in breast feedings. Cow's milk leaves the stomach more slowly, an ordinary feeding requiring at least two and a half, and more commonly three hours, a large feeding even longer. Three hours would seem, theoretically, a minimum interval, and four hours a better average interval between feedings. Experience has amply confirmed this theory in practice.

Quantity Of Milk

The quantity of milk given during the twenty-four hours is even more important than the strength of the food. Overfeeding in general, or with one or the other food element, is the greatest factor in the production of nutritional disturbances in infancy. The prevention of overfeeding is, therefore, of the greatest importance in feeding babies. One must watch them carefully for the evidences of overfeeding that are commonly easily recognizable (see next chapter). Not the least of these is too rapid a gain in weight. A gain of eight to twelve ounces a week, in artificially fed babies, is not a thing to be proud of, but rather to be considered and heeded as a warning. Of very great value, further, in all cases, and especially in those that cannot be watched carefully, are certain numerical measures of food requirements that serve as approximate guides to the amount of food to give healthy babies. Thus it has been found, when using such dilutions and modifications as above recommended, that the amount of milk in the twenty-four-hour mixture, taken by healthy, thriving infants, usually lies between one and one and a half ounces per pound of baby, with an average of about one and a quarter ounce. The first amount is commonly too little to gain on properly, and distinct evidences of overfeeding usually arise before the maximum amount is reached. We would expect, then, to find a normal infant of twelve pounds to be taking between twelve and eighteen ounces of milk in its twenty-four-hour mixture, with an average amount of about fifteen ounces.

Calorimetric Control

Equally useful and applicable to all kinds of food mixtures is a calorimetric control advocated by Biedert, and elaborated and popularized by Heubner, of Berlin. Heubner found that normal thriving breast-fed babies took about 100 calories per kilogram of body weight daily during the first few months of life; that after the sixth month this so-called energy quotient gradually sank to 80 or 85 at the end of the first year; and that 70 was the approximate energy quotient on which a baby would neither gain nor lose. Experience has proved these figures to be of immense practical value, as indicating the maximum amount of food that an infant should be allowed to have. They should be used - and this applies equally well to the milk-volumetric guide above - as a check on overfeeding and underfeeding, and not as an advance measure of the amount to give. They tell us not how much to give so much as how much not to give, and apply only to well babies, and are used only as an adjunct to careful clinical control. We have not, then, a system of infant feeding, but a valuable aid in infant feeding. By keeping tab on an infant's energy quotient, we can, on the one hand, be warned when we are approaching or exceeding an amount that usually gives evidence of overfeeding; and on the other hand, we can prevent an all too frequent condition of prolonged unrecognized underfeeding on a cereal water, or skimmed milk, or other mixture of low food value.

The practical application is very simple. It is only necessary to remember the caloric value of one ounce each of the usual ingredients of food mixtures, and from these and the baby's weight to calculate the energy quotient. Thus the caloric equivalent of one ounce of cow's milk, or human milk, may be placed at 21; of sixteen per cent cream at 54; of fat-free milk at 10 or 11; of sugar at 120; of flour at 100; of barley water (one ounce to the quart of water) at 3; of "baby foods" at about 110. If a baby of ten pounds gets milk, 12 ounces; barley water, 16 ounces; milk sugar, 1 ounce, the energy quotient is calculated as follows:

The energy quotient is, of course, equally well expressed in calories per pound, and our figures corresponding to 100, 80, and 70, would be 45, 36, and 32. The former is retained because it is commonly used in the literature on the subject.

After a little experience this calculation can be made in simple mixtures without paper and pencil, and after a time the energy quotient can be estimated very closely at a glance. In such mixtures as here advocated, it will be found that the calorimetric and milk volumetric guides run quite parallel.

In feeding a baby on cow's milk for the first time, it is always best to begin with a small amount and gradually, under clinical control, proceed to a satisfactory amount of food. For example, a normal, well baby of twelve pounds is to be fed artificially. Five feedings of six ounces each would seem an appropriate amount for each twenty-four hours. We might start with milk ten ounces, barley water twenty ounces, milk sugar one half ounce, and watch the result. The milk and sugar can then be increased gradually, depending upon how well it agrees with the baby, until at the end of a week or so the child is getting, say, milk, fifteen ounces; barley water, fifteen ounces; milk sugar, one ounce. This seems to agree with the baby, and from a milk standpoint (one and a quarter ounces to a pound), and from a caloric standpoint (e.q. = 88), we feel satisfied and wait for a week to see if it gains. If it gains four or five ounces and seems well in every way, we leave this food unchanged until the gain is no longer satisfactory. Then we slowly increase the food again all the more cautiously, because we are approaching figures that we have learned to regard as warnings.