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Page 23
_What should be the guide in deciding upon a formula with which to
begin for a child who is to be artificially fed?_
The age and the weight are of some importance, but the best guide is
the condition of the child's digestive organs. One should always begin
with a weak formula, particularly, (1) with an infant previously
breast fed; (2) with one just weaned, as a child who has never had
cow's milk must at first have weaker proportions than the age and the
weight would seem to indicate; (3) with infants whose power of
digestion is unknown. If the first formula tried is weaker than the
child can digest, the food can be strengthened every three or four
days until it is found what the child is able to take. On the
contrary, if the food is made too strong at first, an attack of
indigestion will probably follow.
_How should the food be increased in strength?_
The first essential is that it be done very gradually; abruptly
increasing the food usually causes a disturbance of digestion.
It is never wise to advance more rapidly in strengthening the food
than from one formula to the next one in any of the series given; with
many infants it is better to make the steps of increase only half as
great as those indicated (page 72).
_How rapidly should the food be increased in quantity?_
The increase should not be more than a quarter of an ounce in each
feeding; or from one and a half to two ounces in a day.
_When should the food be increased?_
In the early weeks an increase may be necessary every few days; in the
later months sometimes the same formula may be continued for two or
three months. It is, however, impossible to give a definite rule as to
time. One cannot say with any child that an increase is to be made
every week or every two weeks. A much better guide are the conditions
present.
The signs indicating that the food should be increased are, that the
infant is not satisfied, not gaining in weight, but is digesting well,
i.e., not vomiting, and having good stools. One should not increase
the food, however, so long as the child seems perfectly satisfied and
is gaining from four to six ounces a week, even though both the
quantity and the strength of the food are considerably below the
average; nor should the food be increased if the child is gaining from
eight to ten ounces a week, even if he seems somewhat hungry. The
appetite is not always a safe guide to follow.
_How can one know whether the strength or the quantity of the food
should be increased?_
In the early weeks it is well first to increase the strength of the
food, the next time to increase the quantity, then the strength again,
etc. After the fourth or fifth month, the quantity, chiefly, should be
increased.
_If a slight disturbance or discomfort occurs after the food has been
strengthened, is it best to go back to the weaker formula or to
persist with the new one?_
Symptoms of minor discomfort are seen for a day or two with many
infants after an ordinary increase in food; but in most cases an
infant soon becomes accustomed to the stronger food and is able to
digest it. If, however, the symptoms of disturbance are marked, one
should promptly go back to the weaker formula. The next increase
should be a smaller one.
_Should one be disturbed if for the first two or three weeks of
artificial feeding the gain in weight is very slight or even if there
is none?_
Not as a rule. If the infant does not lose weight, is perfectly
comfortable, sleeps most of the time, and does not suffer from any
symptoms of indigestion, such as colic, vomiting, etc., one may be
sure that all is going well and that the infant is becoming used to
his new food. As the child's appetite improves and his digestion is
stronger, the food may be increased every few days and very soon the
gain in weight will come and will then be continuous. If, however, the
scales are watched too closely and, because there is only a slight
gain in weight or none at all, the food is rapidly increased, an acute
disturbance of digestion is pretty certain to follow.
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