General Rules for Guidance in the Use of the Formulas Given

It should again be emphasized that these formulas are not intended for sick children nor for those suffering from any marked symptoms of indigestion. For such infants special rules are given later.

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.

Is not constipation likely to occur if the child is on a very weak food?

It is very often seen and is due simply to the small amount of residue in the intestine. Under these circumstances, if the bowels move once every day, one should not be disturbed even when the movements are small and somewhat dry. As the food is gradually strengthened, this constipation soon passes off; while if injections, suppositories, or cathartics are used to produce freer movements, the functions of the bowels are likely to be disturbed.

Under what circumstances should the food be reduced?

Whenever the child becomes ill from any cause whatever, or whenever any marked symptoms of indigestion arise.

How may this be done?

If the disturbance is only a moderate one and the food has been made up for the day, one third may be poured off from the top of each bottle just before it is given, and this quantity of food replaced by the same amount of boiled water.

If the disturbance is more severe, the food should be immediately diluted by at least one half and at the same time the quantity given should be reduced.

For a severe acute attack of indigestion the regular food should be omitted altogether and only water given until the doctor has been called.

If the food has been reduced for a disturbance of digestion, how should one return to the original formula?

While the reduction of the food should be immediate and considerable, the increase should be very gradual. After a serious attack of acute indigestion, when beginning with milk again, it should not be made more than one fifth the original strength, and from ten days to two weeks should pass before the child is brought back to his original food, which should be done very gradually. It is surprising how long a time is required with young infants before they completely recover from an attack of acute indigestion, even though it did not seem to be very severe. The second disturbance always comes from a slighter cause than the first one.