The science of feeding infants and children has advanced so during the present generation that few now need die through failure to suit the diet to the child. With this increase of scientific knowledge in feeding, has also come, for some reason or other, a marked increase of cases with anorexia or poor appetites. It has become one of the big problems of the pediatrician and the general practitioner as well. This is seldom found in the children of the poorer classes, the free clinic, etc., but in the children of the well-to-do whose children have had everything that money and science could supply. I do not intend to talk about the children with a pathological cause for their lack of appetites, but about the ones who have apparently no reason for it. In these cases anorexia is a symptom and not a disease entity.
In many homes with little ones, parents and children are engaged in constant battles at meal times in which the children are usually victorious. As a result of this we find many undernourished children who have developed marked behavior disturbances, and many worried, anxious and worn mothers and nurses; as well as indignant fathers. Many mothers become nervous wrecks and lose much of the joy and pleasure in their children from this constant agitation over the dinner table, because they cannot get them to take what they think is sufficient food.
There are many things that have helped to cause this trouble. School nurses and doctors have paid too much attention to a average weight charts. Notices are sent home from school that their child is so many pounds underweight. The parents immediately begin trying to make them eat more in order to bring them up to average weight. This attempt to make all children come up to given standards for age, weight and height are not only futile but they are positively dangerous to the physical and mental development of many children.
Hereditary differences cause variations in weight and stature which are beyond our control. Children usually take after one or the other of their parents. If they are inclined to be stout, it is almost impossible to hold down their weight, and if they are inclined to be slender, it is just as difficult to make them gain. Children vary tremendously in their ability to assimilate food as well as in their ability to utilize it economically after assimilation. Childrens appetites vary in amount of food needed as much as automobiles vary in the number of miles per gallon on gasoline.
One child will eat enormous quantities of food and remain thin, while another will not eat one-third as much and take on weight. Appetite is the best gauge for indicating the amount of food a child should eat. The one thing that will make children lose their appetites, above all others, is to try to force food on them.
The giving of milk between meals at school is a mistake if the child has a poor appetite, even if they are below weight. Milk is one of the foods which passes out of the stomach very slowly. It may remain in the stomach until lunch time and thus prevent hunger contractions. If food is given between meals it should be such that it can be easily and quickly digested. Fruits meet this requirement best. It is all right to give milk to the underweight child between meals if he has a good appetite at meal time.
I do not believe that a newborn baby should be given anything but water as a general rule before the milk comes into the breast. There has been a tendency the last few years to start feeding a baby right after birth to prevent the initial loss of weight. This prevents hunger and makes the baby less aged for the breast and may be the start of a poor appetite.
Temperance in eating helps to stimulate the appetite and intemperance to destroy it. Overfeeding of the infants tends to destroy his subsequent appetite. From earlier infancy the baby should be given a meal which will be finished hungrily. If we are to develop good appetites, we must be careful not to overfeed the baby. Rarely should an increase in the formula be made unless the child is completely emptying each bottle. A baby who is making an average gain in weight should not have an increase in food unless he is ravenously hungry. A steady gain in weight is more to be desired than a rapid one. A small baby may be physically superior to the fat one.
The weaning period is often the beginning of anorexia. Where it is possible a baby should be weaned gradually. If he refuses to take food, it is better to take drastic steps and allow the baby to become acutely hungry before offering him any food, rather than to try gradual reduction as it may prevent future trouble. After a preliminary starvation of eight to twelve hours, it is advisable to offer the baby two ounces of skimmed milk. If he takes this and seems hungry for more, three ounces may be given at the next feeding. This should be gradually increased attempting to lag behind the childs appetite in the amount of food offered. After a few days he will emerge a wiser though hungry child with a good appetite. If you keep trying to fore food on him, he emerges from the weaning period with no appetite.