At first one feeding a day of plain milk and barley gruel may be given; later, two feedings; then three feedings, etc.  Let us suppose an infant to be taking such a modified milk as Formula IV or V (page 76), six feedings a day.  The plain milk diluted only with barley gruel would at first replace one of these feedings; then two, three, four, etc., these changes being made at intervals of about two weeks.  The proportions of the milk and barley gruel should at first be about 5-1/2 ounces milk, 2-1/2 ounces barley; later, 6 ounces milk, 3 ounces barley; still later, 7 ounces milk, 2 ounces barley, until finally plain milk is given to drink and the cereals given separately with a spoon.  This is reached with most infants at fourteen or fifteen months; with many at twelve or thirteen months.  Other forms of farinaceous food may of course be used in the place of the barley, and in the same proportions.

With some infants the addition of a pinch of bicarbonate of soda may be advantageously made to each milk-feeding when the lime-water is omitted, but with most this is unnecessary.

If the infant strongly objects to the taste of the milk when the milk sugar has been omitted, a small quantity (one fourth to one half teaspoonful) of granulated sugar may for a time be added to each feeding, then gradually reduced.

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).