|
Introduction
to Infant Nutrition
|
Prior to the twentieth
century, if a mother could not or would not breast feed her child, the
infant faced two formidable risks-the risk of inadequate nutrient intake
and that of contaminated milk and water. Wet nursing was a substantial
career for some women, and the wet nurse was often seen both as a mother
surrogate and as essential to the survival of the child. Although physicians
were almost unanimous in their support of breast-feeding, they regularly
encountered infants receiving other nourishment. It was not always possible
to find a satisfactory wet-nurse and mothers and physicians struggled
to create substitute sources of milk for the infant (Still, 1931; Wickes,
1953).
The problem of creating
an adequate breast milk substitute occupied much of the attention of
certain physicians during the last half of the l9th century (Cone, 1976;
Cone, 1979). Experience was their primary guide and, as is often the
case, it seemed to lead them in differing directions. Although cow's
milk was the basis of the most common substitutes, goat's milk was strongly
advocated by some practitioners. Some believed in the combination of
cereals and milk and all had certain favorite formulas that they recommended
to their patients (Wood, 1955).
Toward the end
of the 19th century systematic research began to provide reliable information
that could be applied to the artificial feeding of infants. Arthur Meigs
in Philadelphia, as well as certain European physicians, developed extensive
information on the basic composition of milk from various sources (Meigs,
1887; Levinson, (1928). This provided the basis for "percentage feeding",
a system popularized by Thomas M. Rotch (1896; 1903; 1907) at Harvard,
whereby cows milk was modified to yield a composition similar to that
of human milk. From about 1890-1910, this method (sometimes called the
"laboratory" or the "American" method) dominated more sophisticated
pediatric practices. Nonetheless, it was complicated and required reliable,
and often expensive, sources of milk, cream and lactose. Some physicians,
such as Jacobi, were not convinced of its efficacy. Moreover, there
was lack of understanding about the digestibility of the fat and protein
in cow's milk. This led to inappropriate modification of milk in some
cases (Holt, 1903; 1925).
A reliable and clean
source of milk was of major concern to those who were creating artificial
formulas for infant feeding (Cheadle, 1889; Rotch, 1896. Especially
in the summer, diarrhea due to contaminated milk was far too common
and the result was much higher infant mortality in the summer months.
Pasteur's well-known work on bacterial contamination was reported in
the 1860s but the adoption of pasteurization of milk was not widespread
in the United States until after World War I. To address the problem
of cleanliness in the 1890s, certified milk was introduced and soon
became available from milk laboratories in the major cities (Waserman,
1972). In Boston, and later in certain other major medical centers,
laboratories that could supply modified milk to fit a physician's prescription
were established (Rotch, 1907). They operated much like specialized
pharmacies, filling very precise prescriptions for the composition of
the milk to be fed to infants from well-to-do families. Poor families
could neither afford the medical advice nor the expensive products of
these laboratories.
By 1920, the advances
of nutrition science were ready to be applied to infant feeding. Percentage
feeding had fallen out of favor because it was too complicated and there
was little evidence that it was greatly superior to simpler systems
of milk modification. Moreover, pasteurized milk had become widely available
and the incidence of infant diarrhea had greatly diminished. In addition,
Otto Heubner and Max Rubner (1899) in Germany had provided experimentally
based information on the caloric needs of infants. Their data formed
a scientifically based standard for feeding, a standard based on calories
rather than the more elaborate percentage feeding schemes.
Scurvy and rickets,
however, were epidemic in certain American infant populations, as they
had been in parts of Europe for over a century. The American Pediatric
Society (founded in 1888) focused on scurvy, creating a system to summarize
the current knowledge of cases (Cone, 1976). Later, Alfred Hess (1920;
1929) in New York City was a leader in demonstrating the value of orange
juice and cod-liver oil in treating or preventing these diseases. Improved
sanitation plus adequate attention to nutritional needs resulted in
much lower mortality among those infants who were artificially fed.
Additional advances
were made in finding ways to simplify the modification of milk for infants
so that mothers or other care-givers could easily make the appropriate
adjustments themselves. McKim Marriott in St. Louis was a strong and
influential advocate of the use of evaporated milk as the basis from
which simple modifications could be made (Marriott and Schoenthal, 1929).
Phil Jeans in Iowa City provided leadership within the American Medical
Association in providing up-to-date information to physicians regarding
nutrient needs of infants and how to supply them.
From the mid-1860s,
commercial concerns used the latest information to modify their products
in keeping with the existing standards and to assure they were easily
employed in infant feeding (Liebig, 1866; Rotch, 1903). At first they
were based on very inadequate information and could be actually harmful
to the infant. In his textbook, Rotch (1896) stated: "My own opinion
in regard to patent foods is that they must necessarily be unreliable."
As scientific knowledge improved, however, these products greatly improved
and their use in infant feeding was encouraged (Committee, 1965). Nonetheless,
researchers continued to struggle to understand the nutrient needs of
infants and how best to support infant growth and development (Fomon,
1965; 1967)
By the 1950s attention
was drawn to the question of how soon foods in addition to milk should
be included in the infant's diet (Committee, 1958). In l900 it was common
to recommend additional foods only when the infant was about 12 months
old. That recommendation rapidly shifted downward, however, until by
the 1960s some infants were receiving cereals and other foods within
the first month of life (Guthrie, 1966).
Scientific progress
during the Century of the Child has greatly improved the well-being
of infants through improved understanding of infant nutritional needs
and the basis for those needs (Foman, 1967). Nonetheless, still better
understanding is needed.
Patricia Swan, Ph.D.
Home