HEUBNER'S SYSTEM OF INFANT FEEDING EXPRESSED IN CALORIES AND ENERGY UNITS
Journal of the American Medical Association
No food, no growth. After the fourth week of life in a qualitative, and after the sixth week in a quantitative manner, a certain normal feeding has been established for the child which allows of an average estimation in quantity and quality of food taken. The single and daily feedings of the infant will closely approximate the averages fixed. After the sixth week the child requires from 600 to 900 (from 20 to 30 oz.) grammes daily and after the fourth month from 1,000 to 1,100 grammes (33 to 36
... oz.) ; these amounts are seldom exceeded. These fig¬ ures have been established by weighing a large num¬ ber of children daily for months and represent average values. According to the observations of Dr. Feer the amount of food taken daily by one individual infant varies greatly; in this the child resembles an adult. These daily variations in feeding of infants must be remembered when we take up artificial feedings. The number of daily feedings in the cases observed and con¬ trolled were not frequent. The first three or four weeks of life the infant was fed every two hours ; after this from six to seven times daily. After the fourth month six daily feedings were given, and in many cases only five. The quantity taken at each meal varies from 50 to 200 (1% to 6% oz.) grammes. The time taken for a meal varies in individual cases from fifteen minutes to one-half hour. After the third week there is very little variation in the chemical quality of the mother's milk. The constituents are not so fixed as in a mineral water ; fat varies greatly at the different feedings. Fre¬ quent examinations of milk obtained in sufficient quan¬ tity of the same breast, repeated for days, will show a surprising sameness. Purther, the examination of milk from many different mothers also agrees so nearly that an average has been established. In 100 grammes (3 oz.) of mother's milk the infant gets according to the form established : Unknown organic sub-Proteids. Fats. Sugar. Salts. stance. (13y2-15 grs.) (50-60 grs.) (90-105 grs.) (2.85 grs.) (6 grs.) 0.9-1.0% 3.5-4.0% 6.7-7.0% 0.19% 0.6% When the milk reaches the stomach it is rapidly changed. The casein is precipitated, but, as there is but little casein in mother's milk, the precipitation is fine and flocculent. Casein and salts remove the acid of stomach secre¬ tions and it requires from 1 to l1/^hours before it re¬ appears. According to von Mehring, whenever the in¬ testines are filled up, no more food is allowed to escape the stomach, and thus the bowels are guarded against overflow and overwork. All foods entering the body are acted on by the in¬ fant's organs and are disposed of in various ways. Much of it escapes through urine, fecal matter, exhalations from lungs and perspiration. Some of it, however, is added to the body as an increase. · These processes are expressed in terms by Rubner as Energie-Wechsel (bod¬ ily activity) and Energie-Bilanz (increase). All duties performed by the body inclusive of adding to the growth are expressed by the term Energie. The energy of a given food is expressed by the heat given off in its burning. The balance of food remain¬ ing in the body can be expressed in calories by deduct¬ ing the amount lost through fecal matter, urine, etc., from the amount entering the body. Food given can be expressed in calories and is of greater significance than if expressed by weights and measures. It can be stated, a priori, that in a healthy infant of a steady, regular growth, for equal units of bodily weight we have equal working power in each individual case. In this case the introduction of food or energy must be regular and of given quantity. By carefully exam¬ ining a considerable number of normal thriving in¬ fants, being able to control them in every respect, so as to establish a proper basis for calculation, Heubner was enabled to express the energy power of the food re¬ quired by the infants. The daily amount of food required by a normal thriv¬ ing infant expressed in calories per kilo (about two pounds weight) of infant is called energy quotient. A more thorough analysis of these infants showed that from the end of the third week to the end of the sixth month the energy quotient is 100 grammes; that is, for every kilo (2 lbs.) weight we require 100 grammes food (31/3 oz.). In the succeeding months to the end of the first year there was a gradual reduction in energy quotients. The amount of work required of the infants simply to preserve life-that is, energy power of the food taken minus the energy power of fecal matter, urine and growth-appears in the first six months to equal 70 calories per kilo weight daily. This has been proved by von Feer, Beuthner, Nordheim, and particularly Schlossmann, through various experiments to be approx¬ imately right for the first three months at least. Schlossmann is inclined to place the energy quotient to 110 grammes; this determination is based on milk ob¬ tained from wet nurses and reduced to calories. Czerny and Kellar have not succeeded and point out what they consider inaccuracies. It will require further study and experience to prove whether they are inaccuracies or not. Not only in case of breast-fed infants is the food thus to be expressed, but in artificial feeding, the food can be expressed in calories and by learning the caloric value of the several foods used in artificial feeding we can easily compute or compound a food for an infant.