ANSTITUTION Health Services and Mental Health Administration (DHEW), Rockville, Ad

DOCUMENT RESUME

ED 075 564 OD 013 559

AUTHOR Fomon, Samuel J., Ed.; Anderson, Thomas A., Ed. TITLE Practices of Low-Income Families in Feeding Infants and Small Children, With Particular Attention to Cultural Subgroups.. ANSTITUTION Health Services and Mental Health Administration (DHEW), Rockville, Ad. Maternal and Child Health Service. PUB DATE 72 VOTE 128p.; Proceedfngs of. a National, Workshop, Airlie Conference Center, Warrenton, Va., March 17-18, 1971 AVAILABLE FROM Superintendent of Documents, Government Printing office,' Washington, D. C. 20402 (Stock Number 1730-0200, $1.25)

EDRS PRICE MF -$O.65 HC-$6.58 DESCRIPTORS American'Indiane; *Child Rearing; *Cultural

. Differences; Cultural Factors; Early Childhood; *Eating Habits; Economically Disadvantaged; Family Characteristics;. Health Needs; *Low Income; Negroes; *Nutrition; Preschool Children; Social Differences

ABSTRACT The contents of,this document include the following papers,-each followed by a discussion amongst workshop participants: "Nutritional Studies on United States Preschool Children: Dietary Intakes and Practices of Food-Procurement, Preparation, and Consumption, "Kathryn M. Kram and George M. Owen; "Food and Nutrition Intake of Children from Birth to Four Years of Age," Juanita A. Eagles and Priscilla D. Steele; "Child Feeding in the Rural qiow-Income Family, "Yana W. Jones; "Infant and Child Feeding Practices in the Urban Comftnity in the Nortlr-central Region," Norge W. Jerome, Barbara B. Kiser and Estella A. West; "Poor People, Good' Food, and Fat Babies: Observations on Dietary Behavior and Nutrition Among Low-income, Urban Afro - American Infants and Children," Betty Lou Valentine and Charles A. Vralehtine; "Cultural Determinants of Food Habits in Children,of Mexican Descent in California," Phyllis B. Acosta and Robert G. Aranda; "Infant and Childhood Feeding,Practices AmOng Low-Inconie Families in Urban Hawaii," Myrtle L. Brown and Claire Hughes Ho;.. and, "Infant and Child Feeding Practices. Among Low-Income Reservation and Rural American Indian and Alaska.Native Families," Mary A. Peterson. (JM) Practices of low-indome families in feeding infants and- small children (-with particular attention to cultural U.S. DEPARTMENT OF HEALTH. subgroups EDUCATION & WELFARE OFFICE OF EDUCATION THIS DOCUMENT HAS SEEN REPRO- DUCED EXACTLY AS RECEIVED FROM THE PERSON OR ORGANIZATION ORIG- INATING IT POINTS OF VIEW OR OPIN- Proceedings of a IONS STATED ,.)0 NOT NECESSARILY National Workshop REPRESENT OFFICIAL OFFICE OF EDU- CATION POSITION OR POLICY , Air lie Conference Center Warrenton, Virginia March .17 -18, 1971

Samuel J. Fomon, M.D., and Thomas A. Anderson, Ph. D., Editors I.

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Health Services and- Mental Health Administration Maternal and Child. Health Service Rockville, Maryland a 1972 For sole by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 - Price $1.25 Stock Number 1730-0200' Contents

Page

Introductory Remarks by-Thomas A. Anderson 1

Survey Information 3 Nutritional Studies on United States Preschool Children: Dietary Intakes and Practices of Food Procurement, Preparation and Consumption, by Kathryn M. Kram and George M. Owen Food and Nutrient Intake of Children from Birth to 4 Years of Age, by Juanita A. Eagles and Priscilla D. Steele 19 Discussion 32

Rural Low-Income Groups 35 Child Feeding in the Rural Low-Income Family, by Jana W. Jones 37 Discussion 43

Urban Low-Income Groups 49 Infant and Child Feeding Practices in an Urban Community in the North-central Region, by Norge W. Jerome, Barbara B. Kiser and Estella A. West 49 ," Discussion 57 Poor People, Good Food, and Fat Babies: Observations on Dietary Behavior and Nutrition Among Low-Income, Urban Afro-American InfantS and Children, _ by Betty Lou Valentine and Charles A. Valentine 59 Discussion 71 ° Mexican-American Low-Income Groups 75 Cultural Determinants of Food Habits in Children of Mexican Descent in California, by 'Phyllis B. Acosta and Robert G. Aranda 75 Discussion 88

Low-Income Groups in Hawaii 91 Infant and Childhood Feeding Practices Among Low-Income Families in Urban Hawaii, by Myrtle I. Brown and Claire Hughes Ho 91 Discussion 96

Indian and Alaska Native Low-Income Groups - 101 Infant and Child Feeding Practices Among Low-Income Reservation and Rural American Indian and Alas1 a NatiVe Fatnilies, by Mary A. Peterson 101 Discussion 113

General Discussion 115

Summary by Samuel J. Fomop 121

Index 123.

dii I

Workshop participants

DR- PHYLLIS B. ACOSTA DR. NORGE W. JEROME DR. GEORGE M. OWEN Associate Professor of Nutrition Assistant Professor Professor Schooj of Home Economics And School ofDepartment of Human Ecology Department of Pediatrics Medical Sciences University of Kansas Medical Center Ohio State University University of Nevada Kansas City. Kans. Columbus, Ohio Reno, Nev. DR. OGDEN JOHNSON MARY A. PETERSON LUISE E. ADDISS Director. Division of Nutrition Chief. Area Nutrition and Dietetics Branch Nutrition Consultant Food and Drug Administration Indian Health Service Head Start Program U.S. Department of Health, Education, and HSMHA,U.S.DepartmentofHealth. New Tors. N.Y. -Welfare Education, and Welfare Washington. D.C. Billings, Mont. ELSA ALVAREZ Chief Nutritionist 7A.N.t. W. JONES DR. MERRILL S. READ Children and Youth Project Nutrition Consultant Director, Growth and Des lopment Branch Hahnemann Hospital Team Evaluation Center, Inc. National Institute of Child Health and Whitehall Medical Center Human Development Philadelphia, Pa. Chattanooga, Tenn. U.S. Department of Healtkv Education, DR THOMAS A. ANDERSON and Welfare Associate Professor MARGARITA KAY - Bethesda, Md. Department of Pediatrics Griduate Student in Anthropology of Iowa University of Arizona FAUSTINA SOLIS Iowa Ci. Iowa Tucson, Ariz. Associate Professor Depirtment of Community Medicine DR. MYRTLE L BROWN KATHRYN M. SRAM School of Medicine Associate Professor Research Associate Nutritionist University of California at $115 Diego. Department of Nutrition Department of Pediatrics. La Jolla. Calif. Rutgers University._ Ohio State University Columbus, Ohio HELEN STARINA New Brunswick, N.J. Nutritionist "CATHERINE COWELL DORIS E. LAUBER Division of Child Health Services Principal Nutritionist Regional Nutrition Consultant Montana State Health Department Department of Health Maternal and Child Health Service Helena, Mont. Bureau of Nutrition HSMHA, U.S.DepartmentofHealth, New York, N.Y. Education,-and Welfare BETTY LOU VALENTINE San Fretncisco, Calif. Co-investigator DK JUANITA A. EAGLES Depart:I:tient of Anthropology Nutritionist DR. RUTH M. LEVERTON Washington University Consumer and Food Economics Research Assistant DeputrAdudnistrator St. Louis, .Mo. Dichdon Agricultural Research Service Agricultural Research Service DE:CHARLES A. VALENTINE U.S. Department of Agriculture Research Professor U.S. Department of Agriculture Washington, D.C. Department of Anthropology Hyattsville, Md. Washington University MARY LYNCH St. Louis. !do. MART C. EGAN Nutritionist Chief, Nutrition Section Maternity and Infant Care Project and Maternal and Child Health Service Children and Youth Project DR. PHILIP L. WHITE Health. Secretary HSMHA, U.S. Department of Boston Department of Health and Council on Food and Nutrition Education, and Welfare Hospitals American Medical Association Rockville. hid. Roxbury, Maas. Chicago, Ill. DR. LLOYD J. FILER. JR. DR. WILLIAM hi. MOORE DR. MARJORIE GRANT WHITING Professor_ Medical Anthropologist Nutrition Adviser for Office of Heald, Department of Pediatrics Growth and Development Branch Affairs University of Iowa National Institute elf Child Health andOffice of Economic Opportunity Iowa City, Iowa Human Development Washington, D.C. U.S. Department or Health, Education. PR. SAMUEL a. FOMON and Welfare DR. CHARLES F. WHITTEN Professor Bethesda, Md. Department of Pediatrics Professor of Pediatrics University of Iowa Wayne State University Iowa City, Iowa DR. MARY MURAL Detroit, Mich. Assistant Clinical Professor BARBARA GARLAND School of Public Health MARY ELLEN WILCOX Nutrition Consultant University of California Nutrition Consultant N.C. State Board of Health Berkeley, Calif; Dade County Department of Public Health Hickory Regional Office Miami. Fla. HiekorY, N.C. HELEN GER OLSON Chief, Nutrition and Dietetics Branch DR. VIRGINIA H. YOUNG VIRGINIA C. JAUCH Indian Health Service Chairman Director. Nutrition Section HSMHA, U.S.Department ofHealth,Department of Sociology and Anthropology Chicago Board of Health Education, and Welfare Finch College Chicago, Ill. Rockville, Aid. New-York, N.Y. Introductory remarks

Dr. Thomas A. Anderson, Session Chairman : various cultural groups, especially those of low in- I should like to review the events that have led to come. Rather tbar, attempting, to cover the entire this meeting. childhood age span from birth through adoles- One of the specific recommendations of the 1969 cence, it was decided to focus on practices pertain - White House Conference on Food, Nutrition, and ing to children during the first 3 years of life. This Health 1 was expresser) as follows : decision did not imply that other age groups were Recommendation No 8. Need for compila- less important. Rather, it was believed that by lim- tion and dissemination of information re- iting the age range to be considered, the topic could garding nutritionally sound feeding practices. be examined in greater depth. A task force should be assembled to record Although inforniation on practices of low-in- what is already lmown and to define specific come groups in feeding infants and preschool areas in which additional information is children has appeared in the literature, the reports needed regarding.feedhig. practices of infants, toddlers, school-age children and teenagers are not always easy to locate. In addition, nutri- among various cultural groups. ple with tionists, social workers, anthropologists, public firsthand information regaregardingsuch prac- health nurses, and many other workers carry in tices' should be included. From° informa- their heads a wealth of information about feeding tion reference materials should be developed for advising parents regarding choice and practices. We hope that the published report of preparation of foods including milk and for- this meetingthe formal presentations and ab- mula. Every effort should be made to complete stracted discussionswill provide a convenient these reference materials by the end of 1970. source of information. The task force should classify (as to calorie We do not anticipate that the report of this and individual essential nutrients) commer= workshop will present a completely balanced and cially available foods and, particularly, foods used in sixeific cultural groups and determine comprehensive view of the subject. Feeding prac- the types of information to be included in a tices of low-income rural families in Montana and data bank, which can then serve as a ready Appalachia will not necessarily be similar to prac- reference source for health workers: tices of low-income families in other rural areas; In the followup of the White House Conference, feeding practices among Mexican-Americans in the Maternal and Child Health Service of the California and Arizona may differ widely from Health Services and Mental Health Administra- those of Mexican - Americans in Texas. We shall be tion, DREW, provided funds to hOld a workshop focusing on examples. However, with the diver- devoted to the topic of feeding - practices among sity of experiences represented by the participants, we hope to be able to record something of the range 1 White House Conference on Food, Nutrition and Health. Final Report Washington, D.C., U.S. Government of feeding practices among low-income groups and Printing Mee, 1970, p. 50. perhaps to make Some generalizations. Survey information

Nutritional studies on United States preschool children: dietary intakes and practicez of food procurement, preparation and consumption

Kathryn M. Kram and George M. Owen Department of Pediatrics, Ohio State University, and Children's Hospital Research Foundation, Columbus, Ohio

INTRODUCTION would be meaningless without some indications Between November 1968 and December 1970, we of why children eat the foods they eat. For this undertook a study which had as its primary ob- reason, information was sought concerning family jective the description of nutritional status of socioeconomic factors, family and child eating preschool-age children in the United States'. The practices, methods of obtaining foods, amount of population group aged 12 to 71 months was chosen money spent on food and related items. In addi- because little information was available concern- tion, the sociologist on the team included informa- ing this age group and, as judged by observations tion of itS. descriptive nature on community and in developing countries, this is clearly the_nge recreational activities of families with young interval when the greatest rewards of prevehtiVe children. medicine can be realized. There is also consider- This report will present a brief statement of able sociological evidence that the effects of social, the survey sample, personnel and methodology economic and educational disadvantage are already used. Results will be presented on only the first manifest by the age of 3 years and that if inter- half sample (November 1968 to December 1969) vention is to be successful, it must be initiated prior of the total study population. Demographic char.7 to this time. acteristics and data on food procurement arid Assessment of nutritional status was made by preparation will be presented as family data. In- the collection of 2-day diet records by a trained-formation on nntrient intakes and on-infant and interviewer in the home, past medical history of child feeding practices will be given only for chil- the subject and pertinent.. infornultion on the dren 12,47 months, with references to practices of mother's prenatal history, anthropometric meas- older children where indicated: urements .which included height, weight, and thoracic skin fold thicloiess, detailed physical ex- SAMPLE amination by a pediatrician, hand-wrist X-ray, dental examination by a dentist, and extensive A national sample of dwellings had been de- laboratory studies. These measurements were made signed by the Survey Research Center, The Uni- on each selected subject who cooperated with the versity of Michigan, to represent households full survey protocol. conterminous United States exclusive of those on The investigators believed that the collection. of military reservations (1). 'The 74 sample points, scientific measurements on nutritional-status per se currently located in 36 states and the District of Study supported by Maternal and Child Health Service, Columbia, included 12 major metropolitan areas, HSIIHA, HEW, Research Grant H-170. 32 other Standard Metropolitan Statistical Areas (SMSA's) and 30 counties or county groups rep- though other compositional tables were used (4-- reseering the nonmetropolitan or rural portions 10; as well as information from major food com- of the country. In the multistage sample., first- panies for commercial products. At the conclu- stage stratification was carried out independently. sion. cf the 9.-day diet record, the interviewer within each of four major geographical regions asked each respondent whether the child was cur- northeast, north-central, south, and west- -each of rently receiving a vitamin and/or mineral supple- which received representation in proportion to its ment. The brand name, amount, and frequency population. Criteria for the formation of strata of cousemption were recorded, and standard codes included SMSA classification, size of the largest were assigned for various kinds of supplements. city, rate of population growth, major industry Calculation of the nutritive .values of diets and of or major type of fartninf,r, and in the South, the vitamin /mineral supplements was performed by proportion of nonwhite population._ computer at the Columbus Laboratory of Battelle To balance the 2 :yearly samples, one-half of Memorial Institute. The interviewer also made ap- each of the six largest metropolitan areas was pointments for the children to be seen later in the scheduled for interviewing in each year. Division week for a physical examination. Most children of the remaining 08 primary areas into halves was ware examined near the end of the sameweek the controlled in such a manner that each year's inter - home interviews had been conduct. -d. views comprised a national cross-sectional sample At the time of the clinic examinaiion, the med- of preschool children. Since data from the second ical history of the preschool child and the mother's half sample are still being compiled, this report obstetrical history,, including age at first and last includes data from the first year only. pregnancy and total number of pregnancies, were reviewed. Questions were asked about prenatal and perinatal events pertaining to the preschool METHODS child under. study. The child's birth weight, pl.,ee Basic- information concerning the composition of birth, and a statement of condition at time of of each family with preschool children included birth were recorded. Information was obtained in the study was obtained by one of the 15 trained concerning his immunizations, illnesses, accidents, dietary interviewers (home economists and dieti- and hospitalizations. - tians on our staff) who visited in the homes. The Each child's standing height and weight, head numhey of adults and children in the family unit circumference, and thoracic, fat-fold thielmess was recorded. No more than three preschool chil- were measured. An X-ray wa; taken of the hand- dren (1-0 years old) per selected family were wrist to assess skeletal maturation and to detect included in the study. Occupational and educa- evidence of metabolic disorders. A gefieral physical tional attainment of heads of households were- examination was completed by a pediatrician, and listed and estimates were made of total family about half the children had dental examinations income. including money-in-kind. The interviewer performed by one pedodontist. virtually all med- collected information on type of dwelling and ical histories, anthropometric data, and X-rays recorded information about family mobility. were taken by five nurses. Altogether, some 25 Dietary data were collected by the dietary in- pediatricians, the majority being residents at Co- terviewers during 3-day home interviews. The lumbus Children's Hospital, performed physical dietary interview schedules included information examinations: on family and child food habits and customs, Blood. (approximately 5' ml.) was obtained by Sources of food, and amount of money spent on venipuncture; and hemoglobin and h'unatocrit food. A 2-day record of food intake, including determinations were completed' in the field lab- recipes of all home-prepared foods, was collected oratory. Erythrocytes and plasma were separated, for each eligible preschool child in the family. processul for freezing and shipped to the Using a coding'manctal adapted from one devel- Nutrition-Renal Laboratory in Columbus for de- opedby :the U.S. Department of Agriculture (2), - termination of iron, iron-binding capacity, total each interviewer coded the records she obtained. protein, albumin; vitamin A; vitamin 0, urea The majority of fodd and nutrient values were nitrogen, cholesterol, and triglyceride content of taken from Agriculture HandbOok No. 8 (3) al- plasma. Plasma .proteins were also determined

4 electrophoretically and a.wys for pseyidocholin- come quartile. Intakes of calcium and vitamin C esterase:activity were completed on the majority seemed particularly related to income group, Pro- of plasma specimens. Hemoglobin electrophoresis tein intakes _were frequently two timesa s great was performed on selicted sampW of erythrocytes. as the Recorntnended Daily Dietary Allowances trine specimens ' oided in the clinic were tested (II DA ), and less than 5 percent of children had there for glucose and protein. Specimens were levels below the allowance (11). However,more then acidified, frozen and shipped to Columbus than 90 percent of children under 3 years ofage for determinations of creatinine, iodine, urea failed to meet the RDA for iron. nitrogen, thiamin, and riboflavin content. At each age inteival, the percentage of children . All information collected in the field by demog- using supplements tended to increaseas income raphers, interviewers, and clinic teams was sent to increased (table 13). Within each income quartile, Columbus. X-rays were developed in Columbus the proportion of children receiving supplements -and sent to the Center for Human Development, tended to be greatest in the 12--23-monthage University of Michigan, for interpretation by Drs. group. The majority of children taking supple- Stanley Gam and Roberto Frisancho. ments were using multivitamin preparations which did not contain iron. The percent improvement from the contribution RESULTS 4.ND COMMENTS of vitamin supplement to the nutrient- levels of vitamin A, thiamin, riboflavin, and vitaminC is Socioeconomic Characteristics presented in table 14. A sample of children W'hich represents a cross- section of the total United States population could Infant Feeding Practices be subdivided in a variety of ways, the object of any subdivision being the reduction of variance While the focus of theoverall nutritional status within the group. For the purpose of simplicity study was the preschool child, some information and in light of the challenge of this workshop, we on infant feeding practices and prenatal and peri- have chosen to divide the population into four natal events was collected by the nurse at the time of the clinic examination. Table 15 presents in- -groups of relatively equal size basedon per capita income for the family unit. formation on percentages of children breast-fed and bottle-fed at 1 week and at 2 months of Table 1 presents income data for families in- age. '''a cluded in the first half sample of the Preschool No particular income trends were apparent. Nutrition Survey. These four income quartiles When asked, "Did your child receive supple- will be used throughout the remainder of thisre- mentary vitamins or iron at any time between 3 port where income differences in values or re- and 6 months of age r, most mothers replied that sponses were present. A sununary of pertinent the child did (table 16) ; more than 75 percent demographic characteristics is presented in table 2, said they had taken a nutritional supplement during Pregnancy with this child. Because of the his- Dietary Intakes torical nature of the questions, respondents were not asked to quantify this information nor to in- Frequency distributions of intakes of total , calories, calories/kg., total protein, protein/kg., dicate whether supplements were taken regularly, calcium, iron, vitamin A, thiamin, riboflavin, and vitamin C from diet plus vitamin and/or mineral Child Eating Pritctices supplements are .presented in tables 3-12. The To illustrate changes in eating patterns in the population is divided into 1-year age 'intervals in age range under consideration, data are presented each income: quartile. Since the focus of this workon children in the age groups 12-23 months and shoP is the infant and young child, intakes of chil- 2447 months. Whenever differences between pat- dren from 12 throngli 47 months only are pre- terns of children or their parents in each of the sante four income quartiles seemed important, these Ineneral, intakes of. calories and nutrients, differences are also presehted. withttieexcepti6n of iron and to11101128extent via- Conn- .,..7n has been expressed that sizable numbers min A, tended to, increase with -age and with in- of children come to school 'without breakfast (It- /4). As illustrated in table17, relatively few pre- upper income quartiles there seemed to be less schoolers in our study reportedly had nothing to tendency for mothers to cater to their children's eat in the morning. This impression was confirmed food preferences as age increased. by the daily diet record obtained (to be reported There were fewer differences between the reac- elsewhere). With increasing age, more children tions of parents of different in groups to poor prepared their OW11 breakfasts some of the time. child eating behavior than might be expected. Although there were few differences between Table 21 presents these re;ponses by age-group and children's reactions to new foods based,on family income level. It was attain apparent that parents \_..,_ income, there were differences between children by were more strict with older children than with age (table 18). The question was geared to assess younger ones. The mother was the more dominant initial response to a new fruit or vegetable. In the figure for 12-23-month-old children while the 122.3-- 'onthiold age group, 52 percent of children father assumed a greater share of discipline for would r lontarily try a new fruit or vegetable older children. (combination of "tastes and rejects' and 'tastes Characteristics of children in the first half sam- and usually eats'). and 68 percent would eat the ple attending child care programs are presented in food after tasting it. However, only 66 percent of table 25. A total of 21 children (2 percent of 12-47- 24-47-month-old children would willingly try the month-old children) were enrolled in some type of new food, and 58 percent would at it. This pat- child care program. There vIere proportionately tern persisted among 48-71-thonth-old children more upper income chile.ren attending nursery (not reported here) and may be interpreted as an school or daycare programs. expression of emerging childhood identity or a griming aversion to fruits and vegetables. Food Procurement and PreOiration One of our primary objectives in obtaining in- In the 1940's, the late Kurt Lewin proposed the formation on family and child eating practices was "Channel theory" to explain how food gets to the to investigate parental permissiveness in regard to table anwhy. Ete postulated that within each young children's eating habits. As indicated in family t ere was a "gateloeper" who determined table 19, there seemed to be an increasing tendency how foodtered each channel. The attitudes and among all income groups for mothers to set con- behavior of this person plus the forces governing trols over meal and snack times for older children. his or her decision at each stage of food procure- Families in the upper income quartiles reportedly ment determined the kind and amount of food set controls twice as often as did those in the lowest available for consumption -(15). incot,e group. The manner in which parents re- Tables 26 through 28 present data relevant to warded or disciplined their preschoolers varied by this theme; i.e., who buys food for the family, who age of child and by income level (tables'20-22). As prepares food, and who feeds or serves food to indicated in table 20, there mental to be an increas- the preschool child. In each case, data are ,pre- ing tendency for parents at alx income levels to use seated for the family members responsible for this food to reward or punish older children. Tables 21 task most of the time and some of the time. If and 22 indicate that just as rational discipline was one person was responsible for a given function all more frequently used by upper income families in of the time, the data were not repeated in the response to misbehavior, so also was verbal praise second entry. In tables in which information is not more frequently used by these families in response broken down by age group, numbers and percent- to good behavior. Low-income families tended to ages refer to total families who responded to a useaphysical discipline or a physical and tangible given question. reward more frequently. From these tables it is apparent that the mothers When asked the question, "if child (insert name) studied assumed major responsibility for food pro- does not like what-you fix for the-rest of the fam- curement, preparation and child care. However, ily, do you fa him something different f,"- mothers in the low-income family someone other than the in the lowest income quartile replied that theii mother assumed a greater share of responsibility children seldom asked -for :"different" foods. 13e for these houtehold tasks than in more well-to-do tween 12 and 23 months, children in the poorest families. families did not eatas much baby and junior food We might postulate that one reason for this oc- as those in higher income families (table 23). In currence was the increased incidence of fatherless families among thisgroup (table 29) tin. the and would now like to confine our discussio:1 to greater number of persons per familyamong poor low-income families. Children in the lower income families (table 30), which place greater burdens quartile were divided into two groups: Children on the female head. However. greater numbers of having low dietary intakes of calories, protein_ mothers in families ha.ving.moderateor high in- calcium, vitamin A. or vitamin C and those-hav- comes were employed in gainful occupations. The ing adequate intakes of calories and these nutri- raVerstarifigures for employment of mothers exits from all sources. ie., diet plus vitamin:min- was: 21 percent, quartile I; 20 percent, quartile II; eral supplements. 31 percent, quartile III; and 28 percent, quartile Basic demographic characteristics for childifen ICr. Mothers in upper-income quartileswere re- in each group are shown in table 3:). It is readily portedly also away from home more hours per apparent that children who had low intakes were k* week than mothers in the lowest income quartile more likely to live in poor housing. their fathers (table 31). had occupations with less social prestige, and pub- The attitude of the mother or other personre- lic or private welfare (rard5..,0 or 7) more fre- sponsible for meal planning and preparationto- quently provided the source,/ of income. The ward food and use of new foods may also affect the mothers of these children had less education than diet of the childrDoes the person who is responsible did mothers of better fed children. for meat preparation consider her jobs chIre, or In some respects. it should not be surprising.that does she enjoy cooking? Trble 32 indicates that .itudes toward food preparation and recipes more respondents in upper income quartiles re- were more negative among, mothers or plied they enjoyed cooking. Similarly,more re- mother figures_ of children having lOw intakes. spondents in these quartiles indicated they tried Although the-numbers are admittedly small,-the new foods or new ways of fixing foods and used differences between practices exhibited by these printed recipes more frequently. mothers are consistent. There were age-differences between families of differing income levels in regard to themanner in which the person responsible for foodprepara- CONCLUSION tion obtained information about food.. Aspre- In a pilot study conducted in Mississippi be- sented io table 33,fewerlow-income franilies used tween Novemb'er 196T, and March 1968, low-income professional or public service channels, suchas4reschool children were.. found to be at greater clinics or government publicatioi s,. as their pH.- risk nutritionally than -were more affluent young- mart' source of information. It is not surprising stern in the populationt16, 17).Information from that a. neighbor or relative was more frequently the first half sample of the national study mentioned as a source of information among low- seems to confirm these observations. Growth achievement income families; however, none of the differences between income groups was really striking. (18)and biochemical findings(1941) lendsup- Table 34 presents data on the kind of store used port to the dietary data presented here and indi- by families of different income levels for their cate that poverty children are smaller than average major grocery shopping and thereasons given and appear to have biochemical levels more indica- for shopping at small grocery stores,supermar- tive of suboptimal nutrition. kets, or discount markets. Although supermarkets Table L--income data for familiars of children (12-47 were mentioned most frequently by all families, it months) In first half sample 1 of the Preschool Nutrition is interesting to note that 19 percent of low-income Survey

families shopped at small grocery stores and that Income quaff& Farnilies 'Children Ranges Median 26 percent of those who used the small grocery (Number) (Number) store did so because they felt food prices were lower. I 239 39 80 -1900 8590 II 241 208 901-1,390 1,12 III 327 271 1,301,1,900 1,625 Characteristics of Low-Income Families IV 361 286 1,901-6,700, 2,50:

In preceding sections of this piper, we included sross,seefiona I sample ot U.S. population. a Basedon total take-frome pay Inc family unit divided by number of Individuals in data on families and children of all income levels thefamily unit.

7 F4140°' " 'or .4 .2 .4 N01140,-..Ch wwww N a As = .; VEIggg Ile ggg RIR ggg 4"MMSU M Oft we w, t4 4,3 RIR aaaRIR RIRa-a AIRaaa .041 -i1"511(1a."" NOM ON0 vow s yr...a mv.r. f10of OWV 04 40 .4 .4 NMMrOD we f I 1 04 004 CD Of 0 04 .0naDO ..nz "20 ^414 we m0 04 04 e4 04 1 'J 400ILTiy; 1 .spl.!Ali i0 11 pi Oarsximiennm sr.= Ilme awn Wow 4uo 41t Ain 21.14 Kmr. AS"' .11.. =wrft plti I, am-32y ':4' .100 M 00 WO= m...0 maw -mn "by,.0 C. 0 ooe *am 0 0 0 IIP/4"" UAM gggaCe 000ggg 000egg 000ggg 000ggg tf .1 ' 1 . . c. ., Table 4.-Frequency distribution of Calories per kilogram.(kcal./4.) for childrr In first half sample, PreschoaNutrition Survey

. . - . Age (Num. than- 50 60 i0 80 .90 10Ci 110 120 130 140 150 , Incomeifuertile- .(loos) bet) than -to -to 5, to- to-,-- 4 41).---to to to to____And Jtienn.: On) Median 50 . 59 69 79 . "89 99 109 119 '29 139 149 above ..-

12 -23 (43) 1 0 5 2' 21 7 28 2 5 9 17 11310 . (297)) 1042 (57) 2 .4 11 16 16 7, 19 2 (64) 5 6 6 l0 13. 17 11 11 3 5 2 6 94 .00 94

91 (48) - '5, .2 10 19 13* 13 10 10 ''4 4 96 (27) 107 99 , f, (45) 0 7 9 17 22 7 11 9 13 (32) 36-47 (65) 0 " -4" 0 5 15 14 17 14 12 12 A 3 -101 (24) 98

12-23 (54) 4 2 11 ,. 7 15 7 11 15 13 6 2 7 1 1C4 (37) 103 24-35 (78)- 0 3 9 5 9 17 17. 10 10 6 8 6 107 (30) 106 36-47 "(74)- ^3 4 .3 9 23 16 11 ..0 12 7 3 . 3. 99 (32) 95

e 10 IV. 12-23 4(62) 2 " 0 5 16 13 13 \8, 6".P. 11, 5. 11 .111. 1 1 10 4 15 10 22 .6 6 103 .(27):133 ?4-35 (67) 6 .- 36-47 (83) 0 1 . 12 .16 22 14 12\ 6 6 2 5 102 1281 97 ' "- - 9 8 .4 8 Total 12-23 1 (r) 2 .2 ,7 11 16 10 15 \ 7 k C24-35 (48). , 2.` 9 6..14. 16 a 11 \ 9 4 5 %, 8

36-47 (286) 3 . 16 .18 13 12 ..7 5 3 4

A . -.

1 Percentage dl eachage andIncome group in horizontal line:

-4 Tb ,, Table 5.-:Frequency distribution of total Rrot,in (gm.) for children in firsthajf sample, Preschool NutritiOn Survey - Age (Num- Less 10 20 30 40 60 60te 70 "..80 90 100 \ 110 aM Income quartile, (mos.) ber) than to to to to. to:c, to to to to to hand . (SD)Medial 10 19 29 1 39' 491* 59 69 7q 89 Igoabove

12-..23- (66) -1 0 2 .28 27 24 11 6 .; . ItP1,-,V; *-0 , . 0 0 47. . (116) . 45 1 1 . 24 -35 (87) . 0 2 "16. ,. 31 16 13,4., . 7 4' , 50 (17),o*'.46' i 24 ; 5 1 '1 r4 36-47 (86).. 0 : 23 : 14 $1.91.7-' 'I43;. . , D 0 445: - 38 II 12-23 (65) 0 .e. 2 17 38 8 17. 12. .. 11 3 2 0 :-Ii... 24 -35 (60) 0 0 5.: "20 - 23 23 17 . .3 .5 -.61 . (16)1, 50 36-47 (83)..'0 0 2 16 18 .. '44 17 . 11 8 1 . 2 .,6, 8,§7 (18) . .57 .1,.., . . 0 . 1 - ". 46 :' 43 III 12 -23 . (74) 0 . 15 30' 24 12 N 9 5 0 (18) ilp. 0 . 0 52 (15) 52 . "' 24,35 . -.(100): 0 7 15 23 28 11: 11 . 4' . 36-47 --- . (97) 0 1 2 15; 16 30 16 8 , . 3 3 3 2 58 (22) N 57 -., .. 4, IV 12-23. '. (89) 2 6 . 19-. 4, ' *9 3, 6 -0 0 -50' (16):. 48 24-35., (93) 0 2 3 : 17'" ,, 26 18 11' 2 0 1 0 53y, (1.) 54 P 3647 (104), 2 10 .33 14 . ,s. .11 7 -, 2 0 . 0 56 (15) . 53. . . . s- Total'.....0 12-23 .. (294): A 1 .. 11 ,.28 ,..24 '17 10 4 3 1 0 icii- 24-35 (343) 6 . 17 .- 24" 24. 14 9 4-01 0 ) ,36-47 (370) 2 " 14 23 25 15 10 6 2''' .. , . ' 1.Perceritageoleach age and income 'group in horizontil

`, 4,7

0- Table 6.-Frequency distribution of protein per kilogram (gm./kg.) for children in first half sample, Preschool Nutrition.. e Survey -

Age !Num- Less 1.0 1.5 2.0 .2.5 .31'0 3.5 kb 4.5 5.0 55 6.0 , Incomequartile (mos.) her) than to . to . to , to to to to to, to to and Mean (SD)Median 1.0 1.4 1,9 2.4 1 2.9 3'4 3.9 4.4 4.9 5.4 5.9 above

I 12-23 (43) I 0 0 - 0 7 9 21 14 9 - 9'' 7 9 14 4.2 (1.5) 3.8 24-35 (57) 0 4 2 11 11 12 12 23 11 2 2 2 3.4 (1.5) 3.9 -36-47 (64): 0 5 -13 9 11 20 13 8 . 3 6 3.7 (1.5) 3.5 II 12-23 (48) 0 0 4 . 6 17 15 23 8 4' 10 8 4 3.8 (1.2) 3.9 24-35 (46) 0 0 2 9 7 20 22 " 11 9 2 13 4.1 (1.4) 4.2

36-47 ,(65) 0 0 0 8 22 It 18 14 9 5 5 . 8 3.8 (1.1) 3.7

III 12-23 (54) 0. 0 0 :11 715 ..11 9 ', 17 9 11 4 13 4.2 (1.6) 4.1 24-35 (78) 0 0 1 8 14 . 10 14 21 14 4 '8 6 3'9. (1.2) 4.0 36-47 (74) : 0 0 3 11, 9 16 20 14 12 5 1 8 3.8 (1.4) 3.7

i IV 12-23 (62) 0* 0 5 5 6 18 13 23 8 8 13 4.5 (1.5) 4.6 -4 24-35 (67) 0 '1 1 4 7 24* 10. 25 '10 6 4 3.9 (1.2) 4.0

' 36-47 ON , 0 0 1 4 16 . 25 12 20 4 4 '2 1 7 (1.0) 3.5

.. . -. ) . -Total 12-23 (241) 0 0 1. 7 11 13 16 12 12 9 7 11 24-35 (248) 0 1 2 8 10 16 11 23 12 4 5 8 36-4" (286) 0 1 1 8, 14 18. 19 r 12 13 5 3 6

pepatage of each age and income group In horizontal line.

,Table 7.T-frequency distribution of calciuril (mg,) ktciiihircen:in first half sample, PreschoolNutrition!Survey

Age .(Num.. Cass 200 300 400. 4-:*..500 .600 70d 800 . , 900 1,000. 1,200 1,500 Inconte Oaartdo, (mos.) ber) than t;9 tcf. to to to to to to to and Mean (SD)Median' 499 599 .699 , 799 899 999 1,199 1,499 above

12-23 (66) 8 6 .15 5 15 - 783 417) 745 24-35 (87) 5 15, 10: 10 9 625 (321) 36-47i*tg .7(86) 7 12 ,16 12 9 654 (321) 54661'4 I

12-23 .(65) . 2 20 9 9. 9 12 14 6 2 751 (302) 728 24 -35 (60) o 3 3. ;10 5 15 10 8 3 785 (346) 718 36-47 (83). 0 4 -10 G.. 18 10 8 '12 8 837 (385) 766

12-.23 (74),. o 0 11 11 11 8 14 15 8 934.(451) 852 gpg 24-35 (100)... 0 4. 3 14 14 13 . 47 7 1 810 (290) 36-47 (0) 2 1 9, 7 12- 15 14 10 7 854 (355) 818

12-23 -(89). 0 0 6 3 '':10 10 13 10".13. .13 .11 9 921 (375) 885 24-35 (93) t 6 6 '10_ 14 8 12 8 17 10 4 823. (363) 7806 36 47, (104) 0 2 2 2 13 13 23 11 9 15 7 '3 833'(289) 770

. . 12-23 (294) 2- 1 *. 5 7.-,c10 -9 12 10 10 . 14 6 . 24-35 (340) 3 4. .19 11 13 9 12 9 14- 2

36-47 (370)- 6 - 10 -16 11 10 . 12 .5

I Percentage of each age and income, grouP in horizontal line.

/ 4 Table 8.-Frequency distribution of iron(mg.) for children in first half sample, Preschool Nutrition Survey

Age (Num- Less 2 4 6 8 10 12 14 16 19 22 25 Income. quartile (mos.) ber) than to to to to to to to to to to and Mean (SD) Median 2 3 5 7 9 II 13, 15 18 21 24 above

3 9 3 2 8 7 1 12-23 (66) 3 0 11 23 33 11 0.. 3, (7) 7 24 35 (87) n 3 . 28 22 21 8 6 I 5 2 2 2 9 (7) 36-47 (86) 0 5 10 33 264 9 6 -2- 1 6 1 1 8 (5) 8 . _ - . 7 5 11 12-23 (65) 0 34 18 18 6 5 3 3' 6 3 0 (6)

'24-35 (60) 0 3 37 23 20 . -.5 2 0 7 2 0 2 7 (5) 6 1 1 1 36-47 (83) 0 1 -16 27 19 22 - 1- . 1 .10 9 (5)

III I--23 (74) 0 '48 32 19 8 4 4 4 5 0 1 .4 7 -(7) 6 4 5- 2 8 8 :- 24-35 (100) 0 -5 21 21 27 12 2 0 1 (5) 36-47 (97) 0 2 22 26 22_' 7 3 2 6 4 3 3 9 (6) 8

. . 7 i. 12-23 (89) 1 9 28 21 18 9 3 2 4-- 2 1 0 (4) 7 3 3 8 ..2 0 3 8 (6) 7 24-35 (93) 0 6 16 ....31 15 12. 8 36 -47-004) 0 1 15 32 20 . 12 5 l 5 5 5 0 9 (5)

Total- 12 -23 (294) '0 17 26 23 .II. '5 ...4 . 1 24-35'(340) 0 5 24 24 21 10 3 6 3 1..... 2 .-- .. 16 29 -22 12- 4- . 2 4. 36-47 (370) t,

1 Intakes from all sources. a Percentage of each age and income.group in horizontal line. Al;

Table 9.-Frequency distribution of vitamin.f Al (IU) for children in first half sample, Preschool Nutrition Survey

r _ Age _(Nurn- _ Less 500_ .1,_000.-1,1590____2.009 2,500 3,000 3,500 4,000 6,000 8, 000 _ 11,000 '-quartile-truartile (mos.)-- ber) than-"-to --to to to to to to to ," to -- to and Mean ...(SD) Median 500 999 1,499*1,909 2,499 2,999 3, 499.3, 999 5, 999 7,999 .10,999 above

I 12-23 (66) s 5 3 3 8 8 29 14 2 5 4,570 (3,980)3,970 k 24-35 (87) 2 5 14 13 6 7 5 11 24 6 6 3 3,800 (2,750)3,530 36-47 (86) 5 8 5 10 '9 8 10 6 4 23 - 8 3 5 4,100 (4,040)3,220

II 12 -3 (65) 0 2 5 9 . . 12 14 5 5 27 17 - 6 0 4,180 (2,150)4,070 24-35 (60) 0. 3 7 10 8 8 8 33 7 5 7 5,130 (6, 54e)4,160 _36-47 (83) 0 1 7 8 7 4 4 4 36 17 .8 5,060.(3,290)4,740

8 5 8 5 , 1 8 0 ( 3 , 3 6 0 ) 4 , 8 2 0 - 1.11 12-23 . (74) 0 3 ^ 5 3 42 24 _35 (100) 0 1 6 7, 6 5 32 -'15 10 4 5,340 (4,800)4,810 , .35.4r,' 407) 0 4 12 10 -5 1 6 ,.37 16 3 2 4,620 (3,230)4,490

. . 4

IV 12-23 (89) 1 4 3 7 6 6 2- 37 12 12 9 5,690 (3,390)5,190 1 2 5 , . 3 . ,. 6 4::"4,.6 4 -3 '35' 16 10 6 5,320 (3,030)5,080 - --. 24-35 (93) 4 35 19 7 6 5330 (3,110)5,090 36-47 (104) 0 1 - 5 .

Total__ __T 12-23 (294) 2 4 5 9 9 4 34 13 7 '24-35 (340) 1 3 8 8, 6 7 6 31 . II 8 36-47- (370) 1- 3 5 9 8 6 5 33 15 5

lInlake from all sources. 3Percentage of each age and income group in horizontal Ilne.

"0-:',..-'4 Table 10.-Frequency distribution of thlamini(mg.) for children in first half sample, Preschool Nutrition Survey

Age (Num. Less .10 20 .30 .40 .50 .60 .70 .80 .90 1.002.00 Income quartile (mos.) ber) than to to to to to . to to to to to and Mean (SD) Median .10 .19 .29 .39 .49 .59 .69 .79 .89 .99 1 99above

I 12-23 (66) I 0.. 0 3 6 11 9 8 9 6 8 31 9 1.01(0. 59) 0.83 24-35 (87) 0 1 2 1 13 11 9 10 8 3 34 7 1,03.. (.59) .81 36-47 (86) 0 1 0 5 6 13 14 10 7 5 31 9 1.05 (.61) .81

II 12-23 (65) 0 0 0 11 15 15 5 8' 0 5 12 1.07 (.65) .76 24-35' (60). 0 0 3 3 5 12 12 8 5 3 35 13 1.17 (.67) .93 36-47 (83) 0 0 1 2 5 12 '-' 5 7 5 5 37 20 1.30 (.68) 1.14

III 12 -23 (74) 0 0 1 5 9 12 1 5 7 7 . 41 11 1.24 (.70) 1.09 24-35 (100) 0 1 3 5 4 3 10 9 8 .36 21 1.37 (.69) 1.32 36-47 (97) 0 1 1 3 3 7 5 9 6 5 31 28 1.43 (.78) 1.41

. . IV 12-23 (89) 0 2 4 8 9 9 2 4 45 12 1.29 (.69) 1.41 24-35 (93) 0 0 0 1 8 9 13 4 3 38 20 1.42 (.72) 1.69 36-47 (104) 0 0 0 0 ° 4 9. 6 9 11 3 38 22 1.46 (.74) L 68

.. . Total -12-23 (294) 0' 0 2 11 _ ._11 5 37 11 -24-35 (340) 0 0 1 7 8 8 11 7 5 36 16 36-47,.;(370) 0 1 1 2 4 10 7 4 34 20 _ .

I Intake from all sources. Percentage of each age and income group.in horizontal line.

- Table 11.-Frequency distribution of riboflavin I Ong) forzniuiren In first half sample, Preschool Nutrition Survey

Age (Num- Less . 50 0.80 '1. 10. "- 1.40 Li() 2.00 2.30 2.60 2.90 3.20 Income quartile (mos.) ber) than to to to to to to to to to to and Mean (SD)' Median' .20 .49 :79 1.09 L39 1.69 1.99 2.29 2.59 2.89 3.19 above

1 -12-23.- .....ao .. s0; 8 15 17 -12 8 8 8 6 . 9 1.78(0.90) 1.54

24-35 ..(87)...i; 15 16 19 9 9 3 11 2 5 . 6 1.55 (.8.7) 1.27 3647- (86) 8 16 20 . 15 5 7 5 6 6 1. 57 (.84) 1.38

. . , 12-23 (65) . J) 0 -9: ..;...11 21' 14 2 6' 11 9 11 8 1.87 (.90) 1.56 24-35 (60). ' 0 3 5 10. 18; 5 8 13 0 13. 12 12 2.08(1.25)..2.02 36 -47' (83) i 0 0 11 6 14 8 5 -j,41 8 17 6 13 2.08 (.92) 2.18 . . . 0 4 /...III . 12-23 (74)- 0 15 11 7 9 14 12 11 14 - -2.28(1.05) 2.31 .- -(-. ,,.,.. 24-.35.O00)- 0 1 5 8 .13.. 10 6 10 10 14 . 14 2.20 (.96)- 2.29

. 16-47 (97) 0 .3 . 1.1 14 8 u 3. 9 8 14 19 :2.26(1.05) 2.30 - . IV 12-23 (89) 0 0- 7 11 8 8 7 , 7.' 11 :10' i1 ..24 2.37(1.08) 2.42 24-35 (93) 0 1 10 - 11 10 6 4' 5 14 12 20 2.27(1.08) 2.44

. 36417 (104) 0 0 3 5 19- 10. 5 3 10 12 16 18 2.32(1.01) 2.53

Total (294) 0 1 .7 9 - 16',.. '11 . 6 7 10 10 10 14..' 24-35 (340), 0 2 8 11 13 10 6 7 10 11 13

36-47 (370) 0 2 6 8 16 12 6 _ 5 9 10 11 14 . . ..

I Intake from all sources. Percehtage of each age and income group in horizontal line.

12 Table 12.Frequency distribution of vitamin C 1 (mg.) for children in first half sample, Preschool Nutrition Survey

Age (Num- Less 15 30 45 60 75 90 105 120 135 155 180 Income quartile (mos.) ber) than to to to to 'to to to to to to and Mean (SD) Median 15 29 44 59 74 89 104 119 134 154 179 above

. I. 12-23 (66) 1 20 18 8 8 14 14 6 2 3 6 3 ,0.. (45) 56 24-35 (87) 11 29 9. 9 14 10 7 1 1 I ,- 1' 55 (44) ..49 36-47 (86) 20- -19 13 5 9 7 10 6 3 1 5 2, : 62 (56) 45

II_ 12-23 (65) 12 15 9 6 18 8 12 11 3 2 3 0 66 (41) 70 -24-:35 (60)- 3-- -20 7 13 _ 8 -1$ ----10--_7 --,---_5______LL_____Z__.__76___(51) 7.0 36-47 (83) 5 . 17 12 5 10 7 10 7 4 7 -II'' 91 (66) 84

III 12-23 (74) 1 20 9 9 11 11 12 11 5 4 4 1 76., (51) 74_ 24-35 (100) -3 6 0 10 16 11 11 8 6 6 t 3 12 98 (67) 84 36-47 (97) 5 16 7 3 10 14, 15 7 7 4 3 6 85 (59) 80 _ . . -. . . IV 12-23 (69) 6 8 11 9 12 16 11 8 . 7 4 2 '84 (47) 85 . 24-35 (93) 5 9 4 6 4 17 f4 8 8 9' 6 . 10 100 (58) 93 ,- 36-47 (104) 7 7 5 5 5 17 11 8 11 12 7 8 102 (63) 95

Total ' 12-23 (294) 9 '15 10 8 12 11 12 9 5 5 4 1 . 24-35, (340) 6 15 7 9 11 13 11 . 6 ,5 5 5 7 ,. 36-47 (370) 14 9 4 8 13 11 8 , . 7 5 5 7

. 1 Int ke from all sources. I Percentage oflaach age and Income group In horizontalfine.

Table '13. Proportion of children* in 'first half sample of Table-15.Percentage of breast- and bottle-fed Infants Preschool Nutrition Survey receiving vitamin/mineral . . supplements, by age and Income quartile lot werk of ". 2 months of age

Income quartile (Num- Bottle- Bottle Children . -:, ber) Bottle Breast and Bottle-Breast , and Age and Income quartile breast breast Total Percekt ,- number supplemented - . . .. I. (169) 165'.. 27 8 82 11 - 7 12-23 months: Ii' '... (167) '72 .24 4 83 14 2 (21p). 70 28 2 .. 83 13 4 1 66 34 -- III. (211) 71 28 1 84. .15 1 If -e. 65 . 46 IV :III . : 2." 74..-- 57.. IV 89 . 65.. 1 percentage of Income group In iteritoqtal hoe for each characteristic. .

24-35 months: . I 87 34 Table16.-r' Vitamin/Mineral-Si4;ipmentation . II 60- 44. .. II I 100 '59 _ . IV 93 57 .Mothers tupplennAted'- Children between 3 and , j . during pregnikcy .m o n t h s of-age taking Income (Number) IN N supplements 36-47 months: quartile .. 86" 30 No ' Yes -.. No Ye* .'. 44 Il 83 :- 97 50 Ill -:I (168) " 1 25 75 3I,: 68 IV 104 . 59 II (165) 9 91 17. 83

III (208) 9 91 11 - . 89 s IV (208) 7 93 12 88 Table 14.Percent Increaie in nutrient levels with can-. . tribution of vitamin supplements to mean daily intakes, 1 Percentage of IncoMe gritip in horizontal line for each cDaracteristic. first -half sampleePreschool Nutrition SUrvey. 1 r, ,-. - Income quartile Age (Number) Vita-Thiamin . Ribo- 'Vita- (mos.) min A flavin min C - Table 17.Breakfast patterns -

121 24-47 Months I . 142 83 , _ 12-23 Months 212-234-35 {Vi 17 104 75 84. Child 36-47 (26) . 80 100 80 . 76 Income quartile .(Num- Someone Someone . - ber) None else her). None prepares else II 131 72 98 prepares .prepares ii---g . 2(61 21 128 36-47 (37), 76 117 -82 85 "(68) 11 99 (172) 6 5 III 12-23 129 7-, 104 I 97 (150) . 1 2 4-35 {li) .- Z! 125 c, 80 II (63) 4 95 36-47 (48) 70 84, 83 III 33-- - 97 1200) 3 5 92 - ..... IV (88) 1 98 (196) 3' 5 .93 IV 12-23 129 67 84 24-35 {g131 82 146 90 90 -36-47 (61) "84 143 92 72, 1 Percentage of income group in horizontal line for each age group.

. . - 13 Table 18.Child's reaction to new fruit or vegetable Table 21.Parental discipline for.mIld misbehavior

. Ignore or Restrict TastesTastes Income quartile (Number) Never mis- Rational Physical Tastes behaves,disciplinediscipline isolate privilege Age (mos.) (Num- NeverRefuses... and under and Varies beer) offeredto try rejectsprotestusually eats 12-23 months

(294) 1 <1 4 14 7 68 12-23...... I (69) 2 26 43 25 .4 24-47 (710) <1 13 8 14 58 7 , 11...... 4., ...... (63) 11 54 25 8 2 ili..,...,5,... -. - -- (77) 18 52. 19 9 1 (88) 63. 9 0 1 Percentage of age group in horizontal one:- IV' - 9 19 -7 -1 - 24-47 months

(171) 11' 43 'if'''15 II (150) 5 56 15 3 Table 19. Parental control over meal and snack times Ill..... (200) 5 63 17- 14 2 IV (190) 2 67 15 15 2

Set meals, Set-meals, Set meal Income quartile' (Number): No controls Iree- controlled and snack . .1 hiclydrii: "Redirect attention." snacks snacks times r Percentage of income group in horizontal line for each age group.

12 -23 months 'Table 22.Parent I response to good behavior

1 38 29 26 6 Physical or - I (68) Verbal tangible (63) 10 27 60. 3 Income quartile . (Number Do nothing response I I response (78) 17 24 56 3 IV '(88) 15 24. 55 7 , 12-23 months _ . 2447 months I (66) 1 27 17 56 Ii -(63) 27 II 55 ". i II -- ,..4._.4: 07) 31 21 48 I . (172) 30 27 . 38 IV .Ar(87) 17 31 49 II (150) 14 22 57 7 ... - . III (200) 10 27 62 1 24.47 months IV (194).. 9 r. 31 56 4 ..-

I (170) . 4 18 19 .1.204 63 Includes category "has set meal times and never lets child snack." 11 . '36 53 I Percentage of income group in horizontal line for each age group. II 4 (148) III (200) .15 38 47' IV (194) 19 48 41

r percentage of Income group in horizontal l'triri fOrieach age group.

Table 20.Parental use of food to reward or to punish 23.Mother caters to food preferenCes . used to Punish. Food used to reward Income quartile (Nu Eats baby Never asks No Yes - No. Yes Income quartile (Number) No' Ves or junior for different.. foods foods

12-23 months 12-23 months ,1

1 (68) 1 78 22 56 44 (68) 2 35 44 . 3 18

. 17 . 58 42 II (63) 16 52' 24 8

. 60 40 III . (78) 81 19 m (78) 19 53 21 IV --(88) -94 6 77 23 j (88) 32 48. 9. 11

24-47. months 24-47 months

I (170) 44. 0 r 16 74 26 43 57 (171) 0507 45 1 5 II (150) 71 .- .29 44 56 II 0" 9 III (199) -51 . (200) 70 30 56 45 III lY 43 48 8 IV (194) 77 23 43 . '

Includes "yes, always"'and "always has something he likes." 1 Percentage of income group in horizontal line for each age group and characteristic- Percentage of income group in horizontal line for each age groups

14 Table 24.Parental 3onse I when child does notat as Table MCharacteristics of children attending child care par: believe he should programs, first half sample, Preschool Nutrition Survey

Nursery school Head Start or Neither Both are Mother Father or day care prekinderorten Income quartile (Number) is strict equally . is more is more strict strict strict

Total number. 19.. 2- Mean age in months 35 43 12-23 months : Age distribution:

12-23 months. 1 1 . 24-35 months 7 I (49) I 14 I& 41 29 36-47 months 11 II (59) 15 10 44 31- Sex: III (76) 11 12 50 - 28 Male . 12 IV ...... (87) 16 9 . 49 25 Female 7 0 , . .. Race: . -\,

White 18 1 24-47 months Black 1 .; Income quartile: ---- l' 0 ii i 1 (126) . _11 _10 -. -43- 37 1- ,i 7 1 II ... (142) 5 10 38 4/ IV 9 1.11 (192) 7 . 12 43 38 Region: IV (192) 9 12 39 : 41,4 Northeast 3 1

North-central 3 3 ., South 10 0 -: I Question asked only if both father end mother tigtitelivedin the home. West 3 0 I Percentage of income group in horizontal line for each age group. .

Table 26.Person who shops for family

- Most of the time Some of the time

Income quartile Mother Someone lilotuhreer . Other relative Unrelated (Number).Mother Father figure .else (Number) Mother 'Fath.er fig person >15 yrs. <19 -urn.

I J -(239) *80 9 3 8 (98) 24 48 4 - .. 12 7 4 (240) 86 9 1 3 (85) 20 74 <1 5 0 0 II . .

III ). -(321). 90 -- 8 2 1 (125) -15 81 1 2' 0 1 IV_ (361) 96 4 <1 <1 (118) - 7 .-- 86 1 . -3 1 2

Percentage of Income group In horizohtal line.

Table 27.Person who cooks for. family

- Most of the time ..S-ome of the time

. Income quartile Mother .Someone . Mother Other relative Unrelated (Number) Mother Father figure _else (Number)i,!her Father figure per , ' >15 yrs. <15 yrs.

(239) *87 <1 6 6 (106) 20 16 4 29 25 6 U. (240) 95 <1 2 3 (92) 10 38 1 30 20 1 9 '51, 1 5 -., (321) 96 0 2 2 (111) 20 14 ; 1 11 59 IV (361) . 96 <1 (105) 2" 11 6 40-.

*Percentage otingpme group In horizontal line.

15. Table 28.Person who supervises mealtime

12-23 Months 24-47 Months

Income quartile (Number) Child *other Father Soicneet (Number) Child Mother Father Someone. else

Most of the time

...... r (67). r0 88 3 9 (1.72) 2 88 2 3 91 4 II (62) 0 94 3. 2 (149) 3 (76) 0 91 5 4 (199) 2 89 5 4 ill el 5 1 6 3 IV (88)- 92 3 (194)

Some of the U .

13 30 I._ _-, (42) 2 5 24 69 , (101) 1 56 -5 11 47 .37 II (36) 6 8 61 25 (87) -- 15 ...... -.. -61 4 12. t7 It0. III (38) 3 15 (112) 28 9 14. eft. 29 IV (57) 0 12 60 (119)

1 Percentage of Income group In horizontal line for each age group.

Table 29. Characteristics of families of 88 children 1247 months old having no father and no father figure, first. half sample, Preschool Nutrition Survey

Number Percent of group

Race: + White 45 51 Bqmk 40 45 Other .- 3 4' -,_ . . !owes quartile: 0-900 68 75 901-1,300 9 10 1,301-1.900 s 10, >1.900 4 5,,

Income source: Salary 7 8 Wages 21- 24. Priqate support- 8 Public welters 48 Other public support.. 4 5

1 Mean ale of children, 29 months; standard teviatioN 11 months.

Table 30.--Number of persons per family

Income quartile (Number) 2 essif 4 5 6 7 8 910 or more Mean %SD).6 Median ' 14 10 9 6 ,(2) 6 1_ (239) 1 4 12 16 16 10 9 Ii (241) 1 y 16 22 29 12 6 4 . (2) 6 1 -iip2 4 (1) 4 III (321) 1 13 40 22 17 - 6 ; - 4 (361) 2 31 39 21 5' 1 1 , .<1 3',1", 4 (1) IV ' -

1percsnigme of Income group in horizontal line.

16 Table" 31.Number of hours mother or mother figure Is away tad, week

50 and more Mean Income quartile (Number) None Less 5 to 10 11 to 20 21 to 30 31 to 40 41 to 50

3 1 5 I (239) i 5 62 10 8 3 2 6 2 9.7 II . (241) 7 48 22 9 3 7 3 19 6 7 7 7 4 11.8 -III (321) 9 41 7 6 10 3 14.4 IV (360) 3 31 21, 13

1 Percentage of in a group In horizontal line.

Table 32.Respondent attitudes toward' food preparation and recipes

Likes to cook Prepares new foods Tries new way; of preparing - Uses printed recipes foods

Yes Insane gunge -(Number) No Yes- Na Yes flo RaTely. s, Often Some- Always Some- Often 1". Sorir- Often Some- times times times times

3 , . 41. 43 77 23 <1 57 38 5 33 15 31 I (239) I 16 56 12 Ii (239) 13 32. 56 71 26 2 46 45 9 21 11' 10 61 . 74. III (315) 9 30 6i 66 33. 1. 40- 50 10 15 3 35 49 16 9° 9 .63 if IV (359) 13 28 59 61 36

s percentage Winsome groups In horizontal line for each characteristic. e,.

Table 33.How respondent obtains information about food

Recipe or TY, 'magazines, Neighbor.or Proiessioal or Income quartile (Number)floes not know cookbook grocery store relative public services'

(235) s g 42 14 25 9 (233) 7 4' 27 11 II (310) 4 47 11 24 14 ICI (352) 2 48 14 21, 14 IV

1 Percentage of income group in horizontal line. .Table.34.Store used for major grocery shopping

Kind of store

IncOme quartili" Small Super- Discount (Number) grocery or market market commissary -

, 4238) 1 19 73' 7 II 10 85 6' III piii- 11 6 87 7 IV s 358

Store and reason

Discount market Small grocery or commissary Supermarket - ... Trading stamps, Lower .7 fradintemps, Buycol Lower I me quartile ' Trading stamps, Buy on Lower : quality, or, price quality or credit price. (Number) .quality, or . credit .price .(Number) . convenience . convenience \-. .(Number) convenience . . . , 2 54 (16) 42 ;58 I (45) 54 20 26 (174), 44 52 (14) 15 . 85 II (23) 99- 0 11 (202) 0 (35) 7 93 III {28) 89 0 11 (256) 53 0 47 63 37 , (26) 19 '. 81 IV (20) 94 0 6 (313) 0

'Percentage of each income group 01 i10rIzo 1 line for each characteristic.

17 Table 35.-- Demographic characteristics for low-Income 4. B. T. Burton, The Heinz Handbook of Nutrition, 2d families of12-47-month-old children with adequate dietary intakes and with low Ini lkes ed. (New York : McGraw4.1111Book Co., 1965). 5. C. F. 6hurch and H. N. Church, Food Values of Por- ..loeconomic rating Scale flow Commonly Used, Bowes and Church, 11th ed: Variable Number 2-3 4-5 6-7 (Philadelphia: J. B. ,Lippincott Co., 1970). 6. R. , Feeley and_ 13. K. Watt, "Nutritive Value of Dwelling type 155(84) II (0) 49(35) 50(63) Foods Distributed -Under USDA Food Assistance Dwelling area 155(84) 1(0) 61(38) 49(62) Programs, " -J. Amer. Diet. A8800. 57 (1,070) :528-547. Occupation, male wage earner 100(58) 9(1) 19(25) 72(74) Income source 155184) <1(1) 67(60) '26(38) 7. S. J. ninon, Infant Nutriiion (Philadelphia : W. B. . SaundersCo., 1967).

Variable Number 0-6 7-9 10-12 13-15 8. Handbook 'of Infant Formulas, 5th, ed., Medical De- years years years years partment, Chas. Pfizer & Co., J. B. Roering Division (September 1967). Mother's education 153 (83) 7 (11) 30 (37) 61 (53) 6 (1) 9. B. 5...Platt, Tables of Representative Values of Foods Commonly Used in Tropical Countries, Privy COun- Variable Number White Black Latin Other -ell, Medical Research Council Special Report Series No. 30.- (WM, rev. 0. Or Special Report No. 253 Base 155 (84) 54 (38) 39 (51) <1 (1) 6 (4) (1945).

Intake from all sources. Numhers of children and percentage figures for children .10. .Woot-Tsten Wu Leung, and M. Flores, Food Composi- who had adequate calorie and nutrient intakes are unbracketed while those for children who had low intakesare enclosed in parentheses. Criteria for low intakes were: ;:sal./14. tion Table for Use in Latin America, INCAP-1CNND <75 for 12-23month old children and <60 for 24-47-monthold children; protein <1.2 gm./kg.lcalcium <400 mg.; vitamin A <100 IU/kg., and vitamin C <15 mg. joint project, June 1961. Based on scalerForralthigyrimery ratings-of-lour status characteristics, Warner, W. L.: "Social Class in America , Harper & Row, New York, 1960. The socioeco- '11. Food and Nutrition Board, Recommended Dietary nomic rating scale ranged from excellent, rank 1 to very poor, rank 7. 41/moanees, 7th ed., National Academy of ,Sciences 'Percentage of each group in horizontal line, Publication No. 1694 (Washington, 1968): Chrintakis et al.,- "A-Nutritional Epidemiologic In- Table 36.-Respondent attitudes toward food preparation ._ vestigation of 642 New York City and recipes in low-income families of children with adequate dietary intakes and with low intakes L. J. Olin. Nutt*. 21. (1968) : 107-126. 13. M. J. Dibble et al., "Some Preliminary BlOchemical Yes Variable NUmber No Findings -in Junior High School Children fh Syra- RarelySometimes Often cuse and Onondaga County,. New 'York," Amer. J. Olin. Nutr.1.7 (1905) : 218 -239.. - Likes to cook 150(80)215(21) 36(47) 49(32) 14. M. L. Myers et al., "A .Nutrition Study of School

Fixes new foods 149 (80) 73(83) 28(15). 01(1) Children in a Depressed Urban District: I. Dietary Findings," J? Amer. Diet. Assoc. 53 (1968) : 226-233. Prepares foods new ways 148 (80) 52(66) 42(32) 6(1)' 15. 1K: Lewin, "Forces Behind Food Habits and Methods

Uses printed recipes 148 (80) 29(43) 13 (19) 33(25) 27(11) of Change; in Report of the Committee on Food Habits 1941-43. The Problem of Clinging Food. Habits, National Research Council Ball. 108 1948) Intake from all sources. Numbers of children and percentage figures for children who had adequate calorie and nutrient intakes are unbracketed white those for children who had low intakes are enclosed in parentheses. Criteria for low intakes were: kcal-ill. <25 for 12-23-month.old childremg nti <60 for 24-47-month-old children;pro.' 16. G.431. Owen ,et al., "Nutritional Sirvey of rldississippi tein <1.2&m./kg.; calcium <400 .; vitamin A <100 11.1/kg. and vitamin C <15 ml. I Percentage of each group in horizontal line. Preschacit Children," A Pilot Study, Amer. J.' Clan. . Ntitr. 22 (1969) :14444458: References 17.. G. M. Owen and K. M. Kram, "Nutritional Status of Preschool Children in Mississippi:. FooeSources of '1. L. Lish and I. Hess, The. Survey Center's National Nutrients' in the Dieta,". J. Amer. Diet.' Assoc. 54 Sample ofDttellings, I. S. R. No. 2315, Institute for (1969.) : 490-494. Social Research, (Ann Arbor : University of. Mich- 18. G. M. Owen; unpublished observations. igen, 1965). . 19, G. 11.:OWen, C. B.:Nelson, and P. J. Garry, "Nutri- 2. S. F. Adelson, "Coding Manual tolandle Data from tional Status of PresChool. Children: Hemoglobin,. NatiOnwide Survey of Individuals, Spring 1965," Plematocitt and Plasma. Iron Values," J, Pediat. 76 USDA Agricultural Research Service CHB 296, 1966 (unpublished). (1970) : 761-763.. 3. B. K. Watt and A. L. Merrill, Compoeition of Foods, M.G. U. Owen et al.,. "Nutritional Status of Preschool Agriculture. Handbook No. 8, rev., Agricultural Re- Children :..Plasma Vitamin A," J. Pediat. 78 (1971) : search Service, USDA' (Washington: U.S. Govern- 10424014: ment Printing Office, 1963). 21. G: M. Owen and P. J. Garry, unpublished observations. . .

. 18 Food and nutrient intake of children from birth to four years of age

Juanita A. Eagles and Priscilla D. Steele Consumer and Food Economics Research Division, Agricultural Research Service, U.S. Department' of Agriculture Hyattsville, Maryland

The 'U.S. Popartment of .Agriculture. has made, age quantities- for groups ofpersOns classified by five nationwide surveys of household food con- sex and age. The average nutritive content of the sumption during the past 35 years. Asa part of the food eaten by the different sei,and age. groups most recent survey made in 1965-66, information was compared with the 1968 RecommendedDie- was obtained on the food intake- ofindividual taryAllowances (RDA's), FoOd and Nutrition members of the households interviewed. This was' .'Board, National .A.'4,clemy of Sciences-National the first time in a, .nationwide survey that data Research' Council, "adapted to match. the sex -age, were collededwhich-PrOvide for a comparison of groups used in the study:\ levels of consumption by sex -age 'groups in the . No information was,..obtained on the nntritional- United States by regions; urbanization, and in- status- of individuals. Therefore, no conclusions come classes. These data' help in determiningwhat can be drawn On the. existence ofmalnutrition or groups, of persons in our households havediets in hunger. need of improvement. Low-Income Families with Children from METHOD. OF DIETARY APPRAISAL Birth to 4 Years of Age Nationwide 06566 Survey of,Diets of LOW-inconie households,In---the- 19dd--66..survey, Men, Women, and Children were assumed to be those with 1964 moneyincome,

Reports of foodlitake for 1 day, the previous . after taxes, under $3,000. For the special purposes 24-hour period, wereiibMined for approximately of this workshop, -19w4neome hOuseholds were 14,500; persons. This sample Was drawn from 6,200 classified'as those with incomes Under: $4,000. households included in the sprint). portion Of the .-= In addition to the averageValues computed for household survey: Data were collected' during all all sex-age: groups, individual diets of children days of the week including Saturday and Sunday. Under 4 .years were analyzed and.:distributions -Information was obtained .on the kind, quantity; computed to 'show dispersion of consumption of and-method of preparation of foods and beverages foods and nutrients. These values -May not be a eaten at home and away from home. The time of good indicator of the quality 'of an individual's day food was eaten ind:the use of vitamin or diet, since one day's food intake May not be typi- mineral preparations were investigated also. cal of average food consumption by theindividual.- The nutritive value of the foods eaten was com- They'shoUld. not ho-Used in statements about the puted =mainly from-T.1.S. Department of ..4.gricul: .percent of Children whose dietd were .aboveor. tune Handbook No. g, Composition ofFoods: Raw, helow RDA's.; They do perniit, however,- a de- Processed, Prepqred, rev: 196grand unpublished tailed study of the different kinds and amounts of data of the Consumer and Food Economics Re, food used by children within defined levels of search Divisitht The data were computed in aver- :bnutrient intake..

Ai POPULATION CHARACTERISTICS come levels, and fcacr regions of the United States. Income and geographic distribution of the For protein and vitamin A value, average intakes studied are given in table 1. Children were 2 to 3 times the recommended allowances. under 4 years were classified in household income Average nutritive values show iron being very loW groups of .under. $2,000, $2,000-$2,9b0, $3,000- for most groups tabulated. $3,999, and $4,000 and over. Regions and urban- Diets of infants 0-.-2 months old furnished about ized areas, as defined by the Census Bureau, were half the amount or iron recommended, except for also reported for children in the study. infants at incomes under $4,000 in the North- Of the 719 children under 4 years, of age, about east. In the South and West regions, -dicta of 0-2- half were boys. About twice as many children lived month;old infants in two income classes furnished in urban as in rural households. Almost 30 percent .about two-thirds of the allowance for ascorbic of the children under 1 year lived in households acid. with incomes under $4,000; almost 50 percent of -Infants 3-5 months old had diets which fur- the children 14 years lived in households with nished less than two-thirds RDA of iron, except incomes under $3,000., for the Northeast and West under $4,000, and the Information- on race, age, education, andem- South over $4,000..Only two regions, South under ployment Of the homeMaker was 'collected for all $4,000 and Northeast over $4,000; did not meet households. the alloWance for ascorbic acid, but met at least two- thirds of it. NUTRITIVE VALUE OF DIETS Average diets of infants 6-11 months old met Average daily dietary intakes of calories and the RDA's for all nutrients studied except for iron five nutrientsprotein, calcium, iron, vitamin A and ascorbic acid. Iron intake was less than two- titirds of the allaWarkes for all infants in the four - value; and ascorbic acidere given in tables 2; 8. regions and at both incomes. At incomes under These nutrients' were selected because of the gen- $4,000, ascorbic acid was less than' two-thirds of eral interest in protein intakes by 'persons on low incomes and our preliminary finding that calcium,' the allowance in'the South; in the'North-central iron, vitamin- A Valtie, and ascorbic acidare the and West, it was at least two-thirds. 'At incomes of nutrients most often found below recommended $4,000 and over, infants in the Northeast ap- allowances in the diets of persons in the income proached the RDA's for ascorbic acid while infants class under $3,000 (1). in other regions wereabove it. In general, iron .and ascorbic acid seem to be . Primary emphasis should be given to compari-. sons of the average diets of. the different age the problem nutrients.r infants under 1 year groups rather than tothe individual intake values of age: In many instances, iron was about. 34 to for calories and nutrients (tables'4711)...The aver- 70 percent below the recommendations. Ascorbic ages provide data that are representative of the acid was from 26 to37 percent low for infants 6-2 months, and about 6 to 37 percent for infants various age groups of children. . In reporting average nutrient intake, values for, 3-11 months old. infants under 1 year are given for households with About one-half of the infants froni birth to 11 incomes under $4,000 and .for those with incomes. months used supplements during. the 24-hour .incomes under $4,000, of $4,000 and in four r1-4,1o.. ns. Values for chil- period of the survey. At dren -120 3 yeari are given fok, households with 42 percent of infants were giien supplements; M. ,percent- were given supplenlents at incomes of 4ficpmes under $2,000; $2,000-$2,999, $3,000 - $3,999 'in the Northwhich includes the Northeast, the. $4,000 and over (table 12). . Nortb-centrar Region', and the 'Westan& the Children 1-to 3 Years South. The simple Wes not large enough to 'war- Average -diets of c-hildren 1 to 3 years met the rant. separate tabulatims 'for urban- and rural recommended allowance for protein and vitamin A classifications, value. In several age groups they averaged over twice the.alloviance. Infants Uriider 1 Year. The diets of children 1 and 2 years of age, ex- Average nutritive values of diets of infants cept, for those in the North with incomes under under :1 year of age met the RDA's for protein;---$2,000, f-urnished less than half the amount of iron calcium, and VitaminA value in all age groups, in.,7 recommended. Except for one group in the South, 20

sr the average values of iron intake by 3-year-olds citrus and tomatoes, while those also low in vitamin were more than two- thirds the recommendation for A value, used about 3. ounces vegetables or fruits. this age group. However, as the Food and Nutrf- Those below recommendations in calcium in addition Board hasindicated, recommended allowances tion to iron, vitamin. A value and ascorbic acid. for iron are not expected to be met through ordi- Used less than 11/2 cups .milk, almost 41/2 ounces nary foods by all sex-age groups (s). About 6:mg. meat or substitutes, and 3 ounces vegetables- or of iron per 1,000 calories in all that might come fruits, including about 1- ounce citrus and tomatoes. from a normal U.S. diet, without additional forti- Practically all the children win.. 'net the recom- fication of foods beyond the present leVels. On that mendation for ascorbic acid used tomatoes or citrus basis, and considering that some caloric intakes fruit, while only a small number of those who were were below recommendations, the normal diets of below ,the recommendation . for this nutrient used young children cannot be expected to meet the cur- these foods, usually in small amounts. Dark green rent recommended intake. Individual intakes of and deep yellow Vegetables were not used to any iron for iday were between 4 and 7 mg. for 56 extant. Milk provided the majorsoutes of vitamin -percent _of_ the children 1 tb 3 years and' belOw 4 A value and ascorbic acid for thee children avCr- mg, for II percent. .aging below recorntnendati,ns in these two nutri- Except for some groups in the North, the diets ents, The vegetable- fruit'group needs the 'greatest of children 1 to 3 years were below the recommen- increase in number of servings andimprovemeni dations for ascorbie acid, seraptimesby as much as in choice of vegetable or fruit in order to meet the 50 prcent. Thirty-eight, percent of the children servings recommended for young children (3). had individual intakes: fOl. day that were below. 15 me ; :;., FOOD 'INTAKE 'Calcium on the basis of average quantities in the diets, was below the recommended alio-A/anus for Kinds and, amounts of foods eaten were tabu- children of ages 2 to 3 years but to a lesser extent lated by 12 food groups: Milk and milk products; than,for iron and ascorbic acid. One-year-old chil- eggs; Meat, poultry, and fish ; legumes and nuts; dren had average diets that furnished the amount fats and oils; grain .products; tomatoes and citrus, fruit; potatoes; dark green and deep yelloiv vege- of calcium recommended for this age. . Percentages of children with low intakes of cal- tables; other vegetables and fruit; sugars and cium, iron, and ascorbic adidfn the three income sweets; and beverages other than milk and juices. groups are shown in table 13. Quantities 'eaten and percent of persons eating are When averages are .beloV/ the recommended al- shown in table 14. Average amounts of some food small num- lowances for an age group, it is..safe 'to conclude groups consumed were low due to the that some persona within thatgroup,have.dItts in bers of children using-those foods. need of improveinent. Iron ivas the nutrient most commonly found below. recommendations in the Infants Under 1 Year diets of children 1 to 3 years, either singly or along In the ,United States as a whole, at incomes. with 'other nutrients studied. It was most com- under $4,000, infants' formula consistedmainly of monly found below recoMmendationsolong with ascorbic acid;'in dietslow in two nutrients. whole milk and evaporated' milk. At this income Urban children of ages 1-2 years, whose -diets level, 56 percent of the infants had whole milk and were below recommendations in iron only,iused-an 30 percent had evaporated milk. average of about 3 cups of milk, 5 ounces of meat or Young infants (Q-2 inonths) at the lowerin- substitutes, and 12 minces of vegetables`Or fruits, come level rarely Consumedwhole milk; consump- including less then I mules green and yellowveg- tion' increased with age and income.Neither (stables and about 5 ounces citrus and tomatoes. ready-togtse liquid nor aw formula was 'fre- Those below recommendations in iron plusascor- quently,uSed.by infants at this income. bic acid, or iron plus vitamin A value and ascorbic Of eighteen 0-2-month-old infants, 5 were on, acid, used 21/2-3 cups milk and 3-41/2ounces met formula alone, and '11 were having baby cereal or substitutes. Those, below recommendations in with-their fermula. Even after 3.months, I out of iron plus ascorbic acid only, used almost 5 ounces 37 infanta was still consuming only .forinula, while vegetables or ,fruits, including less than I ounce of the rest had either fruit or juice,cereal, meat and/ a or eggs. Forty-three percent of the 3-5-month-old , i mine, deep yellow vegetables, beans, or peas, and infants had at least formula and cereal. white potatoes were the Vegetables most frequently at incomes of $1,000 and over, 71 percent of the used._ /Infants had fluid whole milk, 10 percent of these. At the lowest income (under $2,000), no fruit being less than 2 months of ago. At this income 10. was used by the younger infants. Frequency of use percent of the infants under 1 year got evaporated increased with age and income. fruits most fre- milk, as compared with 30 percent for the lower quently. used by infants were apples and apple-. income level. Consumption of evaporated milk de- sauce, citrus fruit and juice (mostly orange jurce)', creased.with age for both income levels as use of and peaches, in that order, whole milk increased. ° At incomes of $4,000 and over, use of fruits was A greater variety of read -to-use liquid formula more common at an earlier age, use increasing with was consumed by infants at higher.incomes. At in- age Again, fipples and applesauce, citrus fruit, comes of $4,000 ar' over, 17 percent of infants and juice were ustid most frequently, followed by consumed ready -to -use formulas, compared with pears and peaches. Apples and applesauce were 10 percent using them at:the lower income. Dry used more frequently by all age and income groups formulas were liaud by 6 percent of infants at than any other- fruit. higher incomes and by 2 percent atincomes under . $4,000. el" 'Children,l. to 3 Years At incomes of $4,000 and over, 28 percent of 0-2-1 It has been reported that only 10 to 20 percent month-old infants and 4 percent of infants 3-5. of all persons in the various age groups in the 1965 months were consuming formula alone. About 10 survey ate any of the dark green and deep yellow percent of .all.children 3-5 months had eggs :tailed vegetableS in a day. (1). This fact coupled with to their daily food intake. Lewin's finding that people like what they eat At both income levels, cereal seems to be 'the rather than eat what they 'like (4) prompted,ari first and most popular solid food for infants 0 investiiationfd the vegetables used by 1-to 3 -year-

to 5 months:of age. At low income;, 49 percent old children. \ . had formula plus cereal, and at higher. incomes, Dark greel and deep yellow vegetables were 41 percent. used by 10 Percent of these children in the North- . In the United States as a whole, the use of foods and liy 18 ,orcent in the.Sonth. Spinach, carrots, other than formula increased as age and income and sweet Totitoes were used by th largest num- increased. Baby and/or junior vegetable and meateAber, about 3 percent each, iand411 rds by 2 per- mixtures were used almost twice as frequently as cent. Broccoli, mustard greens, turnip greens, and Meat and vegetable mixtures. These two mixtures squash were each 7ased by 'ewer than 2 percent. Make up a laige part of _the meat products con-- Potatoes were used by a considerable number of stimed by infants under 1 year of age.. Use of these children. Mashed potatoes were used' by 16 meat items Started at about 3 'months, for both percent; chips an4fietl, by 7 percent each; boiled income levels. By 6 months, 33 .percent of lOw- and french-fried, 147'.*percent eaoh; and baked, income infants and 38 percent at incomes of $4,000 by 2.',perCent. Potatoes ifi' cream sauce and potato and' over had some *meat mixtures added to their salad were used also. diets. Of the vegetables include in "Other Vege- At incomes under $1,000, vegetables, were infre- tables," corn was used by the largest number of , quently used by young infants (0-.2 months). In children (about 10 percent), followed by\green the 3-.5 months' age group, consumption increased beans and green peas _(abotit 7 percent each), csj,7,is .. only atincoinel" over $2,000. By 6 months of age, bage (6 percent), and Jana beans and lettucOt 35 percent were using vegetables. White potatoes, '-(about 4 pertent'each). Asparagus, blapkeye peas, beans or peas,and deep yellow vegetables (mostly,green 'onions, cucumbers, sweet peppers, beets, and:: carrots' and sweet potatoes) were; the 'vegetables celery were used by smaller numbers of.children; . most frequentlyntied; wax beans, cauliflower, eggplant, okra, Olives, ma- At incomes of $4,000and over,.a: later number ture onions, raaishesauerkifaut, squash, turnips,

of young.. infants consumed vegetables. In. the .artichokes, and red cabbage by none. 111ixed'v.ege- group between 3 and 11 months of age,.71-pereent" tables wete used-by about 3 percent and vegetable. of the infants were consuming vegetables:At this Soup by about 8 percent.

22 REGIONAL, INCOME, AND. -ream AVerage intakes of calcium' were below AGE DIFFERENCES recommendations for some children 1 to 3 "(- - _ years. There was nogni.flcant difference 0 :percent Average- were above the RDA's for infants and children under 4 years in protein levely due to region, income, or age between the and vitamin A Taloa.: Infants under 1 year mean intakes of iron by infants and children under were above the recommendations in calcium 4 "years o'1, age or between mean intakes of food also. energy and protein by children 1 to 3 years. Average intakes of calories by some age Mean into kis of vitamin A value by children 1: groups were telow _the allowances. Physical to -3 years appeared to be influenced by regional activity and -body size of the children, were factors, the North having higher values than the not imown, Infants, in the United States as a whole, South. The small number of cases combined with consumed more whole and evaporated exceedingly high intakes by two children. how- than ready-to-use formulas. About two- thirds ever, may have influenced the test. Of'the infants from birth to 11,montlig-Con- Both region and income influenced mean intakes sumed -whole milk, and 16-percent, evaporated of ascorbic acid by children-1 to 3 years: The North. milk. Ready-to-use formulas were consumed by 15 percent of the infants, 12" percent of had higher values than the South. The means for which were in income classes of $4,000 and the income class $2,000-$2,999 were lower than over. Dry formulas accounted for about4 per- those of the income under $2,000 and the income cent; and less than 1- percent-reported using

$3,000-$3,999, the latter two being similar to each soy formulas. . other. There was a significant difference due to age in, Table 1.Distribution of children by region, age, the mean intake of calcium by children 1 to 3 years and income and of calories, protein, calcium, vitamin A value, Income class and ascorbic acidly infants under [year. Children 1 = II III IV Region and age Number 1 year of age had higher values than children 2 or Under $2,000- $3,003- 60,000 $2,000 $3,999 and over 3 years old. $2,999

United States :719 9' ..I12 216 294 , ;CONCLUSION Northeast: ei; e Total 157 14 49 86 The data presented were compiled from a' na- 0-2 months 19 1 5 13 3-5 months 36 1 1 , 2 32 tionWicfe survey of the diets Of men, women, and 6-11 months 51 2' 2 6 41 children carri ut in the spring of 1965 by the I year 17 2 3 12 0 2 years 23 3 5 15 0 U.S. Depart ent of Agriculture. In the survey, 3 years 11 0 2 9 0 no inforniatiowas obtained on the nutritional ids. North Central: status of indivi Total 144 lib 32' 88 This reportpplements the earlier reports by 0-2 months 18 0 O 1. 17 3-5 months 21 0 4 16 the U.S. Depa.ent of Agriculture on the dietary 6-11 months 60 3 55 levels of individual members of households. It re- 1 year. 16 8 7 0 .2 years 12 0 4 0 7 9 0 inforces the need for increased consumption of 3 years 17 4 vegetables and Is generally, and of 144:-

some iridividu and the need for better food Total, 316 73' 67. 103 73 sources of iron. 0-2 months--; ...... 19 3 5 10 3-5 months 44 9 5 10 20 This study of children from birth to 4 years of 6-11 months:. 79 13 10 13 -43 age showed that: I year 45 12 22 0 2 years 59 15 "420 24 Average diets of infants under 1 year met 3 years 23- . 18 29

the MA's for-more nutrients than did aver- West: age diets of children 1 to 3 years. Toll 102 10 13 32 47 On the basis of average diets of children 0-2 months 15 0 2 0 13 under 4 years in low-income families (table 3-5 months...... 14 0 1 3 40 6-11 months 36 3 2 24 15), the major problem was low iron intake. 1 year 15 2 3 10 0 Average intakes of ascorbic acid were also 2 year 3 4 , 4 0 below recommended levels for some groups 3 years 11. 2 I 0 of infants under 1 year and children 1 to 3 23 Table 2.-Nutritive value of food Per person in 1 day, infants under 1 year

Age, annual income, and region ,Food energy"' (cal) Proteic (Et.) Calcium (mg.) Iron (mg.) Vitamin A value (UK) Ascorbic acid (m2.) _ -

0-2 months: Mean S.E.1 Mean S.E. Mean Si. Mean S.E. Mean S.E. Mn u Si. Under 54,000: Northeast (6) I. 300 51 29.0 5.7 1,005 164 11.9 4.8 1,900 270 SO 8 North Central (1)7 605 0 11. 6 .0 504 0 .4 . 0 2.370 0 47 0 South (9).._ ..- 711 51 27.8 4.0 971 138 3.6 .9 1,950 -250 26 8 West (2) 762 184 25.0 IL 8 849 351 1.8 .7 1, 390- 170 2Z 20 54,000 and over: Northeast (13) 712 58 20.5 1.9 755 49 3,4 .6 3,530 910 38 7 North Central (17)______...... 7 _ 816 100 26.5 3.5 896 100 3.3 .9 3.950 820 40 11 44 21.1 2.9 790 990 3.2 _9 1.920 VO 22 7 South (10)----- ______- 648 West (13) 630 1% 22.8 4.9 81B 167 4.3 1.7 1,930 _ 430' 25 8 3-5 months: Under $4,000: .. Northeast (4) 982 .120 3L2 5.3 936 190 8.3 4.3 5.130 1.090 77 25 North Central (5). 937 322 29.4 6.3 996 212 2:4 .9 3,321 1.490 55 30 1. 4 3,170 BOO 26 8 . South (24)___ 843 75 36.0 3.3 ' 1,154 106 6.0 West (4) 890 140 25.6 3.5 793 126 6.6 3.1 2, 540 750 46 , 16 $4,000 and over Northeast (32) 842 53 32. 0 2.7 899 76 5.2 4, 070 550 33-. 8 North Central (16) 823 66 29.1 2.3 908 71 3.8 1.1 5.120 I. 010 46 - 10 South (20)* 966 49' 43.5 7.8 1, 072 70 11.9 6. 4 5.840 I, 530 45 7 West (10) 873 '139 28.4 5.8 832 155 4.0 1.0 3,890 1.220 68 13 6-11 niciptbs: . Under $4,000: Northeast (10) 975 -74 43.9 4.8 1,139 101 6.9 'L7 5,630 1,040 47 11 ..`- Nodh Central (5) 925 95 43.6-- 1.0 -I; 264 94 2.2 .3 4,900 I, 060 .33 14 South (36)-....,..------; ---1, 045 56 46.6 2.9 1,199 76 6.1 1.4 4, 470 860 22 3 1,069 126 '46.4 5.9 1.177 136 6.7 2. 4 4,720 960 29 8 -West (12)_ v " $4,000 and over Northeast (22) 1.188 65 50.7 3.0 1,149. 78 6.8 .8 5, 980 900 34 5 .7 4,180 . 330 40 4 , North Central (55) I, 041 44 46.1 2.2 1, 087 47 5.8 South (43) I, 060 48 43.4 22 1,105 59 8.4 1.2 5, 030 680 41 5 West (24) I, 036 56 52.6 5.6 1,110 80 7.5 1.3 7, 530 1.370 38 6

I Number of infants. ;Standarderror of mean. Tgble 3.-Nutritive value of food per person in 1 day, children 1 to 3 years

Age, annual income,and region Food energy (cal.) Protein (gm.) Calcium (mg.) Iron (nag.) Vitamin A value (I.U.) Ascorbic acid (mg.)

Mean S.E.I Mean Si Mean Si. Mean S.E. Mean S.E. Mean- 5,5 1 year: Under $2,000: . . North (5) I 1, 214 127 53.8 4.9 1,107 133 8.0 2.9 4, 531 1,7130 65 21 .9 2, 810 510 . 29 8 South (12) 1, 432 159 552 4.5 I, 226 . 127 5.6 12,00042,999: ' 38 9 North (14) 1, 368 76 .62.2 4.7 . 982 0 79 6.4- .6 3,200 '580 South (11) 1,115 125 45.8 3.6 913 77 4.2 -6 3,250 1,220 .22 10 13,00043,999: . North (29) 1,313 73 53.6 2.7 952 66 6.6. .1 4,120. 780 44 7 South (22) 1,089. 77 45.5 3.8 808 .95 5.2 .6 2, 900 530 32' 7 4, 2 years: ,:. p Under 12,000: 1,556 148 64.2 5.6 1,020 37 8.5 1.4 13,920 10,740 86 21 A" .i N4rth (6) 26 8 -.. 0 .&105) 1,333 195 52.6 7.6 . 930 179 7.0 1.2 2,970 900 . '''',- 32999: fiertg.(13). 1,18f1 95 47.5 4.8 632 67 6.6 .8 2,980 91D 29 6 590 zs -10 So 20) I4 1,300 137 51.0 4.6 762 70 6.0 .7 2,670 51,000-41,999 ;- it. , North (27) 1, 410 98 53.0 4.2 839 46 6.3 .5 2, 700 350 53 11 290 19. 4 ... South (24): 1, 465 89 54.6 5.0 685 64 7.2 .8 2, 080 3 ran: Under 12,000: 20 North (6) ' 1, 270 154 48.9 3.8 684 163 7.0 1.3 9, 870 6;190 53 3 South (23). 1,570 173 62. 0 6.4 846 154 9.8 1.1 2,930 - 450 23 $2,000 - $2,999: North (7) 1, 315 '121 53.8 4:5 742 179 7.6 .7 3, 220 1,110 30 ;South (18) 1,167 108 37.6 4.1 519 107 5.9 .5 3, 580, 1,120 27 - 53,000-$3,999: 64 7.9 . 7 5.720 1, 840. 50 / North (26) 1;596 103 661. 2 4.4 944 ' South (29) 1,236 90 47. 1. 4.7 507 56 7.1 .7 2, 540 370 .30

Number of children. Standard error of mean. 24 Table 4.Frequency distribution of iron (mg.), diets of Infants under 1 year

Less 2 4 6 8. 10 12 14 16 19 22 25 Age to and Inns (mos.) Number than to to to to to 00 to to to 2 3 5 7 9 - U 13 15 18 21 24 above

0 0 0 0 0 0 0 Under 32.0000) 0-2 1 0 1 0 0 0 0 0 --2 3-5 -10 4 2 1 0 2 0 0 0 a 0 0 6-11 19 8_2 1 4 0 0 1 0 0 0 0 0 0 0 0 0 12,00042,999 (11) 0-2 6 3- 1 2 0 0 0 3-5 8 4 0 0 0 0 2 1 0 0 1 0 0 0 0 6-11 15 1 5 3 3 1 1 1 0 0

0 0 0 1 $3,00043,999 (III) 0-2 11 2 2 2 0 1 1 1 1 0 3-5 19 5 4 3 3 1 1 0 2 0 0 0- 6-11 29 3 8 8 4 1 1 0 0 1 1 0 2

Under 14,000: 1 1 1 1 0 0 0 1 Total 0-2 18 5 4 4 0 3-5 37 13 6 4 3 3 3 1 2 0 1 0 1 0 2 6-11 E 3 7 21 13 8 6 2 1 1 1 1

1 1 1 0 1 0 $4,000 and over (IV) 0-2 53 18 16 6 7 2 3-5 78 15 27 13 6 6 3 2 3 1 2 0 0 6-11 163 9 45 35 16 6 14 4 2 2 4 4

Table 5.Frequency distribution of ascorbic acid (rng.), diets of infants under 1 year

Age Nam- Less 15- 30 45 60 75 90 105 120 135 150 165 to to to and Income class (mos) her than to to to to to to to 15 29 44 59 74 89 104 119 134 149 164 above

O. 0 0 0 0 0 0 0 to . Under$2,000 (I) 0-2 1 1 0 0 0 3-5 10 7 1 0 0 2 0 0 0 0 0 0 6-11 19 8 7 2 1 1 0 0 0 0 0 0 0

0 1 2 1 0 0 0 0 D 0 0 32,00342899 OD 0-2 . 6 2 3-5 8 2 2 2 0 0 1 0 0 0 0 0 1 6-11 15 5 8 2 0 0 0 0 0 0- 0 0 0

1 2 4 0 1 0 0 0 a 0 0 13,000- 33,999(III) 0-2 11 3 3-5 19 10 3 1 0 , 1 0 2 0 1 1 0 0 0 6-11 20 - 8 9 2 3 1 4 1 1 0 0 0

Under 34,000: 1 6 1 1 0 0 0 0 0 to Total 0-2 18 6 . 3 3-5 37 19 6 3 0 3 1 2 0 1 1 0 1 6-11 63 21 24 6 4 2 4 1 1 0 3 0 0

1 0 0 14,000 and over (IV) 0-2 53 25 5 4 9 5 0 2 2 0 1 0 0 3-5 78 20 15 11 - 9 12 3 4 0 3 6-11 163 39 52 23 13 10 9 6 4 5 2 0 0

Table 6. Frequency distribution of calories, diets of children, 1 to 3 years

Age Less 200 400 0 1,000 1,200 1,400 1,600 1,800 2,000 2 205 o to to -to a nd Income class (yrs) Number hn t80 399 799 999 199 1 399 2199 v e

0 3 2 2 4 3 1. t Under $2,000 (I) 1 17 0 1 3 0 1 3 2 21 0 0 5 1 .4 0 4 3 29 .0 3 -5 3 5 4 - 2 1 1 0

0 0 3 2 7 3 4 5 1 0 o $2,00042.999 (II) 1 25 7 1 0 2 2 33 0 0 4 8 4 5 2 3 25 0 1 4 1 -6 4 4 1 3 1 0

6 10 14 5 3 '2 1 53,00043899 (III) 51 0 9 - 4 2 51 0 0 1 6 9' 12 9 4 4 2 9 3 55 0 1 8 3 7 8 9

19 13 11 3 3 1 1 93 0 1 12 11 19 5 3 2 105 0 0 10 15 17 19 18 9 9 3 109 0 2 15 9 16 17 17 12 7 4 10

25 Table 7.Frequency distribution of protein (gm.), diets of children, 1 to 3 years

Age ram- Less 10 20 30 40 50 60 70 83 93 100 1107 Income class (yrs.) ber than to to to to to to to ZS vott 10 15 29 39 __AS ---73 83 99 109 above

--Under-823nay.:- 1 17 0 0 1 1 3 7 4 0 0 1 0 0 2 21 0 1 2 5 2 2 2 3 2 1 0 1

3 29 U 1 0 5 6 6 5 1 2 0 1 2

52,000-V4999 (I 0---;------...... 1 25 0 0 1 2 6 10 2 1 1 2 0 0 2 33 0 1 2 8 9 4 3 3 2 - 1 0 - 0 . 3 .25 1 2 --3 3 3 4 2 2 0 0 0 0

$3,000-53,999 (I IQ. 1 51 0 1 6 6 10 12 10 5 1 0 0 0 2 51 0 2 2 9 .10 13 6 4 1 2 1 1 3 55 0 2 9 6 6 15 3 6 2 2 3

Total 1 93 0 1 8 9 19 29 16 6 2 3 0 0 2 105 0 t4 6 22 21 19 11 10 5 4 1 2 3 109 1 5 12 14 20 25 10 9 4 2 4 3

Table 8.Frequency distribution of calcium (mg.), diets of children, 1 to 3 years

Age Num- less 200 300 400 500 600 700 800 900 1,000 1,203 1.500 Income class (yrs.) ber than to to to to to to to to to to and 200 299 399 499 593 699 799 899 999 1,199 1,499 above

-......

Under 12,000 (I) 1 17 0 1 0 0 0 1 1 3 4 5 2 21 1 2 1 0 1' . 2 1 3 2 4 1 3 3 29 5 2 2 2 1 1 2. 4 2 -2 3 3

52,000-42,999 (II) 1 25, 0 1 0 1. 1 1 3 1 5 7 5 0 2 33 1 2 1 4 6 4 3 3 3 4 2 - 0 3. 25 7 0 3 3 2 4 1 0 1 2 0 2

$3,000-$3,999 OD_ 1 51 1 4 2 ' 2 3 5 3 4 8 8 5 6 2 51 1 1 2 6 8 6 4 5 7 9 1 1 3 55 5 5 4 7 2 5 4 6 2 6 9 0 . . . Total 1 93 1 6 2 3 4 7 7 6 14 18 14 11 2 105 5 4 10 15 12 - 8 11 12 17 4 4 3 109 17 7 9 12 5 10 ' 7 ID 5 10 12 5 \

/ Table 9.Frequenci distribution of Iron (mg.), diets of children, 1 to 3 years

Age Num- Less 2 4 6 8 - 10 1.2 14 16 19 22 25 Inme class (yrs) ber than to to to to to to to to to to and 2 3 5 7 9 11 13 15 18 21 24 above

Under 52,000 (I) 1 17 1 I 7 3 2 2 0 0 0' 1 0 0 2 21 0 4 4 5 4 0 0 3 1 0 0 0 3 29 7 8 4, 3 1 0 5 1 0 0

8000-42,499 (II) 1 25 1 5 6 8. 4 1 0 0. 0 0 0 0 2 33 1 5 6 11 7 2 0 0. 1 0 0- 0 3 . .'25 0 1 8 6 9 1 0 0 --0 0 0. 0

$3,000-43,993 (iII) 1 51 0 8 15 18 3 4 2 o 0 0 1 0 2 51 20 11 11 2 1 2 0 0 1 0 3 55 0 5 14 14. 8 3, 7 2 2 0 0 0

Total 1 93 2 14 28 29 9 7 2 0 0 1 1 0 2 105 2 .11 30 27 22 4 1 5 2 0 1 0 3 109 0 6 29 28 21 7 8 2 7 1 0 0

26 Table 10.Frequency distribution of vitamin A (i.U.), diets of children, 1 to 3 years

Age Num- Less 500 1.000 1,500 2,000 2.500 3A00 3,530 1.000 5.000 6,000 7.000 Income class (yrs.) per than to- to to to to tD to to to to and 500 999 1.499 .1-999 2,499 2,999 3.499 3.999 4.999 5,999 6.999 above

Under 12.000 (I) 1 17 0 2 2 1 2 2 1 4 1 0 1 1 2 21 1 5 2 1 3 1 2 1 1 0 I 3 3 29 1 4 5 2 0 5 3 1 3 0 1 4

.92,000-32,999 (i1) 1 25 1 3 0 4 3 5 5 1 0 0 0 3 2 33 1 7 4 4 6 3 1 1 3 0 0 3 3 25 1 6 7 1 3 6 1 0 0 i 1 3

$3,000-$3,999 (Ill) 1 51 0 6 5 5 8 7 4 3 5 1 2 5 2 51 2 3 11 8 19 7 2 2 2 0 1 3 3 55 3 5 8 10 6 2 6 3 1 1 3 7

3 9 rota! 1 93 1 11 7 10 13 14 10 8 6 1 2 105 4 15 17 13 19 11 5 4 6 0 2_ _9 3 109 5 15 15 13 9 13 10 4 4 2 5 14

Table 11.Frequency distribution of ascorbic acid (mg.), diets of children, 1 to 3 years

Age less 15 30 45 60 75 90 105 12t 135 150 165 Income class (yrs.)Number than to - to to to to to to to to tr and . 15 29 44 59 74 89 .104 119 134 149 164 above

Under 42.000 (I) 1 37 5 5 r 2 1 1 0 1 1 0 0 0 2 21 8 3 3 2 0 1 0 2 1 1 0 0 3 29 9 11 a 2 1 0 1 0 I 0 0 0

92,000-32,999 0 0 1 25 10 8 1 3 0 et 1 0 2 0 o 0 2 33 16 9 2 3 1 1 0 - 0 0 0- 0 1 3 25 11 7 3 1 1 0 1 0 1 0 0 0

0 $3,000-33,999 (III)_ 1 51 18 12 5 2 6 2 1 2 3 0 0 2 51 19 13 7 1 0 4 0 4 2 0 o _ 1 3 55 20 15 5 3 3 2 1 0 2 1 1 2

3 Total 1 93 33 25 1 7 7 3 2 6 0 0 0 2 105 43 25 12 6 1 6 0 6 3 1 0 2 3 109 40 33 12 6 5 2 3 0 4 1 1 2

Table 12.Vitamin or mineral supplements, and race, infants under 1 year

Income under $4,000 Income of $4,000 and over

Region and age Vitamin or mineral supplement Race Vitamin or mineral supplement Race

Number Using Not Not re-. White Negro Other Number Using -Not Not re- Wt.'/e Negro Other using porting using porting

Total 118 50 65 3 67 45 6 294 159 128 7 249 34 11 Northeast: 0-2 months...-. 6 4 2 0 5 1 0 13 4 9 0 12 1 0' 2 31 1 o 3-5 months 4 1 2 1 2 2 0. 32 17 13 6-11 months__ 10 5 5 0 7 3 0 41 25 , 15 1 36 3 2 North - central: 1 17 0 0-2 months 1 0 1 0 1 0 0 37 10 6 0 14 1 1 3-3 months 5 2 2 1 3 2 0 16 -8 8 0 2 3 3 1 1 55 20 35 0 49 4 6-11 months. 5 A _ South: , 0-2 months___. 9 5 4 0 5 4 0 10 5 5 0 9 1 0 . 0 17 3 0 3-5 months-- 24 8 15 1 11 13 0 20 17 3 23 18 2 27 15 1 ° 6-11 months-- 36 13 23 0 21 14 1 43 West: 0 1 0-2 months 2 1 1 0 2 p 0 13 8 11 1 3-5 months____ 4 2 2 0 2 1 1 10 3 1 7 1 2 6-11 months._ _ 12 1 5 0 5 4 3 24 16 8 0 19 3 2

27 Table 13.-Percentages-of-cbildren-1163-yearsirith -tow daily intakes of 3 nutrients

1000nle

Less than 02.000- 03.000- 52. coo 022.999 53.999

Number of children...... 67 83 157 Calcium: (<400 mg ) - - ...... - 21 18 16 (<200 mIt.) 9 10 4 Iron: (<12mg.) 22 99 89 (<8 rat) 60 70 69 Ascorbic sr ".. (<15 mg.) 33 45 36

Table 14a.-Quantity of food per person in 1day and percent eating-(infants under 1year)

Quantity per person le grams Percent or persons eating Number Legumes, Fats. Grain Age, annual income and region of Milk and Meat, Legumes. Fats. Grain Milk and Meat. polity. nuts lets products persons milk Eggs poultry, outs oils products milk Egg.s products' fish Products fish

0-2 months: Under 64,000: 100.0 Northeast.. 6 447 7 30 100.0 16.7 North-central 1 388 55.6 South- - ...... 9 643 7 8 100.1C1100 22.2 66.0 West 2 509 28 100.0 $4,000 and over: ______69.2 -13 183 5- 10 110.0 7.7 5.9 _1 76.5 North-central 17 613 16 12 100.0 40.0 South_ 10 500 6 100.0 69.2 West. 13 518 8 100.0 3-5 months: . ,Under PGOO: 100.0 Northeast 4 1659 29 7 21 100.0 75.0 25.0 20.0 60.0 North - central. 5 673 3 2 5 100.0 20.0 25.0 8.3 83.3 South 24 686 1 22 1 14 95.8 4.2 50.0 25.0. -100.0 West. 4 468 31 127 11 100. 0 $4,000 and over: 40.6 12.5 - 84.4 Northeast 32 614 13 36 26 21 87.5 15.6 31.2 87.i North-central 15 739 (I) 24 12 100.0 6.2 45.0 75.9 South 20 790 13 23 11 100.0 25.0 50.0 90.0 West__ 10 504 20 11 100.0 6-11 months: Under $4.00': 80 .0 Northeast_ 10 854 36 72 16 100.0 48.0 60.0 80.0 North-central S 1.039 31 100. 0 36.1 52. 8 13.9 33.3 94.4 South_.... 36 769 26 58 12 6 33 97.2 22 100. 0 33.3 50.0 33.3 75.0 West.. 12 751 16 94 3. $4,000 and over: 12 2 17.1 90.2 Northeast- 41 803 1 ) 92 8 3 33 100.0 43.9 65.9 16.4 29.1 92.7 North-central. 55 825 31 83 11 3 24 100.0 38.2 60.0 9.3 0.3 83.7 Soul 43 721 26 79 53 2 20 95.3 39. 5 67.4 2 28 100.0 41.2 62. 5 4.2 25.0 95.8 West.. 24 797 14 72 11

I Calcium equivalent 'Flour equivalent. Less than 0.05 gram.

28 -- Table 14b.--Quantity of food-per person in 1 day and percent eating-(infants under 1 year)

Quantity per perms; is grams Percent ol persons eating

Dark Otter Dark Other Age. annual income and Number Toma- green, Pota- vete- Other Tama- green. Pato- veg.- Other region of toes, deep bes, tablet Sugars, never- toes, deep toes, tables Sugars, bever- persons citrus yellow white and sweets ages citrus gentler white and sweets ages fruit vete-. fruit fruit vote- fruit tables tables

0-2 months: Under K000: Northeast 6 57 209 11 50.0 100.0 33.3 North-centraL I South 9 12 8 40 13 3 2.2 11.1 33.3 33.3 1L1 West 2 56 50.0 $4,000 and over: Northeast__ 13 -2 12 26 10 7.7 30.8 53.8 23.1 North - central 17 6 10 53 1 11.8 17.6 41.2 23.5 South_ ...... -----_ 10 6 31 15 10.0 50.0 SO. 0 West 13 36 9 38. 5 15.4 3-5 months: Under $4,000: Northeast 4 91 2 191 75.0 M 0 75.0 North-central 5 10 82 2 20.0 80.0 20.0 South 24 24 9 3 76 16 25.0 12.5 4.2 58. 3 33.3 West 4 146 0 75. 0 ; 25.0 $4,000 and over: 15.6 ,. ,. Northeast 32 18 18 152 4 18.8 31.2 87.5 North-central 16 34 21 164 2 37.5 31.2 87.5 25.0 South 20 32 14 157 27 5 30.0 30.0 90.0 30. 0 5.0 West 10 65 14 58 23 40.0 40.0 70. 0 20.0 6-11 months: Under $4,000: Northeast 10 47 26 272 1 40. 0- 30.0 100.0 10. 0 North-central ...... z-__... 5 25 9 43 105 14 20.0 20.0 60.0 60.0 60.0 South 36 - 12 17 12 121 15 22 11.1 16.7 19.4 63.9 36.1 13.9 , West 12 13 24 8 175 13 15 8.3 25.0 16. 7 100.0 50.0 8.3 $4,000 and over: Northeast 41 30 17 4 248 9 16 19.5 220 9.8 87.8 26.8 9.8 North-central 55 33 10 14 233 2 21.8 12.7 20.0 90.9 25.5 South 43 23 11 11 247 5 10 14.0 16.3 25.6 86.0 30. 2 7.0 West 24 18 23 . 10 228 16 1 16.7 29.2 16.7 100.0 25.0 4.2

Less than 0.05 grams.

449-725--72------3 Table 14c.-Quantity of food per person in 1 day and percent eating-(ctildrerr 1 b3 3 yrainrs)

Quanthy per person in grants Perrtestt of Pders-_, ruoi _Naaiget Age, annual income and mice: of Milk and net Legumes. -Fats. Grain Milk wad 'Heat. Grata persons milk Eggs poultry. nuts ors products a milk Eggs .paultry, products products" fish products to.n

1 year: . Under 32J3010: North 5 843 16 227 2 9 33 130.0 43.0 100.0 J E2.3 South 12 749 45 - 57 21 12 63 91.7 S.3 75.0 . 5F_: '...Y2. $2,1303-$2_999: North 14 671 43 113 15 25 71 100. 0 57.1 78.6 7 57.1 IX. 0 South 11 653 30 55 12 4 65 100.0 45.5 63.6 ,'..3 45.1 1010 $3,000-53999: North 29 680 Z7 108 10 17. 61 100.0 44.8 93.1 20.7 58.E 303.1 South.- 22 530 35 86 11 7 .i2 95.5 50.0 77.3 18.2 54.1. 93.9 2 years: Under 32,000: North 6 671 A 94 15. 8 90 100.0 66.7 83.3 16.7 50.1 100.0 South 15 312 33 80 18 9 84 80.0 53.3 80.0 40.0 40.2 100.0 $2,000-12.999: North_ 13 428 16 120 17 14 65 100.0 30.8 92.3 30.8 531 100. r.. South 20 490 Z7 91 29 13 65 95.0 45.0 85.0 40. 0 65.1 100.. 63,000-63.999: North 27 568 23 98 22 15 56 100.0 40.7 B1.5 29.6 44.. 100.0 South 24 356 17 145 25 10 69 95.8 29.2 91.7 50.0 66.7 100. 0 3 years: 7. Under 2,000: North 6 440 15 61 15 18 88 83.3 33.3 100.0 33.3 66.7 100.0 South 23 356 34 164 20 15 103 69.6 43.5 95.7 21.7 65.2 100.0 $2,000-42.999: North-. 7 422 27 79 47 13 91 85.7 57.1 71.4 42.9 71.4 100.0 South 18 258 25 59 31 8 80 66.7 44.4 66.7 50.0 55.6 101 0 $3000- $3,999: North 26 650 24 104 37 14 80'100.0 46.2 84.6 50.0 65.4 100. 0 South 29 278 21 114 23 11 64 82.8 41.4 96.6 34.5 62.1 100. 0

I Calcium equivalent. Flour equivalent

30 Table 14d.-Quantity of food per person in 1 .-gay and percent eating - {children 1 to 3 years)

Quantity per person in grams Percent of persons eating

riL -nter Darr( - Oath Age. antigal .ft[Drrle Tonle- veer. Other Other Torres- grew, Other Other awl feral perss toes. dr-p Potatoes, vege- Sugars. hewer- toes. deep Potatoes. Vege Sofa* hewer- citrus yellow- *rote tables sweets ages ct"....s veer vote tables sweets ages fruit liege- and tun' trate liege- and fruit tables tables

1 year: Under 12.000: North 5 -al S Al 12 25 60.0 20.1 100-3 40 -0 20.0 South_ 12 :7 4 9 56 23 34 16.7 8.3 16.7 50.0 41.7 16.7 32,000-32,999: North-. 14 39 8 29 155 10 - 113 3.6 14.3 64.3 78.6 429 35.7 South 11 23 12 9 25- 9 190 9. 1 27.3 27.3 54.5 27.3 72.7 53.00043.999: North 29 52 2 43 162 32 48 31.0 6.9 44.8 85.2 65 -5 24.I South 22 52 6 11 76 12 93 36.4 -13.6 27.3 50.0 40.9 654.5 2 years: Under 12.000: North 6 135 26 20 111 11 31 66.7 53.0 33.3 33.3 50.0 16.7 South 15 46 24 21 91 35 126 26.7 26.7 20.0 10.0 53.3 46.7 $2.000-52:999: Nardi 13 36 7 47 117 31 62 30.3 7.7 61.5 69.2 61 -5 38 -5 South 20 31 9 12 50 35 128 25.0 10.0 40.0 45.0 80.0 50.0 11.000-53,999: ..

North Z7 50 6 49 166 45 117 40.7 11.1 55.6- 118 .74.1 51_ 9 South.... 24 26 8 17 62 55 227 20.8 20.8 33.3 41.7 83.3 62.5 3 years: Under 12.000: - North__._ 99 16 18 90 29 1.3 50.0 16.7 50.0 66.7 53.0 33.3 South 23 7 10 11 93 49 125 8.7 17.4 26.1 69.6 60.9 43.5 52.000-92,999: - North 7 52 45 100 15 156 42.9.. _ ., 85. 7 65.7 57.1 71.4 South 18 33 14 19 170 41 306 22.2 11.1 38.9 50.0 77.8 83.3 53,000-53,999: North 26 66 3 26 161 35 94 26.9 3.8 46.2 69.2 65.4 34.6 South 29 47 9 21 103 39 113 20.7 20.7 48.3 75.9 69.0 62. 1

Table 15.-Nutritive value of food per peison in 1 day, Reference's United States, income under $4,000 1. Consumer and Food Economics Research Division, NumberFood Protein Calcium Iron Vitamin Ascorbic Agricultural Research Service. USDA, Food Intake Age of energy(gm.) (mg.)(mg.)A .Value- acid persons{cal.) - (I.U.)(mg.) and Nutritive ralue of Diets of Men, Women, and Children intheUnited States, Spring 1965, A 0-2 months 18 774 27 943 6. 0.-- 1.890 Preliminary Report, ARS 62-18 (Washington. 1969). 3-5 montns 37 876 33 1, 070 5.8 3, 330 38 2. Food .andNutrition Board : Recommended Dietary 6-11 months 63 1, 029 46 1, 191 6. 1 4, 730 28 - Allowances, 7th ed., National Academy of Sciences 1 year 93 1, 255 48 962 5.93.443 37 2 years 104 1, 373 53 787 5.7 3.270 35 Publication 1694 (Washington, 1968). 3years 109 1,386 53 709 7.74.000 34, 3. Consumer and Food ...Economics Research Division, Agricultural Research 'Service, USDA, Your Money's Worth in Foods, Home and Garden Bulletin No. 183 (Washington:U.S.Government PrintingOffice, 1970). 4. Committee on Food Habits, National Research Goan- cil, Manual for the Study of Food Habits, NAS-NRC Bulletin III (Washington, 1945).

The authors wish to express thei; appreciation to-Alex- andria Spanias, food consumptidh branch, Frances E. Bowie and Brucy C. Gray, survey statistics staff, for their assistance in the processing of data. _ -

31 Discussion

Dr. Charles A. Valentine: When we review tabled reflects actual behavior or whether it merely survey data, it is important to.ask how valid the reflects what people soy they do. This is tine of data really are. Not long ago, we and the Bureau answers to questions relating to income and also of Census investigated precisely the same sample to quantities and patterns of eating. of people. They blew nothing of our procedures What seemed to me Striking about most of the or intentions and we knew nothing of theirs. The comparisons reported to us by Kram and Owen and qUestions were focused in considerable part on by Eagles and Steele is the relatively minor differ- household structurepresence or absence of per- ence in food selection from one income level to sons of various ages and sexes. The Census Bu- another. The extent of this similarity may actually reau found the population to consist of 24 percent be less than that reported. Regardless of what male-headed households, whereas we found 67 people eat, most people know what they are ex- percent Male-headed households. We found further pected to eat. They tend to answer questions in that 62- percent of the males over 20 years of age terms of these understOod standards. They may not were missed by the Census Bureau. In comparing-deliberately falsify, but they are most likely to the two sets of Adat.a, we could understand why shade their responses to agree with the expecta- every one of those males was missed and why the tions of the questioners. Results obtained from this data on household structure were so distorted. type of study need to be questioned and checked These families have three major sources of in- continuously against direct observation. come: conventional employment, public welfare Dr. Virginia H. Young: Another problem of the and illegal activities of various kinds. It is literally questionnaire approach is that it requires the per-

.impossible for the vast majorityprobably 90 person. being interviewed to translate behavioral data centof the households to survive with any kind into verbal terms. This isn't always an easy tran- of adequacy without making use of at least two sition. It doesn't mean that these people are less of these three sources of income. Yet, one of the articulatemerely that the vocabulary of the ques- three sources of income is illegal in its own right tioner may not be one by which the respondent and the other two are incompatibleone is illegal thinks of his behavior. in the presence of the other. Dr. George M. Owen: On the other hand, if a Dr. Phyllis B. Acosta: I would like to point person came to my door and asked questions of a out too, that in Mexican-American communities personal nature, I could probably relate more effec- many people may be in the United States illegally tively to the stranger than to the person who lived and constantly fear that they ctr.11 be reported around the corner. The anonymity that goes with to the immigration authorities ands be deported. talking to a total stranger may. increase willingness Dr. Valentine: The difference between our re- to be honest and frank sults, obtained bypartieipant observation, and Miss Faustina Solis: But your bcckground is those of the Bureau of Census, obtained by ques- quite different from theirs. Most probably you have tionnaire, illustrates theimportance o participant lath; to fear from "the authorities." In low-income observation in obtaining reliable information. from groups the respondent will ask himself, "Where low-income groups. does this person come from? What is lie going to In any questionnaire approach there will be the do with the infomation I 'give him? Is this for my difficulty of deciding whether the information oh- benefit\ or my detriment ?" The low-income re-

32 spon dents have many doubts and will be very the information, we will come much closer to learn- guarded in their responses. I seriously doubt that ing what the child is actually eating. these people can relate readily to someone from Dr. Eagles: Table 14-D in our paper presents the dominant culture. questionnaire data on the use of beverages other Mrs. Elsa Alvarez: If a total stranger came to than milk and fruit juices. These beverages are a door in the neighborhood *here I work and asked chiefly soft drinks. The people questioned could some questions about food or income, the first thing hardly have thought that "the experts" were en- that would come to the mind of the person being thusiastic about giving soft drinks to small chil- questioned is that this man belongs to the FBI or dren. Yet, as the intake Of fluid milk decreased, an police, or is a bill collector. Many people in the increase in the use of soft drinks was noted, with neighborhood are hiding from the authorities. as many as $0 percent of 1- to 3-year-old children Dr. Eagles: We are acutely aware of the prob- receiving them. lems in obtaining valid food intake data. There is Miss Mary C. Egan: Many nutritionists work- no question that the difficulties are more -serious ing in community health facilities have become among- the lowest income groups and among indi- identified with the community without necessarily viduals whose language or vocabulary differs Living in it. They have developed rapport with the greatly from that of the interviewer. families and I believe that their information will Dr. Ogden Johnson: The methods themselves compare favorably with that derived by the par- the questionnaire versus participant observation ticipant observation method. It may be a dangerous are probably not as important as the people whc overgeneralization to suggest that a nutritionist use them-and how they-areatsed. Thal an outsider (=not he effective unless he or she lives in the may not be able to ask the question properly or to community. Neither do I think we should conclude evaluate the answer is really separate from the that direct oliservation is the only way to gather validity of the methods. Participant observers may valid data. be poorly trained, biased or otherwise scientifically Miss Barbara Garland: Having just completed weak. Their results may therefore be worthless but 6 months of surveying, I do not believe that people this does not mean that the method is faulty. care what they tell you. They're not hiding infor- Dr. Valentine: That isa fair comment. When I mation as to what they eat. They don't know that spoke of "the questionnaire method," I meant one much about it and they just don't care. I think it is that is used by outsiders. Quite a number of persons wrong to assume that they will not tell you the in the low-income, Afro-American community truth. where we live are aware that we know the com- Dr. Valentine: You may be right. My own con- position of their hoiiseholds, but they, never speak viction is that people generally are poor observers of this directly. In fact, they do not speak of it of their own behavior. Let us do more studies in even among close friends and relatives. which the two methods are directly compared. The The problem of questionnaire data is a general more of these results we view, the better guidance one yid applies to most information obtained. Vir- we will have. - tually all of our mothers told us they gave their Mrs. Mary Ellen Wilcox: I should like to ask child a great deil more'Milk than they actually Mrs. 'cram and Dr. Owen whether the word did. They were not trying to deceive us but merely "snack" was their term or one used by the had in their minds the notion that "the experts" respondents. recommend milk very highly as. a food. Miss Catherine Coivell: I am also concerned Dr. Acosta: I don't think mothers aver-report about the word "snack." To many families this the use of milk because they want to please us. On itriply° foods that were purchtted separate and the basis of 24-hour recall data that I have obtained apart from food available in-the home. in clinics, I am convinced that mothers generally Mrs. Kathryn M. Kram: Actually, our inter- overestimate the amount of milk used by 'about viewers rarely used the word "snack." The inter- 10 percent. When we ask for a 3 -day written record, viewer merely asked the respondent to report every we get a much truer _picture of what the child is food the ehild put into his nioeth'and allowed the really consuming. Again, if we establish rapport respondent to label the intake as a "meal" or a with these families and if they know why we want "snack."

33 Mrs. Wilcox: When you speak of parental control of the chi ld's eating patterns. does the response include quantity of food consumed ? Mrs. Kram: In the questionnaire portion of the survey protocol. ouantitative data were not soughtmerely type of food and time of eating. Only in the diet record collected in the home by the interviewer were quantities of food recorded. Dr. Acosta: Were there differences in snacking patterns in relation to the presence or absence of a father in the home? I suspect that eating patterns are More structured when the family unit is complete. . Mrs. Kram: We asked, 'Who feeds the child or who sees that food is prepared ? Then'we asked, "Does anyone have an influence on foods eaten in the evening or at bedtime?" Our data on family eating patterns are not fully analyzed. Dr. Acosta: We need more information about calorie requirements of children who are poorly clothed and are reared in unheated or poorly heated homes. Requirements may be greater for such children than for those reared in well-heated homes. _ . Dr. Young: We should also obtain more information about the effect of rearing children in overheated, middle -class homes. Dr. OWert: In Mississippi, we noted -that 'rural black preschool children from the lowest income group slept an average of .1% hours longer each day than did *children from families- with greater income. Increased sleet). could be a compensatory response to relative unavailability of calories, or could be simply a method of keeping warm.

S. Rural low-income groups

Dr. Virginia H. Young, Session Chairman: As.' we now turn our attention to various low-ineome groups, we should recall that within each cultural group people ad and think on two levels. First, they are participants in the general American culture. They participate to a great extent in certain general American valuesthe belief in equal op- portunitiestand certain evaluations of health and in attaining a better standard of living. This affects goals and behavior. At the same time, they are operating at another level that encompasse behavioral styles, concepts and concerns of their own culture. Attitudes of the adults willaffect care of the child, including feeding and nutrition. In some cases this second level of operation will be weak and easily displaced by that of the dominant culture. In other instances it will be strong and cannot readily be displaced.

35 child feeding in the rural raw -income family Jana W. Jones Team Evaluation Center. Inc. Whitehall Medical Center Chattanooga. Tennessee

FAMILY DIFFERENCES. health, less chance of becoming trained or em- AMONG THE RURAL POOR ployed less chance of seeing hip children finish high school; he is more isolzik. and has fewer When we attempt to understand feeding. prac- assets than his urban --cotuatei-parta good tices of infants and children in rural low-income chance he has no water or sewage facilities other than a well or outdoor privy. ...He families, we need a better understanding of how doesn't know of benefits or resources in the the rural poor family differs from the more af- county. fluent family in background before determining He wants for himself and his family the the specifics of what and how the infant and young same things Sou and I do, a decent standard of child within this group sit fed. living, education and a better life. ...The "There are several conditions in life that in- poor in rnial America are getting neither a proper nor a proportionate share of our nat- fluence the assortment of foods a person will eat. ural resources-or concern. Yet-one-hal f of our One is the socioeconomic level into which a child people live in .rural America where we con- is born." (1) . tinue to stockpile po--eity in the midst of In what respects do rural low-income families plenty-, differ from families higher on the income scale? Mrs. EdnaOlson. of Brandywine, Md.,- stated : In 1968 an estimated 25 million Reopleone- "I think poverty in the rural area is a little more - eighth of the populationhad income§ below pov- extreme simply because there is no transportation erty level. and everything is so far apart." (3) Thirty-seven percent of households surveyed in About 13 percent of all white children and 49 196.5 that had incomes below $3,000 Met NRC al- percent of all nonwhite children were members of lowances for all seven essential nutrients measured, poor families in 1966. The incidence of poverty according to a bulletin on theCklational Food Situ- was highest (78 percent) among childrenin non- ation outlook frian the Economic Research Service. white families headed by a woman. In 1966, among Almost one in every two rural families has a cash both nonwhite and white poor families, one out of income of less than $3,000 per year. One-fourth three children-was under 6 years of age. of all rural nonfarm families are without running. Of the 12 percent of 48.9 million families in the water (2). United States who were classed as poor in 1966i Mr. George H. Essex, Jr., of Ikrorth, Carolina, 5.6 million were nonfarm and 0.5 million were in describing the rural-poor in" a section of North farm families. Even on farms, gardens are not al- Carolina, stated in hearings before the National ways productive-:---in cotton regions spray may kill Advisory Commission err rural poverty: garden produce; in the Ozarks, Soili may have low The average resident. (rural poor) has leas productivity; on the steep mountainsides of the eilcation, a more dilapidated ehouse, poor Appalachia coal mining area, few gardens thrive. . 37 So being a rural poor family does not always mean NUtrition and Human Needs of the 13.S. Senate, that'' food is produced at home to supplement David. 0. Cox stated : income. . Care of infants of the poor shows some dif- Rural. adults in the poverty class lag .almiisst -2 ferences from that of the more affluent : years behind urban adults in years of formal 1. The parents are generally of a lower order schooling. Rural children receive one-third_ less Of literacy 1 They are exposed to fewer broad. cultural medical attention than urban children. (4). experiences because of geographic and so- According to an article, `.'White Americans in . cial isolation Rural Poverty" by the USDA Economic Research 3. They generallylack knowledge of nutrition Service, rural poverty may be classified into three 4. Nutritional needs of the breadwinner or types (5). Type I consists of predoniinately white potential breadWinner generally receive greatest emphasis* populations in southern Appalachia, the Ozarks 5. Much rural water supply has potential for and UppeCGreat Lakes Region. These areas are contamination by pathogens and nitrates "usually isolated and lack the arteries of commu- .6. Many .families lack. normal sanitary

nication and transportation'that are necessary . facilities economic growth. Many times there is,allOng his- 7. Care is more often provided by parent sur- roF,tatesolder children (sometimes by only tory of intergenerational poverty." Bectilise some a few .years), often disinterestedrelatives of.the so-called farms,in the Ozarks region are so or neighbors low in productivity, often the families must work S. More of the. fainilies are fatherless,with for an off-farm income, or depend on welfare aid. resultant additional strain on mothers and Type Ms: the migrant family (to be. discussed older siblings 9. These infants receive much less medical elsewhere in thiS conference). supervision, which decreases opportunities The article states : "Type III is a relatively de- for nutritional guidance of the mothers and pressed area with a poor white minority %thin a for correcting the infants' nutritional prob- poor nonwhite majority. These include smallplot early. ittliteoften there is little continuity he- farmers and tenant farmers. In thisfroup there tw.een hospital feeding and what is .available is continuous out-migrat*td;,,,northein 'cities. atiloine (7). There may be more interracial contact in these So far this discussion has been on some aspects groups. 'There_ may be Poorer edneational of the picture of rural family in poverty. How hete. Less jobs' are available in this area There does all of this. have a bearing on infant and child '-is little experience with instruction in community feeding? With less family mobility. than the more .activities. Tbis group is least informed on possible affluent or urban household, children ofthe rural benefits and may entail relatively major short-term poor are frequently started,on food tiefamily ;personal and family sacrifices." (5). can afford to buy from a,inarket which may be In an article on "The Extra Cost of :Being more limited than citymarkets: Educationally as Poor," Trienah Meyers, 'staff assistant to the "ad7 well as economically there are handicaps to better ministrator of the Economic Reseaich Service; nutrition. The child may be exposed to lees variety USDA, states from study and observation that it from .the family table when ,he starts on "table actually costs more to be pOor--eCOnomically,,edu- food." It may also mean he is started on "table .cationally, psychologically, and physically. For food" earlier because prepared baby, food is less example, whereas the more affluent family can go available to the family. from one store to another in the city for the best buy in food, the rural poor are fenced iia,,by eco- BREAST VERSUS BOTTLE FEEDING mimic barriers so that they are forced to buy from the nearest store.- In some instances, ,prices have What is the prevalence of breast' feeding as been raised about the time welfare checks arrive. compared toAottle feeding for the infant of the Storage,lacilities may be so. that -the family rtiral low4ficome houSehold? In 1966 a surrey in- cann9t,-take advantage of pea "bilys" that. may . *My own observations in Arkansas'and rrenileSSee.are be available to them (6). in agreement with this comment. Women and children In a bearing before the :Select Committee on come last, k particularly in relation to protein-rich foods.

38 dicated the areas with greatest incidence of.hreast mothers are left with the grandmother. even feeding were the suburbs and the inner city slums. great-grandmother, who have firmlyin- In a review of infant -feeding practices Meyer grained ideas on feeding and child training. By t.'s.e time' the child has reached his third states year he is ,following the eating pattern of The incidence of this ancient art [Of breast those with whom he lives (10). feeding] has declined over the last 40 years due to many complex anthropologic and soci- Hutcheson, from his experience in private and public health practice, commented on infant feed- . ologie factors.. .the decline in the last 10 years' is less precipitous and it is hoped in ing by saying: some circles that. the trend will be reversed. It I would say that bottle feeding is much has become the "in" thing; to breast feed the more common than breast feeding, that most infant among the intellectuals as well as in mothers have a tendency to feed milk in such areas.of the academic community. So; too, has quantities that the baby's appetite for other it becOthe popular in higher economic levels of foods- may be minimal, that many mothers our social order. .believe it is important to get the baby on In 1930 it was paipularto leave breaSt feed- homOgeiiized milk as quickly as possible. The ing and turn to the new-more popular process usual as for weaning is after 1 year old ' of cfornmla" feeding. Them, as now, thonew. (often after 2). A prevalent usual areal pat- mothers e.f higher -revels or our culturset :tern is carrying about a bottle wherever you the pace. now breast feeding is the n w go so that the baby has milk whenever he life style. wants it. - It is. hoped that this new sociologic ccept The use of "table food" is 'often emphasized will operate here-that the trend ward by low income rural families and, .as, a result, breast feeding will:seep through tothe lower the children's nutrition suffers since the type . strata of the cosmic pile, and that more of it of table foods that can bemanaged bybalmes,_. will occur Where it would be of-greatest bene- are sucii things as mashed potatoes and gravy fit psychologically and -economically (8). that ale easy to swallow but may not have Perhaps if this keeping up with the "in" thing the nutrients needed by the baby or child (11). does operate here, it would have adVantages One project nutritionist from Mobile, Ala.., for thepoor. stated some Mothers seemed to haVe the belief that Some specific coMmentsOf persons with experi- "the more milk the better. Some older babies were ence among the rural poor in the United States reported to drink from one-quart to One-half gal- would, be of interest here : lon of milk per day. Mothers of these babies com- Dr. Frances. C. Rothert, fernier MCH Director, plain that the babies won't touch solid food. iii in the., Arkansas ..State Board' of Health-, stated: anymore" (12). The Maternal and Child Health Division of According to Filer and Martinez, reporting on the Arkansas State Board. of Health made the intake of infants in the United States; "iron studies' f the feeding practices some time during the 1950's and foundund more breast feeding is the nutrient most often in short-supply.---more- in rural areas and much less" illness among thanhalf of infants do not get the lowest-recom- __breast-fed babies. Studies also revealed that mended provision. Amounts of said foods. con- babies weaned directly to the clip and who Wiling iron are not eaten in sufficient. quantity had spoon feeding of early. supPlethents:did to provide the iron babies need. Since milk is better than those weaned from breast to bottle. ingested. more freely, a formula .Containing iron The usual age for weaning varied greatly (4. 'would bean advantage to these babies" (1.9). Apparently in the last 10 or :2 .years 'rural The prevalence of mild nutritional anemia ap- Arkansas practice, too; has changed, as evidenced pears to be common among low4r.come groups as 'front a :more recent comment of a nutritionist indicated in the Mississippi study by.Oiven et al,- from the central Arkansas region around' Pine (14) the study reported by Hutcheson, from rural Bluff, Ark.-She stated :- Tennessee (15) and others. -Does .some this also MOst.,Rf the mothers-receiving Health De- reflect poor intake of supplementary foods because partmeiN services elect to bottle fectl.:. their milk quantity is large? . babies. Most of the -problems related to In an unpublished study of infant feeding prac- mina are related to Sanitation rather than tices in well-baby clinics in Knox County, Tenn., composition..Even in the loW4nCome families there is often too much milk volume. This in 1967, 31 mothers fed their -babies as follows : 18 turn creates a feeding problem of ingestion used a proprietary formula (of this`grolip 12 used o :other foods. 8ometimes babies of young the:formula given at the hospital) ; 10 used.evap-

39 ()rated milk; two were breast feeding; for one, society, the infant may have a hard metal spoon introduced into a mouth which has the type of feeding was unknown. Of 11 of the in- never experienced anything so solid or hard, fants who were 6 months of age, two were on a a mouth in which teeth have not yit erupted: proprietary formula, four on evaporated milk and In Polynesia the infant may get premasti- five on homogenized milk; the others in the study cated food warmed in the inother'S mouth par- were under 6 months of age(16). tially predigested with "her salivary juices from which a mother puts food with her lips In the coal mining region of -three counties in into the mouth of the baby(21). eastern. Kentucky, the study of infant feeding practices of 38 mothers ranking in acre, froni 10 to Lest one suppose the latter practice is far removed from present-day United States, it should 49 years showed that the majority bottle fed their babies. The long child bearing period of the be noted that the practice of prechewing food for women in this area was Strongly evident inthis the infant, although infrequent, was reported in group's age range. The interviewers in this study recent years by Children and Youth projects in found no correlation between what the mothers Columbus, Ohio(20)and North Central. Florida (22) ; Maternity and Infant Care projects in Dade fed as first solid food, the mother's age; education, number of pregnancies or weekly food 'budget County, Fla., (el) and Houston, Tex.(23) ;and thehealthdepartmentinJeffersonCounty, (17). Ark.(10). In another study in Sullivan County, Tenn., in Who influences the mothers in choice of foods July, August, and September 1970, not one of 36 mothers interviewed breast fed. their infants(18). fOr infants? Robertson in reporting. on breast feeding prac- . In a study of prenatal diets made in Charleston, tices reports that "variation in maternal age, ur- South Carolina:.. Those mothers living in ruralareas tended ban or rural residence and whether the infant was to exhibit more peculiar food habits than under the care of a pediatrician or practitioner did those living in towns or in the city. Moreover, not correlate with Significant differences in the if a grandmother was living under the same incidence of breast feeding at 1 week of age." He roof, she appeared to be the most influential, concluded that a "complex of cultural factors factor contributing to any peculiar idea which rather than a particular personality pattern of the they had about food. Opinions' voiced by (24). mother or the spedific attitude of her attending elders were believed and respected physician is primary in influencing her choice of "Many young mothers take their mother's or feeding technique. Regional location of the mater- grandmother's advice when it comes to questions nal residence. was found to be associated with the on feeding the baby," accolTling to a report from most significant variations."(19).Apparently Alabama .(1e). some of the comments and studies reported here- In the Sullivan County stu (18)regarding in reflect this same complex pattern in cultural the feeding of 110 babies, it wasand that advice values. was sought. from the. following : One prOject reporting on bottle feeding found The family physician, by 40 mothers; Relative or friend, 25 (the mother or' grand- the practice of introducing alcoholic beverages motherbeing the most frequent) ; into the baby's bottle in order to make him sleep The public health nurse, 21 mothers; through the night (20). Although undocumented, Twenty-five mothers "just decided" on their one nutrition worker stated some babies are given own when to feed supplementary food; One learned from a book; somegave multiple tranquilizers-to keep them quiet. answers. When were solid foods first introduced into the SOLID FOODS, child's .diet ? The time for addingaddin solid food noted in Dorothy Lee, in discussing "Cultural Factors in this. review was repOrted by an Atlanta project, Dietary Choice,'.' says that culture decides "when which found the 'following 'foods being added at

we shOuld have an appetite for what" and even 7 days of age; three 3-ounce bottles of . what constitutes food. scrambled egg,' steak fat, cornbread and bean juice. Culture frequently dictates what the first Babies yolinger than 6" weeks \sere given snow solid foods given to infants will be. In our cones, tea, catnip tea, potato chi* etc. 05).

40 Most project reports reviewed in the southern derive chiefly from socioeconomic status(29,30). -region listed the usual time for addition of first Crim, discussing nutritional probleths of the poor, food as beitig from 1 month to 6 weeks of age. states : What types of foods were introduced first? Meals of the Southern Negro resemble those A number of studies reported cereal given in of the same socioeconomic class of whites. the bottle. Other solid foods frequently included For example, one chicken may be cooked for a family of eight to 10 and fruits and milk are rice, grits, mashed beans, pot liquor (frequently not usually included in the diet. When fam- with bread in it), mashed potatoes and gravy ilies move to the city, green or yellow vege- made from lard or greaSe from fatback(26). tables are even More difficult to obtain so In north-central Florida, extras such as soda there is even more drastic reduction of intake pop, Fool Aid, and iced tea with a lot of sugar, of vegetables in urban communities.(31). were frequently introduced at 1 month of age. The Itis clearly important for the pediatrician, the soft inner flesh of fried fish was also given. In the nurse, the nutritionist, the social worker, anthro- same report, custards and fruit desserts were said pologist, etc., to have facts regarding the local and to be given as first foods by almost all mothers. regional dominant cultural patterns and family Meat with vegetables was preferred and ..baby 'environment before attempting to enhance the meats alone seldom given (p2). nutritional pattern. In Attala County, Miss., at 1 month to 8 months The studies reviewed indicate that there are of age, mashed biscuit and syrup, gravy, pot liquor, many questions yet to be resolved regarding feed- cornbread, rice, and boiled fatback were part of ing practices among the rural poor before we can the common fare (27). be fully effective in helping the families realize Most of the project reports reviewed indicated better nutrition for their children. We need more that by 8 months to 1 year of age, most children indepth studies of actudfeeding practices and fac- were on "table foods." In many poor families it tors influencing attitudes regarding food, the role seemed that less milk than would be desirable was of parents, and of other social and environmental consumed. In some poor families children were factors that accompany malnutrition..(32). started on table foods as early as 6 months. How- ever, as indicated previously, these generally References seemed to be soft foods, i.e., grits,. rice, potatoes, 1. M. A .Hill,"Creating Good Food Habits, Start gravy, pot liquor.. . Young-rNever Quit," The Yearbook of Agriculture, Beer was mentioned in several reports as being 1969, Fbod For Us All (Washington : U.S. Govern- given to young children, along with soft drinks ment Printing Office,,1969) , p. 260. and snacks. 2. S. J. Hiemstra, "National Food Situation," Outlook, Bryan and Anderson, in a study of 119 cases Economic Research Service, U.S. Department of Agriculture, N.F.S. 131, February 1970. referred for crippled children services in 1963, 3. Senate Subcommittee on Employment, Manpower and stated they were impressed with the limited num- Poverty, Labor and Public Welfare Committee, ber of foods in the diets of loW-income families. Hunger and Malnut.ition in America, Hearings "In many of the families only one food, i.e., a large. Before the.Subcommittee on Nutrition and Human pan of biscuits or when sweet potatoei. were inex- Needs(Washington: U.S. Government Printing pensive, a, large pan of these,- was cooked in the Office, 1967). 4.U.S. Department of Health, Education, and Welfare, morning and left out for the eMldren to ea,i'when- Social Security Administration, Research and Sta- ev(;e they want them." The children in their study tistics Note No.. 23, _Fact Sheet on the American generally had few food dislikes; nevertheless it Family in Poverty (Washington : U.S. Government was noted that even one; or two food dislikes can Printing Office, 1967). -be critical when the variety of foods available is 5. U.S. Department of Agriculture, Economic Research Service, White:Americans in Rural Poverty, Agri- so strictly limited (28). cultural Economic Report 124 (Washington: U.S. Another comment bears out this same pattern: Government Printing Office, 1967). "In the fall, sweet potatoes are eaten daily until 6. Trienah Meyers,-The Extra Cost of Being Poor," the bushel purchased is exhausted." (10). Journal of Home Economics 62: 6 (1970) : 379-384. 7. Select Committee on Nutrition And Human Needs, The habit.of !reporting information by color United States Senate, Nutrition and Human Needs: rather than by in'come.fosters the habit of attribut- Hearings Before the Committee (Washington: U.S. ing to .ethnic babkground differences that in fact Government Printing Office, 1969), p. 4646.

41 S.II. F. Meyer, "A Review of Infant. Feeding Practices 20. Letter from Shirley Brantford, Children and Youth in Hospitals!," Resident and Staff Physician, Octo- Project No, 607, Children's -Hospital, Columbus, ber 1970, pp: 53-87. Ohio, November 9, 1070. 0. Letter and questionnaire from .Frandes C. Rothert,' 21. Dorothy Lee, "Cultural Factors in Dietary Choice," former MCH Director, Arkansas State Board. of Amer, J. din. Nub'. 5 (March-April 1957)166-170. Health, November 1970, 22. 11..E. Wilcox, Report from Children and youth Proj- 10. Letter and questionnaire from Kathleen Brown, nutri- ect No. 636 and Maternity and 'Infant' Care Project tionist, Jefferson County Health Department, fine No. 515, Dade County Department of Public health, Bluff, Ark., November 19, 1970. -Miami, Fla., April-June 1968. 11. Letter from R. H. 'Hutcheson, Jr., Director, Division 23. Victoria Bowie, Report from Maternity and Infant of Family Health Services, Tennesgee Department Project No. 535, Houston, Tex., August 1965. of Public Health, Nashville, Tenn., September 20, 24. 11. J. Bartholomew and F.' E. Posten, "Effect of yowl 1970. Taboos on Prenatal Nutrition," Journal of Nutrition -12. Joanne McGowan, "Report from Maternity and Infant ticatioh 2;1 (Summer 1970) : 16. Care Project No. 551," Mobile County Board of '25. D. P. 11C1Iillan, Report from Maternity and Infant Health, Mobile, Ala., 1908. Project, Grady Memorial Hospital, Atlanta, Gil., 13. L. J. Filer, Jr. and 0. A: 'Martinez, "Intake of Selected . if)(18. Nutrients by Infants in the United States," Olin. 26. K. H. Beavo, "Solid Food in Diets of Infants and Pre- school Children,- Middle Tennessee Region," Ten- Pedial. 3 : .(November 1964) : 633-645. .\- 14. G. M. Owen et al., "Nutritional Status of Mississippi nessee State Health- Department, Ashville, Tenn., Preschool Children," A Pilot Study, Amer. J. Clin. 1968. Nutr. 22 (1969) : 1444. 27. Fonda Webb, "Research Regarding Addition of Solids 15. R. H. Hutchesoil, "Iron-Deficiency Anethia in to Babies' Food." letter, Mississippi State Board of Tennessee Among Rural Poor Children," U.S. Pubiic, .Health flies, Jackson, Miss., September 1968: Health, Service Reports 83 (1968) : 939.. 28. A. H. Bryan and E. ;Ander2on, "Dietary and 16 Al N Traylor, "Infant Feeding in Well Baby Clinics, Nutritional Problems of Crippled Children in Five Knox County, Tenn." (unpublished report, Univer- Rural Counties of North Carolina,"'Anicr.,./. Public sity of Tennessee Department of Nutrition files, health, 55 (October.1965) : 1545-1554. 29. E. Herzog,. "FaCts and Fictions About the Poor," 1967). . 17. JeamKincaid et al., "Infant Feeding Practices Among .Monthly Labor Review 92;2 .(February 1969) : Mothers in Eastern Kentucky," Maternity and Infant. 42-49. Care Project, Kentucky State Department of Health 30. E. P. Crump and C. P. Horton, "Growth and Develop- Information, Frankfort, Ity., 1968. ment in Negro Infants and Children," Laved Si: 12 IS. M. II. Saylor, "Study of Infant Feeding" (unpublished (December 1961) :507. study,Sullivan County DepartMent of Health, 31. S. S. Crim, "Nutritional Problems of the Poor," Nutri-

Blountville; Tenn., 1968). . tion Outlook (September 1969), Pik 65-67. 19. W. 0. Robertson, -"Breast Feeding Practices: Some 32. M. S. Read,-"Malnutrition and Mental Retardation," Implicationsof Regional . Variations," Amer. J. Journal of Nutrition Education 2: 1. (Summer Public Health. 51 (July 1964: 1035. 1970) :23-251 Discussion

It showed utilization of child healthfacilities and .Dr. Virginia H. Young, SessionChairman: The limited number of foods in diets oflow-income professional advice. In this town the nutritionist rural. families impressed inc alsoin the small -town would be dealing with a population ready and Negro group which I studied.,As one mansaid, 'able, in terms of values, food preferences, child raise its "It hurts to eat beans, potatoes andcornbread all care systems and social institutions, to the time, but that's what we eat."And, indeed, the standards of nutrition. The main visible problem odor of beans slowly cooking on thestove .hung, is lack of access to more costly foods. over most of my conversations in thesehomes. The Many of the obstacles to improved nutrition field peas and okra, the greens, thechickens and within the cultures of. low-income rural.. people spareribs were .-,poken of with relish andpride, arise from the misapprehension of habits of which and the vitamin supplements weresquirted into the investigating culture disapproves. An exam- the children's mouths in the yards aspublic sym- ple is the commentary by Cox quoted in Miss Jones' of bolic actions. The kitchen tables inShacks in rural paper. He seems to suggest that because the care hamlets outside the town limits wereoccasionally infants of the poor is different from that of the heavy with quart, jars of peaelies and"soup mix" affluent, it is less beneficial. When care is provided by parent surrogates among the poor, is it inferior put up by older women who had been taught to can the by 'a home economist with the Departinntof-Agri- to that provided by parent:surrogates among culture some years ago. The younger :omen had middle class, by the perhaps indifferent or hostile never been taught homecanning. and I saw none servant or by the high school babysitter? We have doing it. to ask hew well the low7iiicome Mother has trained My impression was that limited diets werenot the nurse-girl, whether she supervises her, and if the relatives' care is really disinterested. I found a matter of choice. Withadequate resources these people's food preferences would- providethem that the nurse-child was 'usually competent, fully much better nutrition. It is iniportant.to establish familiar with family practices, and highly moti-. Whether poor diets are the result of relatively ob- vated to carry out her mother's directions. The-use jective factOrs such as income and shoppingfacili- of child -tending groups with a nurse-child in .ties or whether poor diets:result from foodpref- charge was an important part of the social struc- erences or food habits. Obviously,. remedial meas- ture, mid Was constructive in the 'adjustment and training of children of all ages. Relatives in the. tiresareverydifferentinthe 'alternative towm I studied seemed generally to give excellent circumstances. care and to have real concern for children. intheir We laCk genetfifastimates of therecepti*y of our rural low-income people. toletter nutritional charge. standards and of.their ability to utilizeimprove- We also 'have to ask other questions of the Cox ments. How inclined are they to'accept adyice generalizations. DoeS the absence of a father place given through professional channels? How capa- more strain on Mothers and oldersiblings? New ble are they of carrying outthe advice? How ap- analyses. of mother- headed families suggest that propriate is the generatconte.it of care' ? they are a much more viable cultural form than My.own research on child care among Negroesin used to be assumed. The, greater independence of Georaia town indicated a. high level of corn, women in the Negro Cultural'tradition, and the 'petence aid attentiveness in childcare. Social indifferent, traditional values associated with raising stitutions,: provided for .the. security. of thechild children: out of wedlock, Make the woman who and an extended network of responsibilityfor him. shires these traditions able to, head .a family suc. cessfully. The strength of close kin ties-lalsolends 1 Young, V. H.: Family and childhood in a southern support to the mother-headed family. Negro community. Amer. Antkroel. 72: 209, 1970. 43 What are the grounds for Cox's statement that moon. The guidance may not be harmful, and fol- the nutritional needs of the breadwinner receive lowing it gives the sanction of tradition to the greatest emphasis? I do not believe this pattern mother's action. Weaning is, of course, an emotion- is prevalent in Negro families and I doubt that it -charged. transition and a woman may need is widespread among whites. to feel the support of her culture and kinsmen.. We can also look more closely at the suggestion Il:ness is another crisis in which grandmother's that geographic and social isolation lead to in- advice. may figure. The emotional support gained ferior child care. To estimate the quality of care from using community-sanctioned remediesis it is necessary to examine the strength of local probably as important in sustaining the mother's social institutions, including both the role of medi- care as medical piocedures are in treating the cal and nUtritional_ resources in the community, illness. and the customs of child care. Access to health care Furthermore, the actual social ties between and profe§sional information may, of course, con-. generations may be an important resource in the stitute problems' among rural populations, and as child care system of the. community, so that if Miss Jones points out, inadequath transportation Mother alienates grandmother Vtaking the nutri; among the rural poor deters advantageous shop- tionistis advice, .mother :nay make antagonist ping practices.. These, reflect problems of access.,. out' of a helper, to say nothing of the potential 'and availability to a much greater. extent than entanglement of other family members in the issue. they reflect inability, or lack of inclination to ac- Generational cooperation is an important factor in cept such advantages. Customs of care, however, stabilityoffamiliesinthe. Negro cultural must be distinguished from external factors of ,.tradition. this kind. These customs cannot be graded accord- The nutritionist has the difficult job of working ing to their closeness to cosmopolitan trends. Their in a total situation yet being a specialist. She needs quality probably depends mainly on the general to know about the specific local cultural context of

vitality of the local culture. . the food practices she may want to change.. The An impediment to understanding people arises practices may be an integral part of a set of values not only from ethnocentric judgments but also and social habits which themselves are an impor- from lack of awareness of cultural context. Knowl- tant source of stability to people and communities. edge of food habits signals the areas where the The nutritionist has to ask, Is that practice so. mother does nutritional right and wrong and sng- detrimental that I should attack it even if weak- gests, now the nutritionist can make her * advice ening one part of the network will tend to weaken more acceptabh to .the mother. In addition, food the whole, and even if attacking it tarnishes my habits are part of a large area of associated habits, image .as ft source of help ? Is she certain that the and, all are tied up with family organization and grandmother's, advice is detrimental ? It seems W community social structure. The nutritionists who me that the nutritionist can afford to look benevo- suggest that people. chaAge their food. habits, may lently-on the networks of advice emanating from be suggesting not one simple change, hilt ramify- kin and commuIity, eSpecially when low-inCome ing changes, because any habit is embedded in a groups seem to show ready utilization of child web of behavior and institutions. Change is some- health facilities and high receptivity to. profes- times easy; sometimes habits are readily taken up sional advice: This seemed to be the case in Sulli- or practices abandoned. as tin:igh with a sigh of van County, Term., wherellissJones reported that relief, but sometimes change causes disruption 62 mothers sought professional advice, while 50 beyond the single :habit. mothers, acknowledged no advice or sought it from A case in point.is that "source of peculiar ideas," friends or relatives, some of whom 'undoubtedly the grandmother. Miss 'Jones states that "many transmitted the word of professionals. young mothers-. take their mother's and grand- Dr. Ogden Johnson: By having scheduled. a mother's, advice when it comes to questions of feed- separate session of this workshop to discuss rural ing the baby." Advice from Mothers _and grand- low-income groups, we. may be making a rural.- mothers might not be entirely inappropriate, and urban distinction that is more artificial than real. a sense of conviction offloingtl?ingS right may be With the exception of the greater transportation more valuable than the folk remedy is detrimental. problems and differences in availability of cer- For example, the grandmother may advise, that tain foods, the. rural-urban differentiation would Weaning should- be accomplished with a. Certain. seem to have little` Substance. 44 Dr. Philip L. White: What is our working ghettos, but rural slums prevail in areas where definition of rural? land is thought to be plentiful. The high percent- Dr. Young: The Bureau of Census defines a age of crowded, dilapidated, substandard dwel- rural community as one of less than 1,500 persons. ling,s, coupled with unsafe water supplies creates a Approxiniately 00 percent of the rural population hazardous existence for most of the rural poor. is nonfarm and includes persons of 'various cul- The distribution of the population, widely dis- tural backgrounds. It .is true that we shall not be persed over large areas without the benefit of pub- able to make many general statements about behav- lic or private transportation, prevents the develop- ior of rural low-income Americans. ment of political or social cohesiveness that is often Miss Faustina Solis: I agree that rural' low- a supportive factor among the urban poor. Mass income Americans are an amorphous group. Even media have less of an effect on the rural popula- the availability of various foods is not necessarily tion due _to- psychologic as well as geographic .a distinguishing feature. When a migrant worker sepantisin. Family ties and traditions are held has picked a particular fruit all day for a mull more firmly, sometimes seemingly as a defense to ber of days, even the sight of the fruit may cause maintain the oily values that are totally .theirs. some nausea. Its availability will not necessarily Unwillingness to accept the intrusion of the out- be a factor in the diet: sider is manifested more openly. Mrs. Kathryn M. Kram: At least some rural BabieS may be given larger amounts of milk populations seem to be distinguished by a greater than necessary becauSe milk is still considered the use of gardens. In these instances the growing and "all PUrpose" food and because it is practical and preserving of fOods affects the' diets of the chil- easy to give. In areas of California where fruits dren. are available, babies may be given juices or bits Miss Barbara Garland: a survey of 100 of fresh. fruits as well as cooked soft vegetables. families whose female members were receiving Among Mexican-American farmworkers, mothers services from the Kentucky M&I 'project in 1968, try to reduce fruit intake of infants and very only 50 percent had gardens of any kind, and these young children to decrease the likelihood of were sinall,.suPplementing the.diet for just a few diarrhea, which is sometimes quite common during weeks each year: The population lacked the nec- summer months. essary knowledge, facilities, and cash for food MexiCan-American families migrating to the preservation through canning or freezing. Thus, west cons' t may be forced to adapt their feeding for many of the rural poor, food production is not practices to the available food supply. Lack of a major factor in food procurement.' lmowledge of their new cultural environment and Miss Catherine ,.Cowell :Preserving food is inability to find traditional foOds makes meal plan- time-consuming and expensive: I we are liv- ning difficult. . ing in a world of fantasy if we imagine that many Migrant families, interestingly; seem to exhibit rural families are growing and canning their food. greater adaptability to change,. because adjust- Mrs. Margarita Kay: I am presently working in a city of 350,000 people, and within the city ment to alternatives .must be made as quickly as possible by all members of the crew limits there is a particular. sector where many peo, or of the pie have garden plots and somehave cows or goats: family. Their knowledge of other patterns is These people probably grow more of their own broader than that of rural people who never leave food than do people in most rural areas.' their area. There is less fearfulness of ekperiment Dr. Norge W. Jerome: One-third-of the popu- ing with new foods 'and new methods ofprepara- lation (150 families, 575 people) that I have tion. Food selection then becomes dependenton studied in Kansas City grow some of their own facilities for storage, refrigeration and cooking food and do preserve some of it-by canning and, equipment. Foods which must be consumed freezing. We. really do need. to look .at the en, quickly if there is no refrigeration can be expen- vironmental influences in specific communities and sive. More time must be spent in cooking each also at the resources available, to people. meal if there is no storage or refrigeration. Most Miss Solis: The rural poor as described by Miss migrant families supplement. their meals with JoneS resemble in many'respeets the 'urban poor. .fruits or vegetables that are being harvested but Reduced living:space for the poor in the :cities often they tire of these. Meats are not alWays : has contributed to the development of slums and plentiful, but soups and stews are commonly eaten 45 because they can be prepared economically and tated by their philosophy or religion. In many in- with only one pan. Lighting a fire outdoors for Stances, they a re twel 1-educated and, as a group, are cooking or using a one- or two-plate burner en- interested in ecology and problems of pollution. courages all-in-one meals. Four- to five-month-old Many are antiestablishment. An increasing num- babies may be offered meat or vegetables from ber of this group have become adherents to the Zen stews. macrobiotic diet.- This diet was advocated by the bite Georges . Dr. Young: It is a point of great interest that migrant workers, even though they are at the low- Ohsawa, a ;fa pa nese 'philosopher, who taught. that est socioeconomic level, are more receptive to nutri- there are two antagonistic but complementary tion practices of the dominant culture than are forces in the universe c Yin (expansion) and Yang .people with considerably higher incomes: This (contraction). The greatest health and happiness suggests weakness of retention of cultural back- can be achieved by a faVorablebalance- between rounds. Yin and Yang. Cereals, notably brown rice, which Mrs. Mary Ellen Wilcox: Our experiences in represent Yang, are at the heart of the Macrobiotic . south Florida are similar in many respectito those diet: They are supplemented by very small reported by Miss Jones., Data collected .several amounts of other foods, either .Yin or Yang, inyears ago indicated that less than 2 percent of 103 cluding vegetables and occasionally fish, meat,- infants were being or had been breast-fed. Thirty- dairy products or fruits. Diinking fluids are taken five percent received commercially prepared for- sparingly. These 'people-believe that a child who nulas, and most of the remainder (perhaps 60 eats grains and vegetables has a better memory percent) received evaporated milk fOrmul as. Some and better understanding than the child. who eats of these infants were from urban areas, but little Mainly meat. His mind is clearer and more agile. difference was noted in practices of urban and His answers in school are more precise. IIis decl- rural mothers. More recently, we have' surveyed aims, in anything he undertakes, are very quick. practices of fainilies, predominantly black, attend- As the student of macrobiotic philosophy advances ing health denters.in Homestead, South Dade and in his learning, 'he may choose progressively more South Miami. Only six of 116.infants ive re breast -' severe diets; at the' most extreme hewould subsist fed, and most of these were from the rather few only on brown rice. MeXican-American families. Reports from public health clinics indicate that The one group of mothers who do appear to be infants and small children. are raised on these breast feeding a substantial proportion of their diets.' Cases of anemia have been fOund. When babies are the so-called hippies. In Dade County children become anemic, parents will not allow they are Mainly concentrated in an urban area iron supplenients since itis. against the Zen lmown as the artists' colony but others are being religion. . seen in clinics serving oursemirural areas. Some Mrs. Wilcox,: Virtually all indigent women in of these young mothers report using various drugs Dade County deliver at one large county hospital. during their pregnancy and will undouhtedly con- A well-known. proprietary formula is used_ in the tinue using them during the lactation period: As hospital nursery, and a supply of this is given to was pointed out by Arene,2 the effects of drug the mother at the time of discharge. Although the usage by the mother upon the breast milk and' hospital gives out a 'booklet with instructions for hence upon the infant .are unknown. Some of the preparing an evaporated milk formula, a pam- mothers are 'practicing "cult". dietsYin, Yang, phlet supplied by the manufacturer-of the commer- vegan, etc., in some instancesnutritionally inade- cially prepared formula is also given. Many of quate for the demands of breast feeding. Although the mothers are.illiterate or barely literate. They income may be adequate, the commune life style is confuse the directions for preparation of an evap-

likely to result in a social and geographic isola- orated milk . formula with those for preparing tion similar to that experienced. by low- income the propriefary formula. Very young infants are groups. not infrequently fed evaporated milk diluted with Dr. Mary Mural:- A sizable group of_ indi, an equal volume of water: Thestiess'of the warm viduals in the United States, including the "flower climate plus a heavy renal solute 1lbad 'resulting eliildren,'". have distinctive dietary practices die- froni inappropriate dilution may have serious con- sequences.' Alternatively, 13. ounces 'of. the com- Arena, J. M.: Contamination of the ideal food. Nutri- mercially prepared:formula may be mixed with tion Toilay. Vol. 5, No. 4, .winter 3.811),. pp. 2--8. 46 18 ounces of water and 3 'tablespoon's of syrup. the "liquor." Unfortunately, regular grits are sub- Finally, the ready-to-use proprietary formula is stituted quite early for the iron-rich bal'iy cereal. sometimes confused with that requiring addition Kool-Aid, fruit juices and carbonated drinks are of an equal amount of water. offered from the bottle during the day to children The Jelliffeshave Tointed out that. the un- of various ages. sophisticated new townsman of Jathaica is easy Most black children appear to be fed almost ex- prey to skillful advertising for items he could not clusively from the table by 1 year of age. Introduc- afford to buy in sufficient quantity. Some of our tion of solid foals and the use of table foods seems isolated rural and semirural poor fit into this to occur somewhat later in Mexican-American than category also. in Negro families. Our observations in Dade County indicate that Miss Helen Starina : The rural low -income many infants are not held forfeedings, the bottle population of Montana is primarily second and rt being "propped" for evenVeryyoung-. infants. third generation Anglo. Most of these low-income Homogenized milk not infrequently replaces for- families live in or near towns and communities. mula feedik-T by age 3 months. The reasons com- Ajthough there are rural farm families with a monly given are, "it is easier," "it is more conven- yearly cash income of less than $3,000, many are ient," or, "the homogenized milk is already in the sell'- sufficient for foodproducing their own meat, house." vegetables, etc. (These comments are not intended As may be seeti front Table 1, infant cereal, of- to reflect the practices of the Indians liviijg on ten.mixed or high-protein, and commercially pre- reservations.) pared strained foOds are frequently begun by 4 Breast feeding is rarely practiced in this area or 5 weeks of age. The cereal may be fed alone or regardless of economic status. We believe that this inconjunctionwithcommerciallyprepared is related to two factors: First most physicians do strained fruit. Strained vegetables, vegetables with not eneoura.ge _breast feeding or even give much meat, various "dinners," fruit desserts, custards, support to MotherS who haVe started breast feed- puddings and soups are rather commonly used. ing. Rather, many of them discourage the practice Many mothers add strained foods to the bottle. because they feel that it requires too much of their Strained meat or egg is seldom fed, although time or because they are concerned about reports mothers often report feeding meat to 'a child when, of high levels of DDT in human milk. Second, hos- in fact, they are feeding vegetables with meat. pitals send home with the mother a supply of pro- 4urrior foods are infrequently fed. prietary formula with the unspoken implication that this is the "best possible food for the infant." Table 1.Feeding of 38 3- to 6-week-old infants in Dade Initially, infants are fed commercially prepared County, Fla. formula almost exclusively, but by 2 or 3 months of age they-are often being fed whole milk. Very Number of infants receiving various, foods little evaporated milk is used. Age (weeks) Formula Cereal Cereal and Total fruit The belief that a purchased food prepared espe- ,i daily for an infalit is the best food available car- 3 1 1 1 ries over to the use of commercially 'Prepared in- 4' 4 14 3 24 5 2 1 12 11 fant foods. It is common for mothers to boast about 6 2 2 the number of jars of strained food consumed at

I One infant also received strained vegetables and meat. a feeding; as if this were a scale by which to judge development. It isstrongly believed that a fat baby The use of table 'foods is begun early. Black is a healthy baby, and some infants have been children 5 months of age are commonly fed grits, 'known to triple birth weight by 6' months. mashed potatoes, mashed, cooked dried beans or Most babies are fed Cereal at bedtime as soon as peas, and rice with gravy. they are released from the hospital: By '1 'month Some Negro mothers report that-they are feed- of age, most are also receiving strained fruits, veg- ing "pot liquor" from cooked greens as early as .g etables, and meats. Infant cereal is usually discon- months. Sometimes corn bread is crumbled into tinued by about, 6 months. Jello water and Kool- Jelliffe, D. B., and Jelliffe, E. F. P.: The urban ava- Aid are often used rather than juomes..The use of lanche andchildnutrition. Amen Diet.Assoc. JellO water is based; in part, on the belief that 57:,114-11S, 1970. Jello is a, good.protein source and the fact the baby 47 "takes it so good." Table foods are fed in only more than 16 percent of the housitholds were eli- small amounts until 1 yea of age, but there is gible for food assistance progtarp but only 3 extensive use of commercially prepared "junior" percent participated. foods, especially the less expensive dinners and In a study of 416 pregnant woinen in Appa- dessert iteuis. Some mothers use undiluted canned lachia; it was found that 28.3 percent :,qd had lioup as a junior Mod. no protein from meat, fish or poultry on the day Generally by 11/2 years of age, the child is ex- of study; 45 percent had had no milk; 79 percent pected toat regular table food with the rest of had had no source of vitamin A; and 70 perceit the family. It is at about this age that excessive had had no source of vitamin C. In 100 families intake of milk is often- notedprobably because from this same economic stratum, it was found milk is so easy° to consume. ...'...ahough the food that 27 percent were participating in food pro- available to these families may be limited, we are grams, while 49 percent.were eligible but not par- not aware of any families eating just one food all ticipating. Among these funnies, 55 percent had day or until it is gone. gardens of some kind; 15 percent depended on rel- Miss Garland : Practices in Montana seem to atives, friends, or neighbors for food; 58 'percent be almost totally different from those in Appa- had no indoor water, and 6 percent had no lachia, although both groups are primarily second refrigeration. and third generation Angloe Although I not infrequently hear disparaging Miss Starina: The differenee'may relate largely comments about the high consumption of soda to the level of poverty. It seems likely that the pop by individuals of all ago groups among the poverty4level in Appalachia is more extreme. rural poor, I think this practice is easy to under- Miss Garland : By all indications the nonwhite stand when one sees and tastes the water available to many of them. population may be the poorest of the poor. How- Dr. Jerome: I think Miss Garland's comment ever, it is important to remember that most of deserves emphasis: most of the poor are white. the poor are white. In the Appalachian area the We are inclined to focus our attention on such white to nonwhite ratio among the poor is perhaps subgroups as Indians, Mexican- Americitns, Puerto \9 to 1. The population 'consists mainly of rural Ricans, and Cubans, and these groups are indeed i onfarrning households. In the Appalachian area interesting and important. However, most of the o North Carolina, approximately 50 percent of poor are White. They live not only in Montana allreschool children live in rural households, and Appalachia but in inner-city sections and in 10 pe cent in homes with incomes of less than rural farm and rural nonfarm areas of most $3,000 jeer year. According to reported income, States.

48 vs

Urban low-income groups

Infant and child feeding practices in an urban community in the north-central region ."

Norge W. Jerome, Barbara B. Kiser, and Estella A. West Department of Human Ecology University of Kansas Medical Center, Kansas City, Kansas

INTRODUCTION to food use are to be stractured. For example, the urban consumer living in an industrialized society The diet and foodways of a people usually re- like the United States of America has the oppor- flect the resources of their physical and rsocial en- tunity to select and consume a wide variety of vironment. In general, people living in isolated foods, at various processing stages, from a variety. regions or those who have experienced very few meaningful cross - cultural contacts utilize only of food service centers, at any hour of day ornight. those food items, food processing techniques, and Limitations will he imposed by economic con- food consumption methods specific and appropri- straints (income, occupation,occupational sched- ate to their physical and social environment. AC- ules), sociocultural background (lmowledget cordingly,aaa unit, they manifest a high degree of 'lief, and value systems), and mostimpOrtantly, by uniformity in general food consumption as well personal charaCteristics (personality characteris- as in infant feeding practices; this is slightly mod- tics, personal resources, and4oa.ls). Three pajor ified by individual personality factors. factors influence thefoos1:-nsumption practices of Less uniformity, and greater variety in general the 'American-(U.S.A.) urbanitethe dominant food constunTtiOn. practices are to be expected in culture and economic system; the. individpal's sub- liuinin societies experiencing rapid social change cultural backgroumi and orientation; and his per- generated by scientific and technological ,develop- sonal characteriStics. Each individual, while utiliz- ments, industrialization and urbanization. These ing the resources of his immediate and distal en- developments, and their attendant innovations and vironment, will enlarge upon theniormodify expansions in areas such as agricultural and food them in accordance with his frame of reference technology, transportation, marketing, communi-: and life-style: Directly Or indirectly, this holds cations, and in occupational specialities and work schedules Will foster diversities in food use and . truefor the adult; adolescent, child, and infant. consumption practices. The preceding concept of food use and con- The physical and social environment, therefore, sumption represents a framework for observing, serve as strong forces limiting and expanding what recording, and.ciiescribinginfant and child feeding items are to be utilized as food,. how, where, and practiCes in an urban community in the north- central region.' The focus is on the infant, and when-, 'they are to be, stored, processed, and consumed and how interpersonalinteractionsrelevant chili; the focal materials are the resources= personal,immediate and * This research was ,supported by USDA Grant No. environmentaland 12-14-10079907. distant

49 METHOD were encouraged to follow their own thought pat- In an attempt to record and describe the diet terns and their own organizational format in discussing their dietary practices. and food habits oi 150 households (575 residers) of an urban community, anthropological tech- The data comprising the bulk of this, paper rep- niques of participant-observation were combined resent but one small segment of the foodways of with the more formal sociological method. This the 150 households participating in the study. combination of methods permitted the collection of data that can only be derived from direct observa- THE COMMUNITY tion and participation in the daily routine of the North Central City, located in the heart of two respondents. It also allowed four fieldworkers to well-defined and locally recognized communities collect and organize data gathered froma fairly hi Kansas City, Kans., is encompassed by three large urban :population. census tracts (2). Physically and socially, the area Between September 1969 and February 1970, we combines what may be termed the best and Worst conducted five sets of preliminary field studies of urban living. One very small area has many of among 42 households in three different urban com- the characteristics of suburbia, another seems al- munities in the Greater Kansas City area. As a most rural, one strip is said to be the vice district, result, we refined a food habit research tool de- and most of the area is officially defined as the veloped by the senior author.M.a previous anthro- "inner city'? pological study (1). Thereseaieh tool, a structured Many of the services obtained in North Central interview schedule, permitted us to record and City are much like those obtained in urban com- structure field observations and informants' re- munities of similar age, _structure, history and sponses to 178 questions concerning individual populatiOn characteristics..The services are limited and family food practices. in quality and quantity and distinatly. -inferior to One hundred and fifty households,a 5 percent those found in modern neighborhood or cominu- random sample of the households in thecommu- nity service centers: Residents rely upon Mass nity described below, participated ina food habits' media and the larger social system for certain. study conducted between March and December basic information and services. However, many 1970. services of a social and personal nature may be The structured interview schedule developed for obtained M the immediate area..Ofteni these aro this study was administered to each of the respond- small outlets of national or regional commercial ent households until'. all relevant data were col- enterprises and branches of governmental ages lected. An initial, contact andan informal visit ClBS. Individuals and families, dependinmo. upon designed to establish rapport with meribers of their world view and life space and transpdtation the households -were folloWed bya Series, of close available to them, mist decide whether to rely on interactions with families, thus affordingus nu- North Central City and its adjoining communities ineroris 'opportunities for observing and recording for some .or all of their, consumer services or go ongoing events directly and indirectly relatedto elsewhere to obtain them: As far as food is con- food use., Although we did -not reside in the field cerned, the local supermarkets provide whatever site, the enthusiaStic response and cooperation of food items they deem basic merchandise as well the respondents permitted us almost daily contact as those for which: there is significant consumer with each respondent household for the equivalent demand. . of 10 days. We interactedas often as was neces- . Of the tr\o defined communities spanning North sary and for 'as long as was mutually convenient Central City, one, community A (approximately until all data. were collected. In many instances, two-thirds of NOrthogentral City), pos.sessesmany the relationship continued many months after the of the external eliseteriStics of an "inner city" pertinent data were-recorded. Sonie interviews and is, in fact, the locus of a model cities-prograrit began as early as. 7 a.m. and others endedas late The single-family residential structUres ahich as 11 p.m. on a scheduled or -nonscheduled basis, predominate in this particular community vary depending upon the type Ocrelationship devel- from good to fair in one section and from poor oped with a particular respoWnt household:- Al, to those slated for clearance in another. The ma- though we used a 'structured. interview schedule, jority of the population in this community .con- all interviews were free-floWing_ and informants sists of young and, middle-ag4.black adults; the so vhite minority consists mainly of middle-aged and OBJECTIVES. "retired- adults. The community isserved bya This paper represents but, one segment of a number of small shopping strips located primarily larger study. It der,:ilibes infant and child feeding along major vehicular routes. These strips usually practices from the vantage point of the respond- consist of one or two national chain stores, one or ents. It deals mainly. with qualitativedata. and two independent, grocery Stores; a number of no attempt will be made toanalyze the informa- grocery-variety stores, liquor stores, and laundro- tion collected from respondents or to quantify the mats.. Other businesses inelude barber and beauty foods consumed by the infants and children ob- shops, drive -in eateries, food carryout shops, gaso- served. These will he the subject of Inbsequent line service stations, and hardware-variety stores. papers.- These business places serve as communication Guidelines to the organization of this paper have centers and informal meeting places for residents been (a) thesocial and ecimomie characteristics and nonresidents alike. However; structured com- of the respondents, (b) the acquisition offood. ( c ) munity social activities take place in the numerous earlinfant feeding practices, (d) the rhythm Protestant churches located in the community. Ed- and pattern of eating, and (e) feeding, practices ucational facilities include one junior high school, of children aged 18 to 36 months. Attemptswill be 11 elementary schools, and many Head Start and made to relate each topic to the physical and adult job - training canters which are fairly, new social environment of North Central city. This in- to the community. Health services in the com- eludes the present practices of mothers and women munity include a children and youth project and of Childbearing age and past practices of women a few physicians' offices. Well-child clinics are who have passed the period of childbearing.Both conducted once or. twice per week in churches, in types of information are importantsince older other community service centers and in the offices women and grandinotherkareinfluential in infant of physicians. and end care and feeding in their roles as tem- The other third of North Central City is located and as advisers in community B. The greater part of this com- porary and permanent babysitters munity's populatidn is white ; the racial/ethnic to young mothers. distribution varies considerably from sector to'sector. Although the area has many of the physical SOCIAL AND ECONOMIC and social features-of suburbia, due to recent an- CHARACTERISTICS OF RESPONDENTS nexations, it is generally considered part, of the Of the 150 households studied in Nord'Central "inner city." This section contains very few neigh- City, the racial/ethnic distribution was 112black, borhood stores'and has no major shopping areas. 37 white, and 1 Mexican-American. Ahousehold, is Drive-in restaurants, barber shops, beauty shops, defined as the group which ustially inhabits.`a and -food carryouts/ are found along the major common domicile andregularly shares its re- vehicular routes/*.h ich are fairly. well removed. sources to provide food, andshelter f6r its mem- front the residential areas. Educational facilities bers. Of the 575 individuals in thesehouseholds, in the community include nine elementary Schools, 453 were black, 116 _white, and 6Mexican-Ameri- three junior, high schools and One Senior high can. school; Health faCilities within the community One hundred and twenty househOldsconsisted., boundaries are- virtually nonexistent; residents of nuclear families: Of the remainder,17 were ,must seek health care in other areas of the.city. lineally extended (i.e., they included personswho North Central City is a community in the sense family/but who had lineal that it is welded- by its own social institutions, were not of the nuclear kinship to either the male or feinale head ofthe network of friendships, family ties, mutual obliga- household) and 13, were laterally extended(Cc!,. tions and dependence. Many persons refer to three 'they included persons who were. not ofthe nuclear generations of kinsmen who live within: walking kinship with the distance of each other, and a majority of the resi- family and who- either lacked male or female head of the household or were more dents relate to at least one other generation living extended in close proximity. There is little out-migration in distantly related 'than in the lineally North Central City;' most of the single.-family households). dwellings., are owned or are being bought, by the Of the 137 households consisting of more residents. oneindividual, 02 were headed by a male and 37 51' by a female. In eight instances the houSeholds con- ing and by hunting small game. These "home- sisted of persons not related by blood or marriage. °Town" items are considered to be delicacies. Size of the.households is summarized in:Table 1, A relatively small number of households (1G) and formal educational attainmenrof the person participate in the USDA commodity food dis- interviewed -( female in 438 of 150 instances), and tribution program. However, throuzli an intricate spouse is presented in Table 2. Among the 574._ system of exchange, a majority_of the respondents individuals included in the study, there were 316 receive and use one or more of the food items adults or individuals over 16 not attending high generally referred to as "commodity foods." Trips school, 180 children 6 to 16 years of age and teen- to the supermarket within and ()inside North age minors attending school full- time, and 79 Central City for major grocery purchases are children less than 6 years of age. Nearly all of the spaced -according to household needs; however, the children less than 6 years of age were black. trend is either once each week or twice each month The labor force status of the 316 adults and (Table.4 ) coincident with the pay-day Cycle. Many individuals over 16 not attenclidg, high school was respondents volunteered, however, that it is not as Allows: 209 were employed; 68 were unem- uncommon to have members the family pick up ployed, retired; and 39 were unemployed, nonre- bread, milk and lunch meats almost every lay at tired. The occupational classification of the head either the supermarket or corner store. In house- of the household (male or female) could be speci- holds with small children, approximately 25 per- fied for 143 of the MO households: 43 unskilled ceat of a week's food purchases is obtained through workers, 32 skilled manual, 31 semiskilled, 13 this type of supplementary Shopping. lower. level professional, 9 sales or clerical, 8 technicians, and 7 managers. (Occupational classi- EARLY FEEDING OF INFANTS fications were derived from Strauss and Nelson (3) and professional levels were based on the years Data on infant feeding practices were obtained needed to complete professional training and the, from all women who had had children. This means prestige accorded the occupation by American that information of this type was obtained from society.) more than one woman in extended households (,20 On the basis of data from the Bureatrof Labor percent of sample). The number of women and Rile Statistics, U.S. Department of Labor, for the Kan- total number of children born to them (live births) sas City (Missouri-Kansas) area for spring, 1970, are shown in Table 5. It is difficult to say whether 60 households were below the lower budget cost, 32 there is, indeed, a decline in family size in North were Within the lower budget cost, 24 within the Central City, since many of the women aged 30 intermediate budget cost, and 34 within the higher and below are still in the childbearing age. \budget cost. One hundred and twenty-one house- Infants and children living in North Central }olds ownedor held equity in their dwelling; 27 City were born in hospitals. Approximately 1G rented and two lived rent-free. Most of the house- hours after birth, infants are given their first food holds (143) occupied a single-family house; three from the breast or bottle, according to the wishes of lived in a two-family house, two in a three-family the niother. Thereafter, they are fed "on demand" house, and two in an apartment building. The every 3 to 4 hours until they leave the hospital, dwellings of 85 households had more than six no later than 3 days .1 fter the baby's birth. rooms, the dwellings of 63 households had four to .Until they are approximately 3 weeks old, in- sits rooms, and the dwellings of twohouseholds had fants are fed either entirely by breast or by bottle. one to three rooms. The regional backgrounds of Physicians, grandmothers, relatives of tile new the respondents (usually female) and spouses are mother, and older adults Within and outside the presented in Table 3. community are called -nrion to furnish bask information to the inexperienced mother. Pottle-fed ACQUISITION OF FOOD babies receive eitlier milk or formula, depending The supermarket serves as the major locus of upon the advice or cluster of advice, mothers are food procurenient (144 households), although one- offered. At approximately 3 weeks of age, breast- third of the respondents supplement their grocery fed babies begin to receive a bottle, and other purchases by maintaining small vegetable gardens, changes in general .feeding practices hegin to by gathering wild greens and mushrooms, by fish- occur. 52 Early infant feeding practices are also depicted The infant's refusal of food is not taken 'seri- in Table 5. The table shows shifts in emphasis on ously by mother : he is coaxed into trying new and breast feeding over the past four decades. A ma- different types of commercially prepared foods. jority of the women beyond the childbearing age However, substitutions are made for those items had breast-fed almost all of their children, while causing digestive _onsets and the offending items the opposite holds true for the women who are are removed from the infant's diet still bearing children. Women between 31 and 54 While the use of commercially prepared "baby" years. apparently were caught in the transitional and -"junior" foods is firmly established in current period when breast feeding of infants was on the early feeding of infants, and although the timing decline. The national trend in the decline in breast of the introduction of such foods is also well es- feeding has been well-documented in earlier tablished, the patterning and style of the menu studies (4). 'often extremely innovative. The abundance and Individualism, a cherished American value, variety of these foods permit choices in selection aptly describes the trend in the length of breast of food and brand (by parents, friends and rela- feeding depicted in Table 6. Regardless of the tives), in method of serving, and in blending. mother's age group, she uses her autonomy and Often, that which appears to be a bottle of milk possibly that of the infant to determine when or formula to the casual observer may actually breast feeding will be terminated. The data indi- turn out to be milk or formula plus a mixture of cate, however, that infants born at an earlier two or more commercially .prepared baby foods, period were breast-fed lonaer, than present-day "baby cereal," or a pureed food such as applesauce. Also, it is not uncommon to observe an infant One-thiid of the infants of young mothers (age being served from four or five baby-food jars and 30 and below) receive food other than milk or a baby 'bottle at one meal. The liquid from the formula from approximately 2 weeks of age. By bottle offered between 2 or 3 spoonfuls of semisolid food helps "wash down" the semisolid mass. the age of 4 months, approximately all infants (92 Regular table foods or family fare are given to percent) have begun to receive additional foods and/or beverages. It is at this time that -many infanta 'When, in the words of a 20-year-old mother motho's substitute milk for formula.. The cut-off of a 14-week-old infant, "he feels he is. ready for period for infants born at least a decade ago (those it." ThiS is determined "when he starts pulling at born to mothers over 30) was 6 or 7 months:The the food we (adults) are eating." Another mother data for North Central City are consistent with of a 16-week-old infant confided, "He ate like he national trendS (4). However, as with the length wanted; he pulled. it dawn from my inouth," No of the breast feeding period, the trend toward in- particular trend can be identified from the data dividualism in the feeding of infants is demon- shown in Table 9 or from on-the-spot observa- strated when milk and formula are supplemented tions of mothers with infants. Again, the mother's with other foods. (Table 7). resourcefulness,. autonomy, and her stated ability to sense the needs and wants of the infant deter- The influence of the sociotechnological environ- mine whether the infant is to be started on "regu- ment on the types of foods (other than milk or lar table food." . milk formula) first given to infants is clearly de- .. The introduction of regulaable food into the pitted in Table 8. Commercially prepared baby infant's dietary does not signa the end of the foods and juices are popular ampng the young bottle Or the jar. Although "the bottle" serves as mothers (age 30 and below), whose first taste of solid foods was received in the form of crushed the core of the diet, each type of food has its "regular table food." 'Orange' juice, other juices, place in the infant'S varied and individualized baby cereals,:meats and meat dinners; vegetables, menu and rhythm of, eating until he is anProxi- fruits and desserts are the most popular items first, mately 18 months old. He is then changed per- given to infants of mothers up to age 30, while manently to "regular table food"often on his mothers aged 55 and above served their infants. own iiiiinitiative. \. reku 1 a r cereal," "regular table food" mashed-with THE RHYTHM AND PATTERN OF EATING gravy, eggs and egg yolks. A combination of these types of food was popular -with mothers aged. The infant establishes his own rhythm of eatin 31-54. at an early age. He gives the-signals and tho

53 providing care respond. with food. Crying and a...mind of their own.-- Individualism is sanctioned other indicators of discomfort are usually inter- and encouraged and expressed through food. preted as a request for food. The bottle, always For the child of IS to 36 months-, there are three within easy reach of an adult, oldeisibling, visitor, patterned eating schedules.Breakfast is served ei- or the infant himself. is given at the more infor- ther at home or at a babysitters, depending on the mal feeding timesthe equivalent of snack-time family's situation and the occupational schedules in the noninfant world.Early experimenting with of the working- adults As a result, the tinning of "regular table food" and the serving of plain this meal varies widely. Lunch and dinneras meal- water, Kool-Aid and vitamin supplements _aLso times are also patterned, but again. with wide vari- take place at these informal feeding times. ations in spacing due to work schedules and The circumstances surrounding the giving and family circumstances. Foods almost always listed receiving of food to infants of North Central City as favorites of children within this age group dur- are very similar to those of the town in Georgia ing structured eating times are as follows: _alined described by Virginia Young (5). 9Vhen the baby dinners, spaghetti dimmers, -fried chicken. mashed shows discomfort the mother almost invariably potatoes with gravy, green beans, dressing, corn. offers the bottle....The feeding is. casually in- carrot sticks, variety fruits, bread, cheese, hot and terrupted at any sign of decreased demand from cold cereal, milk, chocolate milk, hot dogs, lunch the baby and as .casually begun again atany in- meats, hamburgers and Vienna sausage. Infants terval." The giving of food is to comfort and and children of this age are invariably given vita- satisfy; food is not viewed as a symbol of reward, mins every day. Special efforts made to adhere or punishment. "When the 'nether or other indi- to this practice during the winter months. The in- viduals responsible for the infant'scare feel that fluence of babysitters in fostering and transmit- he is undoubtedly hungry: e.g., a in nap, ting foodways is recognized by mothers of children when he cries in a certain way, or at the first within this age range. Often, information. on ing of the day, a freshly prepared bottle br baby likes and dislikes included that reported foods are given. by the babysitter to the mother. CONCLUSION FROM 18 TO 3e MONTHS The sample of 150 households in North Central Early established; rhytixraic eating patternscon- City is approximately 75 percent black and 25 per- tinue during. childhood (and presumably adolescent white; one Mexican-American -family is also cence and adulthood): The toddler or young child included in the sample. The incomes of 61 percent. often initiates the act of eating by either requesting of these families are either below or just within a specific food or by serving himself. One fre- e lower budget cost established by the U.S. De- quently sees a young child help himselfto one or pa\tment of Labor; officially, then, these families more of the many foods (fruits, cereal, .cooldes, receive inadequate incomes. chips,. bread, lunch meat) present,or request those The tirrent national interest in hunger and mai- not within his reach, e.g., ice cream, milk, popsicle nutritica has been translated into programs aimed and other ices. at many cmens whose lives and living conditions, :Mothers attempt to fulfill the wishes of their for the mostit, are not too dissimilar from those children by selecting during the food quest food experienced by a majority of the residents in North items preferred by the children, The focus is on Central City. This &per emphasizes the need to the child or children and the gratification of their "ew holistically thetal patterning of eating food needs and wants. "I always cook what they within the ..framework o environmental and per: like" was often heard as mothers described their sdnal resources. The. abilityf the residents of North Central City to use; modifand enlarge food consumption .practiers. One very' articulate resources 'from the wider andimmediateenviron- respondent described very vividly. how her chil- ment in an effort to achieve satisfaction\ik eating dren, ages 3 to 7, participated in the weekly grocery testifies to the establishment, transmission and shopping planning. Each child was given the op- maintenance of food habits through environmental potunity to request one special food each week inputs and stimuli. Intervention of any kind must "so that they would grow'up as individuals with take these factors into account..

.54 The data indicate that the food habits of the Table 5.-Early feeding practices of mothers by age groups respondents, especially as they relate to infant and Agegroup ofmothers inyears child 'feeding practices, are content with the Feeding, practis 30 and below 31-50 55 and Macro socioenrirownental and personal forces that de-. termine the selection, consumption, preparation, Mothers: Breast-fed-all children_-_._ 7 22 26 serving and general use of food. The timing, se- Breast-fed-some children__ 6 22 5 quence and frequency of feeding are also part of Breast - led -no children 31 15 1 Totals tt4 59 22 the continuum established within the social milieu. Children: Breast-fed 27(26.2';) 110(45.4':) 93(57. 3'.:) Table 1.-Distribution of respondent households by size Bottle-fed._ . ____ _. 76(73.8'7) 131(54.6; ) 2007-770 in North Central City. Totals- _.----_-_ ..... 103 241 113

Number Number I Except for one or two cases, women beyond childbearing age had no diffP:ohy in Household size of house- Household size of house- recalling their infant feeding practices. The information was obtained when respond- holds holds ents described differences between practices of "modern" mothers and their own.

1 13 8 7 4 Table 6.-Average age of infants at end of breast feeding 2 42 i 9. by age group of mothers 3 32 : 10 1 4 11 .111 I , 5 18 I,12 Age group of mothers in years 10- Age of infant in months 6 30 and 31-54 55 and Totals 7 10 Total 150 balow abn:e

0- 1.0_ _ 8 15 8 31 Table 2.-Formal educational attainment of respondents 1.25- 2.0_ 3 14 1 18 and spouses 2_ 25- 3.0 5 15 1t 31 2 11 3.25- 4.0 1 8 Respondents Spouses 4. 25- 5.0 2 5 3 10 Number of years of formal education 3 23 18 44 NumberPercent NumberPercent 5.25- 6.0 6.25- 7.0 1 3 7 11 7.25- 8.0 4 7 11 1-6 11 7.3 5 5.7 12 27 39 8.25- 9.0 . 1 7-9 28 18.7 15 17.2 9.25-10.0 _...... __ 4 5 10-11 23 15.3 21 24.2 10.25- 11.0.___ 1 1 12/compl. H S 88 58.7 46 52.9 11.25-12 0 4 7 2 13 12.25 up 2 1 3 Totals 150 100.0 87 100.0 Don't know 1 1 Not applicable 1 1 Note: Since a majority of the respondents are female (138 of 150), the spouses column refers to males, essentially. Totals 27 110 93 230

Table 3.--Regional background of major informants on food practices Table 7.-Number of infants by age at time of initiation to food other than milk -or formula, according to age group U.S. regions: Respondents I Spouses 2 of mothers

Age group of mothers in years North-central 87 70 Age of infant in months 30 and below 31-54 55 and above I South 67 32 Totals Northeast 4 1 Numbei percent Number Percent Number Percent West 3

32 31.1 52 21.6 2 1.8 86 Total 161 103 0 -1.0 136 1.25-2.0 39 37.9 73 30.3 24 21.2 2.25-3.0 8 7.8 47 19.5 26 23.0 81 I Refers to area in which individual resided from birth toege 16. Only rarely did an 3.25-4.0 16 15.5 30 12.4 12 10.6 58 dividual claim more than one region. 4.25-5.0 3.0 3 1.2 12 10.6 18 Since a majority of the respondents are female (138 of 150), the spouses column 52 1 0.9 17 7.1 34 30.1 eters to males, essentially. 5. 25-6.0 6.25-7.0 2 2.0 18 7.5 28 2 1. 8 3 7. 25-8. 0 ______. 1 0.9 Table 4.-Frequency of major grocery* shopping. 8.25-9.0 9.25-10.0 10.25-11.0 1 0.4 1 Number Number 11.25-12.0 Frequency of house- Frequency of house- 12.25 up holds holds Don't know 1 0.9 1 Not applicable 1 0.9 Daily 2 1 time per month 16 457 Totals 103 100.0 ,241 100.0 113 100.0 2-3 times per week 6 3 times per year 1 1 time per week 91 No set pattern 1 2 times per month 33 Total 150 'Those women 55 and above probably would not have had commercially prepared strained foods available for use during their childbearing years.

!",,t't55 Table 8.Number oil infants given specific foods at time References of initiation to solid foods, according to age group of mothers I. N. W. Jerome, "Food Habits and AcculturationDie- tary Practices and Nutrition of Families Headed by Age group of mothers in years Southern-Born Negroes Residing in a Northern Food/beverage served 30 and below 31-54 55 and above Metropolis" (Ph. D. dissertation, University of Wis- consin, 1967).

Orange juice-' 51 129 27 2. Community Renewal_ program, -.4n Analysis 'of Cons- Other juices 30 64 11 munity Needs and Renewal Potential: Northeast Baby cereal 82 110 20 Community, Eansas City, Kansas City, Baas., Plan- a:by meat/meat dinners 33 44 7 ning Department, 1969. Baby vegetables 33 61 7 Baby fruits/desserts 41 62 9 3. 3L A. Strauss and J. I. Nelson, Sociological Analysis: Egg Yolk_ 16 24 26 An Empirical Approach Through Replication (New Eggs 12 39 27 York : Harper and Row, 1963). Regular cooked cereal/milk 8 64 55 Regular table food. mashed______12 79 78 4. S. J. Fomon,- Infant Nutrition (Philadelphia : W. B. Regular canned fruits, mashed_ 3 6 Z2 Saunders Co_, 1967). Fresh fruits, mashed 3 7 1.2. 5. V. B. Young, "Family and Childhood in a Southern Don't know 1 Negro Community," American Anthropologist 72 Not applicable 1 (1970) : 269.

Note: More than one food given to infant when initiated to solid food. Acknowledgment Table 9.Number of infants by age at time of initiation to "family foods," according to age group of mothers We wish to acknowledge the assistance of Miss Age group of mothers in years Njeri King'ang'i in the fieldwork for this study Age of infant in months 30 and 31-54 55 and Totals and that of Dr. Ethel Nurge in reading and com- below above menting on this paper..

0-1.0 6 13 19. 1.25 -2.0 7 11 8 26 2.25 -3.0 9 23 17 49 3.25-4.0 19 40 16 75 4.25 -5.0 7 10 11 28 5. 25-6. 0 17 68 33 118 6.25 -7.0 11 26 37 7.25-8.0 8 5 1 14 8.25 -9.0 3 18 1 n 9.25-10. 0_____ ...... 5 2 7 10.25-11.0... 1 1 2 11.25-12.0 6 10 17 33 12.25 up 1 7 8 Don't know 13 2 15 Not applicable._ 4 4

Totals. 103 241 113 457 Discussion

Virginia C. Janch, Session Chairinan : I sug- was necessary for foo,l. ::em?.,.mnlless of the need. for gest that we now invite questions particularly restrict economy azlik lated to this presentation.. We shall then hear from Miss Fanstirea Er4 :eve that is a the Valentines, entertain questions about their general pattern. frK'll us-Lally receivis presentation and, finally, move into a more general relatively low pril,7-,y of low-income discussion. families. From my in rural, and Dr. Charles A. Valentine: Although 40 per- migratory areas, rent first, then utilities cent of the households were found by Dr. Jerome and transportation, wiQ. renalaing hinds be- to fall at or below the "low budget cost" level, ing budgeted for foo,;::: !Lad z,ther expens. In vari- nearly 25 percent were in the higher budget cost ous ways it is important to know the priority of level, suggesting a lot of variation in expendable food in the budget and thL et7imsideration of each resources. Could you relate the different levels of fareily member in the v.se of this food. available resources to the other reported variables? Mrs. Addiss: I If you do not pay your Dr. Jerome: Black are in a higher budget cost rent, you will be evicted., 11 yon; do not pay your level than whites in this particular community be- light and gas bills, services will be discontinued. cause those whites who could afford to move have In many instances, food secras to be the item that moved. Those remaining are retired people with gets cut the most. fixed incomes who could not afford to move. Dr. Whitten: Did you see a difference in infant- Dr. Charles F. Whitten : I notice the absence of feeding practices related to the time of month? grits as a first food and the absence af. greens in Dr. Jerome: Yes. Commodity foods, for ex- the list of favored foods.- ample, were eaten primarily in times of scarcity. Dr. Jerome: We have included grits among These were time foods resorted to when nothing cooked cereals. Greens are not favored foods of else was available for the infant to eat. children in this community. There is a distinct Dr, Philip L. White: Is the quality of life that generational difference with respect to consump- you found in this community a reflection; of sta- tion of greens and cornbread. These are not fa- bility worth passing down to the children ? vored foods of infants or children and are not Dr. Jerome: The whole area is quite stable. forced upon them. Many Government programs are tested there be- Mrs. Luise B. Addiss: Can you comment on cause there is little out-migration. the level of poverty, in the families you studied? Dr.-Samuel J. Fomon : The description of this Dr. Jerome: There are various ways to define urban area fits quite well the description of many poverty. I felt that the Bureau of Labor Statistics towns of 500 to 1,000 people. Inmany respects your was best able to define it. I realize that people live description suggests rural nonfarm rather than at various sublevels below the lower budget cost inner-city urban. level. I purposely did not use a $3,000 annual in- Dr. Whitten: What are your views on the. valid- come as a cut-off point because I view that as a ity of the data relatiVe to age of introduction of destitution figure. Many of the families receiving solid 'foods? Hoiv do -you validate information welfare payments would not have qualified for given by mothers who at. age 55 may not have 'fed 0E0 benefits. an infant. for 25 years ? Mrs.Addiss: In addition to cultural influences, Dr. Jerome: In general, these persons focuson economics is a potent factor in determining how present situations and compare them with those the mother feeds her baby. How important are of their own era. I- believe this resulted in valid these economic factors in interpreting your data? answers. -Dr. Jerome: Most of the people seemed to Dr. Whitten: Recently we asked mothers of 9- believe that food was important. They spent what month-old infants specific questions concerning

57 introduction of baby foods. Some of the women that records of fond pur::ase, mar be amon- the had diflicultY in recalling age of introduction of most useful sources of data. various foods. In other studies, detailed informa- We observed that people purchased food on the tion about feeding practices was gathered and 2 or basis of what they saw in the !rrocerr store or years later the mothers were asked to recall and advertised on TV, suggesting that the supermarket describe ae-ain. There was a discrepancy between was a great influence. We therefore developed a the two sets of reports. "supermarket simulator' consisting of a large Miss Doris Lauber: Accuracy of recall might number of food labels in catalog form. There be related to the number of children the mothers are four volumes which each interviewer carries had. to every interview. We begin with a volume of Dr. Marjorie G. Whiting: It would seem that condiments of various kinds and ask whether a records of food purchases at the checkout counter specified item is used, when orhow it was intro- might provide useful information. duced to the family, whether- the entire family Miss Mary C. Egan: Although in some coun- eats it, etc. Other volumes concern meats, fruits, tries the male is the first fed, children next, and vegetables, and cereals. We record all the informa- the homemaker last, in our own society this does tion by hand during the interview. I found this a not seem to be a common pattern. The food pur- good way to get an entire family to discuss their chase approach might therefore yield quite useful particular likes or dislikes and to elaborate on information. how certain foods are prepared. Miss Solis: However, in many low-income Dr. Whiting: Is it true that families with Mexican-American homes, the mother, whether limited incomes cannot shop for bargains because pregnant or not. will feed the husband and children they cannot afford to experiment with something first. Then, if there is anything left, she will eat. that may turn out to be unsatisfactory? The wave-earner is commonly given first access to Dr. Jerome: I do not believe that question can available food. be categorically answered yes or no. Some low Dr. Jerome: Meals, as such, are frequently not income families seem willing to experiment. consumed in the traditional way.. Food is present Dr. Whiting: Do you think they are inclined in the refrigerator or cupboard. and persons. within to shop for standard brands? . the household prepare individual meals or snacks Dr. Jerome: Yes. If they are satisfied with a when they are hungry. This fostering of individu- specific product. they are not anxious to accept a alism must be strongly borne in mind. I believe substitute.

58 Poor people, good food, and fat babies: observations on dietary behavior and nutrition among low-income, urban Afro-American infants and children

Betty Lou Valentine and Charles A. Valentine Department of Anthropology Washington University St Louis, Mo.

INTRODUCTION Thus we find leaders of welfare rights groups and nonwhite minority militants citing this formula- It is widely assumed that poor nutrition is tion as evidence that society is crippling their chil- closely associated with poverty and with mern- dren's minds. At the same time, representatives of beiship in nonwhite minority groups. Inadequate teachers' unions and education associations cite the diet, particularly in infency- and childhood, is same conception to show that they and their insti- usually a factor mentioned in the many recent tutions aie not responsible for educational failure writings on the "cycle of poverty," the "tangle of among the poor. pathology" found in black ghettos, or the -syn- The nutritional problemsWhichhave been asso- drome of "cultural disadvantage." Widespread ciated with poverty are generally perceived as em- public attention to the nutritional dimension of bedded in a social context. provided by a distinc- poverty has lately been encouraged by congres- tive life style ascribed to the poor. Here is a typical sional investigations and mass media presenta- expert description of the nurturing milieu into tions. Most recently, dietary deficiency has been which children of poverty are born (4). put forward as a major biological cause of behavior by poor people which perpetuates their poverty The child draws his first breath in a small drafty, Sparsely furnished wooden house al- through mental retardation and school failure ready overpopulated with children whom no (1, 2). one really wants. His needs will be attended., A rather dramatic illustration of this public to after a fashion by somebody if he squalls attention has recently appeared in the form of an loud and ong enough. For a. while the some- article by a Southern Senator ina national maga- body willrobably be his mother since she is nursing h. .When she stops feeding him his zine under the_ title "Feeble Bodies, Stunted care is often relegated to his brothers and sis- Minds." Citing the National. Nutrition Survey; ters, who may or may not take much interest in this author calls special attention to "the effect of him. For a hile he will have a bottle when he hunger upon mental capacity... thebrain is is hungry,. d eventually he will find out how to drink ou of a cup. It is quite exceptional stunted ...protein deficiencies before birth and that anyone will spend much time cuddling during the first few years of life can cost a child him or pla frig with him or teaching him up to 20 percent of his intelligence" (3), Mean- how to do in When he is able to get while, spokesmen for the most diverse and even around by If f; be will trail the other chil- mutually opposed interests are publicly using the dren or play alone. During the day they all come and finsome food in the house from supposition. that malnutrition causes lasting men. time to time i they are hungry, While at night tal impairment to support their various positions. they join inWatkver the family has for sup-

59 per if they like it. No one is muchconcerned to the facts of dietary behavior. The interviewer about proper nutrition, or about whether the or collector of questionnaires is considerably re- children eat or not. moved from the clay-to-day realities of infant and Another learned passage shows how this concep- child feeding in people's homes. His method allows tion of lower-class behavior is made relevant to a the possibility of considerable misunderstanding. particular ethnic group (5). omission, or distortion of information. Clinical evaluation of sample populations can, of course. For instance, a less adequate nutritional level than is found among whites is one factor identify the distribution of significant biomedical often cited in accounting for the poorer aver- conditions. Yet the presence of clinical sires and age health status of Negroes. It isconceivable symptoms does not in itself r.ecessarily establish that Negroes could improve their nutritional etiology, whether the suspected causes be nutri- status immediately by altering their .present tional or otherwise- likely patterns of food consumption, but. this is While the weakness of either approach by itself to occur less as a result of education and prop- aganda. than as a. byproduct of changes in the may be admitted, there se-ems to be an implicit caste-class situation. .. Maximizing the op- assumption in the literature that when the two portunity for Negroes to achieve the values methods produce consistent results they are mu- and norms of the general Aram3lcan middle tually confirming. There may be little reason to class is likely to do more to change the eating habits of the Negro population than all of the question this logic in investigations which exten- written or spoken exhortations of home econo- sively document very extreme denial of basic ma- mists or the most seductive television com- terial needs (e.g., see refs. 6-9). In these instances mercials. A shift in social class supplies the the material conditions of existence appear to motivation to change, and such a shift is de- establish a persuasive case. . pendent upon an increase in the number and proportion of Negroes entering white-collar Yet major published discussions show a strong occupations. tendency to generalize and to encompass "the poor" as a totality in the same analysis. As one recent When we turn to works arguing the biological source puts it, "It will be taken for granted that effects of malnutrition working within our society, the poor get less or lower quality food than the we find that thesegeneralizations by social scien- other classes." The context of this quotation makes tists have been assimilated by medical and other it clear that the deficiencies the author has in mind specialists on nutrition. Thus early in his book are such as to cause severe and permanent organic Hurley (1) gives extensive attention to the "self- damage (1): This kind of generalization rests on perpetuating" nature of the "culture of poverty." a conception of "the poor" as a unitary category Most of this volume is devoted to the thesis that with uniform characteristics. This conception is there are various clausal relationstiipsincluding again supported by the theoretical notion of a nutritional onesbetween poverty and mental re- "culture of poverty" which, as we have seen, also tardation. Toward the end of his exposition he goes has an important place in this same literature. so far as to argue that "a ghetto child usuallysuf- Thus the arguments of Birch, Hurley, et al.that fers some, if not all, of the ill effects of malnutri- poverty is significantly perpetuated by unhealthy tion simultaneously and synergistically." Simi- dietary behaviorappear to be extended through larly, Birch and Gussow (2) reinvoke the social several levels of -abstraction rather far beyond science conception of poverty as "a way of life" to available empirical evidence. conclude their demonstration that poverty is per- In particular, these enthusiasts have ignored the petuated by malnutrition and poor health leading more sober scientific evaluations of the problems to school failure and unemployment. at issue. One careful review of "the supposition The dietary and nutritional evidence cited in that malnutrition causes permanent mental retar- such studies has generally been produced by one dation" recently concluded that "there is little of two research methods, In the mie 'approach, conclusive scientific evidence to support such a interviews and questionnairea are used to elicit supposition." The same source warned that "sur- from children or parents a picture of diet in terms miseS :should not be treated as facts and millions of reported food intake. The other type of method of malnourished children should not be condemned involves clinical assessment of medical conditions as pernianently retarded mentally" (/0). While we which are assumed to have nutritional causes. Both as cultural anthropologists can contribute little to these methods are somewhatindirCt approaches resolving the biomedical issues involved here,- we 60 do happen to be in a good position to collect evi- jug, and child care pattenas that are typical of dence on the behavioral dimensions of this problem Afro-Americans in Blacten.. Throughout most area. of this work, however, our investiesaion was not With these considerations in mind, we have primarily focused on dietary behavior as such. carried out the research described in tleisepaper. Our broader domestic inquiries thus provide a A major purpose of this work is to provide a Uad context and background for a more intensive and of evidence that has not, to our lmowledge, pre- systematic study of diet in a smaller sample viously been used to test hypotheses absent relation- population. ships between nutrition and poverty. Our aim is During the latter part of 1970 we chose a sub- to develop direct observational data on the actual sample of youngsters and households which we eating patterns among the infants and young chil- believe is representative of families with young dren of a poor population. We shall then discuss children among the Afro-American majority of the implications of this evidence both for the nutri- the community. Relevant characteristics of these tional conclusions cited earlier and for the social individuals and their domestic situations are sum- and cultural interpretations associated with them. marized in Table 1. (There, as in the other tabula- tions, individual subjects are arranged by age METHODS AND DATA from infant A, 3 months, to child S, 20 months.) This sub-ern-4)1e consists of 20 children living in This research is part of a larger project, an 15 distinct domestic unite Subjects B -i and B-2 anthropological study of low-income urban Afro- are twins whose elder brother L also lives in the Americans. This wider study is designed to define same house. Other closely related children residing the social structure and cultural patterns of an together are A and S, D and Q, G and N. All but inner-city community in order to test several hy- three of the sample households also included older potheses about the sources and perpetuation of children whose dieti were not under study at this Afro-American inequality. Since mid-1968 we have time. been carrying out this work in a poverty-stricken Of the youngsters whose eating behavior was district of a major northeastern city which, for studied intensively, half (10) were infants less reasons of confidentiality. we refer to by the than 1 year old, while the ether half were children pseudonym Blackston. (11). between 1 and 3 years, About three-quarters (16) The principal method of gathering data in this of the total are females. All members of the 15 research is the anthropological technique of par- households are Afro-ArnerIcans. In most cases, ticipant observation. The key to this approach is the parents of the children observed were born and that throughout the fieldworkwhichwe _expect brought up in the northern, urban United States, to extend over 5 yearswe and our young son live while more of the grandparents were from ill Blackston and immerse our lives in the social Southern States. All children and parents were processes of the community. Our basic sources of free of any known serious illness at the time of information are direct observation of ongoingso- observation. Three children (A, G, N) were suffer- cial behavior, together with participatory experi- ing from colds, and one of these time (G) had been ence of the prevailing conditions of existence in diagnosed as anemic on the day preceding the community under study. We do not employ observation. questionnaires or other formal interview tech- All but two of the households studied receive niques. We do get to know a great many people financial support from Aid to Families.With Pe- very well and are able to elicit through informal pendent Children. In Blackston this means an verbal interaction much information not accessible average annual income for a family of four to observation or participatory investigation. amounting to approximately $3,000.'This can be In part of our overall research- design. dealing compared with a national poverty level of $3,555 with domestic and family patterns, we have chosen for a family of four. It should also be. note-1. eiat a representative sample of over 100 households the Bureau of Labor Statistics has recently estab- for especially intensive study. Over the past 21/2 lished the following four-person family incomes as Years we have made a great many observations required for various standards of living in the and collected much detailed information on these metropolitan area in which Blackston is located: domestic units. This part of the work has given us $n,lat for a "moderate" level, $7,183 for a "lower" extensive general knowledge of the cooking, eat- level. While Blackston incomes do not reach the 61 449-725--72------5 depths of extreme destitution to be found in some with a standard balance scale. The results of these areas, there can be no doubt that the families in computations and comparisons are summarized in our subsample are poor. Table 3, with the detailed data eirented in During late 1970 and early 1971, approximately Table 4. 250 hours were spent) in direct observation and A number of findings can be derived from the recording of food intake and associated behavior evidence which has been tabulate& From Table 1 of these children, their parents, and other family it can be seelretat the birh weight of all in- members in their natural domestic settings. This deeideale in the sample was within the normal included at least 1 full day from waking to sleep- range, and the weight gain of infants in the first ing for each infant and child. Everything eaten yeltr was within the limits of healthy growth (cf. was carefully measured or estimated as to quantity.....Spock, 18). (Although the present weight of the In all cases of commercially packaged and pre- older children in the sample was not measured, pared items, designated nutritive constituents none of them appears to be seriously under- or were noted. All '.hese observations were carried over-weight.) out by the senior author of this paper. Because the The dietary histories presented in Table 2 show households observed are very well known to us, a number of regularities. Although more than a because we took care not to interfere with existing third of the subjects began life with scheduled feeding practices, and because is many cases the feedings established by the hospitals where they observer was not-expected belore she arrived, we were born, 80 percent were soon following the pat- are confident that these observations produced tern of demand feeding which is the choice of most valid record of =disturbed customary behavior. mothers in this community. Most newborns are Two additional procedures rounded out the data- started on commercially prepared formulas by the gathering phdie of this project. Many hours were hospitals. (Breast feeding is neither encouraged by consumed with the adults of each household re health institutions nor approved by the mothers.) cording the dietary histories summarized in Table Babies are switched to evaporated or whole milk 2, collecting parental impressions of the children's quite early because these are less expensive and eating habits, and eliciting' expressions of beliefs because mothers tend to regard prepared formulas and values connected with related aspects of child as appropriate only for very young infants and care and child rearing. Observations were carried children who are unhealthy or not growing well. out in five local food markets to deterMine the Introduction of solid food generally begins with cost and availability ofCOMI01011dietarritems, cereals added to the milk or formula. Addition of The quantitative data from observations of food this ,and other solids to the diet regularly occurs intake of each child in the study were analyzed. substantielly earlier than conventional authorities Food energy, protein content, and iron content appear to expect (14,18, 19). Vitamin supple- were assumed to be the most important nutritional ments are generally recommended by hospitals and values for asseeeing the foot': eaten. These values clinics, and they are regularly given to nearly all were calculated for each ;cigested. e be princi- infants and younger children in the sample. pal sources usied in computing the nutritional com- The picture that emerges from the daily food position of foods were Church and Church,. (/e) intake recorded in Tables 3 and 4 iS somewhat and Beech-Nut (13). Supplementary sources also more variable. Approximately three-fifths of the used for this purpose included Cooper et al. (14) sample were observed to achieve calo intakes and, wherever possible, U.S.D.A. (15). The total equal to or above the ecommended dai allow- food valiies consumed in a day were then calm- ances. Only four of the 20 youngsters fell AO per- Wed for each subject, and this total was com- cent below this level, two of them being ill nd on pared. with Recommended Dietary Allowances medication for colds; another four were 040 and, where applicable, with minimum daily re- percent below the recommended level. All di- quirements for the relevant ages. The standards vidpals but one exceeded the recommended in ke for theme comparisons were taken from publica- of protein;` indeed 13 out of 20 consumed double tions of the Food and Nutrition Board (161 and the deurecommended level in this category. the Journal of the American Dietetic Association iron consumption few youngsters came up to th (17). Where the body weight of intants is required recommended daily allowance (two infants an to compute dietary requirements, this was obtained two children) . On the other hand, one-third of

62 the infants and SO percent of the children exceeded definite connotation of being well fed and gen- the minimum daily iron requirement It should erally well cared for. Parents and offspring have be noted that in cases of generally low consump- little contact with nutritionistsmost exceptions tion, such as child 0, mothers volunteered that being the result of referrals by clinics and hos- their chidren normally consumed more than they pitalsbut when such contacts do occur, they fre- did on the days when their intake was measured, quently result in conflict on this standard of child and our own observations tend to bear this out. health. Nutritionists tend to regard this as a mis- Several considerations seem to be relevant to leading criterion of health. The nutritionist in a the apparently low intake of iron among these local health institution reports that the most com- children. The principal sources of iron in these mon nutritional problem she sees is'obesity, which diets are cereals and meats. Cereals enter the diet, she associates with over-eating and excessive dom- however, chiefly as the earliest supplement to milk inance of milk in children's diets. (The next most and tend to be dropped as the infant grows into frequent relevant disorder, though considerably childhood. Mothers regard cereal as functioning less common, is said to be anemia; no incidence chiefly to make the early milk diet mom robust figures are available either for these problems and filling. Meats, particularly during the earliest or for pica.) Except for cases of obesity suffi- months before table foods begin to be consumed, ciently extreme to impress a layman's eye, which are introduced only in mixed prepared forms con- are rare in our experience, parents generally do taining little iron. No infant or child was obsarved not accept this position of, the nutritionist eating strained or junior meats and no mother Mothers generally attend well-baby clinics quite reported using these. Instead, parents give their regularly. They are aware of two main themes of youngsters the mixed baby food "dinners," both nutritional advice from these institutions, one of because they are less expensive than unmixed which they understand and accept, while the other meats and because people value the combinations is not meaningful to them. Prescriptions of vita- of vegetables, starches, and other items as "more mins and similar dietary supplements are wel- complete." (At the same time, it should be noted comed. Suggestions that solid foods are being that current iron requirements for young children introduced too early, on the other hand, are gen- have recently been revised and appear to be still erallyrejectedas being without convincing a matter of some controversy among nutri- rationale. tionists (20).) Some more qualitative matters, not directly re- RESEARCH CONCLUSIONS flected in:The tabulated data, deserve brief atten- The-research described here has certain limita- tion. In Blaclaton, mothers, grandmothers, and tions which may restrict the generalizability of other older family members are very concerned Not conclusions to be drawn from it Our sample and involved' in the care and feeding of young- of systematically observed subjects is MAIL The stem Babies are rarely left to cry for food or number of quantitative observations so far carried children to fend for themselves when hungry. It out is likewise limited. The nutritional_ analysis is generally believed that the young should eat as much as they want. Despite scant financial of our data can perhaps be more definitively inter- resources, budgeting and sharing are practiced so preted by specialists in tie health sciences than that 'children's wants are seldom frustrated. Par- by us as cultural anthropologists. ents pay close attention to the health of their off- Nevertheless, the available evidence points to spring and take pride in their growth and develop- some suggestive interpretations. There is no doubt ment. Rapid maturation in eating habits is valued that the Afro-Americans of Blackston live in a as a sign of healthy growth. condition of severe socioeconomic inequality and The ruling criterion in these matters among thoroughgoing poverty. Yet it does not appear that Blackston Afro-Americans is the standard of the their infants and young children suffer froin ex- "fat baby." There is no greater approbation or tensive or extreme malnutrition. In major respects source of familial pride for parents and grand- the diets of Blackston youngsters appear to be parents than to be known for having one or more fairly adequate as to quantity, quality, and vari- fat babies. The adjective generally denotes robngt- ety: Giving a high priority to the health and ness or plumpness rather than obesity, with a growth of their younger members evidently 'en-

( 63 . ables most families to maintain reasonable natri- attention to extremely deprived groups --such as tional levels in spite of inadequate resources. migrant workersmight well have revealed more Our findings are inconsiFepnt with much that severe problems. Nevertheless, the evidence ae it has been written about the "Culture. of poverty" stands is impressive testimony to the determination which is supposed to determine not only dietary and ability of poor people to insure the-survival habits and child care patterns, but so much else of their offspring. in the social behavior of poor people. In particu- Ethnic differences, in the sense of 'contrasting lar, we find nothing to support such supposedly cultural traditions, stem to produce cute minor specific characteristics of nutrition among the poor differences in diet at this age leveL Afro-Ameri- as "only milk diets," rejection of solid foods for cans and poor whites of southern origin appear to infants, or resistance to prescribed nutritional sup- share a regional.dietary pattern in this respect (cf. plementation (2). In more general terms, the qual- ,Jones, p. 37; Jerome et al., p. 49). Chicano and ity of feedhig, and care of children in Blackston Latino traditions about "hot" and ''cold" foods bears no resemblance to the portrayal quoted from evidently have minor or ambiguous significance for Stone et al. in the opening section of this paper. the diets of the' very young (see Acosta and Similarly, our evidence gives no support to the Aranda, p. 75). Such culturally exotic items as cited view of Drake that Afro-Americans must Hawaiian poi (Brown and Ho, p.. 91) or Eslthno first become middle cla. ss to achieve an adequate 4 and native American wild foods (Peterson, p. 101)) nutritional level. do not seem to be the major determinants of meth- These findi gs fufther suggest that &eneraliza- tional status. tions about relationships between poverty and nu- The so-called culture of povertywith its em- trition based on questionnaires and clirfical data phasis on ignorance, disorganization, and inability alone must be questioned. Indeed such hypotheses to copebulks large in the.expectations of experts, should be regarded as undemonstrated until much but it receives little support from the aiitual evi- 'further direct evidence as to actual dietary be- deuce reported here. 'this point is most explicitly havior among poor people can be brought to bear supported by the material from Blackston and on these theoretical questions. Meanwhile it is from North Central City (Jerome et al.). How- highly dubious to conclude that maladaptive nu- ever, the same cm/elusion seems to us to be implied tritional habits of the poor are a major factor in b; the other papers as well. perpetuating the general phenomenon of poverty. Our evidence indicates, rather, that the major The deficiencies and 'Problems which do recur from one group to another are most clearly related forces responsible for maintaining socioeconomic inequality should be sought outside the nutritional to the stark material conditions of poverty. Thus Owen et al. have found essentially the same limited process. supply of vitamins and minerals in the diets of GENERAL CONCLUSIONS poor 3fissiisiPpians (29) and Apache Indians (23). In a more specific example, the economically The stated purpose of this workshop has been determined dependence on commercially prepared "cataloguing the 'mown practices and customs of strained dinners occurs over and over from Florida various low-income greups within the United to Alaska. Tire chief limiting factors regularly ap- States" (2%). Each paper and each set Of prepared pear to be" insufficient financial resources and comments has contributed information toward economically determined unavailability of nutri- this goal. We would like to offer-some generaliza- tious foods. tions' which we think can be derived from this information. These generalizations can be con- In discovering the facts of low-inconie dietary sidered as our discussions proceed, with an eye behavior, there is no adequate substitute for direct toward formulating some conclusions at the end "observation and intimate experience of the condi- of the workshop. tions of lifer Interview qaestionnaires and clinical Most of the groups Of poor peopig reported here visits alike produce results which are ambiguous appear to succeed remarkably well in providing and difficult to interpret. (The contrasting and their infants and yoUng children with diets that sometimes confusing expert opinions as to the preVent major severe nutritional deficiencies. This significance of "hot" and "Gold" food categories in is certainly no cause for complacency. Greater SpanisheAinericA diets are a case in point. In another kid of example, Afro - mothers ernmental food policies, and the economic position in consistently o the amount of of the poor and minorities. milk actually consumed by th offspring, ap- It is, of course, not difficult to think of many parently reflecting the widesp belief that milk .specifics within these broad problem arras More is authoritatively recommended the food for vigorous efforts are obviously needed to insure the very young. We suggest that that effective requirements are imposed on food in the literature abtort "ail milk diets" may be manufacturers with respect to enrichment proce- largely due to respondents believing that this is dures, including iron supplementation. It seems what interviewers regard as an approved response. self - evident that a national doverriment that spent Similar factors are probably at work in other in- "$36 billion in farm subsidies in less than a decade stances where questioxmaire evidence conflicts -,with to rid itself of the effects of abundance." (3) must data from observation. do better than the current annual rate of little more We should perhaps remind ourselves thatpro- than $1 billion expended on food stamp programs, viding nutrients to infants and young children is plus the other equally minimal forms of nutritional an aspect of social behavior that is rather imme- assistance now available to the poor. Equally open diately rooted in basic material, biological, and hu- to question are the policies of State governments mann Here wa. are evidently dealing with an which reduce welfare benefits every year or two. elementspanluaman capacity for survival which, For example, _in New York, in the spring of 1911 in its finis, is relatively little influenced by the legislature cut the assistance received by over dill cultural styles, standards, values, and one and a quarter million persons to a level 10 the e. We have impressive evidence that the percent below the federally certified need, provok- most diverie and even very poor human groups ing a few specialists in pediatrics andAutrition to maintain reasonably adequate feeding practices. forecast "weaker diets" and "mandated malnu- Moreover this is done largely without benefit of trition" (New York Times, 29 Apra 1971). specialized nutritional lonowledge or expert die- Beyond such specifics we must begin to deal with tary education. somewhat more basic issues. We must acknowledge The major failures and unresolved problems'tag fact that some of the Most nutritionally de- lie rather in the socioeconomic system which dis- prived groups in our population are the dispol- tributes necessary material resources. We therefore sessed heirs to the soil itselfnative Americans suggest that this workshop consider a reordering as well as many of the people whose labor coaxes of priorities for those concerned professionally such an abundance of produce from the same With infant and child nutrition. Specifically, we groundmigrant farm Yorkers, sharecropper-a, propOse that cataloguing, evaluating, and influ- and tenant farmers. Ultimately all of us who claim encing the indigenous or traditional feeding pat- a knowledgeable interest in the basic problems of terns of poor people be reassigned to a secondary human sustenance must face the implication that priority. The primary application of nutritional the social system which manages the allocation and expertise should rather be to interrelations be- distribution of the necessary material resources is tween diet and the larger socioeconomic system. In fundamentally unjust. To) understand and to particular, nutritionists should study and act upon change this systemnot the feeding customs of the the dietary effects of commercial institutions, gov- poor -- should be our priority concern.

65 Table 1.Personal and social characteristics of individuals observtd

Birth weight, Present weight Pretent age Resides with Regional origin Subject 5'o,1 (in months) (lbs.) (ozs.) (tbs.) (ozs.) Parents 'Grandparents Parents Grandparents

. .

A F 8 8 15 10 3 X X North South B-1 F 5 12 - ,:"11 10 4 X North - North 8-2 F 6 8 '--13 1315 4 X North North

C F 6 10 13 .. 12l 4 X North . South D . F 8 9 15 1054 6 X North South L. ,. F . 5 134 19 10 8 X Honduras Honduras

F M 8 2 21 -93. , . 8 'A North North .G...... ___ M 5.4 11 21 13 9 X X North , South __. H. M. 7 0 23 5. 10 X North North i F `6 0. 21 - 3;4 11 X X. Stiuth . North' J F 6 7 14 lc' North North K F 7 8 15 X South . South L M 9 4 19 X N orAh North M F 8 13 20 X South South n F 6 9 20 .X X North South 0. . F 6 1315___, 20 X South South .P. F 7 10 23 X North South Q F 9 15 25:.. *X North' . South .-I cf R F 5 7 26 X Sbuth South S F 9 10 30 X South South

T-able 2.Dietary histories of individuals observed

Milk or forniuta Subject Demand or schedule reeding Age at change Initial' Present

5,.., A Schedule Carnation 1:1:2T I 'Homogenized milk 3 months e-r Demand.' ' Carnation 1 :1:2T Carnation .1:1:2T . Undetermined

8-2 Demand . Carnation 1:1:2T. Carnation 1:1:2T Undetermined C Schedule-demand SMA formula Homogenized milk 1 month D_ Schedule Carnation 1:1:2T.... Homoginized milk 3 months E...... , Schedule-demand Similac ; Slmilac-Iron. 3 months F Schedule' Carnation 1:1:1T Homogenized milk 3 months G Demand SimIlac Carnation 3:5 6 months H_ ,Schedule-demand Similac Carnation 1:1:2T 5 months . 1 - Demand- Similac Homogenized milk 4 months Schedule-demand Similac Homogenized milk 4 months K demand Enfarftil - Carnation 1:1:2T 11,5 months 'Demand Enfamil Carnation 1:1:2T . 3 weeks Schedulet Enfamil Homogenized milk 6 months N Demand Sim ilac-iron Homogenized milk 4 months

0 Demand Enfamil Carnation 1:1:2T . 6 monthS Demand Carnation 1:1:2T Homogenized milk 7 months Q Demand Similac Carnation 4:6:1T I month R Demand Enfamil. Homogenized milk 4'mo nthS S. Demand ShillIC Homogenized milk \ 3 monthS

z carnation formal' reported in terms of the milk-to-water ratio and-the added sugar or syrup.

,66 Table 2.-Dietary histories of individuals observed-Continued

Age (in weeks) at od4ition to diet ltamins Subject Cereal fruit Meat and Table food Ever taken_, Presently taken vegetablei

A 4 4 4 Polyvisol Polyvisol 6-1 4 4...... _ Trivisol Trivisol ,Trivisol 8-2_ 1 4 4 Ttiviscil 8 Pglyvisol Polyvisol 0. 1 3 0 '6 8 8 Trivisol Trivisol E. 6 6 6 Trivisol Tricisol Until 3 months F 1 4 8 Trivisol Trivisol and Ferinsol G -._ 6 6 6 Trivisol Polyvisol H ,2 2 5 Trivisol Polyvisol I 1 1 8 16 2Polyvisgl J 1 1 a 28 Polyvis I Polyvisol Until 6 months K 1 4 4 32 Triviso Polyvisol I. I 4 12 Trivis 1-A-Day M 1 I 1 30- Viper! e N 1 I i 8 16 Trivipol Trivisol Until 18 mouths 0 ...... 4 4 6 Vipenta Until 13 months P 8 16' 16 20, Polyvisol Polyvisol Polyvisol Q 8 12 i 12. 32 Until 15 months R 1 8 / 8 8 Pelyvisol Polyvisol s._ 4 4/ .4 24 Polyvisol

Table 3.-Comparisons of -daily food s and Recom- Table 4.-Det iled 1-day food intake of individuals mended Dietary Allowances observed-Continued

Food Food energy (kcal.) Protein (gm.) On (mg.) Su biect energyProtein Iron Subject . Observed RDA Observed RDA Observed RDA 1332-1 (kcal.) (gm) (rag.) oz. Cs rnationforL'ula(1:1:2T Karo) 834 35.20 2.56 A 736 770 26.43 14.0 ,.15.32 10 6% oz. Beech- NuL areal, egg yolks and bacon 177 5. 24 1.19 B -f 1, 058 600 40.73 11.01 196 10 2 t Beech-Nut vetable soup (strained) 4 .11 .04 8-2 952 .660 35.85 12.11 3.40 10 2% oz. Beech-Nut pears (strained)... 43 .18 .17 C 950 660 ^ 26.52 12.01 en 10 664 770 22.14 14.0r 17.14 15' 1, 058;'40.73 3, 96 E 918 800 20.44 14: 12.74 15 _ 13-2 743 1, 000 - 28.58 18. 3.13 15 -30 oz. Carnatio formula (1:1:2T Karo) 782 33.00 2. 40 739 1, MO:, 29.51 18.01 1.80 15 2% oz. Beech- ut cereal, egg yolks and bacon. 59 1.75 .43 I, 213 I, 000 :. 49.12 18.11 2.76 15 o 2% oz. Beech Nut vegetable soup (strained) 25 _74 .26 832 1,800 36.86 18.00 6.53 14 ,4% oz.°Beech Nut pears (strained). 86 .36 .34 094 1,100 51.36' 25.00 7.91 115 K I, 222 I, 100 59' 89 25.00 10.02 _15 952 35.85 3.40 1, 442 60.01 25.00 9.07 15 1100 C ' 1, 808 1,100 91.77 25.00 1166 15 18 or horn nized milk 362 20.25 . 23 I, 412 1, 100 62.02 25.00 7.46 15 4% oz. Bee h-Nut turkey and rice with vegetables_.., 59 1.75 . 37 0 373 1,100 14.:18 25.00 .55 15 4% oz. Be ch-Nut apple betty (strained)..... 156 .43 .32 P- 1, 254 1,100 50.75 25.00 7.11 15 4 oz. Beec -Nut mixed fruit Juice (strained) 69 .26 . 79 1, 545 1, 250 81.55 25.00 7.33 15 Q I Cup coo ed Farina 140 3.80 2. OD 1,373 1.250 63.54 25.00 .85 15 2 t butter 72 .03 . s 983 1, 250 36.94 25.00 48 15 2Tsuga, 92 . 01 Minimum daily requirement for infants more than 1 year of age is7'15mg. 950 26.52 3.72 Table 4.- Detailed 1-day ;food intake of.IndiAduals. 181 10.13 .11 observed . 9 nz- ogenized milk 7% oxeach -Nut creamed cottage cheese with pineapple (Junr) 184 6_07 1.42 Food A .19 .25 Subject erisrgrP: otein Iron oz 13eechNut apricots (strainziro)- 56 1.36 8 oz.eech-Nut orange juice (strained) 135 1.13 Neu Beech.Nut oatmeal cereal (dry) I08 4;62- _ 14.00 (kcal.), :(1111.) (In-) A 664 22.14 17.14 17 oz. Carnation formula (1:1:2T sugar) 429 18.7if 0.26 94 3.12 .55 4)% oz. Beech-Nut macaroni (strained) 1 ginger snap 17 - .20 .10 108 ,13 .51 4% oz. Beech-Nut applesauce (strained) 24 z. Similec with Iron 480 12.25 8.57 35 cup Beech-Nut mixed cereal (dry) 105 4.48 1 00 3 oz. Beech-Nut vegetables and liver with rice and parley au nior) 44 2.88 1.67 736 26.43 1 1 32 3% oz. Bauch-Nut sweetpotatoes (junior) 72 .77 .39 .57 See footnotes at end of table. cup mashed potato and cotutrds. 62 Z 50

67 Tabl 4.-Detailed 1-day food intake of individuals Tabl),.., a.II.t.tailed 1-day Food intake of individuals observed-Continued obsorvedConthyted

Food Food Subject energyProtein Iron Stlbject (nervyProtein Iron

(kcal.) (gm.) (mg.) (kcal) (gin.) (mg.). 3 oz. Beech-Nut bananas (strained) 77 .26 .26 K 4% oz. Beech-Nut peaches (strained) 112 .98 1.01 26 oz. homogenized milk 523 29.25 .33 3 Nabisco vanilla wafers 54. .60 .04 1 slice spiced ham lunch meat 81 4.60 .40 1 fried chicken wing 54 6.85 .55 918 20.44 12.74 %cup soup-made with- F 2 lb. 1 oz. can tomatoes 16 oz. homogenized milk 322 18. 00 .20 i lb. 1 oz. can okra 434 oz. Beech-Nut vegetables and lamb with rice and 1 lb. 1 oz. can corn barley (strained). 69 2.66 .47 2 cups cooked rice.. 43 1.57 .53 4joz. Beech-Nut chicken noodle dinner (strained) 53 1.98 .56 1 slice enriched white bread 62 2.00 .60 4H oz. Beech-Nut chicken soup (strained) 51 2.35 .35 Hcominercial waffle (enriched) 104 3.50 .65 2X oz. Beech-Nut garden vegetables (strained) 27 L 52 .39 13.4 cup spaghetti In tomato sauce 179 7.00 2.40 434 oz. Beech-Nut squash in butter sauce 54 .90' L 64 34 cup Beech-Nut oatmeal cereal (dry) 108 4.62 14.00 4,14; oz, Beech-Nut applesauce and cranberries (strained). 127' .27 .40 1 t Imitation maple syrup 19 .26 3.5Seabiscult cracker 37. .90 .12 1 T Bosco 49 .50 3.30

743 28. 58 3.13 1,222 59.89 10.02 I. 24 oz. Carnation formula (3:5) 423 21.50 .30 11/2 cup cooked spaghetr 249 7:65 2.10 56 .55 3 t scrambled egg. 3.65 22 oz. milk (Carnation skim dry mix) 242 24.20 65 5 T potato mashed in beef gravy* 1.90 .50 21/2 oz. meat (governmint surplus)#i 208 9.88 .87 3 t applesauce 45. .10 ..25 11/2 scrambled eggs 168 10.90 1.65 2 saltine crackers 28 -58 1 cup cooked canned tomatoes 52 2.60 1.20 2 Oreo cookies 80 1.18 11/2 cups applesauce 364 .80 2:00 1 solid chocolate egg (marble size) 42 .60 .20 3 fresh cooked onion 15 .60 .20 34 cup Cream of Wheat 93 1 38 1.u5 739 29.51 1. 80 1 "i" sugar 46 H 29 oz. homogenized milk 583 32.63 .36 1,442 60.01 9.07 . -5 oz. Gerber's la.agne dinner with sauce and ham" M (junior) 86 3.70 .70 14 oz. homogenized milk 281 15.75 .18 1 cup mashed potatoes 188 4.20 .8o 1 slice fried bacon 43 1.80 .20 34 cup frozen broccoli 26 2.90 .70 I t peanut butter 33 1.70 .13 7.34 oz. Beech-Nut peach melba (juniar)te 204 3.50 .20 1 fried chicken breast 232 26.80 1.30 3 soda crackers 90 2.19 - 12 cocktail peanuts... 77 2.65 .20 1 t butter 36 % cup speckled beans* cooked with smoked pork neck bones 523 34.35 9.80 1, 213 19.12 2.76 1 medium apple 87 .30 .50 131/2 oz. canned sweetened orar.ge juice 208 2.80 1.60 13 oz. homogenized milk 262 14.63 .16 1/2 cup Cheerios 51 1.70 .55 434 oz. Gerber's vegetables and beef (strained)' 80 3.30 1.36 1 oatmeal - coconut cookie (small) 86 1.32 1 t peanut butter 38 1.70 .13 1/2 cup boiled rice 80 1.60 .60 2 oz. pork roast.. 116 12.20 1.80 1 slice enriched white bread 62 2.00 .60 34 cup collards mashed with potato 31 1.25 .35 1 t grape jelly. 18 4 t Beecii-Nut mixed cereal with fruit 43 .62 .90 1 t sugai 15 434 oz. Deech-Nut applesauce (strained)" 108 .13 :51 434 oz. Gerber's orange juice 71 .60 .72 1,806 91.77 )5.i6 1 arrowroot cookie 21 .43 1 slice enriched white bread 62 2.00 .60 N 17 oz. homogenized milk 342 19, 13 .21 832 36.86 6.53 2 oz. undiluted evaporated Carnation milk 68 3.50 .05 4 slices bologna 266 17.80 2.60 .1 73 9.00 24 oz. homogenized Milk 483 27.00 .30 Stew beef (1z1z1/2 inch) L40 1 fried Thicken wing 54 6.85 .55 1 cup boiled potato in beef gravy' 118 3.15 .90 Stew beef (approx. 1 inch square) 73 9.18 1.40 2 T Farina, cooked 14 . 38 .20 2)4 slices enriched white bread 155 5.00 L 50 1 cup Cheerio 102 3.40. 1.10 1 oz. barbecue potato chips 165 1.65 .60 T fried potatoes and onions 46 .68 .18 160 2.36 34 cup peas and carrots 24 5,05. .58 4 Oreo cookies X cup boiled potato with beef gravy' 65 L90 .50 1 t grape jelly 18 33 . 05 4 Dipsy Doodle chips ' 50 ma. n.a. 1 t mayonnaise 4 marshmallows 100 .80 2 t sugar 30 1, 412 62.02 7.46 1 T Bosco 49 .50 3.30 0 3e5 t margarine 10 12 oz. Carnation formula (1:1) 260 13.20 .18 2 T Beech-Nut pears (strained) 21 .09 .09 1,094 51.36 7.91 1 t Beech-Nut lasagne dinner (junior) 3 .09 a .03 See footnotes at end of table. 1 t margarine 36

68 Table 4.-Detailed 1-day foodintake of individuals References observed-Continued 1. R. L. Hurley, Poverty and Mental Retardation, a Caus- al Relationship (New York : Random House, 1969). Food Subject \ energyPrctein Iron 2. H. G. Birch and J. D. Gussow, Disadvantaged Chil- dren: Health, Nutrition, and School Failure (New (kcal.) (gm.) (mg.) York : Harcourt, Brace and World, 1970). 56 cup Kellogg's Rice Krispics 53 .80 .25 3. B. F. Hollings, "Feeble Bodies, Stunted Minds : The 373 14.18 .55 Reality of American Hunger," The Nation 212: 17: P (1911) : 518. M cup undiluted Carnation evaporated milk 137 7.00 .10 4. T. I. Stone, D. C. Leighton, and A. H. Leighton, "Pov- 359 oz. fried porgy fish 279 22.70 1.50 1 cup Campbell's chicken with rice soup 32 2.90 .30 erty and the Individual," in Poverty Amid Affluence; 8 oz. glass Tang 110 1.40 .50 edited by Leo Fishman (New Haven: Yale Univer- 1 cup cooked Quaker Oats oatmeal 148 5. 40 . 1.70 sity Press, 1966). 1 oz. potato chips 165 1.65 , .60 5. St. Clair Drake, ."The Social and Economic Status of 1 cup Beefaroni (macsroni with beef in tomato sauce) 153 7.50 1.90 34 egg & onion matzo 34 1.00 .10 the Negro in the United States," in The Negro 2 T sugar . 01 American, edited by T. Parsons and K. B. Clark 2 chocolate chip cookies (small). 104 1.20 .40 (Boston : Hougtion 1986). 8. Citizens' Board of Inquiry into Hunger and Malnu- 1,254 50.75 7.11

Q trition in the tnitcd. States, hunger USA 19118 14 oz. homogenized milk 281 15.75 .18 (Washington : New Community Press, 1968). 2 oz. slice corned beef hash ,.60 7.10 1.20 7. Southern Regional Council, "Hungry Children," a 1M scrambled egg 168 10.90 1.65 Special Report, Atlanta, 1967. -359 oz. veal 298 29. GO 3.80 2 T peanut butter 230 10.40 .80 8. Senate Subcommittee on Employment, Manpower, and 34 cup cooked spinach 22 2.40 2.30 Poverty, Labor and Public Welfare Committee, 34cup mashed potatoes 94 2. 10 .40 Hunger' and Malnutrition in America: Hearings 4 oz. orange juice 52 .70 .40 Before the Subcommittee on Nutrition and Human 2 T Bosco 98 1.00 6.60 54 cup Jell° 65. 1.60 Needs (Washington :U.S. Government Printing 1 t margarine 36 Office, 1987). 1 oz. Cheese Doodles 141 n.a. n.a. 9. Select Committee on Nutrition and Human Needs,

1,545 81.55 17.33 United States Senate, Nutrition and Human Needs: Hearings Before the Committee (Washington : U.S. 16 oz, homogenized milk 322.18.00 .20 Government Printing Office, 1969). 3 small pork sausages 282,10. 50 1.20 J.O. R. E. Frisch,' Present Status, of the Supposition .That 1 slice liverwurst 795..00 1.60 1 slice minced ham 81 4.60 .40 Malnutrition Causes Permanent Mental Retarda- 1 oz. chuck roast 94 12.80 1.90 tion," Amer. J. Clin. Nutr. 23 (1970) : 189. 34 cup boiled rice 80 1.60 .60 11. C.'A.Valentine and B. L. Valentine, "Making the 34 cup pea beans and rice. 167 7.50 1.60 Scene, Digging the Action, and Telling It Like. It. 5 T potato salad++ 111 2.55 .35 3 Ritz crackers 51 .99 Is," in Afro-American Anthropology: Contemporary 34cupginger Me 40 Perspectives, edited by N. E. Whitten and J. F. 4 pieces of candy (Dots) 66 Szwed (New York: Free Press, 1979). 2 t strawberry flavor PDQ milk flavoring ma. ma. n.a. "Blackston: Progress Report on a Community 1,373 63.54 7.85 Study in Urban Afro-America," mimeographed,. 1970: 6 oz. homogenized milk 121 6.75 .08 "What the Anthropologist. Does : Case Study 19 cup Campbell's pork and beans 110 5.54 1.64 of Research in a Complex Society," in Anthropology 2 T peanut butter 230 10.40 .80 1 Neil chicken wing 54 6. 85 .55 , Today: An Introduction (Del Mar, Calif.: CRM 1 cup unenriched cooked rice 160 3.20 .1.20 Books, 1971). 2 slices enriched white bread 126 4.20 1.20 "Deficit, Difference, and Bicultural Models of 1 t jelly 18 Afro-American Behavior," Harvard Educational 2 t margarine 72

4 2 T sugar 92 .01 Review 47. (1971) :137 -157. 12. C. T. Church andH.N. Church, Food Values of Por- tares Commonly Used; 10th ed. (Philadelphia: J. B.. Lippincott Co., 1986). Figures for gravY not available. 13. Nuiritive Values and Ingredients of Beech-Nut Baby **Product values not available. Figures based on Gerber's macaroni with tomatoes, beef and bacon. Foods, 'Beech-Nut Baby Foods, Inc., New York, #Product values not available. Figures based on custard pudding. #4110 ingredients listed. Figures based on "Treet" 1989. +Calculation based on calico beans. 14. L. F. Cooper et al., Nutrition in Health. and Disease, -Hi-Calculation based on macaroni salad. n.a.-not available. 1 14th ed. (Philadelphia : X. B. Lippincott Co., 1983).

149-725-72---6 69 15. R K. Watt and A. L. Merrill, Composition of Foods, 23. G. M. Owen et al., "Nutrition Survey of White Moun- Agriculture Handbook No. 8, rev. Agricultural Re- tain Apache Preschool Children,"inNutrition, search Service, U.S.D.A. (Washington, 1963). Growth. and Development of North American In- 16. Food and Nutrition Board, Recommended Dietary j.if4/1,Children, edited by W. M. Moore, M. Silver- Allowances, 7th ed., National Academy of Sciences bvrg, and M.-S. Read, USPHSDREW (Washing- Publication No. 1694 (Washington, 1968). : U.S./Government Printing Office, 1972). 17. D. F. Miller and L. Veris, "Chronologic Changes in the Recommended Dietary Allowances," J. Amer. Diet. Assoc. 54 (1969) :109. 18. B. Spook, Baby and Child Care (New York: Pocket Books, 1957). .Acknowledgments 19. W. E. Homan, Child Sense:4 Pediatrician'S Guide for Today's Families, (New York: Basic Books, 1969). Our research in Blackston is supported I); flier- 20. Committee on Nutrition, American Acadeazy of Pedi- National 2cience Foundation. Thomas A. Ander- atrics, "Iron Balance and Requirements in Infancy," son (1970) is, responsible for stimulating us to Pediatrics 43 (1969) : 134. make the observations of dietary beluivi4 reported 21. T. A. Anderson, a personal communication, 1970. 22. G. M. Owen et al., "Nutritional Status of Mississippi here by inviting us to contribute to this Work-. Preschool Children." A Pilot Study, Amer. J. Olin. shop. We are also grateful to nutritionists S. Lurie Nair. 22 ,(1969) and I. Ibanez for helpful comments.

70 Discussion

Miss Mary Lynch: How are dietary patterns in Miss Catherine Cowell: How do you explain Blackston influenced by cultural patterns? What the fact that drinking fluids other than milk were k- has been the effect of migration from the South not reported? to the North ? Mrs. Valentine: We did our survey in the Mrs. 'Valentine: Our impression is that among winter months, and- the patterns do change sea- Alto-Americans from all parts of the United sonally, Fool -Aid, 'popsicies and soda pop are Statei,--foedpreferences in general are derived mainly sumed in warmer weather. You will from a regional pattern that is rooted in the ecology note fr our table, however, that some Kool- and social structure of the South and share.d_by_Aid was used even during the winter. both blacks and whites at. the lower socioeconomicDriVirginia H. Young: The concept of "cul- levels. This dietary pattern is not highly distinc- tural deprivation" has been: seized upon by the tive in the foods given to infants and younger education establishment to explaiii1Wfailure_of children, though it becomes mere. "different from the poor in school programs that are presented in national, middle class preferences as items of the the social, linguistic and value structure of the adult's diet are introduced with advancing age. middle class. It is therefore highly significant that The main`results of moving North are a greaear the research of Jerome, Kiser and West and of the range of commercially available items and some Valentines portrays poor families feeding their improvement in financial resources. These changes children adequately, caring for them with concern, are generally _greater for whites than for blacks. possessing ideals and goals for them, and bringing Afro-Americans, in the North at least, appear to them up in a tradition of utilizing the productiv- have participated in major national trendS, such ity of the woods and the backyard plot. When we as the general abandonment of breast feeding. see the,poor in this image, wo have to acknowledge Dr. Myrtle Brown: In our experience, also, that there seems to be no generic failure of intel- ethnic customs really have very little effect on the lect, morals, health, energy or habits. diets of infants. They begin have an influence I wonder how the Valentines would account for somewhere after 1 year of age. the high nutritional standards of Blackstonians. Miss Helen G. Olson : Are ,any of the fond Do these result frOni good public health services, assistance programs of theepartment of Agri- from general public education or from other culture operating in the area in which, your ob- factors? servations were made? Are the families eligible Mrs. Valentine: Certainly the answer is not and do they participate? in either of the two possibilities you suggest. Mrs. Valentine : When We first came to the area, Health institutions in Blackston dramatically il- there was a commodity program, and at that time lustrate the inadequacies 'of quantity and quality most of the people in this sample did receive generally found in the major public servicespf commodity foods. They seemed to use these low-income Afr6-AMerican communities. ; There selectively.. are a. few exceptions to this dismal picture in the Dr. Charles F. Whitten: Would yeu comment form of special- prograine of limited size, such is on the manner in which you selected these 15 families ? I was surprised that mOstof the mothers a federally funded comprehensive child care pro- attended well-baby clinics so regularly. gram at a local hospital. Parents and children alike Mrs. Valentine: We were living in the acom- have also been confined to inferior, segregated, and munity we were studying. We listed everyone discriminatory education. The principal expert within several blocks who had children under the guidance in infant and child feeding they receive age of 3. We then started at the top. of the list and is advice' from well-baby clinics. As already noted, 'tried to contact all of them. this advicejs evaluated and accepted selectively. 71 e believe the feeding practices that we observed average income about $3,000 per year. Weekly rent reflect the families' great interest in the welfare is generally between $1S and $21. of the very young, high valuation of food as a Ninety-eight percent of the families residing in source of health and growth, flexible household the community receive some form of Government and kin group patterns that are well-adapted to assistance. Only about 30 percent of the families supporting and caring for dependents, and prag- buy food stamps. matic use of common sense and general public We work with the families in the areas of thera- knowledge. These patterns appear to be adapta- peutic nutrition (e.g., overweight, underweight, tions to the historical and continuing problems of iron-deficiency anemia) and preventive nutrition, survival' underconditionsofsocioeconomic including nutrition education. Our activities take adversity: us into the homes of the families and provide op- Blackstonians generally manage to feed and care portunities for observing them and for offering for their youngest offspring adequately in spite practical advice. of severe individual and family problems com- The majority of the adults speak little English. monly associated with poverty. In the sample we Many are illiterate and they generally lack knowl- have reported, all families live in more or less edge of nutrition. They commonly live, in over- substandard and overcrowded housing, most crowded apartments, and many of these are in- households have had to cope with an absence of fested by rats and roaches. The sanitary facilities fathers from time to time, a number include un- do not function properly. Oil is used for heating, married teenage mothers with their 'c sev- but heater's are frequently out . of order.. Very eral families have one or more heroin addicts young children are given the burden of care and among their members, and the majority consume -1sponsibility for their younger siblings. sizeable quantities of alcohol. Indeed these prob- The Catholic faitli is practiced by the Spanish- lems are an important part of the context .within speaking members of the Spring Garden Commu- which early child care customs function. These nity, but at the same tiros they practice spiritual- factstogether with our observations of social ism and believe in fortune-telling. Common-law service 'and public. health institutions in Black- marriage is common. It is impOrtant to a family stonpersuade us that such agencies have little to use the father's name, even though he is not the to teach Afro-Ainericans about the art of survival legal father..There is a strong tendency for rela-. under conditions of inequality. Rather, what is tives to liVe close to one another. .needed to improve levels of nutritionand: of Even after they have lived in this country for health in generalis a change ithe structure and several years, their old food patterns persist. The operations of all relevant institutions in the clieec7 main dibhes are rice, beans, starchy vegetables and tion of socioeconomic equalitY. roots, codfish and coffee. 'Children eat these foods Mrs. Virgilnia C. Janch, Session Chairman: from infancy. The frequent concern that I hear Let us' now hear,something from Mrs. Alvarez expressed about toddlers drinking coffee is mis- about the Puerto Rican community in Philadel- placed. "Our. "coffee" is milk with just a litZfe cof- phia; and something from Mrs. Wilcox about loW- fee added 'for flavor. Recipes are usually prepared income ,Cubans in Dade County, Fla. I shall then on the advice of the grandmother or eldest neigh- report. some of, our observations of low-inconie bor. Tomatoes and raw carrots are considered ra.la groups in Chicago, bit food and are avoided. Milk is not served with Mrs. Elsa, Alvarez: The Children and Youth citrus fruits or juices. Fish is considered poisonous program,AmbulatoryOut-PatientPediatric in winter, Meat is usually fried and served daily if the food Clinic of the Ilahnemami Medical College and!,budget permits. Chicken, pork or the cheapest Hospital, Philadelphia, has an enrollment of 3,714 grades and cuts of beef are most commonly pur- families with 4,7\13 children ranging in age from chased. Codfish is very often used. '3 weeks to 14 years, These families are 61 percent Breakfast usually consists of coffee, with or Spanish-speaking (Mainly Puerto Rican), 30-per- without milk, and Spanish crackers. Lunch is cent Negro' es, and 6 Percent Anglos, all living in likely to be codfish with a starchy vegetable and what is known as "The \Spring Garden Comum7 soda, and supper is rice and beans with soda. pity," a poverty area located in Center City. The Using data from analyses of foods by various average number of children per family is six, and laboratories in Puerto Rico, Mrs. Rosa Marina 72 Torres from Puerto Rico University has compiled meat and rice; lower income Cubans tend to eat tables of tropical foods. We have found these larger quantities of meat than do Puerto Ricans or tables, together with USDA Handbook No. 8, other cultural groups of similar income status. A "Composition of Foods," most useful in calculating typical shopping list starts with meat, rice, season- nutritional values of foods consumed by the ing (green pepper, onion, garlic), lard, beans, cof- Puerto Rican community in Philadelphia. fee, milk, bread, potatoes, malanga or plantains. When a baby is born he is given Similac while Mrs. Marjorie .Amable, public health nurse, and in the hospital. As soon ag the mother brings the Mrs. Levina S. Phillips, nutrition consultant, both baby home, she feeds' evaporated or regular milk, of the Dade County Department of Public Health, using half milk and half water. The water is sel- have provided the follov ing information about, dom boiled, and sterilization methods are not prac- foods commonly used by Cubans in Miami: As in ticed. Breast feeding is practiced by only 3 percent Cuba, the day starts with cafe con leche (5 parts of mothers. The mothers that do breast feed are milk to 1 part of strong coffee with added sugar) usually recent arrivals from Puerto Rico. and Cuban bread, with or without butter or mar- Commercially prepared strained foods are used garine. Whereas in Cuba these families would alternately with home prepared food, depending have large meals at noon and in the evening, work upon the finances. patterns in Miami dictate one large evening meal. Bottles are given the baby on a demand basis. At For main dishes they use a sofrito of onion, green about 3 weeks of age, cereal is added to the milk pepper;bay leaf, garlic, cumin, oregano, salt and in the bottle. Fruit, fruit juices (especially orange pepper and sometimes tomato sauce. Ham butts, juice) and egg yolk are introduced when the baby salt pork, and chorizo (Spanish sausage) are used is 2 or 3 Months of age. Ripe bananas or egg yolk in manyrecipes..Rke is often seasoned with saf- may be mixed. with milk in the bottle. Home-made fron. Lard and oil are used in large quantities; soups may be strained and fed to the infant at age many foods are fried. Sugar is used abundantly. 2 or 3 months. Nutritional health and body fat are considered As the child grows, commercially prepared baby synonymous. Fat babies are considered healthy foods are eliminated from the diet and soda be- and "sunny" children- are considered ill. Special comes a major beverage. Cornm,;a1 may be given to cooking -is done extensively for the babies and small childfen during the afternoon as a snack but young children. Many starchy foods are cooked, otherwise cerealsare rarely fed after 1 year of age. mashed or blended for the young. Strained baby Bottle feeding' may be. continued until the child vegetables and fruits are purchased for both is 6 years old.. babies and young children. Mrs. Mary Ellen Wilcox: Cuban families in Milk is well accepted and-often fed to infants Miami are" argely concentrated in a central urban .and small children in large amounts. Sugar and section. Local grocery stores and meat Markets vanilla or chocolate are often added.. Adults use

.cater to their buying patterns, and many of the limited amounts, mostly at breakfast, in their cafe familiar foods are grOwn or processed locally. con leche. Condensed milk is widely nsed. Cheese

. Cuban mothers tent,o be permissive about food is used as a snack or in sandwiches. and eating habits. By North American standards, Beef, cMcken, pork and fish are especially liked. weaning from the bottle is delayed, and table foods Palomilla steak, made from cheaper cuts of beef . areintroduced later than in. black farrillies. These and think sliced, is pUrchased in local markets, mothers attempt to feed their 'children as well as marinated in Sour orange juice, garlic, salt and income allows but health is "by the pound"; they. pepper, then pounded and pan fried. It is served prize plump babies. Many Cuban mothers seen in with chopped onions. the C & Y clinics areunclidy concerned over "poor Ground beef is used extensively. Dried beef and appetites" of apparently well children. The ma- fish (especially dried codfish) are well liked but jority of. overweight children seen at C & Y pro- because of cost are not used to the same extent as jeet No. 636 during 1968 and 1969 were of Cuban in Cuba. Black beans, chick peas or garbanzos, red origin. beans, and some white beans are served with,rice. The Cuban people are particularly conscious not Beans and rice (moros) are served with the meat only of calories but also of protein. Meat imised course. Dried bean_ s are widely used, although not twice daily and is an important staple of the diet. as frequently as they were in Cuba. -Eggs are The first items bought at the grocery store are served with rice or meat dishes. 73 Rice is eaten in large quantities once or twice Each infant appears to establish his own rhythm daily. Potatoes are widely used, mostly prepared of eating at an early age, and the mother or other like french fries, but in thicker pieces, called caretaker responds to this pattern, Spanish cuts. Plantain, ripe or green, is usually The majority of our infants continue to receive fried. Boniato, a white sweet potato; calabaza, a the proprietary formulas after hospital discharge, yellow squash similar to a winter squash; and with only an occasional mother changing for eco- yucca, a variety of cassava, are usually boiled. nomic reasons to evaporated milk. The mothers Soups are made from meat, malanga, potato, cola- discontinue feeding of formula at about age 3 .to baza and carrots. Canned soups are rarely used. 4 months. At this time whole milk is given; some- Lettuce, tomatoes, radishes, and cucumbers are times sugar is added. The Blackston infants dc used in salads. scribed by. the Valentines appear to make the Bananas, oranges, orange juice, coconuts, and change from hospital formula to evaporated or canned fruits packed in heavy syruppeaches, whole milk somewhat later than do our infants. pears and fruit cocktailare favorites. Pineap-: Like the Blackston babies, the majority -of our ples, avocados, mangoes and grapes are, widely use babies are offered cereal at, age 1 week. The in season. - mothers say they are hUngry. Baby cereals are Cuban bread, a .white crusty bread similar to eaten daily until 6 to 8 months of age. Hot adult Italian bread, is commonly used. cereals are then fed; most frequently used are Sugar cane is pressed for the juice, whies grits, oatmeal, rice, and Cream of Wheat. Often, serves with ice--4-"guarapofrio."Carbo.,,;. sugar or salt and margarine are added to hot beverages are used moderately. Virtually all Cu-. cereals. Rice is often served with meat gravies. bans like ice cream. Flan, a caramelized; baked ,Fruits and the meat and vegetable combinations custard, is the national dessert. Cuban fariailies are introthiced at approximately 3-4 weeks of do not have dessert every day, and the low-income age. As was true in Blackston, -many infants con- group uses fewer desserts. tinue to eat some baby foods until 1. year of age. Mrs. Jauch: In. 1969, 85 percent of women Table foods are introduced early, usually by 3 registered in the, Chicago Maternal and Infant to 4 months of age, coincident with discontinuation Care projects were nonwhite, and 35 percent were of formula feeding-Our nurses have observed 3- receiving public assistance. Most of these people month -old infants being fed mashed potatoes, live in multifamily dwellings. Infant feeding mashed green beans, and greens. Margarine" or meat-flavored pot liquor is ofteu, added to these practices are similar to those reported, by .the vegetables. Dried beans, mashed and flavored with Valentinesearly introduction of strained foods, pot liquor, are sometimes fed. Vitamin supple- early introduction of table foods, and feeding ments provided by the clinics are well accepted. ondeanand. Breast feeding is rare.' Boltle feeding Custards may be fed at % to 3 months, soft pies may be continued' until 18 or 24 months of age. and pound cake at 5 to 7 months, ice cream 'cones Commercially prepared strained- foods are rarely as'early as 9 months. Other foods not uncommonly fed after 1 year of age. Jimior foods are seldom fed are potato chips, corn bread soaked in pot used. liquor, biscuits, soda ; gool-Ald and Coca-Cola.

74 Mexican-American low-income groups

Cultural determinants of food habits in children of Mexican descent in California*

Ohyllis B. Acosta School of Home Economics and School of Medical Sciences, University of Nevada, Reno, and Robert G. Aranda, University of California, San Diego

INTRODUCTION mestizos,poorly educated, Catholic, without any special skills. Burma. (2) points out that folklore, Persons with Spanish surnames comprise the tradition and custom played large roles in their largest minority group in Califernia-1,426,638 "lives, particularly since many of the elders were il- individuals or9.1percent of the State's popula- literate. The major difference between Mexican im- tion in. 1960. Many (80 percent) were born in the migration and that of other ethnic minorities in United States; 228,426 (16 percent) were born in this country is that the Mexicans can and do go Mexico (1). Mexico, which owned California over back and forth across the border, renewing cul- 100 years ago, has contributed to the population, ture, customs, tradition and folklore. culture and tradition of the State. There are four groups of Mexicans in,Califor- From the time that California became part'of .nia in various stages of acculturation: middle- the United States until about 1930, transit be- class Mexican-Americans, 'frequently descended tween the Unitiid States and Mexico was =re- from many generations, born in California and stricted. With decline of the economic situation in exhibiting many characteristics of the dominant the United States in the lath 1920's and early 1980'S middle-class culture; the second - and third-gene- the stream of migration slowed. However, since ration ,Mexican-Americans at various stages of 1910, there has been an increase in migration, both acculturation, but- still' clinging to some of the legal and illegal '(2). Thus, the "3/1eicican" may customs, culture and traditions of their parents be native to the area and be. Mexican-AmeriCan;- and grandparents; fastgenerationor Mexican na- . or, aMexican national, he may have entered legally tionals who are well versed in all the traditions; (bracero or '!green card" holder) or illegally (wet- cultures and customs of Mexico, holding tena- back) to workOr live. ciously to these beliefs,and practices while speak- While these immigrants varied widely in cul- ing nostalgically of returning home; migrant ture, leVel of literacy, religion, language, 'racial farmworkers who may be drawn from any of the stock and experience, mostly they were peons and three mentioned groups, but for reasons of con-,

. . start travel, low income, and extremely low edu-. *The data relative.t6 San sYsidro, Calif.; were obtained through support received under a memorandum of agree- tiOnal level, are less likely than 'the other groups ment between Boa Angeles Children's Hospital and Colum- to acculturate to dominant middle -class customs. bus Children's Hospital Reseirch Foundation (Grant 31- Families in California with Spanis-hsurnames 170, Maternal and Child Health Service, U.S. Dept of tend to be larger than other white and nonwhite' Health, Education, and Welfare) ; Grant 9854 from Office families. In 1960, almost one-fourth (24.1 percent) of Economic &mutt:tatty ;- and funds from the Associated Student Body of the University of California, San Diego. of such families were comprised of six or more

75 persons. Among nonwhite families 18.6 percent have no significant scientific value and should had six or more persons, and among white fami- be left alone;(3)unclassifiable practices which should also be left alone pending lies in general, only 10 percent had six or more. In further observation and consideration; (4) addition, families with Spanish surnames include harmful practices which require alteration, a predominance of young people, with 70.4 percent but alteration in a way that will permit the under 35 years of age. Individuals under 15 years essence of culturally accepted practice to be of age made up 38.6 percent of this ethnic minority retained. group. The most important single set of ideas governing In 1960, the educational,level was below that of food-related behavior in Latin America is a folk the white and nonwhite population; more than manifestation of Greek humoral pathology, Modi- half of the men with Spanish surnames and almost fied and developed in the Arab world, diffused to half of the women over 14 years of age had com- Spain, and transmitted to Spanish-America at the pleted less than 8 years of school (1). This low time of the conquest- (7). As indicated by Clark, level of educational attainment results in part from (8)these ideas have been transmitted to the the fact that school attendance-in Mexico is com- United States in the migr4ory process. Foster pulsory for only 6 years and in part reflects a (7) briefly reviews these ideas 'follows: fitilure of the U.S. educational system to reach Foods, herbs, illnesses and bodily states many persons of Mexican descent. (such as sleeping and pregnancy) are char- The median income in 1959 of men with Spanish acterized by degrees of "hot" and "cold"; surnames was $3,849; nearly 20 percent of the sometimes actual temperature is involved, as families had annual incomes of less than $3,000. when a person becomes overheated by the sun Both the low educational achievement and the or wet from contact with cold water,but more often the putative degrees of heat and cold low-income status of families with Spanish sur- are innate characteristics, or properties, of names are germane to consideration of food habits, substances. "Hot" illnesses or bodily states since it has been shown that food habits are re- are treated with "cold" remedies. lated to the educational level of the mother (8) Clark (8) has listed""hot" and "cold" foods as and that individuals with low incomes generally dosignated by the people of Sal si Puedes, Santa have relatively low intakes of nutrients (4). Clara County, Calif. (Table 1). Thus, there are a number of reasons for evaluat- Food in Pregnancy,and Lactation.'Slanjur et al. ing habits and customs of families with Spanish (3) in theft study of a southwestern Mexican vil- surnames: many have immigrated from Mekico lage did not find that food was restricted during with attendant habits; .customs and culture ;' the pregnancy. This is in contrast to practices in families are commonly large with a predominance Peru, (9) where the mother consumes less meat,, of young persons; educational achievement of eggs, fresh fruit and vegetables, and among both mother and father is frequently low; in- Mexican-Americans in Sal si Puedes, (8) where eoMe4s frequently low.. a "hot" -food items are avoided during pregnancy. In Pedro Martinez (10) Experanza iiidioated that ATTITUDES TOWALU) FOOD "cold" foods were to be avoided even during the Burgess and bean (.6) have pointed out that, in menstrual period, whenever,it was economically Mexico, the-distribution of available food among possible to do so. In the immediate post partum members of the family is determined by the cut- period (40 days), "cold" foods are avoided in fural pattern, and food habits are preserved by Peru (9) and Mexico (3, 7) arid by Mexican- the -older Members of the family and perpetuated Americans in Sal si Puedes (8). in the younger members through attitudes to and Food in Infancy. Mexicangnfants in the past concepts of, health and disease, and through the have been breast-fed, frequently until 2 to 3 years transmission of traditional ideas regarding food of age (10, 11). Supplementary foods consisted values. Jelliffe and Bennett (6) have categorized of gruel (stole), usually made of corn flour or customary practices into fOur classifications ac- cassava, rice gruel, pumpkin, sweet potato, tortilla, cording to their public healtkvalue: bread, bean soup: and sometimes fruit. Meat and eggs were not given since they were thought to be (1)Benefleial practices which should be supported and adopted in local health teach- responsible for digestive disorders in "weazilings ing; (2) neutral practices which" appear to (1E). Patterns of infant feeding by Mexican-

75 American mothers in Sal si Puedes (8) were sim- cerning migrant farrnworkeis, in Hanford, King's ilar to those in Mexicoi.e., breast feeding was County, Calif. (16). practiced by about 40 percent with the idea that prolonged breast or bottle feeding years) was Southwest Mexico "good." Cereals were generally introduced at 3 Sanjur (3) assessed feeding patterns andwean- to 4 months of age and some fruits were introduced ing habits in a group of 125 infants ina village of at about 6 months of age. Thus, the quantity of 6,000 populatiOn, 65 miles southwest of Mexico solid foods given during the first year of life was City. Feeding patterns and weaning habitiwere usually small, at least so long as the child was correlated with mothers`' social characteristics and nursing or receiving formula.. other presumably related background factors. Jelliffe (13) points out that prestige foods and Diet. During Pregnancy and Lactation. itwas "physiological group foods," which are usually found that before delivery a pregnantwoman floes protein in nature, frequently bypass the pregnant not eat special foods to nourish herselfor thelaby. woman and young child, being reseved for elder Of 125 mothers, 90 percent indicatedno modifica- males in the community. These "cultural blocks" tion of their regular diet during this 'periOd. In may frequently limit or delay the introdUction of contrast, many foods were restricted during the available protein foods for young children. postpartum period and lactation.,; Foods 'inchas ' Food in 11 Inas. Villagers in Mexico know that vegetables, fruits, milk, eggs, and 'meatwere fre-' food is related to health and illness, but they tend quently excluded from the diet (Table 2). to see this relationship in a negative rather than As pointed out by Lewis 00),1 foodsare es- positive fashion. There is little recognition 'that a eludedor included in the diet during this period balanced diet promotes good health; rather, a per- based on their classificationas "hot"Or "cold ". son who enjoys good health can afford the luxury Food in Infancy. Breast feeding ofthe neonate Of eating what he wants or can afford. Because of was begun on the second day of, life in-22 percent these beliefs about the relationship of food to of the cases, on the third day in 49percent. This health, food- thought to be in conflict with body delay in feeding was attributed to two factors:14 equilibrhun during illness is withdrawn from the percent of the mothers considered colostrum unfit diet (7). for the child, while 38 percent of the Mothers Clark (8) has stated that in Sal si Puedes dietary stated that "milk does not come down" Until the regulation- is thought to be vital to good health third day. During the period of time before initia- and that many disorders are traced to imbalanced tion of breast feeding, herb teas, suchas -yerba intake of "hot" and "cold" foods or to inclusion in buena (spearmint), manzanilla, Cinnamon,ore.- the same meal of foods which are extreme oppo- gano, rose; de castilla, anise, lemon; and. orange, sites in heat and cold. Thus, folk concepts from leaves were given. These teas are considered to Mexico of disease are still important to Mexican- have medicinal effects and are recommended for. Americans; it, would appear -that many of \ these stomach ache (colico).. beliefs persist in the thinking of second- and third- ;'Breast feeding was begun by the thirdday in 87 . generation Mexican-Americans. -- percent of the cases. Only one' of the 225 mothers 1 reported inability to breast feed. In the.e4ent of FOOD PRACTICES inability to bre.9:st feed, 65 percent of the mothers indicated that they would choose bottle feeding To gain -perspective on the role of culture and over "communal" feeding. Of theinfants 61 per- tradition and its influence on food habits of in- cent were exclusively breast -fed during the first 3 fants and children in families of Mexican descent, months of life, whereas only 9 percent- werecom- five studies will be reviewed. The first was con- pletely breast -fed at the age of 9 months. Infailts ducted in southwestern Mexico (3) and the second were generally fed on demand whenever they in a border 'zone of northeastern' Sonora, Mexico cried, night or day. However,,some 40 percent of (14), areas from which migration to the United -the Mothers were in favor of .a more rigid feeding States is frequent. The other three studies were schedule. Human milk and herb teas were the basic Conducted in the United States; the first in ,San diet during the neonatal "periotl:However, by 6 Ysidro; Calif.a. semirural community south of months of age,. cews milk, fresh, powderedor San Diego, bordering Tijuana, Mexico (th); the evaporated, or gOat's milk was Offered to 60 percent second in East Los Angeles (18); the third,pon- of the infants:

77 Fruits (mainly banana, Orange and apple), bean -from the city. of Apia Prieta, 'and 99 0rom the soup (caldo de frijol) r.nct 'tortilla were given to rural comrtumity of Esqueda (14). Infant mortal- about 40 percetit of the-infants by age 6 months. ity xafes in the area were high-106 per 1,000 live Sanjur (3) beeves that the mother's readiness to births compared to 6313er 1,000 live births for' all introduce these foods, rather than availability of of Mexico. The high level of infant mortality the foods, determines whether they are given to was thought to be related to early weaning from the infant. the breast and a lack of knowledge on how to Other food items were introduced during the achieve maximum nutrition. and Minimal contam- first 6 months of life; however, they were not ination. consistently used by all infants. These items were Families chosen for study w re classed into one gruel (atoles) ; bread, crackers, cookiesf a watery of three economic categories. average- or high- noodle soup (sopa aquada) ; cocoa or coffee with income families, low-incomfamilies, and rural milk; eggs and jello. _families., All children beeen the ages of 9 Cow's milk given to the children was almost months and 5 years were studied to obtain informa- always boiled, primarily because unbolled milk tion on food habits. The investigation included 55 was considered tohe "cold." Flavoring agents, such children in. the average- and high - income category, as cinnamon, lime leaves, chocolate and coffee were 70 in the low-income category, and 72 in the rural used for the same reason. Plain cow's or goat's category. milk was little used. An imitation apple-flavored Food in Infancy. The pattern of breast feeding soft drink, (manzanita) was very popular, par- was variable (Table .3). Many mothers did not ticularly when children were ill with diarrhea or brea,st feed, while some continued breast feeding. fever. fol. more than 18 morithi: A greater percentage The age at which infants could be expected to of children were never breast-fed in average- and shire fully in family meals was believed by 5 per- high-income families than in low - income and rural cent of the 'mothers to be 9 to 11 months,. by 45 families. percent to be 1 to 2: years of -ege, and by 46 per- Great. variability was also noted in introduCtion

- - cent to be 2 years or older. . of solid foods: This is presumably due to the lact Food in Illness. The notion was widespread that that Agua Prieta is in a transitional situation, a "healthy"'child could afford, to eat, ratlier than mixing the 'native custom of late introduction of that a balanced diet promoted health. Mothers solid 'foods with the AMerican' custom of early often prohibited foods evai to ,healthy Children. introduction. Fruit, avocado; beans (frijoles) and pork were the Cow's milk (fresh or evaporated) was in- foods most frequently eliminatedfrom, their diets. troduced into the diet during.the first 6 months of Children were cautioned not to eat hot pepper or life in two - thirds of infants in the average- and too many thick tortillas, since their "heat" might high-income families; in one-half of those in the cause colic. Up to 2 years of age, protein-rich foods low-income families, and in'10 percent of those were removed from the diet of a child who devel- in the rural families. In the rural families, one- oped symptoms the mother attribqed. to worms. fourth of the Children older .than 9 months had During fever, diarrhea or Measles, fobd was gener- not been given milk other than human milk at ally restricted; 44 percent of the children had re- the time of the farnilfiriteryiew. strictions with fever, 66 percent during diarrhea, *.iTable 4 indicates the, age of introduction of and 78 percent during measles. various foods. The'vlierai tortilla is giyen-to the young child, although it is not widely consumed Agua Prieta and Esqueda, Sonora, Mexico by the adults. There was great similarity in intro- Three distinct cultures are being mixed in this duction of bread and Soups in all income levels. border zone in the northeastern' part of Sonora: Beans, eggs anctmeat were!, all introduced into the the "regional" of Mexico,, the "semi-ArneriCan" diet earlier in families of average and high income of the highlands of Mexico, and that of the United than in low.:income and rural families. This may States: This mixing of cultures gave opportunity be partially related to economics, since almost 12, to study the effects.* food habits. Investigators percent of children under 6, months of age in .the of the Division of Nutrition of the National Insti- average- and high-income families had been intro-- tute of Nutrition in Mexico studied 273 families -timed to commercially prepared strained meats,

78 whereai none of the children of rural families in Half of the families had yearly incomes of this 'age range had received such meats. less than $5,000. Yearly per capita income aver- Fruits and fruit juices were introduced into the aged $767, The mean educational level was 6.9 diet earlier in average.- and high-income families',years. Of the 80 mothers:, 14 had completed 3 years than in low-income or rural families. In many of or less of ,school, 29 had completed 4 to 6 years, the rural families frUsits had not been given. 14.had completed 7 to 9 years, and 19 had com- Neither commercially prepared strained vege- pleted 10 to 12 years. No response regarding tables nor home-prepared vegetables were widely schooling was obtafitecl from four mothers. The used. In the rural and low-income families, a high relevance of mothers' educational levels to feed- percentage of the children had not been given ing practices has lx*it well documented (16, 3). vegetable purees or juices. Although it is custom- Feeding Methodi and Eating Habits. Informa- ary to give chile to children, it was not. widely tion on methods of feeding in the first week and used by the groups studied : 11.8 percent of the the second month of life was available for 79 of children in average- and high-income families, the 80 children. During the first week of life 60 of none of those in the low-income 'families and 3.2 the 80 infants were fully bottle fed; 18 were fully. percent of those in the rural families had received breast fed; one was fed both at the breast and by' chile. bottle. By agemonths, 69 were bottle fed and 10 were breast' fed. Dietary records of 56 of the San Ysidro, California' children (70 percent) \ere obtained. These data are Summarized inTabfes7r9. At the time of the This semirural community of about 8,000 pop- study, only one child was breast fed and he was in ulation, bordering Tijuana, Mexico, is a frequent the 0-6.months age-group. Of the 33 children over. temporary location of individuals entering the 18 months of age, 36 percent still received milk United States from Mexico. Infant and child feed- from a bottle. Feeding of strained foods was com- ing practices of people of Mexican descent in this mon duringthe first 18 montlisiN4- life. Junior community are probably influenced by the num- foods were rarely fed. Eleven of 092 children ber of people of Anglo and/or other cultures in the 19 'tofu months of age. and all of the children area, birthplace (United States vs. Mexico) , length to 36 !months of age were receiving foods from the of time in the United States, parents' education, family table. language, socioeconomic status, whether the family Frequencx,..of eating by the Children varied frthn- has a physician and, if so, his location (United two to nine times daily with a median of four States or Tijuana, Mexico), and by the type of times. This is in contrast to the two meals a day people who migrate. stated to be the rule in some developing countries Data presented here were accumuli, ted as part (7, 13). Infants 7 to 12 months a age ate more of a larger study of nutritional and developmental frequently than other age groups.-, surveillance of Mexican-American children in San "Cultural" foods other than suera (sugar water) Ysidro, from birth to 6 years of age. Demographic Were infrequently given to young infants, but data and food habits relating to children from'children over 19 months of age were generally birth to 3 years of age will be presented: The total offered rice, corn tortillas, flour tortillas and study population was randomly chosen by utiliz- frijoles. ing records of the local school district, All indi- Daily Food Intake. Diet records for 1 day for viduals of Spanish surname were identified and, 56 children were evaluated to determine the from. these, 200 families were randomly chosen to amounts consumed of milk, meat, breads and participate; provided they were of Mexican de- cereals, vegetables and fruit, and fat, as well as the . scent, had children of the appropriate age, and number of different food items ingested in 1 day. were willing to participate. Bilingtial interviewers For ease of calculation, a serving was considered then visited the _holies to, ascertain the presence to be the, same as that used in diabetic exchange . of children of the appropriate ages: From this lists (17). The number of different food items eaten larger population, 80 children from birth to 3 daily was 'evaluated to obtain some index of vari- years of age (Table 5) and their families were ety in the diet. identified for study. Descriptive data concerning Mean intake of milk and meat appeared ade- families of those children are presented in Table 6. quate in all age groups (Table 8). Milk intake was

79 comparable to that found by Burroughs and Sanjur indicated that fats most frequently used Iluenemann (18) in infants and children of rural in Mexico were lard and cott-oneed oil. is milies in Coachella Valley of southern Cali- Foods Mo'hers Considered to be "Good- for fornia. Infants less than 6 months of age were not Children.. The SO mothers were asked what foods offered meats in any form. Most children received.-they considered to be good for. their children an imdequate number of servings of food items in i.,c; health foods or body "builders. Fifty-three the bread-cereal and vegetable-fruit groups. Fats women mentioned meat; 3S, milk; 33, vegetables; were used in the diets in sis.m.fficaut amounts begin- 22, soup; .21, fruit; 20, eggs: S. cereal; and 7. ning at, 1 year of age. In Mexico, according to potatoes. Candy, corn, jello and liver were each Ramos-Galvan (11), intake of fat by children is mentioned only once and chop suet', fish, ice cream, inadequate. Food items that fitted into none the juice and tortilla were each mentioned twice. previous categories were listed as miscellaneous. Orange juice, chicken, rice, beans, cheese and oat- These items, such as sugar, carbonated beverages, meal were mentioned three to fire times. When cocoa. chocolate, etc., contributed calories tothe food items mothers considered to be "good" for di 11 age levels. However, children 19 to /24 their children were classed according to the "h/1 isie moil, of age had a greater intake of these items four" food groups, foods in the meat group (beans, than did children of any other age group. Judged cheese, chicken, eggs, fish, liver and "meats") were by the number of different food items eaten daily, mentioned in 90 instances by the 80 mothers. there appeared to be a greater complexity of diet Fruits and vegetables were mentioned rl times : with increasing age (Table 8). milk, 38 times; breads and cereals (cere41; corn, Frequency --of Use of Foods. Food use was as- oatmeal, pasta,.potato, rice, tortilla) , 29 tunes; and sessed brthe following categories: milk, protein- other items (candy, chop suet', ice creaiii, jello, rich :foods, breads and cereals, vegetables and soup, "anything"), 29 times. It appeared hat, in fruits, and fat. Homogenized milk was used by 45 regard to the meat group, mothers were p cticing of the 80 children and diluted evaporated milk by what they knew about nutrition. Howeve what seven (Table 9). Commerciallyprepared formulas influences were modifying their practices Alth re- Enfamil,, Modilac with iron) were fed spect to vegetables is unknown. to four infants, all less than 6 months of age. As Vitamin and Mineral Supplementation-At the previously mentioned, one infant was breast fed. time of the survey, 34 of the 80 children were re- Two infants in the 19 to 24 months age group were ceiving supplements (Table 10). Of, the 69 chil- fed nonfat cow's milk. dren9ore than 6 mouths of age, histOry of Supple- Eggs and beef were the most frequently used mentation of the diet between 3 and 6 months of high- protein foods (Table 9). Of items in the-age, was as follows: 24 had received no supple- bread and cereal group, dry cereals, Irish potato,- mentation, 39 had °received a vitamin supplement, rice, infant cereals and white bread weremost two"had received an. iron supplement, and four commonly,fed. All of the infant cereals weresold had received supplements of both vitamins and by one manufacturer (Gerber), andchoices of iron. cereal were nearly equally distributed between high protein, mixed, oatmeal and rice. It be seen East Los Angeles, California froisii Table 9 that most of theinfants receiving As part of a preliminary study (15) on nutri- these cereals were less than 1 year of age. Ashad tional status of Head Start Mexican-American bep found by Sanjur etat: (3) for children in'children in East Los Angeles, information was ob- satithwe.stern. Mexicot_hananas and Oranges were rtalned on birthplace, income, and family size, as the most frequently-thnsumed fruits in San Ysidro. well as on breast and forinula feeding, weaning Frozen fruitsid vegetables were rarely used..- time, utilization of vitamins and the introduction Other ite were eithei fresh or canned. Of the of solid foods. Retrospective information was ob- relativ few vegetai3ies used, stewed vegetables tained concerning 41 children from 26 families.. (ca/ o), fresh tomatoes and tomato sauce were Of the 21 mothers for 'whom information on ost common. birthplace was_ obtained 12 had been born in the Fats most frequently used were shortening, but- United States(nine in 9California and seven of ter and lard. This was perhaps a reflection; of the these in Los Angeles County)`, and eight had been number of families receiving."commodity" foods; born in Mexico. The mean length of time the fami- . --- lies had been in the United States was 12.5 years Table foods were introduced early in compari- with a median of 7 years. Five families had lived son. to ages considered proper in southwestern Mex- in Los Angeles County 25 years or more, five other ico (3). Of `40 infants for whoni information was families from 10 to 25 years; the remaining 11 available, nine had received table foods before 6 fazillies had lived in the area from 1 to 7 years. months of age. Table foods were introduced into Four of the 20 families for which income data the diets of 11 children between 6 and 9 months could be obtained had yearly per capita incomes of of age. On the other hand, 17hildren did not leas than $500, 15 had yearly per capita incomes of receive table foods until after 1 year of age. Kinds $500 to. $1,0110, and only one had a yearly per carzta of 'table foods offered most frequently consisted of income greater than $1,000. Five of the 26 families food combinatiolis (26 of 35 children). These food were receiving general public assistance and three combinations consisteded of meats and soft, easily were receiving Aid to Families with Dependent chewable foods sueh as some vegetables, rice, fri- /Children. joles and mashed potatoes. Mothers were asked if The mean family size was 5.6 individuals; the any foods should be restricted for the young child median, six. and the lactating mother. Nine of 26 mothers re- Feeding Practices. Iniormation Was obtained by sponding stated that meat and eggs should be questionnaire concerning breast and bottle feed- elimint±:Zed from the diet of the young child being, age of weaning, utilization of vitamin supple- cause taey were irritating. Of thesemothers, 13 ments, age of introduction of solid foods and the stated that gas-forming and highly seasoned foads mother's Imowledge of nutrition. should be eliminated from the diet of the nursing Of 41 infants, 13 had been breast fed, three for as woman. long as 9 months and one for 12 months (Table 11). Beliefs that certain foods should be eliminated Only two of the 23 infants for whom duration of from the diets of infants and lactating women may bottle feeding was known werc fed by bottle after be related to the "culture of poverty" within the age 12 months. Of the 30 bottle-fed infants for"barrio"here the Mexican-American commu- whom in.forma,tiou was available, 10 received evap- nitywith further limiions on married women orated milk formulas, nine received Similar,, and imposed by "machismo"ie., once women enter 11 received various other formulas, including the barrio they do notleo\ve for socialectdtural or homogenized cow's milk, Enfamil, Soyalac and minor medical purposes 0195. Carnalac. Of 40 mothers, 32 stated that they had .., administered supplements of vitamins; many had Hanford, California done so over prolonged periods of time. Bowden (20) has studied nutritional beliefs and Early introduction of strained foods appeared food practices of 35 Mexican-American mothers in to be the rule. Of 36 infants for whom information Hanford, King's County,alit About one-half of on this point was available, 19 received strained, the fatherS in. the group we e farm laborers. Of the foods before 3 months of age. Strained foods were mothers; 15 had been born in California, 11 in introduced into the diets of infants between 3 Texas, seven in Mexico, one in New Mexico and

and 6 months of age and into the diets of four one in Oregon.. 1 , infants after 6 months of age. The mean number. of - school ..y -ars completed by Combinations of foods were more frequently the mother was 6.9, with 13ie,ar the shortest period introduced than were single food items. Fdr of schnolattendanee and 12 Fears the longest. Five stance, eight of the mothers introduced a combina- mothers had completed TAO 1 to 3 years of school- tion of fruit and cereal initially while combina- ing, nine hakiVninpleted 4 t4.6 years, 15 had corn- tions of fruits, cereals, vegetables and meats were .pleted i t,; 9 years, and six l ad comp3.eted 10 to 12 often used. Five of the mothers- Aated that, they years. .. . had used choPped or mashed table foods from; the Mein family size was 6.7 individuals; families beginning. Possibly, these families were not able to were slightly largerthan th of Mexican-Ameri- afford strained baby foods in addition to the regu- can tan:ies in San Ysidror, East Los Angeles.. lar foods the rest of the family ate. Eggs were,not TheAyearly per capita in me of these families introduced at an early age. was $392. Welfare payments` contributed tothe'in come of 74 percent of the families. All families and pactice,--: Mothers in southwestern Mex- had incomes falling within the poverty classi&a- ico hold a body of beliefs that are transmitted tion of the Office of Economic Opportunity, Pov- from mother to daughter. Beliefs affect food intake erty Guidelines(21i. during lactati on, childhood and illness; frequently, Nutritional Beliefs.In addition to a number of protein foods are limited during these critical pe- other questions; each motherwasasked what foods riods. Breast feeding was the preferred method should be eaten every day for health, in her 'own of feeding in southwern Mexico. case and in the case of a pregnant woman, a lac- -With migration to border areas, there was a tating woman and a child. Answers were rated by precipitous decline in the practice of breast feed- the number of "basic four" food groups mentioned. ing. Bottle feeding was frequently continued for In response to the question of what foods should prolonged periods. 4 number of food items were be eaten every day for health:three women said introduced into the diet during lie first 6 months they did not lulow. However, as may be, seen from of life; however, meat was not commonly intro- Table 12, the women generally demonstrated good duced during this periodperhaps clue to the be- ...understanding of the merits of fruits and vr7geta,- lietthat meat is irritating to the young child. bles, .good recognition of the value of tWmeat In the East Los A geles area, breast feeding group, fair appreciation of the value of milk, and was practiced by a greater percentage of women little awareness of the value of the bread and cereal than in the border areas. Strained foods, excluding group. 'S one of the women mentioned the common meat and eggs, were frequently added to the diet Mexican-American foods listed by Maim(22)as before 3 months of age. Mothers held to beliefs good and fai urces of vitamin C (chile peppers, that certain foods should be eliminated from the guavas, cactus I es) . diets of infants and nursing mothers. These beliefs When asked wher a pregnant woman should held women in the East Los. Angeles barrios "eat for two," 2,0 rcent Of the women said they may be related to their entrance into the barrio did not know. Fort -three percent did not believe with its "culture of povert7" with further limita- that the pregnant woman should "eat fOr two," tions of married women imposed by "machismo." whereas 34 percent felt that .she should "eat for There appeared to be more free exchange with wo." One woman stated that a pregnant woman other cultural groups in border areas than in East should eat less. Los Angeles. The mothers were asked whether they ha4ver Mothers in Sal si Puedes still held to maw I heard of "hot and cold" foods. Noneof tbvfnothers beliefs of "hot" and "cold" foods. Although admitted knowledge of this concept. /- mothers in Hanford, Calif., denied' knowledge of The questions regarding type4f food which this concept, a number of food items considered the mother considered "harmful" to herself, to a harmful in Hanford fitted well into the classifica- pregnant or lactating woman, and to a child were tion of "hot" and "cold" foods. intended lo reveal other folk beliefs and food Low educational achieyemerit, large families, misinformation. A tabulation revealed that chile inability -to speak English, social and class dis- peppers, dried beans, and port all common items crimination, subtle racial discrimination, and low in the mothers' diets.were most frequently named incotrie may have contributed to decreased com- as harmful (Table 13). munication with other cultures, particularly in the barrio. Occasional visits to Mexico by those in SUMMARY Los Angeles, as well as entering migrants from Migration patterns of families from Mexico ap- Mexicr,), may have helped to perpetuate beliefs pear to have a definite effect on food habits, be- wad practices. Table 1.-Foods designated as "hot" or "cold" by persons of Sat si Puedes, Santa ClaraCounty, Calif.'

Des4gnation Thor' or "cold': Food types very cold Very hot not Temperate Cold

Cucumber Vegetables_ Chile pepper Onion Beans, green green Beet Fielder red Cabbage Purslane Garlic Cauliflower Spinach Coriander 'Tomato -Parsley Peas Pumpkin Radish Squash Turnip

Hen ce pull' Meats and milk Craddei Capon Goat Beef Fish Boar Milk, goat Lamb Miik, human Pork Milk, cow Turkey Milk, donkey Mutton Rabbit

Starches and sweets Beans, white Barley Beans, pinto Beans. red Bread, wheat Sugar, whit. Lentils Beans (habas) Oatmeal nen Tortillas. corn P Irish Vermicelli Potato, sweet Rice Sweet rolls Tortillas, wheat Wheat Honey Sugar, brown Salt

a Data of Clark (8). Table 2.-Percentage of- respondents in a southwestern Table 4.-Age of introduction of various foods into the Mexican Oillage reporting that specified foods were per- diets of infants in a border zone of northeastern Sonora, mitted or restricted post partism or during lactation I Mexico

Permitted Percent of Restricted Percent of Percent of children receivingfolid Respondents Respondents at variout ages Food - Never Less 6-12 13-18 More given months months than 18 86 Avocado 54 than 6 Sow's gthicken broth, sops actUada) mantels months Atoles 85 Fruits_ SO Toasted tortillas 83 Pork 43 56 Red beans 41 Boiled milk Tortilla: Chicken, beef 50 Vegetables 5 Wheat: 47 "Red" meat.... 12 Black bean bralh Uppers Income S.8 35.2 37.3 13.8 3.9 45 Milk, cheese, Charcoal broiled cheese Lower income 8.2 37.7, 45.9 6.5 1.7 eggs 17 Rural 18.8 46.8425.0 4.7 4.7 Corn: I Data of Sanjur. et al. (3). tipper Income 7.8 23.5 15.7 23.5 29.5 Lower income 5.0 18.0 37.7 8:2 31.1 Table 3.-Duration of breast feeding in a bordei zone of Rural 7.8 32.8 15.6 7.8 36.0 northeastern Sonora, Mexico " Bread: Upper Income 13.7 35.3 33.3 4.0 13.7 Upper a Lo Rural 11.5 34.5 36.0 6.5 11.5 Den of breast feedi ng (months) income (percent) Lower Income (percent) (Pe4nt) Rural 11.0 46.9 29.7 6.2 6.2

Pasta and Rice Soups: . \ Less .. . 6 27_ 5 18.0 31.0 Upper Income 21.6 47.1 25.5.: 1.9 -"' 3.9 6 to 12_ 15.7 27.9 34.1 13-.8 48.2 28.4 4.8 4.8 131. 18 19.6 27.9 37.5 Lower Income__ . ... . Rural 18.0 50.6 25.0 I, 8 4.6 More t. en 18 7.8 13.1 23.3 Other' 25,4 13.1' 14.1 Beans: . 7.8 2.0 e Upper Income 33.3 45.1 11.8 1 Data 4 Division of Nutrition, National Institute of Nutrition, Mexico (14). Lower income 28. 0 31. 1 29. 5 5.0 6.4 a"Avengeor high." . .. ° Rural 29.7 48.4 17.2 0.0 4.7 a a Botta fed since birth.

83 Table 4.-Age of introduction of various foods into the Table S.-Descriptive information concerning mothers and diets of infants in a border zone of northeastern Sonora, Mexico 1-Continued families of children studied in San Ysidro, Calif.,

Percent of childfen receiving food Birthplace: s. of mothers at various ages United States__ 20 Food Never !eerier) so Less 6-12 13-18 More given than 6 mods months than 18 months months Years in United States: hc arty- 3

Less Um -3 year 1 F 1 to 5 ynxi 15 35.2 35.2 13.8 11.8 4.0 5 to 10 years 72 24.5 3L 1 26.2 9. 8 8.4 More than 14 years 39 Run 17.2 36.0 25.0 :4_0 7_3 Education of mothers: Years Meats: Mean__ 6 9 Commercially prepared strained: Median 6 Upper income 11-7 17.7 5.9 1.9 62.8 Range-- 0-12 Lower income. 3.3 6.6 4.9 13 81.9 Rural 0.0 L'6 1.6 1 0 96.8 Family income: No_ of families Othe.: No answer. 3 Upper incom_e_ 4.0 15.6 IL? 9.9 58.8 $1.000 to 62,999 11 Lower income _ 1-6 11.6 18.0 16.3 52.5 $3,000 to $4,999 39 Rural 3.1 23.4 35.9 6.3 31.3 $5,000 to $6999 17 $7,000 to $8,999 10 Fruits: Commercially prepared strained: Family size: No. of members "-roe( income. a'3.3 19.6 3.9 2.0 41.2 Mean_ 5.9 Lower income.. 3;.1 21.3 3.3 3.3 41.0 Medias S Rural 7.8 12.5 1.6 3.1 75.0 Range 3-13 Other: Location of family physician: Upper income 13.7 77.5 11.8 1-9 45.1 lie. of families Lower income, 23.0 21.3 9.8 5.0 40.9 In United States.. 35 In Tijuana 15 11.0 25.0 7.8 7 8 48.4 -Y.-. ---- No physician 30 Fruit juices: Commercially prepared strained; Upper income 31.4 29_4 3_9 0 35.3 Beta randa et it (unpublished). Lower ineorne 29,5 26.3 & 2 34.4 Rural 7.9 28.0, 7.9 I...a 54.6 Other: Upper income 17.6 15.7 9 S. 9 56.9 Lower income 21.3 16.3 3.1 6.6 52.5 -Table 7.-Methods of feeding and types of food fed to Rural 6.3 18.8 10.9 4.6 59.4 children less than 3 years of age in San Ysidro, Calif.'

Vegetables: Commercially prepared strained: Number of children Upper income - 15.6 -25.6 5.9 0.0 52.9 Age (months) Lower income 3.8 6.5 0.0 3.3 86.4 Rural Less 6-12 13-18 19-24 25-36 Total 0.0 1.6 0.0 0.0 98.4 than 6 Other: Upper income 3.9 19.6 7.9 2.0 66.6 Lower income__ 5.0 8.3 4.9 3.2 78.6 Present feeding method: Rural 1.6 6.2 3.2 6.2 82.8 Bottle 6 7 7 5 7 33 Breast_ 1 1 I Oat, of Division of Nutrition, National Institute of Nutrition, Mexico (14). Cup/glass 1 7 14 22 a "Average or bites." Present food consistency: None 2 2

Strained 5 5 5 1 16 Table 5.-Age and sex of children less than 3 years of age Junior 2 1 I1 in San Ysidro, Calif.' Table 2 4 11 21 38 Number of times child eats Number of children daily: Mean 5.4 6.3 4.4 !. 0 4.2 4.6 Age (months) Median 4 Range Less 6-12 13-18 19-24 25-36 Total 4-8 3-9 2-7 3-5 3-7 2-9 Bun 6 t Number of cultural foods daily: Moan 0.3 0.6 0.2 1.0 1.0 0.7 All children '11 11 12 14 32 80 Range 0-1 0-1 0-1 0-3 0 -3. 0-3 Males 3 4 7 8 21 43 Females 8 7 5' 6 11 3; Data of Aranda et al. (unpublished). at al. (unpublished). 2 Also recalling strained foods. Table8.--Dadfintakesof various foods by cbAciren less Table 9.-Use of various foods by 56 chachen less than 3 than 3 years of age in Sass Ysidro, Calif. years of age in San Ysidro, C8lif-1. -Continued

Shmiber or r'eadren Age(MrnittS) Typeoffond Type pf food Age Om Less 6-12 13-13 19-24 25-36 Wan 6 Less 6-12 13-18 19-28 25-36 Totes trot 6 (7) (9) (12) (21) 0' (7)2 (7) (9) (12) (21) :56) Milk, ounce: Bread_and cereal; 29 30 21 22 1t3 Mean__ Cereal. dry 1 3 4 16 24 23 16 21 16 Median Potato, Irish__ 1 7 6 16 22-32 16-49 9-40 8-48 4-48 Range Rice_ I 1 6 16 Meat, ounce: Infant cereais 5 . 6 2 I I 15 Mean_ 0 2.9 1.8 3.3 3.7 Bread. while 2______4 14 0 2 2 1 5 4 .. Pasta 2 7 9 0 0-11 6-4 1-6 0-19 Range Tortillas, corn 3 4 7 4 Bread-cereal, serving: Sentries...L._ 2 1 1 1.0 14 2.1 13 3.5 4 Mean__ Tortillas, Sour 1 3 1 .1 2 3 3 3 Median Pancakes 1 2 6-8 1-3 0-6 2-6 0-8 Range-. Panes duke 1 2 3 Vegetabie-fruk,serving: 2 Cemal, cooked-,._ 1 1 L 1 2.3 3.2 1.4 2.0 Mean Bread, banana_ _._..- 1 1 Median. 0 1 3 1 1 Range 14 0-9 0-11 0-3 0-11 Fruit 7 11 Fat, serving: Banana, tresb 1 1 2 2 7 Mean- 0 0.3 2.0 2.3 2.5 Orange juice 1 3 1 4 4 Median 0 0 2 2 2 Orange. fresh- 4 Range 0 0-2 0-4 0-6 0-8 Banana Mt__ i 2 1 3 Mllaneotts items,* serving: Pears (6) 3 3 Mean__ 0.9 0.9 1.1 2.2 L 5 Applesauce (6) 2 1 2 2 1 1. 1 2 2 Watermelon di Median , 1 1 2 Range 0-2 0-1 0-2 0-5 Raisins_____ 1 2 Number differem food items: Rumple Juke- 1 2 2 Mean 3.7 0.8 8.4 10.8 9.2 Peach.fresh__ ... 2 2 Median 3 6 8 it 9 Fruit dessert(G)______2 2 Raage_ 1-8 5-10 4-13 5-16 6-13 Arrays, fresh.- - Prunes (G) 1 1 1 Plums, f resh 1 1 Data of Aranda et al. (unpublished). Peaches, canned 1 I %Values- in parentheses indicate number of children in each age group. 1 *Sugar, carbonated beverages, cocoa, chocolate, etc. Grapes 1 t Grapefruit-pineapple juice 1 1 Fruit juice, mixed 1 1 Table 9.--Use of various foods by 56 children less than 3 Fruit conned 1 1 years of age in San Ysidro, Calif.° Apricot-pineapple juice- Apricots, fresh_ 1 1 Applesauce and apricots (G) 1 1 Number of children Prunes 1 1

Type of food Age (months) Vegetable: Veletables, shmed- 2_____ - 1 3 6 6-12 13-18 19-24 25-36 Total Less Tomato, fresh 1 5 than 6 5 Tomato S.anCe- 2 3 Tomato, canned a. 2 2 4 (7)1 (7) (9) .12) (21) (56) Vege.able soup 1 1 1 3 Celery 2 1 3 Milk:* Lettuce 1 1 2 Cow, homogenized 2 6 7 11 19 45 Radishes.- 1 1 7 Cow. evaporated 1 2 2 2 Tomato juice .1 1 2 Cow, nonfat.. 2 Mixed vegetables (G), 1 1 3 Human 1 Mixed vegetables, frozen. 1 1 2 Wasik 2 Green sand . 1 1 1 Enfatml 1 Carrots (S)-__ 1 1 . Modilac with iron 1 Carrots, fresh 1 1 8Mccoli, frozen 1 1 1 1 Protein-rich foods: Beans, green c ... Eggs-- 4 5 Il 16 36 1 1 6 8 16 Fat: Beef 3 11 2 6 8 Shortening_ 1 2 Poultry (chiduan) 1 4 4 9 3 2 3 8 Butter Cheddar cheese- 4 2 4 6 Lard 3 Fish- 3 3 6 1...... 2 6 Margarine. Beans, pinto. 1 2 3 6 Strained meat w/vegetabiel 4 4 011 .3 4 Mayonnaise 1 4 5 Lucheon Meats 2 -z Pork 1 3 Cream- 0 Strained meat 1 1 1 3 1 Peanut Miner-. 1 rode of Arendt' et V, (unpublished). Lentils 1° 1 Members in parentheses indicate total number of children in each age groups Three children sack received two types of milk- Seefoothotii at end of table. a Gerber Products Company. f35 Table 10.Dietary supplementation of chBdren less than Table 13. Foods suggested as "harmful" by 35 Mexican- 3 years of age in San Ysidro, American women in Hanford, Calif.'

Number of diiieren Person t vrharn_fond is "tannfla- Food item of times Age (months) Self Pres-Tram Lancet :atChildme5:tioned woman woman Less 6-12 13-18 19-24 25-36 Tutu than 6 . ___ 2 None_ 6 6 8 2 la 46 CtiOe oeO7ers- 5 4 5 Vitamins- . -______3 4 3 3 5 15 1 3 1nnn_- 0 0 0 0 5 2 0 0 Matt beans- Vitamins & iron__ _ . ______2 0 4 3 9 18 I x _ 3 x 1 Vitamins. iron, Inoricie-______0 0 0 0 1 1 Pork j x 2 1 1 Data of Armenia at at. (argmbliShec:- 'Smelts'. I x 1 x I I Carbonated beverages_r__t ____ z x _____ 1 Table 11.Duration of breast or bottle feeding of 41 x x 1 children of Mexican Sescent in East Los Angeles' 4 'Stanthy" foods______I 4 1 z I Apples law z Duration of feeding (months) Breast Bottle feeding feeduit Fan, fresh 5 _ 1 Otitk x . Meat, raw x 1 1 3 1 Bologna x 1 2 2 Salt-. x 1 3 2 2 Sugar 4 1 4 4 'Creasy hod" x 1 5 1 a Chocolate t 1 6 SPA, %ads- x I . 1 7 -... i Beets x _ _ -. 2 8 . - Ainumils x 1 9_ Oak Med.- 1 12 Avocado- 1 1 24 1 c Data of Bowden (20. Other 7

Data of Aranda at aL (unpublished). Duration not specified. References I C. L. Dellums, chairman, Fair Employment Practice Table 12.Food groups named as daily essentials by 35 commission, "Californians of a Spanish Surname," Mexican-American women in Hanford, Calif.' Division of Fair Employment Practices, State of California, May 191:14.' Number of times mentioned for 2. J. H.Burma,Spanish-SPeaking Groupsi the United roodgroup Self Pregnancy Lactation Oild States(Durham, N.C. :Duke . University Press, 1954). 3. D. M. Senjur et aL, "Infant Feeding and Weaning Milk.... 22 22 18 23 Fruits and vegetables: Practices in a Rural Preindustrial Setting : A Socio- Vitamin A rich.-- 5 5 3 5 cultural Approach,"Acta .Paediat. Boand., supple- 8 Vitamin C rich.- 6 4 . 6 . ment 200 (1970) : I. Other 30 26 i 23 4. AL(3Hampton et al, "Calorie andNntrtentIntake of Meats. 31 27 163 23 Breads and cereals 14 11 7 it Teenagers,"J. Amer. Diet. Assoc. 50 (1907) : 385. 5.A. Burgessaudit.F. A. Dean, eds., Malnutrition and t Data of Bowden (20). Food Habits (New York.:Macmillan Co., 19(e).

86 c. a B. Jeliife and F. 3. Bennett. ~a:aural and An- It Z. Cravioto. R. DeLLmrdie, 47.1d IL It Birch. -Nnt-i- .thropoUrAcal Factors &Infant and Maternal Nutri- t xm. orvutil and Nearvinr-f=ative Derelopmemf: tion," Fed. Proc. 20: 7 (1961:1 1S5' An Experime71:a1 and EL -Le- Stmir," Pediatric:: 7. G. N. Foster, International Conference on Prevention 38 (1.4661 :319. of Malnutrition in the Pre-;=Setool Child, "Social 17. D. F. Turner. Handbook of Digit TheroPY. 5th ed. Ant hrouolo-rs. and Nru.ritim t...e Pre-School Child, (Chicago : University of Chicago Press, 190). e5pecially as Related to i,arin America," in Pre- 1S. A. L, Brcrroorhs and R. L. Hue_nemann. "_ran Defi- School Child Main:annum: Primary Deterrent to ciency in Rural Infanta and Childrer.," J. Amer. Hannan Progress (Washington: Neicrual Academy Diet. Assoc. 57 (1970) : of Sciences-National Research Council, 1966). S. M. irk, Health in the Mexican-American Culture: A 19. R. G. Amuck and P. B. Acosta, nficration. Culture, Community Study (Berkeley : University of Cali- and Health of Mexican- Americans in an Accaltnra- fonila Press, 1959). tion Gradient" (Paper presented at the Sixty-ninth 9 E. Wellin, "Maternal and Infant Feeding Practices in Animal Meeting of the American Anthropological a. Peruvian Village," J. Amer. Diet. Assoc. 31 (1955) : Association, San Diego, Calif_ November 1:2, 1970). 889. 20. S. Bowden, "Nutritional Beliefs anti Food Practices of 10. Oscar Lewis, Pedro Martine:: .4 Mexietos Peasant and Mexican-American Mothers" (Thesis., Department His Family (New York: Random Ho, se, 1964)- of Home Economics, Fresno State College. 1968). Ii. R. Ramos -Galvan, International Conference on Pre- 21. Office of Economic Cpportnnity, Poverty Guidelines, vention of Malnutrition in the Pre-School Child, "MelnutritIo2. In the Pre-School Child in Niexico: 1986. Prevalence and Propar,....s" in Pre-School Child a v. R. Mann, Food Practices of the Mexican-American Malnutri'tion: Primary Deterrent to Haman Prog- in Los Angeles County; Los Angeles County Health ress (Washington : National Aeademy of Sciences- Department, 2966. National Research Council, 1966). 11 M. Swaminathan, "the it and Feeding of In-: tants. and Pre-School Children in the Developing Countries," World Rev. Star. and Diet. 9 (1968) : 85. 13. D. B. Jelliffe, "The Pre -Se bool Child as a Bio-Cultural Transitional," J. Trop. Pediak. 14 (1968) : 217. Acknowledgment 14. Division de Nutrition del Institute National de la We should like to acknowledge the support re- Ntralcion, "Habitos de .Alimentacion en -tma Region ceived from Mr. Robert Taylor, airector of Eco- Frouteriza," Saha Publiea de Mexico U (1969) : 357. nolnic and Youth Opportunity Agency and Head 15. R. G. Aranda et al.. "A Preliminary Study of Nutri- Start in the Los Angeles area, in the accumulation tional Status in Mexican- American Pre-School Chil- of data for East Los Angeles. Mary Ellen dren, L Experimental Design, Selection of Subjects, StateCollege, Los Data Collection and Description of 11,`am1les" Hendricks of California ( unpublished) . Angeles, analyzed data on early feeding practices. Discussion

Miss Doris amber, Session Chairman : In and other health practices, moth. mothers-in- my stuciies of several groups of Mexiam-Ameri- law, and husbands often insist follow cans in Phoenix and other areas of 1415 ricopa Coun- them: Orange and other fruit juices nsiderecl ty, Ariz. (carried out in 1960-43), I found no "pretty fresh" for babies. Meats may not be given restriction on food during pregnaney. During the before 6 months; a raw egg may be given in the 6 weeks after birth (and also durinm menses), formula because a raw egg is easier to digest than specific foods are taboo. Some foods are considered a cooked eeg and does not cause gas. "hot" and 'heavy"; others are classed as "cold" The first solids may be introduced at about 3 to or "acid." None of the foods in these categories are 6 months. Infants are also fed broth from potato permitted, Classification of these foods by some of or macaroni sopas, or fried beans, mashed, and the Maricopa County residents does not entirely thinned with a little water. By 6 months of age, conform to that reported in tatle 1 of the paper the baby is often given a beaten raw egg with by Acost:. and Aranda. For example, cabbage, added cinnamon and white or port wine because cauliflower, chile peppers and chocolate are all this is believed to give the baby a good appetite. considered "hot" foods. Peanut butter anu eggs are As in San Ysidro, a very young infant may be both "hot" and "heavy." In addition, eggs are given suers (sugar water) made with 6 oz. boiled thought of as "gas-forming." "Cold" foods include water and 1 oz. Karo syrup. citrus fruits, tomatoes, ice cream, gelatin dessert, Wild mint leaf is given for stomach ache, and dried peaches and apricots, strawberries, cheese, cinnamon tea for colic. During the summer in the onions and garlic. Green beans are "cold," ``gas - Guadalupe area, Brazil wood is purchased at the forming," and "acid." drugstore, scraped with a knife and placed in a Other foods forbidden but not considered espe- bottle of water to soak for y2 to 1 hour. The water cially "cold" or "hot" include pork, chorizo, bo- turns red; it is then sweetened and given to chil- logna, candy, carbonated beverages, Kool-Aid, ap- dren 1 year of age and older to build blood. ples, dried beans, fish, end fried potatoes. Prob- By tie-, time the infant is about 1 year old, he ably the one item most frequently eaten during the might be expected to, eat the following: Meat early postpartum period is a light soup. However, soup, beans, oranges, bananas, and fruit juices. tomato soup is not peimaitted. Cereals, poultry, Babies are not permitted to eat strong vegetables bread, crackers, coffee, tea, milk (if boil, 1), liver such as cabbage, cauliflower, onions, garlic, to- (if boiled), prunes, raisins, and potato chips are matoes, chile, corn, or greens. permitted. Pumpkin seeds are often dried, ground, There is still a prevalent belief in our ojo, a folk and used in the preparation of a gruel that is con- diagnosis in which sickness is caused in a child -7 sidered especially desirable for lactation. someone who has the power to bring about this Many of the findings in San Ysidro pertaining to special illness. Praise or compliments may be suf- breast and bottle feeding are comparable to those ficient to cause such illness. Thus, in child health found in Arizona. The number of women who clinics, -workers need to understand that some breast feed their infants is not large. Evaporated mothers may be displeased when the staff pays too milk is widely used even beyond the period of early much attention to their infants or children. infancy. Leek of refrigeration is oft.n an impor- A cause for great concern is a "low" fontanelle. tant factor leading the mother to offer the older in- F :It medicine doctors know lace: to cure a low fon- fant evaporated milk rather than whole milk. tarielIe using the "eye of an egg and spit." There Some interesting beliefs were reported by is also a belief that disease is often an expression youngermothers in the Guadalupe area. Although of the will of God and that not much can be done some of these mothers do not believe wholeheart- about it. edly in many of the teachings pertaining to food Infants and children who "seem poorly" (fail to thrive ) are often considered to hare empacho_ the median age is less thae. median eduea- Some of the mothers in Guaialupe reported that tional level less that fourth erase. With money Aneio doctors did not lmow how to treat empacho, matters, tleman of one home is in complete so they- need their own witch doctors. Treatment charge.'' _Te is apt to do the erocery shopping or may consil4 of tea or certain rituals. Certait Iv accempany his wife, particularly if they are recent, these belief:. have decided implications for health immigrants. workers, who need to know them and sire them About half of the mothers in the project express due consideration if they expect to develop rap- a eteAre to breast feed; however, the mothers are port with theee they hope to serve. not encouraged to do so in the hospital following In Arizoiaa --es in San 1-.1ro, extended bottle delivery and, in addition, the younger girls may feeding is practiced. T'ne ckiin may be 2y., to 3 return to school. As noted by Acosta and Aranda, years old before he is weaned. Very few cfldren bottle feeding is extended for 2 years or longer. zee given milk from a cup. Junier foods ere rarely According td Kerrigen, all foods ma- be fed by pmehased. Too often., mothers are advised to stop bottle until the infant is at least 1 Tea: olde- breast feeding oa hottle feeding wiL&out any con- efees, cereal, and commercially prepareci strained sideration to whether or net apreopriate food is foods being added to the milk orformula. It is available for the older infant, or to the beliefs and also fairly common here, as it is in Arizona, to give feelings of the mother and her family_ the infants liquid jello water. The mothers seem In low-income families, the basic diet usually to believe that it is a high protein food and very consists of beans chile, rice, and tortillas (mostly good for the baby. This conception may arise be- made of flour). Added to this may be fried po- causeit has been prescribed during certain tatoes, eggs, macaroni and spaghetti, sopas, Kool- illnesses. ...id, mimed soups (i.e., chicken noodle, chicken In the fire geographic areas discussed by Acosta neeej, and, when income permits, round steak pre- and Aranda, and in Arizona, meat is not added pared with tomato paste, onion, garlic, and oreg- to the infant's diet at an early age. However, ano. The mother often buys canned soup for lunch. neither is meat per se part of the routine daily ;Iiet One can of soup may be diluted with two or three of tle older children and adults in lows - income times as much water as specified. Along with the families. In leizona, eggs constitute an important soup, Kool-Aid and "store" cookies may be given. part of the &et of infants, children and adults. Several fruits are well-fiked but considered too Kerrigen reports that the antepartal patients like expensive by most low-income families. Bananas, raw eggs mixed in orange juice, and in Arizona, oranges, and grapefruit are all used when fried eggs for breakfast are popular, as well as vailable. huevos rancheros. Snack foods are popular and the well -known The mothers in Hanford, Califel were all born eastek wagons" find aIn the more remote streets.. in the United States, and it is not known what There are obviously many reasons behind the use generation of Mexican-Americans they represent. of limited funds to purellse such items as ice My observations agree with those expressed in the cream bars, frozen,ices, carbonated beveaeges, final paragraph of the` report by Acosta gni candy, and potato chips. Probably the great' Aranda. Certainly the beliefs are perpetuated by is the need to show love for the child, to give him the barrio-type life styles, as well as the accessibil- something material, though rapt ctly consumable, ity of the "Lomeland." Extended families continue that ether children have. On a hotrday, a bottle to live in dusters, with the female members rarely of sada maybe the ..ealy cold beverage that the communicating with "outsiders" and thus greatly child has. influenced by the older women in the area. For The nutritionists in &Maternity and Infant Care instance, young expectant mothers in /Phoenix project in East Los Angeles have shared some of were influenced to eat clay or dirt because it was their findings. Kathleen Kerrigen reports that thought to be good for them. In East Los Angeles, "about 76 of every 100 residents in East Los An- ; Kerrigen reports pica in many antepartal pa- geles are Mexican-American. There is an island tients. Some of the items eaten include Mexican of poverty (8 square mike); where the median education, income, and standard of living of the sVowden maritime Beliefs. end Food Practices of population are the lowest in the health district, and Mexican-American Mothers. Thesis, Department of Home the number of children per family is the highest Economies, Frew, State College, Prceno, Calif, 1968. 89 clay pottery, ashes, carbonate of magnesium, and, ills teas. stoI,rice water, and other liquids are less commonly, starch.- fed.- but no solid foods_ The infant's digestive Wass Faestina Solis: Becau se opposing atti- potential is considered to be yet undeveloped for tudes influence food habits, it is extremely di-a- Main foods. Bland foods such as rice, cereals, cult to generalize. For many people it is easier squash cooked potato can be introduced but with and less traumatic to relinquish language heritage caution to avoid "packing the stomach.' than to give up food preferences. On the other Arms Lauber:- In as orldng with some of the hand, the impact of the dominant culture is a Mexican-Americans in Arizona I found that phy- pervasive force. In many U.S. localities, various sicians instruct mothers to feed infants 7-Up dar- staples and herbs basic to traditional meal prep- ing ill: sse Mothers often misunderstand and con- aration are absent or expensive so that substitu- tinue with this feeding after the -child has tions must be made. Children explore and observe recovered. the world about them and play a role as `'inter- - Mrs. Betty Lou Valentine: Directions for preters of the community." They become familiar treating sick infants in our community often in- with foods of the dominant culture and cajole clude feeding tea. Mothers think the child 'can- their parents into purchasing these foods. Thus, not survive on tea so = Bey give -Aire and cereal the interplay of many factors determines the in addition to or in place of the tea. rapidity and extent of changes in food patterns. Dr. Thomas A. AndeIrson: The concept of hot Although border populations of Mexican immi- and cold foods seems inaPortant to some Spanish- grants are generally believed to hold more tena- speaking groups in the United motes and not at ciously to cultural food habits than do other all is- portant to others. groups, I have noted a tendency toward experi- Mrs. 31-Argarita Kay: Persons of Mexican mentation with new foods. In fact, it sometimes descent is.. the Tucson area do _sot generallyappear seems that U.S.-born residents of Mexican descent to be Imoisledgeahle about classification of foods are mo- selectively "Mexican" in their food habits into categories of "hot" or "cold." However, other than se, immigrant Mexican families. distinctions are made and these should be learned Parents who have known severe hunger are by professional health workers in each geographic particularly inclined to feed their children often area. and abundantly if it is posale to do so. The Mrs. Mary Ellen Wilcox: Many of the Span- chubby child is often considered healthy and the ish-speaking people in Florida migrated from thin child is considered sickly. In addition, par- Texas rather than from Mexico. They have been las may find it impossible to deprive children in contact with the dominant culture for some foods, even those that are not nutritional' y time. In my conversations with mothers, I find sound. The quest for food has been such a major that a food is fed because it is thought to be good, battle for many of these families in the past that or her mother used it, or it has been approved by they feel guilty if they deprive their children of the family. 'I found no reference to hotor cold. food, particularly sweets. They may say a food is too heavy foran infant. Many Mexican-American families believe-that Dr. Acosta: I think the terminology has fresh, home-prepared foods are preferable to changed in recent years. Whenyou look at some other forms. It is therefore more acceptable to of the descriptions of foods, you may find that they mash feed', prepared foods for feeding to infants fit into a frame of reference of hotor cold. and t,Nicilers than to purchase commercially pre- Dr. Virginia H. Youpg: The Hanford study pared strained foods. reports Cat items common in the mother's diet As mentioned by Miss Lauber, "empacho" is aowere mostfrequently named as harmful foods. term frequently used tc describe illness in the in- There also appeared to be little awareness of the fant It is aignificAnt that each Mexican family value of breads and cereals. Theseare surprising &scribes empacho differently. I never assumethat findings, and one wonders if this isa case of denial I know the meaning of the term. When a person of one's own food patterns or rejection of the rays the baby has empacho I want to know how question.. the mot sir thinks the baby feels and behaves. Dr. Acosta: Common everyday foods do not For certaT, illnesses the common thatment seem to have value in the minds of the family. some areas of Mexico is to prohibit eating, tamest When we asked mothers what was good for chil- as if "to starve out" the illness. When infants are dren, we found bread class rated low.' 90 I. Low-income groups in Hawaii

Infant and childhood feeding practices among low-inc-te families in urban Hawaii Myrtle L. Brown, Department of Nutrition Rutgers University, New Brunswick, New Jersey, and Claire Hughes Ho, Nutrition Branch State Department of Health, Honolulu, Hawaii

The data to be reported here were compiled the specific cultural patterns of the Hawaii essentially from studies carried out during the immigrants.) last 5 years among families of low- or lower- The low-income families from which our sam- middle income status in Honolulu,. Hawaii. loav- ples were drawn were not characteristic of the income families are those which can qualify for ethnic distribution of the population as a whole food stamp asbistance and for clinic services pro- but comprised chiefly part-Hawaiian and "other" vided* the Hawaii State Department of Health. groups. The lower middle- income families were For the latter, incomes of less than $350 per month chiefly part-Hawaiian and Japanese. However, for a family of three qualified for well-baby although retained ethnic and cultural patterns clinics; the eligibility level increased by $50 for influence to varying degree the food choices among each additional child. This represents the older children and adults in Hawaii (2-6), in our family income level designatedas as len experience, food practices amongInfants and very income status. A large number of families studied, young children do not appear to be influenced however, earned less than the maximum allowable, significantly by etb An or cultural background of and incomes were more- similar to food -stamp the family. requirements. INFANT FEEDING PRACTICES BACKGROUND As in other areas of the United States, breast The population of Hawaii comprises many feeding is less commonhan artificial feeding. In diverse ethnic and cultural groups. Accorcaug to a sample of 281 infants of = and lower-middle- the census of 1970, the population was roughly income families, only 25 percent were completely one-third Caucasian, one-third Japanese, per-. breait-fed, and 11 percent itre partly breast-fed cent, Hawaiian or part-Hawaiian, 6 percent (6). Sixty percent of the nursing mothers termi- Chinese, and 8 percent other groups (r). The last nated breast feeding befdre the infant was 3 categcky includes persons of mixed heritage (ex- months old, and by 6 months of age, 80 percent of eluding Hawaiian), Filipinos, and, other Polyne- nursing mothers reported terminating brevet sian, Oriental, .and Pacific Island groups, many of fisedmg. whom have immigrated fairly reel)* to Hawaii. Fewer low-income mothers tend to breast feed (The problems faced by these Ocent immigrants their infants than do mothers of lower middle in- are similar, in general, to those of any immigrants'dome (about one;fifth compared with one-third). from rural to urban settings but reflect, of couress, It appears, however, that the mother's educational

. 91 level an importantactor innuencinz the choice We obtained retrosnecti.data fromintk_rvE--ws of feedin,, method whereas income level per se of mothers of '2- and :3-yeas-old cllildren and 3-day is relatively unimportant. Our conc.: usiOras are sup- food records ofih -its attemi f well-baby clinics ported by other studies. Guthrie 4 7), for er.11-1ple, (6. 0. The retrospective data are probaL,Iy less re- has reported that nearly half of mothers Jutpr- liable than the food records, but C:1S.:. tiered vie wed in a university town lireaa-fed their in- .ttroly, the two types of data provide some insight fants and that breast feeding was favored-by the into the patterns of infant feeding among better educated 7---0 n low-income families in Honolulu. The use of sl.-1:cially prepared infant formulas Although feeding of solid foods prior to the was more prevalent than might be expected among third month is common practice, feeding of cereals these lower income familie.wLichalso indicates a and occasionally other foods durinz the first month lack of influence of income per se in choice of of an infant's life is relatively ra.re:Illowever, by infant feeding. In Honolulu, special formulas the second month of life roughly one-third to range in price from 10 cents to as much as 26 one-half of infants are getting foods other than cents more per can than a can of evaporated milk Cereals, fruit or fruit juice, and vegetable- milk Roughly one-third to one -half of two survey meat combinations are most frequently given: By samples (6, 9) used special formulas for infant 6 months of age, meat and eggs are fed. Ems, With the discontinuance of hospital for- however, are used infrequently, and vegetable- mula rooms, most babies are started on special meat combinations are more often used than meat formulas in Honolulu hospitals. Mothers are pro- alone. Commercial baby foods are used 'almost ex- vided with a mall supply on leaving the hospital clusively. In fact, low-income mothers appear to be a nd probably simply assume the formula to be influenced a great deal by advertising techniques, a preferred fOrtn of feeding. Many health workers and in the Honolulu area one particular brand was also believe that special formulas are an infant used by all mothers in our sample. Infant foods "status' food, It has been our experience that with exotic names are frequently chosen in prefer- this is possibly true and is perhaps one example ence to simple food items. of an indireet cultural influence on infant frAding. The amount of food consumed varies consider- Among island cultural groups, infants are highly ably (table 1). Infants are Usually fed on demand prized and ieceive very, special care for the time (crying), and relatively few low-income mothers that they are completely dependent upon their follow a rigid feeding schedule. mothers. (The pattern often reverses when the Ethnic background. apparently has little effect child is able to walk and fend for himself.) An on early feeding pattern. However, we have noted expenee.ee fdrmula is one wayof prcoviii.dne, this . that mothers of Hawaiian ancestry favor feeding special acre and love for the child- poi and meat at a somewhat earlier age than Evaporated milk formulas are the other most mothers of other ethnic groups (6). Poi is a paste- commonly used form of milk. The feeding of like product prepared from taro and is a tradi-. fresh milk prior to 4 or 3 months of age is tional Hawaiian food. It is commonly used as a rare substitute for cereals for potentially allergic The amoutrt of milk consumed by infants in- infants, and many pediatricians fa-elor poi as an creates sligh ly from birth to 6 months of age infant cereal (10). While poi contains a fair

., amount 0.and then dines by Gut three-quarters bf pre- iron, it does not compare favorably vious intake as more solid foods are introduced with the enriched infant cereals' in this nutrient,. into the in is Aiiet (9). The use of poi in infant feeding is probably the only major difference between feeding practices in INTRODUCTION OF SOLID FOODS - Hawaii and other areas of th united States. We have no quantitativeto on infant diets The time it which, solid, foods are introduced among middle- or upper- come families in into the inft's diet and the type of foial Hawaii. However, retrospec ve data obtained by duced vary considerably. Antonr low-it:00mo, interview suggests that thegeneral feeding pattern families, itppea e,.... that mailers tend to follgry for infants is similar at le between low-income the advice o relatives or friends to a greater ex- and lower- middle -into families. Aniong children 2 to 3 years old, how ver, we have found that tent than th advice of/ a physician or other prefes- sionalNkealtliworlmr (9,). diets of low-income chil re.ni contain less milk and 92

tz more cereal grains than those of children of lower- 3.0 percent (8). The incidence of anemia, thus. La middle-income familin Consumption of eggs, somewhat lower than that reported for some low- green and yellow regrAables, and citrus fruits tend income populations ori the mainland (12). How- to berelatively low among both low-income ever, although exact figures are not availabk from and 1o...tar-middle-income children (8). well-baby clinic records, the incidence of anenn Since 2.- and 3-year-old children share the among infants wider 1 yearof age in Honolulu is family table, they cornanne ethnic foods to some believed to be higher than we have found for degree. As has been observed by Wenkam (2). children :2 and 3 years of age. breakfast and lunch usually consist of conventional American foods and cliches, and ethnic NUTRIENT INTAKES foods may be used for dinner (evening meal) or Mean nutrient intakes inaa derived for infant, as snacks. Soy sauce and soybean curd (tofu) are and for children 2 and 3,years of age from 3-day widely used in cooked dishes as well as snack food records (table 2). The NRC recommended foods. Combinations of vegetnibles and meat at o allowances are shown in table 2 for purposes of common among all ethnic groups. The ingredients gross comparison. The ranges of intakes emphasize used in these mixed dishes vary considers., ly in the extreme variation among individual children. kind and amount and present real problems in diet With the exception of iron, nutrient intakes of 0alcuiations. Certain oriental snack foods such as infants compare favorably with the recommended .-.foreserved seeds, sushi, dried squid, and various allowances and often are well shove recommended !meat, vegetable, and dough mixtures are popular. levels. On the whole, infants appear to be some- tfary of these foods are introduced by the sixth what better fed than the 2- and 3-year-old children month of life. The consumption of these food items in our samples. These differences may be due to is not confined to any specific ethnic group. They the vagaries of the behavior patterns of 2- and 3- are readily available and are enjoyed by many year -old children, but also may be due to the groups. Beyond infancy, however, poi remains greeter choice allowed to the young child, who most widely consumed by families of Hawaiian often selects snack foods of relatively low nutrient ancestry. Unfortunately, the availability of poi has value./ decreased steadily with urbanization, and its price has increased to about 20 cents for a half cup. Poi, Income class (and associated socioeconomic fac- therefore, is an expensive food item. tors) apparently affects nutrient intake to some degree. Calcium, ritaiflivin, and ascorbic arid in- VITAMIN AND MINERAL takes were found to be lower for low-income children than have been reported for children of SUPPLEMENTATION lower-middle-income status (8). The difference is Routine daily vitamin supplementation due apparently to lower consumption of milk and nil. In our; expe:ience, few low-income citrus productaaLow vitamin A intake also appears mothers in Honolulu actually follow ins ructions to be more common among low-income children. in giving-pros Pled supplements. R aghly 30 per- Of the ethnic groups studied, the part- Hawaiian cent of our sample of infants under 1 year of age and Japanese samples were large enough to permit rnd 34 percent of children 2 to 3 yeaos of age comparisons of nutrient intakes. Unfortunately ostensibly were taking vitamins, but few were only the lower-middle-income groups are repre- given the supplements daily and some apparently sented, since only one Japanese family in our sam- never received the suppleinent. The decision to ple was clawed as low-income. The data on nutrient supplement appears to be an arbitrary judgment intakes of low-incor e and lower-middle-income unrelated to the ehild's needs (11) and is made by Hawaiianchildren,and lower-middle-income the mother or relative as often as once advice of Japanese children are shown in table 3. Energy, a physician. iron, and niacin intakes of Hawaiian children tend Iron-containing suppleinents are given less often to be higher than those of Japanese children. En- than vitamins, although the need for ironi appears ergy and ascorbic acid intakes are lower among to be greater. We found that roughly $ nercent of low-income Hawaiian childrenthan among a sample of low-income children 2 to 8 yec.,rs of age middle-income liawaiian children. had hemoglobin levels below 10 gm. per 1G) We are, reluctant to speculate on the significance but only 1 percent of heraatocrit levels were below of these trends, but diffetnces in caloric intake 93 449-425--42-=t - are possibly related to differences in size. Hawai- the second month of life roupfily one-third to one- ian children are taller and heavier than Japanese half of infants were fed some form of solid food, children (13). Energy intakes of low-income Ha- chiefly cereals, fruit or fruit juice, and vegetable- waiian children,,lowever, were more similar to meat combinations. The amount of milk consumed those of the smaller Japanese children. Whether by infants inemsed from birth to 6 months ol.age these differences persist into latir life and could and then 'declined as more solid foods were intro- ultimately affect growthis uncertain. duced into the infant's diet, Commerciallypre- pared infant foods were used almost exclusively. SUMMARY Children 2 to 3 years old appear to be less well fed The data presented here were compiled from than infants under 1 year of age, but there. Was surveys carried out during the last five years on little e;idence of serious malnutrition.- Diets of two sample groups in the city of Honolulu. Arti- low-income children 2 to 3 years of age contained ficial feeding was favored over breast feeding by less Milk and citrus products and more cereal a large majority of low-income mothers. Specially grains than has been reported for children Of prepared infant formulas were used by One-third slightly higher income families in Honolulu. Ac- of sample groups; evaporated milk formulas were .cordiagly,calcium,riboflavin,andascorbic the other most common form of milk feeding. By intakes tend Co. be lower.

Table. 1. -food intake according to infants° ages r.

Under 2 months 2 to 3 months 4 to 6 months Over 6 months food NumberAver- NumberAver- NumberAver- Number Aver- ..of age Range of. age Range of age panne of ode Range infantsintake infantsintake infantsintake infantsintake

Milk (oz.) :4.27.7 14.7 736. 5 10 29.4 la040. 2 18 31.9 15.5 -61.3 20 24.8 8.0 -38.5 Dry cereal (oz.) 2 .1 .08-.19 4 . 4 .17- .27 9 .7 _17 -2.3 13 .30 .08- 1. 0 0 Egp (number; 0 2 1.0.33- .66 3 .90 .t3- 1.0 Fruit(oz.) 0 7 3.7, .99. 4 13 5.1 .77-12.5 16 3.3 .17-12.7 Fruitjuice (oz.) 0 6 3.7 1.3 -7. 9 11 4.7 .50 -16.0 15 4.3 .66 -15.0 0 VegeMble (oz.) 4 " 1.4 17-2. 4 9 2.6 .33- 5.2 11 .22- 6.2 Vegebblefmeat (oz ) 0 5 2.0 .17-2. 4 16 5_4 .33-11.3 18 4.9 .33 -15.0 Meat(oz.) , 0 I 2.3' 6 1.5 .27- 3.5 12 1.3 .33- 2.3 Prepared cereal (dz.) 0 3 2.5 1.3 -4.6 6 3.4 1.0 - 7.8 17 1.9 .33- 4.7 Custard pudding (oz.) 0 2. 2.5 1.5 -3.f 3 2.5 1.5 - 4. 5 7 1.3 .5 2,3 Pol (oz.). 0 0 4 1.6 .5 - 2.7v 3 1.8 1. 2 - 2.2 Bread products (oz.) 0 0 10 .6 .18- 1.8

. Table 2.-Nutrient intakes of infants and young children derived from 3-day food records

Under 4 months (N -.14) 4-6 months (N...18) 7-9 months (N 2 years (N=.65) 3 years (1-42)

Intake RDA Intake RDA Intake RDA -Intake RDA Intake ROA

Energy (kcal.) 725 480 983 770 890 900 1,186 1, 250 1, 386 1,400 Range .843-1, 186 526-1, 673 658-1, 405 _,._ 470-2, 586 569-2, 714. Protein (gm.) 25.5 8 35.3 14 .33.8 - 16 46.6 25 51.6 30 -Range 9.8-44.3 10.2-74.2 14.6.63.2 17.5 -86.1. 20.8-110.3 Calcium (mg.) . 897 500 1,085 500 .973 600 602 800 631 800 Range 380-1, 529 364-2, 389 404-2, 464 115 .1, 578 178 -i, 660 Iron (mg.) - 5.1 10 10.0 10 8,9 15 6.3 15 7.6 10 Range .4-14. 2 .4 -35.8 2.5-19.1 2:3-17.4 . 3.0-25.4 ...... Vitamin A (111.) 2, 539 1,500 5,537 1.500 4,390 I, 500-,. 2, 510 " 2,000 3, 000 2, 000 Range 336-8, 559 I, 641-30, 900 842-9, 544 220-10, 580 410-15,420 Thiamin (mg), .47 .4 .71 .4 .60 :: .58 .6 .68 .7 Range .10-1.40 .32 -2.22 ,23 -1.09 .19-1.54 .23 -1.66 Riboflavin (mg.) 1.40 .5 2.01 .5 1.60 .60 1.15 .7 1.22 0 Range .62-2.58 .614.99 76-2.90 .38 -2.59 .38-2.97 Nlw.ln (mg) & 4 . 1 7 . 5,9 7 6.0 8 .7.7 8 8.7 3 Range .7-9,4 2. 1-,, 13.4, 2.0-8.6 2.8 -20.6 3.3-16.9. Ascorbic kaki (mg.) 43 35 35' 77 35 33 SO 42- 40 -..-----Range 2-134 14.b-170 10-433 3-110 1 -180 1 Mg. equIveienb.

ti Table 3.-Nutrient intake.; of Hawaiian and Japanese 5. K. L. Howard, "Food Choice and Acculturation Among children, 2 and 3 years of age Some Ethnic Groups in Hawaii," Hawaii Med. J. 26 (1967) : 209. Hawaiian Japanese Low income Eddie income Middle income 6. IL L. Brown and S. F. Adelson, "Infant Feeding Prac- (N =76) (4 =42) (4=60) tices Among Low and Aliddle-Income Families in Mesa S.11' Mesa3.1). Mean S.D. Honolulu," Trop. Geogr. Died. 21 (1969) : 53.

.-. Enerity (itaal-) 1.343 48111,516 674at 217 393 7. H. A. Guthrie and G. M. Guthrie, "The Resurgence of Protein (gm ) 50.4 22.2 55.0 20.2 46.2 17.9 Natural Chita Feeding." Olin. Pediat. 5 (1966) : 481. Calcium (413)- 615 390 742 398 733 365 Iron (at) 7.3 4.2 17.5 3.5 15.9 3.9 8: IL L. Brown et al., 'Diet and Nutriture of Preschool vitamin A (l.U.) Z 7302,990 3,290 2,3202.960 2.830 Children in Honolulu." J. Amer. Diet. Assoc. 57 Thiamin (t.g.).. .64 .34 .73 .31 .61 -.29 (1970) : 22. Riboflavin (mg.) lalli .63 1.40' .63 1.27 .58 Nicht (mL) L1 4.6 a &9 4.3 164 3.5 9. C. H. Ho and M. L. Brown, "Food- Intake of Infants Ascorbic add (m) 39 -44 59 77 159 52 Attending Well-Baby Clinics in Honolulu," J. Amer. Diet. Assoc. 57 0970) :17. IStandard devtation Significantat 2%level. 3 Significant at 5% level. 10. A. is.oth, R. 3i. Worth, and' I. J. Lichton, "Use of Poi in the Prevention of Allergic Disease in Potentially References Allergic Infants," Ann. Allergy 25 (1967) : 501. 1. State Department of Planning and Economic Develop- 1L M. L. Brown, "Practical Aspects of Supplementation ment, Statistical Report Na 77, State of Hawaii, of Children's' Diets in Honolulu," Hawaii Med. J. 1970. 29 (1970) : 370. 2. N. S. Wenkam and R. J. Wolff, "A Half Century of Changing Food Habits Among Japanese in Hiwail," 12. S. J. Fonion, "Prevention of Iron - Deficiency Anemia in J. Amer. Diet. Assoc. 57 (1970) : 29. Infants and -Children of Preschool Age," Public 3. J. Masuoka, "Changing Food Habits of the Japanese v Health Service Pub. No. 2085, Maternal and Child in Hawaii," Amer. Social. Rev. 10 (1945) : 759. Health Service, IISMHA, HEW (Washington, D.C.: U.S. Government Printing Of 4. D. R. Basset, et al., "Coronary Heart Disease in 1970). Hawaii : Dietary Intake, Depot Fat, 'Stress,' amok- 13. D. S. Smith and M. L. Brown, "Anthropology in lag, and Energy Balance in Hawaiian and Japanese Preschool Children in Hawaii," Amer. J. Olin. Nutr. .Men, 'Amer. J. Olin. Nuts: 22 (1969) : 1483. 23 (1970) :982. 0. Discussion

Miss Doris E. Lauber,_ Session Chairman : In -50 percent reported by Brown and Ho. Both formation pertaining to feeding practices of in- studies certainly confirm the current tendency fants and preschool children in Hawaii has been toward early introduction of solids despite the obtained by the -nutrition staff and other health added cost and lack of professional advocacy. personnel employed in Maternity and Infant Care As on the mainland, thereseems to be some un- and Children and Youth projects: In particular, explained _status connected with early introduction I should like to ;thank Airs.. Flora Thong; Mrs. of most infant foods. By 2or 3 months of age, Clara Tamura ; Miss Alma Tanaka ; and Mrs. infants are fed all varieties of infant cereals,Is, pucl--_ Carole Ito, Hawaii Department of Health, for dings, fruits, juices, vegetables, and vegetable- sharing their findings and observations With' us in :neat dinners. As reported by Brown and Ho, writing. I shall quote verbatim from their reports. strained meats and either canned,or fresh egg The findings are similar to those repOrted by yolks are not,commonly fed. Eggsare thought to Brown and Ho. The "typical" project patient' is cause "rash" and strained meats are considered non-Caucasian, nonwhite, and low-income. too expensive. Infants are seldom breast-fed. As noted by The typical Hawaiian' diet, including -.cooked Brown and Ho, those mothers who do breast feed fish, raw fish or seafoods, seaweed,coconut, etc., often discontinue this mode of feeding by the time is seldom fed to infants. Poi Is ani6-eeption. By the infant is 2 mouths of age. 1 to 2 -months of age, 1 or 2 tablespoons of fresh Commercially prepared formulas are given to poi is 'frequently added to the formula.Commer- the mothers when they and their infants are dis- cially prepared strained infant foodsare preferred charged front the hospital, but some of the women to home - prepared foods because ,Of statusand feed evaporated milk formulas after discharge: 'convenience. Despite recommendations to the contrary by For most _infants, bottle feedingcontinues physicians, nurses, and others, many mothers feed through the first year of life and it isnot uncom- cereals and strained fruits and vegetables to their mon to find 2-year-old children stilk, taking milk babies during the first 4 weeks obi life. Mothers from. a bottle: Commercially preparedformulas state that their babies are not satisfied with only are usually discontinued between 2 and 6 months the formula. Infant cereals and strained fruits-of age, -and the infant is then usuallygiven an and vegetables usually are mixed with the formula evaporated -milk formula, and later,whole milk. in the amount of about 1 tablespoonper bottle. Infants are. fed strained babyfoods and then Most babies are not held when fed. Mothers report table foods; junior foods p.re'seldoni used.Between that they are too bizy. 3 and 4 montheof age most infants areintroduced In an unpUblished study of 40 high-risk infants, to table, foodsrice, gravy, cannedsoups and Mrs.-Tamura found that 33 infants were initially meats; bread and crackers. In Tamura's studyOf fed commercially prepared formulas (only one high-risk infants, 12 were eatingsome table food with iron), six were fed evaporated milk, and one by 6 months of age. Although all 27who had a soybean -based formula. By 1 month of age, cereal attained the age of 12 monthswere eating table was being fed to 29 infants (rice cereal to 28) ; foods, only two infants had been, given junior poi was fed to three; strained vegetables to foods. She hated commonly used 'tablefoods as seven; strained fruit to two; strained desserts to bread, carrots; potatoes, rice, chicken, beef,stews, two; fruit juices to two ; and vegetable-meat din- corn, peas,' spinach, canned sows, scrambledor ner to one. Seventy-two percent Of infants were boiled eggs. (although only 10 of 2 ported using fed some form of solid food during the second -eggs), crackers, Vienna sausage, W fish, .ice month .of life, a larger percentage than the 33 to- cream, fish, luau-leive.s, aria pumpkin: e absence 96 of fruit as well as cereals from thg* list should others. There are a number of beliefs on appropri- be noted. Papayas and bananas are seldom red ate foods for lactating women. In the Chinese since they are not home-grown andare considered group, pigs feet with ginger is a traditional dish expensive. given to mothers soon after they give birth. Pig's In the study by Brown and Ho,as well as.in feet with ginger and .a high concentration of vine- a study of intake and dietary practices in the gar are cooked for a long time at very low tempera- Waituanalo Children and Youth project, the_tures. This dish is probably high in calcium and changes in nutrient intakes are reflected in feed: phosphorus. Salted or fermented fish and salted ing practices. AsCorbic acid intakesare low in duck eggs are also traditional dishes allowed the pr.eschool children despite the fact that guavas nursing_ woman during the first months of lacta- are plentiful and are an excellent iouree. Guavas tion. It was almost standard practice for families are sold for commercial use for needed cash by to bring this special food to the hospital for the many families. Few families grow their own pa- mother after birth of an infant andwas permitted paya, though this fruit, too, is an excellent source by the professional staff. The Japanese favor miso of vitamin C. soup (soup made with soybean paste) for greater Kool-Aid, carbonated beverages, coffee, and tea breast milk production. The Koreans give seaweed may be given between 6 months and 1 year of age: and clam soup to nursing mothers. Orange drinks, orange base, or punch syrup di- In the past there was great emphasison lacta- luted with water is often put in bottles and fed tion; breastfeeding was prizedas a necessity for - as "juice." a healthy child. No doubt these beliefs and prac- Intake of sweets and carbohydrates by preschool tices no longer apply to the majority, but such be- children is generally found to be high. Rice is liefs are still existent. If grandparents, whoare a popular food, and diluted canned soup served strong believers, are the decisionmakers andpower with a quantity of rice is considered to be an ade- wielding members of the familygroup, these prac- quate or acceptable meal by many families. tices are -likely to persist in the familygroup. Patterns of infant feeding or of preschool food Beliefs of the dominant culture are intertwined choices seem to vary little from one part of Oahu with customs and beliefs of snbcultures. In dif- to a aother. There are wid, choices of foods, and ferent periods in the life cycle,one set of beliefs there is certainly an amalgamatiOn of ethnic food may dominate over the other, depending on hew patterns. deeply these are ingrained and the state of accul- Dr, Mary. Mural: On the basis of observations turation of the, population group. made during 15 years of working and living in Brown and Ho noted- that mothers of Hawaiian Hawaii and frOm subsequent frequent visits, I ancestry favor feeding poi and meat at a, somewhat want to.emphasize the point made by Drown and earlier age than mothers of other ethnicgroups. I Ho that, their findings cannot be generalized to have noted that Chinese and Japanese mothersgive other ethnic groups, of which there are many in rice gruel or soft rice (rice cooked with large Hawaii. Smile of the other ethnic groups may not amounts of water) and soybean curds earlier than acculturate as rapidly as the Hawaiians. The con- mothers of other ethnic groups. Soybean curd is clusion, "robd practices among infants and very made from soybean milk by precipitating thepro- young children do not appear to be influenced tein with calcium. r magnesium salts and pressing significantly -by ethnic or cultural background of it into cakes. This product hasan iron content of the family," is undoubtedly true; however, even 1.5 nig. per .100 grams and very little crude fiber, within these groups the degree of acculturation and theprotein has a very high coefficient of digest- varies. The great amount of travel between and ibility. It is usually given freshor cooked and is immigration from the countries of origin of some bland in taste. of the Asiatic groups continually reinforces beliefs As the child reaches 2-or 3 years of' age, his and customs. .I have been struck by the increasa diet becomes a mixture 'of Caucasian!Chinese) in 'number of Japanese foodshopa which 'are Japanese, Hawaiian, and other ethnic foods. As .branes Of shops located in Japan. Culture, cus- stated by the authors,. poi remainsmost widely tOmi, raditions, and folklore persist in varying consumed by' families of Hawaiian ancestry,.and degrees:\ rice isWidely consumed by other groups,who con- Infant \feeding practices ° can probably be sider it their most important staple. adapted by, some subculture§ °More easily than Dr. Brown : I would like to raisea -few (pies-

44'3- 725 -i '--s) N

tions that seem relevant. First, are those families lar diseas"s anion:: black children and are reluctant who visit a clinic typical of the entire low-income to have mothers feed any kind of fruit juice. par- population, or do they represent the most moti- ticularly orange juice, to the young infant. vated families? Second, in our studies of almost Dr. Broivn: I Imow that some pediatricians in 300 children, we had a 30-percent cooperation rate, Hawaii also hold this view, but I do not know how which meant we learned nothing about 70 percent general it is However, the advice of the pediatri- of the people. I wonder what these 70 percent are cian is often not followed.; like. Did we get the right people in our sample? Dr. George M. Owen: Pediatricians are aware Can the people we examined tell us what we really that their advice is often not followed. However, need to know ? I would guess that orange juice is less commonly Miss Lauber: According to regulations of the fail to infants today than was the case 25 years welfare program in Hawaii, if a woman comes for ago- prenatal care and is certified to be pregnant, she Mr& Mary Ellen Wilcox: We provide vitamin receives an increase in food allowance. This serves and iron supplements in our clinics, and our guide- as an incentive to come for prenatal care and, once lines recommend that orange juice not be fed in the clinic, patients are counseled on th&impor- until 6 months of age. However, most of the tance of good nutritional practices. mothers have introduced it by the time the baby Dr. Brown: Altitudes of mothers toward their is brought in at 4 or 5 weeks of age. infants in Hawaii are such that income exerts rela- Miss Lauber: Many physicians working in the tively little influence on feeding practices. Income clinics that serve these low-income families in begins to make a difference in the nourishment of Hawaii do not believe in the efficacy of iron- the child beyond 1 year of age. fortified formulas and therefore do not recom- Miss Mitry Lynch: Do-you think that use of mend that mothers feed them. If the Academy of expensive foods for the infant less than 1 year of Pediatrics' recommendation 1isaccepted, this ageplaces,a strain on the family budget that practice may change in the near future. One is makes it unduly difficult to provide adequate food reminded When visiting some of the prenatal clinics for other family members? ' or well-baby clinics in Hawaii that there is no Dr, Brown: The low- income families average' typical Hawaiian. One might see a part-Hawaiian, about six -members. What the costs of infant pert-Japanese, or part-Filipino who has adopted_ formula and strained foods do to the budget, I some of the food patterns from each of these and' don't know. many other cultures. Dr. Ogden Johnson: Is there a greater use of Dr. Brown: We found that mothers are given fruit juice and fruit products among children in free iron supplements in the clinic but for the most the 2-, to 4-year-old age group in Hawaii than in part do not use them. A few give medicinal iron the other parts of the United States regularly to their infants but many use it infre-

Dr. Brown: No. Fruit drinks seem to be used quently or not at all. , -- more -than fruit juices. In our studies, 25 to 30 per- Dr. Mural: The comments of Mrs. Marjorie cerit of the dietary ascorbic acid came from to- Abel, chief nutritionist for the State of Hawaii, matoes and citrus fruits and 50 percent from other are' of interest. She agrees with Brown and Ho fruits. Many families used drinks which were . that the ethnic backgroundS'of low-income groups fairly low in ascorbic acid.- Pineapple is notpopu- are mainly "part-Haivailan," Samoan, and Fili- lar in Hawaii:Practicelly everybody who halved pino. She emphasizes that family relationships are in Hawaii all his life has at one timeor an; ther changing rapidly in Hawaii. Even among the worked in a, pineapple factory. If you work in a Chinese and Japanese, who traditionally honor the pineapple factory all day, you do not want to eat pineapple. Its is the 'least popular fruit at least elderly, older people are now often placed in nurs- among college students. Popular fruitS are 'apples, ing' homes. The influence of older persons, in the bananas, "and oranges. Neither papaya nor pine- practices of the young is sharply reduced. Thirty apple is popular. years ago, families gave infants exactly what was Miss. Catherine. CoWell: A number of pedia- ordered by physicitins,. even if this meant depriv- tricians in New York City advise ageing feeding &Committee on Nutrition, American Academy of Pediat-, orange juice before 9 or 10 months of Elg. They ries :Committee statement :Iron fortified formulas. claim there is a high incidence of a_ sthiaaan shill- Evanston, Ill,, December 16, 1970. 98 - ing the rest of the family. Now, theyare inclined bol. If the nest door neighbor's infant is eating to anticipate the plysician-4o begin feeding cereal and yours is not, there must be something strained foods and table foods earlier thanis wrong. The biggest problem we have had in man- recommended. A traditional idea is thata fat baby aging PKU infants is keeping solid food out of is a healthy baby and one who reflects the family's the diet until 3 months of age. economic status. Early introductionof various Dr. Brown: The physician may not want foods is believed to Make the infant healthy. mothers to feed solid food as earlyas they do, but Mrs. Abel says that whereas 20years ago about in our experience he doesn't really discourage them 90 percent of infants received evaporated milk from doing so. Because it makes the mother happy formulas, now nearly all receive commercially to feed the baby early, the assumption is that if prepared formulas. The principal argument by the mother is happy, the baby is happy. Mothers physicians is the nead for iron, but I wonder how seem to think thit if the baby gets more to eat, many mothers actually buy the iron-fortified he will sleep through the night. In recentyears formulas. we are-Ending more overweight children, suggest- Claire Ho has recently talked withpersons at ing that many mother r may be overfeeding their the Kapiolani Hospital, includingthe dietitian. children throughout childhood. They report that the most recent immigrantgroup Dr. Samuel J. Fomon: Ifa normal infant re- with significant problems in infant nutritionare ceives an adequate (and not excessive) intake of the Samoans. The influx of Asiaticgroups is in- calories and of every essential nutrient, it really significant and their influenceon their Hawaiian is of no nutritional significanCe whether the nutri- coup rparts is nil. ents are provided solely from formulaor partly Dr. Phyllis B. Acosta: In PKU clinicswe had from formula and partly from other foods. Early established a rule that we would not add any. introduction of strained foods may have important solid foods to the infant's diet until 3 months psychological, social and economic implications, of age. It is very difficult to keep mothers from but the nutritional consequencesseem insignificant adding solids hecause it has becomea status sym- unless poor food choices are made. Indian and Alaska native low-income groups

Infant and child feeding practices among low-income reservation and rural American Indian and Alaska Native* families

Mary A.-Peterson Indian Health Service Area Office Billings, Montana

INTRODUCTION practices are housing improvements, economic sta-, The material presented was assembled from re- tus, employment of mothers, available transporta- ports of Indian Health Service public health nutrition, Federal food assistance-programs, proxinaity tionists and a dietary'consultant. Since there are to food markets, physical and mental health status, limited data on dietary intakes of infants and and degree of knowledge of the importance of preschool children, the statements are primarily food to health. impressions drawn from observations and per- The permissiveness Of mothers is highlighted in sonal experiences. The exceptions which are re- reports from Indian Health Service nutritionists : ported separately are surveys by Dr. Christine Perhaps the practice which has the greatest Heller, Arctic Health Research Center; the Nutri- influence on what the Indian chiaeats is a tion Survey of White Mountain Apache Preschool part of the Indian culture which recognizes-'. each child as an individual. Therefore, the Children by Dr. George M. Owen with participa*- child by 2 years of age may eat when he's tion of Indian Health Service nutritionists; and , eat what helikes and what is avail- limited data on this age group from the Montana able,he adult tends to keep the kinds .of (Blackfeet and Fort Belknap Reservations) and foods the child likes best and those which are the Lower Greasavood (Navajo) Nutrition Sur- convenient for him to eat when he's hungry. Mothers and grandmothers are very perinis- _ veys conducted by Dr. Ainold ,E. Schaefer et al. sive with children about food. They let chil- and the Indian Health Service. dren, regardless of age, choose the food they Due to the transitions in Indian society-, tradi- want at whatever time they want to eat. tional food practices based on hunting; fishing and Some mothers have little understanding- of food gathering have greatly diminished. Most differences in foods or oa child's nutritive needs other than calories. Gandy and soft families now depend on local grocery-stores, res- drinks may seem as essential to them-as meat ervation trading posts and commodity foods and vegetables.- (where this program exists) for their principal 'food supplies. The extent to which traditional An example was given of a mother ordering a pre- practices are prevalent varies also with local avail- school child to share candy with an infant. ability of wild game, fish, wild foWl, berries and Another factor affecting food habits and nutri- roots. Seasonally, certain of these foods make im- tional status is family disorganization and the in poi-tent contributions to the family food intake. numbers of infants and children receiving Other factors which are influencing, feeding care outside the family. The resulting emotional . stresses and interrelationships. havereceived *Eskimos, Indians, and Aleuts. slight documentation interms of nutritional status.

101 ti

e, BREAST AND FORMULA FEEDING In the villages the incidence of breast feeding in the first month declined from 53percent in Feeding practices of infants and preschool chil- 1960-02 to 33 percent in 196S-70. Only_3 percent of cleen are gradually changing, with no set pattern Bethel infants Were breast fed during the first predominating. Breast feeding varies with degree month. In the 1960-62 study, bv 6:9 months ofare of acculturation. The working mother tends to formula was the sole source of milk for 40 percent bottle feed her baby. Breast feeding increases of infants and breast feedieg. for 25 percent. where job- opportunities are not available to the Screrity percent of village infants (G--9 months) young women. and 82 percent of infants in Bethel were r-ceiviner Information fromthe Lower GreasewOod formula feeding entirely by 1968. (Navajo) Nutrition Survey (I) indicates that "of In both studiee, canned evaporated milkwas 108 children, half were bottle fed from birth. Those almost always the formula fed to infants. Onlyone that were breast fed, were breast fed to 3 months village infant received a commercial formula. of age." The decline in breast feeding is greateramong In the Oklahoma City Indian Health Service Indian groups where other milk suppliesare read- Area (primarily Oklahoma, Mississippi, and ily available. The use of proprietary 'formulas North Carolina) infants are apt to be sent home when the infant leaves the hospital has increased from the hospital on a proprietary formula con- due to free discharge _pacts and prescriptions by taining iron, as ordered. by the physician, but this physicians. A study of records in the Blackfeet may be discontinued very soon in favor of the less Indian Health Service Hospital (Montana) found expensive evaporated. milk. This may be a "filled only 10 percent of newborn infants who 'were milk" called "Milnot" which costs less than the breast fed on discharge. Families who cannot af- usual evaporated milk. Proprietary formulas are ford to buy the proprietary forniulas often switch not always available in rural stores or trading to evaporated milk, which is available as acom- posts where Indians shop for groceries. modity food. Reports by Heller and Scott (2) concerning The -Indian Health Service dietary consultant 555 diet records for Eskimo and Athapascan for the MS Navajo Area and Albuquerque Area. babies 24 months of age and under in 11 Alaska (Navajo and Pueblo Tribes) reports that bottle Native villages noted 382 of these dietaries were feeding may be of evaporated milk, proprietary for formula-fed Breast feeding *as com- formulas, or commircially prepared ready-to-use mon for infants2 m teas of age and ycamger,`"but formulas. Goat's runic maybe used when available. after this age, 1 I IIula feeding was the more Soft drinks, Kool-Aid, powdered orange-flavored common. practi Breast feeding was the sole -drinks (such as Tang), coffee and teaare fre- source of milk about 50 percent of the records quently used in bottle feedings. Aboutpercent of for infants-c er 4 months of age, and a partial Indian children in Irie Head Startprogram had source foraadditional 25 percent. By 4 to 7 not been weaned from the bottle. The same prob- months of leas than 30 percent were being en- lem is found with this age group in hospitalized tirely b .t fed and about an equal number-were Indian children. partially reastfed. BYB to 12 months, less than20 Continuation of bottle feedings well-beyond in- percentere entirely breast fed. Almost 66 percent fancyhes also been reported among several other of di:.infants were fed entirely by foiraula. Indian 'and Alaska Native groups. Heller believes Trenin a 10-year period in breast and forniula that among the Eskimos, this practice is carried feed' g are shown. in =published data gathered over from early 'practices of continuing breast bye Arctic Health Research Center (3), Tables feeding up to 3 or even to 5 years ofage. While .Information about milk feeding prabtices .only three reedrcls in her study of 555 infantrec- a,d solid food supplenentation walkobtained-by ords shwa/ children being breast fed beyond 24 urses who visited an average of three times in months of age, 105 records show childrenover 2 the home of each infant. In 27 small Alaska Native years of age still receiving part of their milk from villages 282 infants were included in the 1960-62 the bottle. Most of these children were receiving study. In 10. of these sem villages and Bethel family: diets, and the formula was usually given (2,000 estimated popiilatiOn in 1969), 249 infants in the late evening or early, morning and thus *ere included in the second study in 1968:70. may have served only as a pacifier (2).

102 ADDITION OF SOLID FOODS mashed vegetables from stew, fried potatoes. tortil- Latv introduction of solid foods, as well as very las, pinto beans. and/or soup from the .beans. earl supplements, has been reported by several Coffee and tea are introduced at an early age. Indian Health. Service nutritionists. Solid foods Coffee. however, usually has added milk and sugar. for infants in the Oklahoma City IHS Area have Solid foods are sometimes introduced on demand been reported to be started within a week after by the older baby, who might be sitting on the birth or delayed for several months. First solid mother's lap while the mother is eating. The child food is frequently gravy made from drippings and may accept or reject the food the mother offers flour, sometimes with milk added. Table food may be started quite early. Depending upon economy, If available, a selected lamb bone is provided the family diet is likely to be high in carbohydrate for teething. Corn and potato chips are also offered and in fat, limited in god quality protein, and and used for teething.' The late introduction of short in sources of vitamin C and iron, at least. solid foods and failure to learn to chew have been Few children are brought into clinics after the first quite noticeable among Indian children in Head Start programs which now have 3-year olds. This year or two, except for illness. Public health nurses same problem is found in hospitalized Indian pre- report that infants may be taken off milk, arid have school children. "pop" substituted, before the end of the first year. Cookies and candy are often preferred over other After weaning, milk consumption may be solid foods and a high degree of permissiveness greatly reduced in order to provide milk for 'a is usual. newborn or to be shared with other family members. The belief that milk is only for babies also -Although nutritionists in the Indian Health reduces the consumption. Service., Oklahoma City Area, caution against gen- The 1961 -62 Montana Nutrition Surveys (4) eralizations, some general trends were observed. conducted ohe Blackfeet and Fort Belknap In- Lean meat is seldom used. Salt pork and bacon dian Reservatio e terdepartmental Com- are used by almost everyone, as are eggs in either mittee on Nutrition for National Defense in co- fresh or dried form. Dried beans are found in operation with the Indian Health Service and the nearly all diets and serve as the basis for the diets tribal goternments included a sample of children of the very poor. Vegetables are seldom used and ages 0-5 years. Dietary intakes of this age group fruits, even more infrequently, or not at all. Milk were not published; therefore, the family food in- is not consumed in any quantity as a beverage, but takes are discussed as an index of nutrients is added to home-prepared bread by many fami- available. lies. Bread in one form or another is used by Calories and protein were provided in abun- everyone. dance for the majority of families studied in both Table food for North Carolina Cherokee babies seasons (fall and spring). Foods providing vita- is apt to be poorly selected. Family food contains min A or carotene and ascorbic acid were used less rather large amounts of fat and carbohydrate. , frequently. F ru tswerewell liked, but more canned In the Portland Indian Health Service Area fruits than fresh or citrus type were reported. Cal- (Oregon, Washington, Idaho), "pure" foods are cium and riboflavin were in short supply. There frequently- the first,Lother than milk, given to the were inadequate intakes of iodine and fluoride and infant. These foods are picked by \the mother and excesses of concentrated sweets. Pie-Pared especially for the child. Crushed huckle- Family diets were -high in meats, starches, . berry was used to break in each child in one fam- sweets and, fats,,and lOW in milk, fruits and vege- ily. Other foods reportedly used for this purpose tables. The degree of iron4leficiency anemia in this are roots, salmon, dried eel, meat, chokecherries age group is uncertain due to the small sample size and blueberries-often referred to as Indian foods. of 39 children with biochemical assessments. In the Navajo and Albuquerque Indian Health The traditional basic diet of the Indian people Services Areas .(principally Arizona and New in the Billings IHS Area (Montana Mexico), late introduction of solid foods poses a ming) was meat-sprincipally-buffalGaer, elk and big problem. Very often these foods are not intro- antelope. All edible parts of the animal were duced before 1 year, or even Up to 3 years; Family eaten. This custom still prevails among -families foods introduced first might be broth from stew, who raise cattle or hunt wild game. Some families

103 have a supply of dried or frozen wild berries and solid food -for the cohort Until the 'continue to prepare. deed IllPItg Generally the fifth month of life, milkwas essentially the only 1e poile to usage of traditional foods is, "Where nutriment provided. can I get it?,'' indicating that supplies on hand Maynard, emphasizes the associations are insufficient. in his findings- between respEra tory diseasefrequen,.y, Physicians and nurses in Billings Area Indian hemoglobin levels and infant. feeding practices. Health Service facilities have reported that fami- He also cites the work of Scott andHeller 41964) lies who start solid foods early-tend ter fei;cl theni explaining the widespread prevalenceof iron- all at once rather than by gradual introdtirtion. deficiency anemia in Western. AlaskaEskinhiS as There _are other cases of withholding Solid foods due to a dietary preponderance ofcereal and ti,h until late in the first 3-ear. Thereare still many protein calories. Maynard states: hospitalized infants who hale -to be taught to eat from a spoon. Young mothersare more apt to use Our result:, show that this deficiencyis already well established in infancy,and pro- canned baby foods if moneY is available An indi- vide. an epidemiological groundworkof sup- cator of usage of these items is the supply of baby port for the assertion of Andelman andSeesid.. foods on hand in small reservation stores. Evapo- (1966) that increases in infant dhemoglobin rated milk (also used by the faidly), infantce- levels through dietary ironsupplementation can result in a decreased incidence of respira- reals, vegetables, fruits, puddings, juices, and tory infection. junior dinners are often available. Proprietary formulas, meats and eggs for infantsare not.Heller's studies (6) in Alaska turn the most generally stocked. definitive data currently availableon dietary prac- Families who feed table foods to infants have tiees cif Anierican Indianand Alaska Native in- reported using mashed potatoes andgravy, soup or fants and preschool children.Although the diet of stew with mashed vegetables, and- juices. The in- the urban Eskimos and Indiansis essentially the fant may be given a large piece of meatto chew same as that of the rest of the U.S.population, on. A mother reported, "he held it and chewed un- local meat and fishresources are still the most inr- til it was white, with no meat left." portant sources of several nutrientsfor Eskimos Public health nurses reporta low milk intake and Indians living in theirnative villages, and after infancy. Comnvetity nonfat dry milk is their use is expected to continue.Imported foods, poorly utilized due to problems in reliquefying the particularly milk, cereals, and breads,are impor- spray-dried p.roduci. The instant type hasnot been tant sources of calories. Theuse of canned and available as a commodity. fresh products is limited becauseof cost and lack of proper storage facilities. Poorsanitation and ALASKA STUDIES lack of sufficient lmowledge ivater- and food- borne illnesses complicate the Maynard, in a study of growth, nutrition picture, morbidity and and "vreanling diarrhea" continuesto be a major mortality among 643 Eskimo infantsof Western health problem in the north. Alaska (b), noted that weightcurves for Eskimo male and fiinale infants did not differmarkedly Seasonal Factors from the Falkner standards for North American Nutrient cloaticiendes and diarrhealdiseases Caticasian children. Height in both. Eskime'rikales show Seasonal peaks. Nutrient' and females began to lag by the deficiencies in the second month of diets of infants and preschoolchildren, as 'wellas life. By the_ enl of the firstyear, mean Eskinio in family 'diets,were- More common from 'about heights approached the lower fifth percentile of midwinter to late spring. This is-aperiod when the Falkner curves. the supplies of both imported With regard to feeding practices and stored local during the foodi are generally low, and freshSupplies are first month of life, qs percent of thesr;infantswere not 'yet available. Heller (6) cites breast fed only; by, the. 12th troilth work of For- , of life, this tuine (1965-66), who found theincidence of acute percentage had decreased to 29. Solid foodaddi- diarrhea affecting infantswas especially high dur- tives of cereal and fishwere generally introduced ing the traditional "camping. by the sixth Month. Canned baby months"- Of June foods or fruits through September in the-Kuskokwim-Yukon of any kind did not providea major source of 'Delta area of Alaska.

164 Nutrient Intakes / Vitamin preparations were usedvery infre- Heller (4) analyzed 282 .diet records for for- quently,but when reported, they appeared most revla-fed infants, ages 24 months and under': from frequently in fall andearlywinter dietaries, but a total of 555 diet records in 11 Alaska villages. seldOrn in summer. Considerable discrepancy existed between the low Irniorted foods, mostly milt and grainproduets, and high. average daily intakes ior all 11 nutri- furnished the major portion of nine of the 11nu- ents throughout this age period. regardless of trient; for which the dietswere analyzed. Local season. Average daily intakes of calories, iron, thi- foods contributed -20 percent oftheprotein, iron, amin, niacin and ascorbic acid were usually below niacin and ascorbic acid. the National Research S..;:vancil's Recommended. Dietary Al:owanees. Solid Food Supplements A significant number of average daily calcium Low nutaient intakes were due, primarily,to intakes below the -Recommended Allowances were failure to add `suitable solid foodsupplements to found at the 6- to 11-month age level. inreaSing the infant's milk diet. Thiswas due, in part, to to over-50 percent at the 18- to 23-month age level. lack of knowledge of theimportance ofsuch foods Average daily intakes of protein and vitamin A and the-inability to obtain them (6). were Seldom below the Recommended Dietary Xl- - The -addition of solid foods to the diet of the lovrances until infants w months of age and Alaska Native infant isnot conunonly practiced older. It appears thatgnificant numbers-of these until 8 to 12 months of age. Only 30 percentof the infants, ages 12 to 23 months,, do not receive ade- diet records for infants under 8months of age quate amounts of milk, nor do they have adequate showed asui)plementaty feeding ofany kind. At supplementation of their diets With meat, fish or 8 im,12 months of age, 60 percent of therecords- showed some solid food being used, huteven at About 75 percent of die dietaries at allage levels 13-18 months, about 10 percent of recordsshowed -failed to meet the RDA for ascorbic acid. About that the child was still receiving milk only. 30 percent appeared devoid of ascorbic acid, and Precious data cited (3) -from home visitseby* about 25 percent showed average daily intakes of nurses who visited three times in the home of.,each 1 to 5 mg. Most of-the foods that mitt possibly tinfant are shown in Tables provide at least minimal intakes, such as local The sections of the' questionnaire regardingmilk meats, fish, berries and greens, were infrequently feeding habits were similar in the twostudies. The given to infants under 9 to 10 months of age. With sections regarding food additives differed.In the the older infants, these foods appearedi dietaries 196042 study, 10 foods (canned baby food,bread; ,optsporadically or seasonally. cake, cookies, soup with no meat,soup with meat Of the total ascorbic acid intake, vitfnin sup- or fish, Cereal, meat, fish, seal oil) anda category plements furnished about 40 percent;fruits. for "other" 'were listed; in the1968-70study, three mostly native berries, about 50 percent; dairy and foods (meat, fish and babffood) and"other" were vegetable products, about 5 percent each. ' listed. The data for both the1960-62and1968-70 Ascorbicacidintakesvaried much more studies indicate that there isan increasing number throughout the seasons than did those ofany of of infants receiving foods other tha.ninailk,cereal, the other nutrients. During both thesummer and and soup in both the villages and- Bethel.A few fall seasons, use of mixed food preparationscon- observations and impressions of the AlaskaIndian taining cloudberries (178 mg.or more ascorbic Health ServiCe public health nutritionistsare: acid per 100 grams), wild ediblegreens, or fish 1. Prernastication by the mother of foods livers increased. Because of the plentifulness of such as meat is still a practiceamong some these foods in some areas, the Mean intake oitas- Eskimos. corbic acid in summer and fall approachedthe 2. Evaporated milk is sometimes diluted Naiional Research Council's 'RecommendedDiej more than with equal parts of water when used for toddlers. For exam-T.1c, bedtime taiy Allowances. The, few familieswho went to but-. ties that are largely water are sometimesused. traditional spring camps seemed to fare the best, Sometimes who:e claimed milk (65 to 80cents for these campsites are usually located wherefresh a quart). is diluted. Nonfat dried milk for fam- fish, .wild fowl, wild fOwleggs, and sometimes ily use is inersating, but often it isunpopular wild edible greens are obtainable, and has the 'reputation for causingillness (which may be due to the water used) 4411-723-12----9 105- 3. Use of "jarred" baby and junior foods is were, with the exception of the latter taco, increasing.Unfortunately, `dinners" and those also in limited supply for some Mi-mis- other mixtures seem to be lost popular. sippi children. It appeared that the pro- . 4. Dry, precooked baby cereals are Very rtiotr of Apache children with low levels of popular. I 11II chin in blood or of iron, vitamin A, 5. "Tang" is increasing in use and is moll Vitamin C in plasma and of riboflavin in urine like- d. (Table VIII) was similar to thet of low- 6. Kool-Aid and soft drinks are widely mediae children in Mississippi, andwas two or used in quantity. Some mothers do not con- three times the proportion of children in the sider these to be "sweets," which they know National study with lo* values.... Protein are- not recommended. One. reason for con- intake was quantitatively acceptable butwas fusion is that mothers are told to "give "pop" often of poor quality and in many instances during periods of diarrhea and fever. may have been utilized to some esisnt to meet 7. Wild berries are very popular and widely energy-needs. Average growth in height was used in season, often.- to make "ice cream." sigmfacantlg retarded (38 percent below the' Wild greens are much lefi frequently used.. 10th percentile of the reference chart), al- but they are iimportant in some remote Eskimo though skeletal maturation was not delayed. villa The majority of Apache children were in- t. Rose hips seem to be important among gesting insufficient iron to meet current needs-

some Athapascan Indians. and to create iron stores (7). _ 9. Unenriched rice and pancike raises are used in large quantities. Recently a popular Data shown in Table V raise some questionsre- brand of pancake mix showed enriched flour garding standards used by Owen for evaluating in one pac.el size. dietary intakes of pieschool children. Figures 10. Homemade yeast bread, fried breads, given for "lots" intakes are considerably lower and pilot crackers are important staples. The than Recomniended Dietary Allowances. Calcula- most frequently used brand of pilot crackers tions using data in Table IV on percentage distri- is enriched, but other brands that are increas- -ing in popularity are not enriched. butions of nutrients for two age groups, 12 to 23 months and 24 to 47 months, reveal the following NUTRITION SURVEY OF percentages of children failing to meet "the Na- -TORTE MOUNTAIN APACHE tional Research Council's Recommended Dietary PRESCHOOL CHILDREN 4 Allowances: During 3 weeks of April 1969, George M. Owen Approximate percentages of children with' Intakes below et aL (7) conducted a nutrition survey of children theMRC recommended diethry allowances (19613rev.)

between 1 and 5 years of age who are members of- Ara in Pro- Cal - Vit.Alcor- Thiel- Mho- months Cabties:tern -Iron Mum A bac min florin the White .Mountain Apache Tribe in Arizona. acid Five Indian Health Service public health nutri-

tionists obtained two 24-hour diet records on each 12 to 23-- 69 23 100 69 41 65 84 23 of 201 children by visiting their homes accom- 24 to 47 60 9 88 90 72 56 76 62 panied by a bilingual Apache woman. Diet records %;IPeil.rmmtama distributions o1 biochemical values in bkod or serum appear in TOM were coded by Owen's staff and nutrient intakes analyzed by computer (Tables IV, V, VI and Foods as sources of nutrients for the White Moun- VII). tain Apache children are shown in data of Oifen Of children visited ii the home, 80 percent (164) et al. (Tables VI and 'nu. 71)- were also examined in the clinic. Age distribution '' was 22 children, ages 12-23 months; 68 children, Dairy toodg ages 24-7 months. The children lived on,the Dairy foods made the greatest perceatige Clintri.- reservation in the general areas of Cibecue, bution to the daily intake of nutrients of children river and East Fork. I 1 to 2 years of age. The decline in consurrAion of Owen et aL in comparing these intakes with these' foods is shown in the drop in supply Of cal- those of presch;o1 children in MissieSippi (8). cium from dairy foods: 80 percent, in 12. to123- stated: months-olds to 51 percent in 24- to 47-month-old ..thoSe items in limited supply forsome children. the corresponding decline in mean cal-, Apache children, i.e., calories, calcium, I as. cium intakes (Table IV) is from 609 mg. to 399 corbio acid, iron, vitamin A and riboflavin, mg 106 Meat and Poultry school years. E Meat and poultry supplied rather small percent- grams of food ages of the total protein (17 percent) ;Iron- (15 percent at 1-2 3 pereent), thiamin (10 percent) , and niacin (25 per- and soft drink: years to 35 pert ,-)r 1 to 2-year -olds. The percentage in- -- to 47-month-old children indicate a "amily foods. FOOD AVAIL A. review of aes is incomplete 'Beyond the age of 2 years, leguines supplied economiC data approximately 13 percent of the protein, 22 percent families: Some of the iron and 13 percent ,Of the thiamin. decline in availi and therrelatiVe Grains Alaska Native Grains made appreciable contributions to the \ compounded by diet at both age levelssupplying 18:-23 percent of Pkemental food dren. There-is i ;the protein;23-31percent of the calories;36-40 and `consultatio] loercent of the carbOhydrate;32-39percent of the thiamin ;12-19percent of the riboflavin;' and ap- to loci of 'nutr proximately 30 percent of the niacin and iron. The U.S. ne -mental Food Fruit Vulnei.aple to Citrus fruits and juices and other fruits supplied reservations. TI the major amounts of ascorbic acid, with potatoes Services progra supplying the repiainder. portunity is opt grams under tri Vegetables "The Food Ste Leafy green and yellow vegetables, since not been well act didnot appear in tkte diete frequently, provided to -"certain Of only small amounts of vitamin A (carotene). With There` Mai :be the clectine in milk_ consumption after infancy and lowing- modifies low intake Of_butter and margarine,- the dietary- in Table IN for intakesof carotene and vitamin A could beex- cats that bonus peetectiq deereEkse. This tendency alsoappears 'in tribution,*hid the data onpereentage distribution of daily intakes trice, :due perhaj --(Table IV)'f or age 2 years.' and over: holds p articip at some of Fats and Oils improve' feeding These fooils are not habitlially eatenas spreads school children. On breads: Usage-is principally in foodprepara- tion. Only 2 percent-of less of the calorles:coul SUMIVIARY aitributed-to-anim-alTindetable fez oilS and The most. stri viewed is the in plied by family the year. Transit Suiiirs, syrups, jellies, end candies previded9- the family deper 12-percent of thG carbohydrate. An additional9-15 supplies from co percent was furnished by soft &Mks. assistance". prog - changes are, note Beverages feeding; theinci The use of tea and soft drinks,'which- began in 'tea, pad Koolai _infancy, 'steadily increased throughout- thepre- 'dren; theinei.e.su

%: !s. Expressed as a "percentage of total rood intake,": milk decreased from 32 1-2 yeaysto 11 percent at 2-4 years; tea rinks increased' from 24 percent at 1-2 percent at ages 2-4 years.

rAILABILITY of infant and child feeding practiCes te without further mention of socio-. Ida and the food resources of .Indian ome factors are limited cash income, vailability and use of indigenous foods, tively,higher fOod costs in Indian. and ,ive reservations and Villages. This is d by inflation and'iack of suitablesup- foods for infants and preschool chil-' cis heed for more nutrition education ;ation than is possible'to provide; due nutritionists. Department of Agriculture Supple- d, grogram for Low- Income Groups alnutrition is not available on most 3. e Emergency -Food and Medical agram ot the Office of Economic Op q operated by Community Action pro- r tribal,a.uspices.on some .reservations.... Stainp, program, where available, has a acceptiObVp.dian people due chiefly of the' inistratin feqUirements. be -improyementS in prticifiatioafol- lifleations *tlie Program. The data foBethely-Nonie and Kotzebue )nus coupon's made a signifiCant con- grOater. in the Bethel dii- rhaps to the laiief number of house- dpati4:and toldwer incomes. Hope- of theg" fUnds. are being utilized to Kling practices of infants and pre. [ren. r striking evidenco fiom the data re- inadequacy oftotal_nutrients sup- lily foods throughout most seasons of ansitionsin 'Indian society have made ependent on a cash economy and food n commercial, ourees or Federal food programs . whereavailable.These. noted; in the marked decline in breast .-"incteathituse of sweets, soft drinks, )1-Aid for infants and 4reschool chil- creases in usage of imported foods. in . . 107' 'Alaska; and the decline in availability anduse bility within acontext of rapid changes in Indian of native: foods. family living and environment. Although-there is Certam.of tit.e formulas substituted for breast no simplistic answer to improving food habits, it milk are inadequate in nutrients, improperly di- is apparent that too little'has been invested within luted and unsafely, prepared in the home. Indian communities to solve the problems identi- Solid table foods are often added late. in the fied. Recent developinents involving tribal gov- first year in the fOrm of broth frcim stew,' mashed ernments and training of indigenous. Indian.allied table vegetate' ,2s,' mashed potattieS and gravy, health workers provide an additional resource. Mashed beans, ades. or .juices, and cooked cereals. . Hopefully, the information obtainedy the If loCal supplies -Of .meats; fish or wild berries are nutrition researchers, and public health-inutri- available- in. season, the child may be given these tionists will'be Useful in giving direction to lefforts foods at 9 to 10 'Months of age. of. the Indian people and Indian-Health Service Lack of knowledge .of the importance of sup- personnel. plementary foods and inability to Obtain themAte. printaiY-yeasons for. these .feeding practices. The .Table I.Percentages of infants fed by breast or f6amula use of cAnnedlitby and junior foods is increasing. in 3 Alaska communities 1 "Dinners" and' mixed foods seem to be more pop- /-",- ular than the more nutritionally adequate meats 1960-62 1968-70 1968-70 ivnillaanyies village Bethel orvegetablei. Infants

Significant numbers, of children ages 1-4 years . . .- in Alaska, Montana, and Arizona studies had in- Breast feeding In 1st Month 53 33 3 Breast feeding In 6 to 9 months 25. 12 4 adequate intake&Or milk and other -high quality FOnnula leading in 6 to 9 months -40 10_:. az protein foods. Tithite,.Mountain Apache - preschool 'Dale of Bender (3). -Children. receivedo.183: percent of their protein . . from grains and 13 percent from fegurnes:- "Ger- .. Lain n.onenriched'prodUctsrice, Pancake mixes, sTable..11.-Percentagesof infants of various ages in 3 Alaska communities not receiving foods other than milk and pilot crackersare sold in Alaska; Arizona', or formula 1 . % and Montana. The latter two Statis. depot require enrichmentof:flonr. Montana recently, enacted all 1960-62 1968-70 1968-70 village village Bethel enrichment law. to be effective July 1971. infants infants infants FoOdS which 'are good sources of vitamin A

and ,ascorbic acid were very limited in the diets 1 month 89 /81 23 of preschool children and :their., families during '-'24::°0roltro 51 - 29 . 18 18. 11 -6 most seasons of the year. 6 to 9 months 5 2 3 Nutrition-studies have demonstrated the causa- 1° to11 inonthal 0 1 tivefactors of lack of education and food availa- 'Dataof Bender (3).

Table 111.--Foods o_ ther than milk or formula commonly-Included in diets of Alaska infants in three communitiesI

Age (months) Ranking or food additions - 2-3 . . 0-1 - 4-5 6 9 10-11

1960-62 Village infants Cereal Cereal ' Cereal Cereal Bread ;.?. Second Other Soup, no meat . Soup, nomeat Bread Soup with meat or fish Third Baby food Other Soup with rdeaf or'fishSouir with moat or fish Cereal 1968-70 . - ' Village infants - First.__ Cereal' = Cereal Carrie! Fish - Meat Second _Fish .. Baby food Baby food Meat . Fish -ma Baby food Fruit' Mint Cereal Table food 1968-70 Bethel infants First Cergal Cereal . Vegetables Meat Melt Second , Baby food Baby food- Baby food - Third, Meat Fruit_ Meat Fruit' . Veistebles

'I Data of Binder (3): ada. Table IV.:-Percentage distribution of intakesof calories and nutrients by Apache children t Intwo age groups

Less 40 50 60 70 80 90 100 110. Calories (kcal./kg.) than to to to 120 to to to .- to to and 40 49 59, Number Mean 69 79 . 89 99 109 ' 119 -.above - 12 to 23 mos 14 0 23 '14 18 24 to 47 mos 9 4 14 22 85 12 12 15 22 12 12 4 4 4 68 76

Less 1.0 -1.5 2.0 2.5 3.0 3.5 :Protein (gm2/kg.) ' than to 4.0 4.5 5.0 to - to to to to to and 1.0 1.4 1.9 Number Mean 2.4 2.9 3.4 3.9 .4 4.9 above

12 to 23 mos 9 5 9 18- 18 9 23 0 5 24 to 47 mos 5 22 . 2.8 1 8 13 22 28 12 10 2 4 0 68

Less 100 200 300 40 500 600 700 800 900' Calcium (mg.) than . to to to to to to to to and 100 199 298 399 Number Mean 499 599 699 799 .899 above

12 to 23 mos 9 13 4 4 13' 22 9 4 17 24 to 47 mos 6 23 609 22 13 15 19 6 1 4 1 7 -72 399

Less -.50 100 150 200 250 300 350 400 Vitamin A (I.U./kg.) than to to to .450 to to to to to and 50 99 149 199 249 Number Mean 299 349 . 399 449 above

12 to 23 mos 9 23 18 14 g2 24 to 47 mos 31. 182 29 11 10 12 3 0 0 68, 126

Less 15 30 45 Ascorbic acid (mg.) 60 .75. 90 105 120 135 than to . .to to to " to to to to and Number , 15 29 :. 44 59 Mesa, 74 t'._, 89 104 119 134 above .. 12 to 23 mos 43 22 9 4 9 0 24 to 47 mos 9 ; 0 0 23 33 39 21 18 8 - 2 4 72 31

Less. 2 4 6 8 .10 12 ,eIron (dig.) than 14 16 -19 to to to . to to to to to 2 3 and Number Mean 5 7 . 9' 11 13 _ 15 18 above

12 to 23 mos 35 38 12 12 24 to 47 most 0 0 26 4.73 10 35 29 14 . ..2 0 94 6.30

- - .. Less 0.10 0.20 0.30 '0.40 0.50 o '0.60 030 0.80 0:90 Thiamin (mg./1000 kcal.), .than to 'to to to 1.00 to to to to to and ,- - 010 0.19 0.29 ,0.39 0.49 Number Mau,. 0.59 0.69 0.79 0.89 0.29 above-

12 to 23 mos 0 15 35 8 19 --- 0 0 - 12 24 to 47 mos 0 - 4 26 4144 - 2 5 11 17 20 9 15 5 7 5 3 94 *". 0.52

Less 0.20 0.50 0.80_ 1.10 1.43 1.70 -2.00 2.30' 2.60 Riboflavin (mg /1000 kcal) than _ to to to - to to to to to and 0.20 0.49 039 1.09 Number Mean 139 1.69 1.99 2.29 2.59 above

12 to 23 mos- 19 8 27 23 4 12 24 to 47 mos 4 0 0 26 1.01 1 28 .19 10 - 4 1 1 0 94 0.76

- Table V,Mean daily Intakes of Apache children 12-47 months old

Calories Proteii; Calcium Vit. A Ascorbic acid Thiamin Riboflavin Iron (kcal./kg) (gm./kg.) (mg.) (LG./kg.) (mg.) _ (mg /1,000 kcal.) (mg.)

Mean 78 2,6 .450 140 32 0.5 0.8 6 Percent loVv 31. 4 30 15 40 19 12 80

Low Intakes s <75 <1.2 <250 <35 <15 <0.3 <0.4 <8 .<60

I Data -01 Owen et al. (7). <75 for children 12-23 months; <60 for children 24 months and older.'

Table VI.=Percent contribution of 10 food grqups to daily caloric and total nutrient intakes, of 12- to 23-month-old Apache children _

Percent contribution to daily intake

Dairy Meat, Eggs legumes Grains Fruit: Yew Fat, Sweets Beverages foods poultry tables oils

, Total grams 33 4 3 3 12 14 5 1 2 24 Nutrient: :t... ..2 Calories 32 7 6 5 23 10. 5 s 4 5 ... Protein a.- 42 17 11 '6, 18 ,1 4 <1 1...... ; ^Ft Fat ,, 45 11 12 16 5 5 <4" Carbohydrate 19 1. <1 5 30 20 - 6 9 9 , , <1 Calcium. 80 .' 1 3 2 9 3 2 <1 Iron 7 . 15 14 13 31 10- 9 1 2 Vitamin A...... _ ...... 32 3 17 <1 -9. 12 27_ <1 Thiamin. 29 10 6 6 32 9 7 I -<1 Riboflavin 67 6 8 2 12 2'" 2 <1 <1 1 Niacin' 25 25 1 4 30 3 11 1 <1 Ascorbic acid 17 1 <1 <1 6 60 16

.. Data of Owen et al. (7).

Table VII.--Percent contribution of 10 food groups. to daily, caloric and total nutrient intakesOf 24- to 47-month-old Apachd' children 1

Percent contribution to daily intake

Dairy Meat, Eggs Legumes Grains Fruit Vega'. Fat, Sweets Beverages foods poultry tables oils

.1s. Total grams 1.'" - .6 2 6' 16 7 7 1 2 42 Nutrient,, .

.''Calories 11 - 14 5 9 31 :. 4 . 9 2 - 7 Protein 16 31 ' 10 13 23 1 5 <1 1 Fat.' .17. 28 11 7 20 <1 -- 10 5 2 Carbohydrate fi 1'' 7 <1 9 40 7 9 -. <1. 12 15 . 7 i" Calcium 51 .... 2 -5 25 5 3 <1 .-1' <1 Iron ,-.. ,.. 1- 22 .. 9 22 31 4 .8 <1 2 <1 Vitamin A 14- 19 22 - 2 . 9 13 : 20 1 <1 ThiaMin 10 15 5 s13 39 . 7 11 <1 1 Ribofliiiin 36 18- 11. 5 19 2 5 <1 1 .. - . Niacin 4 38 : I. 8 27 3. , 17 <1 . 1 - Ascorbic acid 5 1 <1 1. 1 62 ' 30 " ,.

I Dativoi Ovemfat al. (7).

.110 Tab le VIII.-Percentage distribution of biochemical valuesIn blood or plasma of Apache 'children

Less 10.0 10.5 11.0 11.5 12.0 12.5 13.0 13.5 14,0 Hemoglobin (gm./100 mi.) . than to to to to to to to . to and 10 10.4 NumberMean 10.9 11.4 11.9 12.4 12.9 13.4 13.9 above

12 to 23 mos 24 19 - 10 10 5 10 14 9 0 0 21 10.8 24 to 47mos 3 3 2 2 7' 20 .17 19 ,14 13 59 124 ...

. . Less 30 20' 40 50 60 70 80 90 100 Plasma iron (µg./100 ml.) . than to to . to to to to to to 20 and . Number Mean 29 - 39 49 59 69 79 89 99 above

12 to 23 mos 23 41 5 5 15 - 22 37 24 to 47 mos. 7 7 10 20 10 12 6 12 69 63

Less - 10.. 20 e. 30 .. ..40 50 "0 60- 70 80 Vitamin A (pg./100 ml.) to 90 than to to to to to to - to and Mean ". 10 19 29 NuMber 39 49 59 . , 63 '9 89 above

12 to 23 mos !. 0 10. 50 20 10 10 0 0 0 0" 24 to 47 mos 10 33 2 19 44 10 -- 15 6 2 0 - .0 48. 31

. Less 0.1 0.3 0.5 0.7 0.9 .1.1 1.3 1.5 -Aicerbic acid (mg./100 ml.) than to to . 1.7" to -. to to to - to to and Number 0.1 0.2 0.4 Mean 0.6 - 0.8 1.0 1.2 1.4 1.6 above

12 to 23 mos 9 30 13 17 4 '13 9 0 23 0.6 24 to 47 mos 0 16 20 21 15' 11 0 3 66 - 0.7

Less 2,5 3.0 3.5 4.0 4.5 5.0 Albumin (gm./100 than to to . to to to and Ndmber Mean 2.5 2.9 3.4 3,9 4.4 4.9 above

12 to 23 mos.. 0 0 71 29 0 21 3.9 24to 47 mos 2 3 30 57 63 4.0

1 250 500 Ad 1,000 1,250 1,500 1,750 2,000 2,500 Thiamill 04./gm. thus 10 . to- to to to to to .to , 249 NOmbor Mean 499 749 999 1,249 1,499 1,749' 1,999 2,499 above

_ 12 to 23 mos 0 0 0 o 0 33 .33 3 4,550 24 to 47 pm 12 . 5 - 8 12 4 10 43 49 2,757

1 250 - 500 -750 1, 000 Riboflavin Org./gm. Cr) 1, 500 000 2, 500 000 3,500 thru to to to to '- to to to to and, . 249 499 Number Mean 749 999 1,499 1,999 2,499 2,999 3,499 above

12 to 23 mos 0 o 0 13 0 . 24 to 47 moss 67 3 5,750 2 5 17 9 21 6 6 11

1 *90 100 200 300' 400'- 500 600 700 800 mind (oo.len.cr.) to to to - to to to to 49 99 to and Number Mean. 199 299 399 499,, 599 699 799 ..above`

12-to 23 mos . 0. 0 0 0 0 .0 `-0 -100 - 3. 3.925 24 to 47 mos 0 - 4 13 13 9 8 47 45 1, 558

t Data of Owen et al. (7).

e a, Table IX.-Participation in thethe- food stamp program in 3: T. R.' Bender, "Alaska Activities, 1960-70," Ecological various Alaska communities, 1970 through October 1970 InVeitigationi program, Center for Disease Control - (unpublished). . Number of Total dollar Amount Value of 4. Bhiehfeei and Fort Belknap Indian Beservation 'Nufrt.. Month householdsNumbor of value of paid by bonus -part:tingingindividuals coupons participants coupons lion Surveys, reports by the Interdepartmental Com- -lc, issued mittee on Nutrition for National Defense and the In- , A. dian, Health Service, USplIS,-DHEW, December Bethel Welfare 1964.=t District: 5. J. E. Maynard,"A.Study of Growth, Morbidity and April 1, 024" 5,685 . 158,704 - 15,871 142, 833 May 955 5, 449 152, 951 15, 066. 137, 085 Mortality Among EskimoInfahts !of. Western June 1,005 5,811 159, 910 15, 478 144,432 Alaska," Bull. World Health Org. 42 (1970) : 613. July 911 5, 312 142, 015 17,948 124, 067 6. E. M. Scott and C. A. Heller, "Nutrition in. die Arctic, August . 869 5, 143 144,260 16,391 127, 869 Physiologic Adjustments to Cold and Altitude," Arch.- September._...... 864 4, 290 146,791 16,125 130,066 'October 958 5, 735 163; 903 .18,356 145, 547 Environ. Health 17 (1968): 603. Nome Welfare 7: G: M.Owen et al., "Nutrition SurVey of White Moun- District: , - . . . tain Apache Preschool Children,"inNutrition, April 363 1,819 53,137 13,757.' 39,380 May \ 359 1,885. 54,286 - 14,671 39,615 Growth, and Development of North American In- June 348 1, 827 49,117 13,247 35, 870 dian Children,' edited -by W. N.Moore, M. Silver-, July 302 1,680 47,715 1 ,., 12,050 35,665 berg, and M. S. Bead, USpHS-DHEW., (Washington: August 296 1, 649 45,194 12,850 . 32,344 Septem bar %:S. Gcivernmeht Printing Ofilee, 1972),, 281 1, 522 39,860 10,778 29,082 8. G. October "...:28@ 9,530 44,178 11, 214 32, 964 M. Owen et al:, Status of MisMssippi Kotzebue Welfare reschoof Children," a`-' 1.--ilrot-:-s" Andy, 'Amer. J. .07in. District: .- Ntitr, 22 0669) :'1444. April ...... 268 1,366 -41.120 8,699 32,421 May 276 A 1,413 39,216 9,021 30,197 ... June 271 1,394 39,556 ^. 7,678 - 31,878 July 253 1,371 39,874 :Aanowledgments' _ 9,832 :30,042 ,,,.. August 248 1,218 34,630 9, 440 , 25,190 September 221 1,Q98 32, 800 7, 282 25,518 Grate 11, aelmowledgment isgiven to15r, October 269 1;309 38,786 8,015_ . 30,771 Thomas. Bender, Dr. George M. Owen, and Dr. James t.aynard, for makingavailable their un- References publi hed data; and to the following Indian 1. A. E. Schaefer et al.; "A' Study Conducted 'by the De- Serviee .1gutriiion and Dietetics Branch partment of CoMmunity- Medicine, University: of "staff who contributed information ---Onfeeding Pittsburgh, The National Nutrition Suriey, and the: liracticesS United States Poblic Health Servic0 -Indian Health 'ServiCe, Nutrition .Survey,of the. Lower Greasewood Beryl-C+..Becker,--Anchorage Area Office. Chapter Navajo Tribe," Final Iteport 1969 (unpub- lisbed); Doris P. Longman, Oklahoma City Area Office. 2..C. A. Heller and Et. M. Scott,- The- 4laeka DietarySur- . veg. 195641, -Environmental Health Series,,L.rctic Rebecca "M.' Roseberry, Albuquerque and oHealth', P.H.S. publication NO. 999.-AH--2 (Washing- _Navajo Area Offices. ton: U.S. GOvernment Printing Office). Veta Mae Wenzel, Portland Area Office. Discussion

Miss Helen Ger Olson, Session Chairman : As- reported*- to ho incredibly high. I don' believe a we hitye discussed, the Indian -population' of the thormIgh ,tudy O1 1. Ai l'i ' --q' 11044, yet. been carried - United' States includes more that] it ,,Alt. tribes and Alaska native, village groups. These in- Mlss -Olson: Arizona does not have lawsfor diViduals...live priinarily in 24 States and eco- enrichment of. flour-and. bread. Unenriched bread nomically, educationally, and in health compare and 'flour are sold in trading posts on a number Of unfavorably with the general "population: The the Arizona Indian reservations. .-- 4 majority of Indians live on land of marginal pro- '-sA. very high- incidence of diabetes mellitushas ductivity, bid few employment opportunities are been reported in adult Indians .of -some tribes but available. Indian families average 'about six per onset is usually not until after 35 years of age. Fre- sons. Two-thirds of the population subsists on less quently it is poSsible to control the diabeqi with .than $3,000 family per`year and about one- only moderate dietary restriction and, if indicated, half of family incomes are less than $2,000, per *eight loss, but without insulin or hypoglycemic year. The infant mortality rate is 1.1/2 times and agents. the postneonatal mortality rate three times that . of the general population. A high incidence of ip-- Dr.-Ogden Johnson: Gam has' notedltetarded bone growth in Indian children, -probahlSr,,reflect- fectious diseases accounts for the majority of the ing suboptimal nutri!tional status. In- neonatal death's. .e lower Greasewood area, milk seemed to be,: eplaced by MisS Petersen The cyclic nature of infectious milk phis coffeetutan.early. age.lqs'ihis a typical

diseases and malnutrition is evident, in. Alaskan I. diry studies.- Acute diarrheal _diseases, which arerespeciallYidgh during the camping months of Miss Olson . I think it occurs not only. among JunetO September, are superimposed on nutrient the Navajos but tong Indians on the majority of defiCiencies common from midwinter to late Spring reseriatkons. It is probably explained, at least in when, supplies' of stored fiods are low. part; by the lack of refrigeration and high. price of milk. Mrs. Kathryn M. Kram: Among- the :White Johuson:/Inthe Lower Greasewood area Mountain Indian tribe i4rizona, we notedextenz sive use of unemiched flour, although enriched-' infants were fed table foods very early. Coiumer- flour waavailable'free as part of the commodity Cially prep,led stiiiined foods were mot widely used. distribution program. We also noted widespread consumption of soft, drinks, which may be due in , part to the unsatisfactory water supply. The editors are not aware of published reports con cerninthe. prevalence of diabetes mellitus. in . Papaw) 7 Mrs. Margarita Kay: The PapagoIndians are Indis. HoweVer,a:recent report indicates a high not as numerous as the Apaches or Navajos but dO prealence among.pima Indians and re:frs" to other re- po of highpreValenee in Seneca; Cherokd.Coeopah represent a considerable number of people. Their. diens (P.. H. Bennett, T. A. "Burch, and M.. : diet consists primarily of popovers (fried bread) iabetes Mellitus in.American (Pima) ne Lan- madefrom white flour and fried in lard. These are cet, July 17,1971, pp. 125-128). usually served with beans. Papago In fan babies 1Deiartbient of CommunitY Medicine, 1UniveisitY of weigh apprOximately, 9 pounds at birth and; Pittsburgh, The National. Nutrition Survey and the US as a PHS, Indian .Health ServiceNutrition Survey of the rule, groW into fat children. By the timethey Lower GreasewoodChapter, Navajo Tribe, 1908-69. (Pub- reach adulthood, blood sugai levels of -Manyare lisher and publication date -not 'cited in booklet.)

113 te.

Dr. Ruth M. Leverton : At the request of the about contaminating the contents of thecan; the medical staff t.,2 the Indian 'Health Service, the problem arises after the powder is taken from the USDA islauliching a pilot study of feasibility can and mixed with water. of furnishing an iron-enriched poivdered infant Dr. Saraiel J. Fomon : Some yearsago we did a formula to- the Navajo Reseriation as part of the small study on blcte- ial content of formulaspre- commodity distribution program. The logistics of pared These were well,ducated transportation arc ," girn1)(''t in favorof pow- mothers who were breast feed.Oig their babiesand dered formula rather LlIAL11 evaporated milk. or...making up 1 bottle a day to feed to the infantas concentrated liquid formula. The Navajos know. a supplementary feeding. We requested that they about boiling water because that is how they make make up 2 bottlesone forme baby andone for their -coffee. Mother's might therefore be taught us. Probably they iinagineihtbast vve were going to how,..so make the powder into a sale formula. It test this for chemical complestibo to seeihow close has been suggested thatthese infants should be fed- they came to what wethougglittthe baby was get .ready--to-feed formula provided in disposable Ling. We didnot *:cuss. Whromewantedlthe bottle. units,thus elithinating a major source of infection: A number of mothers were4telog a powdered for- However, cost is extremely high and problems of mula, and we reviewed, wit hittisan how they made transportation would be formidable: it up. :A. few were lasing whaeorecall "finger level- Miss Olson: ManY families have ',onlyone ing7 (a; scoop of powder-Aves Nveled with the bottle with no spare--surely a contributing fac- finger) ; the number of orosuisisisper milliliter tor to the high incidence of infection; disease by the time of our analysis weisiathe millions. The coliform count was not higherraitith finger leveling among Indian infants. The water is often unsafe than with use of unsterillisiosiales without finger fir human. consumption,. and a substantial pro leveling. In- :either itnwas very- high. portion of the of Indians and Alaska na- Miss Mary Lynch : Manyveople in Roxbury tives are without a watiiiinpply,other utilitiesor use- only L bottle, especially; thastmorer.peopte who any safe means Of waste disposal. do not have enough money' fora second bottle. Dr. Lloyd J.tFiler, Jr.: It is impossible to grovi BElsa Alvarez: Maw people IvkVisit. in bacteria -in. a dry powder. These powders have Philadelphia also-e-only,vala 'bottle. N about 2 percent-moist-rue content. Ifa can of pow- r dered formula is inoculatedwith staphylococcal Thomas, L. X., iderns. IL L.: Baetetrittl cotintwof forzmourpreputredby mothera. organisms, they will notgrow. I am not Worried Letter to tba;Mditor, J...rediat.M1122, 1969 General discussion

Dr, Lloyd J. Filer, Jr., Sesston. Chairman: feeding, although the actionlaindireet. Physicians Thus .far in our meeting, a number of persons reftiee to insert-the-IUDin the absence ofmen- have mentioned customs relating t6 breast feed- Strual-1111--ig. Since lactation 'inhibits ovulation,, ing, formula fe=eding, feeding Of commercially pre- :at least in the early Months, women may avoid pared strained and f"junior" foods, and of table breast feeding. or.may discontinue this methOd of foods. I think it would now be appropriate to en- foecling..earliertha,n would otherWise be the ease gage in more general discussion of each of these`.in order, to be eligible for insertion ofan IUD. topics. Dr: Virginia H: Young: The trend will be dif-' , ficolt_t,o reverse. Some low-income groups discon- BREAST FEEDING . tinue breast feeding because it is a part of the Fomon: Prolonged breast feed- old pattern and no's part of what they believe re-/ ing ie rarely Practiced in the United States. Fol. fleets higher status. the country:1118'a whole, approximately. 25 percent Dr. Myrtle Bioiirn: Middle-ineomo _mothers of infants .arglireast fed at the dine of discharge who want to breast feed must often_ shop around from the hospital, but .only 15 percent are breast for a sympathetic physician who ,will ..help .them. fed for 3 months and only 10 percent for /months:I' Low-income mothers have much less opportunity to Among. low-income;groups it would appear, that do this. 7., . considerably- fevibf:Nian 25 percent even begin Miss Barbara Garland: Failure to breast feed breast 'feeding., tiat breast, feeding is lees fre among these women may result fronieiniPle in- quently practiced among low-income than among ability to provide an ample supply of milk. We higher income, grbups. is remarkable because .the must ask' whether a woman who is exhibiting low- income women are less frequently separated .symptorriS of malnutrition can be expected to from their infante -for extended' periods. breast feed'.` In Kentucky we did not encourage I believe that most physicians do not encourage,' women. toibreast feed because many were living and in fact discourage, breast feeding. Breastfeed2,on gravy and 'biscuits or fried potatoes and water. ing is likelis to be a :nuisance to- the Aysician..-Nevertheless, ina recent survey of preschool chil- Mothers ask him hard queatiOnithat he is not well dren, we found that 27 percent had been breast prepared tiranswer. Rather than be put in that fed-ta higher perceniage than among most Ameri-- ban groups. - he has the Mother use a method of :feeding IVES'S Faustina Solis: Imnifgrants face ad- that causes him,less trouble. In addition, oralcon -_ traceptives- are widely ;used- and unquestionably,. .ditional problems in relation to breast feeding. Life in a new country requires adjustments thatcan these inhibit lactation. 2. 3 . Mrs. Margarita gay: The intrauterine -cOntra- be very ,harah. Children need more care ata , .ceptive .device, (IUD) algo *orlth against breast qUiCker Pace;:whiCh does not allow for the casual nursing of babies. Mang 9fthe won haveto work . outside the honie to augment laraily income and *Fomon",. S. J. afilatrician lgoke at eartir nutrition. thus cannot continue to nurse theit babies. 'nil Bun. N.Y. Aoad..11eil, 47:509, 191L- . . ' Miller, G. H.; mid flughes,14. R.: Effects of a new low is particularly true of the mothers in the rural. dooral contraceptive (*lactation and genital involution areas whO engage in fieldwork, inbre,t feeding mothers. Observations on. the .effeet.on Mexicans have long linked emotional stresses to their Obstet. thee. 36 : 44,1373. physical disorders.. Mothers who are Under stress IFemon, J., Frier, Thomas; and Rogeri, R. R :rowth and serum chemical valteii of or constantly worried are reluctant to breast feed. normal breast-fed itints..Aota Pled, Soand. (SuppL 202), They _believe that their milk will sour and be -1970. harmful to the baby_. .

!115 ,Miss DOris E. Lauber: I''now 'Of oue large States (figs. 3 and 3). However, in general hospital in clinic practice a major western .city to which in New York City- (fig.4)', there is much greater women come from low-income. areas-to have their use of evaporated milk formulas and lessuse of babieS2 Stifling in the hospital isinsufficient to commercially prepared formulas. take the infants to the mothers for feeding;Breast feeding is therefore discouraged: Second,mothers may be given medication to "dry up". the milk. INFANTS WITHIN AGE GROUP 101 II? 96 9261 .60 49 49 43 43 26 45 772 TOW. Filially, the mother is givena commercially .pre: too pared formula to take home and, believingthat it must be best for the baby, sheattempts to con tinue using In doing so, she'inay overdilute the a formula, in order to reduce cost. Previous cultural Patterns, such as those relating to breastfeeding, zW 60 are given up beCaUse the individuals have migrated. FRESHMILIC. 0- away froin their families and no longer have Big) CANNED FORMULA EVAPORATED mothers and relatives- to give, them adviceand BREAST-FED moral, support. Et Miss: Mary Lynch: In Roxbury thereare a 20 number of Central .Americans and PuertoRicans who, in-theirown cultureA:...itiould breast feed their' 23436 7 89 10 II 12- infants at nighta.ndlii. the early morning.During AGE (MONTHS) the day tlykyl'iould workon the farms. They be:- figure 1.Frequency of use of various kindsof milk lieveJla heat of the sun is harmful to thebreast among infants seen in private practice in NewYork City and therefore would give and San Francisco, spring 1969. Source:Rivera, 1, a milk 'fOrmula "A.J.P.H." 61: 277, 1971. during-the daily. 'In the United Statesmost of these same.mothers bottle feed. They have beentaught, 80 in the clinics and. liospitals that bottlefeeding is . the thing to do. 70 'MILK AND. FORMULA FEEDING 60 Dr.Ruth M. Leverton: In i.e14ionto the use ' of evaporated 'Milk in _feeding. infaiitsof low- 50 income grcups, I.would like to bring to the atten- °KS 40 tion of thez.---,.sup a recent 'report by Rivera 4 -con- '- 14, culling the frequency ofuse of- various kinds of 41. 30 milk during infancy in middle -:andlower-class families. Perhaps one of the pediatricianswould 20 'discuss this report:- Dr. Foinon: Ag-may be seen fidin figure 1, 10 Rivera's data on types of ,milks andformulas fed to infants cared for:bY....pediatricilmsin private 1950 52 545658606Z6466 60 70 practice in NeNiYork-Citand. San Franciscoare Figure -2. Percentage of'lnfants in the United States that - similar to data reported a for the entire United received. various ,types of feeding between 1951-70. Data pertain to the time of discharge froMhospital after birth.Legend:' o:.---,evaporated formulas; J.: -The frequency of use of variouskinds of, milk during infancy in middle and lower 13.__breast feeding; --=commercially-prepared income families. =whole cow's m_ A.J.P..11. 61.: 277, 1971. A small percentage of the breast- fed infants also received Iroimon, S. J.: A pediatrician looksat 'early nutrition. a formula. Source: Fonlon,. Bult.W.Y. Acad. Med. 47: 569, 1971. S.' J., "Bull. N.Y. ACad. Med.' 47: 569, 1971, using data of D. 0: Cox.

116, 80 where we'were able to supply formula, free of charge, the .infants did .continue to receive it. 60 Dr. Leverton: Wunderle and Call 6 have reviewed experiences with the Food Certificate pro- ° ___graminChicago. Use 9f commercially prepared 'ru 40 forniulas was practicallythe same whether mothers ct 'were getting additional good, certificates to pur-. 4- 20 chase the formula or were using their own cash resources. Apparently the families aro convinced of the importance of feeding a commercially pre- 0 pared formula and Are going. to see that their young infants have it, yegardlesS of income: Figure 3.Percentage of 2- month -old infants In United States receiving various types of feeding between Dr. Filer: The findings of Wunderle and Cali ° 1959-70. Legend: Same as in fig. 2. Source: same as are summarized in Table G-1. Approximately for fig. 2. two-thirds of the infants less than 6 months of age were receiving, commercially prepared formulas. INFANTS WHIR AGE GROUP ISO 201, 115 lo5 82 101ar82 85 5. 75 100 lass-TOTAL A somewhat higher -percentage of these infants, 100 than of infants' froni higher families were ...-ve**% receiving evaporated milk. s'e_ao I wouldlike to i'domment on relative costs of

1'25 feeding prepared fonuda,a, evaporated milk and , ziaea 60 homogenized milk. Its shown in Tible G-2, the ;price differential is not great. it.;14fE,CRANSNHEint141.1LA =; EVAPORATED . Dr. Thomas : We might also corn- W4.40 \ +e nient on. costs of-Ammeroially prepared strained foods in relation to costs of formula or evaporated 42 20 milk. Table G-3 indicates that cost per 100 kilo- calories -from strained foodsissubstantially

I g 6 8 '810 - 12 a6gelMonisiti7 _Table G-1.Millis and formulas fed to'Infants.of poverty .Figure 4..7Frequency ciruse of various kinds of milk . groups in Chicago, Ill., and Macon, Ga., in 19701 among Infants seen in well-baby clinics In New York, spring'1969. Source: Same as for fig: 1.. Age less than Age 6-12 months .6 months Miss Mary Egan: In a sample of 74 infants, Chicago Macon Chicago 'Macon 3'Weeks to2months of age, studied in an M & I Number of infants 305 186 361 185 -..---project in Houston in 4968, 43 percent were fed Type of milk or formula (percent of evaporated_ milk and lri2 percent were fed com- Infants receiving): Commerciallyprepared formula mercially preparedformulas. Five percent were fortified with-iron -16 27 6 breast fed: Between 3 and 5 months of age 35 per- CommerZiallypreparedformula not fortified withiron 49 42'. 17 8. ..cent were receiving homogenized milk 4mong the Evaporated milk formula_ 15 17 9 15 to8-inonth-old 'infants' (107 infants),16 percent Whole cow's milk 19 12 67 69 'were fee., evaporated milk; 30 percent, commer- No milk or milk-freeformula 2 1 1 2

CiallYpt4ared formulas; and 53peroent, hoMog- Datafrom Tables 3.38 and 3.39 of Wunderle and Call (footnote 6). enized These data..are generally similar to --ieliorts We have received from various clinics in other:sections of the country. °Wunderle, R. E., and Call, D.L.: An 'Evaluationcie Miss Garland: -In North Carolina, perhaps one the Pilot Food Certificateprogram in Chicago, Ill., and of 10 women continue tofeedcommercially pre- Bibb County, Ott. Research Report submitted from fhe Graduate Schoolof Nutritirw, Cornell. University,Ithacitc` pare& formulas...PSualli the afant is given evapo- N.Y., to the Fiiod and Nutrition. Service, U.S.D.A.;-Ailri1 rated- milk for economic reasons." In Kentucky,- 1971.

117 Table G-2.--Cost comparison: infant feeding by 1 or 9months of.age. A rather strikingdiffer; Range in costCost of added ence between higher income and lower income Item per 26 ounces iron shd Tail cost vitamins' groups relates to the use of junior foods. Per capita consuraption of junior foods isalmost certain:y Homogenized Milk 0.2040.28 $0. 07 SO. 27-SO. 35 much greater by infants of -upperincome groups. Formula A .10.29- 0.33 0.29- 0.3.i The lower income Formula B 10.29 - 0.33 0,29- 0,33 groups use strained 'foods in Evaporated Milk 1 0. 16- 0.20 . 0.07 0.23- 0.27 many cases, but do not seen .to.use junior' foods: Table foodsappear to be introduced much earlier I Per 26 oz.Vitamins A, C, 8, In drops (0,6 ml.), 50.04; 15mg. FeSO4,141.03. I COst of 13 R. oz. canwill provide 26 oz. when diluted water. With an equal volume of than textbooks would lead usto believe. In low- income groups most infantsarek;robablyftsi table

Table G-3.Comparative costs of Infant foods' foods by the sixth month of age. _ Miss Catherine Cowell: In several Item Cents per Cents per of our ounce 100 kcal. Infant Day Care Centers in NewYork, we stocked up on. junior "foods but found that by ,6 months Strained Foods: the infants were totallyon table foods so we Plain Vegetables 2.3 20.4 Soups and. Dinners .2.3 14.7 \did not have an opportunity touse the junior foods. Fruits 2.3 9.6 Prepared Formula; Miss Helen Starina: In Montana,"mothers are Ready-to-Use reluctant to feed table foods, 6 1.7 8.6 even mashed potatdes, Concentrated liquid: Diluted 1:1 1. 1 5.8. at ages 6, 9 and 12 months. We Evaporated Milk Formulas 0.6 3.1 see a widespread use of junior foods. I think it is largely-amatter 'Supermarket prices, 1970, Iowa City, Iowa. of convenience and because parents Evaporated milk, 13 fl. oz,; 19 O. water and 1 oz. of Kato sirup. are convinced that baby foods are especiallysuitable for the baby. . greater. It should be noted also thata considerably greater percentage of a can of preparekiiinulaor Dr. Filer: In 1962 and° 1963, Martinezand I evaporated milk Aian-Of-i-jar of babOoodis surveyed 8,000 mothers by questionnaire'and re,. likely to be consumed by the infant.Especially ported' our observations of what 6-month,old with ..young infants, a substantialproportion of a Tants eat Recently- Martinez has repeated the jar of strained food. may end upon. the infant's . studies in relation to fOod intakedata of 6-, S- face, bib or clothing. and 12-month-old infants. Hisfindings are re- Dr. Ogden Johnson: Comparativecosts of baby ported, in Table G-4. The percentof calories ac, foods 'adonot seem, to me avery relevant counted for by solid foods ata specified age are' -consideration. probably somewhat greater in 1971 thanthey were -. Dr. Norge- W. Svromc: Iagree. To view food in 1962 and 1963 and also somewhat.greater for use in these terms does not take intoaccount the low-income groups than for thOse of higherincome. meanings of food.to people. . Miss Egan:Doyou think theie is more pot, Fdaton: We are not suggesting that f'odds' -liquor used in rural farmareas than in Urban for infautS. be purchased_ on a cost -per- calorie . .. basis. On the other hand, itis highly 'desirable for TableG-4.7--Effect of age On Contribhtion of solid. foodsto.' -, nutritionists and physicians to be.-aware of cost' the infant diet 1. difference's so that they willnot- encourage use of Number of Percent of calorie intake dieta that -era' muchmore ex:pensive than neces- Age (months) infants -Formida Solid foods sitiy.- If a family considers earlyintroduction' of strained foods to be a synibol of. .3 love or an indica- 3,197 69 31 6 tion of ability to provide fortheir children, the 4, 607 62 38 significance of the fOod:clearly-oversluidoWa 9 2, 923 42 sa con- it 1,576 , 36 64 sideration.of cost. 9 % Unpbblished data of Gilbert A. Martinez, Ross Laboratories, 1970. FOODS OTHER THAN MILK -ORFORMULA Dr. Fomon: As is true of higherincome grOups., L. J., Jr., 'and Martinez, G, A.: Intake of seldeted there appears to bea widespread practiceamong nutrients by infante in the United States: An low,income grouPs of of 4,000 representative 6-month-olds. Olin. Pedlar. d:633, introducingstrained foods 1964. areas? What d8 we know about'the nutrient values Finally, we should remind ourselves' that feed- of pot liquor Y ing infants and children is an aspect of social Miss Cowell : Frequently among certain faith- behavior that is tether deeply rooted in material, .liett in Our child health clinics in New York City, biologic and emotional needs. We are dealing with pot liquor with crumbled oarnmeal-type dunip- an elementary human capacity for survival little lings (to. give thicker consistency) is fed from influenced by- different culthral styles, standards

bottles: We have.also found that. someCentral and values. American and ..Sonth American mother's mash beans to theeeniistency of Cornmeal and feed them DIETARY SOURCES OF IRON from a bottle, either added to the milk or in place Dr. Filer: The Valentines. reported. that only of Milk. five of 20 infants in'their study were receiving 10 We ;know 'Very little about the nutrient content mg.. or -mere of 'iron per day. This obseriation of pe liquor. We might be in tor soniCstirprises. agrees with my belief about the United States as 4. AS a graduate student I sampled many buihels a whole. Of the five- infants, three were receiving of ka a and collards Cooked by various Methods: most of their iron intake from iron ;fortified infant We ume.that Vitamin Cis easily destroyed by cereals, one was receiving an iron-fortified formula heat,Ilnit I found that 'after kale and 'collards had and one- was receiving Bosco. been/cooked for several hours and stored in'the Miss Cowell : Less than .1 percent of infanti,in refrigerator" for a few days, some vitamin C our survey sample were being fed iron-fortified mained. For some, the contribution of vitamin C formulas. . would be appreciable becaise of the quantity of Mrs. Mary Ellen Wilcox : Most of the families greens-in their diets. we see do not recognize the importance of feeding Miss Lynch: In Roxbury, we find that infants iron-fortified: -formUlas. Our olinics provide iron and toddlers are fed mashed potatoes with gravy and vitamin supplementation free hut I am not at but no meat.. It is thought that 7m-e,encourages in- all sure the suPigements are giVen regularly

testinal paraSitee. Fresh &his fed to promote brain . enough to fill the need. development. Some Spaniskspeakingmothers Dr: Foniat-i Infatt cereals are much 'better not give their, children Cereal because they :cannot sources of iron 8 than are. streiL.-cd. and junior read the labelS and therefore do. not- know.how to foods.' UnfortUnately, theyare not iegularly fed prepare the food. They are accustomed to using to infants after 6 month's of. age. The ptoblem.of a Rotato starch, cornstarch or arrowroot starch, *supplying irOn infantS, between 6 months and n4edwith milk and seasoned with nutmeg and 18 months of age 'seems to be-a particularly diffi-

sugar. cult one. . . -Dr. CharleS AZValentine: It seems thata few Dr. Filer:: At Via. recent workshop on iron, Dr. generalizations may be Permissible. On the baiia Hartley 'Howard of the. Borden Co: described a a the various papers and comments. First, =At ofmarket test in _Georgia and in a.Mid*est groups of poor people described aPpear toauc- conuttunity.BordenreplaCed regular rentarkably .well in providing. their _infants homogenized, vitamin D4ortified Milk with a d young children with 'diets which prevent 'at s4anilar prothict fx; which 10 mg, of ironhad been lkast major .nutritional. deficiencies.,Next,. ethnic added'per-quartNIn Georgia it was priced 1¢ above differences, in the sense of contrisinigoulturaltra- )the previons market price, Whereas in the Midwest "-4itions,seem to produce only-miner differences in the price for the new :precinct was the same as for the [diet at this particular age the old. Advertising was carried out by television ."%iltiire of poverty," with its emphasis on or newspaper. Sales dripped in Georgia, in the - = Ligniorance, disorganization and to.cope, face of the 1¢ Price differential, but when'the price sais.loom rather,large- in. the expectation of was reduced, sales returned to the previous level. "experts" blit. recoil*. little support from the ". Anderson, T. A.; and Fomon..3. J.: Commercially-pre-- ual evidence reported.- TheSedeficiencies and pared infant cereals: Nutritional considerations.J. blemi 'which ....do recur -from, one .group to Pediat. 78:788;1971. Anderson; T. A., and lemon, B. J. Commercially pre- other-tire most clearly related-to the Stark- ma- pared strained and junior roods: - Nutritional consIdera- vial conditions of poverty..' . tions. a. Amer. Diet. Assoc.-58: 520, 1971.

. ,a

In the Midwest, sales were not affected bythe prices are more favorable in the supermarkets. Be- change in product. Of sales 75percent wereonade cause of the problems invcived in keeping perish- to persons who did' not realize theywere buying an ables and because of food preferences of try, iron ,,nriched product. Therewere no adverse com-, lies, the stores are likely to provide' little Variety plaints about the new milk. By interviewingthe and few fresh meats and vegetables. Thus,even purchasers, it was found that they knew dietary when food stamps or cash are available, the family ,iron to be important forwomen, but many were does not always have access to the food supply not aware of the need for iron supplementation of which would provide a nutritious diet. Similarly, the diets of infants and children. After4.,monthS the 'variety of strained- baby foods available for of test Marketing, Borden abandoned theprogram purchase is usually limited to applesauce,a few and went back to the original homogenized,vita- vegetables, meat with vegetables, 'puddings and min D-fortified milk., custards. Although rice cereal may bemom- mended for the infant, it is often noi available. OPTIONS FOR PURCHASE OF FOOD The bond ultimately developed between thelo- Dr. Filer: We are frequently told thatlow- cal store owner and tkhe family cannot bebroken inconie groupsmay pay more for food than do by the possibleadvantagesof shoppingplsewherc. people with higher incomes. I wonder whetherwe I'urthermore, the stigma attached to theuse of might now turn our attention to, this,oint.\ food. stamps is considerably greater ina strange Miss Solis: The vicious cycle of indebteessaa environment such as the supermarket than intile that plagues the urban and ruralpoor usually cen- localgrocery *here one is kaown; 4 ters on the food Many families purchase food I Mrs. ElsaAlvarez: Several small Spanish through credit, often payingmore without having markets ("bo4ga,s")are located in the Spring better choice \of foods. During; peakemployment, Garden_ Commnity in Philadelphia.They differ outstanding bills are commonly paid,at least in from the "botanicas" where herbs, saint imagesand part, but 'during seasonal unemploymentthe in- rayeNs are sold. The 'residentsusually buy on debtedness again increases. .credit. he storeowner is bilingual and isable to Mrs. Betty Lou Valentine: The most accessible help his 'customers with interpreting outlets in Blackston when the need are small corner grOceries. arises in.,relation toa bill collector, the landldird, Here the products availableare generally restricted to' half a dozen prepared food items: the Police, or the door-to-door salesman:Heis their one or two Counselor and friend and maybe the kinds of trait, oneor two kinds of vegetables, and 'godfather to a mixed-dinneror two; one' type of baby cereal; some of their children. He provides them- with merchandiSe 'without plus evaporated and homogenized milk.Prices for money, lends them cash if these :itenis in small stores.are approximayy 20. they need it. Usually rite merchandiseis more expensive than in the American percent higher than in supermarketchains. The. grocery store, but range of items and brands available is muchwider the petple feel content in paying theextra cost in chain stores. Supermarket pricesfor prepared because of the close personal ties andother ben& baby4.orOds are about, the same withinBlackston fits: Most of the food is boughton a daily basis. and in'neighboringhigher`income, predominantly Children are sent to thestore without money sev- white-communities.. On the) other hand,the- same eral times a day t4.6- obtain whatever isneeded. chains often have legs variety andgenerally charge Rkcords fire kept by the storeowner but rarelyby an average of 25 percent mitre formost other com- the' head of the household. mon fads in their outlets iii the -blackcommunity. Miss Solis:. It has impressedme that the Afro-Araerican parents therefore makemost of grocery store entrepreneur is more sensitive to the their major food purchaseS insupermarkets, and food habits of his families thanare the service they try to shop outside theircommunity when agencies. The grocer's profit is dependent possible. upon hiS knowledge of liijustomers andhis abilityto sup- Miss Garland: Options :forpurchase of foOd by We- POor. in Appalachia ply-their needs. It is interesting to observethe are also limited. The rapidity with which thanges in food availability local grocer. has asually provided.credit ton fam- 'fly over the occur when grocers become familiar with 'new fam- years. The family therefore feels obli- ilies in their locality ; .Health and soCial services gated to trade with himeven when Selection and often do not seem to have that flexibility. 120 a Summary

Dr. Samuel J. Foniou: We began this workshop Obviously, a survey u2.iliziug the most exquisite with the presentation of survey data and discus- sampling design is of no value 'if the data accu- varsdity of such data. Because surveys mulated are inaccurate. Yet, if valid data can be charazteristiqally depend to a large extent on ques- obtained, a survey bas:td on sound populationsam- tionnaires admini.sterea by ,strangera37 there is pling technique can provide a basis' for generaliz- bound to be- some uncertainty concerning whether ing about an entire community,-a region, or even the answers to the various questioni reflect what a country. The questionnaire approach and par- - people do or merely what they say-they do. It was ticipatory observation should be considered coin-_ pointed out that most people 'are poor observers vplementary rather than antithetic. Participatory of their own behavior; furthermore, they are likely observation can be an extremely important tool for to shade their responses to correspond with what' determining the validity of survey data. Results they believe to be the expectancies of the of surveys may at times permit cautious exten- questioner. sion of conclusions derived from participatory Vncloubtedly,problems in the use of a question- observation. naire approach are multiplied in dealing with low- It should not be imagined that participatory income groups and cultural subgroups. For vari- Observation is the only method of validating the ous reasons, there is a tendency to look with suspi- results of surveys conducted by questionnaire. Di-- cion on strangers from the dominant culture, and etary intake data obtained by questionnaire-canbe answerstto questions may be evasive or misleading.' verified by biochemical -data on bli';od and urine: In addition, the translation of behavioral data into In addition, questionnaire, data can be examined verbal terms is always difficult-and becomeseven with respect to internal consistency. For example, more difficult when the vocabulary of the ques- within the same families, it is somewhat unlikely tioner is not one by which the redibndent ordi- that intake of a %specific nutrient 'Would be over- narily thinks of his behavior. reported for one -.a p group and not far another. 4- In considering the enormous difficulties involved During this *4-.shop, pram and Own and in accumulating 'valid data by the questionnaire EagleS and Steele have reported results obtained approach, we discussed.sOme of the differences be- by-a questionnaire approaoh; the Valentines have, tween this method of data collection and partici reported results of participatory observation;. parry observation. I believewe were all inclined Jerothe, Kiser and- Wstlave-mportedireults-W---- agree that highly trained observers living in a tamed -partly by ,participatory observation and ` rune-unity and .aceepted by its inllabitants will partly by struoinwecl interview. Nearly .all of the be able to obtain" information that would no be othlir participants in thisv5orkshors have prey obtainable by other methods. Numerous cross- sented their osvn impressions ,ftoin- perso-nul- .ob- ch-s on the data Can be introduced, and it seems servations, often inc,lndVie clata.,:from formally or me that participatory observation at its best informally administered questiqinaireS. Many of

almost certainly yield data of greater validity than the participants in the workshop are well: known . will the best survey relying on the questiOnnaire to -inhabitants of the communities in which they approach. This judgment does not mean thatwe work. Theyare trusted and able to (pain believe participatory observation to be the most mation that mightber difficult or inipossible for a suitable approach for all purposes. Because of the' stranger to obtain. I cannot,iniagine, for example, small size of the sample that it is feasible to.study that the Spanish-speaking residents of the Spring by partieinatOry observation and the iniposSibility. Gallen Community of Philadelphia would, with- of employing a fully satisfactory' Sampling de- hold information from Mrs. Alvarez for femi. that Sign,the ability to generalize the results to a wider:;' she would report them to "the inthorities:"am population is severely limited. therefore not greatly concerned about the validity of data preSented at this workshop; it is. however, convenience is suggested by the infrequentuse extremely. .diffieult to -decide how far these data of commercially prepaced junior foods. should be genezeized to other low-income groups We discussed a number of reasons for there- or to any cultural subgroup. This is the point markable infrequency of breast feedingamong stressed by Dr. Anderson in his opening remarks. low-income groups.' In general,- breast feeding is Iii-planning the workshop we felt it necessary considered "not the American way," buta wide -to designate several low-income groups to serve as variety of other considerationswere also men- local points for presentation of data and discus- tioned. Evaporated milk formulas are morecom- sion. There is no doubt that some of these designa- monly fed in low-income families than in familiei tions were not very meaningful. Rural low-income with higher incomes. A corollary to the infrequent families, for example, comprise a notablyamor- use of commercially prepared junior foods phous group. Only a small percentage liveon relatively early introduction of table foods into farms, and many live near cities oFtowns. There the diets of many infants of low-income families. appears to be little to distinguish shuns from We heard a number of times that among var- urban slums. Perhaps the most important distinc- ious low-income groups, a fat baby is considered tion is that where population is sparse, the social healthy and a thin baby is considered sickly: This and political cohesiveness that often servesas a concept was widely held among higher income supportive factor among_ the urban poor fails to groups 30 years ago. dev:elop. Oifr categorizations may also have led'us, I should like to conclude my remark withsev- :--somewhat unfOrtunately, focrus- on Indians, eral recommendations based on discusgions during Mexican-Americans, Puerto Ricans ,Qubans,fetc., this worlmhop. First, a great deal of information --distraeting our- attention from the larger groups about feeding practices of low-incomegroups of low7income white persons ironetroPolitan'cen- could be obtained in Children and Youth projects, ters, Endillaaized'cities and small towns through- Maternity and Infant Care projects and well-child out the Nation. clinics. Such information; systematicallyaccu- In the course of the various presentations and mulated throughout the United States, would Our 'discussions, I think we were all more im- greatly expand our knowledge of the feeding of pressed by the similarities than by the Jiffferences infants, small children and individuals of other in infant feeding practices from one ethnic group age groups. to another. With respect to infant feeding, the When large surveys are conducted, a satisfac- general American culture appears to predonlinate tors..poptdation sampling design is essential,. and over that of the 'cultura4-4aftroupta, *which- the-.die data should be evaluated criticallywith re- rfamily belongs. In total, expendituresby low- spect to validity. ' -. income families, food. is likely to receive lower Finally, it is clear that many low-income fam- priority than rent, utilities and transportation, ilies are not-being reached by health care services, but in' the case of the young infant, food receives and the urgent need to eipand serviceprograms high priority, possibly even at theexpense of diets continues. Iii those areas where facilities doex- of other members of the family. Isuspect ti at ist, a vigorous attempt should be made with the feedingofcommercially 'aid of indigenous workers to identify those- low- prepahtl_ strained income families 'which have not thus far sought foodaa relatively expensiveway of providing the infant with his nutritional .requirements---b.health care. In many instances these families need health care more desperately than thosenow re- signifies love, high regaril and abilityto provide. ceiving it. Causes for failure to seek help should That theSe foods are not chosen primarilyfor also be determined. 4 4

122 Index

Afro-Americans, Calorie intake- Continued (see Blacks) general discussion, 118, 119 Alaska- Hawaii, 93-95, 99 infant and child feeding, Indians, Eskimos, and Aleut% Preschool Nutrition Survey, 5, 7, 9 . 101-120 = USDA-survey, 20, 23, 25 Analysis, Cereal intake- (see Nutritional analysis) Alaska, 104-106, 108 Appalachia, 37, 38, 48 American Indians, 104 Ascorbic acid intake- Blackston, 62, 63, 67, 68, 72-74 Alaska, 105, 108 general discussion, 119, 120 American Indians, 103, 104, 106-111 Hawaii, 92-94, 96, 99 general discusslon, 119 Mexican-Americans, 77, 79, 83, 88-90 Hawaii, 93, 94, 97,998 rural low income, 41, 46 Mexican-Americans, 82, 86 urban low income, 53-54 Preschool Nutrition Survey, 5, 7,13 USDA survey, 21, 22 USDA survey, 20, 21, 23-25 Children- eating habits of, low-income urban families in Hawaii, Blacks- 91-99 child feeding, low-income rural, 41, 43, 46 feeding of, in rural low-income families, 35, 37-48 child feeding, low-income urban, 59-74 feeding of, in urban community, 49-58 low-income Chicago families, nutrition in, 74 feeding patterns in low-income rural American Indians rural preschool children, sleep patterns in, 84 and Alaska Natives, 101-120 stereotype of malnutrition in, 59-65 nutrition in low-income families, USDA survey, 19-34 Black. ston, 61274 nutrition of low-income urban black, 59-74 Bottle feeding-- Preschool Nutrition Survey, 8-18 and breast leading, 5, 13, 38-40, 46, 47, 52-55, 76-88 Cubans- bacteria count of formula, 114" in urban Miami, nutrition, 72-74 Breakfast- (see also Mexican-Americans, Puerto Ricans) children's eating of, 5,13 4 . Breast feeding=- Demographic and socioeconomic characteristicri- Alaska, 102, 104, 108 Alaska, 107, 1.13 American Indians, 102, 107 Blackston, 63-66, 71, 72 and bottle feeding, 38-40, 46, 47, 52, 53, 55 Hawaii, 91, 93 and IUD, 115 Mexican-American, 77, 79, 81 ,4* Blackston, 62, 74 - Preschool Nutrition Survey, 3-5, 7, 8,18 general discustOn, 116-120 rural low income, 41, 46 Hawaii, 91, 92, 94, 96, 97 urban low income, 49, 61 Mexican-Americans, 76-83 Diabetes- Preschool Nutrition Survey, 5, 18 among Indians, 113 rural low income, 38740, 45, 48,115 Diet- urban low income, 52, 53, 55 macrobiotic, 46 Calcium intake- Eating patterns-- AlaSka,105 and parental permissiveness, 6,14 American Indians, 103, 106, 107, 109, 110 low income, 53, 54 Blackston, 62 Mexican-American, in California. 75-90 Hawaii, 93-97 seasonal factors in, for Indians, 104 - Preschool Nutrition-Survey, 5, 7, 10 . Empacho-- USDA survey, 20, 21, 23, 26-2840, 81 Mexican folk illness, 89-90 )r"..4 intake- Ealdmop- 104; 105 and Indians, child practices, 101-120 ....merican Indians, 103, 106, 107, 109, 110 Ethnic groups, Blackston, 62 (see specific ethnic groups) Feeding- Iron intake-Continued breast versus bottle, 3S, 41 general diseussion. 114, 11S-120 solid foods to infants, 40, 41 Food- Hawaii, 93-99 Mexican-Americans. SO, SL 86 hot and cold. 31exican-American attitudes. 76. 77.0S2,83, Preschool Nutrition Survey, 5. 11 88. 90 rural low income, 39 priority in budget, 57 USDA survey, 20, 21, =, 26, 2S. 31 reward or punishment, 6, 14. 54 (ace also Infant foods) Kansas City, Kans.- Food intake - Survey of child feeding practices. 49-55 and sleep, 34 (See also Solid foods, Strained fonds ?Lacroldotic diet, 46 and income, 6 Mealtime supervision, 16 Food preparation- Mental retardation- attitudes, 18 and malnutrition, 60 person who cooks. 6, 15 Mexican-Americans- Food procurement- farmworkers and migrants, 45-1S and income, 6. 120 in California, food habits, 75-90 in urban households. 52 in PhoenlIk, Ariz., eating habits, SS, 89 person who shops, 6, 15 (see also Cubans, Puerto Ricans. specific nutrients) stores used, 17 Mexico- - Formula feeding. eating patterns in,-77-79 (see Milk or formula feeding) Milk or formula feeding- Alaska, 102, 104, 105, 108, 113. 114 Hawaii, Honolulu- American Indians, 102, 106, 113, 114 infant and child feeding in low-income urban fami#es, Blackston, 59, 62, 65- 69,.72 -74 91-99 general discussion, 115-119 Hippies, 46 Hawaii, 91-99 - Mexican-Americafil, 77 -90 Income- Preschool Nutrition Survey, 13 Alaska, 101-120 rural low income, 38-40, 45-47 Blackston, 59-74 urban low income, 52-54 Hawaii, 91-99 USDA survey, 21-23, 33 Mexican-American, 75-90 Mineral supplements, Preschool Nutrition Survey, 3-18 (see Vitamin or mineral supplements) rural low income, 35, 37-48 urban low income, 49-58 Negroes, USDA survey, 19-34 (see Blacks) Indians- 41 Nutrition- American 'and Alaskan, infant and childfeeding prac- in low-income families, USDA surrey, 19-34 tices, 101-120 in urban black infants and children, 59-74 diabetes in, 113 poor,and mental retardation, 60 White Mountain Apache, NutritionSurvey, 106-111 PreschoolNutrition Surrey, 3-18 Infant foods- Nutritional andysis-:- for children up to 3 years, 21-23 plaisma, 4, 5, 111 (see alao Food) urinalysis, 5 Infants- Obesity- eating patterns of Mexican-American, 75-90 Cuban children. 73 feeding of: Preschool NutritionSurvey, 5 urban black children, 63 feeding of,in Hawaiian low-income urbanfamilies, Orange juice, 98 91-99 4... -- feedingof in rurallow-income families,37-48 Poi, 92, 93, 96, 97 feeding of, in urbancommunity, 49-58 ProteirAntakes- feeding patterns,low-income rural American and Alaska; 105, 108 Alaska Indians; 101-1/0 American Indians; 103, 100, 110 nutrition in low-incomeurban black, 59-74 Blackston, 62, 67-69, 73 Hawaii, 94-97 (sae also Breast andbottle feeding, Children) Interviewis- MexicanAniericans, 78, 80, 82, 85 on dietary patterns in national sample, 4 Preschool Nutrition Survey, 5, 7, 9,10 Iron intake- rural low income, 47 USDA survey, 20, 23, 24, 26,31 Alaska,102, 104, 105, 114 Puerto Ricans- American Indians, 103, 106, 107, 109-111 low-income families in Philadelphia, nutritionin, 72-73 Blackstan, 02, 63, 65, 67- 69,119, ( aee- also Cubans, Mexican-Americans) 124. Race, Surveys- (see specific races) Census Bureau, Riboflavin intake- child feeding in Kansas City, 49-5S American Indians, 103, 3.06, 109-111 Preschool Nutrition Surrey, 3-18 Hawaii, 93-95 USDA survey, 19-34 Preschool Nutrition Survey, 5, 12 White Mountain Apache. Preschool Children Nutrition Rural- Survey, 106-108 AmericanIndians, infant feeding practices, 101-120 Thiamin intake- definition, 45 _ Alaska, 105. low-Income families, child feeding practices,35, 37-48 American Indians, 106, 107, 109-111 Sampling- Hawaii, 94-96 black urban studies, 59, 61 Preschool Nutrition Survey. 5. 12 Preschool-Nutrition Survey; 3 United States- USDA survey, 19_1, versus Mexican eating patterns, 75-90 (see also Survey desigi ) regional diets, 71 Shopping, regional nutrition differences, 23 (see Food procurement) regional poverty and child feeding, 37-18 Sleep- United States Department of Agriculture (USDA) Food Consumption Survey (1965), 19-34I and caloric intake, 34 Urban- Snacks, 14, 33 community, child feeding in, 49-58 Socioeconomic characteristics, loW-hicome blacks, nutrition in infants and children, (see Demographic and socioeconomic characteristics, 59-74 Income) lOw-income families in 'Hawaii,,. infant and child feed- Solid foods, intake of- ing, 91-99 Alaska, 102, 104, 105, 108, 113 Vegetables- American Indians, 103- consumption by infants, 21-23 Blackston, 62, 63, 67-69, 72, 73 Vitamin A intake- general discussion, 118-120 Alaska, 105-108 Hawaii, 92, 94, 96, 97, 99 AmericanInftans, 103,106 -111 . Hawaii, 93-95 Mexican-Americans, 78, 81;83, 84, 88, 89 rural low income, 38, 41, 47 Mexican- Americans, 86 urban low income, 53-57 Preschool Nutrition 'Survey, 5, 7, 11,13 USDA survey, 21, 23, 24,27, 31 USDA survey, 21, Vitamin C, Strained foods- (see Ascorbic acid) Alaska, 102,104 -106, 108, 113 Vitamin or rattle-rat supplement- American Indians, 113 Alaska, 105 Blackston 62-64, 67, 68, 72-74 American Indian, 114 general discussion, 115, 116, 118, 3,19 Blackston, 62-64, 74 Hawaii, 92, 94-97, 99 general discussion, 119, 120 Mexican-Americana, 78, 79, 81, 82, 84, 89 Hawaii, 93, 98 rural low income, 47 Mexican-American, 80, 81, 86 urban low income, 55 Preschool Nutrition Survey, 4, 5, 7,13 rural loW income, 43 Survey design urban low income, 54 "Kansas City survey, 50 USDA survey, 20-27 - national sample, Preschool Nutrition Survey,3 participant observation, 32, 61, 121 White House Conference on Food, Nutrition, and Health USDA survey, 19, 20 (3969), 1 *validity of, 121 Whites- (see also Sampling) child feeding, low-inco rural, 37, 38, 41, 48 child feeding, low-income urban, 57, 64,71

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