CHAPTER IVARTIFICIAL FEEDING
WHEN ARTIFICIAL FEEDING IS NECESSARY—WEIGHT THE TEST OF PROPER NOURISHMENT—COW’S MILK, CAREFULLY MODIFIED, IS THE BEST SUBSTITUTE FOR MOTHER’S MILK—SOURCE OF SUPPLY AND CARE—CARE OF THE BOTTLES AND NIPPLES
WHEN ARTIFICIAL FEEDING IS NECESSARY—WEIGHT THE TEST OF PROPER NOURISHMENT—COW’S MILK, CAREFULLY MODIFIED, IS THE BEST SUBSTITUTE FOR MOTHER’S MILK—SOURCE OF SUPPLY AND CARE—CARE OF THE BOTTLES AND NIPPLES
Successfulartificial feeding of infants is one of the big problems which the medical profession strives unceasingly to solve. It has never found a perfect substitute for mother’s milk, but it has greatly reduced the rate of infant mortality, due to artificial feeding, by working out formulas that combine the food properties provided by breast milk. And not the least valuable result of its investigations has been the agitation for pure milk supply, the sanitary care of milk and dairies.
Any mother who has followed the reports of pure milk commissions, and heard the talks and lectures given by specialists in infant feeding, must realize the tremendous chance she takes in weaning her baby. Therefore, she will not takethe step unless convinced that her milk positively disagrees with her child.
The most important test is the child’s development or lack of development, gain or loss in weight. This cannot be determined during the first week, for the average normal child loses from four to eight ounces during the first six or seven days of its life. Thereafter it should gain at the rate of from four to eight ounces a week, until it is six months old. After that the gain per week runs from two to four ounces, until the child is a year old, when the first danger-period of feeding is past.
During this time—and, in fact, throughout its childhood—an accurate record of its weight and measurements should be kept by the mother. For this purpose, the well-equipped nursery should contain a good pair of scales and a measuring board. The scales should record at least forty pounds. They are of the platform, not the spring, variety, with a basket for holding the baby while it is small and helpless. Later, when the child is able to sit up, the basket is replaced by a pad.
The measuring board used at the Better Babies Contests is a great convenience and can be made by any carpenter. It consists of a smoothly planed board forty inches long and eleven inches wide, with a firm, upright headpiece, and a sliding footboard which runs on grooves on the outer edges of the board. On one of these edges is tacked asteel tape, in the inch-scale. The baby, up to eighteen months of age, is laid on the board with the back of the body touching the board all along, from head to foot. The nurse makes sure that the little head is placed firmly against the headpiece. Then, while the mother or some other assistant holds the baby’s knees firmly in place, the nurse adjusts the sliding board until it touches the flat soles of the baby’s feet. The child is then lifted up, without moving the footboard, and the measurement is read from the tape where the footboard stops.
After the child is eighteen months old it is measured standing. For this purpose the board is reversed. The firm headpiece is placed on the floor for the child to stand on, and the sliding footboard is brought down to touch the top of the child’s head.
After its third year, the child may be measured according to good old nursery tradition, by a pencil mark against the woodwork.
Measuring a baby with a tape-line is not accurate. While the height is not so important a factor as the weight in determining the development and especially the nutrition of the baby, it should be watched; and this measuring board, which represents an investment of only a dollar or so, will be found very useful.
The baby that is thriving on mother’s milk should show a gain of at least two pounds at theend of thirty days. The baby which weighed seven pounds at birth should weigh nine pounds when one month old; ten and one-half pounds at two months; twelve pounds at three months. When the gain is less than these figures, the baby’s diet needs attention. The following symptoms point to the fact that the mother’s milk does not agree with the child:
(1) Excessive vomiting, with loss of weight or no increase of weight for two weeks or more.(2) A persistent diarrhea, with loss of weight or no increase of weight for two weeks or more. If there is a progressive gain in weight, however, loose bowels are not a danger signal.(3) Steady loss of weight extending over a period of three weeks or more, in spite of the fact that otherwise the child seems normal.
(1) Excessive vomiting, with loss of weight or no increase of weight for two weeks or more.
(2) A persistent diarrhea, with loss of weight or no increase of weight for two weeks or more. If there is a progressive gain in weight, however, loose bowels are not a danger signal.
(3) Steady loss of weight extending over a period of three weeks or more, in spite of the fact that otherwise the child seems normal.
Sometimes the trouble can be corrected by a change in the mother’s diet; and this must be discussed with the family physician. Sometimes the mother is too much exhausted by household duties to provide the amount and quality of milk needed to nourish the child. If it is possible to lighten the mother’s burdens, and thereby strengthen the breast milk, this is better economy than investing in bottles and artificial food.
If, in spite of the doctor’s efforts to build up the mother’s strength and improve the quality of the breast milk, the baby does not thrive, then mother and doctor together must work out the problem of artificial feeding.
The scientific and successful raising of a baby on the bottle depends upon two distinct lines of care and caution: the selection of the food to be supplied, and the care of the bottles. The best of food in an unsanitary bottle or drawn through an unclean nipple becomes dangerous to baby’s health.
In choosing artificial food for your baby, remember that even physicians differ on this question. Most American specialists for children insist that fresh cow’s milk, properly modified, is the only substitute for mother’s milk. European authorities recommend goat’s milk. And there are other recognized authorities on baby-health who have found it advisable to prescribe for delicate bottle-fed babies a combination of milk and patent food. Not only must the mother consult her family physician on this question, but, with the physician, she must watch the effect of the chosen food on the baby.
Vomiting, restlessness, sleeplessness, and the condition of the bowels, all tell the tale of food that is not being assimilated.
In this connection the inexperienced mother must understand that there are two forms of vomiting in the young baby; or, more properly speaking, there is a difference between vomiting and regurgitation—slight, to be sure, but worth watching. Regurgitation is merely the overflow of milk when the baby has taken too much. Itfollows almost immediately upon having the breast or bottle taken away, and the milk is in practically the same condition as when it entered the stomach. But when the baby vomits habitually after feeding, and the milk is curdled or tough or sour, there is something wrong with the bottle diet.
The bowels are a sure indication of the way in which the bottle diet agrees or disagrees with the baby. When the passage is hard and bullet-like, when it shows curds or white lumps like cheese, or when mucus is present or there is diarrhea, the mother may be sure that the food does not agree with her baby, and the doctor should be consulted immediately.
No medicine should be given in such cases without consulting a doctor. What the baby needs is not dosing, but the right sort of food, the food its stomach will digest.
At one contest in the midwest the mother of a little prize winner told me that, at eleven months, she almost lost her baby. She had changed diet time and time again, varying from certified cow’s milk to a well-known patent food. The baby was reduced to a skeleton when the physician decided to try not milk, but cream, diluted with barley water. The change in baby’s condition was immediate, and it continued to thrive without further change of diet. On theother hand, some babies fed on this modified cream would not thrive.
Frankly, feeding a baby deprived of breast milk often resolves itself into an experiment; but an experiment which must be conducted in an intelligent manner, with the advice of a physician. Do not consult your neighbor, no matter how many babies she has raised successfully. The bottle food which was nourishment to her babies may be poison to yours. There are no hard and fast rules for bottle foods. Each baby is a case unto itself and requires the most delicate attention and unrelenting vigilance. Even two babies in one family may require different forms of artificial nourishment, or at least different modifications of cow’s milk.
Perhaps there is no phrase familiar to the maternal ear which is so generally misunderstood and abused as “modified milk.” It is confused with sterilized, pasteurized, and condensed milk, and with patent foods. In reality the phrase means any milk, other than mother’s milk, so modified by the addition of elements like water and sugar as to bring it as near as possible to the quality of breast milk.
The substitute for mother’s milk most generally approved by American pediatrists or specialists in the care of children is cow’s milk, carefully modified.
The safety of the child that is to be fed onmodified cow’s milk depends largely upon the source of milk supply. The mother should acquaint herself with this source of supply and the conditions under which the cows are housed and milked. If you had to hire a wet nurse, you would not choose a tubercular or personally unclean woman. Why permit your baby to drink milk that comes from a tubercular cow, or one which is milked in a filthy stable?
If you live in a city, write to your department of health or your health officer for information regarding properly inspected dairies. If no such information can be furnished you, then it is high time that you started a campaign for dairy inspection in your town. If you live in the country, find a dairyman or a neighbor whose cows will stand the test and whose stables are clean. Do not buy baby’s milk at a grocery-store or dairy whose source of supply you cannot trace.
Cow’s milk which comes from a herd of healthy cows, or at least several cows, is preferred to that which comes from a single animal, as it varies less in quality and elemental proportions. It is not necessary to order rich milk from highly bred Jersey and Alderney cows. In fact, physicians agree that the milk produced by ordinary grade cows in the herd is better suited to the needs of the child. You should be quite sure, however, as to the age of the milk. In cold weather it must not be fed to the child after it isforty-eight hours old. In summer it should never be more than twenty-four hours old.
In nearly all large cities are now found agencies of dairies which specialize on milk for infants. This is sometimes known as certified or guaranteed milk. The cows from which it is drawn are carefully inspected, the stables and milkers are clean, all the utensils, pails, cans, etc., are sterilized before use, and the milk is cooled immediately after it is drawn from the cows and kept at or near a temperature of 50° F. until delivered to the purchaser. Milk produced in this way saves the mother anxiety and trouble. It costs only a few cents more a quart than milk which is not certified.
When certified milk is received in the home, the stoppered bottles should be placed immediately in the refrigerator or set in a pail of ice-water to remain until it is modified for use during the next twenty-four hours.
The city mother, with her stationary refrigerator and convenient ice supply, has no possible excuse for not keeping the baby’s milk in perfect condition. Some of the new refrigerators have separate compartments. One of these should be used for the baby’s milk. In many well regulated homes you will find special nursery refrigerators which can be bought at any department or house-furnishing store. These have their own supply ofice and nothing but the baby’s milk is stored in them.
The small town or country mother, whose ice supply is irregular and who depends upon an old-fashioned ice-chest or perhaps a spring or cool well for chilling the baby’s milk, faces a more difficult problem. It is especially important that she keep the milk bottle tightly stoppered. If she uses the old-fashioned ice-chest, where food and ice are not separated and where germs lodge easily, she had best pack the stoppered bottles in a covered pail and set them next to the ice. If she has no refrigerator at all, she should induce her men-folk to provide a substitute, if it is only one strong wooden pail set within another, the sawdust and ice packed between. Then she can thrust her stoppered bottles into the inner pail, cover all with heavy felting or burlap, and feel tolerably safe.
At one of the contests a mother told me how sad experience had taught her the importance of having such a safeguard in her home. With her first baby she kept the milk in a tin pail, hung in the cool water of an old well. The milk absorbed germs and the doctor traced the baby’s death from acute bowel trouble to these germs.
Next in importance to the supply and storing of milk comes the care of the utensils for modifying it and feeding it to the child. These should be kept in a sanitary condition that is absolutelyabove suspicion. If the mother herself does not take charge of this task, she must delegate another member of the family or a servant upon whose faithfulness she can depend. The supply of milk for the ensuing day should be cared for at a certain hour each morning, soon after the milk is delivered. The utensils should be used for this purpose alone, and should not be kept in a cupboard with ordinary cooking equipment.
For the ordinary modifying of milk the following utensils are needed:
A strong measuring glass, holding sixteen ounces, divided into ounces, which can be bought at any hospital supply house and in many department and drug stores; a two-quart pitcher with a wide neck; a glass funnel, which fits easily into the neck of the nursing bottle; an enameled tablespoon; an enameled saucepan for boiling the water or gruel; a quart glass jar, with an air-tight cover, in which the boiled water or gruel is set away until it is cool; a wire rack, which will hold eight or ten nursing bottles; eight or ten plain, round, cylindrical bottles with a narrow neck; a half dozen plain nipples of a size to fit around the neck of the bottles; a long-handled brush for washing the bottles; soap, washing-powder and borax for cleaning purposes.
The shape of the bottles is extremely important, for a round bottle offers no corners in which germs can lodge; square bottles have this disadvantage.The number of the bottles is governed by the number of feedings in twenty-four hours, one for each feeding. The wire bottle-rack protects the bottles from breakage and is an economical investment. The nipple changes in size with the age of the baby; for the small baby care should be taken that the nipple is not long enough to choke the baby and make it vomit.
The size of the hole in the nipple also is important. If it is too small the baby has to work too hard for its nourishment. If the hole is too large the baby will gulp the feeding, which may cause colic, indigestion, or vomiting. Test the nipples by holding the filled bottle in a horizontal position and watch how the milk drops from the nipple: the drops should be an inch or more apart.
New bottles and nipples should be put into a cheese-cloth bag and then into boiling water to be sterilized before using. After the baby has been fed, the bottle should be washed out with the long-handled brush with soap or washing-powder. When the soap has been rinsed out with hot water, a teaspoonful of borax and a little warm water are turned into the bottle and shaken vigorously. When the borax is dissolved, the bottle is filled to the brim with water and permitted to stand in this way until needed the following morning. When the borax solution has been thrown away, and the bottles rinsed with clearwater, they are ready for use. It is not necessary to boil bottles cared for in this way; and borax will be found a more satisfactory antiseptic than the bicarbonate of soda which the average mother uses in cleansing her bottles.
The nipples must be cleansed with equal care. After the feeding, a pinch of borax should be dropped into the nipple, then a little water added and the nipple gently rubbed between the thumb and fingers. It is then rinsed out and laid on a clean saucer, with a clean glass turned over it, to protect it from dust.
It is a time saver to prepare the boiled water or gruel several hours before it is to be used for modifying the milk—even the night before. It can then be placed in the quart jar, tightly covered, and set in the ice-chest.
Now comes the important hour for mixing the food. The bottles are emptied of the borax water and turned upside-down in the wire rack to drain. Next they are filled with hot water for rinsing out the borax, emptied and again turned upside-down in the rack to drain. By the time the food is mixed the bottles are cool enough to fill.
In mixing the food the process is the same whatever the proportion. The bottle of milk is turned into the pitcher so that the cream will be mixed in well. It is then poured into the glass measure and, when the right amount has been secured, it is poured back into the emptied pitcher. Nextis measured the boiled water or gruel, and this is then turned into the pitcher. The sugar must be measured very carefully with a tablespoon. If a level spoonful is ordered, it must be leveled off carefully with a knife. A heaping spoonful means all that the spoon will hold. Stir the mixture together—milk, gruel or water, and sugar—until the last is dissolved. Now, using the funnel to avoid waste, pour into each bottle the exact amount of this modified milk which has been prescribed for a single feeding. Cork the bottles with rolls of clean absorbent cotton, set the bottles in the wire rack, and place it in the ice-chest.
As the hour for each feeding approaches, one of these bottles is taken from the ice-chest, placed in a pan of hot water, or in any patent bottle heater, to be warmed for the baby’s use.
It will be seen that by following this process the milk is never touched by any hand, and if the utensils are kept immaculately clean, there can be no danger from germs or contagion. And right here a word of caution: After keeping the nipple in borax water, do not test the heat of the milk by tasting it through the nipple. Never put the baby’s nipple in your own mouth or allow any one else to do so. The food should be what is known as body temperature, and it can be tested by letting a little drop upon the bare forearm. Remember that a baby’s mouthis very tender and easily burned. Never give the baby the bottle without testing the temperature of the food.
It should take about twenty minutes for the baby to drink the prescribed amount of either breast milk or artificial food. In cold weather it is a good idea to cover the bottle with a little flannel or crocheted bag, to keep it warm until the last drop is drained. Food which becomes chilled may cause colic.