CHAPTER VFORMULAS FOR ARTIFICIAL FOODS
FORMULAS FOR MODIFYING MILK—MILK SUGAR, CANE SUGAR, OR MALT SUGAR—HOW TO TELL WHEN THE BABY IS PROPERLY NOURISHED—LIME WATER IN THE MILK—CONDENSED MILK—PATENT FOODS
FORMULAS FOR MODIFYING MILK—MILK SUGAR, CANE SUGAR, OR MALT SUGAR—HOW TO TELL WHEN THE BABY IS PROPERLY NOURISHED—LIME WATER IN THE MILK—CONDENSED MILK—PATENT FOODS
Formulasfor the preparation of artificial food for infants will some day form a vital feature in the practical education of girls for motherhood. Chemistry, physiology and dietetics, all subjects which are taught to young women in high schools and colleges, will contribute to a better understanding of this very important subject.
The mother who is able to nurse her child has no conception of the difficulties which confront her sister or neighbor who must raise a baby on the bottle. She should be profoundly grateful that she is spared the study and working out of food formulas by the gracious dispensation of Providence which supplies her child with the natural form of nourishment. Certainly no woman who reads the chapters of this book, devoted tothe sanitary and scientific care required to carry a baby through the period of bottle feeding, will wean her baby unless such a step is absolutely necessary.
The mother whose family physician has specialized in diseases of children and infant feeding has half the battle fought for her. The physician who has made a study of artificial feeding knows exactly the proportions necessary for producing a nourishing modified milk, and the quantity to be given at each feeding. But there still remain all over the country a large number of busy and successful general practitioners who have given little or no study to formulas for infant feeding, a condition fortunately due to the fact that the majority of the mothers whom they attend nurse their babies.
Again many mothers are so situated, geographically and economically, that they cannot place the baby to be artificially fed under the constant supervision of a physician. It is for such mothers that this chapter has been written, and the material which it contains represents the best ideas of men who have long specialized on the feeding of infants.
These physicians have decided that the simple formula which includes plain cow’s milk, with the cream stirred in, water and sugar, is the best substitute for mother’s milk until the baby has passed its sixth or seventh month. Then barley or oatmealgruel may be used instead of the water. Cream, top milk, whey, lime water and patent foods should not be used except with the approval of a physician. The mother who finds herself forced to work out alone the problem of artificial feeding, should give the simple formula a thorough trial before trying more elaborate experiments, and, above all things, before taking the advice of her neighbors.
Mother’s milk is composed of thirteen parts solids and eighty-seven parts water. The solids are fat, sugar, proteids and salts. The fat is represented by cream; the sugar by lactose or milk sugar; the proteids by the milk-curd. The fat encourages bone growth and fat in the baby’s body; it produces heat and is good for the nerves. The sugar also produces fat and heat and has a laxative effect on the bowels. The proteids go to make body cells in the blood, the muscles and the various organs. The salts are needed for bone-making. The water serves two purposes: it keeps the solids in solution so that the food can be easily digested; it forms the medium through which the body throws off its waste material.
Formulas for artificial food should follow the proportions found in mother’s milk by expert analysis. Plain cow’s milk unmodified is too rich in solids to be given to an infant. On the other hand, the nursing baby, or the baby fed on properly modified milk, does not require much plainwater, as it receives an ample supply of water in its feedings to quench thirst and keep the body in good condition.
For the baby which is to be artificially fed at one month or less, plain cow’s milk, boiled water, and malt sugar form the best possible combination.
Milk sugar, once very popular with dietitians, has been condemned by specialists in infant feeding. Cane sugar is preferred to milk sugar, and pediatrists recommend most highly the Dextri-Maltose, or malt sugar, manufactured by Mead, Johnson & Company, Jersey City, New Jersey.
Having decided on these ingredients, the next problem is their proper combination in correct proportions. These are governed by the baby’s weight. In twenty-four hours a baby should be fed twice as much plain cow’s milk in ounces as he weighs in pounds; this means that a baby weighing twelve pounds should be fed twenty-four ounces of plain cow’s milk in twenty-four hours.
In preparing this quantity of cow’s milk for the baby’s consumption, it must be borne in mind that this milk contains only half as much sugar as mother’s milk, while it holds three times as much proteids and salts, and both the proteids and the fat are less digestible than those found in breast milk. This explains why water must be used to dilute the heavier cow’s milk. For thenew-born baby the following proportions are recommended when what is known as plain milk is to be used:
Four ounces of milk.One ounce, or two rounded tablespoonfuls, of Dextri-Maltose.Sixteen ounces of boiled water.
Four ounces of milk.
One ounce, or two rounded tablespoonfuls, of Dextri-Maltose.
Sixteen ounces of boiled water.
In two or three days this formula may be changed to:
Five ounces of milk.One ounce, or two rounded tablespoonfuls, of Dextri-Maltose.Fifteen ounces of boiled water.
Five ounces of milk.
One ounce, or two rounded tablespoonfuls, of Dextri-Maltose.
Fifteen ounces of boiled water.
If the baby is digesting this food without trouble, about the tenth day, increase the milk by one ounce and decrease the water by one ounce.
A normal child, with whom modified milk agrees, is able at the end of a month to digest its food in the following proportions:
Eight ounces of plain milk.One ounce, or two tablespoonfuls, of Dextri-Maltose.Twelve ounces of boiled water.
Eight ounces of plain milk.
One ounce, or two tablespoonfuls, of Dextri-Maltose.
Twelve ounces of boiled water.
At seven months the baby is ready to have gruel combined with the water and the milk in the following proportions:
Nine ounces of plain milk.One and one-half ounces (3 tablespoonfuls) Dextri-Maltose.Five ounces of water.Six ounces of gruel—made as follows:Two tablespoonfuls of prepared barley, wheat, or oat flour; smooth with cold water; have ready one pint of water boiling hard; add a pinch of salt; stir in the smoothed flour; cook for thirty minutes in a double-boiler, and strain through a hair sieve. Add enough boiling water to make a pint, and set it away to cool.
Nine ounces of plain milk.
One and one-half ounces (3 tablespoonfuls) Dextri-Maltose.
Five ounces of water.
Six ounces of gruel—made as follows:Two tablespoonfuls of prepared barley, wheat, or oat flour; smooth with cold water; have ready one pint of water boiling hard; add a pinch of salt; stir in the smoothed flour; cook for thirty minutes in a double-boiler, and strain through a hair sieve. Add enough boiling water to make a pint, and set it away to cool.
At ten months the child is taking modified milk in these proportions:
Thirteen ounces of plain milk.One heaping tablespoonful of Dextri-Maltose.Six ounces of thin gruel; no water.
Thirteen ounces of plain milk.
One heaping tablespoonful of Dextri-Maltose.
Six ounces of thin gruel; no water.
Milk thus modified can be given to the child until it is one year old.
Between the first and the seventh month the increase in the amount of cow’s milk and the decrease in the amount of boiled water will depend entirely upon the condition of the child’s digestion. After the first month the increase in cow’s milk should be made quite gradually, and several days should be permitted to elapse after each change, to watch the effect upon the digestion.
The child himself furnishes a pretty fair indication of when the strength of the food should be increased. If he drains the bottle rapidly and cries when it is taken from him, or if he begins to fret anywhere from an hour to half an hour before his feeding time, and if he constantly sucks his fingers in hungry fashion, either the quantity of the food or its strength must be increased.
If the food is already too rich for the child, this is shown by indigestion, vomiting, diarrhea, or constipation. The increase in the strength of the formulas should be at the rate of half an ounce or less in three days or more for about a month after artificial feeding begins; then a greater amount of time should be permitted to elapse.
The increase in quantity should be at the rate of a quarter of an ounce at each feeding, made at intervals of four to seven days, according to the growth and appetite of the child. It will be noticed that there is a more rapid increase during the first month of the child’s life than at any other time. This is because exquisite care must be taken to start the child on the most delicate form of artificial food. Then, if modified milk does agree with the infant, it thrives and demands artificial food of increasing strength, precisely as the mother’s milk gains in strength as she gains in health and energy after her confinement.
It will be recalled that mother’s milk up to the fourth or fifth day is practically sweetened water on which the baby thrives. The child’s digestion is not injured when the flow of mother’s milk is suddenly established and becomes rich. In planning the diet for a bottle-fed baby, those who have given the matter study follow as closely as possible the rules laid down by nature in supplying breast milk.
These are the simplest and most reliable of formulas with plain milk as the foundation.
The use of cream and top milk in the place of plain milk seems to be purely a matter of difference of opinion between medical authorities. If the top milk is used, the quantity of boiled water used in modifying it must be greater, and gruels are added at a much later date.
A question frequently brought up at contests was that of adding lime water to modified milk. This, too, represents a difference in medical opinion. Dr. L. Emmett Holt, one of the first American specialists in the care and feeding of children, advises that one ounce of lime water be included in every twenty ounces of modified milk, to correct acidity in cow’s milk. Dr. Roger H. Dennett, Professor of Pediatrics at the Post Graduate Hospital, New York City, does not consider lime water essential to a successful formula. Other authorities differ in the same way. The mother who feels any anxiety on this score will do well to consult her own physician, who can study at first hand the general condition of the baby, its appearance, the stools it passes, and what it may vomit if the artificial food is not properly digested.
There are almost as many feeding tables in existence as there are specialists in the care of children. This is another question where hard and fast rules cannot be laid down. But here aresome general tables which have borne the test in families where artificial feeding is a stern necessity:
Any baby weaned under three months of age should have bottle feedings as it would have had breast feedings, at intervals of every two hours between 6A.M.and 10P.M.It should also have one feeding in the night between one and two o’clock. This represents ten feedings in twenty-four hours, up to the time the child is three months old.
The quantity to be supplied at each feeding varies with the baby’s age:
During the first week the baby should be given one and one-half ounces at each feeding. This, with ten feedings in twenty-four hours, means from ten to fifteen ounces of nourishment a day.
During the second week the amount at each feeding is raised to: 2 ounces, or 20 ounces in twenty-four hours.
Third and fourth weeks: 2½ ounces for each feeding.
Second and third month: 3 ounces for each feeding.
During the fourth month the table of feeding changes. The child is now fed every two and one-half hours from 6A.M.to 9P.M., with one feeding between 1 and 2A.M.Four and one-half ounces at each feeding, or 36 ounces in twenty-four hours.
During the fifth month the feedings are still farther apart; every three hours between 6A.M.and 9P.M., and one feeding in the night. Five and one-half to 6 ounces at each feeding.
So, from month to month, the feedings are a little farther apart and each feeding a little heavier.
At five months, if the baby is strong, the night feeding may be omitted. At eight months the baby is fed six times a day, at three-hour intervals, eight ounces of food to the feeding.
It must be understood that the feeding tables here given are planned for a normal, healthy baby. The sickly baby, or the child whose digestion is very poor and whose appearance denotes malnutrition, should be placed under the care of a physician who is capable of planning special diet.
Only in case of emergency is the baby weaned within a day or so after birth. As a rule, the mother attempts to nurse the child, and weans him only when she realizes beyond all question that her milk is not sufficiently nourishing. In such cases it is not necessary to wean the child abruptly; the feedings can be alternated, breast and bottle. In this way certain properties in the mother’s milk correct possible ill-effects on the digestion from bottle feedings. Moreover, the mother sometimes gains in strength, the milk improves and the bottle is then given at rarer intervals.When it becomes necessary to wean the child completely from the breast, because of its age, or pregnancy in the mother, half the battle has been fought in accustoming the child and its digestive apparatus to the bottle food.
A question frequently asked by mothers is this:
“What is the difference between pasteurized milk and boiled milk, and which is better for the child?”
Pasteurizing milk consists of heating it to a temperature varying from 155° to 175° F. in apparatus specially made for this purpose, which can be bought at prices varying from four to eight dollars through dealers in surgical instruments. Directions come with the apparatus. To pasteurize milk without an apparatus, fill the bottles with milk, cork them with sterile cotton wool, set in a pail, fill the pail with boiling water, cover it tightly and set aside for forty-five minutes; then cool the bottles rapidly and place them on the ice.
Boiling milk—or sterilization, as it is known to medical men—means keeping the milk at a boiling point for at least one hour in a double-boiler. The utensil containing the milk is then set in ice-water so that it will chill in twenty minutes or less. The milk is next poured into clean bottles, corked with sterile cotton wool, and placed on ice.
The milk to be fed to babies should be pasteurizedor boiled when there is doubt as to the source of milk supply; also when there is an epidemic current, such as typhoid fever, diphtheria, etc. Both processes are supposed to kill bacteria, boiling being more effective than pasteurization.
It is far better for the baby’s health, however, to secure certified milk than to treat it as described above. Boiled milk may be given to a baby during the first two or three weeks of its life, also to babies suffering with diarrhea and other acute digestive disturbances. But the child who is fed for a great length of time on boiled milk receives no fresh food, and is therefore subject to scurvy.
If, for any reason, the mother feels that it is necessary to feed her baby the boiled milk, she may counteract the effects on a child, three months old or more, with the strained juice of half an orange, morning and evening.
Particularly in mining towns, mothers must depend upon condensed milk as artificial food for babies. While it is much better to use fresh cow’s milk, if it can be secured, the condensed milk is preferable to stale cow’s milk. If a reliable brand is secured, the mother is buying fresh milk which has been sterilized and then evaporated. A can of condensed milk is equal to about three times as much whole or plain milk, sweetened with cane sugar.
When the child must be placed on condensed milk practically at birth, the milk should be dilutedin the proportion of one level teaspoonful of condensed milk to sixteen spoonfuls of boiled water. This gives a very weak and watery solution, and the young mother is apt to think it does not contain enough nourishment for her child. But she should bear in mind that mother’s milk is equally thin, yet sufficiently nourishing for the child one week old or less. Forty-eight hours later the dilution may be strengthened to one spoonful of milk to fifteen of water; then gradually to fourteen, etc. At three months the baby may be taking a solution of one part condensed milk to eight parts of barley water.
Babies raised on condensed milk gain rapidly in weight because the condensed milk, being low in fats and proteids, and high in sugar, is easily digested. However, the same children show little resistance when attacked by acute disease, and, if fed on condensed milk exclusively, they may develop rickets or scurvy. It is therefore desirable to secure a good quality of fresh milk to alternate with the condensed milk and, eventually, to serve it for all the feedings.
Medical authorities differ on the question of patent foods. Men who have specialized on the feeding of infants agree that the safest substitute for mother’s milk is modified cow’s milk, and claim that whatever nourishment is drawn from patent foods is due to the sugar or carbohydrates in the patented article and to the cow’s milk with whichit is prepared. These foods have no medical or life-giving properties; and most of them, in analysis, show a combination of starches, various kinds of sugar, dried milk, and even eggs. They should be given to the child only under the direction of the family physician.
The same is true of buttermilk, casein milk, and peptonized milk. The use of these foods is necessary only under certain conditions, when the child’s digestion is seriously disturbed. They should not be fed to a baby on the advice of a neighbor or a druggist. I have known many mothers who, at the first sign of indigestion, dosed the baby’s milk with quantities of lime water and peptonizing powder. This should not be done without consulting a physician.
Above all things, the mother of the baby artificially fed should keep calm and cool-headed. Even breast-fed babies have occasional attacks of indigestion, vomiting, colic, and diarrhea, which yield quickly to treatment. The same trouble in bottle-fed babies will yield to treatment.