Elementary Principles of Milk Modification—The Secret of the Efficiency of Mother's Milk—Two Important Factors in Successful Artificial Feeding—Every Child is a Problem in Itself—Proprietary Foods of Little Value as Infant Foods—Their Value is in the Milk Added to Them—The Credit Belongs to the Cow—Difference Between Human and Cow's Milk—What "Top-milk Feeding" Means—Utensils Necessary for Home Modification of Milk—Artificial Feeding from Birth to the Twelfth Month—How to Measure Top-milk—Easy Bottle-feeding Method—Condensed Milk Feeding—Objections to Condensed Milk Feeding.
Elementary Principles of Milk Modification—The Secret of the Efficiency of Mother's Milk—Two Important Factors in Successful Artificial Feeding—Every Child is a Problem in Itself—Proprietary Foods of Little Value as Infant Foods—Their Value is in the Milk Added to Them—The Credit Belongs to the Cow—Difference Between Human and Cow's Milk—What "Top-milk Feeding" Means—Utensils Necessary for Home Modification of Milk—Artificial Feeding from Birth to the Twelfth Month—How to Measure Top-milk—Easy Bottle-feeding Method—Condensed Milk Feeding—Objections to Condensed Milk Feeding.
Elementary Principles of Milk Modification.—Mothers who have to raise their children on artificial food should understand the elementary principles of milk modification. They should know, for example, that the one object of milk modification is to render it as nearly an exact substitute for mother's milk, according to the age of the child, as is possible. If we could do this with scientific exactness, artificial feeding would be a simple process. We cannot, however; nor has there ever been devised a method by which we may hope successfully to duplicate mother's milk. It is a comparatively simple matter for the efficient chemist to analyze the breast milk of any nursing mother; and it is quite possible to duplicate the milk according to the analysis, with chemical exactness, but the two fluids will not be the same. There is present in the mother's milk something which synthetic chemistry cannot discover. This something is nature's secret,—it is akin to the life-giving principle which is contained in the germinal fluid, and in the hen's egg. We cannot therefore hope to build up an artificial food that contains this mysterious life-giving principle which is the secret of the efficiency of maternal milk,—we can only hope to approximate it.It is possible that we might be successful so far as its nursing efficiency is concerned, if all children were alike, if all children were of a uniform standard of health. As a matter of fact, no two babies are exactly alike. And while the mother of each child undoubtedly secretes a milk suitable to the degree of healthfulness of her own child, the same milk might not be equally suitable to another child. The milk, therefore, that is manufactured to agree with an average mother's milk is dependent for its success upon the vitality of the child to which it is fed. If that child is not a well child, according to an accepted standard, the milk will not agree with it, even though it is the best possible substitute for an average breast milk.
We have consequently two factors to consider in successful or efficient artificial feeding:
1. Our inability to duplicate exactly mother's milk.2. The lack of a uniform health standard in children.
1. Our inability to duplicate exactly mother's milk.2. The lack of a uniform health standard in children.
It is the lack of a uniform health standard in children that gives to artificial feeding all its difficulties. It renders the successful artificial feeding of children a personal or individual problem. Some children,—those who approximate a standard of health for their age; in other words, "well" children,—thrive on a milk modification that experience has taught us is suitable for well children of their age. Others, and they are in the majority, have to be fed on a modification which actual test proves to agree with their digestive capabilities. Every artificially fed child therefore must be studied from its own individual standpoint. A certain modification of milk may not agree with a child fed every two and one-half hours, which will be found to agree if fed in the same quantity, to the same child, every three hours. The slightest change, a change which would seem to be so insignificant in itself as not to justify serious consideration, may mean the difference between normal healthfulness and constant ill health. A food that is too strong for a child's digestive ability, and which causes vomiting, colic, and diarrhea, may be rendered exactly right by the slightest modification one of its constituents. To effect such a change quicklyand successfully, one must be trained to interpret the symptoms correctly and to know how to make the change in the modification of the milk. Mothers cannot be expected to possess this degree of skill: they should therefore refrain from experimenting, because an experiment on a baby is not only dangerous, but ethically it is criminal. Call the family physician; put the burden on his shoulder.
It is this element of uncertainty in our ability to effect a standard modification of milk that has afforded manufacturers the rich opportunity of putting on the market various baby foods for which much is claimed. These foods are really substitutes for the inefficiency of the average mother. There is no real justification for their use. If all mothers were clean, faithful, and efficient, there is no reason why each one could not be taught to modify cow's milk to suit her child, just as satisfactorily, or more so, than a manufacturer who never saw her child. The manufacturers, however, do the work, and the naturally ignorant or lazy and inefficient mother, is willing to pay for the extra cost of labor, to save herself the trouble on the one hand, and to subject her child to a series of experiments in order to discover the manufactured food that is particularly adapted to her particular baby on the other hand. We believe that most mothers have never considered the question from this standpoint; that most mothers adopt this method of artificial feeding at the direct suggestion of their family physician, and are not, therefore, responsible. These foods do not contain the nutritional elements necessary to healthy growth; or as they exist in normal breast milk; or as they can be approximated in ordinary milk modification at home. Proprietary foods are of decidedly poor value in infant nutrition, and should not be used. They have a value, however, in certain diseased conditions, but within a very small range. As a food for a healthy growing infant, they should not be used, and when the average physician appreciates this fact, and so instructs the mothers of the country, it will be to the distinct advantage of the race in every respect. Proprietary foods to which freshcow's milk is added, are not foods at all,—they depend upon the milk so far as any nutritional value is concerned; and it would be far safer to modify at home a good milk than to buy a proprietary food, the analysis of which cannot be depended upon. The credit for the fat, healthy babies we see advertised does not belong to the manufacturers, but to the cow whose milk you add to the manufacturer's sugar.
The proprietary beef foods are also valueless as infant foods. In certain illnesses, when we want a mild stimulant, a teaspoonful or two in hot water may have a certain value, but that is all. The beef juice of home manufacture is much more valuable.
Difference Between Human and Cow's Milk.—The composition of cow's milk is as follows:
Fat (represented by cream)4%Sugar4%Proteids (represented by curd)4%
The composition of an average human breast milk is as follows:
Fat4%Sugar7%Proteids1-1/2%
It will be observed from a comparison of the above tables that cow's milk is much richer in proteids (the substances which form with water the curd of sour milk) than is human milk. If one remembers that cow's milk is manufactured by nature primarily for the feeding of calves, not for babies, and that the stomach of a calf is intended to exist exclusively on vegetable products, and that nature is preparing it for this purpose, and feeds it a food when young that will enable it to grow so as to be adapted for that purpose, one can understand that the problem of the modification of cow's milk to suit the stomach of a baby is not by any means a simple matter. Since the proteids are so much in excess in cow's milk, we must dilute cow's milk with twice its bulk or more of water to render it fit food for a new born baby. If we dilute cow's milk to this extent to get the proteid percentage right, we immediately disarrangethe percentage of the cream or fat. We overcome this difficulty by taking the cream from the top of the bottle and diluting it because it is richer in fat and does not need so much dilution. This is the explanation of the so-called "top-milk feeding." The percentage of sugar represents another problem. The percentage of sugar in cow's milk compared with the sugar in human milk is deficient, so we add milk-sugar to the cow's milk to make up the deficient percentage.
There is yet another feature which we must rectify; cow's milk is acid, while human milk is alkaline. To overcome this difference we add lime-water. We must also take into consideration that cow's milk is ordinarily full of germs, while human milk is free from them; to overcome this danger we resort to heating the milk to a degree which experience has taught us will kill all germs. Cooked milk is not as wholesome as uncooked milk, and it has a tendency to cause constipation. We have to a certain extent overcome the need for cooking all milk for babies, as will be noted later, but in summer time, unless the milk is known to be pure and free from germs, it is advisable to sterilize it.
One dozen round, eight-ounce nursing bottles.One dozen black rubber nipples.One eight-ounce measuring glass or graduate.One brush for cleaning bottles.One two-quart glass preserve jar for mixing the various ingredients.One one-ounce Chapin dipper, for removing the top-milk.One glass funnel.
One dozen round, eight-ounce nursing bottles.One dozen black rubber nipples.One eight-ounce measuring glass or graduate.One brush for cleaning bottles.One two-quart glass preserve jar for mixing the various ingredients.One one-ounce Chapin dipper, for removing the top-milk.One glass funnel.
A detailed description of the proper kinds of bottles and nipples will be found elsewhere. The measuring glass or graduate should be wide-mouthed. It is not safe to spoon the top-milk off, nor is it safe to pour it out. Absorbent cotton should be provided to close the nursing bottles when filled and left standing in the ice box.
The following formulas for the different ages may be found useful for well babies:
From the third to the tenth day:
Milk (top 16 oz.)3 ounces.Lime-water1/2 ounce.Milk-sugar1 ounce.Boiled water to make16 ounces.
Ten feedings in twenty-four hours; 1-1/2 to 2 ounces at each feeding.
From the tenth to the twenty-first day:
Milk (top 16 oz.)6 ounces.Lime-water1-1/2 ounces.Milk-sugar1-1/2 ounces.Water to make24 ounces.
Nine to ten feedings in twenty-four hours; 1-1/2 to 2 ounces at each feeding.
From third to the sixth week:
Milk (top 16 oz.)10 ounces.Lime-water2-1/2 ounces.Milk-sugar2 ounces.Water to make32 ounces.
Eight to nine feedings in twenty-four hours; 2 or 3 ounces at each feeding.
From sixth week to the third month:
Milk (top 16 oz.)12 ounces.Milk-sugar2 ounces.Lime-water3 ounces.Water to make32 ounces.
Seven to eight feedings in twenty-four hours; 2-1/2 to 4 ounces at each feeding.
From third to fifth month:
After this age two bottles of milk are required, 16 ounces being taken from the top of each bottle and mixed.
Milk (top 16 oz.)18 ounces.Milk-sugar2 ounces.Lime-water4 ounces.Water to make40 ounces.
Six feedings in twenty-four hours; 4 to 5 ounces at each feeding.
From the fifth to the seventh month:
Milk (top 16 oz.)21 ounces.Milk-sugar2 ounces.Lime-water5 ounces.Water to make42 ounces.
Six feedings in twenty-four hours; 5 to 7 ounces at each feeding.
From the seventh to the ninth month:
Milk (top 16 oz.)27 ounces.Milk-sugar2-1/2 ounces.Lime-water6 ounces.Water to make48 ounces.
Five to seven feedings in twenty-four hours; 6 to 8 ounces at each feeding.
From the ninth to the twelfth month:
Milk (top 16 oz.)35 ounces.Milk-sugar2-1/2 ounces.Lime-water6 ounces.Water to make56 ounces.
Five to six feedings in twenty-four hours; 7 to 9 ounces at each feeding.
It will be observed that 16 ounces of top-milk is used to make the various formulas from. This means that the mother will dip off, with a Chapin dipper, 16 ounces from the top of a bottle of milk which has stood for four or five hours to allow the cream to rise; she will then mix this and take from the mixture the number of ounces called for in the formula she is using according to the age of the child. The ordinary milk that is delivered in New York City may be assumed to have stood the four or five hours necessary. This may not be so, however, in the country, as it is frequently delivered there as soon as it is milked. In such cases the mother will permit it to stand in the ice box until the cream has risen.
When the mother is about to make the mixture called for in feeding from the third to the fifth month she will observe that 18 ounces of milk is called for. Now since she only uses 16 ounces of the top-milk from one bottle this will not be enough. She must therefore use 16 ounces from two bottles of milk; this she will mix together and from this mixture she will take the 18 ounces wanted. Whatever milk is left over may be used for ordinary table purposes.
The following formulas and instructions for bottle-feeding are taken from the Rules for the Care of Infants and Young Children which are used by Dr. Kerley at the out-patient department of the Babies' Hospital and give the simplest and easiest means of bottle-feeding:
Bottle-Feeding.—The bottle should be thoroughly cleansed with borax and hot water (one teaspoonful of borax to a pint of water) and boil before using. The nipple should be turned inside out, scrubbed with a brush, using hot borax water. The brush should be used for no other purpose. The bottle and nipple should rest in plain boiled water until wanted. Never use grocery milk. Use only bottled milk which is delivered every morning. From May 1st to October 1st the milk should be boiled five minutes immediately after receiving. Children of the same age vary greatly as to the strength and amount of food required. A mixture, when prepared, should be put in a covered glass fruit-jar and kept on the ice. For the average baby the following mixture will be found useful:"For a child under six weeks of age: Nine ounces of milk, twenty-seven ounces of barley-water, four teaspoonfuls of granulated sugar. Feed from two to three ounces at two and one-quarter hour intervals, nine feedings in twenty-four hours."Sixth to the twelfth week: Twelve ounces milk, twenty-four ounces barley-water, five teaspoonfuls sugar. Feed from three to four ounces at each feeding."Third to the sixth month: Eighteen ounces of milk, thirty ounces of barley-water, six teaspoonfuls of sugar. Feed four to six ounces at three-hour intervals, seven feedings in twenty-four hours."Sixth to the ninth month: Twenty-four ounces milk, twenty-four ounces barley-water, six teaspoonfuls granulated sugar. Feed six to eight ounces at three-hour intervals, six feedings in twenty-four hours."Ninth to twelfth month: Thirty-eight ounces milk, twelve ounces barley-water, six teaspoonfuls of granulated sugar. Feed seven to nine ounces at three and one-half hour intervals, five feedings in twenty-four hours."
Bottle-Feeding.—The bottle should be thoroughly cleansed with borax and hot water (one teaspoonful of borax to a pint of water) and boil before using. The nipple should be turned inside out, scrubbed with a brush, using hot borax water. The brush should be used for no other purpose. The bottle and nipple should rest in plain boiled water until wanted. Never use grocery milk. Use only bottled milk which is delivered every morning. From May 1st to October 1st the milk should be boiled five minutes immediately after receiving. Children of the same age vary greatly as to the strength and amount of food required. A mixture, when prepared, should be put in a covered glass fruit-jar and kept on the ice. For the average baby the following mixture will be found useful:
"For a child under six weeks of age: Nine ounces of milk, twenty-seven ounces of barley-water, four teaspoonfuls of granulated sugar. Feed from two to three ounces at two and one-quarter hour intervals, nine feedings in twenty-four hours.
"Sixth to the twelfth week: Twelve ounces milk, twenty-four ounces barley-water, five teaspoonfuls sugar. Feed from three to four ounces at each feeding.
"Third to the sixth month: Eighteen ounces of milk, thirty ounces of barley-water, six teaspoonfuls of sugar. Feed four to six ounces at three-hour intervals, seven feedings in twenty-four hours.
"Sixth to the ninth month: Twenty-four ounces milk, twenty-four ounces barley-water, six teaspoonfuls granulated sugar. Feed six to eight ounces at three-hour intervals, six feedings in twenty-four hours.
"Ninth to twelfth month: Thirty-eight ounces milk, twelve ounces barley-water, six teaspoonfuls of granulated sugar. Feed seven to nine ounces at three and one-half hour intervals, five feedings in twenty-four hours."
Barley-Water.—The barley-water used in the above formulas may be made in the following way: To two teaspoonfuls of pearl barley, add one quart of water, and boil continuously for six hours, keeping the quantity up to a quart by the addition of water; strain through coarse muslin. The barley will be better if it is soakedfor a number of hours, or over night, before cooking. The water in which it is soaked is not used.
An equally good barley-water may be made in an easier way by using Robinson's prepared barley. This may be procured in the drug stores. It is only necessary to take one even tablespoonful of this barley to twelve ounces of water and cook for twenty minutes.
Condensed Milk.—When the mother cannot afford to buy bottled milk from the wagon, when she has no ice-chest and cannot afford to buy ice, she should not attempt cow's-milk feeding, but may use canned condensed milk as a substitute during the hot months only. The can, when opened, should be kept in the coolest place in the apartment, carefully wrapped in clean white paper or in a clean towel. The feeding hours are the same as for fresh cow's milk:
"Under three months of age: Condensed milk one-half to one teaspoonful; barley-water, two to four ounces.
"Third to sixth month: Condensed milk, one to two teaspoonfuls; barley-water, four to six ounces.
"Sixth to ninth month: Condensed milk, two to three teaspoonfuls; barley-water, six to eight ounces.
"Ninth to twelfth month: Condensed milk, three teaspoonfuls; barley-water, eight to nine ounces."
Objections to Condensed Milk Feeding.—Condensed milk is not to be recommended as a permanent food where good cow's milk can be obtained. In most cases it should be used as the sole food for a few weeks only. It may be used when the digestion is impaired for some reason. If the symptoms are intestinal it will be more apt to agree than if they are caused by stomach ailments. The symptoms of intestinal disturbances are,—colic, flatulence (gas), curds or specks in the stools, constipation or diarrhea. It will not be found suitable if the child is simply vomiting.
The objections to condensed milk are: It is very rich in sugar and very deficient in proteids and fat. Children fed on condensed milk often gain very rapidly in weight but have little strength or resistance. They do not fight disease well for this reason; they are apt to develop rickets and scurvy.
How to Prepare Milk Mixtures—Sterilizing the Food for the Day's Feeding—How to Test the Temperature of the Food for Baby—When to Increase the Quality or Quantity of Food—Food Allowable During the First Year in Addition to Milk—Beef Juice—White of Egg—Orange Juice—Peptonized Milk—The Hot or Immediate Process—The Cold Process—Partially Peptonized Milk—Completely Peptonized Milk—Uses of Peptonized Milk—Objections to Peptonized Milk—What a Mother Should Know About Baby's Feeding Bottle and Nipple—Should a Mother Put Her Baby on Artificial Food if Her Supply of Milk, During the First Two Weeks is not Quite Enough to Satisfy it—Certain Conditions Justify the Adoption of Artificial Feeding from the Beginning—Mothers' Mistakes in the Preparation of Artificial Food—Feeding During the Second Year—Sample Meals for a Child Three Years of Age—The Diet of Older Children—Meats, Vegetables, Cereals, Bread, Desserts—Fruits.
How to Prepare Milk Mixtures—Sterilizing the Food for the Day's Feeding—How to Test the Temperature of the Food for Baby—When to Increase the Quality or Quantity of Food—Food Allowable During the First Year in Addition to Milk—Beef Juice—White of Egg—Orange Juice—Peptonized Milk—The Hot or Immediate Process—The Cold Process—Partially Peptonized Milk—Completely Peptonized Milk—Uses of Peptonized Milk—Objections to Peptonized Milk—What a Mother Should Know About Baby's Feeding Bottle and Nipple—Should a Mother Put Her Baby on Artificial Food if Her Supply of Milk, During the First Two Weeks is not Quite Enough to Satisfy it—Certain Conditions Justify the Adoption of Artificial Feeding from the Beginning—Mothers' Mistakes in the Preparation of Artificial Food—Feeding During the Second Year—Sample Meals for a Child Three Years of Age—The Diet of Older Children—Meats, Vegetables, Cereals, Bread, Desserts—Fruits.
The mother should always remember, that the secret of success in raising a baby efficiently on artificial food is to be cleanly and to be exact. The bottles and the nipples must be scrupulously clean; the hands of the mother must be clean; the water used must be boiled and each ingredient must be measured exactly.
First dissolve the sugar in the boiled water, which must be the exact quantity; then remove the top-milk and measure the exact amount wanted in the graduate, pour into the jar, add the water and sugar mixture, and finally the lime water.
It is always desirable to make the entire quantity for the day at one time. After the total quantity has been mixed in the jar, fill each bottle with the amount for each feeding, put in a cotton stopper, and place the bottles in the ice box.
In measuring the sugar, it should be remembered thattwo scant dipperfuls equal one ounce by weight of the sugar.
When each individual bottle is to be filled, do it with the aid of the glass funnel which has been previously sterilized.
Sterilizing the Food For the Day's Feeding.—The simplest method is to place the two-quart jar containing the milk mixture for the next twenty-four hours' feeding upon a saucer in the bottom of an open pan, and then to pour enough tepid water into the pan (outside of the jar) until it will come up as high as the milk level. The water in the pan is then brought slowly to the boiling point. The pan is then moved to the back of the stove and left for half an hour. The jar is then removed and rapidly cooled by allowing cool water to flow over the outside; the individual bottles filled and put in the ice box.
It is always wise to taste the milk before making up the day's feeding to be sure it is not sour. The milk from a herd of good cows is always better than the milk from one cow no matter how good that one cow may be.
When about to feed the baby, the bottle is taken out of the ice box and heated to the desired temperature in a water bath. The temperature of the milk can be tested by allowing a few drops to fall on the wrist; it should feel warm, not hot; it should not be tasted by putting the bottle to the mouth of the nurse, or mother, as it may become infected by doing so. A flannel cover, or bag, should be made to fit the bottle and it should be put on while the baby is nursing so that the milk may retain its heat. The baby must not be disturbed while nursing, nor should he be jounced or carried around after nursing. These habits cause vomiting and indigestion. He should be put in his crib.
When to Increase the Quality or Quantity of Food.—Children of the same age may have different digestive abilities. A strong, robust child may be permitted to take a richer quality of milk than a weak, puny infant of the same age. If the quality or quantity of each feeding is too weak or small for the baby he will be dissatisfiedand he will cry after the feeding. In such cases, if the bowel discharges are natural and yellow without curds or white specks, and if he is not gaining sufficiently in weight, the next stronger formula may be tried. If it is decided to put him on the stronger mixture, it is wise to cut the quantity down for a day or two in order to test out his digestive ability. If the stools remain good after three days, the quantity may be slowly increased until the amount in the recipe is allowed. It is a much more serious risk to overfeed the baby than to underfeed him. If too large a quantity is given, he may vomit it at once, or he may develop colic with intestinal indigestion. Such babies lose weight, become fretful and irritable, even though the appetite may remain good. If too strong a quality is given he may vomit sour, buttery-smelling milk, or have colic, and pass curds in the stool. If this happens it may be necessary to go back to a weak formula and work up from that standard. This is always a tedious and anxious experience and may lay the foundation for digestive disturbances for a long time. Don't be too anxious to increase the quality, or quantity, of your baby's food. It is much better to go slow and have a well baby, than to try to force matters and get into all kinds of trouble. No science calls for more elementary common sense, than the science of infant therapy.
Digestive disturbances incident to this period are fully explained in the chapter on Diseases of Children.
About the twelfth month the baby should receive plain milk mixtures instead of the top-milk heretofore used in making up the food. At first the milk may be plain milk from an ordinary bottle shaken up. Of this he may take five ounces, to which may be added three ounces of barley water. The barley water may be gradually withdrawn, an ounce at a time, replacing this amount with milk, until the child is taking eight ounces of milk and two ounces of barley water. Later plain mixed milk will be suitable for a child about the fourteenth month.
Barley water may be added to the milk at any timeafter the third month in place of the plain boiled water in the preceding formulas. It is advisable to do this if there is any trouble with digestion, or if there are curds in the stools. Some children take more kindly to barley water than plain water at a very early age.
Beef Juice.—The juice squeezed from broiled steak may be given a child at about the eighth or ninth month, or, in cases of anemia, earlier than this. It is given before the milk feeding, diluted with an equal amount of water. At first a teaspoonful of the extracted juice should be given with the same quantity of water; increase every four days until at the end of two or three weeks two tablespoonfuls are given.
White of Egg.—Place an egg in boiling water and allow the water to cool with an egg in it. In ten minutes the white of the egg will be coagulated and ready for use. It may be used in place of the beef juice if the latter does not agree and may be begun at the sixth month and given once daily. One-half of the white of the egg should be tried, then at the end of a week, if it agrees with the child, the whole white of one egg may be given.
Orange Juice.—This juice has a good effect on the bowels and may be given even to very young children who are disposed to be constipated. It is also of benefit in counteracting the effect of boiled milk. The juice should be extracted from fresh oranges and strained. One teaspoonful may be given at first one hour before a feeding. The amount may be increased until four teaspoonfuls, or one tablespoonful, are given daily.
Peptonized Milk.—The object of peptonization of milk is partly or wholly to digest the casein, or curd, of the milk before feeding.
Fairchild's Peptonizing Powder is used for this purpose. The powder is put up in tubes, and instructions are furnished in each box as to its use.
There are two methods of using the powders:
The Hot or Immediate Process.—Fifteen minutes before feeding add from one-eighth to one-quarter of the contents of a tube to the milk mixture in the nursing bottle ready for use. The bottle is then put in water at a temperature of from 110° to 120° F., and allowed toremain in the water for fifteen minutes. The amount of the powder used and the temperature of the water depend upon the amount of milk in the nursing bottle.
The Cold Process.—Four ounces of cold water are put into a clean quart bottle and the powder from one of the tubes. Shake the mixture thoroughly until the powder is dissolved. Add a pint of cold fresh milk, shake the bottle again and place directly on ice. When any of this milk is used the bottle should be again shaken and put immediately back on ice.
If necessary this process may be modified so that partially or completely peptonized milk may be made.
Partially Peptonized Milk.—Put four ounces of water and a whole tube of powder into a clean pan and stir well; add a pint of cold milk and heat to the boiling point, stirring the mixture all the time. There should be enough heat to bring the milk to the boiling point in ten minutes. Allow the mixture to cool somewhat and strain into a clean jar, cork tightly and keep in a cool place. Shake the jar before and after using any of the contents.
If partially peptonized milk is properly prepared it should not become bitter.
Completely Peptonized Milk.—Put four ounces of cold water and the powder contained in one of the tubes into a clean quart bottle and shake thoroughly. Add a pint of cold fresh milk and shake again; then place the bottle in a pan of warm water about 115° F., or not too hot to place the hand in comfortably. Keep the bottle in the water bath for thirty minutes; then place the bottle directly on ice.
Uses of Peptonized Milk.—Partially peptonized milk is useful in young infants who have difficulty in digesting the curd of milk. Completely peptonized milk is frequently used during attacks of indigestion. It is used also to tide a delicate infant over a period when for some reason the digestive apparatus refuses to digest and assimilate even dilute mixtures. It is of value also in acute or chronic illness when the child has to be fed through a tube. When it is necessary to feed per rectum peptonized foods are often selected in preference to others.
Objections to Peptonized Milk.—Complete peptonization of milk renders the milk bitter. For this reason many children will not take it. Very young children whose sense of taste is not developed may be induced to take it after a few days. It is not wise to continue its use long because the function of the stomach will become accustomed to the use of predigested food and refuse to work when called upon. If it is used for a number of weeks it is wise to stop it gradually in order to permit the stomach to resume its function in a normal way.
What a Mother Should Know About Baby's Feeding Bottle and Nipple.—In the first place, always buy round bottles,—round everywhere, inside and out,—there should be no corners anywhere. The reason for this is, that bottles that are round everywhere, are easily cleaned, and can be thoroughly cleaned, and having no corners they do not lend themselves to collecting dirt and bacteria. When these bottles are first bought they should be boiled. After each feeding they should be thoroughly washed with soap or washing powder. A long-handled bottle brush should be used to help clean the bottle. After the bottle has been thoroughly rinsed a number of times with hot water, it should be set aside filled with warm water into which one teaspoonful of bicarbonate of soda has been put. Before filling them with the freshly prepared food each morning the bottles should be boiled. Every mother with a bottle-fed baby should buy a dozen bottles, all of the same kind and size to begin with. This is a great advantage for a number of important reasons, two or three of which I will mention:
1st. Having enough bottles means that each bottle will be used once only during the twenty-four hours; there is less chance therefore of a bottle being cleaned carelessly.
2nd. Having a fresh bottle for each feeding permits all of the food for twenty-four hours being made at one time. This ensures uniformity of quality of each feeding.
3rd. By cleaning all the bottles at one time (previous to filling) it is more apt to be done thoroughly; and by making all the food for a day at one time it is moreapt to be correct than if each feeding was made separately.
The baby's nipple should be made of plain black rubber. It should not be too thick because it is necessary to turn it inside out in order to clean it thoroughly. The hole in the nipple should not be too large—if the child can empty the bottle in less time than fifteen minutes the hole is too large. If the milk drops out but does not run it is about right. Don't buy nipples too long or too large. A long nipple tends to gag the child and cause vomiting. A large nipple prevents the child from sucking properly and usually allows the food to be taken too quickly and with air, which causes colic and indigestion. It is well to have always half a dozen nipples of the right kind on hand. When new, nipples should be boiled before using. After each feeding the nipple should be washed in borax and water on both sides, then it should be put in a dish containing fresh, cold, borax water and left there until again required. A large portion of the success of raising healthy, bottle-fed babies is in being everlastingly clean in the details of caring for the bottles and nipples which are in daily use.
Should a Mother Put Her Baby on Artificial Food if Her Supply of Milk, During the First Two Weeks, is Not Quite Enough to Satisfy It?—This is a question that cannot be answered by a simple yes or no. A great deal depends upon circumstances, and these circumstances must be weighed and counterweighed before an answer is given. It is a serious matter, in our judgment it is a criminal proceeding for a physician to advise the use of an artificial food without exhausting every aid and means to preserve and increase the mother's milk. This is a subject in need of earnest missionaries in all walks of life, and it should be the duty of every woman's club and gathering to voice the conviction of the highest womanhood by advocating the use of mother's milk with every child born. A woman who can and will not nurse her own child is scarcely deserving of the name of mother.
It does not seem quite human to deprive a baby of the milk which rightfully belongs to it; yet in certain walks of life this is not an uncommon procedure. On the otherhand the percentage of women able to nurse their children is decreasing. This is especially true as applied to cities, though it is also true, in a less degree, in the rural districts. One eminent authority states that less than twenty-five per cent. of the well-to-do mothers, who have earnestly and intelligently attempted to nurse their babies, succeed in doing so for a period longer than three months. This authority also says: "An intellectual city mother who is able to nurse her child successfully for the entire first year is almost a phenomenon." Women nowadays have so many diversified interests, that the primal duty of maternal nursing is not at all a fashionable function. If, however, the mother is willing, and has conscientiously tried to nurse her baby, and after seven or eight days it is found that she has not enough milk to satisfy it, and if the quality seems to be good, some expedient should be immediately adopted to tide the condition over until the mother resumes her customary household routine. The safest expedient under these circumstances is to alternate the feedings; one feeding from both breasts of the mother, and the next an artificial food. Some arrangement of this kind is the just and the safest way, because a very large percentage of mothers suffer from inactivity while lying in bed after a confinement. This inactivity expresses itself in a failure of some of the organs to perform their duty properly. This may affect the quantity, and sometimes the quality, of the milk, but it is, as a rule, quickly rectified as soon as the mother is up and active.
If, however, the milk is still found to be inadequate after she is up and has resumed her usual habits, and if her health is good, and she is eating well, it is distinctly best to put the child exclusively on an artificial diet.
1st. Woman suffering with any wasting disease such a cancer or tuberculosis. (One of these days, and very soon we hope, it will be legally impossible for a tubercular or cancerous patient to become a mother.)
2nd. When a mother is the victim of any of the serious childbed complications such as convulsions, kidney disease, extensive loss of blood or blood poisoning, or runs a high temperature because of some disease occurring at the same time as the confinement, as, for example, appendicitis, scarlet fever, typhoid fever, etc.
3rd. Epilepsy, chorea, insanity, are also conditions which render artificial feeding necessary.
It is much wiser immediately to put the child on artificial feeding if there is a justifiable reason for it than to experiment, because any experiment at this time is almost certain not to be in favor of the child. Artificial feeding is a comparatively easy and successful problem, provided it is begun with healthy digestive organs. If you keep the child at the breast of a mother whose milk is inadequate in quantity or quality, or both, for two or three days, and then begin artificial feeding, the child's stomach is already unable to perform its duty, and you have to treat it with the greatest degree of care and attention, and probably begin with a weak food, until you regain the lost ground.
Mothers' Mistakes in the Preparation of Artificial Food.—Another interesting condition which is quite common, is the tendency on the part of the mother to fail to follow instructions correctly,—even though written or printed,—regarding the preparation of the baby's food. When the baby is not thriving and gaining steadily in weight, or is fretty and cries a good deal, and does not rest and sleep peacefully, something, of course, is wrong. If, after a careful physical examination of the child, nothing is found to justify these symptoms, a physician invariably finds, if he questions the mother closely, that she has mistaken the instructions and is preparing the food wrongly.
Infinite care in every little detail is the price of success in raising babies as well as in every other field of human endeavor. Revise carefully your method of preparing baby's food if there is any trouble such as is described above. Despite your absolute assurance that you are making no mistake, do not be surprised to find that you are not following directions to the letter, and because ofthis unintentional mistake, your negligence is responsible for your baby's condition. Go over the instructions with your husband, and let him follow your method of preparation, as you repeat it. He may detect the mistake if any exists,—two heads are always better than one. So important is this matter that the following two actual cases will demonstrate how easy it is to make a mistake, despite the absolute confidence of the mother, in each case, that she was following the printed directions correctly:
I was called to see a baby whose mother informed me that it was having a great deal of trouble. It was apparently not thriving; its bowels were bad; it constantly cried, and seemed to be suffering from colic and indigestion. The mother stated that it lay with its legs constantly drawn up and passed enormous quantities of gas. The baby certainly looked sick. It had been a small baby at birth; and at three months it weighed only six pounds. After a careful examination, I could find nothing in the physical condition of the child itself, which satisfactorily explained the condition, and had made up my mind that the food upon which it was being exclusively fed, and upon which it had been fed since birth, was not agreeing with it. Before recommending a change of food, I asked the mother to state in detail just how she prepared it.
The directions printed on the can in which the food was bought called for so many ounces of a certain quality of "top milk." She thought this meant simply so many ounces off the top of a bottle of milk, which, of course, meant that she was feeding her baby exclusively a very rich cream and absolutely no milk. The result was that the baby—small and weak to begin with—could not digest this rich mixture, so it gradually lost vitality, as the mother kept increasing the strength of the food, according to the age, as directed by the instructions, until it was completely knocked out. I pointed out her mistake and suggested a change in her methods; she was instructed to use the formula for a child of two months, instead of the one for three months, as she was doing. The child immediately began to pick up and in the course of six weeks was entirely cured, and had gained considerablyin weight. This mother was a careful, clean, painstaking, attentive nurse, and it was a long time before she forgave herself for the mistake. The mistake here was a little matter, but the results were big and convincing.
The second case was that of a child of about the same age, but in this instance it had been a robust, healthy child when born, and of normal weight and size. The mother nursed it for about one month, when her milk failed, and it was put upon a well-known, patent barley preparation. The food seemed to agree with it for a time, but, as the mother explained, the child soon seemed to be dissatisfied at each feeding,—it gave her the impression that it was not getting enough to eat, so she increased the quantity. Despite this increase of food, it was apparent that the baby was getting weaker, and more and more irritable, and sleepless, until there was no rest night or day for the mother or baby. About this time the child began to "swell up" as if dropsical; it lost its healthy color and looked as if made of wax. It was very evident that the child was being starved, yet this scarcely seemed probable when the actual quantity of food consumed was considered. The directions on the can of this food, called for a certain amount of the barley powder to be mixed with boiled water; and in an additional paragraph it was directed to mix this with a certain amount of milk. When I requested the mother to state how she prepared the food, I was astonished to learn that she had evidently never read the second paragraph of the directions. She was feeding her baby on barley powder and boiled water,—an excellent starvation diet. When her attention was called to the grave carelessness she had been guilty of, she was the most contrite mother I ever knew. As soon as the milk was added to the food the baby immediately began to thrive was very soon a robust, healthy infant.
Of course these were errors of bad judgment and gross negligence of which few mothers would be guilty, but these types of mistakes come to the attention of physicians frequently, and emphasize the need of constant vigilance in every detail in the management of babies if we wish to achieve success.
At the beginning of the second year the child should be fed at the following hours, 6 and 10a. m., 2, 6, and 10p. m.
Early in the second year the child should be taught to drink from a cup.
A proper diet for a child of twelve months, of average development, would be as follows:
6a. m.Milk and barley water, or milk and oat gruel, in the proportion of seven ounces of milk to three ounces of the diluent.
9a. m.The juice of an orange (strained).
10a. m.The same as at 6a. m.
2p. m.Chicken broth with rice or stale bread crumbs, six ounces; or a light boiled egg mixed with stale bread crumbs; or beef juice, three ounces. Milk and gruel same as at 6a. m., but four ounces only.
6p. m.Two tablespoonfuls of cereal jelly in eight ounces of milk; a piece of stale bread and butter. (The jelly is made by cooking the cereal for three hours the day before it is wanted; it should then be strained through a colander; oatmeal, barley, or wheat may be used.)
10p. m.Same as at 6a. m.
About the fifteenth month the cereals may be given much thicker and fed with a spoon. The child can at this time take a number of various fruit juices. Orange juice is the best. Carefully strained juice of ripe peaches, strawberries, raspberries, may be given in reasonable amounts, one or two tablespoonfuls, once daily. Custard, cornstarch, plain rice pudding, junket, wheatena, cornmeal, hominy, oatmeal, zwieback, bran biscuit, each with butter, may be added in reasonable quantities between the eighteenth and twenty-fourth months. When cereals are given they should be thoroughly cooked, usually for three hours, and strained. When apple sauce is given to a child about the second year it should contain very little sugar and baked apples should be fed without cream. Water must be given to the child between meals especially during the summer. It should be boiled and cooled kept in a cool place. The following schedule for a child about the third year constitutes a good average diet for a healthy child: