The cause of stomach trouble in a baby a few days old, fed exclusively on mother's milk, is invariably to be found in the quality of the milk.

The quality of the mother's milk may be affected in a number of ways which will render it unfit for the baby. For example, if the mother for any reason becomes sick, and has a high fever shortly after confinement, it will affect her milk and render it unfit temporarily.

If the mother worries or becomes highly nervous during the first few days of her baby's life, she will so affect her milk as to render it unfit for baby. If a baby is fed for a number of days after its birth by its mother, and it should prove afterward that she has not enough milk to continue feeding it, and has finally to put it on artificial food, the baby will most likely have acquired slight stomach ailments that may be troublesome for some time, because in this case both the quality and the quantity were no doubt wrong. Constipation in the mother will also cause trouble. The child will develop colic and extreme irritability until the mother's condition is relieved.

Each of these conditions affecting the milk of the nursing mother usually demands a change of food for the baby, and the substitution of the proper artificial food will invariably immediately correct the trouble. In some cases, however, the quality of the mother's milk is not dependent upon a temporary temperamental condition, but is caused by errors in diet, or conduct, or both. The milk of a physically tired, worn-out mother, is not good, no matter whether the exhaustion is caused by actual physical labor or by the exactions of a strenuous social programme. The milk of a mother who persists in eating irregularly, or who willfully caters to an appetite which craves the rich, highly seasoned articles of diet, or who attempts to satisfy a legitimate hunger by drinking large quantities of stale tea or coffee and eating bread, is unfit for her baby.

These cases are amenable to the proper treatment, which of course means, that the mother must change her conduct if at fault, and live strictly upon the diet prescribed elsewhere for nursing mothers.

If these troubles occur in babies who have been fed exclusively upon artificial food, an entire change of food is frequently necessary.

FRESH AIR FOR BABY

Baby's first journey out of doors depends upon so many contingencies that no specific age can be given when it would be perfectly safe to take it.

First, the weather and season of the year should be considered. The baby should not be taken out at all when it is wet, or foggy, or very humid; nor when it is extremely cold.

Second, the vigor or vitality of the individual child must be considered. Some children can safely be taken out if the weather is propitious when two weeks old, others cannot be taken out without risk until they are two months old, regardless of the weather conditions. If a child is robust at birth, and nurses well, and increases in weight from the beginning, he can be taken out when he is two weeks old while the sun shines during the middle of the day. If a child is small and puny when born, and begins to have nursing troubles from the beginning, does not increase in weight, is fretting, and crying, and sleeps spasmodically, it would be unsafe to take it out before the sixth week unless it is at a season of the year which would justify exposure to the sunshine.

The question of suitable clothing will be important, and will decide the advisability as to when the baby should go out. Every baby should be dressed in wool weather is not too distinctly bad. Remember always to [Transcriber's note: words missing in text] from neck to ankles. Its head should be warmly clad. Dressed thus and well wrapped in blankets, a healthy child is ready for an out-door trip at any time, if the [Transcriber's note: words missing in text] have plenty of blankets below the child as well as above it, if it is in a baby carriage. In very cold weather the child should be buried in blankets, and a hot water bottle can be wrapped in near his feet. Great care must be taken that the water in the bottle is not too hot, and that it does not actually touch the skin. No matter how many or how few blankets are used, the face should be exposed directly to the fresh air. When the air is very gusty, or high, a light veil can be laid over the face, but never at any other time.

AIR BATHS FOR BABIES.—Babies necessarily require plenty of exercise and plenty of fresh air, as has been pointed out. It is a splendid custom to allow the baby to lie naked after his bath for half an hour. If the room is comfortably warm, select a spot that is free from draughts, and lay the baby on a pillow or two and let him kick and coo. In the sun by the window, his head and especially the eyes shaded from the direct rays of the sun, is an excellent place in the summer time. The influence of the direct sun rays on the little naked body is conducive to good sturdy health, good nerves, and sound sleep.



CHAPTER XVIII

BABY'S GOOD AND BAD HABITS. FOOD FORMULAS

Baby's Bed—The Proper Way to Lay Baby in Bed—Baby Should Sleep by Itself—How Long Should a Baby Sleep—Why a Baby Cries—The Habitual Crier—The Habit of Feeding Baby Every Time it Cries—The Habit of Walking the Floor with Baby Every Time it Cries—Jouncing, or Hobbling Baby—Baby Needs Water to Drink—The Evil Habit of Kissing Baby—Establishing Toilet Habits—Baby's Comforter—What can be Done to Lessen the Evil Effects of the Comforter Habit—Beef Juice—Beef Juice by the Cold Process—Mutton Broth—Mutton Broth with Cornstarch or Arrowroot—Chicken, Veal, and Beef Broths—Scraped Beef or Meat Pulp—Junket or Curds and Whey—Whey—Barley Water—Barley Water Gruel or Barley Jelly—Rice, Wheat or Oat Water—Imperial Granum—Albumen Water—Dried Bread—Coddled Egg.

BABY'S BED

THE PROPER WAY TO LAY BABY IN ITS BED.—The baby should be accustomed to sleep by itself from the day of its birth. Mothers have been known to smother their babies during sleep. The mother may pull the bed-clothing over the baby's head during the night and thus deprive it fresh air. A mother is much more apt to nurse her baby regularly and to do it more efficiently, if she is compelled to get up to do it. If she occupies the same bed with baby, she may fall asleep while nursing him; the baby consequently nurses too long, fills his stomach too full, and soon develops indigestion and colic in addition to acquiring a very bad habit.

For the first few weeks an ordinary basket arrangement is all that is necessary. As soon as the baby begins to move around it should have a regular baby crib, so that possible accidents may be avoided.

When the baby is placed in bed after a feeding, it should be laid upon its back, being tilted slightly toward its right side. By placing a soft, small pillow, under its left side, the baby will rest more on its right side, which is the proper position. The reason of this is because the liver of a child grows quicker and larger than any other organ, and it is on the right side. By placing the child on this side, it prevents the heavy liver from sagging over on the little full stomach. If the child were laid on its left side, the liver would crowd the full stomach and embarrass the heart, and cause pain and restlessness. Frequently a change of position fully to the right side, when a child has been restless or crying, and especially if it has been lying on its back, will at once relieve it and allow it to go to sleep again. It is the knowledge of these little things that count in babyhood.

HOW LONG SHOULD A BABY SLEEP?—A perfectly healthy baby should sleep, while very young, eighteen or twenty hours out of the twenty-four. As it grows older it will sleep less. It should have, and nothing should interfere with its having, two sound naps every day,—one in the forenoon after its bath, and the other in the afternoon. When four or five months old, it should also sleep from 7 P. M. until 10 P. M., then it should be fed and allowed to sleep until morning. It has been aptly said, that, "a child might easily overeat, but he practically never oversleeps." During the second year a child should sleep twelve hours at night, and about two hours during the day. The twelve-hour night rest should be continued until the child is six years of age. The practice of taking a nap at noon is a very good one, and it should be encouraged as long as possible. It can usually be kept up until the child begins school life. The strenuous activity of childhood, makes some such rest highly desirable, and the result will necessarily be a stronger body, a better disposition, and firmer nerves than otherwise. The practice of retiring early should be strictly enforced during childhood. Children of two years of age, should retire at 6:30 P. M., or at latest at 7 P. M., those from three to five years, may remain up an additional hour. At thirteen or fourteen the regular bedtime should be at 8:30 P. M. There is no justification for the late hours which growing children are allowed to keep, especially in large cities.

Regular sleep is largely a matter of habit, and if the infant is started right, with suitable feedings, given at definite times, followed by the proper periods of sleep, but little trouble will be experienced with sleeplessness. When sleep is disturbed and broken, it means bad habits, unsuitable food, minor forms of indigestion, or positive illness of some kind. Sleep is absolutely essential in infancy and all through childhood for purposes of growth. It is wrong to permit a child to sleep too much during the day; it will become a habit, and it will not sleep well during the night as a consequence. In order to prevent or break this habit, the child should be kept in a well-lighted room and should be amused and entertained so as to keep it awake. The nap during the middle of the day is an exceedingly important factor in keeping the average child in good physical condition. It is a valuable adjunct in preventing, and in treating, nervousness in children. Children who are anemic should be encouraged to sleep long and freely in well-aired rooms.

WHY A BABY CRIES.—As has been stated, every healthy baby should cry for half an hour each day. Nature suggests, demands this as an essential exercise. Muscular movements involving a greater part of the whole body accompany the act of crying and furnish this necessary exercise. It is of great importance to an adequate and uniform development of the lungs; deep breathing is necessary to lusty crying, hence the lungs are expanded and the blood renewed and oxygenated. Crying is also of material aid in moving the baby's bowels. Babies in perfect health will, however, cry under any of the following circumstances, and doubtless under circumstances of lesser importance and frequency when frightened or uncomfortable from hunger or position, soiled napkins, inflamed buttocks, earache, pain, from heat or cold, unsuitable clothing, and during difficult bowel movement, when displeased or angry. Children slightly but painfully ill may cry incessantly for an hour or two. Thus, with intestinal colic, when the cry is loud and continuous until the child is relieved or until he falls asleep from exhaustion.

The healthy, well trained child seldom causes trouble; it is the rule for it to be happy and good natured in its own way.

THE HABITUAL CRIER.—If a child becomes a habitual crier, it is because it is uncomfortable and unhappy. There are restless, often vigorous, crying, whining infants, and the trouble, as a rule, is in the intestinal tract. Badly managed, "spoiled babies" cry from inattention, and when left alone. If they are taken up and talked to, the crying ceases, thus proving that it was not pain or discomfort that was causing the crying. In the case of the habitual crier we try to find out the cause of the bowel trouble and cure it; the spoiled infant we discipline rigidly, or leave it alone if its parents prefer that kind of baby.

THE HABIT OF FEEDING BABY EVERY TIME IT CRIES.—The habit of regular feeding will, if persisted in and successfully established, render advice on this subject unnecessary. So also will the explanation of the evil of overfeeding have its effect on mothers. Apart from these reasons, however, the habit of feeding baby every time it cries is a pernicious one, and no doubt the mother, who will be striving to faithfully follow instructions, will have to overcome the advice of meddling friends who will regard it as a cruelty to allow the baby to cry. Do not give in to these busy-bodies; insist on attending to your own affairs, but be absolutely sure baby is not crying for a just cause. A child can only cry; that is its only language, but it cries for many things other than the nipple or the bottle. Examine it carefully,—a wet diaper a pin, an uncomfortable position, a drink of water, any of these may be the cause.

It is just as essential that a child should cry as that it should sleep. Every healthy child should cry for twenty or thirty minutes every twenty-four hours. Nature calls for this as an exercise in order to develop the lungs; therefore, if there is no just cause for the crying you must regard it as a necessary evil, even if you look upon it as a domestic affliction.

THE HABIT OF WALKING THE FLOOR WITH BABY EVERY TIME IT CRIES.—This is another habit that is indulged in to the sorrow and ridicule of the race. If you are a victim of this habit, you have yourself to blame. It is a matter of education, or habit, pure and simple, and, like all bad habits, it is difficult to break away from. In the preceding paragraph, you have been told that when baby wants something, or is uncomfortable, it employs the language nature gave it,—it cries. No child ever cried to be walked up and down the floor in the dead of the night. Begin at the beginning, when it first cries, find out why it is crying. Offer it a little water if it is not feeding time. Examine its diaper and if soiled change it. It may be overdressed and consequently hot, perspiring, and uncomfortable; change its position. Find out if any pin is open and hurting it; loosen the binder so it can breathe easily. If it is a colicky child follow the instructions given in the treatment of colic. Be patient the first few nights, and be thorough, because you may discover why it cries and each discovery will help you next time. If you discover something wrong, some reasonable excuse for the crying, does it not prove the folly of walking the floor? If it wants a drink of water, or if its diaper is wet, how is walking the floor going to cure it, or how can you expect the baby to stop crying when you so unjustly construe its reasonable and its only way of asking a favor? If walking the floor stops its crying, it stops it by exhausting the child, not by relieving it of its little ailment.

JOUNCING OR HOBBLING BABY.—This is another habit that should be frowned upon. So many persons are addicted to this form of baby torture, that it is astonishing more immediate harm does not result from it. Be particularly careful not to indulge in it, or permit anyone else to do it immediately after feeding. If you form the habit of putting baby down at once after each feeding, as you have been instructed to do, the opportunity to jounce it will not exist. A little reasoning will clearly convince you that to subject a baby to violent exercise when its stomach is full would interrupt digestion and so shake the full stomach hat it would distend it and cause indigestion. You would not think of exercising yourself after a meal; why exercise a baby?

BABY NEEDS WATER TO DRINK.—Boil a quantity of water each morning, put in a clean bottle, and keep in a cool place. Give the baby some, three or four times daily between feedings. One teaspoonful is enough to begin with, and as it grows older it will take more. It may not always take the water but it will take what it wants, and it needs some every day; it is therefore your duty, inasmuch as baby cannot ask for it, to offer it regularly each day as part of your daily routine.

KISSING

A child should never be kissed on the mouth by anyone, not even its own parents.

Kissing should not be allowed among children. If any kissing is done it should be on the brow, never on the mouth, hands, or fingers.

Many diseases are carried by this pernicious habit, and you cannot afford to have baby's health jeopardized by this promiscuous and unnecessary liberty.

ESTABLISHING TOILET HABITS

When baby reaches the age of three months, a regular systemized effort should be made to educate it to "habits of cleanliness." Nothing can be done in this direction previous to this age, as a child at that period of its life is scarcely conscious of the natural functions of its body. Each time a baby, after the third month, is making an effort to move its bowels, the nurse or mother should go to it as it lies in its crib, and talk to it by making a certain sound or say a certain word—whichever word or words you want to educate your child to say, when it wants to move its bowels. By constant attention and effort in this direction, a child with quick perception and initiative will soon associate the sound and the function, and it will begin to make the sound when the function is about to be performed. As soon as it begins to make this sound, if prior to the act of moving the bowels, the child should be immediately taken up and held on a chamber, into which some hot water has been put, and encouraged to relieve itself, the nurse or mother still repeating the sound, or word, or words.

Having successfully accomplished this programme a number of times, the child should be encouraged and petted every time it gives a satisfactory warning, and discouraged and reproved every time it wets or soils its napkin. A little later, say about six months, the child should be held on the chamber at a certain time each morning and evening, thus encouraging it to move its bowels regularly twice daily. The careful carrying out of a scheme such as the above will establish regular, cleanly habits, and will to a very large extent guard against constipation in the future.

BABY'S COMFORTER.—The discovery and introduction of the comforter or rubber teat was an unfortunate episode in someone's life. By the careless, conscienceless nurse, or thoughtless mother, it is regarded as a real comfort and blessing. Any temporary comfort, however, which the nurse or mother may enjoy as a result of its use, is at the expense of the health of the child. Its use is a serious reflection upon the good intention and intelligence of the mother who permits her child to use one. It is a bad habit from every viewpoint possible. In order that mothers, open to conviction and capable of reasoning, may appreciate the character of the harm done by the use of the comforter, we will briefly record these conditions:

1st. The constant sucking pulls upon the delicate structures of the mouth and throat, and so impairs the health tone of these structures that they become flaccid and feebly nourished. This to a certain degree causes adenoids, enlarged tonsils, loose palate and weak throat, with the constant tendency to winter colds and coughs, and to catarrh.

2nd. It causes an excessive flow of saliva. Saliva should only be stimulated previous to stomach digestion. By causing an excessive flow of saliva into an empty stomach, the digestive powers are interfered with, and seriously weakened. Stomach trouble, and consequently intestinal disease, may therefore be caused by the seemingly innocent comforter.

3rd. A constantly used comforter always causes disease of the mouth. Mucous erosions, canker sores, little ulcers, etc., are produced in this way.

4th. The use of the comforter makes it impossible to put the child to sleep, or even to leave it alone, without first placing it in its mouth.

5th. To stifle a baby's cry, by pushing the comforter into its mouth, is as bad as giving it chloroform to mask a serious and dangerous pain. If may have a just reason for crying, as is explained elsewhere, and if that reason is not searched for and found, it may mean serious trouble later.

6th. Actual deformities of the mouth are produced by constant use of the comforter. The continuous sucking affects the gums, pushes them out of shape and position, and the teeth as a consequence come at wrong angles, thus causing unsightly deformities, which last throughout the life of the child.

7th. The worst fault of the comforter is to be found in its uncleanliness. We are quite satisfied that the use of the comforter will be legislated against one of these days. If preventive medicine means anything, it must certainly reckon with the comforter in the very near future. Have you ever watched your baby suck on its comforter? If you have, you must have noted the tireless energy with which it works its tiny jaws and tongue. Suddenly the comforter slips from the little mouth and baby begins to cry, attracting the attention of the mother, or nurse, or little sister, who promptly, recognizing the trouble, pounces on the offending comforter, which has fallen to the floor, and with a perfunctory wipe replaces it in baby's mouth. It is done just as we have written it, many thousand times, and yet the problem of infant mortality is represented as a vexatious mystery. The newspapers solicit charitable aid, and write eloquent appeals regarding the necessity of sending a few babies to the seashore in the summer time or to supply a few with ice during the hot spells. A hundred other energetic enthusiasts send forth their laudable effort to raise the standard of child hygiene, yet the manufacturers of the comforter, and the ignorant mother and nurse who use it, do more harm in one day than all the honest effort of these combined forces can neutralize in a year.

The rubber comforter is one of the most fertile causes of infection and illness in babies because of the peculiar adaptability to collecting germs which it possesses.

When the comforter is finally discarded the habit of sucking is so firmly established that the child will suck its thumb for many years after. This results in further disease and deformity to the growing mouth and throat, and also to the thumb.

After a child has used a pacifier or comforter for some time it invariably becomes a mouth breather. A mouth-breathing child is very apt to catch cold and as a consequence of the habit may become catarrhal or tubercular.

WHAT CAN BE DONE TO LESSEN THE EVIL EFFECTS OF THE "COMFORTER" HABIT?—It is a most difficult habit to cure when once established. The very least that can be done is to keep the comforter scrupulously clean, washing it several times daily. To have not one, but two or three, kept in a saturated solution of boracic acid, ready to put into the baby's mouth should one be required to replace another that has fallen out. We should furnish a large shield to prevent it being swallowed. We can try the method of weaning the baby from the comforter by tying a ribbon to it and to the child's bodice. The system is gradually to shorten the ribbon until it becomes too short for the baby to suck in comfort. It will then gradually grow away from the habit.

FOOD FORMULAS

BEEF JUICE.—Take one pound of round steak and broil it slightly. Press the juice out with a lemon squeezer, or, with a meat-press. Season with salt and serve hot or cold as desired. If it is heated after it has once been cold, it should not be overheated as this will coagulate the albumen which will appear as flakes floating on the surface of the juice.

BEEF JUICE BY THE COLD PROCESS.—Take one pound of finely chopped round steak, six ounces of cold water, a pinch of salt; place in a covered jar and stand on ice, or in a cool place, six hours. This mixture should be shaken from time to time. Strain and squeeze all the juice out by placing the meat in a coarse cloth and twisting it very hard. Season and feed as above.

Beef juice made in this way is more nutritious than that made from the steak when broiled; it is not, however, quite so palatable.

Beef juice made in either of the above ways is much more nutritious than the beef extracts sold ready to use.

MUTTON BROTH.—Take one pound of finely chopped lean mutton, including some of the bone, one pint of cold water and a pinch of salt, cook for three hours over a slow fire down to half a pint, adding water to make up this quantity if necessary; strain through muslin. When it is cold remove the fat and add more salt if required. It may be fed warm or cold in the form of a jelly.

MUTTON BROTH WITH CORNSTARCH OR ARROWROOT.—Add to the above sufficient cornstarch or arrowroot to thicken, cook for ten minutes and then add three ounces of milk, or one ounce of thick cream, to a half pint of broth. This makes a nutritious and extremely palatable broth.

CHICKEN, VEAL, AND BEEF BROTHS.—These may be made and used in the same way as mutton broth.

SCRAPED BEEF OR MEAT PULP.—Take a rare piece of round or sirloin steak, cut the outer part away, scrape or shred with a blunt knife. Cutting the meat into small pieces is not satisfactory. One teaspoonful to one tablespoonful may be given well salted, to a child a year and a half old. It is best to begin with a small dose and work up to the larger to accustom the digestive apparatus to its use.

JUNKET, OR CURDS AND WHEY.—Take one pint of warm fresh cow's milk, a pinch of salt, a teaspoonful of granulated sugar, to which add two teaspoonfuls of Fairchild's essence of pepsin and allow the mixture to stand until firmly coagulated—this may take about twenty minutes—place in the ice box until thoroughly cold. Nutmeg may be added for older children and adults.

WHEY.—The coagulated milk prepared as above is broken up with a fork and the whey is strained off through cheesecloth. If a stimulant is desired, brandy, in the proportion of one teaspoonful to six tablespoonfuls of the whey may be added.

BARLEY WATER.—One level tablespoonful of Robinson's barley is rubbed up with a little cold water, to this is added one pint of boiled water containing a pinch of salt. The mixture should be stirred while the water is being added. Cook for thirty minutes in a double boiler and strain. Enough boiling water should be added to the mixture to make up the full pint if any has boiled away.

BARLEY GRUEL OR BARLEY JELLY.—Repeat the above process, but instead of using one tablespoonful of the barley powder, use from two to four according to the consistency of the gruel or jelly desired.

Barley water may be made from the grains. A formula for this process will be found in the chapter on artificial feeding.

RICE, WHEAT, OR OAT WATER.—These are made from the rice, wheat, or oat flour in the same way as barley water described above. They may be made from the grains also, using the same proportions as in the making of barley water.

IMPERIAL GRANUM.—This is prepared in the same way as the barley flour above described.

ALBUMEN WATER.—Take half a pint of cold water, the white of one fresh egg, a pinch of salt, and a teaspoonful of brandy, shake and feed from a spoon or from a bottle. This is frequently used in cases of vomiting, or in irritable stomachs. It is often retained when all other food is rejected.

DRIED BREAD.—Cut either stale or fresh bread into thin slices and place in the open oven. When it is dried and crisp but not browned it may be given to children in preference to crackers.

CODDLED EGG.—A fresh egg with the shell intact is placed in boiling water which is immediately removed from the fire. The egg is allowed to remain in the water for eight minutes when it is ready for use. The white only should be used if the digestion is poor.



ARTIFICIAL FEEDING



CHAPTER XIX

ARTIFICIAL 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.

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 quickly and 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 fresh cow'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% Sugar 4% Proteids (represented by curd) 4%

The composition of an average human breast milk is as follows:

Fat 4% Sugar 7% Proteids 1-1/2%

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 disarrange the 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.

UTENSILS NECESSARY FOR HOME MODIFICATION OF MILK

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.

ARTIFICIAL FEEDING FROM BIRTH TO THE TWELFTH MONTH

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-water 1/2 ounce. Milk-sugar 1 ounce. Boiled water to make 16 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-water 1-1/2 ounces. Milk-sugar 1-1/2 ounces. Water to make 24 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-water 2-1/2 ounces. Milk-sugar 2 ounces. Water to make 32 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-sugar 2 ounces. Lime-water 3 ounces. Water to make 32 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-sugar 2 ounces. Lime-water 4 ounces. Water to make 40 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-sugar 2 ounces. Lime-water 5 ounces. Water to make 42 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-sugar 2-1/2 ounces. Lime-water 6 ounces. Water to make 48 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-sugar 2-1/2 ounces. Lime-water 6 ounces. Water to make 56 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.

EASY BOTTLE-FEEDING METHOD

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."

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 soaked for 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.



CHAPTER XX

ARTIFICIAL FEEDING—CONTINUED

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

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 that two 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 dissatisfied and 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.

FOOD ALLOWABLE DURING THE FIRST YEAR, IN ADDITION TO MILK

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 time after 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 deg. to 120 deg. F., and allowed to remain 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 deg. 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 more apt 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 other hand 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.

CERTAIN CONDITIONS JUSTIFY THE ADOPTION OF ARTIFICIAL FEEDING FROM THE BEGINNING

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 of this 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 considerably in 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.

FEEDING DURING THE SECOND YEAR

At the beginning of the second year the child should be fed at the following hours, 6 and 10 A. M., 2, 6, and 10 P. 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:

6 A. M. Milk and barley water, or milk and oat gruel, in the proportion of seven ounces of milk to three ounces of the diluent.

9 A. M. The juice of an orange (strained).

10 A. M. The same as at 6 A. M.

2 P. 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 6 A. M., but four ounces only.

6 P. 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.)

10 P. M. Same as at 6 A. 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:

TABLE OF STANDARDS

(As Adopted and Copyrighted by the American Medical Society)

PHYSICAL DEVELOPMENT

[Transcriber's Note: The ages were difficult to read and may not all be correct.]

Age in Months Weight Height Circumference of head Circumference of chest Circumference of abdomen Lat. Diameter of chest Chest front to back Length of arm Length of leg ———————————————————————————————————————- lbs. in. in. in. in. in. in. in. in. 6 17 27 17-1/2 17-1/2 17-1/2 5 4-1/2 10 10 9 19 28 18 18 18 5 4-1/2 11 11 12 20 29 18-1/2 18-1/2 18-1/2 5 4-3/4 12 12-1/2 16 23 30 18-1/2 18-1/2 18-1/2 5-1/2 5 12-1/2 13-1/2 21 24 31 18-1/2 19-1/2 19-1/4 6 5 14 15 24 25 32 19 20 19-1/2 6 5 14-1/2 15-1/2 28 27 33-1/2 19 20 19-1/2 6 5 14-3/4 15-3/4 32 29 35 19-1/2 20-1/2 19-1/2 6-1/4 5-1/2 14-3/4 15-3/4 36 32 36-1/2 20 21 20 6-1/4 5-1/2 15 16-1/2 ===============================================================================

MENTAL DEVELOPMENT

Attention, facial expression, irritability and disposition should be considered.

Six Months

Child sits unsupported for a few minutes.... Balances head.... Eye follows a bright object.... Looks in direction of an unexpected sound.... Child seizes an object and holds it....

Twelve Months

Stands and walks with support.... Makes a few sounds, such as mam-mam, da-da, co-oo.... Plays with toys.... Attempts to use paper and pencil.... Shows interest in pictures.... Clings to mother....

Eighteen Months

Child walks and runs alone.... Says a few words, such as Mama, Papa, Baby.... Points to common objects in pictures.... Imitates a few simple movements, such as placing hands on head or clapping hands....

Two Years

Runs.... Repeats two or three words.... Knows features.... Obeys simple commands, such as "Throw me the ball".... Imitates movements....

Two and One-Half Years

Talks in short sentences.... Knows names of members of the family.... Roughly copies a circle.... Recognizes self in mirror.... Imitates more complex movements....

Three Years

Talks distinctly.... Repeats sentences of six simple words.... Repeats up to two numerals—meaning repeats first one numeral and then two numerals.... Enumerates objects in a complex picture and attempts to describe it....

Four Years

Knows its sex.... Names familiar objects, such as key, knife, etc..... Repeats three numerals.... Compares two sticks (can select the longer).... Distinguishes the longer of two lines....

Five Years

Compares weights and lengths.... Copies a square.... Counts four pennies.... Describes a picture....

Breakfast:—(7 to 8 o'clock) Oatmeal, hominy or cracked wheat (cooked three hours), served with milk, a little salt but very little sugar. A soft egg, boiled, poached, or coddled. Stale bread and butter. One glass of warm milk. At 10 o'clock, the juice of one orange.

Dinner:—(12 o'clock) Strained soup, four ounces. Chop, roast beef, steak, chicken, small quantity of any one. Baked potato and cooked rice, or spaghetti. A selection of green vegetables may be made from asparagus tips, string beans, peas, spinach, cauliflower, carrots; they should be cooked until very soft, and mashed or put through a sieve. For dessert, plain rice pudding or bread pudding, stewed prunes, baked or stewed apple, junket, custard or cornstarch. A glass of milk or water.

Supper:—(6 o'clock) Cereal; farina, arrowroot, cream of wheat, wheatena (each cooked two hours), with salt but no sugar. Give two or three tablespoonfuls. Drink of milk with stale bread and butter. Twice a week, a little plain ice cream, or junket, custard or cornstarch.

Three meals a day at this time are better than more frequent feedings. The child has a better appetite and much better digestion. It may be found necessary to give delicate children a luncheon at 3 o'clock. A glass of milk and a Graham wafer, or a cup of broth and a zwieback, will answer the purpose. Children recovering from serious illness will need more frequent nourishment. Up to the sixth year the diet may conform to the above schedule, increasing the individual quantities as circumstances may warrant.

THE DIET OF OLDER CHILDREN (FROM SIX TO TEN YEARS)

After the sixth year the diet will conform to the adult diet, with certain exceptions. The important exceptions are as follows: All meats are to be excluded except roast beef, steak, lamb chops, roast lamb, mutton chop; all meats should be cooked rare and either scraped or finely divided. They should be broiled or roasted, never fried, and never given oftener than once daily, and then only in small quantity. Pies, rich puddings, pastries of all kinds, gravies, sauces, all highly seasoned dishes; wine, beer, coffee, tea, should never be given to children. Ham, bacon, sausage, pork, liver, kidney, game, and all dried and salted meats, codfish, mackerel and halibut, are particularly bad.

The following articles are permissible: Broiled chicken, shad, bass. The "platter gravy" from a roast is very nourishing if given in small amounts. Milk should continue to form an important part of the dietary up to the tenth year. It should be clean and fresh but not too rich. Sometimes it is found advisable to dilute the milk with water that has been boiled and cooled. Some children will take it if a pinch of salt or bicarbonate of soda is put into it, and they will digest it easier and better. They should never be allowed to take more than one quart daily and frequently less will do more good. Cream is not good for children of this age. Eggs are valuable; they should never be given fried or in the form of omelets, they are best given boiled, poached or coddled and only slightly cooked. It is never necessary to give more than one egg at a meal. There are children with whom eggs do not agree; these children are disposed to "biliousness."

VEGETABLES.—Certain vegetables are objectionable at this age: Raw celery, radishes, raw onions, cucumbers, tomatoes, lettuce, corn, lima beans, cabbage, egg plant. The following are good: White potatoes (never fried), spinach, peas, asparagus tips, string beans, celery, young beets, carrots, squash, turnips, boiled onions and cauliflower. It is important to remember that all vegetables should be thoroughly cooked; they cannot be cooked too much. After boiling for some time the water should be drained off and fresh water used to complete cooking. Vegetables should be fed in small quantities. From the third to the tenth year they form an important and essential part of the diet of all children. After the tenth year they can be eaten as served to adults, and other vegetables may then be added. As a rule salads of all kinds should be omitted until after the twelfth year.

CEREALS.—Children should not be allowed to eat too much cereal at one meal,—never more than one small saucerful. Cereals should be properly cooked. It is not safe to adhere strictly to the directions on the package of any cereal. As a rule they require much longer cooking. They are best cooked in a double boiler. They may be served with milk, salt, and not more than one teaspoonful of sugar.

BREAD.—Fresh bread is never allowable. Graham wafers, oatmeal crackers, Huntley and Palmer breakfast biscuits, bran muffins, rye bread, corn bread, stale rolls, are all suitable to growing children.

Hot bread, fresh rolls, buckwheat or griddle cakes, all sweet cakes, are objectionable.

DESSERTS.—The only permissible desserts for this age are junket, custards, plain rice, or sago; or bread pudding. The only safe rule to follow so far as "sweet things" are concerned, is not to give them at all. This applies to candy, ice cream, pies, pastries, jam, syrups, preserved fruits, nuts and dried fruits. The parent who indulges a child to "a taste," is guilty of a bad habit, and it can only lead to trouble.

FRUITS.—These should always be fresh and selected with care. Fruit is the most important article of diet to a child of this age. Up to five years it is safest to use only cooked fruits and fresh fruit juices: of these the juice from sweet oranges, grape fruit, peaches, strawberries, and raspberries may be given. Stewed or baked apples, apple sauce, figs, prunes, peaches, apricots, pears are excellent because of their effect on the bowels. When the bowels are loose, and especially in hot weather, great care must be taken when fruit of any kind is used. The pulp of any fruit should never be used; cherries, bananas, pineapples, and berries are not to be given to children. Milk should never be allowed at the same meal when sour fruit is served.



WHAT MOTHERS SHOULD KNOW



CHAPTER XXI

"Life has taught me that it is the women of a country in whose hands its destiny reposes. No cause that is not great enough to command their devotion and pure enough to deserve their sympathy can ever wholly triumph."

JOSEPH H. CHOATE.

THE EDUCATION OF THE MOTHER

What Mothers Should Know About the Care of Children During Illness—A Sick Child Should be in Bed—The Diet of the Sick Child—A Child is the Most Helpless Living Thing—The Delicate Child—How to Feed the Delicate Child—How to Bathe the Delicate Child—Airing the Delicate Child—Habits of the Delicate Child—Indiscriminate Feeding—Poor Appetite—Loss of Appetite—Treatment of Loss of Appetite—Overeating in Infancy—What Correct Eating Means—Bran as a Food—Breakfast for a Child at School—Lunch for a Child at School—Bran Muffins for School Children—Bran Muffins in Constipation—Hysterical Children—What a Mother Should Know About Cathartics and How to Give a Dose of Castor Oil—Castor Oil—Calomel—Citrate of Magnesium—When to Use Castor Oil—When to Use Calomel—Vaccination—Time for Vaccination—Methods of Vaccination.—Symptoms of Successful Vaccination.

WHAT MOTHERS SHOULD KNOW ABOUT THE CARE OF CHILDREN DURING ILLNESS

Every child has a certain amount of vitality and resistance. When illness comes it should be our duty to maintain the vitality and resistance to the highest degree. We should, therefore, irrespective of the nature of the illness, surround the child with all the conditions that will minister to the preservation of whatever strength and vitality the child has. Experience has taught us that there are certain requirements that should be carried out in the general management of sick children.

A SICK CHILD SHOULD BE IN BED.—In the first place a sick child should be in bed. There is no exception to this rule. It is impossible to do justice to a child if you allow him to dissipate his strength and exhaust himself moving from place to place while he is sick. A mother should not forget that it is she who must exercise wisdom and decide what is best for her child. The judgment of a sick person is not to be relied upon, and it would be wrong to submit to the whims and fancies of an ailing child, if these are known to be medically disadvantageous to its best interests.

Quiet surroundings are essential in all acute illnesses. The nurse should be congenial to the child. If the patient demands the presence of the mother she should remain, but she should not try to entertain him or interfere with the nurse.

The clothing of the patient should be the ordinary night-dress which is worn in health. In no disease is any special kind, or quantity of clothing required.

The temperature of the room should be 68 deg. F. Thermometers are cheap and an exact knowledge of the degree of heat in a sickroom is an essential requisite. Nothing drains the vitality during sickness quicker than varying degrees of heat and cold. It uses up nerve force and energy and renders the patient irritable and difficult to manage.

The strictest attention should be paid to the ventilation of the sickroom. We are learning more and more that fresh air is essential to the speedy cure of all diseases and to the general well-being of the patient. A direct, continuous communication between the sickroom and out-of-doors is imperative. It is a splendid measure to use two rooms for the patient and to change him twice daily, and to air thoroughly the unused room.

The sickroom itself should be large and in a quiet part of the house. In summer time the windows may be wide open, in winter months the degree of ventilation can be regulated by the thermometer.

Many mothers fail to appreciate that drinking water is an important requisite in all ailments of childhood, should be given freely, but it should be known to be absolutely pure. The same rule applies to sponging the patient. It must be done every day; sometimes it is necessary to do it more often, but if so it will be so directed by the attending physician.

THE DIET OF THE SICK CHILD.—Prescribing the diet of the sick child is an important undertaking. It should be remembered that during sickness the digestive capacity is reduced; consequently the food must be lessened in quantity and in strength. If the patient is an infant at breast the best way to accomplish our purpose is to give before each feeding two ounces of boiled water, cooled to the temperature of the body. This dilutes the mother's milk and renders it more easy of digestion. If bottle-fed, it is accomplished by replacing one-half of the milk with water. In certain diseases milk is totally withdrawn, but these cases will be noted when discussing the treatment of the various diseases. With older children, we give milk diluted with water, or gruels, soups, or cereals, as conditions warrant.

Needless interference with the patient must not be indulged in. Sleep and quiet are essential features of nature's reparative process. It is seldom necessary to disturb a sick child for the giving of food or medicine oftener than every second or third hour. Medicine may always be given with food. Meddlesome interference, talkative attendants, or excessive noise may exhaust a child and may prolong and render dangerous or fatal a condition that would otherwise go on to recovery.

One satisfactory movement of the bowel daily is essential to the comfort and progress of a sick person. If this does not take place naturally, it should be obtained by an enema.

At the beginning of any illness in childhood it is a safe procedure to give a dose of a suitable cathartic as soon as it is discovered that the child is sick.

A CHILD IS THE MOST HELPLESS LIVING THING.—Nature endows the young of every species—except those of the human family—with certain instincts, which, when developed, govern and control their lives absolutely. The technical definition of an instinct is an exceedingly complicated word picture. It is only essential to an intelligent understanding of our subject that the reader should have a definite idea of the difference between an act that is the result of a process of reasoning and an act that is the result of an instinct. If a man finds his way out of his burning home he will stay out as long as there is any danger. The crudest kind of reasoning will teach this lesson. A horse, on the other hand—and incidentally it may be noted that a horse is regarded as an intelligent animal—if led out of a burning stable and let loose, will immediately reenter and be burned to death. The horse is the victim of instinct; he obeys the unconquerable instinct to return to his stall—he cannot reason as the man can that a home that is burning is not a proper place to seek safety in. When an ostrich fears danger he buries his head in the sand, under the impression that if his head is out of sight he is safe from danger. This is his instinctive plan of procedure in the presence of danger, and it is the plan of every ostrich, everywhere, always. A little reasoning would show them how foolish the idea is—but they cannot reason. That is the province of man alone. If the first member of a flock of sheep jumps over a fence to get into the next field, every member of the flock will follow, each one jumping the fence, though there may be an open gate between the two fields a few yards away. Instinct dictates the plan to the sheep as they have received instructions from their ancestors always to "follow the lead." This is their hereditary legacy and they cannot disobey it.