 |
Orange juice is also unsweetened and well strained, and is administered in increasing amounts, beginning with one-half teaspoon one hour before the afternoon feeding, until the juice of a whole orange is greedily enjoyed by the time of the first birthday. The vegetable juices are obtained from cut-up spinach, carrots, tomatoes, and potatoes, strained, with a flavor of salt and onion—really a bouillon—and is given just before the bottle at the six P. M. feeding. They are also begun in teaspoon amounts.
FOOD FOR THE TRAVELING BABE
Baby travel should be reduced to a sheer necessity; never should the babe be subjected to the exposure of disease germs, the change of food, the possibilities of draughts and chilling, for merely a pleasure trip—the risks are too great and the possibilities of future trouble too far reaching.
If you are in touch with the milk laboratory of a large city, you will find that they make a specialty of preparing feedings which are good for a number of days for the traveling baby, and we strongly advise that their preparations be accepted; but in the event of not being in touch with such a laboratory we suggest the making of a carrying ice-box covered with wicker, which must be kept replenished with ice. Food kept in such a device may be kept fresh for twenty-four to forty-eight hours. Plans other than the laboratory preparations or the ice-box are risky, and should not be depended upon.
Many of our railway dining cars now pick up fresh, certified milk at stations along the line for use on their tables, and where such is the case fresh preparations of milk may be made on a trans-continental trip by the aid of an alcohol stove. Malted milk may also be used, provided you have accustomed the baby to its use a week before leaving home, by the gradual substitution of a fourth to a half ounce each day in the daily food; all of which, of course, should be done under your physician's direction.
If possible, leave baby at home in his familiar, comfortable environment in the care of a trained nurse and a trusted relative, and under the supervision of the baby's own physician. He is much better off, much more contented, and we are all aware of the fact that contentment and familiarity of sights and people promote good appetite, good digestion, and happiness—the very essentials of success in baby feeding. We speak touchingly and sympathetically to the mother who must leave her babe; and likewise we wish to cheer her as we remind her that by wireless messages and night letters it is possible to keep in touch with loved ones though a thousand miles away.
The sanitation and modification of cow's milk, as well as stools, etc., are taken up in later chapters.
RULES FOR THE BOTTLE-FED
1. Never play with a baby during or right after a meal. 2. Lay the baby on his side when nursing the bottle. 3. Three full hours should intervene between feedings. 4. Don't give the food too hot—it should just be warm. 5. Make the test for warmth on the inner side of your arm. 6. Give a drink of water between each meal if awake. 7. Never save the left-overs for baby. 8. If possible, give three feedings each day in the cool air, with baby comfortably warm. 9. Do not jump, bounce, pat, or rock baby during or after meals. 10. Never coax baby to take more than he wants, or needs. 11. No solid foods are given the first year. 12. Orange juice may be given at six months; while, after four months, unsweetened prune juice is better than medicine for the bowels.
CHAPTER XVII
MILK SANITATION
Cow's milk, like mother's milk, is made up of solids and water. In a previous chapter we learned that in one-hundred parts of mother's milk, eighty-seven parts were water and thirteen parts were solid. These thirteen parts of solids consist of sugar, proteins, and salts; this is likewise the case with cow's milk, except that in the case of the cow's milk, the sugar is decreased while the proteins are increased as will be noted by the accompanying comparative analysis:
MOTHER'S MILK
Fat % 4.00 Sugar 7.00 Proteins 1.50 Salts 0.20 Water 87.30 ——— % 100.00
COW'S MILK
Fat % 4.00 Sugar 4.50 Proteins 3.50 Salts 0.75 Water 87.25 ——- % 100.00
Mother's milk is absolutely sterile, that is, free from the presence of germs; on the other hand, cow's milk is anything but sterile—the moment it leaves the udder it begins to accumulate numerous bacteria, all of which multiply very rapidly. Cow's milk is generally twenty-four to forty-eight hours old before it can possibly reach the baby. It is just as important to keep in mind these facts of milk contamination—dirt, filth, flies, and bacteria—as it is to plan for the modification of cow's milk for the purpose of making it more nearly resemble mother's milk. While mother's milk has about the same percentage of fat as cow's milk, it is almost twice as rich in sugar, and has only one-fourth to one-third as much protein. This protein is vastly different from that found in cow's milk, which you recall has a tough curd, as seen in cottage cheese. While mother's milk contains a small amount of casein similar to that found in the cheese of the cow's milk, the principal protein constituent is of another kind (lactalbumin), and is much more easy of digestion than the casein of cow's milk.
This is a most important point to remember, because the baby's stomach is not at first adapted to the digestion of the heavier and tougher protein curds of cow's milk. It requires time to accustom the infant stomach to perform this heavier work of digestion. There are a number of factors which must be borne in mind in the modification of milk, whether it be cow's milk, or goat's milk (for many European physicians use goat's milk entirely in the artificial feeding of infants): namely, the cleanliness of the milk, the acidity of milk, the difference in the curd, the percentage of sugar, and the presence of bacteria.
SUGAR
In the modification of cow's milk, sugar must be added to make up for the sugar which is decreased when the water was added to reduce the protein. There are several sorts of sugar used in the modification of milk. These sugars are not added to sweeten the milk alone, but to furnish a very important element needed for the growth of the baby. Sugar is the one element which the infant requires in the largest amount.
Milk sugar is probably most universally used in the modification of milk, but a good grade of milk sugar is somewhat expensive, costing from thirty to sixty cents a pound, and this places it beyond the reach of many mothers. It is added to the food mixtures in the proportion of one ounce to every twenty ounces of food. Cane sugar (table sugar) may also be used, but it must be clean and of good quality. It is used in rather less quantity than that of milk sugar, usually from one-half to one-third of an ounce by measure to each twenty ounces of food. Dextri-maltose (malt sugar) is very easy of digestion and may be used in the modification of milk. Maltose seems to help the children to gain more rapidly in weight than when only milk or cane sugar is used. It is also exceedingly useful in constipation, as its action is more laxative than any of the other sugars; but it should not be given to children who vomit habitually or have loose stools.
ACIDITY
Like mother's milk, the cow's milk is neutral as it comes from the udder; but, on standing, it quickly changes, soon becoming slightly acid, as shown by testing with blue litmus paper. In fact, what is known as ordinarily fresh milk, if subjected to the litmus paper test, always gives an acid reaction. This acidity is neutralized by adding lime water to the formula in the proportion of one ounce to each twenty-ounce mixture. Ordinary baking soda is sometimes prescribed by physicians in place of the lime water. In the event of obstinate constipation, milk of magnesia is sometimes added to the day's feedings.
CREAM
There may be procured in any large city an instrument called the cream gauge, which registers approximately (not accurately) the richness of milk. Some milk, even though rich, parts with its cream very slowly; while some poor milk allows nearly all the cream quickly to rise to the surface. We know of no way for the mother to determine the amount of cream (without the cream gauge) except by the color and richness of the milk. In cities it is very convenient to send a specimen of the milk to the laboratories to be examined by experts, who will gladly render a report to both physician and mother.
The lactometer is a little instrument used to estimate the specific gravity of milk. An ordinary urinometer such as used by physicians in estimating the specific gravity of urine may also be used. The specific gravity of cow's milk should not register below 1028 or above 1033.
HERD MILK
Milk from a single cow is not to be desired for baby's food because of its liability to vary from day to day, not to mention the danger of the cow's becoming sick. Authorities have agreed that herd milk of Holstein or ordinary grade cows is best for infant feeding. This mixed-herd milk contains just about the proper percentage of fat; whereas, if Jersey milk must be used, some of the cream should be taken away. Our milk should come from healthy cows which have been tested for tuberculosis at least every three months.
Annatto is sometimes added to milk to increase its richness of color. To test for annatto proceed as follows: To a couple of tablespoons of milk add a pinch of ordinary baking soda. Insert one-half of a strip of filter paper in the milk and allow it to remain over night. Annatto will give a distinct orange tint to the paper. The commonly used milk preservatives are boracic acid, salicylic acid, and formaldehyde, any of which may be readily detected by your health officials.
SANITARY DAIRIES
In close proximity to most large cities there is usually to be found one or more sanitary dairies. It is a joy indeed to visit a farm of this kind with its airy stables and concrete floors, which are washed with water coming from a hose. The drainage is perfect—all filth is immediately carried off (Fig. 11). The cows are known to be free from tuberculosis, actinomycosis (lumpy jaw), and foot and mouth disease. The milkmen on this farm wear washable clothes at the milking time, and their hands are painstakingly cleansed just before the milking hour. Previous to the milking the cattle have been curried outside the milking room and their udders have received a careful washing. The milkman grasps the teat with clean hands, while the milk is allowed to flow through several thicknesses of sterilized gauze into the sanitary milking pail. This milk is at once poured into sterile bottles, is quickly cooled and shipped in ice to the substations where the delivery wagon is waiting. In the ideal delivery wagon there are shallow vats of ice in which the bottles are placed, thus permitting the milk to reach the baby's home having all the while been kept at a temperature just above the freezing point.
And why all this trouble? Why all this worry over temperature and cleanliness? Babies were not so cared for in the days of our grandmothers. The old-fashioned way of milking the cows with dirty clothes and soiled hands, while cattle were more or less covered with manure, with their tails switching millions of manure germs into the milking pail, produced a milk laden not only with manure germs—the one great cause of infantile diarrhea—but also swarming with numerous other mischief making microbes. Even tuberculosis, that much dreaded disease germ of early infancy, may come from the dairy hands as well as from infected cows.
There used to be many dairymen like the old farmer who, when interrogated by the health commissioner concerning the cleanliness of his milk, laughed as he reached down into the bottom of a pail of yellow milk and grabbing up a handful of manure and straw, said: "That's what makes the youngsters grow." But it does not make them grow; it often causes them to die, and even if they do live, they live in spite of such contaminated food, for the germ which is always found in the colon of the cow (coli communis), probably kills more babies every year than any other single thing.
It is possible to reduce the growth of these germs by keeping the milk at a very low temperature from the time it leaves the cow until the moment it gets to the home refrigerator. Those which survive this process of refrigeration may be quickly rendered harmless by pasteurizing or sterilizing at the time of preparing baby's food.
In the absence of the modern sanitary dairy, we would suggest that the milk supply be improved by giving attention to the following:
The cattle should be tested for tuberculosis every three months. The walls of the cowhouse should be whitewashed three times a year. The manure should be stored outside the barn. The floor of the cowhouse should be sprinkled and swept each day. The cattle should be kept clean—curried each day, and rubbed off with a damp cloth before milking. The udders should be washed before each milking. The milker can wear a clean white gown or linen duster which should be washed every two days, while his hands should be washed just before the milking. The milking pail should be of the covered sanitary order. The barn should be screened.
CERTIFIED MILK
Immediately after leaving the cow, the milk should be cooled to at least 45 F. It should at once be put into bottles that have been previously sterilized and then be tightly covered, and should be kept in ice water until ready for consumption. No matter how carefully the milk is handled, it is infected with many bacteria, but if it is quickly cooled, the increase of the bacteria is greatly retarded. Under no circumstances buy milk from a grocery store out of a large can. Go to your health officer and encourage him in his campaign for sanitary dairies and certified milk.
Such milk as we have described under the head of sanitary dairies, when it has been tested by the board of health and has received the approval of the medical profession, is known as "certified milk;" and, although the price is usually fifteen to twenty cents a quart, when compared with the cost of baby's illness it will prove to be cheaper than the dirty milk which sickens and kills the little folks.
There is no doubt that the increased use of "certified milk" has been a great factor in the reduction of deaths from infant diarrhea in recent years.
BOILING THE MILK
When certified milk cannot be had, it is absolutely dangerous to give raw, unboiled, or unpasteurized milk to the baby, particularly in warm weather; for the countless millions of manure germs found in each teaspoon of ordinary milk not only disturbs the baby's digestion, but actually makes him sick, causing colic, diarrhea, and cholera infantum. The only way this milk can be rendered safe is by cooking it—actually killing the bacteria. This process of boiling, however, does not make good milk out of bad milk nor clean milk out of that which is dirty, it simply renders the milk less dangerous.
There are two methods of killing bacteria—sterilization and pasteurization. By sterilization is meant the process of rendering the milk germ free by heating, by boiling. Many of the germs found in milk are comparatively harmless, merely causing the souring of milk; but other microbes are occasionally present which cause serious diseases, such as measles, typhoid and scarlet fever, diphtheria, tuberculosis, and diarrhea. It is always necessary to heat the milk before using in warm weather, and during the winter it is also important when infectious or contagious diseases are prevalent.
Milk should be sterilized when intended for use on a long journey, and may be eaten as late as two or three days afterward.
To sterilize milk, place it in a well-protected kettle and allow to boil for one hour and then rapidly cool. This process renders it more constipating, and for some children many of its nutritive properties seem to be destroyed, as scurvy is often the result of its prolonged use. When a child must subsist upon boiled milk for a long period, he should be given the juice of an orange each day. Children are not usually strong and normal when fed upon milk of this character for indefinite periods. All living bacteria (except the spores or eggs) may be destroyed by boiling milk for one or two minutes.
PASTEURIZATION
When baby is to use the milk within twenty-four hours, "pasteurization" is better than boiling as a method of destroying microbes.
There are many pasteurizers on the market which may be depended upon, among which are the Walker-Gordon Pasteurizer, and Freeman's Pasteurizer; but in the absence of either of these pasteurization may be successfully accomplished by the following method:
On the bottom of a large kettle filled with cold water, place an ordinary flatiron stand upon which is put a folded towel. On this place the bottle of milk as it comes from the dairyman, with the cap of the bottle loosened. The cold water in the kettle should come up to within an inch of the top of the bottle of milk. Heat this water quickly up to just the boiling point—until you see the bubbles beginning to rise to the top. The gas is then turned down or the kettle is placed on the back of the range and held at this near-boiling point for thirty minutes, after which it is taken to the sink and cold water is turned into the water in the kettle, until the bottle of milk is thoroughly cooled. It is now ready to be made up into the modified food for baby.
Never let pasteurized milk stand in the room, nor put it near the ice when warm. It must be cooled rapidly, as described above; that is, within fifteen or twenty minutes.
The "spores" of the milk are not killed by pasteurization and they hatch out rapidly unless the milk is kept very cold, and, as already stated, it should be used within twenty-four hours after pasteurization.
THE CARE OF BOTTLED MILK
The certified milk or the ordinary milk that has been delivered to your home and is to be used without pasteurization or sterilization, should receive the following care:
1. It should be placed at once in a portion of the ice box that is not used to store such foods as radishes, cabbage, meats or any other open dishes of food whose odors would quickly be absorbed by the milk. The milk should never be left standing on the doorsteps in the sun, for many reasons: the sun heats the milk, encourages the growth of bacteria, and a passing cat or dog, whose mouth often contains the germs of scarlet fever, tonsilitis, and diphtheria, should it be hungry, laps the tops of the bottles, particularly in the winter when the cream has frozen and is bulging over the edge.
2. It should never be kept in the warm kitchen, as when visiting her sick baby we discovered one young mother doing. In answer to my question, she explained; "Doctor, we do not take ice in the winter time, everything is ice outdoors, so I just set the bottle outside the window bringing it in whenever I need to give the baby some food. I forget to put it out sometimes, but really now, does it matter?" It really matters much, for you see, reader, the milk is first freezing then thawing and it is rendered entirely unfit for the baby.
3. Milk should be kept covered and protected from dust and flies; it should be kept in glass jars which have been sterilized by boiling before being filled, and then placed in the refrigerator. If the milk is sour, or if there is any sediment in the bottle, it is unfit for baby's use.
CHAPTER XVIII
HOME MODIFICATION OF MILK
In a previous chapter it was found from comparing the analysis of mother's milk with that of cow's milk, that they widely differed in the proteins and sugar. The art of so changing cow's milk that it conforms as nearly as is possible to mother's milk is known as "modification." Where protein, sugar, and fat are given in proper amounts, healthy infants get along well; but when either the fats or proteins are given in excess, or when the digestion of the child is deranged, there is often no end of mischief.
There are two groups of milk formulas that are useful. First, those in which the fats and proteins are about the same, known as "whole milk," or "straight" milk mixtures; second, those in which the fats are used in larger proportions than proteins, and known as "top milk"—milk taken from the upper part of the bottle after the cream has risen. And since the larger proportion of babies take the lower fats or "whole milk" formulas, and seem to get along better than the babies who have the "top milk" formulas, we will first take up the consideration of the modification of whole milk.
PREPARATION FOR MODIFICATION
To begin with, everything that comes in contact with the preparation of baby's food must be absolutely clean. The table on which the articles are placed, and any towel that comes in contact with the articles or the mother's hands, or those of the nurse, must be thoroughly scrubbed.
There is only one way to prepare the utensils that are to be used in making the baby's food, and that is to put them in a large kettle and allow them to boil hard for fifteen minutes just before they are to be used. The articles needed are (Fig. 12):
1. As many bottles as there are feedings in one day. 2. A nipple for each bottle. 3. Waxed paper for each bottle top. 4. Rubber bands for each bottle. 5. A two-quart pitcher. 6. A long-handled spoon for stirring the food. 7. A tablespoon. 8. A fork. 9. An eight-ounce, graduated measuring glass. 10. A bottle of lime water. 11. A fine-mesh, aluminum strainer. 12. A square of sterile gauze for straining the food (should be boiled for fifteen minutes with the utensils). 13. One plate, and later a double boiler (14). 15. The sugar. 16. The milk. 17. Ready for the ice box. 18. Refrigeration.
BOTTLES AND NIPPLES
There is but one bottle which can be thoroughly washed and cleaned, and that is the wide-mouthed bottle. It should hold eight ounces and should have the scale in ounces blown in the side (Fig. 10). The nipple for this bottle is a large, round breast from which projects a short, conical nipple, which more nearly resembles the normal breast than do the old-fashioned nipples so frequently seen on the small-necked nursing bottles. There is a great advantage in this, in that the baby cannot grasp the nipple full length and thus cause gagging. These bottles and nipples are known as the "Hygeia," and have proven to be a great source of comfort to the baby as well as to the mother or nurse whose duty it is to keep them clean. There are a number of other nursing bottles on the market, which, if they are used, must be thoroughly cleansed with a special bottle brush each day. The neck is small and the nipple is small and great care must be taken in the cleansing of both of them.
CARE OF BOTTLES AND NIPPLES
When there is a bottle for each individual feeding in the day, immediately after each nursing both bottle and nipple should be rinsed in cold water and left standing, filled with water, until the bottles for one day's feeding have all been used. The nipples should be scrubbed, rinsed, and wiped dry and kept by themselves until their boiling preparation for the following day's feeding.
If the same bottle is to be used for the successive feedings during the day, it should be rinsed, washed with soap and water, and both bottle and nipple placed in cold water and brought quickly to the boiling point and allowed to boil for fifteen minutes. No bottles or nipples must ever be used after a mere rinsing; boiling, preceded by a thorough washing in soap and water, must take place before they are used a second time.
New nipples are often hard and need to be softened, which is readily done by either prolonged boiling or rubbing them in the hands.
All new bottles should be annealed by placing them on the stove in a dishpan of cold water and allowing them to boil for twenty minutes, and then allowing them to remain in the water until they are cold. When bottles are treated in this manner they do not break so readily when being filled with boiling water or hot food.
PREPARING THE FOOD
In a large preserving kettle place all the utensils needed in the preparation of the food—pitcher, spoon, fork, measuring glass, bottles, nipples, cheesecloth for straining, agate cup, wire strainer, in fact everything that is to be used in the preparation of the food. Now fill the kettle with cold water and place over the gas and allow to boil for fifteen minutes. On a well-scrubbed worktable place a clean dish towel, and on this put the utensils and the bottles right side up. The nipples on being taken out of the boiling water will dry of themselves; they should be placed in a glass-covered jar until they are needed for each individual feeding, the nipples not being placed on the bottles as they go to the ice box.
Having been given your formula by your physician, proceed in the following way. Suppose we were preparing the food for a normal two-months old baby that weighed ten pounds, with the prescription as follows:
BABY SMITH. R_{x}
Whole Milk ounces 11 Cane Sugar level tablespoons 2 Boiled Water ounces 121/2 Lime Water ounces 1 Amount at Each Feeding ounces 31/2 Number of Bottles 7 Interval Between Feedings hours 3
DETAILS OF PREPARATION
Two level tablespoons of cane sugar are placed in the agate cup and dissolved in a small amount of boiling water. The solution should be perfectly clear, and if it does not clear up put it over the heat for a few moments.
This is now turned into the eight-ounce measuring glass which is then filled with boiling water and emptied into the two-quart pitcher. We need four and one-half more ounces of boiling water to complete the prescription requirement of twelve and one-half ounces.
The bottle of milk, if properly certified, need not be pasteurized; but if it is not, it should have been previously pasteurized while the utensils were boiling according to the suggestions found in the chapter on "milk sanitation." The top of the milk bottle should be thoroughly rinsed and wiped dry, and after a thorough shaking of the milk, the cover is removed with the sterile fork and eleven ounces are measured out by measuring glass and poured into the pitcher. All is now stirred together with an ounce of lime water, which should never look murky, but should be as clear as the clearest water and should always be kept in the ice box when not in use.
The sterile cheesecloth which has been boiled for fifteen minutes is now put over the nose of the pitcher, the contents of which is accurately measured into the seven clean, empty bottles, each containing three and one-half ounces. Over the top of each of the nursing bottles is placed a generous piece of waxed paper which is held down by a rubber band. Each meal for the day is now contained in a separate bottle, and all are placed in a covered pail of water containing ice, and put in the ice box.
If the prescription for the baby's food contains gruel, it is prepared in the following manner:
Suppose the baby is eight months old and the prescription called for two level tablespoons of flour and eight ounces of boiled water. The two level tablespoons of flour, whether it be wheat (ordinary bread flour), or barley flour, are put into a cup and stirred up with cold water, just as you would stir up a thickening for gravy; now measure out eight ounces of water and allow it to come to a boil in the inner pan of the double boiler, into which the thin paste is stirred until it comes to a boil. After boiling for twenty minutes, remeasure in the measuring glass and what water has been lost by evaporation must be added to complete accurately the prescription requirement of eight ounces; this is now added to the other ingredients of the prescription.
TABLE FOR INFANT FEEDING
We now offer a monthly schedule—a table which is the result of our experience in feeding hundreds of babies in various sections of Chicago. It is not a schedule for the sick baby, but it is a carefully tabulated outline for the normal, healthy, average child ranging from one week to one year in age. In offering this table we remind the mother, if the baby is six months old and not doing well on the food it is getting and a change is desired by both mother and physician, that it is far better to begin with the second or third month's prescription and quickly work up to the sixth month's. This change may often be accomplished in two or three days.
In all large cities there are to be found milk laboratories which make it their business to fill prescriptions for the modification of milk under the direction of baby specialists. This milk can be absolutely relied upon. In specialized diet kitchens in many large hospitals, these feeding prescriptions also may be filled.
ARTIFICIAL FEEDING SCHEDULE
======================================================== Age Amount Baby's Whole Cane Wheat Boiled Lime at Weight Milk Sugar Flour Water Water Feeding - - - - Level Level Pounds Ounces Table- Table- Ounces Ounces Ounces spoon spoon - - - - 1 week 71/2 21/2 1 5 1/2 1 - - - - 2 weeks 71/2 41/2 11/2 9 1/2 2 - - - - 3 weeks 73/4 7 2 10 1/2 21/2 - - - - 4 weeks 8 9 2 11 1 3 - - - - 2 months 10 11 2 121/2 1 31/2 - - - - 3 months 12 15 2 1/2 15 1 41/2 - - - - 4 months 13 18 21/2 1 131/2 11/2 51/2 - - - - 5 months 14 21 21/2 11/2 131/2 11/2 6 - - - - 6 months 15 23 21/2 11/2 101/2 11/2 7 - - - - 7 months 16 25 2 11/2 81/2 11/2 7 - - - - 8 months 17 27 11/2 2 8 11/2 71/4 - - - - 9 months 18 29 1 2 8 2 73/4 - - - - 10 months 19 30 3/4 2 8 2 8 - - - - 11 months 20 31 1/2 2 8 2 9 - - - - 12 months 21 32 7 2 9 - - - - 18 months 24 36 12 - - - -
==================================================== Age Number Interval Soups Total of Between Fruit and Daily Feedings Feedings Juices Broths Calories - - in 24 Hours Hours - - 1 week 8 3 112 - - 2 weeks 7 3 184 - - 3 weeks 7 3 267 - - 4 weeks 7 3 309 - - 2 months 7 3 351 - - 3 months 7 3 447 - - 4 months 6 3 553 - - 5 months 6 31/2 628 - - 6 months 5 4 one one 680 teaspoon tablespoon - - 7 months 5 4 two 1/4 732 teaspoons cup - - 8 months 5 4 one-half 1/4 767 orange cup - - 9 months 5 4 one 1/2 854 orange cup - - 10 months 5 41/2 one 3/4 875 orange cup - - 11 months 5 5 one 1 906 orange cup - - 12 months 5 5 one 1 cup orange arrowroot 950 cracker - - 18 months 3 6 toast, gravies, baked potato and apple, etc. - -
Note 1 ounce of whole milk equals 21 calories 1 level tablespoon of cane sugar equals 60 calories 1 level tablespoon of milk sugar equals 45 calories 1 level tablespoon of flour equals 25 calories The juice of 1 average orange equals 75 calories 1 cup of average bouillon equals about 100 calories
(This table is calculated on the basis of about 45 calories for each pound of baby weight)
TOP-MILK FORMULA
Top milk is the upper layer of milk which has been removed after standing a certain number of hours in a milk bottle or any other tall vessel with straight sides. It contains most of the cream and varying amounts of milk. It may be removed by a small cream dipper which holds one ounce, or it may be taken off with a siphon, but it should never be poured off. To obtain seven per cent top milk which is the one most ordinarily used in the preparation of top milk formulas, we take off varying amounts—according to the quality of the milk—which Doctor Holt describes as follows:
From a rather poor milk, by removing the upper eleven ounces from a quart, or about one-third the bottle.
From a good average milk, by removing the upper sixteen ounces, or one-half the bottle.
From a rich Jersey milk, by removing the upper twenty-two ounces, or about two-thirds the bottle.
Cream is often spoken of as if it were the fat in milk. It is really the part of the milk which contains most of the fat and is obtained by skimming, after the milk has stood usually for twenty-four hours; this is known as "gravity cream." It is also obtained by an apparatus called a separator; this is known as "centrifugal cream," most of the cream now sold in cities being of this kind. The richness of any cream is indicated by the amount of fat it contains.
The usual gravity cream sold has from sixteen to twenty per cent fat. The cream removed from the upper part (one-fifth) of a bottle of milk has about sixteen per cent fat. The usual centrifugal cream has eighteen to twenty per cent fat. The heavy centrifugal cream has thirty-five to forty per cent fat.
The digestibility of cream depends much upon circumstances. Many serious disturbances of digestion are caused by cream.
It is convenient in calculation to make up twenty ounces of food at a time. The first step is to obtain the seven per cent milk, then to take the number of ounces that are called for in the formula desired.
One should not make the mistake of taking from the top of the bottle only the number of ounces needed in the formula, as this may be quite a different per cent of cream and give quite a different result.
There will be required in addition, one ounce of milk sugar and one ounce of lime water in each twenty ounces. The rest of the food will be made up of boiled water.
These formulas written out would be as follows:
FORMULA FROM SEVEN PER CENT MILK
I II III IV V VI VII VIII IX Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz. 7 per cent milk 2 3 4 5 6 7 8 9 10 Milk sugar 1 1 1 1 1 3/4 3/4 3/4 3/4 Lime water 1 1 1 1 1 1 1 1 1 Boiled water 17 16 15 14 13 12 11 10 9 —- —- —- —- —- —- —- —- —- 20 20 20 20 20 20 20 20 20
The approximate composition of these formulas expressed in percentages are as follows:
Formula Fat Sugar Proteins I 0.70 5.00 0.35 II 1.00 6.00 0.50 III 1.40 6.00 0.70 IV 1.75 6.00 0.87 V 2.00 6.00 1.00 VI 2.40 6.00 1.20 VII 2.80 6.00 1.40 VIII 3.10 6.00 1.55 IX 3.50 6.00 1.75
It is necessary to make the food weak at first because the infant's stomach is intended to digest breast milk, not cow's milk; but if we begin with a very weak cow's milk the stomach can be gradually trained to digest it. If we began with a strong milk the digestion might be seriously upset.
Usually we begin with number one on the second day; number two on the fourth day; number three at seven to ten days; but after that make the increase more slowly. A large infant with a strong digestion will bear a rather rapid increase and may be able to take number five by the time it is three or four weeks old. A child with a feeble digestion must go much slower and may not reach number five before it is three or four months old.
It is important with all children that the increase in the food be made very gradually. It may be best with many infants to increase the milk by only half an ounce in twenty ounces of food, instead of one ounce at a time, as indicated in the tables. Thus, from three ounces the increase would be to three and one-half ounces; from four ounces to four and one-half ounces, etc. At least two or three days should be allowed between each increase in the strength of the food.
PEPTONIZED MILK
Another modification which at times may be ordered by your physician is peptonized milk. Since it is infrequent for the proteins of milk to be the cause of indigestion, peptonized milk has only a limited use, chiefly in cases of acute illness. The milk is peptonized in the following manner:
Place the peptonizing powder (it is procurable in tubes or tablets from the drug store) in a small amount of milk, and after being well dissolved, put into the bottle or pitcher with the plain or modified milk, after which the whole is shaken up together. The bottle is then put into a large pitcher containing water heated to about 110 deg. F. or as warm as would bear the hand comfortably, and left for ten or twenty minutes (if the milk is to be partially peptonized). To completely peptonize the milk, two hours are required. Either of these formulas is only used on the advice of a physician.
BUTTERMILK
In many cases of chronic intestinal indigestion, buttermilk is used in place of the milk. It is prepared as follows: After the cream has been taken from the milk and it has been allowed to come to a boil, it is cooled to just blood heat. A buttermilk tablet, having first been dissolved in a teaspoonful of sterile water, is now stirred into the quart of warmed, skimmed milk and allowed to stand at room temperature for twenty-four hours at which time it should look like a smooth custard. With a sterile whip this is now beaten and is ready for the sugar and the boiled water which is added according to the written prescription from the doctor.
CONDENSED MILK
Under no circumstances should condensed milk be used as the sole food of the baby for more than one month. Children often gain upon it, but as a rule they have little resistance, and they are very prone to develop rickets and oftentimes scurvy; and, as noted elsewhere, orange juice should always be administered at least once during the twenty-four hours as long as condensed milk is used.
Of all the brands of condensed milk, those only should be selected which contain little or no cane sugar. Perhaps the "Peerless Brand" of evaporated milk is the most reliable and in the preparation of food from this evaporated milk the same amount of sugar, etc., should be added as we do in the preparation of "whole milk" or "top milk."
We do not in any way advise the use of condensed milk. Fresh milk should always be used where it is obtainable, but in traveling it sometimes has to be used. Holt says, "It should be diluted twelve times for an infant under one month and six to ten times for those who are older."
Malted milk is a preparation suitable in some cases where fresh cow's milk is not obtainable. Even better than condensed milk, this food will be found serviceable in traveling, or in instances where only very bad cow's milk is within reach.
SPECIAL FOODS
Most patent foods are made up of starches and various kinds of sugars, and some of them have dried milk or dried egg albumin added. Many flours under fanciful names are sold on the market today. For instance, one flour with a very fanciful name is simply the old fashioned "flour ball" that our great, great grandmothers made; and, by the way, perhaps there is no flour for which we are more grateful in the preparation of infant food than the flour ball which is prepared as follows: A pound of flour is tied tightly in a cheesecloth and is put into a kettle of boiling water which continues to boil for five or six hours, at the end of which time the cheesecloth is removed and the hard ball, possibly the size of an orange, is placed on a pie pan and allowed slowly to dry out in a low temperatured oven. At the end of two or three hours, the ball, having sufficiently dried, has formed itself into a thick outer peel which is removed, while the heart which is very hard and thoroughly dry, is now grated on a clean grater, and this flour has perhaps helped more specialists to serve more sick babies than any other form of starch known. It is used just as any other flour is used—wet up into a paste, made into a gruel, which is boiled for twenty minutes before it is added to the milk.
Whey is sometimes used in the preparation of sick babies' food and is prepared as follows:
To a pint of fresh lukewarm cow's milk are added two teaspoons of essence of pepsin, liquid rennet or a junket tablet. It is stirred for a moment, then allowed to stand until firmly coagulated, which is then broken up and the whey strained off through a muslin.
The heavy proteins remain in the curd, and the protein that goes through with the whey is chiefly the lactalbumin.
CHAPTER XIX
THE FEEDING PROBLEM
A friend of ours who presides over a court of domestic relations in a large city, recently told us that he believed much trouble was caused in families—many divorces, occasioned, and many desertions provoked—because improperly fed babies were cross and irritable and so completely occupied the time of the mother, who, herself, knew nothing about mothercraft or the art of infant feeding. Consequently, the home was neglected and unhappy, quarreling abounded and failure, utter failure, resulted. The children were constantly cross, and so much of the mother's time was consumed in caring for these irritable, half-fed babies, that the home was disheveled, the meals never ready, the husband's home-coming was a dreaded occurrence, and he, endeavoring to seek rest and relaxation, usually sought for it in the poolroom or the saloon, with the usual climax which never fails to bring the time-honored results of debauch—despair and desertion.
In the beginning of this book we paid our respects to the present-day educational system which does not provide an adequate compulsory course in which all women could be given at least a working knowledge of home making and the care and feeding of the babies; so that statement need not be repeated in this chapter. But we wish to add, in passing, that ignorance is the basis and the foundation of more unhappy homes, broken promises, panicky divorces, and shattered hopes, as well as of more deaths during the first year of infancy, than any other cause. And in speaking of its relationship to babycraft, we believe that ignorance concerning normal stools, how many times a day the bowels should move; how much a baby's stomach holds; how often he should be fed, etc.—I say it is ignorance of these essential details that lies at the bottom of many problems which come up during the first year, particularly the "feeding problem."
INFANT WELFARE
In the city of Chicago at the time of this writing, the Infant Welfare Association maintains over twenty separate stations where meetings are held for mothers, where lectures are delivered on the care and feeding of babies. Babies are brought to these stations week in and week out; they are weighed and measured and, if bottle-fed, nurses are sent to the homes to teach the mother how properly to modify the milk in accordance with the physician's orders. The health authorities of our city also maintain several such stations where mothers and babies may have this efficient help. A corps of nurses are employed to carry out the instructions and to follow up the mothers and the babies in their homes, and thus the death rate has been greatly reduced, not only in our city but in all such cities where baby stations have been instituted. In a certain ward in Philadelphia the death rate was reduced forty-four per cent in one year after the baby stations were established.
CHOOSING A FORMULA
There are three classes of infants who require weak-milk mixtures to begin with: namely, the baby who has been previously nursed and whose mother's milk has utterly failed; the baby just weaned; and the infant whose power to digest is low. If these children were six months old, and the formula best suited to them is unknown, we must begin with a formula suited to a two- or three-month-old child and quickly work up to the six-month formula, which may often be accomplished within two or three days.
THE BOTTLE-FED BABY
When a baby is getting on well with his food, he should show the following characteristics: He should have a good appetite; should have no vomiting or gas; he should cry but little; and he should sleep quietly and restfully. His bowels should move once or twice in twenty-four hours. His stool should be a pasty homogeneous mass. He should possess a clear skin and good color. He should show some gain each week—from four to eight ounces—and he should also show mental development.
As long as a baby appears happy and gains from four to eight ounces a week and seems comfortable and well satisfied, the feeding mixture should not be changed or increased.
MAKE CHANGES GRADUALLY
In our experience with the artificial feeding of infants, we have come to look upon the practice of gradually changing the food formula as the most important element in successful baby feeding.
We recall one mother in the suburbs who came to us with her baby who had been feeding on a certain proprietary food. She declared that it "just couldn't take cow's milk." She admitted "it was not doing well," and so she would like to have help. The baby was old enough, had it been normal, to have been taking whole milk for some time. We recall our having the mother prepare the proprietary food just as she had been used to preparing it, and each day we had her throw away one-half ounce and put in one-half ounce of whole milk, this mixture she fed the baby for two days.
The next time, we had her take out one ounce of the mixture and put in one ounce of whole milk, which we fed the baby for three successive days; and then one and one-half ounces were substituted which was fed to the baby for four days; and thus we carefully, slowly, and gradually withdrew the proprietary food and substituted fresh, certified cow's milk. It took us a month to complete the change, but we are glad to add that it was done without in the least disturbing the child.
Now, had the change been made abruptly—in a day or two, or three days—the baby would probably have been completely upset, while both the mother and the doctor would have been greatly discouraged. Many mothers and even some physicians have jumped from one baby food to another baby food; they have tried this and they have tried that, until the poor child, having been the victim of a number of such dietetic experiments, finally succumbed.
We cannot urge too strongly the fact that, as a rule, whenever a change is made from one food to another, it should be done gradually, unless it be the change of a single element such as that of a very high per cent of cream found in top milk mixtures, when it seems to be a troublesome element in the milk. No bad effects will follow the quick change to skimmed milk with added sugar, starches, etc; but in changing from a proprietary food to a milk mixture, the change should always be made gradually, the quantity of the new food being increased gradually. Milk should be increased by quarter (1/4) ounce additions, and it should not be increased more than one ounce in one week; while the mixture should not be increased as long as the baby is gaining satisfactorily. A wise mother and an experienced physician can usually see at a glance when a child is doing well—by the color and consistency of the stools, the child's appetite, his sleep, and his general disposition.
COMMON MISTAKES IN FORMULAS
First and foremost, we believe a great mistake is often made in using too heavy cream mixtures; babies as a rule do not stand the use of too high a percentage of cream. Formulas that call for whole milk should contain four per cent fat or cream; and while babies often gain rapidly on the higher percentage of cream found in a rich Jersey milk, nevertheless, sooner or later serious disturbances of digestion usually occur. Herd milk is, therefore, better for the babies because in the "whole milk" of the herd of Holsteins we have only about four per cent fat.
Another common mistake is too heavy feeding at the time of an attack of indigestion; even the usual feeding may be too heavy during this time of indisposition. It is not at all uncommon for us to dilute baby's food to one-third its strength at the time of an acute illness.
Still another trouble maker is dirt—dirt on the dish-towel, dirt on the nipple, dirt in the milk, dirt on the mother's hands. Dirt is an ever present evil and an endless trouble maker, as evidenced by stool disturbances, indigestion, fretful days, and sleepless nights. A dirty refrigerator is another factor which has been responsible for much illness and distress.
Indigestion is often brought on because a nurse, caretaker, or possibly the mother, not wishing to go down to the refrigerator in the middle of the night, brings up the food early in the evening and allows it to become warm—to remain in a thermos bottle—and we are sure that had they been able to see the enormous multiplication of germs because of this warm temperature, they would never have given occasion for such an increase in bacteria just to save themselves a trifle of inconvenience.
Still another common mistake is to use one formula too long; a feeding mixture which was good for four or possibly six weeks, must be changed as the child grows older and his requirements become greater. Let the weight, stools, general disposition and sleep of the child be your guides, and with these in mind errors in feeding can be quickly detected and minor mistakes speedily rectified.
SYMPTOMS OF DISSATISFACTION
Some of the pointed questions which are put to a young mother who brings her child into the office of the baby specialist, are the following:
Does the baby seem satisfied after his feeding? Does he suck his fist? How much does he gain each week in weight? Does he sleep well? Does the baby vomit? What do his bowel movements look like? Will you please send a stool to the office?
With the intelligent answers to these questions—after knowing the birth weight and the age of the child and its general nervous disposition—the physician can formulate some conclusion as to the babe's general condition and can usually find a feeding formula that will make him grow.
Vomiting, restlessness, sleeplessness and the condition of the bowels, are the telltales which indicate whether or not the food is being assimilated; and the stools may vary all the way from hard bullet-like lumps to a green diarrhea.
Babies do not thrive well in large institutions where the food is so often made up in a wholesale manner, for the simple reason that the food elements are not suited to the need of each individual baby. Some infants are unable to digest raw milk, and for them sterilized or boiled milk should be tried; others require a fat-free mixture such as skimmed milk, while still others may need buttermilk for a short time. Babies require individual care, particularly in their food, and the good or bad results are plainly shown in the stools, weight, sleep, etc.
FLATULENCE
Flatulence is an excessive formation of gas in the stomach and bowels leading to distension of the abdomen and the belching of gas, and often the bringing up of a sour, pungent, watery fluid.
Flatulence is seen in infants suffering from intestinal indigestion and the food is nearly always at fault. This condition is the result of the faulty digestion of the sugar and starches—particularly the starch—which should be immediately reduced. In such conditions the addition of a slight amount of some alkaline (such as soda, magnesia or lime water) to the food often produces good results. Great patience must be exercised with a child that suffers from flatulence, for immediate improvement can hardly be expected; time is required for the restoration of good digestion.
VOMITING
Vomiting is perhaps more often the result of over feeding or too frequent feeding than anything else. A healthy, breast-fed baby may now and then regurgitate a bit, but it simply spills over because it is too full. We do not refer to this as vomiting, we refer to the belching up or vomiting of very sour or acrid milk which leaves a sour odor on the clothing. This can all usually be rectified by lengthening the intervals from two to three hours and preventing bolting of food by getting a nipple whose hole is not so large. Too much cream in the food will also sometimes cause vomiting.
Too frequent feeding at night is another cause of vomiting. When the stomach is full, the failure to lay the baby down quietly, as is so often seen in those homes where bouncing and jolting are practiced, may also result in vomiting.
Vomiting may be the first sign of many acute illnesses such as scarlet fever, measles, pneumonia, whooping cough, etc.
The treatment for acute vomiting is simple. All foods should be withheld—nothing but plain, sweetened water should be administered, while it is often advisable to give a dose of castor oil. A physician should be called at once if the vomiting continues, and not until the vomiting has entirely ceased for a number of hours and water is easily retained, should food be given, and even then it should be begun on very weak mixtures.
OVER-FEEDING
The size of the child's stomach should be the guide to the quantity of food given, and attention is called to the table given in a previous chapter. All food taken in excess of his needs lies in his stomach and intestines only to ferment and cause wind and colic. The symptoms of over-feeding are restlessness, sleeplessness, stationary weight (or loss in weight), and oftentimes these very symptoms are interpreted by the mother as sufficient evidence that the baby needs more food; and so the reader can see the terrible havoc which is soon wrought where such ignorance reigns.
WEIGHT
The weighing time should immediately follow a bowel movement and just before a feeding time; then, and only then, we have the real weight of baby, as a retained bowel movement may often add from four to five ounces to the child's weight. There should be a careful record of each weighing, for there may develop a great difference if different members of the family endeavor to keep the weight in their minds. The normal baby should gain four to eight ounces a week up to six months, and from then on the weekly gain is from two to four ounces; in other words, by six months the baby should double his birth weight and at the end of a year his weight should be three times the birth weight. A stationary or diminishing weight demands careful attention; a good doctor should be called at once. Likewise, a very rapid increase in weight is not to be desired, as we do not want a fat baby, but we do desire a well-proportioned and alert baby, and, as someone has said, it is better to have little or no gain during the excessive heat than to upset the digestion by over-feeding, designed to keep the baby gaining.
In weighing, usually the outside garments are removed, leaving on a shirt, band, diaper, and stockings with the necessary pins; the little fellow thus protected is placed into the weighing basket and at each successive weighing, these same clothes or others just like them are always included in the weight, and it should be so reported to the physician.
THE STOOLS
In the chapter "Baby's Early Care," the first stools were described in detail, and there we learned that the dark, tarry, meconium stools are quickly changed within a week to the normal canary-yellow stool, having the odor of sour milk.
The bottle-fed babies' stools differ somewhat in appearance; they are thicker and a lighter color, but should always be homogeneous if the food is well digested. They do not have nearly the number of bowel movements each day that the breast-fed baby does. If a bottle-fed baby's bowels move once a day and he seems perfectly well otherwise, we are satisfied. And curds (white lumps), or mucus (sedimentary, slimy phlegm), indicate that the food is not well digested.
BOTTLE FEEDING AND CONSTIPATION
A bottle baby may be constipated because the proteins are too high, the fat too high, the food of an insufficient quantity or quality, or the milk have been boiled, while weak babies really may lack the muscular power to produce a bowel movement. With the help of your physician endeavor to arrive at the cause of the constipation, and, if the baby is two or three months old, from one to two teaspoons of unsweetened prune juice may be administered. Milk of magnesia may be added to the food (leaving out the lime water), or a gluten suppository may be used.
The change from milk sugar to malt sugar has helped many infants; while the giving of orange juice (after six months) is very beneficial in many cases. A small amount of sweet oil may be injected into the rectum which will lubricate the hard lumps and thus favor comfortable evacuation. The periodicity of the bowel movement (at definite times each day) is a matter of great importance. Immediately after a meal, if the child is old enough, he should be placed on the toilet chair. A bit of cotton, well anointed with vaseline and inserted into the rectum just before meals, will often aid in producing a bowel movement shortly after the meal has been taken.
Abdominal massage should be administered in all instances of constipation, beginning with light movements and gradually increasing, with well-oiled hands.
DIARRHOEA
Diarrhoea usually accompanies acute intestinal indigestion and is so often associated with the common disorders of infancy that we refer the reader to the chapter "Common Disorders of Infancy." Dark stools should always be saved for the physician to observe, as they frequently contain blood. Stools full of air bubbles with pungent sour odor show fermentation; in which cases the starches should be reduced, if not entirely taken away from the food mixtures. Green stools mean putrefaction from filth-germs; a thorough cleansing of the bowel should be immediately followed by a reduction in the strength of the food and the boiling of the milk.
REGULATION OF THE STOOLS
At a certain time each day the napkin should be removed and the child should be held out over a small jar. It is surprising to note how quickly and readily the little fellow cooperates. Diaper experiences may be limited to much less than a year if the mother has patience enough and the baby has the normal intelligence to enter into this regulation regime. We recall one caretaker who complained bitterly because the child under her care constantly wet his diaper; so the caretaker was instructed to keep a daily schedule of the baby's actions for five days; and, to her surprise, she discovered that the baby urinated about the same time each day. A regularity was also noted concerning the bowel movements.
The variations in the time of the urinations were only fifteen or twenty minutes, so nearly did the kidneys act at the same time each day. The caretaker was instructed to remove the diaper and hold the baby out at the earliest occurrence on the daily schedule, and, to the astonishment of the entire family, no further accidents occurred, and the child soon acquired the habit of letting them understand when he was about to wet his diaper. Bowel movements may be regulated more easily than the urination. After the child is about a year old, very few accidents should occur.
MIXED FEEDING
In many instances, and particularly if the infant is under six months of age, and where he has had to have additional feeding from the bottle—under such circumstances the breast milk may be continued as "partial feeding," at least until the baby has reached his ninth or tenth month, at which time it may be wholly discontinued.
At each nursing time the baby empties both breasts, and the amount he draws may readily be estimated by carefully weighing him before and after each nursing. By referring to the directions in a previous chapter, the quantity of food needed for his size and age may be determined; while the deficit is made up from a bottle of milk containing properly modified cow's milk.
If the mother's health admits, or if the breasts continue to secrete a partial meal for the babe, mixed feeding should be continued until after the ninth or tenth month, when it can gradually be reduced from four or five times each day to once or twice a day, until it is finally omitted altogether. In the meantime, the baby is gradually getting stronger food and at eleven or twelve months the little fellow is able to subsist and thrive upon whole milk.
INFANT FEEDING PUZZLES
It is very difficult to explain how some babies thrive on some certain food while others grow thin and speedily go into a decline on the same regime. The hereditary tendencies and predispositions undoubtedly have a great deal to do with such puzzling cases.
Again, sometimes a slight variation in technic or some other trifling error in connection with the preparation of the baby's food, may be more or less responsible for the variation in the results obtained. No two mothers will prepare food exactly alike even when both are following the same printed directions and these slight discrepancies are enough to upset some delicately balanced baby.
On the other hand, some babies are born with such strong digestive powers and such a powerful constitution that they are easily able to survive almost any and all blunders as regards artificial feeding, while at the same time they also manifest the ability to surmount a score of other obstacles which the combined ignorance and carelessness of their parents or caretakers unknowingly place in the pathway of early life which these little folks must tread.
The fact that so many babies do so well on such unscientific feeding only serves to demonstrate the old law of "the survival of the fittest"—they are born in the world with an enormous endowment of "survival qualities"—and in many cases the little fellows thrive and grow no matter how atrociously they are fed.
There may be other factors in the explanation of why some babies do so well on such poor care, but heredity is the chief explanation, while adaptation is the other. If the little fellows can survive for a few weeks or a few months, the human machine possesses marvelous powers of adaptation, and we find here the explanation why many a neglected baby pulls through.
INFANT FOODS
Rickets and scurvy have so often followed the prolonged use of the so-called "infant foods" which have flooded the market for the past decade, that intelligent physicians unanimously agree that they are injurious and quite unfit for continued use in the feeding of infants. If they are prescribed to replace milk during an acute illness, or at other times when the fats and proteins should be withheld for a short period, both the physician and the mother should be in the possession of definite and exact knowledge as to just what they do and do not contain. To provide such knowledge, we present the analysis (Holt) of some of the more commonly used infant foods.
1. The Milk Foods. Nestle's Food is perhaps the most widely known. The others closely resembling it in composition are the Anglo-Swiss, the Franco-Swiss, the American-Swiss, and Gerber's Food. These foods are essentially sweetened, condensed milk evaporated to dryness, with the addition of some form of flour which has been dextrinized; they all contain a large proportion of unchanged starch.
2. The Liebig or Malted Foods. Mellin's Food may be taken as a type of the class. Others which resemble it more or less closely are Liebig's, Horlick's Food, Hawley's Food, malted milk, and cereal milk. Mellin's food is composed principally (eighty per cent) of soluble carbohydrates. They are derived from malted wheat and barley flour, and are composed chiefly of a mixture of dextrins, dextrose, and maltose.
3. The Farinaceous Foods. These are Imperial Granum, Ridge's Food, Hubbell's Prepared Wheat, and Robinson's Patent Barley. The first consists of wheat flour previously prepared by baking, by which a small proportion of the starch—from one to six per cent—has been converted into sugar.
In chemical composition these four foods are very similar to each other, consisting mainly of unchanged starch which forms from seventy-five to eighty per cent of their solid constituents.
4. Miscellaneous Foods. Under this head may be mentioned Carnrick's Soluble Food and Eskay's Food.
The composition of the foods mentioned is given in the accompanying table.
COMPOSITION OF INFANT FOODS
Malted Nestle's Mellin's Eskay's Milk Ingredients Food Food Food (Horlick's) Per cent Per cent Per cent Per cent
Fat 5.50 0.24 1.16 8.78 Proteins 14.34 11.50 5.82 16.35 Cane Sugar 25.00 ... ... ... Dextrose ... ... } 53.46[1] ... Lactose (milk sugar) 6.57 ... } } 49.15[2] Maltose } 27.36 60.80 ... } Dextrins } 19.20 14.35 18.80 Carbohydrates (soluble) 58.93 80.00 67.81 67.95 Starch 15.39 ... 21.21 ... Inorganic Salts 2.03 3.59 1.30 3.86 Water 3.81 4.73 2.70 3.06
Ridge's Imperial Carnrick's Ingredients Food Granum Food Per cent Per cent Per cent
Fat 1.11 1.04 7.45 Proteins 11.81 14.00 10.25 Cane Sugar ... ... ... Dextrose 0.52 0.42 ... Lactose (milk sugar) ... ... Maltose ... ... Dextrins 1.28 1.38 ... Carbohydrates (soluble) 1.80 1.80 27.08 Starch 76.21 73.54 37.37 Inorganic Salts 0.49 0.39 4.42 Water 8.58 9.23 3.42
[1] Chiefly Lactose.
[2] Largely Maltose.
CHAPTER XX
BABY'S BATH AND TOILET
From earliest girlhood, women have loved their dolls, and one of the greatest joys connected with the adored experience was the make-believe bath and the dressing of the make-believe baby; so now, when we are the happy possessors of real live dolls, we should go about the task with the same lightheartedness of a score of years ago when we hugged, kissed, bathed, and dressed our dolls. There is one big advantage now, the doll won't break; but, we sigh as we stop to think, we can't stick pins into it as we all did into the sawdust bodies of our dolls those years and years ago.
THE FIRST WEEK
In the chapter on "Baby's Early Care," this subject was fully discussed and we only wish to repeat, in passing, that before baby's bath or toilet is undertaken the hands of the mother, nurse, or caretaker must be scrupulously clean. And while the first day's bath usually consists of sweet oil, albolene, or benzoated lard, if the new baby happens to come during the very warm days of July or August and the oil seems to irritate the soft downy skin, as it often does during those hot days, a simple sponge bath may be substituted. The cord dressing remains as the doctor left it, and if there be any interference, let it be subject to his orders.
The cord usually drops off, and the abdomen is entirely healed by the seventh to the tenth day, after which time baby is daily sponged for another week. And now we will describe in detail the simplest, easiest manner of administering an oil bath or a sponge bath.
GIVING THE BATH
A large pillow or a folded soft comfort is placed on a table in a warm room—temperature not below 75 F. On baby's tray near by, and within reaching distance, are the boracic acid solution in a small cup, a medicine dropper, the warm saucer of oil, the toothpick applicators (made by twisting cotton about one end, making sure the sharp end of the pick is well protected), a glass jar of small cotton balls made from sterile absorbent cotton, the castile soap, talcum powder, needle and thread. A vessel of warm water, several old, soft, warmed towels and the clean garments required, complete the layout.
Into the warm, soft blanket on the pillow or comfort we place the partially undressed baby, for the binder, diaper, and socks are not removed until the head-and-face toilet is completed.
The top of the head, behind the ears, the folds of the neck, and the armpits are now gently but thoroughly rubbed with oil, which is then all rubbed off with a soft linen towel. The eyes next receive two or three drops of the boracic acid solution, put in by the aid of the medicine dropper, while, with a separate piece of cotton, the surplus solution is wiped off each eye, rubbing from the nose outward.
Then with the applicator made by wrapping cotton about the end of a toothpick, oil is put into each nostril, all the time exercising the utmost care not to harm the tender mucous membrane. The ears are also carefully cleansed with a squeezed-out dip of boracic acid on the applicator.
Unless there is an inflammation present in the mouth, and the physician in attendance has ordered mouth swabbing, do not touch it; for much harm is done the mucous membrane of the baby's mouth by the forceful manner in which much of the swabbing is done. The face and head are then washed with warm water; very little soap is needed and, when used, must be most thoroughly rinsed off.
THE SECOND WEEK
And now during the second week, we proceed to sponge the baby's body; the hands are washed with soap and rinsed, and, only those who have performed this feat know just how tightly they hold shut their little fists. These hands must be relaxed, and all the lint, dirt, and perspiration be thoroughly washed away. The arms, shoulders, chest, and back are then sponged. All the time the nurse or caretaker is standing while carrying out this most pleasant task. At any time she may quickly cover the babe and stop for this or that with no inconvenience to herself or the child.
After the thorough drying of baby's upper body, a bit of talcum is put under the arms, in the folds of neck, etc., and the shirt is slipped on. Next the band, diaper, and stockings are removed and after first oiling the groin and the folds of the thighs and the buttocks, the same sponging, drying, and powdering is done here as on the upper body.
The band is now applied, and sewed on. The diaper, stockings, booties, and—if a winter baby—the skirt and outing flannel gown (for babies should wear only night dresses for the first two or three weeks) are now slipped over the feet and drawn upward, and baby is ready for nursing or for his nap.
TEMPERATURE OF BATHS
First few weeks, 100 F.; early infancy, 98 F.; after six months, 97 F., cooling down to 90 F.
A wooden bath thermometer may be purchased for twenty-five cents and it should be in every home where babies are bathed. In the absence of a thermometer do not depend upon the hand to determine temperature. Thrust the bared elbow into the water and if it is just comfortable—neither hot or cool—it is probably about the correct temperature for baby. Do not shock the baby by dashes of cold water, for, while it may amuse an onlooker, it unnecessarily frightens your child, and, subconsciously, he learns to dread his bath.
THE BATHING PLACE
If the bathroom is warm—temperature 75 F.—that is the most logical place for the bath, provided baby has his own tub. Place a couple of strong slats several inches wide across the big tub, six inches apart, and on this place the baby's tub. Of course, care must be exercised to prevent slipping by means of properly fitted cleats on the under surface of the slats. The mother should always stand to bathe her baby and the small tub should be placed at such a height that she neither has to stoop nor bend. Thus the bathing of the baby becomes a pleasure instead of a "job" or an "irksome task."
If the bathroom is not warm then the kitchen table or a small table pulled up near the stove is a place par excellence for the dip.
Many boils seen on young baby's tender skin have been traced to the careless use of the family tub to bathe the baby in. Not until the child is two or three years of age, when his skin has become more toughened, should he be allowed to use the family tub.
FREQUENCY OF BATHS
To begin with, we never bathe either a baby or an adult immediately after a full meal. From one hour to one and one half hours should intervene.
The frequency of baths depends somewhat upon the season of the year, the vitality of the child, and the warmth of the home.
We have seen many infants who were bathed too often. The vitality expended upon the necessary reaction following a tub bath was too much for the little fellow; the daily bath was stopped and a semi-weekly bath substituted, much to the gain of the child. Of course in this instance the hands, face, and buttocks received a daily sponging.
The oil bath may be administered daily. In robust children the tub bath may be a daily affair; while in pale, anemic little folks, the tub bath is perhaps better given twice a week. In hot summer days a sponge bath may be given many times a day.
BEST HOUR FOR BATHING
Again this depends upon several factors; the warmth of the house or apartment, the vitality of the child, and the kind of bath to be administered.
An oil bath may be given any time—often it may be administered entirely under the bed clothes, only care must be taken to keep oil from the blankets.
Many of our mothers prefer to give the tub bath at five o'clock in the afternoon, when the house is thoroughly warm, and the child is thereby prepared for the long night's sleep. Before dressing in the morning an oil bath or rub may be given in such cases.
If the forenoon is selected as the time for bathing the child, then an hour just before the mid forenoon meal is the best. In either event, be regular about it—do it at the same time every day. Let the caretaker attend to her many duties, and, as far as possible, mothers, bathe your baby yourself. The folds of the skin, the creases in the neck, the clenched fists, must all receive particular care, and no one in all the world will ever care as you—the mother—cares.
SOAP AND WATER
Select a soap free from irritants and excess of alkalis. There are few kinds that equal the old-fashioned, white castile soap our grandmothers used.
Very hard water which makes the skin rough and sore may be improved by boiling, but if possible substitute rain water for it. A flannel bag tied over the faucet and changed each day will help to clarify muddy water, provided the stream flows gently through it.
ROUTINE OF THE TUB BATH
Just as we directed the nurse or caretaker to stand while the oil rub or sponge bath was given, so we admonish the mother to stand while the tub bath is given. First, get everything in readiness for the bath as directed for the oil bath, and then the baby's tub setting on the securely cleated slats placed across the top of the family tub may be filled with water by means of a hose attached to the faucet. The temperature should be 100 F. when baby is dipped in to be rinsed.
The head and face toilet are identical with that described before, and with the baby undressed and wrapped in a warm towel placed inside the warm blanket on the pillow or comfort as before mentioned, we proceed with a good lather of castile soap and water to lather the baby's body all over—under the arms, the neck, chest, groins, thighs, buttocks, legs, feet, and between the toes, while the genitals also receive their share of attention. The foreskin of the boy baby is gently pushed back and cleansed thoroughly; while the vulva of the little girl baby, having first been swabbed with boracic acid, is now gently lathered and cleansed. Now grasp the ankles and legs with the right hand and support the upper back and neck and shoulders with the left and gently lower the baby into the water in a semi-reclining position (See Fig. 13). The water should cover the shoulders. Keep a good firm supporting left hand under the head, neck, and shoulders, and with the right, rinse all soap from the body.
After this is thoroughly done, lift the baby out onto a fresh warm towel inside the warm blanket on the pillow, and remain standing, while you gently pat (never rub) the baby dry. All the little folds, creases, and places between fingers and toes, are carefully patted dry, and where any two skin surfaces rub together put on a bit of talcum.
The dressing takes place in the manner already described—first the shirt, then the band (sewed on), the diaper, stockings, skirt, and gown.
Please note that the soap bath is contra-indicated (should not be given) in case of eczema.
BABY'S DAILY RUB
This soap bath should be administered for cleanliness only, and should be given twice a week. If a tub bath is to be given on other days, after the routine head and face toilet, the baby is simply dipped into the water and the soft skin gently rubbed.
If the sponge or tub bath is given in the afternoon just before the long sleep at night, then the oil rub should take place before the mid-forenoon meal; and likewise, if the sponge or tub bath is given during the mid forenoon, then the oil rub or dry hand rub is given before the going-to-bed time. The rub should be a daily procedure for the first two years. Nothing rougher than the soft palm of the hand should be rubbed on baby's soft skin.
USE AND ABUSE OF TALCUM
Babies have come to my clinic with cakes of talcum under their arms, and particularly between their thighs and in the crease of the buttocks. Here the well-meaning but thoughtless mother had reasoned, "a little is good; more is better" which is not always the case.
Talcum is not used to replace careful drying, and it should never be found in quantities on the baby's skin any more than you would expect to find quantities of face powder caked in the creases of the neck or behind the ears of an adult. The skin is first cleaned, then patted entirely dry, and, as a finishing touch, a bit of talcum is put on by means of a puff.
TONIC AND MEDICATED BATHS
Tonic baths are usually given to older children when they are able to enter into the sport and frolic of a cool bath. Baths are called tonic because they call forth from the body a reaction—a sort of circulatory rebound. This rebound or reaction brings the blood to the skin, increases the circulation, and tones up the nerves. The room should be properly warmed and, if necessary, some form of exercise be continued after the bath to prevent the chill that sometimes follows a poorly administered bath.
In the case of the anemic child, after six months of age, the mother's hand dipped in cold water may briskly rub the chest and back until it glows or becomes red. The child should enjoy this bath. Never frighten a child by throwing cold water on it or by giving it a too sudden cold plunge; great harm may be permanently done by these efforts to "toughen the baby."
The simple medicated baths may be administered according to the following directions:
Salt. Use half a teacup of common salt or sea salt to each gallon of water. The salt should first be dissolved in a cup of warm water to prevent the sharp particles from pricking the skin. The doctor sometimes orders a salt bath.
Starch. Add a cup of ordinary, cooked laundry starch for every gallon of water in the bath.
Soda. A soda bath requires two tablespoons of ordinary baking soda to a gallon of water, dissolving it in a little water before adding it to the bath.
Bran. Make a cotton bag of cheesecloth or other thin material, six inches square. Fill loosely with bran. Soak the bag in the bath water, squeezing it frequently until the water becomes milky.
Starch, soda, and bran baths are often used in place of the ordinary soap and water bath when the skin is inflamed, as in cases of chafing or prickly heat.
FEAR OF BATHS
Force and harshness are not likely to cause baby to overcome very much of the fear of a tub bath. Patience, perseverance, and purposeful diversion of mind will bring sure results.
In the case of a very young baby, have a helper stretch a towel across the filled baby tub, lay the baby in it, with its head well supported, and then gently lower the towel into the water, keeping the head out. (Most anyone would fear an all-over ducking, if he had ever been completely ducked into water by a careless or mischievous friend).
In the case of older children, celluloid ducks, fish, or boats may float about on the water, and the entire bath be forgotten by the little fellow's enjoyment of "his boats."
OUT OF DOOR BATHING
Although a baby under two years should never be given a sea bath, a word of caution about sea bathing for young children may not be amiss. The cruelty with which well-meaning parents treat young, tender children by forcibly dragging them into the surf, a practice which may be seen at any seaside resort in the summer, can have no justification. The fright and shock that a sensitive child is thus subjected to is more than sufficient to undo any conceivable good resulting from the plunge. On the other hand, a child who is allowed to play on the warm sand and becomes accustomed to the water slowly and naturally will soon learn to take delight in the buffeting of the smaller waves, but he should not be permitted to remain more than a minute or two in the water, and should be thoroughly dried, dressed immediately, and not left to run about the beach in wet clothing.
MILK CRUST
Any roughness on the scalp must receive immediate attention. This roughness, or milk crust, is entirely avoidable; it is the result of accumulated oil and dirt. When it has formed a complete crust or cake, it may quickly become eczematous and require a physician's advice; however, in the beginning, at the first sight of brown patches or roughness, oil the scalp thoroughly at night with vaseline or cold cream, which should be gently rubbed off in the morning.
This vaseline or cold cream should be applied repeatedly, several nights in succession, followed by the morning's gentle rubbing and daily washing of the head. Often the washing with water must be entirely avoided; only sweet oil or vaseline being used in those cases where the crusting seems to be persistent.
THE EYES, EARS, AND NOSE
At birth the eyes are particularly cared for. First, the mucus is gently swabbed off the closed lids from the nose side outward, and then follows the application of one drop of twenty per cent argyrol or two per cent silver nitrate, either of which thoroughly disinfects the eye and prevents the growth or development of any bacteria that may have gotten into the child's eye during the descent of the head through the birth canal. The neglect of this procedure may sometimes result in lifelong blindness.
Under no circumstances should "a mere cold in the eyes" be neglected; it may result in blindness. Call your physician at once, and if he is not at hand, wash out the eye thoroughly every hour with warmed ten per cent boracic acid solution, by means of a medicine dropper, using a separate piece of cotton for each eye, for if the slightest bit of discharge be carried from one eye to the other an inflammation will quickly appear.
From birth, especially during the first week, baby's eyes are very sensitive to light; hence they must be carefully protected. Babies should be so placed during their outings, sleep, or naps, that they do not directly gaze at either the sunlight or sky. The lining of the hood of the carriage should be green, instead of white, as much eye strain is thus prevented. |
|
