INFANT FEEDING
_What is the best infant food?_
Mother's milk.
_Of what is mother's milk composed?_
Thirteen parts solids and eighty-seven parts water.
_What are the solids?_
Fat, sugar, proteids, and salts.
_What is the fat?_
The cream.
_What is the sugar?_
It is lactose, or milk sugar.
_What are the proteids?_
The curd of the milk.
_Are all these elements necessary?_
Yes; we cannot expect to rear a healthy infant unless they are all in
his food.
_Of what use is the fat?_
It is needed for the growth of the bones, the nerves, the fat of the
body, and the production of heat.
_Of what use is the sugar?_
It is needed for the production of heat, and to make fat in the body.
_Of what use are the proteids?_
They are needed for the growth of the cells of the body, such as those
of the blood, the various organs, and the muscles.
_Of what use are the salts?_
Particularly for the growth of bone.
_Of what use is the water?_
By means of the water the food is kept in a state of minute
subdivision or in solution, so that the delicate organs of a young
infant can digest it. It is also necessary to enable the body to get
rid of its waste.
NURSING
_Should all mothers attempt to nurse their children?_
As a rule they should do so, but there are many conditions when they
should not.
_What are the most important ones?_
If the mother has or has had tuberculosis or any other serious chronic
disease, or is herself in very delicate health, she should not try.
She is likely soon to fail in nourishing her child, and the attempt
may do herself much harm as well as injure the child.
_How often should infants be nursed during the first two days of
life?_
Usually only four or five times daily, since there is very little milk
secreted at this time.
_When does the milk come in abundance?_
Usually on the third day, sometimes not until the fourth or fifth day.
_Should the infant be fed anything additional during the first two
days?_
Usually not; if much food were necessary, we may be sure Nature would
have provided it. Water, however, should be given regularly.
_How frequently should an infant be nursed during the first week?_
After the third day, every two hours during the day and twice during
the night. The frequency during the rest of the first year is given in
the following table:
------------------------------------------------------------------
PERIOD. Nursings in Interval Night nursings
24 hours. by day. (10 P.M. to 6 A.M.).
------------------------------------------------------------------
1st and 2d day 4 6 hours. 1
3 days to 6 weeks 10 2 " 2
6 weeks to 3 months 8 2-1/2 " 2
3 to 5 months 7 3 " 1
5 to 12 months 6 3 " 0
------------------------------------------------------------------
_How long should the child be kept at the breast for one nursing?_
Not over twenty minutes.
_Should the child take both breasts at one nursing?_
If the milk is very abundant one breast may be sufficient, otherwise
both breasts may be taken.
_What are the important things to be attended to in nursing?_
First, regularity; it is just as important as in the case of
bottle-feeding. Secondly, the nipples should be kept clean by being
washed after every nursing.
_What should be the diet of a nursing mother?_
She should have a simple but generous diet with plenty of fluids;
three regular meals may be given and gruel, milk, or cocoa at bed-time
and sometimes between meals. She may take eggs, cereals, most soups,
and nearly all vegetables, avoiding sour fruits, salads, pastry, and
most desserts. Meat should not be taken more than twice daily, and in
many cases but once. She should take but little tea or coffee, and
ordinarily no wine or beer.
_Are fruits likely to disturb a nursing infant?_
Sour fruits in some cases may do so, but sweet fruits and most cooked
fruits are useful.
_What else is important in the life of the nursing mother?_
She should lead a simple natural life; should have regular out-of-door
exercise, preferably walking or driving, as soon after her confinement
as her condition will permit. She should have regular movements from
the bowels daily. She should be as free as possible from unnecessary
cares and worry; her rest at night should be disturbed as little as
possible; she should lie down for at least one hour in the middle of
the day.
_Does the nervous condition of the mother affect the milk?_
Very much more than her diet; worry, anxiety, fatigue, loss of sleep,
household cares, social dissipation etc., have more than anything else
to do with the failure of the modern mother as a nurse. Uncontrolled
emotions, grief, excitement, fright, passion, may cause milk to
disagree with the child; at times they may excite acute illness, and
at other times they may cause a sudden and complete disappearance of
the milk.
_Does menstruation affect the milk?_
In nearly all cases the quantity of milk is lessened so that the
infant is not satisfied and may gain less in weight or not at all. In
many cases the quality of the milk is also affected to such a degree
as to cause slight disturbances of digestion, such as restlessness,
colic, and perhaps some derangement of the bowels. In a few, attacks
of acute indigestion are excited.
_Is regular menstruation a reason for stopping nursing?_
Not invariably; as a rule both functions do not go on together. But if
the child is gaining regularly in weight between the periods, nursing
may be continued indefinitely, although it may be well to feed the
infant wholly or in part during the first day or two that the mother
is unwell.
_What symptoms indicate that a nursing infant is well nourished?_
The child has a good colour, sleeps for two or three hours after
nursing, or, if awake, is quiet, good-natured, and apparently
comfortable. It has normal movements of the bowels and gains steadily
in weight.
_What symptoms indicate that a child who is nursing is not properly
nourished?_
It does not gain and may even lose in weight. It no longer exhibits
its usual energy and playfulness, but is either listless and
indifferent or cross, fretful and irritable, and is apt to sleep
poorly. It grows pale and anæmic and its tissues become soft and
flabby. When the milk is scanty it will often nurse a long time at the
breasts, sometimes three quarters of an hour, before stopping. At
other times it may take the breast for a moment only, and then turn
away in apparent disgust.
_What should be done when such symptoms appear?_
This depends upon the severity of the symptoms and how long they have
lasted. If the child has made no gain for three or four weeks, or is
losing weight, immediate weaning will probably be necessary; in any
case, other food in addition to the breast milk should be given at
once. One may begin by alternating the nursing and the bottle-feeding
and increase the number of bottle-feedings as may be indicated by the
results.
_Is there any objection to a baby being partly nursed and partly fed?_
None whatever; it is often better from the outset to feed the baby
during the night, in order not to disturb the mother's rest.
_What symptoms indicate that the mother's milk disagrees with the
child?_
The child suffers from almost constant discomfort sleeps; little and
then restlessly, cries a great deal, belches gas from the stomach, and
passes much by the bowels, or if not passed, the gas accumulates and
causes abdominal distention and colicky pain. There may be vomiting,
but more often the trouble is intestinal. Sometimes the bowels are
constipated, but usually the movements are frequent, loose, green,
contain mucus and are passed with much gas.
_What should be done under these circumstances?_
If the symptoms have persisted for two or three weeks and the child is
not gaining in weight, there is little chance of improvement, and the
child should be taken from the breast at once. If there is some gain
in weight, one may try for a little longer, endeavouring to improve
the mother's milk by rest, fresh air, careful diet, etc. However, one
should always realize that the trouble is with the milk, not with the
child.
_What changes should be made if a nursing infant habitually vomits?_
If this occurs soon after nursing, the infant has usually taken too
much and the time of nursing should be shortened, or one breast may be
given instead of two; the nursing should also be interrupted by
occasional rests, so that the milk is not taken too fast.
If the vomiting occurs some time after nursing and is repeated, it is
a sign of indigestion; often because the milk is too rich in fat. The
intervals between nursings should then be lengthened; the breast milk
may be diluted by giving one or two tablespoonfuls of plain boiled
water, lime-water, or barley-water, five or ten minutes before
nursing; the mother should eat less hearty food, especially less meat.
_What should be done if the infant has frequent or habitual colic?_
This is usually because the milk is too rich in proteids; the mother
should take more out-of-door exercise, eat less meat, and seek to
control her emotions; all causes of worry should be removed.
_Can constipation in a nursing infant be controlled through the
mother's milk?_
Only to a limited extent. It is important that the mother's bowels be
regular and her digestion good. An increase in the meat and milk of
her diet is sometimes beneficial.
WEANING
_At what age should the child be weaned from the breast?_
Usually weaning should be begun at nine or ten months by substituting
one feeding a day for one nursing, later two feedings, and thus
gradually the child is to be taken from the breast altogether.
_What is the principal reason for weaning earlier?_
The most important one is that the child is not thriving--not gaining
in weight and not progressing normally in its development. Serious
illness of the mother, or pregnancy, may make weaning necessary.
_At what age should the weaning be completed?_
Generally at one year. In summer it may sometimes be advisable to
nurse an infant a little longer rather than wean in warm weather; but
even then the dangers of weaning are much less than those of
continuing to nurse, as is so often done, after the milk has become
very scanty and poor in quality.
_When should a child who is weaned from the breast be taught to drink
from the cup, and when to take the bottle?_
If weaning is done as early as the eighth or ninth month it is better
to give the bottle; if from the tenth to the twelfth month the infant
should be taught to drink or be fed with a spoon.
_How may some of the difficulties in weaning be overcome?_
By feeding every nursing infant once a day or by giving it water
regularly from a feeding-bottle. It then becomes accustomed to the
bottle. This is a matter of great convenience during the whole period
of nursing when the mother or nurse is from necessity away from the
child for a few hours; when more feeding is required at weaning time
the child does not object.
_When should a child be weaned from the bottle?_
With children who are not ill, weaning from the bottle should
invariably be begun at the end of the first year, and after a child is
thirteen or fourteen months old the bottle should not be given except
at the night feeding.
_Is there any objection to the child's taking the bottle until it is
two or three years old?_
There are no advantages and some serious objections. Older children
often become so attached to the bottle that only with the greatest
difficulty can they be made to give it up. Frequently they will refuse
all solid food, and will take nothing except from the bottle so long
as it is given, and when finally at three or four years, it is taken
away, they will not touch milk during the rest of their childhood. The
difficulty is here that children form the "bottle habit." This habit
is troublesome, unnecessary, and should by all means be prevented. An
exclusive diet of milk for children of two or three years often
results in anæmia and malnutrition.
_How should one train a child to do without the bottle?_
This is usually very easy if it is begun at one year. The milk should
be poured into a tiny glass or cup and little by little the child is
taught to drink; at first only a small portion of the food is taken in
this way, the balance being given from the bottle; but in the course
of a few weeks the average infant learns to drink from a cup without
difficulty, and all the food can be so given.
If the child is two or more years old, the only effective means of
weaning from the bottle is through hunger. The bottle should be taken
away at once and entirely, and nothing allowed except milk from a cup
until the child takes this willingly. Sometimes a child will go an
entire day without food, occasionally as long as two days, but one
should not be alarmed on this account and yield. This is a matter of
the child's will and not of his digestion, and when once he has been
conquered it is seldom that any further trouble is experienced. As
soon as a child has learned to drink his milk from a cup, cereals and
other solid foods may gradually be added to the diet. The educational
value of such training is not the least important consideration.
_Can a baby just weaned take cow's milk of the same proportions as one
of the same age who has had cow's milk from birth?_
Very rarely; to give a baby who has had nothing but the breast from
birth, plain cow's milk, or even that milk which a bottle-fed baby of
the same age might take, is almost certain to cause indigestion. The
change in the food is quite a marked one, and should be made gradually
by beginning with a very weak milk and increasing its strength as the
baby becomes accustomed to take cow's milk.
_What would be the proper proportions for an infant weaned at four or
five months?_
About the same as for a healthy bottle-fed infant of two months; the
quantity of course should be larger. The food can in most cases be
gradually increased so that in two or three weeks the usual strength
for the age can be taken.
_What would be the proper proportions for an infant weaned at nine or
ten months?_
About the same as for a bottle-fed infant at four or five months, to
be increased as indicated above.
_Will not a child lose in weight when placed upon so low a diet?_
Very often it will do so for the first week or two, but after that
will gain quite regularly; the acute indigestion, however, which
generally accompanies the use of stronger milk will, in most cases,
cause a greater loss.
ARTIFICIAL FEEDING
_What foods contain all the elements present in mother's milk?_
The milk of other animals,--cow's milk being the only one which is
available for general use.
_Is it not possible for infants to thrive upon other foods than those
containing fresh milk?_
They may do so for a time, but never permanently. The long-continued
use of other foods as the sole diet is attended with great risk.
_What are the dangers of such foods?_
Frequently scurvy is produced (see page 141), often rickets, and in
other cases simply a condition of general malnutrition,--the child
does not thrive, is pale, and its muscles are soft and flabby.
THE SELECTION AND CARE OF MILK USED FOR INFANT FEEDING
_What are the essential points in milk selected for the feeding of
infants?_
That it comes from healthy cows, and that it is clean and fresh.
_Is it not important to select a rich milk?_
By no means; in fact the very rich milk of highly bred Jerseys and
Alderneys has not been found nearly so satisfactory in infant feeding
as that from some other herds, such, for example, as the common "grade
cows."
_Which is the better, milk from one cow or the mixed milk of several
cows?_
The mixed, or "herd milk," is usually to be preferred since it varies
little from day to day; while that from a single cow may vary
considerably.
_How fresh is it important that cow's milk should be for the best
results in infant feeding?_
This depends very much upon the season, and how carefully milk is
handled. As ordinarily handled at the dairy and in the home, milk
should not be used for infants in winter after it is forty-eight hours
old; in summer not after it is twenty-four hours old, and it may be
unsafe in a much shorter time. When handled with especial care milk
may be safe for a longer time.
_What are the two essentials in handling milk?_
1. That it be kept clean and free from contamination. This
necessitates that cows, stables, and milkers be clean, and that
transportation be in sealed bottles; also that those who handle the
milk do not come in contact with any contagious disease. All
milk-pails, bottles, cans, and other utensils with which the milk
comes in contact should be sterilized shortly before they are used,
by steam or boiling water.
2. That it be cooled immediately after leaving the cows, and kept at
as low a temperature as possible; to be efficient this should not be
above 50° F.
Milk produced under hygienic conditions and handled with special care
is sold in bottles in a number of cities under the name of
"certified," "guaranteed," or "inspected" milk. When available such
milk should be used for infants. Of course the extra care bestowed in
its production and transportation increases the cost of the milk, but
the best will usually be found in the end to be the cheapest.
_How should milk be handled in the home when obtained fresh from the
cows?_
That to be used for infants should be strained through a thick layer
of absorbent cotton or several thicknesses of cheese-cloth into quart
glass jars or milk bottles which should be covered and cooled
immediately best by placing the bottles quite up to their necks in ice
water or cold spring water, where they should stand for at least half
an hour. That required for children who take plain milk may now be
poured into half-pint bottles, stopped with cotton, and put in the
ice-chest, or the coolest place possible. This first rapid cooling is
very important and adds much to the keeping qualities of the milk.
Milk loses its heat very quickly when cooled in water, but very slowly
when it is simply placed in a cold room. After standing four or five
hours the top-milk may be removed; after twelve to sixteen hours the
cream may be removed.
_How should milk be handled when bottled milk is purchased?_
It should be cooled as just described, as its temperature is usually
somewhat raised during transportation If it has been bottled at a
dairy, the cream or the top-milk may be removed after an hour or so.
_How should milk and cream be handled when they are purchased in
bulk?_
Such milk should never be used for infants when it is possible to
obtain bottled milk, as it is much more liable to contamination. Both
cream and milk should be poured at once into covered vessels and kept
in the coolest place possible. The cream and top-milk will seldom rise
upon such milk with any satisfactory regularity.
_What are the important things to be secured in nursery
refrigerators?_
Absolute cleanliness is essential; hence the inner portion should be
of metal. Those made entirely of metal are unsatisfactory as in them
the ice melts very quickly. If the ordinary metal refrigerator sold is
encased in a wooden box, we have the best form. Another easy way of
securing the same result Is to make for the refrigerator a covering or
"cosey" of felt or heavy quilting, which can be easily removed when
wet or soiled.
The compartments of the refrigerator should be so arranged that the
bottles of milk are either in contact with the ice or very near it.
The supply of ice should be abundant. Often the amount of ice is so
small, and the bottles so far away, that the temperature of the milk
is never below 60° or 65° F. To be really effective a refrigerator
should have a temperature where the milk is placed of not over 50° F.
The temperature should be tested with the nursery thermometer from
time to time to ascertain what results are being obtained. Spoiled
milk owing to a faulty refrigerator is to be blamed for many attacks
of acute illness among infants. Next to the feeding-bottles it is the
one thing in the nursery which should receive the closest attention.
THE MODIFICATION OF COW'S MILK
_Can cow's milk be fed to infants without any changes?_
No; for although it contains similar elements to those in mother's
milk, they are not identical, and they are not present in the same
proportions.
_Is this a matter of much importance?_
It is of the greatest importance. There are few infants who can digest
cow's milk unless it is changed. To change cow's milk so as to make it
more nearly resemble mother's milk is called _modifying_ cow's milk.
_How is this milk whose proportions have been changed distinguished
from the original unchanged milk?_
The changed milk is usually called "modified milk"? the original
unchanged milk is known as "plain milk," "whole milk," "straight
milk," or is referred to simply as "milk."
_What are the principal differences between cow's milk and mother's
milk?_
Cow's milk has a little more than half as much sugar; it has nearly
three times as much proteids and salts; its proteids are different and
much more difficult of digestion; its reaction is decidedly acid, that
of mother's milk is faintly acid or neutral.
_Are there any other important things to be considered?_
Yes; mother's milk is always fed fresh and is practically sterile.
Cow's milk is generally kept twenty-four hours and sometimes much
longer. It is always to a greater or less degree contaminated by dirt
and germs, the number of which increases rapidly (1) with the age of
the milk; (2) in proportion to amount of the dust or dirt which enters
it; (3) with any increase in the temperature at which the milk is
kept.
It is just as important for success in infant feeding that these
conditions receive attention as that the proportions of the different
elements of the milk are right.
_How is the acidity of cow's milk overcome?_
By the addition of lime-water or bicarbonate of soda. If lime-water is
used, one ounce to twenty ounces of food is generally required; if
soda is used, twenty grains to twenty ounces of food.
If there is a tendency to constipation the milk of magnesia
(Phillips's) may be used; from one half to one teaspoonful being added
to each twenty ounces of food.
_How is the sugar best increased?_
By adding milk sugar to the food; one ounce to each twenty ounces of
food will give the proper quantity for the first three or four months.
This will make the proportion about the same (between 6 and 7 per
cent) as in mother's milk.
_How should the sugar be prepared?_
Simply dissolved in boiled water; if the solution is not clear, or if
there is a deposit after standing, it should be filtered by pouring
through a layer of absorbent cotton, half an inch thick, which is
placed in an ordinary funnel.
_Will not cane (granulated) sugar answer as well?_
Not as a rule; however, there are many infants who get on very well
when cane sugar is used. It has the advantage of being much cheaper. A
good grade of milk sugar is somewhat expensive, costing from
twenty-five to sixty cents a pound, and cheap samples are apt to
contain impurities.
_If cane sugar is used, what amount should be added?_
Considerably less than of the milk sugar. Usually about half the
quantity (half an ounce to twenty ounces of food) is as much as most
infants can digest If the same quantity is used as of the milk sugar,
the food is made unduly sweet, and the sugar is likely to ferment in
the stomach and cause colic.
_Is not the purpose of the sugar to sweeten the food in order to make
it palatable?_
Not at all; although it does that, its real use is to furnish one of
the essential elements needed for the growth of the body, and the one
that is required by young infants in the largest quantity.
_How do we know that this is so?_
By the fact that in good breast milk the amount of sugar is greater
than that of the fat, proteids, and salts combined.
_We have seen that cow's milk has nearly three times as much proteids
(curd) and salts as mother's milk. How are these to be diminished?_
By diluting the milk.
_Will it be sufficient to dilute the milk twice (i.e., add two parts
of water to one part of milk)?_
Not for a very young infant. Although this will give about the
quantity of proteids present in mother's milk, the proteids of cow's
milk are so much more difficult for the infant to digest, that in the
beginning it should be diluted five or six times for most infants.
_If cow's milk is properly diluted and lime-water and sugar added does
it then resemble mother's milk?_
No; the mixture contains too little fat.
_What is the easiest way of overcoming this?_
By increasing the fat in the milk before dilution. It may be done by
using top-milk or a mixture of milk and cream.
_What is top-milk?_
It is the upper layer of milk removed after standing a certain number
of hours in a milk bottle, glass jar, or any tall vessel with straight
sides. It contains most of the cream and some of the milk just below.
The strength of the top-milk is measured by the fat it contains--e.g.,
a 10-per-cent milk contains 10 per cent fat; 7-per-cent milk contains
7 per cent fat, etc. These are the two strengths of top milk most used
in infant feeding.
_On what does the percentage of fat in top-milk depend?_
1. On the length of time the milk has stood.
2. On the manner in which the top-milk is removed.
3. On the number of ounces removed.
4. On the richness of the milk used.
Unless these are known it is impossible to say even approximately how
strong in fat the top-milk is.
_When and how should top-milk be removed?_
If milk fresh from the cow, or before the cream has risen, is put into
bottles and rapidly cooled, the top-milk may be removed in as short a
time as four hours. In the case of bottled milk it makes little
difference if it stands a longer time, even until the next day. The
best means of removing it is by a small cream-dipper[2] holding one
ounce; although it may be taken off by a spoon or siphon. It should
not be poured off.
[2] Obtained from any of the Walker-Gordon milk laboratories,
from James Dougherty, No. 411 West 59th Street, New York, and
from many druggists. Price, 20 cents.
_How can we obtain a 10-per-cent top-milk with the different kinds of
cow's milk?_
From a rather poor milk (containing 3--3-1/2 per cent fat) by removing
the upper eight ounces from a quart, or one fourth.
From a good average milk (containing 4 per cent fat) by removing the
upper eleven ounces from a quart, or about one third.
From a rich Jersey milk (containing 5--5-1/2 per cent fat) by removing
the upper sixteen ounces, or one half.
_How can we obtain a 7-per-cent top-milk with the different kinds of
cow's milk?_
From a rather poor milk, by removing the upper eleven ounces from a
quart, about one third.
From a good average milk, by removing the upper sixteen ounces, or one
half.
From a rich Jersey milk, by removing the upper twenty-two ounces, or
about two thirds.
[Illustration: The percentage of fat in the different layers of milk
of good average quality.]
_What is cream?_
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. It differs from
milk chiefly in containing much more fat.
_In what ways is cream now obtained?_
(1) By skimming, after the milk has stood usually for twenty-four
hours? this is known as "gravity cream." (2) By an apparatus known as
a separator; this is known as "centrifugal cream"; most of the cream
now sold in cities is of this kind. The richness of any cream is
indicated by the amount of fat it contains.
The usual gravity cream sold has from 16 to 20 per cent fat. The cream
removed from the upper part (one fifth) of a bottle of milk has about
16 per cent fat. The usual centrifugal cream has 18 to 20 per cent
fat. The heavy centrifugal cream has 35 to 40 per cent fat.
FOOD FOR HEALTHY INFANTS[3]--THE EARLY MONTHS
[3] The directions and formulas given in the following pages
are intended only for guidance in feeding children who
are not suffering from any special disturbance of digestion;
directions for such conditions are given in a later chapter.
_What are the most important points to be remembered in modifying
cow's milk for feeding during the early months?_
That of the different ingredients of milk the sugar is most easily
digested; the fat is next; while the proteids are the most difficult.
_What relation should the fat bear to the proteids during this
period?_
For most infants with good digestion the best results are obtained
when the fat is three times the proteids. However, this is not true of
all. There are many healthy infants who are unable to digest this
proportion of fat, and who do much better when the fat is made only
twice the proteids.
_How can one obtain formulas in which the fat is three times the
proteids?_
By using for dilution a 10-per-cent milk (i.e., milk containing 10 per
cent fat) which serves as the primary formula from which all the other
formulas of this series are derived.
In 10-per-cent milk the fat is just three times the proteids.
_How can one get the 10-per-cent milk?_
(1) As top-milk, as described on page 64; or, (2) by mixing equal
parts of plain milk and ordinary cream (containing about 16 per cent
fat); (3) from any of the milk laboratories it may be ordered
directly.
_Is it better to obtain the 10-per-cent milk by using a mixture of
milk and cream, or as top-milk?_
If one can get milk fresh from the cows, the top-milk is to be
preferred on account of freshness. The food can then be made up when
the milk is but a few hours old. In cities, if one uses bottled milk,
the upper third may also be used. But if one buys milk and cream
separately, it is usually more convenient to mix these, as the cream
will not rise upon milk a second time with any uniformity.
_How can one obtain formulas in which the fat is twice the
proteids?_
By using for dilution a 7-per-cent milk (i.e., milk containing 7 per
cent fat) which serves as the primary formula from which all the other
formulas of this series are derived.
In 7-per-cent milk the fat is just twice the proteids.
_How can one get the 7-per-cent milk?_
(1) As top-milk, as described on page 64; or, (2) by mixing three
parts of milk and one part of ordinary (16 per cent) cream; (3) from
any of the milk laboratories it may be obtained directly. As in the
case of 10-per-cent milk, the top-milk is generally to be preferred to
a mixture of milk and cream.
_How should the food be prepared during the early months?_
It is convenient in calculation to make up twenty ounces of food at a
time. The first step is to obtain the 10-per-cent milk or the
7-per-cent milk to be used as the primary formula. Then to take the
number of ounces of this that are called for in the formula desired.
Note.--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
give quite a different result.
There will be required in addition one ounce of milk sugar[4] and one
ounce of lime-water in each twenty ounces. The rest of the food will
be made up of boiled water.
[4] If the milk sugar be measured in the milk-dipper, two scant
dipperfuls may be calculated as one ounce. If measured in a
tablespoon, three even tablespoonfuls may be calculated as one
ounce.
These formulas written out would be as follows:
_First Series_
_Formulas for the Early Months from 10-per-cent Milk_
-----------------------------------------------------------
I. II. III. IV. V.
-----------------------------------------------------------
10-per-cent milk 2 oz. 3 oz. 4 oz. 5 oz. 6 oz.
Milk sugar 1 " 1 " 1 " 1 " 1 "
Lime-water 1 " 1 " 1 " 1 " 1 "
Boiled water 17 " 16 " 15 " 14 " 13 "
-----------------------------------------------------------
20 oz. 20 oz. 20 oz. 20 oz. 20 oz.
-----------------------------------------------------------
As the milk sugar dissolves in the water the total in each column
will be exactly twenty ounces. The food is strengthened by gradually
increasing the milk and reducing the water.
The approximate composition of these formulas expressed in percentages
is as follows:
----------------------------------------
FORMULA. Fat. Sugar. Proteids.
----------------------------------------
I. 1.00 5.50 0.33
II. 1.50 6.00 0.50
III. 2.00 6.00 0.66
IV. 2.50 6.00 0.80
V. 3.00 6.50 1.00
------------------------------------------
_Second Series_
_Formulas for the Early Months from 7-per-cent Milk_
-----------------------------------------------------------
I. II. III. IV. V.
-----------------------------------------------------------
7-per-cent milk 2 oz. 3 oz. 4 oz. 5 oz. 6 oz.
Milk sugar 1 " 1 " 1 " 1 " 1 "
Lime-water 1 " 1 " 1 " 1 " 1 "
Boiled water 17 " 16 " 15 " 14 " 13 "
-----------------------------------------------------------
20 oz. 20 oz. 20 oz. 20 oz. 20 oz.
-----------------------------------------------------------
The approximate composition of these formulas expressed in percentages
is as follows:
----------------------------------------
FORMULA. Fat. Sugar. Proteids.
----------------------------------------
I. 0.70 5.50 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 6.50 1.00
------------------------------------------
_How is one to decide whether to use the First or the Second Series of
formulas?_
With a large, strong child, having a good digestion one should use the
First Series. With a smaller, less vigorous child, whose digestion is
not so good, or with one who does not do well upon the First Series,
the Second Series should be used.
_Why is it necessary to make the food so 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.
_How rapidly can the food be increased in strength from Formula I to
II, from II to III, etc.?_
No absolute rule can be given. Usually we begin with I on the second
day; II on the fourth day; III at one week or 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 V by the
time it is three or four weeks old. A child with a feeble digestion
must go much slower and may not reach V 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 3 ounces, the
increase would be to 3½ ounces; from 4 ounces to 4½ ounces, etc. At
least two or three days should be allowed between each increase in the
strength of the food.
_What general rule can be given for increasing the food?_
To increase when the infant is not satisfied but is digesting well.
_How does an infant show that he is not satisfied?_
He drains the bottle eagerly and cries when it is taken away. He often
forms the habit of sucking his fingers immediately after. He begins to
fret half an hour or an hour before the next feeding is due.
_In the series of formulas given in the table the quantities are
mentioned for making only twenty ounces of food. How should it be
prepared when more than this quantity is needed?_
It is equally convenient to make up 25 ounces, 30 ounces, 35 ounces,
or 40 ounces at a time.
To make--
25 ounces of any formula add one quarter more of each ingredient.
30 " " one half " "
35 " " three quarters " "
40 " " twice as much " "
Thus 25 ounces of Formula I would be obtained by using 2½ ounces of
milk, 1¼ ounces of sugar and lime-water, 21¼ ounces of water; 30
ounces of the same would require 3 ounces milk, 1½ ounces lime-water
and sugar, and 25½ ounces water; 35 ounces would require 3½ ounces
milk, 1¾ ounces lime-water and sugar, and 29¾ ounces water. The amount
of water need not be calculated in any case, but after measuring
carefully the other ingredients enough water should be added to bring
the total up to the amount required.
_How great an increase in the quantity should be made at one time?_
One may make up five ounces additional food; but the first two days
only two or three ounces of the additional amount should be given; the
next two days, four ounces; after two days more, the five ounces may
be given.
The increase in the quantity given at a single feeding should not be
more than a quarter of an ounce.
FOOD FOR HEALTHY INFANTS--THE LATER MONTHS
_How long should the fat be as much as three times the proteids?_
This is seldom of advantage longer than three or four months.
_What changes should then be made in the milk?_
After Formula V of the First Series (6 ounces of 10-per-cent milk in
20 ounces of food) has been reached, the fat should be increased very
slowly for this proportion (3 per cent) is near the limit for most
healthy children. The milk should now be strengthened chiefly by
raising the percentage of proteids.
_How is this accomplished?_
The 10-per-cent milk and the formulas derived from it should now be
discontinued, and those made from 7-per-cent milk used.
_Third Series_
_Formulas for the Later Months from 7-per-cent Milk_
-----------------------------------------------------------
I. II. III. IV. V.
-----------------------------------------------------------
7-per-cent milk 7 oz. 8 oz. 9 oz. 10 oz. 11 oz.
Milk sugar 1 " 1 " 1 " 3/4 " 1/2 "
Lime-water 1 " 1 " 1 " 1 " 1 "
Boiled water 12 " 11 " 10 " 4 " 3 "
Barley gruel 0 " 0 " 0 " 5 " 5 "
-----------------------------------------------------------
20 oz. 20 oz. 20 oz. 20 oz. 20 oz.
-----------------------------------------------------------
Since the sugar dissolves, the total will be twenty ounces in each
column.
Of any of the formulas, 25 ounces is made by using one quarter more
of each ingredient; 30 ounces, by using one half more; 35 ounces, by
using three quarters more; 40 ounces, by using twice as much, exactly
as described in the First Series on page 73.
The approximate composition of these formulas expressed in percentages
is as follows:
----------------------------------------
FORMULA. Fat. Sugar. Proteids.
----------------------------------------
I. 2.50 6.50 1.25
II. 2.80 6.50 1.40
III. 3.15 7.00 1.55
IV. 3.50 6.00 1.75
V. 4.00 6.00 2.00
------------------------------------------
_How should the food be increased during this period?_
Beginning with I of this Series, which should usually follow V of the
First or Second Series (pages 70, 71), the increase may generally be
made in a week or ten days to II; in about two weeks more to III; now
more slowly to IV and V. When IV or V has been reached, the same
formula may sometimes be continued for three or four months with no
other change than an increase in the quantity.
_In passing from Formula V of the First Series to Formula I of the
Third Series the proportion of fat is at first reduced. Is this
necessary or important?_
No; it only happens to come so in simplifying the calculation. It may
be avoided by taking off at first the upper 13 ounces as top-milk and
using 7 ounces of this in a 20-ounce mixture, in place of Formula I;
and by using for the next increase the upper 15 ounces as top-milk,
taking of this 8 ounces in a 20-ounce mixture in place of Formula II.
Then should follow Formula III.
_What further addition may be made to the food of the later months?_
Usually about the sixth or seventh month, farinaceous food in the form
of gruel may be added, this taking the place of part of the water and
part of the sugar.
_What changes may be made in the food when the infant has reached the
age of ten or eleven months?_
The proteids may be still further increased, and the sugar and the
lime-water reduced until plain milk is given.
_How may this best be done?_
At first one feeding a day of plain milk and barley gruel may be
given; later, two feedings; then three feedings, etc. Let us suppose
an infant to be taking such a modified milk as Formula IV or V (page
76), six feedings a day. The plain milk diluted only with barley gruel
would at first replace one of these feedings; then two, three, four,
etc., these changes being made at intervals of about two weeks. The
proportions of the milk and barley gruel should at first be about
5-1/2 ounces milk, 2-1/2 ounces barley; later, 6 ounces milk, 3 ounces
barley; still later, 7 ounces milk, 2 ounces barley, until finally
plain milk is given to drink and the cereals given separately with a
spoon. This is reached with most infants at fourteen or fifteen
months; with many at twelve or thirteen months. Other forms of
farinaceous food may of course be used in the place of the barley, and
in the same proportions.
With some infants the addition of a pinch of bicarbonate of soda may
be advantageously made to each milk-feeding when the lime-water is
omitted, but with most this is unnecessary.
If the infant strongly objects to the taste of the milk when the milk
sugar has been omitted, a small quantity (one fourth to one half
teaspoonful) of granulated sugar may for a time be added to each
feeding, then gradually reduced.
GENERAL RULES FOR GUIDANCE IN THE USE OF THE FORMULAS GIVEN
It should again be emphasized that these formulas are not intended for
sick children nor for those suffering from any marked symptoms of
indigestion. For such infants special rules are given later.
_What should be the guide in deciding upon a formula with which to
begin for a child who is to be artificially fed?_
The age and the weight are of some importance, but the best guide is
the condition of the child's digestive organs. One should always begin
with a weak formula, particularly, (1) with an infant previously
breast fed; (2) with one just weaned, as a child who has never had
cow's milk must at first have weaker proportions than the age and the
weight would seem to indicate; (3) with infants whose power of
digestion is unknown. If the first formula tried is weaker than the
child can digest, the food can be strengthened every three or four
days until it is found what the child is able to take. On the
contrary, if the food is made too strong at first, an attack of
indigestion will probably follow.
_How should the food be increased in strength?_
The first essential is that it be done very gradually; abruptly
increasing the food usually causes a disturbance of digestion.
It is never wise to advance more rapidly in strengthening the food
than from one formula to the next one in any of the series given; with
many infants it is better to make the steps of increase only half as
great as those indicated (page 72).
_How rapidly should the food be increased in quantity?_
The increase should not be more than a quarter of an ounce in each
feeding; or from one and a half to two ounces in a day.
_When should the food be increased?_
In the early weeks an increase may be necessary every few days; in the
later months sometimes the same formula may be continued for two or
three months. It is, however, impossible to give a definite rule as to
time. One cannot say with any child that an increase is to be made
every week or every two weeks. A much better guide are the conditions
present.
The signs indicating that the food should be increased are, that the
infant is not satisfied, not gaining in weight, but is digesting well,
i.e., not vomiting, and having good stools. One should not increase
the food, however, so long as the child seems perfectly satisfied and
is gaining from four to six ounces a week, even though both the
quantity and the strength of the food are considerably below the
average; nor should the food be increased if the child is gaining from
eight to ten ounces a week, even if he seems somewhat hungry. The
appetite is not always a safe guide to follow.
_How can one know whether the strength or the quantity of the food
should be increased?_
In the early weeks it is well first to increase the strength of the
food, the next time to increase the quantity, then the strength again,
etc. After the fourth or fifth month, the quantity, chiefly, should be
increased.
_If a slight disturbance or discomfort occurs after the food has been
strengthened, is it best to go back to the weaker formula or to
persist with the new one?_
Symptoms of minor discomfort are seen for a day or two with many
infants after an ordinary increase in food; but in most cases an
infant soon becomes accustomed to the stronger food and is able to
digest it. If, however, the symptoms of disturbance are marked, one
should promptly go back to the weaker formula. The next increase
should be a smaller one.
_Should one be disturbed if for the first two or three weeks of
artificial feeding the gain in weight is very slight or even if there
is none?_
Not as a rule. If the infant does not lose weight, is perfectly
comfortable, sleeps most of the time, and does not suffer from any
symptoms of indigestion, such as colic, vomiting, etc., one may be
sure that all is going well and that the infant is becoming used to
his new food. As the child's appetite improves and his digestion is
stronger, the food may be increased every few days and very soon the
gain in weight will come and will then be continuous. If, however, the
scales are watched too closely and, because there is only a slight
gain in weight or none at all, the food is rapidly increased, an acute
disturbance of digestion is pretty certain to follow.
_Is not constipation likely to occur if the child is on a very weak
food?_
It is very often seen and is due simply to the small amount of residue
in the intestine. Under these circumstances, if the bowels move once
every day, one should not be disturbed even when the movements are
small and somewhat dry. As the food is gradually strengthened, this
constipation soon passes off; while if injections, suppositories, or
cathartics are used to produce freer movements, the functions of the
bowels are likely to be disturbed.
_Under what circumstances should the food be reduced?_
Whenever the child becomes ill from any cause whatever, or whenever
any marked symptoms of indigestion arise.
_How may this be done?_
If the disturbance is only a moderate one and the food has been made
up for the day, one third may be poured off from the top of each
bottle just before it is given, and this quantity of food replaced by
the same amount of boiled water.
If the disturbance is more severe, the food should be immediately
diluted by at least one half and at the same time the quantity given
should be reduced.
For a severe acute attack of indigestion the regular food should be
omitted altogether and only water given until the doctor has been
called.
_If the food has been reduced for a disturbance of digestion, how
should one return to the original formula?_
While the reduction of the food should be immediate and considerable,
the increase should be very gradual. After a serious attack of acute
indigestion, when beginning with milk again, it should not be made
more than one fifth the original strength, and from ten days to two
weeks should pass before the child is brought back to his original
food, which should be done very gradually. It is surprising how long a
time is required with young infants before they completely recover
from an attack of acute indigestion, even though it did not seem to be
very severe. The second disturbance always comes from a slighter cause
than the first one.
THE ADDITION OF OTHER FOODS TO MILK
_How long should modified milk be continued without the addition of
other food?_
This depends upon circumstances; usually, for about six months; but if
the infant is thriving satisfactorily the milk may be used alone for
ten or eleven months; with some infants who have especial difficulty
in digesting cow's milk, it is advisable to begin the use of other
food at three or four months or even from the outset.
_What is the first thing to be used with milk?_
Farinaceous food in some form, usually as a gruel.
_How are these gruels made?_
They may be made directly from the grains or from some of the prepared
flours (page 149). The flours are usually to be preferred as being
more simple of preparation.
_How should they be used in making the food?_
They should be cooked separately, rather than with the milk; when the
food is mixed, they take the place of a portion of the water in the
formulas given on pages 70 and 71.
_How much of the gruel should be used?_
If it is prepared as recommended on page 149, it may make according to
circumstances from one sixth to one half the total quantity of food.
_Which of the farinaceous foods are to be preferred?_
Those most used are barley, oatmeal, arrowroot, and farina. There is
not much difference in their nutritive value; oatmeal gruel is
somewhat more laxative.
_What value do these substances possess as infant foods?_
Some of the starch is digested and absorbed; but the chief value of
gruels is believed to be that when added to milk they render the curd
more easily digested by preventing it from coagulating in the stomach
in large tough masses. This is certainly true with many infants, but
there are others who are not at all benefited, and not a few young
infants whose digestion is made distinctly worse by the use of
farinaceous food, particularly when employed in considerable quantity.
The addition of gruels to milk for all infants is not to be
recommended.
_What further additions may be made to the diet of healthy infants
during the first year?_
Beef juice, the white of egg, and orange juice.
_How and when may beef juice be used?_
With infants who are strong and thriving satisfactorily it may be
begun at ten or eleven months; two teaspoonfuls may be given daily,
diluted with the same quantity of water, fifteen minutes before the
midday feeding; in two weeks the quantity may be doubled; and in four
weeks six teaspoonfuls may be given. The maximum quantity at one year
should not be more than two or three tablespoonfuls.
With delicate infants who are pale and anæmic, beef juice is more
important, and it may often be wisely begun at five or six months in
half the quantities mentioned.
_When should white of egg be used?_
Under the same conditions as beef juice, particularly with infants who
have difficulty in digesting the proteins (curd) of milk. At six
months half the white of one egg may be given at one time, and soon
after this the entire white of one egg. The best in manner of cooking
is the "coddled", egg (see page 151).
_When should orange juice be begun?_
Usually about the eleventh or twelfth month; it should be given about
one hour before the feeding; two teaspoonfuls at first, then one
tablespoonful at a time, and later three or four tablespoonfuls. It is
particularly useful when there is constipation. It should always be
strained, and care should be taken that it is sweet and fresh.
OVERFEEDING
_What is meant by overfeeding?_
Giving an infant too much food; either too much at one time or too
frequently. Overfeeding is sometimes practised during the day, but is
chiefly done at night.
_Is not an infant's natural desire for food a proper guide as to the
quantity given?_
The appetite of a perfectly normal infant usually is; but overeating
is a habit gradually acquired and may continue until twice as much
food as is proper is taken in the twenty-four hours. This habit is
most frequently seen in infants whose digestion is not quite normal;
because of the temporary relief from discomfort experienced by taking
food into the stomach, they often appear to be hungry the greater part
of the time, especially at night.
_What are the causes of overfeeding?_
The most common one is the habit of watching the weight too closely,
and the conviction on the part of the mother or nurse that because a
child is not so large nor gaining so rapidly as some other infant of
the same age, more food or stronger food should be given.
_What harm results from overfeeding?_
All food taken in excess of what a child can digest becomes a burden
to him. The food lies in the stomach or bowels undigested, ferments,
and causes wind and colic. When overfeeding is longer continued,
serious disturbances of digestion are soon produced. The infant is
restless, fretful, constantly uncomfortable, sleeps badly, and stops
gaining and may even lose in weight. Such symptoms may lead to the
mistaken conclusion that too little food is given, and it is
accordingly increased, when it should be diminished. One of the
results of long-continued overfeeding is dilatation or stretching of
the stomach.
_What should guide one as to the quantity of food to be given to any
infant??_
(1) The size of the infant's stomach at the different months; (2) the
amount of milk which the healthy nursing infant gets; (3) the
quantities with which most children do best. The table of quantities
and intervals of feeding, on page 108, gives the average figures
derived from these sources. It is seldom wise to go beyond the limits
there stated; nor should one insist upon giving any fixed amount if it
is clearly more than the child wants or can be made to take except by
continued coaxing.
LOSS OF APPETITE
_What is to be done when without any other signs of illness a child's
appetite gradually fails?_
This is often the result of a long period of overfeeding or the use of
milk too rich in fat. If in all other respects the child seems well
and simply does not want his food, it should be offered at regular
hours, but not more frequently; on no account should he be coaxed,
much less forced, to eat, even though he takes only one half or one
third the usual quantity. The intervals between feedings should not be
shortened but rather lengthened. Often, with a child a year old, it is
necessary to reduce the number of feedings to four or even three in
twenty-four hours. Water, however, may be offered at more frequent
intervals. The food should be weakened rather than strengthened. No
greater mistake can be made than, because so little is taken, coaxing
or forcing food at short intervals through fear lest the child may
lose weight.
THE CHANGES IN THE FOOD REQUIRED BY SPECIAL SYMPTOMS OR CONDITIONS
Infants with weak digestion and those suffering from various forms of
indigestion have often especial trouble in digesting the fat of milk.
To meet the needs of such there is required a series of formulas in
which the fat is lower than in those already given.
These formulas are obtained from plain milk.
_Fourth Series_
_Formulas from Plain Milk (containing 4-per-cent Fat)_
---------------------------------------------------------
I. II. III. IV. V. VI. VII. VIII.
---------------------------------------------------------
Plain milk 5oz. 6oz. 7oz. 8oz. 9oz. 10oz 12oz. 14oz.
Milk sugar 1 " 1 " 1 " 1 " 3/4 " 3/4 " 1/2 " 1/2 "
Lime-water. 1 " 1 " 1 " 1 " 1 " 1 " 1 " 1 "
Boiled water 14 " 13 " 12 " 7 " 6 " 5 " 2 " 0 "
Barley gruel 0 " 0 " 0 " 4 " 4 " 4 " 5 " 5 "
---------------------------------------------------------
20 20 20 20 20 20 20 20
oz. oz. oz. oz. oz. oz. oz. oz.
---------------------------------------------------------
When larger quantities than 20 ounces are required they are calculated
in the same manner as described on page 73 in speaking of 10-per-cent
milk.
The approximate composition of the formulas of the Fourth Series
expressed in percentages is as follows:
----------------------------------------
FORMULA. Fat. Sugar. Proteids.
----------------------------------------
I. 1.00 6.00 0.90
II. 1.20 6.00 1.00
III. 1.40 6.50 1.20
IV. 1.60 6.50 1.40
V. 1.80 6.00 1.60
VI. 2.00 6.00 1.80
VII. 2.40 5.50 2.10
VIII. 2.80 5.50 2.50
----------------------------------------
_Why is it that an infant so often vomits some of its food within a
few moments after finishing its bottle?_
Usually because the quantity is too large. Sometimes it is due to the
fact that the food is taken too rapidly, from too large a hole in the
nipple. It may be due to too tight clothing, or to moving the child
about in such a way as to press upon the stomach.
_What are the principal causes of, and the changes in the food
required by habitual vomiting, regurgitation, or spitting up of small
quantities of food between feedings, often repeated many times a day?_
This is always a symptom of gastric indigestion, and a most
troublesome one. In such conditions the fat and often the sugar also
should be reduced and the lime-water increased.
Formulas made from rich top-milk or milk and cream are to be avoided.
Those made from 7-per-cent milk are less likely to be the cause of
trouble than those from 10-per-cent milk; but if the symptoms are at
all severe it is better to use instead of these the formulas of the
Fourth Series derived from plain milk.
Reduction in the sugar may be made by adding only one half ounce of
milk sugar to each twenty ounces of the food; in severe cases the
sugar may be omitted altogether.
It is often advisable to double the amount of lime-water--i.e., use
two ounces to each twenty ounces of food.
The malted foods and all other foods containing much sugar usually
aggravate the symptoms.
The intervals between meals should generally be half an hour longer,
and sometimes an hour longer, than when digestion is normal.
The quantity given at a feeding should generally be less than with a
normal digestion. Usually a smaller quantity of a strong food succeeds
better than a larger quantity of a weak food.
_What are the causes of, and food changes required by a constant and
excessive formation of gas in the stomach, leading to distention and
pain, or eructations (belching) of gas and often of a sour, watery
fluid?_
This is often associated with habitual vomiting, and is due to similar
causes, but particularly to the sugar, which should be greatly reduced
or omitted entirely.
_What changes should be made when there is habitual colic?_
This is generally due to an accumulation of gas in the intestines
which forms there because the proteids (curd) of the milk are not
digested. They should be reduced by using in the early months a weaker
formula--i.e., instead of Formula V of the First or Second Series, IV
might be used, or, for a short time, even III. The proteids may be
reduced in the middle period by using weaker formulas If we desire to
reduce the proteids without reducing the fat, we may change from the
Second to the First Series.
Another means of relieving habitual colic is the use of partially
peptonized milk (page 115); still another the dilution with
barley-water instead of plain water.
_What change should be made if curds appear in the stools regularly or
frequently?_
This is usually associated with habitual colic, and has to be managed
exactly like that condition, by the means just described.
_How should the milk be modified for chronic constipation?_
The constipation of the first weeks of life has been already referred
to (page 82); it usually disappears as the food is gradually
strengthened in all its proportions.
Habitual constipation at a later period is difficult to overcome by
diet alone. It sometimes depends upon the fact that the proteids are
too high, and sometimes that the fat is too low. Hence it is more
frequent when infants are fed upon plain milk variously diluted (page
90), then when 7-per-cent or 10-per-cent milk is used, and diluted to
a greater degree. But it is not desirable to use a top-milk containing
more than ten per cent fat for this purpose, nor is it wise to carry
the fat in the food above 4 per cent (i.e., 8 ounces of 10-per-cent
milk, or 12 ounces of 7-per-cent milk, in a 20-ounce mixture) or other
disturbances of digestion may be produced.
In some cases the use, in place of milk sugar, of ordinary brown
sugar, in half the quantity, is of assistance; or of some of the
malted foods (Mellin's food, malted milk, cereal milk) also in the
place of milk sugar.
The substitution of the milk of magnesia for the lime-water as
recommended on page 60 will often be found useful.
To infants over nine months old, orange juice may be given.
_What special modifications are required during very hot weather?_
During the warm season it is well to make the proportion of fat less
than during cold weather. During short periods of excessive heat it
should be much less. The fat is reduced by using 7-per-cent milk in
place of 10-per-cent (i.e., the Second instead of the First Series of
formulas, page 71), or plain milk in place of the 7-per-cent milk in
the Second and Third Series (page 90). At such times also the usual
food should be diluted, and water should be given freely between the
feedings.
_What changes should be made in the food of a child who, with all the
signs of good digestion, gains very little or not at all in weight?_
If the child seems hungry the quantity of food may be increased; but
if the child will not readily take any more in quantity the strength
may be increased by the use of the next higher formula. One should,
however, be extremely careful under these circumstances not to coax or
force a child; for this plan is almost certain to cause disturbance of
digestion and actual loss in weight. A better policy is that of
looking after the other factors in the child's life,--the care, sleep,
fresh air, etc., for with these rather than with the food the trouble
often lies.
_What should be done with infants who in spite of all variations in
the milk continue to have symptoms of indigestion and do not thrive?_
Except inmates of institutions who form a class by themselves, most
infants who receive proper care thrive upon milk if the proportions
suited to the digestion are given. Still there are some who do not.
The nutrition of such is always a matter of difficulty.
If a wet-nurse is available the employment of one is the thing most
likely to succeed, particularly if the infant is under four or five
months old.
If the infant is older, or if a wet-nurse cannot be obtained, some of
the substitutes for fresh cow's milk may be tried. One of the best is
condensed milk, Borden's Eagle brand, canned, being preferred. This is
more likely to agree if the symptoms are chiefly intestinal (colic,
flatulence, curds in the stools, constipation or diarrhoea) than if
they are chiefly gastric (vomiting, regurgitation, etc.).
_How should condensed milk be used?_
For an infant three or four months old with symptoms of indigestion,
it should at first be diluted with 16 parts of boiled water, or,
sometimes preferably, with barley-water. With improvement in the
symptoms the dilution may be made 1 to 14, 1 to 12, 1 to 10, and 1 to
8, these changes being gradually made. The intervals between feedings
and the quantities for one feeding are given on page 108.
_How long should condensed milk be continued?_
In most cases it should be used as the sole food for a few weeks only.
Afterward, one feeding a day of a weak formula of modified milk (e.g.,
No. III or IV of the Second Series, page 71) may be given; later two
feedings, and thus gradually the number of milk feedings is increased
until the child is taking only modified milk.
Condensed milk is not to be recommended as a permanent food where good
fresh cow's milk can be obtained.
_What are the objections to its use?_
It is very low in fat and proteids, and high in sugar. This accounts
for its easy digestibility, and also explains why children reared upon
it often gain very rapidly in weight, yet have as a rule but little
resistance. They are very prone to develop rickets and sometimes
scurvy.
_Are the proprietary infant foods open to the same objections as
condensed milk?_
They are. What has been said of condensed milk applies equally well to
most of those that are sold in the market as substitutes for milk.
_What changes in the food are required by slight indisposition?_
For slight general disturbances such as dentition, colds, sore
throats, etc., it is usually sufficient simply to dilute the food. If
this is but for two or three feedings, it is most easily done by
replacing with boiled water an ounce or two of the food removed from
the bottle just before it is given; if for several days, a weaker
formula should be used.
_What changes should be made for a serious acute illness?_
For such attacks as those of pneumonia, bronchitis measles, etc.,
attended with fever, the food should be diluted and the fat reduced as
described on page 95. It should be given at regular intervals, rather
less frequently than in health. Water should be given freely between
the feedings. Food should not be forced in the early days of an acute
illness, since the loss of appetite usually means an inability to
digest much food.
_What immediate changes should be made in the food when the child is
taken with an acute attack of gastric indigestion with repeated
vomiting, fever, pain, etc.?_
All milk should be stopped at once, and only boiled water given for
ten or twelve hours; afterward barley-water or whey may be tried, but
no milk for at least twenty-four hours after the vomiting has ceased.
When beginning with modified milk the quantity should be small and the
fat low, which may be secured by the use of the Fourth Series of
formulas in the place of the First or Second Series. The proportion of
lime-water may be doubled.
_What changes should be made for an attack of intestinal indigestion
attended by looseness of the bowels?_
If this is not severe (only two or three passages daily) the fat
should be lowered in the manner stated just above, and the milk should
be boiled for five minutes. If curds are present in the stools, it may
be still further diluted.
If the diarrhoeal attack is more severe, and attended by fever and
foul-smelling movements of greater frequency, all milk should be
stopped immediately and the diet mentioned just above under the head
of acute disturbances of the stomach should be employed.
_What changes in the food should be made when the child seems to have
very little appetite and yet is not ill?_
The number of feedings should be reduced, the interval being
lengthened by one hour or even more. No greater mistake can be made
than to offer food every hour or two to an infant who is not hungry.
Such a course only prolongs and aggravates the disturbance.
_What other conditions besides the food greatly Influence the child's
digestion?_
Proper clothing, warm feet, regular habits, fresh air, clean bottles,
and food given at the proper temperature are all quite as important as
the preparation of the food; quiet peaceful surroundings and absence
of excitement are also essential to good digestion.
COMMON MISTAKES IN MILK MODIFICATION AND INFANT FEEDING
I. In using modifications made from top-milk, much confusion arises
from the notion that top-milk is a single definite thing, whereas its
composition depends upon a great variety of conditions and, unless all
these are known, it is impossible to tell how strong it is. Directions
for the removal of top-milk should be explicitly followed (see page
63), or the results will be very different from those expected.
II. In formulas calling for a certain number of ounces of top-milk of
any given strength, the mistake is made of removing only the number of
ounces needed for the formula. The proper way is to remove the amount
required to secure a top-milk of the desired strength and then to take
of this the number of ounces needed in the formula.
III. A rich Jersey milk is used as if it were ordinary milk. The
formulas given in this book are chiefly calculated on the basis of a
good average milk which contains about 4 per cent fat. Many persons
have the idea that the richer the milk, the more rapidly the child
will gain in weight, and hence the superiority of such milk for infant
feeding. While it is true that some children taking a very rich milk
may, for a time, gain rapidly in weight, yet sooner or later, serious
disturbances of digestion are nearly always produced.
IV. The food is increased too rapidly, particularly after some
disturbance of digestion. If, in an infant three or four months old,
an attack of somewhat acute indigestion occurs, the food should seldom
be given in full strength before two weeks. The increase in the diet
should be made very gradually, the steps being made only one half
those indicated in the series of formulas on pages 70 and 71.
Otherwise it generally happens that the attack of indigestion is very
much prolonged and much loss in weight occurs.
V. When symptoms of indigestion occur, the food is not reduced rapidly
enough. Indigestion usually means that the organs are, for the time,
unequal to the work imposed. If the food is immediately reduced by one
half, the organs of digestion soon regain their power and the
disturbance is short. In every case the amount of reduction should
depend upon the degree of the disturbance.
PREPARATION OF COW'S MILK AT HOME
_What articles are required for the preparation of cow's milk at
home?_
Feeding-bottles, rubber nipples, an eight-ounce graduated measuring
glass, a glass or agate funnel, bottle brush, cotton, alcohol lamp or,
better, a Bunsen gas burner, a tall quart cup for warming bottles of
milk, a pitcher for mixing the food, a wide-mouth bottle for boric
acid and one for bicarbonate of soda, and a pasteurizer. Later, a
double boiler for cooking cereals will be needed.
_What bottles are to be preferred?_
A cylindrical graduated bottle with a rather wide neck, so as to admit
of easy washing, and one which contains no angles or corners. A single
size holding eight ounces is quite sufficient for use during the first
year. All complicated bottles are bad, being difficult to clean. One
should have as many bottles in use as the child takes meals a day.
_How should bottles be cared for?_
As soon as they are emptied they should be rinsed with cold water and
allowed to stand filled with water to which a little bicarbonate of
soda has been added. Before the milk is put into them they should be
thoroughly washed with a bottle brush and hot soap-suds and then
placed for twenty minutes in boiling water.
_What sort of nipples should be used?_
Only simple straight nipples which slip over the neck of the bottle.
Those with a rubber or glass tube are too complicated and very
difficult to keep clean. Nipples made of black rubber are to be
preferred. The hole in the nipple should not be so large that the milk
will run in a stream, but just large enough for it to drop rapidly
when the bottle with the nipple attached is inverted.
_How should nipples be cared for?_
New nipples should be boiled for five minutes; but it is unnecessary
to repeat this every day as they soon become so soft as to be almost
useless. After using, nipples should be carefully rinsed in cold water
and kept in a covered glass containing a solution of borax or boric
acid. At least once a day they should be turned wrong side out and
thoroughly washed with soap and water.
_What sort of cotton should be used?_
The refined non-absorbent cotton is rather better for stoppering
bottles, but the ordinary absorbent cotton will answer every purpose.
_Which is better, the Bunsen burner or the alcohol lamp?_
If there is gas in the house, the Bunsen burner is greatly to be
preferred, being cheaper, simpler, and much safer than the alcohol
lamp. If the lamp is used, it should stand upon a table covered with a
plate of zinc or tin, or upon a large tin tray. The French pattern of
alcohol lamp is the best.
_Give the directions for preparing the food according to any of the
above formulas._
The nurse's hands, bottles, tables, and all utensils should be
scrupulously clean. First dissolve the milk sugar in boiling water,
filtering if necessary. Then add the milk and cream and lime-water,
mixing the whole in a pitcher. A sufficient quantity of food for
twenty-four hours is always to be prepared at one time. This is then
divided into the number of feedings required for the day, each feeding
being put in a separate bottle, and the bottle stoppered with cotton.
The bottles should then be cooled rapidly by standing, first in tepid
then in cold water, and afterward placed in an ice chest. If the milk
is to be pasteurized or sterilized, this should precede the cooling.
DIRECTIONS FOR FEEDING INFANTS
_How should the bottle be prepared at feeding time?_
It should be taken from the ice chest, and warmed by standing in warm
water which is deep enough to cover the milk in the bottle; it should
then be thoroughly shaken and the nipple adjusted; the nurse should
see that the hole in the nipple is not too large nor too small.
_How may the temperature of the milk be tested?_
Never by putting the nipple in the nurse's mouth. Before adjusting the
nipple, a teaspoonful may be poured from the bottle and tasted, or a
few drops may be poured through the nipple upon the inner surface of
the wrist, where it should feel quite warm but never hot; or a
thermometer may be placed in the water in which the bottle stands. A
dairy thermometer should be used, and the temperature of the water
should be between 98° and 105° F.
_What is a simple contrivance for keeping the milk warm during
feeding?_
A small flannel bag with a draw string may be slipped over the bottle.
_In what position should an infant take its bottle?_
For the first two or three months it is better, except at night, when
it may be undesirable to take the infant from its crib, that it be
held on the nurse's arm during the feeding; later it may lie on its
side in the crib provided the bottle is held by the nurse until it has
been emptied; otherwise a young infant readily falls into the bad
habit of alternately sucking and sleeping, and often will be an hour
or more over its bottle.
_How much time should be allowed for one feeding?_
Never more than twenty minutes. The bottle should then be taken away
and not given until the next feeding time. Under no circumstances
should an infant form the habit of sleeping with the nipple in its
mouth. A sleepy infant should be kept awake by gentle shaking until
the food is taken, or the bottle should be removed altogether.
_Should an infant be played with soon after feeding?_
On no account; such a thing frequently causes vomiting and sometimes
indigestion. After every feeding the infant should be allowed to lie
quietly in its crib, and disturbed as little as possible.
INTERVALS OF FEEDING
_How often should a baby be fed during the first month?_
Every two hours during the day and twice during the night, or ten
feedings during the twenty-four hours.
_At what age may the interval be made two and a half hours?_
Usually at five or six weeks.
_When may it be increased to three hours?_
Usually at two months.
_Why should not a child be fed more frequently?_
It takes the stomach nearly two hours to digest a meal at two months,
and about two and a half hours at five or six months, and if the meals
are too near together the second one is given before the first has
been digested and vomiting and indigestion result. The meals should be
far enough apart to give the stomach a little time for rest just
before each feeding.
_Schedule for Feeding Healthy Infants during the First Year_
-------------------------------------------------------------------
AGE. Interval Night No. of Quantity Quantity
between feedings feedings for one for 24
meals, (10 P.M. in 24 feeding. hours.
by day. to 7 A.M.). hours.
---------------------------------------------------------------------
Hours. Ounces. Ounces.
2d to 7th day 2 2 10 1 -1-1/2 10-15
2d and 3d weeks 2 2 10 1-1/2 - 3 15-30
4th and 5th weeks 2 1 10 2-1/2 - 3-1/2 25-35
6th to 8th week 2-1/2 1 8 3 - 5 24-40
3d to 5th month 3 1 7 4 - 6 28-42
5th to 9th month 3 0 6 5 - 7-1/2 30-45
9th to 12th month 4 0 5 7 - 9 35-45
---------------------------------------------------------------------
This schedule gives the averages for healthy children The smaller
quantities are those required by small children whose digestion is not
very vigorous. The larger quantities are those required by large
children with strong digestion; in very few cases will it be advisable
to go above these figures.
The interval is reckoned from the beginning of one feeding to the
beginning of the next one.
_When should the interval between the feedings be lengthened?_
When there is gastric indigestion as shown by habitual vomiting or the
regurgitation of food long after the bottle is finished; also when the
appetite is very poor so that the infant regularly leaves some of its
food.
_When should the interval between the feedings be shortened?_
This is done much too frequently; it is rarely advisable to feed any
infant, except one seriously ill, oftener than the time put down in
the schedule.
REGULARITY IN FEEDING
_How can a baby be taught to be regular in its habits of eating and
sleeping?_
By always feeding at regular intervals and putting to sleep at exactly
the same time every day and evening.
_When should regular training be begun?_
During the first week of life.
_Should a baby be wakened to be nursed or fed if sleeping quietly?_
Yes, for a few days. This will not be required long, for with regular
feeding an infant soon wakes regularly for its meal, almost upon the
minute.
_Should regularity in feeding be kept up at night as well as during
the day?_
Only up to nine or ten o'clock; after that time a baby should be
allowed to sleep as long as it will.
_At what age may a well baby go without food from 10 P.M. to 6 or 7
A.M.?_
Usually at four months, and always at five or six months. Night
feeding is one of the most frequent causes of wakefulness and
disturbed sleep.
STERILIZED MILK
_What is meant by sterilizing milk?_
Heating milk for the purpose of destroying germs.
_Does all cows milk contain germs?_
Yes; even when handled most carefully, milk contains many germs; but
when carelessly handled, and in summer, the number is enormous. While
most of these are harmless or cause only the souring of milk, others
are occasionally present which may produce serious diseases such as
typhoid fever, diphtheria scarlet fever, cholera, tuberculosis, and
many forms of diarrhoea.
_Under what circumstances is it necessary to sterilize milk?_
1. In warm weather when it cannot be obtained fresh; hence always in
cities and towns during the summer.
2. When one cannot be certain that the cows are healthy, or that the
milk has been carefully handled.
3. When the milk is to be kept for any considerable time (i.e., over
twenty-four hours), especially if no ice can be had.
4. During epidemics of typhoid fever, scarlet fever, diphtheria, or
any form of diarrhoeal disease.
_What are the two methods of heating milk?_
The first is known as _sterilizing_, in which the milk is heated to
212° F. for one hour or one hour and a half; the second is known as
_pasteurizing_, in which the milk is heated to 155° or 170° F. for
thirty minutes. A temperature of 155° F. continued for thirty minutes
is sufficient to kill the germs of the diseases above referred to.
_Will milk which has been thus treated keep indefinitely?_
No; for although all the living germs may be killed, there are many
undeveloped germs, or spores, which are not destroyed, and which soon
grow into living germs. Milk heated to 212° F. for an hour will keep
upon ice for two or three weeks; that heated to 155° F. for two or
three days.
_Is milk which has been sterilized always a safe food?_
No; for the reason that the milk may be so old, so dirty, and so
contaminated before sterilizing that it may be still unfit for food,
though it contains no living germs.
_Is cow's milk rendered more digestible by being heated in this way?_
Sterilizing milk does not improve its digestibility but rather the
contrary. Sterilized milk should be modified for infant feeding in the
same way as milk which has not been heated.
_Is milk in any way injured by heating to 212° F. for an hour?_
There is abundant evidence that milk is rendered less digestible by
such heating; also that it is more constipating, and that for some
children its nutritive properties are interfered with, so that it may
cause scurvy; this, however, is not seen unless it is continued as the
sole food for a long period. These objections are of so much
importance that this plan of heating milk is not to be recommended for
general use.
_When is it advantageous to heat milk to 212° F.?_
For use upon long journeys, such as crossing the ocean. Milk should
then be heated for one hour upon two successive days, without removing
the cotton stoppers from the bottles.
_Is milk in any way injured by heating to 155° F. for thirty minutes?_
This point is not yet definitely settled. Such heating does not affect
the taste of milk and does not render it more constipating. The
unfavourable effects; if there are any, are so slight that they need
not deter one from the use of pasteurized milk, even for long periods.
The preference, however, should always be given to milk which is so
clean and so fresh as not to require any heating.
_How should milk be pasteurized?_
A convenient form of apparatus is that known as Freeman's
pasteurizer[5]; another is the Walker-Gordon pasteurizer.[6]
[5] This can be obtained at 411 West Fifty-ninth Street, New
York, with bottles and full directions; a tin one, at a cost of
$3.50, and a copper one, which is much more durable, for $7.00.
[6] Obtained at the same prices from any of the Walker-Gordon
milk laboratories.
_How should milk be cooled after pasteurizing?_
Always by placing the bottles in cold water, so as to cool them
rapidly; never by letting them stand at the temperature of the room,
or by placing them, when warm, in an ice box.
_Why is this precaution necessary?_
Cooling in the air or in an ice box requires from two to four hours,
and during that time a great many of the undeveloped germs may mature
and greatly injure the keeping properties of the milk. In the cold
water, milk can be cooled in from ten to twenty minutes if the water
is frequently changed, or if ice is added to the water.
MODIFIED MILK OF THE MILK LABORATORIES
_What is "modified milk" of the milk laboratories?_
It is milk containing definite proportions of the fat, sugar,
proteids, etc., put up usually according to the prescription of a
physician, who indicates how much of the different elements he
desires. The most reliable are the laboratories of the Walker-Gordon
Company, which has branches in many of the large cities of the United
States.
This is an excellent method of having milk prepared since it can be
done with greater care and cleanliness than are possible in most
homes. It is besides a great convenience if circumstances make it
impossible to prepare the milk properly at home.
The laboratory should be used for infant feeding only by one who is
somewhat familiar with this method of ordering milk.
PEPTONIZED MILK
_What is peptonized milk?_
Milk in which the proteids (curd) have been partially digested.
_How is this accomplished?_
By the action of a peptonizing powder which is composed of a digestive
agent known as the extractum pancreatis and bicarbonate of soda, which
is added to the plain or diluted milk. This is sold in tubes or in
tablets, and it is the active ingredient of the peptogenic milk
powder.
_Describe the process._
The plain or modified milk is placed in a clean glass jar or bottle,
and the peptonizing powder, which is first rubbed up with a
tablespoonful of the milk, is added and the bottle shaken. The bottle
is then placed in a large pitcher or basin containing water kept at
the temperature of about 110° F., or as warm as the hand can bear
comfortably, and left for ten to twenty minutes if the milk is to be
partially peptonized; for two hours if it is to be completely
peptonized.
_What taste has partially peptonized milk?_
None, if peptonizing is continued for only ten minutes, but at the end
of twenty minutes it begins to be bitter, when the process of
digestion has gone further.
_How is the bitter taste avoided in partially peptonized milk?_
At the end of ten or fifteen minutes the milk may be placed in a
saucepan and quickly raised to boiling point; this kills the ferment,
so that the milk will not become bitter when warmed a second time. Or,
the milk may be rapidly cooled by placing the bottles first in cool
and then in ice water; in this way the ferment is not destroyed, and
the milk may become bitter when warmed for feeding.
_Should the whole day's supply be peptonized at once, or each bottle
separately just before the feeding?_
Either plan may be followed. If the former, it is better to raise the
milk to boiling point after peptonizing; if the latter, it should not
be peptonized more than ten minutes, for it will continue to peptonize
while it is being taken by the child.
_Is not the bitter taste of completely peptonized milk a great
obstacle to its use?_
Not in the case of young infants; one under four or five months old
will usually take it without any objection after two or three
feedings; but it cannot often be used for those who are much older.
_How much of the peptonizing powder should be used?_
There are required for one pint of plain milk, five grains of the
extractum pancreatis and fifteen grains of bicarbonate of soda. This
quantity is usually put up in a single tube or tablet. In the formulas
previously given, less than this will be required; for the weaker
formulas, one half or one third of the powder mentioned will be
sufficient for one pint of food. For a single feeding of four ounces,
one may use one eighth of a tube with a weak formula, or one sixth of
a tube with a stronger formula.
_What are the advantages of peptonized milk?_
Partially peptonized milk is useful for young infants who have great
difficulty in digesting the curd of milk, sometimes even when diluted
as already described; completely peptonized milk, during acute attacks
of indigestion.
_For how long a period may the use of peptonized milk be continued?_
Completely peptonized milk may be used for a few days, or at most a
few weeks; partially peptonized milk may be used for two or three
months, but not indefinitely; it should be left off gradually by
shortening the time of peptonizing, and lessening the amount of the
powder used.
FEEDING DURING THE SECOND YEAR
_How many meals are required during the second year?_
It is usually better to continue five meals throughout the second
year. Some children will sleep from 6 P.M. to 6 A.M. without waking,
but unless there is a feeding at 10 P.M. children are apt to wake very
early in the morning.
_Should each feeding be prepared at the time it is given, or all
feedings at one time, as during the first year?_
During the second and third years it is better to prepare the milk for
the entire day at one time. If it is to be modified by adding cream,
water, etc., it is done as during the first year.
Later, when only plain milk is used, the quantities needed for the
different feedings should be put into one or into two bottles, which
then may be pasteurized or not as may be necessary. In this way the
different feedings are kept separate, and the day's supply of milk is
not disturbed every time the child is fed, as otherwise is
unavoidable. The food should be prepared as soon as possible after the
daily milk supply is delivered in the morning.
_Give a proper diet for an average healthy child of twelve months._
6.30 A.M. Milk, six to seven ounces; diluted with barley or oat
gruel, two to three ounces; after the thirteenth
month, taken from a cup.
9 A.M. Orange juice, one to two ounces.
10 A.M. Milk, two parts; oatmeal or barley gruel, one part;
from ten to twelve ounces in all may be allowed;
it should be given from a cup.
2 P.M. Beef juice, one to two ounces;
or, the white of one egg, slightly cooked; later, the
entire egg;
or, mutton or chicken broth, four to six ounces.
Milk and gruel in proportions above given, four to
six ounces.
6 P.M. Same as at 10 A.M.
10 P.M. Same as at 6.30 A.M., except that the milk may be
given from the bottle.
_How long may this schedule be followed?_
Usually until the fourteenth or fifteenth month. After this time the
cereals may be given much thicker and fed from a spoon.
_May any other fruit juices be given at this period?_
Orange juice is the best; next to this the juice of fresh ripe
peaches, red raspberries or strawberries. All these should be strained
very carefully through muslin to make sure that the child gets none of
the pulp or seeds, either of which may cause serious disturbance. Of
the orange or peach juice, from one to four tablespoonfuls may be
allowed at one time; of the others about half the quantity. The fruit
juice is best given one hour before the second feeding.
_When should a child be weaned from its bottle?_
Most children can and should be taught to take their food from the cup
or spoon by the time they are thirteen months old; but it is
convenient to give the 10 P.M. feeding from the bottle during the
greater part of the second year (see page 52).
_Give a proper diet for an average child from the fourteenth to the
eighteenth month._
The bottle should not be given except at night. Cereals may now form
an important part of the diet. They should be very thoroughly cooked,
usually for three hours, and strained.
The daily schedule should be about as follows:
6.30 A.M. Milk, warmed, eight to ten ounces, given from a cup.
9 A.M. Fruit juice, one to three ounces.
10 A.M. Cereal: one, later two or three, tablespoonfuls of oatmeal
hominy or wheaten grits, cooked for at
least three hours; upon this from one to two
ounces of thin cream, or milk and cream, with
plenty of salt, but without sugar.
Crisp dry toast, one piece;
or, unsweetened zwieback;
or, one Huntley and Palmer breakfast biscuit.
Milk, warmed, six to eight ounces, from a cup.
2 P.M. Beef juice, one to two ounces; and one egg (soft
boiled, poached or coddled); and boiled rice, one
tablespoonful;
or, broth (mutton or chicken), four ounces; one or
two Huntley and Palmer breakfast biscuits, or
zwieback; and (if most of the teeth are present)
rare scraped meat, at first one teaspoonful, gradually
increasing to one tablespoonful.
6 P.M. Cereal: two tablespoonfuls of farina, cream of wheat,
or arrowroot, cooked for at least one half hour,
with milk, plenty of salt, but without sugar.
Milk, warmed, eight to ten ounces, given from a cup.
10 P.M. Milk, warmed, eight to ten ounces, which may be
given from a bottle.
_Give a proper diet for an average child from the eighteenth month to
the end of the second year._
The same order of meals as for the months just preceding should be
followed. For most children milk at 10 P.M. is desirable. There are
many, however who sleep regularly from 6 P.M. until 6 A.M. without
food; for such the night feeding should, of course, not be insisted
upon.
The daily schedule should be about as follows:
6.30 A.M. Milk, warmed, ten to twelve ounces, given from cup.
9 A.M. Fruit juice, two to three ounces.
10 A.M. Cereals: similar to those given from the fourteenth
to the eighteenth month; they need not be
strained although they should be cooked and
served in the same way.
Crisp dry bread, zwieback, or Huntley and Palmer
biscuits, without butter.
Milk, warmed, one cup.
2 P.M. Beef juice and one egg;
or, broth and meat; care being taken that the
meat is always rare and scraped or very finely
divided; beefsteak, mutton chop, or roast beef
may be given.
Very stale bread, or two pieces of zwieback.
Prune pulp or baked apple, one to two tablespoonfuls.
Water; no milk.
6 P.M. Cereal: farina, cream of wheat, or arrowroot, cooked
for at least one half hour, with milk, plenty of
salt, but without sugar.
or, milk toast or stale bread and milk.
10 P.M. If required, ten to twelve ounces of plain milk.
_What fruits may be given at this period?_
If the child has a feeble digestion, only the fruit juices previously
allowed; strong children may have in addition prune pulp, baked apple,
and applesauce. The prune pulp is prepared by stewing the dried prunes
without sugar until they are very soft, and removing all the skin by
putting the fruit through a strainer; of this from one to two
tablespoonfuls may be given at one time. The baked apple should be
given without cream, and the applesauce should have very little sugar.
_How and when should water be given?_
Throughout the second year water should be given freely between the
feedings, especially in warm weather; from one to three ounces may be
given at one time, either from a spoon, a glass, or a bottle. The
water should be boiled daily and then cooled. It should not be allowed
to stand in the room, but fresh water should be put into the bottle
each time.
FEEDING DURING THE THIRD YEAR
_What changes may be made in the diet during the third year?_
The night feeding at 10 P.M. should be omitted. A greater quantity of
solid food may be allowed, particularly at the mid-day meal. It is not
advisable to begin potato and other vegetables until this age is
reached. Three regular meals should be given and milk once besides,
either between the breakfast and dinner or dinner and supper,
whichever is the longer interval. Water should be allowed freely
between meals.
_What would be a proper schedule for an average child during the third
year?_
7.30 A.M. Cereal: cooked (preferably over night) for three
hours, although a somewhat larger variety may
be given than during the second year; given as
before with milk or thin cream, salt, but very
little sugar.
Warm milk, one glass.
A soft egg, poached, boiled or coddled.
Bread, very stale or dry, one slice, with butter.
10 A.M. Warm milk, one cup, with a cracker or piece of very
stale bread and butter.
2 P.M. Soup, four ounces;
or, beef juice, two ounces.
Meat: chop, steak, roast beef or lamb or chicken.
A baked white potato;
or, boiled rice.
Green vegetable: asparagus tips, string beans, peas,
spinach; all to be cooked until very soft, and
mashed, or preferably put through a sieve; at
first, one or two teaspoonfuls.
Dessert: cooked fruit--baked or stewed apple, stewed
prunes.
Water; no milk.
6 P.M. Cereal: farina, cream of wheat, or arrowroot, cooked
for at least one half hour, with plenty of salt,
but without sugar;
or, milk toast;
or, bread and milk;
or, stale or dry bread and butter and a glass of milk.