Can cows' milk be fed to infants without being modified? No; because,
although the elements are similar to those in mothers' milk, they are not
identical, and are present in different proportions.
Is this a matter of great moment? Yes, for very few infants can digest
cows' milk unmodified.
What does modifying cows' milk mean? It is changing cows' milk so as to
make it more nearly like mothers' milk.
What is this changed milk called? Modified milk; and the original milk is
known as "plain milk," "whole milk," "straight milk" or "milk."
State the principal differences between cows' milk and mothers' milk?
Cows' milk contains a little more than half as much sugar. It contains
nearly three times as much proteids (curds) and salts, and the proteids
are different and much harder to digest. The reaction is decidedly acid,
while the mother's milk is faintly acid or neutral.
Any other things of importance to consider? Yes; mothers' milk is always
fed fresh and sterile, while cows' milk is always more or less
contaminated by dust or germs which increase rapidly with the age of the
milk in proportion to the amount of dirt in it and with any increase of
temperature at which the milk is kept. So pasteurization and sterilization
are done to destroy the effect of germs.
How can the acidity of cows' milk be overcome? By adding lime-water or
bicarbonate of soda.
How much lime-water should be used? About one ounce to twenty ounces of
food.
How much bicarbonate of soda? About twenty grains to twenty ounces of food.
Suppose there is a tendency to constipation in the infant? You can then
use Phillip's milk of magnesia, or some other good preparation, adding
one-half to one teaspoonful to each twenty ounces of food.
How can the sugar be increased? By adding milk or granulated sugar to the
cows' milk.
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How much milk sugar is added to twenty ounces of food? About one ounce
will do for the first three or four months. This makes it between six and
seven per cent sugar.
How should you prepare the sugar? Dissolve it in boiled water and strain
if there is a deposit after standing, by pouring it through a layer of
absorbent cotton one-half inch thick placed in an ordinary funnel.
Is not granulated (cane) sugar recommended also? Yes; but all infants
cannot use it. It is cheaper, but a good article of milk sugar should be
bought. It costs from twenty to sixty cents per pound. The cheap variety
contains many impurities.
But if cane sugar is used, how much is needed? Usually about one-half or a
little over one-half as much as milk sugar, or about one half ounce to
twenty ounces of food.
What occurs if too much is used? The sugar is likely to ferment in baby's
stomach and cause colic. The milk is made too sweet.
If you continue to overfeed granulated sugar, what happens? Gas, colic,
restlessness, uneasiness, lining of the bowels becomes reddened and
irritated; the redness shows externally around the rectum, and in severe
cases around the hips.
Unless the amount of sugar is now reduced, what occurs? There follow
frequently watery, splashy stools with much gas and foul odors.
Is cane or granulated sugar safe to use after six months? It does not
usually produce so much trouble later on.
Suppose milk sugar produces irritation? The quantity used should be
reduced to one ounce to twenty-five ounces of food or even less for a
short time.
As a rule should milk sugar be preferred the first six months? Yes.
What are the best grades of milk sugar? Merck's, Mallinkrotz's, or
Squibb's.
Is sugar added to sweeten and make the milk palatable? No; although it
does that, its use is to furnish one of the needed elements for the growth
of the baby, and it is required by young infants in the largest quantity.
How do we know that this is true? Because in good mothers' milk the amount
of sugar is greater than that of the fat, proteids, and salts combined.
As cows' milk has nearly three times as much proteids (curds) and salts as
mothers' milk, how can these be diminished? By diluting the cows' milk.
How much should cow's milk be diluted for a very young infant? Diluted
twice will give almost the same proportion of proteids present as in
mothers' milk, but as the proteids of cows' milk are so much harder for
the infant to digest, the milk should, in the beginning, be diluted five
or six times for most infants.
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Does the diluted cows' milk with lime-water and sugar added resemble
mothers' milk? No; for this mixture does not contain enough fat.
How can this be remedied? By increasing the fat in the milk before it is
diluted.
How is this done? By adding top milk or milk and cream.
What is the top-milk? It is the upper layer of milk, one-third or one-half
of milk removed after it has stood a certain number of hours,--six to
eight hours.
How is the strength of the top-milk measured? By the fat it contains. A
ten per cent milk contains a ten per cent of fat; a seven per cent milk
contains a seven per cent of fat.
Are these strengths used for infant feeding? Yes, they are most used.
What increases the percentage of fat in the top-milk? 1. The longer time
it stands. 2. Manner of its removal. 3. Number of ounces removed. 4.
Thickness of the milk used.
When is top-milk removed? If milk is fresh from the cow or before the
cream has risen, is bottled and rapidly cooled, it may be removed in four
hours. It does not make much difference in bottled milk, and it may stand
much longer.
How should top-milk be removed? Skim carefully off with a spoon, or cream-
dipper (specially prepared) holding one ounce. It may be taken off with a
glass or rubber syphon, never pour it off.
How can ten per cent top-milk be obtained from the different kinds of
cow's milk? From rather poor milk (three to three and one half per cent
fat) remove the upper eight ounces from a quart.
How can it be obtained from good average milk (four per cent fat?) Remove
the upper eleven ounces or one-third.
From rich Jersey milk (five and five one-half per cent fat)? By removing
sixteen ounces or upper one-half from the quart.
How is seven per cent top-milk obtained? 1. By removing the upper eleven
ounces or one-third of a quart from poor milk. 2. By removing the upper
half from average milk. 3. By removing two-thirds or about twenty-two
ounces from rich Jersey milk. As stated before the seven per cent and ten
per cent are the two kinds generally used.
If top-milk is treated in this way, is it like the human milk? The
proportion of the fluids and solids are about the same, but the elements
are different. The curd (albuminous element) is still different in
structure and action from the same element in human milk. The curd of
human milk when it is met by the gastric juice in the stomach coagulates
in minute particles, and the pepsin acts upon this very readily, but the
curd of cows' milk being much coarser and firmer coagulates under these
conditions, into large hard clots or masses, and these are quite
indigestible if the child's stomach is sour from an under amount of acid
being present.
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How can we prevent this? By adding some bland and nonirritating substance
to the milk which will mingle with the particles of curd and separate them
until the gastric juice can act upon each separate particle and digest it.
What can we use for this purpose? Barley or oatmeal water or gruel is
best.
What is cream? It is the part of the milk containing the most fat.
How is cream now obtained? By skimming after it has stood for twenty-four
hours, "gravity cream"; by a separator, and it is then known as
"centrifugal cream"; (most of the cream now sold in cities is "centrifugal
cream").
How much fat has the usual "gravity cream?" Sixteen to twenty per cent.
How much fat is contained in cream removed from the upper one fifth of a
bottle of milk? About sixteen per cent.
How much does the usual centrifugal cream contain? Eighteen to twenty per
cent fat.
How much does the heavy centrifugal cream contain? Thirty-five to forty
per cent fat.
Should the milk be boiled for babies in the summer time? No, not usually.