ARTIFICIAL FEEDING
WHEN ARTIFICIAL FEEDING IS NECESSARY—WEIGHT THE TEST OF PROPER
NOURISHMENT—COW’S MILK, CAREFULLY MODIFIED, IS THE BEST SUBSTITUTE FOR
MOTHER’S MILK—SOURCE OF SUPPLY AND CARE—CARE OF THE BOTTLES AND NIPPLES
Successful artificial feeding of infants is one of the big problems
which the medical profession strives unceasingly to solve. It has
never found a perfect substitute for mother’s milk, but it has greatly
reduced the rate of infant mortality, due to artificial feeding, by
working out formulas that combine the food properties provided by
breast milk. And not the least valuable result of its investigations
has been the agitation for pure milk supply, the sanitary care of milk
and dairies.
Any mother who has followed the reports of pure milk commissions, and
heard the talks and lectures given by specialists in infant feeding,
must realize the tremendous chance she takes in weaning her baby.
Therefore, she will not take the step unless convinced that her milk
positively disagrees with her child.
The most important test is the child’s development or lack of
development, gain or loss in weight. This cannot be determined during
the first week, for the average normal child loses from four to eight
ounces during the first six or seven days of its life. Thereafter it
should gain at the rate of from four to eight ounces a week, until it
is six months old. After that the gain per week runs from two to four
ounces, until the child is a year old, when the first danger-period of
feeding is past.
During this time—and, in fact, throughout its childhood—an accurate
record of its weight and measurements should be kept by the mother.
For this purpose, the well-equipped nursery should contain a good pair
of scales and a measuring board. The scales should record at least
forty pounds. They are of the platform, not the spring, variety, with a
basket for holding the baby while it is small and helpless. Later, when
the child is able to sit up, the basket is replaced by a pad.
The measuring board used at the Better Babies Contests is a great
convenience and can be made by any carpenter. It consists of a smoothly
planed board forty inches long and eleven inches wide, with a firm,
upright headpiece, and a sliding footboard which runs on grooves on
the outer edges of the board. On one of these edges is tacked a steel
tape, in the inch-scale. The baby, up to eighteen months of age, is
laid on the board with the back of the body touching the board all
along, from head to foot. The nurse makes sure that the little head is
placed firmly against the headpiece. Then, while the mother or some
other assistant holds the baby’s knees firmly in place, the nurse
adjusts the sliding board until it touches the flat soles of the baby’s
feet. The child is then lifted up, without moving the footboard, and
the measurement is read from the tape where the footboard stops.
After the child is eighteen months old it is measured standing. For
this purpose the board is reversed. The firm headpiece is placed on the
floor for the child to stand on, and the sliding footboard is brought
down to touch the top of the child’s head.
After its third year, the child may be measured according to good old
nursery tradition, by a pencil mark against the woodwork.
Measuring a baby with a tape-line is not accurate. While the height is
not so important a factor as the weight in determining the development
and especially the nutrition of the baby, it should be watched; and
this measuring board, which represents an investment of only a dollar
or so, will be found very useful.
The baby that is thriving on mother’s milk should show a gain of at
least two pounds at the end of thirty days. The baby which weighed
seven pounds at birth should weigh nine pounds when one month old; ten
and one-half pounds at two months; twelve pounds at three months. When
the gain is less than these figures, the baby’s diet needs attention.
The following symptoms point to the fact that the mother’s milk does
not agree with the child:
(1) Excessive vomiting, with loss of weight or no increase of weight
for two weeks or more.
(2) A persistent diarrhea, with loss of weight or no increase of
weight for two weeks or more. If there is a progressive gain in
weight, however, loose bowels are not a danger signal.
(3) Steady loss of weight extending over a period of three weeks or
more, in spite of the fact that otherwise the child seems normal.
Sometimes the trouble can be corrected by a change in the mother’s
diet; and this must be discussed with the family physician. Sometimes
the mother is too much exhausted by household duties to provide the
amount and quality of milk needed to nourish the child. If it is
possible to lighten the mother’s burdens, and thereby strengthen the
breast milk, this is better economy than investing in bottles and
artificial food.
If, in spite of the doctor’s efforts to build up the mother’s strength
and improve the quality of the breast milk, the baby does not thrive,
then mother and doctor together must work out the problem of artificial
feeding.
The scientific and successful raising of a baby on the bottle depends
upon two distinct lines of care and caution: the selection of the food
to be supplied, and the care of the bottles. The best of food in an
unsanitary bottle or drawn through an unclean nipple becomes dangerous
to baby’s health.
In choosing artificial food for your baby, remember that even
physicians differ on this question. Most American specialists for
children insist that fresh cow’s milk, properly modified, is the only
substitute for mother’s milk. European authorities recommend goat’s
milk. And there are other recognized authorities on baby-health who
have found it advisable to prescribe for delicate bottle-fed babies a
combination of milk and patent food. Not only must the mother consult
her family physician on this question, but, with the physician, she
must watch the effect of the chosen food on the baby.
Vomiting, restlessness, sleeplessness, and the condition of the bowels,
all tell the tale of food that is not being assimilated.
In this connection the inexperienced mother must understand that
there are two forms of vomiting in the young baby; or, more
properly speaking, there is a difference between vomiting and
regurgitation—slight, to be sure, but worth watching. Regurgitation
is merely the overflow of milk when the baby has taken too much. It
follows almost immediately upon having the breast or bottle taken away,
and the milk is in practically the same condition as when it entered
the stomach. But when the baby vomits habitually after feeding, and the
milk is curdled or tough or sour, there is something wrong with the
bottle diet.
The bowels are a sure indication of the way in which the bottle diet
agrees or disagrees with the baby. When the passage is hard and
bullet-like, when it shows curds or white lumps like cheese, or when
mucus is present or there is diarrhea, the mother may be sure that the
food does not agree with her baby, and the doctor should be consulted
immediately.
No medicine should be given in such cases without consulting a doctor.
What the baby needs is not dosing, but the right sort of food, the food
its stomach will digest.
At one contest in the midwest the mother of a little prize winner
told me that, at eleven months, she almost lost her baby. She had
changed diet time and time again, varying from certified cow’s milk
to a well-known patent food. The baby was reduced to a skeleton when
the physician decided to try not milk, but cream, diluted with barley
water. The change in baby’s condition was immediate, and it continued
to thrive without further change of diet. On the other hand, some
babies fed on this modified cream would not thrive.
Frankly, feeding a baby deprived of breast milk often resolves itself
into an experiment; but an experiment which must be conducted in an
intelligent manner, with the advice of a physician. Do not consult your
neighbor, no matter how many babies she has raised successfully. The
bottle food which was nourishment to her babies may be poison to yours.
There are no hard and fast rules for bottle foods. Each baby is a case
unto itself and requires the most delicate attention and unrelenting
vigilance. Even two babies in one family may require different forms of
artificial nourishment, or at least different modifications of cow’s
milk.
Perhaps there is no phrase familiar to the maternal ear which is so
generally misunderstood and abused as “modified milk.” It is confused
with sterilized, pasteurized, and condensed milk, and with patent
foods. In reality the phrase means any milk, other than mother’s milk,
so modified by the addition of elements like water and sugar as to
bring it as near as possible to the quality of breast milk.
The substitute for mother’s milk most generally approved by American
pediatrists or specialists in the care of children is cow’s milk,
carefully modified.
The safety of the child that is to be fed on modified cow’s milk
depends largely upon the source of milk supply. The mother should
acquaint herself with this source of supply and the conditions under
which the cows are housed and milked. If you had to hire a wet nurse,
you would not choose a tubercular or personally unclean woman. Why
permit your baby to drink milk that comes from a tubercular cow, or one
which is milked in a filthy stable?
If you live in a city, write to your department of health or your
health officer for information regarding properly inspected dairies.
If no such information can be furnished you, then it is high time that
you started a campaign for dairy inspection in your town. If you live
in the country, find a dairyman or a neighbor whose cows will stand
the test and whose stables are clean. Do not buy baby’s milk at a
grocery-store or dairy whose source of supply you cannot trace.
Cow’s milk which comes from a herd of healthy cows, or at least several
cows, is preferred to that which comes from a single animal, as it
varies less in quality and elemental proportions. It is not necessary
to order rich milk from highly bred Jersey and Alderney cows. In fact,
physicians agree that the milk produced by ordinary grade cows in the
herd is better suited to the needs of the child. You should be quite
sure, however, as to the age of the milk. In cold weather it must not
be fed to the child after it is forty-eight hours old. In summer it
should never be more than twenty-four hours old.
In nearly all large cities are now found agencies of dairies which
specialize on milk for infants. This is sometimes known as certified
or guaranteed milk. The cows from which it is drawn are carefully
inspected, the stables and milkers are clean, all the utensils,
pails, cans, etc., are sterilized before use, and the milk is cooled
immediately after it is drawn from the cows and kept at or near a
temperature of 50° F. until delivered to the purchaser. Milk produced
in this way saves the mother anxiety and trouble. It costs only a few
cents more a quart than milk which is not certified.
When certified milk is received in the home, the stoppered bottles
should be placed immediately in the refrigerator or set in a pail
of ice-water to remain until it is modified for use during the next
twenty-four hours.
The city mother, with her stationary refrigerator and convenient
ice supply, has no possible excuse for not keeping the baby’s milk
in perfect condition. Some of the new refrigerators have separate
compartments. One of these should be used for the baby’s milk. In many
well regulated homes you will find special nursery refrigerators which
can be bought at any department or house-furnishing store. These have
their own supply of ice and nothing but the baby’s milk is stored in
them.
The small town or country mother, whose ice supply is irregular and who
depends upon an old-fashioned ice-chest or perhaps a spring or cool
well for chilling the baby’s milk, faces a more difficult problem.
It is especially important that she keep the milk bottle tightly
stoppered. If she uses the old-fashioned ice-chest, where food and
ice are not separated and where germs lodge easily, she had best pack
the stoppered bottles in a covered pail and set them next to the ice.
If she has no refrigerator at all, she should induce her men-folk to
provide a substitute, if it is only one strong wooden pail set within
another, the sawdust and ice packed between. Then she can thrust her
stoppered bottles into the inner pail, cover all with heavy felting or
burlap, and feel tolerably safe.
At one of the contests a mother told me how sad experience had taught
her the importance of having such a safeguard in her home. With her
first baby she kept the milk in a tin pail, hung in the cool water of
an old well. The milk absorbed germs and the doctor traced the baby’s
death from acute bowel trouble to these germs.
Next in importance to the supply and storing of milk comes the care of
the utensils for modifying it and feeding it to the child. These should
be kept in a sanitary condition that is absolutely above suspicion. If
the mother herself does not take charge of this task, she must delegate
another member of the family or a servant upon whose faithfulness she
can depend. The supply of milk for the ensuing day should be cared for
at a certain hour each morning, soon after the milk is delivered. The
utensils should be used for this purpose alone, and should not be kept
in a cupboard with ordinary cooking equipment.
For the ordinary modifying of milk the following utensils are needed:
A strong measuring glass, holding sixteen ounces, divided into ounces,
which can be bought at any hospital supply house and in many department
and drug stores; a two-quart pitcher with a wide neck; a glass funnel,
which fits easily into the neck of the nursing bottle; an enameled
tablespoon; an enameled saucepan for boiling the water or gruel; a
quart glass jar, with an air-tight cover, in which the boiled water or
gruel is set away until it is cool; a wire rack, which will hold eight
or ten nursing bottles; eight or ten plain, round, cylindrical bottles
with a narrow neck; a half dozen plain nipples of a size to fit around
the neck of the bottles; a long-handled brush for washing the bottles;
soap, washing-powder and borax for cleaning purposes.
The shape of the bottles is extremely important, for a round bottle
offers no corners in which germs can lodge; square bottles have this
disadvantage. The number of the bottles is governed by the number
of feedings in twenty-four hours, one for each feeding. The wire
bottle-rack protects the bottles from breakage and is an economical
investment. The nipple changes in size with the age of the baby; for
the small baby care should be taken that the nipple is not long enough
to choke the baby and make it vomit.
The size of the hole in the nipple also is important. If it is too
small the baby has to work too hard for its nourishment. If the hole
is too large the baby will gulp the feeding, which may cause colic,
indigestion, or vomiting. Test the nipples by holding the filled bottle
in a horizontal position and watch how the milk drops from the nipple:
the drops should be an inch or more apart.
New bottles and nipples should be put into a cheese-cloth bag and then
into boiling water to be sterilized before using. After the baby has
been fed, the bottle should be washed out with the long-handled brush
with soap or washing-powder. When the soap has been rinsed out with
hot water, a teaspoonful of borax and a little warm water are turned
into the bottle and shaken vigorously. When the borax is dissolved,
the bottle is filled to the brim with water and permitted to stand in
this way until needed the following morning. When the borax solution
has been thrown away, and the bottles rinsed with clear water, they
are ready for use. It is not necessary to boil bottles cared for in
this way; and borax will be found a more satisfactory antiseptic than
the bicarbonate of soda which the average mother uses in cleansing her
bottles.
The nipples must be cleansed with equal care. After the feeding, a
pinch of borax should be dropped into the nipple, then a little water
added and the nipple gently rubbed between the thumb and fingers. It is
then rinsed out and laid on a clean saucer, with a clean glass turned
over it, to protect it from dust.
It is a time saver to prepare the boiled water or gruel several hours
before it is to be used for modifying the milk—even the night before.
It can then be placed in the quart jar, tightly covered, and set in the
ice-chest.
Now comes the important hour for mixing the food. The bottles are
emptied of the borax water and turned upside-down in the wire rack to
drain. Next they are filled with hot water for rinsing out the borax,
emptied and again turned upside-down in the rack to drain. By the time
the food is mixed the bottles are cool enough to fill.
In mixing the food the process is the same whatever the proportion.
The bottle of milk is turned into the pitcher so that the cream will
be mixed in well. It is then poured into the glass measure and, when
the right amount has been secured, it is poured back into the emptied
pitcher. Next is measured the boiled water or gruel, and this is then
turned into the pitcher. The sugar must be measured very carefully
with a tablespoon. If a level spoonful is ordered, it must be leveled
off carefully with a knife. A heaping spoonful means all that the
spoon will hold. Stir the mixture together—milk, gruel or water, and
sugar—until the last is dissolved. Now, using the funnel to avoid
waste, pour into each bottle the exact amount of this modified milk
which has been prescribed for a single feeding. Cork the bottles with
rolls of clean absorbent cotton, set the bottles in the wire rack, and
place it in the ice-chest.
As the hour for each feeding approaches, one of these bottles is taken
from the ice-chest, placed in a pan of hot water, or in any patent
bottle heater, to be warmed for the baby’s use.
It will be seen that by following this process the milk is never
touched by any hand, and if the utensils are kept immaculately clean,
there can be no danger from germs or contagion. And right here a word
of caution: After keeping the nipple in borax water, do not test the
heat of the milk by tasting it through the nipple. Never put the baby’s
nipple in your own mouth or allow any one else to do so. The food
should be what is known as body temperature, and it can be tested by
letting a little drop upon the bare forearm. Remember that a baby’s
mouth is very tender and easily burned. Never give the baby the bottle
without testing the temperature of the food.
It should take about twenty minutes for the baby to drink the
prescribed amount of either breast milk or artificial food. In cold
weather it is a good idea to cover the bottle with a little flannel or
crocheted bag, to keep it warm until the last drop is drained. Food
which becomes chilled may cause colic.