FORMULAS FOR ARTIFICIAL FOODS
FORMULAS FOR MODIFYING MILK—MILK SUGAR, CANE SUGAR, OR MALT SUGAR—HOW
TO TELL WHEN THE BABY IS PROPERLY NOURISHED—LIME WATER IN THE
MILK—CONDENSED MILK—PATENT FOODS
Formulas for the preparation of artificial food for infants will some
day form a vital feature in the practical education of girls for
motherhood. Chemistry, physiology and dietetics, all subjects which are
taught to young women in high schools and colleges, will contribute to
a better understanding of this very important subject.
The mother who is able to nurse her child has no conception of the
difficulties which confront her sister or neighbor who must raise a
baby on the bottle. She should be profoundly grateful that she is
spared the study and working out of food formulas by the gracious
dispensation of Providence which supplies her child with the natural
form of nourishment. Certainly no woman who reads the chapters of this
book, devoted to the sanitary and scientific care required to carry a
baby through the period of bottle feeding, will wean her baby unless
such a step is absolutely necessary.
The mother whose family physician has specialized in diseases of
children and infant feeding has half the battle fought for her. The
physician who has made a study of artificial feeding knows exactly the
proportions necessary for producing a nourishing modified milk, and the
quantity to be given at each feeding. But there still remain all over
the country a large number of busy and successful general practitioners
who have given little or no study to formulas for infant feeding, a
condition fortunately due to the fact that the majority of the mothers
whom they attend nurse their babies.
Again many mothers are so situated, geographically and economically,
that they cannot place the baby to be artificially fed under the
constant supervision of a physician. It is for such mothers that this
chapter has been written, and the material which it contains represents
the best ideas of men who have long specialized on the feeding of
infants.
These physicians have decided that the simple formula which includes
plain cow’s milk, with the cream stirred in, water and sugar, is the
best substitute for mother’s milk until the baby has passed its sixth
or seventh month. Then barley or oatmeal gruel may be used instead of
the water. Cream, top milk, whey, lime water and patent foods should
not be used except with the approval of a physician. The mother who
finds herself forced to work out alone the problem of artificial
feeding, should give the simple formula a thorough trial before trying
more elaborate experiments, and, above all things, before taking the
advice of her neighbors.
Mother’s milk is composed of thirteen parts solids and eighty-seven
parts water. The solids are fat, sugar, proteids and salts. The fat
is represented by cream; the sugar by lactose or milk sugar; the
proteids by the milk-curd. The fat encourages bone growth and fat in
the baby’s body; it produces heat and is good for the nerves. The sugar
also produces fat and heat and has a laxative effect on the bowels.
The proteids go to make body cells in the blood, the muscles and the
various organs. The salts are needed for bone-making. The water serves
two purposes: it keeps the solids in solution so that the food can be
easily digested; it forms the medium through which the body throws off
its waste material.
Formulas for artificial food should follow the proportions found in
mother’s milk by expert analysis. Plain cow’s milk unmodified is too
rich in solids to be given to an infant. On the other hand, the nursing
baby, or the baby fed on properly modified milk, does not require much
plain water, as it receives an ample supply of water in its feedings
to quench thirst and keep the body in good condition.
For the baby which is to be artificially fed at one month or less,
plain cow’s milk, boiled water, and malt sugar form the best possible
combination.
Milk sugar, once very popular with dietitians, has been condemned by
specialists in infant feeding. Cane sugar is preferred to milk sugar,
and pediatrists recommend most highly the Dextri-Maltose, or malt
sugar, manufactured by Mead, Johnson & Company, Jersey City, New Jersey.
Having decided on these ingredients, the next problem is their proper
combination in correct proportions. These are governed by the baby’s
weight. In twenty-four hours a baby should be fed twice as much plain
cow’s milk in ounces as he weighs in pounds; this means that a baby
weighing twelve pounds should be fed twenty-four ounces of plain cow’s
milk in twenty-four hours.
In preparing this quantity of cow’s milk for the baby’s consumption,
it must be borne in mind that this milk contains only half as much
sugar as mother’s milk, while it holds three times as much proteids
and salts, and both the proteids and the fat are less digestible than
those found in breast milk. This explains why water must be used to
dilute the heavier cow’s milk. For the new-born baby the following
proportions are recommended when what is known as plain milk is to be
used:
Four ounces of milk.
One ounce, or two rounded tablespoonfuls, of Dextri-Maltose.
Sixteen ounces of boiled water.
In two or three days this formula may be changed to:
Five ounces of milk.
One ounce, or two rounded tablespoonfuls, of Dextri-Maltose.
Fifteen ounces of boiled water.
If the baby is digesting this food without trouble, about the tenth
day, increase the milk by one ounce and decrease the water by one ounce.
A normal child, with whom modified milk agrees, is able at the end of a
month to digest its food in the following proportions:
Eight ounces of plain milk.
One ounce, or two tablespoonfuls, of Dextri-Maltose.
Twelve ounces of boiled water.
At seven months the baby is ready to have gruel combined with the water
and the milk in the following proportions:
Nine ounces of plain milk.
One and one-half ounces (3 tablespoonfuls) Dextri-Maltose.
Five ounces of water.
Six ounces of gruel—made as follows:
Two tablespoonfuls of prepared barley, wheat, or oat flour; smooth
with cold water; have ready one pint of water boiling hard; add a
pinch of salt; stir in the smoothed flour; cook for thirty minutes in
a double-boiler, and strain through a hair sieve. Add enough boiling
water to make a pint, and set it away to cool.
At ten months the child is taking modified milk in these proportions:
Thirteen ounces of plain milk.
One heaping tablespoonful of Dextri-Maltose.
Six ounces of thin gruel; no water.
Milk thus modified can be given to the child until it is one year old.
Between the first and the seventh month the increase in the amount of
cow’s milk and the decrease in the amount of boiled water will depend
entirely upon the condition of the child’s digestion. After the first
month the increase in cow’s milk should be made quite gradually, and
several days should be permitted to elapse after each change, to watch
the effect upon the digestion.
The child himself furnishes a pretty fair indication of when the
strength of the food should be increased. If he drains the bottle
rapidly and cries when it is taken from him, or if he begins to fret
anywhere from an hour to half an hour before his feeding time, and if
he constantly sucks his fingers in hungry fashion, either the quantity
of the food or its strength must be increased.
If the food is already too rich for the child, this is shown by
indigestion, vomiting, diarrhea, or constipation. The increase in the
strength of the formulas should be at the rate of half an ounce or
less in three days or more for about a month after artificial feeding
begins; then a greater amount of time should be permitted to elapse.
The increase in quantity should be at the rate of a quarter of an ounce
at each feeding, made at intervals of four to seven days, according to
the growth and appetite of the child. It will be noticed that there
is a more rapid increase during the first month of the child’s life
than at any other time. This is because exquisite care must be taken
to start the child on the most delicate form of artificial food. Then,
if modified milk does agree with the infant, it thrives and demands
artificial food of increasing strength, precisely as the mother’s
milk gains in strength as she gains in health and energy after her
confinement.
It will be recalled that mother’s milk up to the fourth or fifth day
is practically sweetened water on which the baby thrives. The child’s
digestion is not injured when the flow of mother’s milk is suddenly
established and becomes rich. In planning the diet for a bottle-fed
baby, those who have given the matter study follow as closely as
possible the rules laid down by nature in supplying breast milk.
These are the simplest and most reliable of formulas with plain milk as
the foundation.
The use of cream and top milk in the place of plain milk seems to be
purely a matter of difference of opinion between medical authorities.
If the top milk is used, the quantity of boiled water used in modifying
it must be greater, and gruels are added at a much later date.
A question frequently brought up at contests was that of adding lime
water to modified milk. This, too, represents a difference in medical
opinion. Dr. L. Emmett Holt, one of the first American specialists in
the care and feeding of children, advises that one ounce of lime water
be included in every twenty ounces of modified milk, to correct acidity
in cow’s milk. Dr. Roger H. Dennett, Professor of Pediatrics at the
Post Graduate Hospital, New York City, does not consider lime water
essential to a successful formula. Other authorities differ in the
same way. The mother who feels any anxiety on this score will do well
to consult her own physician, who can study at first hand the general
condition of the baby, its appearance, the stools it passes, and what
it may vomit if the artificial food is not properly digested.
There are almost as many feeding tables in existence as there are
specialists in the care of children. This is another question where
hard and fast rules cannot be laid down. But here are some general
tables which have borne the test in families where artificial feeding
is a stern necessity:
Any baby weaned under three months of age should have bottle feedings
as it would have had breast feedings, at intervals of every two hours
between 6 A.M. and 10 P.M. It should also have one feeding in the
night between one and two o’clock. This represents ten feedings in
twenty-four hours, up to the time the child is three months old.
The quantity to be supplied at each feeding varies with the baby’s age:
During the first week the baby should be given one and one-half ounces
at each feeding. This, with ten feedings in twenty-four hours, means
from ten to fifteen ounces of nourishment a day.
During the second week the amount at each feeding is raised to: 2
ounces, or 20 ounces in twenty-four hours.
Third and fourth weeks: 2½ ounces for each feeding.
Second and third month: 3 ounces for each feeding.
During the fourth month the table of feeding changes. The child is
now fed every two and one-half hours from 6 A.M. to 9 P.M., with one
feeding between 1 and 2 A.M. Four and one-half ounces at each feeding,
or 36 ounces in twenty-four hours.
During the fifth month the feedings are still farther apart; every
three hours between 6 A.M. and 9 P.M., and one feeding in the night.
Five and one-half to 6 ounces at each feeding.
So, from month to month, the feedings are a little farther apart and
each feeding a little heavier.
At five months, if the baby is strong, the night feeding may be
omitted. At eight months the baby is fed six times a day, at three-hour
intervals, eight ounces of food to the feeding.
It must be understood that the feeding tables here given are planned
for a normal, healthy baby. The sickly baby, or the child whose
digestion is very poor and whose appearance denotes malnutrition,
should be placed under the care of a physician who is capable of
planning special diet.
Only in case of emergency is the baby weaned within a day or so after
birth. As a rule, the mother attempts to nurse the child, and weans
him only when she realizes beyond all question that her milk is not
sufficiently nourishing. In such cases it is not necessary to wean the
child abruptly; the feedings can be alternated, breast and bottle.
In this way certain properties in the mother’s milk correct possible
ill-effects on the digestion from bottle feedings. Moreover, the mother
sometimes gains in strength, the milk improves and the bottle is then
given at rarer intervals. When it becomes necessary to wean the child
completely from the breast, because of its age, or pregnancy in the
mother, half the battle has been fought in accustoming the child and
its digestive apparatus to the bottle food.
A question frequently asked by mothers is this:
“What is the difference between pasteurized milk and boiled milk, and
which is better for the child?”
Pasteurizing milk consists of heating it to a temperature varying from
155° to 175° F. in apparatus specially made for this purpose, which
can be bought at prices varying from four to eight dollars through
dealers in surgical instruments. Directions come with the apparatus.
To pasteurize milk without an apparatus, fill the bottles with milk,
cork them with sterile cotton wool, set in a pail, fill the pail with
boiling water, cover it tightly and set aside for forty-five minutes;
then cool the bottles rapidly and place them on the ice.
Boiling milk—or sterilization, as it is known to medical men—means
keeping the milk at a boiling point for at least one hour in a
double-boiler. The utensil containing the milk is then set in ice-water
so that it will chill in twenty minutes or less. The milk is next
poured into clean bottles, corked with sterile cotton wool, and placed
on ice.
The milk to be fed to babies should be pasteurized or boiled when
there is doubt as to the source of milk supply; also when there is
an epidemic current, such as typhoid fever, diphtheria, etc. Both
processes are supposed to kill bacteria, boiling being more effective
than pasteurization.
It is far better for the baby’s health, however, to secure certified
milk than to treat it as described above. Boiled milk may be given to
a baby during the first two or three weeks of its life, also to babies
suffering with diarrhea and other acute digestive disturbances. But the
child who is fed for a great length of time on boiled milk receives no
fresh food, and is therefore subject to scurvy.
If, for any reason, the mother feels that it is necessary to feed her
baby the boiled milk, she may counteract the effects on a child, three
months old or more, with the strained juice of half an orange, morning
and evening.
Particularly in mining towns, mothers must depend upon condensed milk
as artificial food for babies. While it is much better to use fresh
cow’s milk, if it can be secured, the condensed milk is preferable to
stale cow’s milk. If a reliable brand is secured, the mother is buying
fresh milk which has been sterilized and then evaporated. A can of
condensed milk is equal to about three times as much whole or plain
milk, sweetened with cane sugar.
When the child must be placed on condensed milk practically at birth,
the milk should be diluted in the proportion of one level teaspoonful
of condensed milk to sixteen spoonfuls of boiled water. This gives a
very weak and watery solution, and the young mother is apt to think
it does not contain enough nourishment for her child. But she should
bear in mind that mother’s milk is equally thin, yet sufficiently
nourishing for the child one week old or less. Forty-eight hours later
the dilution may be strengthened to one spoonful of milk to fifteen of
water; then gradually to fourteen, etc. At three months the baby may be
taking a solution of one part condensed milk to eight parts of barley
water.
Babies raised on condensed milk gain rapidly in weight because the
condensed milk, being low in fats and proteids, and high in sugar, is
easily digested. However, the same children show little resistance when
attacked by acute disease, and, if fed on condensed milk exclusively,
they may develop rickets or scurvy. It is therefore desirable to secure
a good quality of fresh milk to alternate with the condensed milk and,
eventually, to serve it for all the feedings.
Medical authorities differ on the question of patent foods. Men who
have specialized on the feeding of infants agree that the safest
substitute for mother’s milk is modified cow’s milk, and claim that
whatever nourishment is drawn from patent foods is due to the sugar or
carbohydrates in the patented article and to the cow’s milk with which
it is prepared. These foods have no medical or life-giving properties;
and most of them, in analysis, show a combination of starches, various
kinds of sugar, dried milk, and even eggs. They should be given to the
child only under the direction of the family physician.
The same is true of buttermilk, casein milk, and peptonized milk. The
use of these foods is necessary only under certain conditions, when
the child’s digestion is seriously disturbed. They should not be fed
to a baby on the advice of a neighbor or a druggist. I have known many
mothers who, at the first sign of indigestion, dosed the baby’s milk
with quantities of lime water and peptonizing powder. This should not
be done without consulting a physician.
Above all things, the mother of the baby artificially fed should keep
calm and cool-headed. Even breast-fed babies have occasional attacks
of indigestion, vomiting, colic, and diarrhea, which yield quickly
to treatment. The same trouble in bottle-fed babies will yield to
treatment.