ARTIFICIAL FEEDING
Elementary Principles of Milk Modification--The Secret of the
Efficiency of Mother's Milk--Two Important Factors in
Successful Artificial Feeding--Every Child is a Problem in
Itself--Proprietary Foods of Little Value as Infant
Foods--Their Value is in the Milk Added to Them--The Credit
Belongs to the Cow--Difference Between Human and Cow's
Milk--What "Top-milk Feeding" Means--Utensils Necessary for
Home Modification of Milk--Artificial Feeding from Birth to the
Twelfth Month--How to Measure Top-milk--Easy Bottle-feeding
Method--Condensed Milk Feeding--Objections to Condensed Milk
Feeding.
ELEMENTARY PRINCIPLES OF MILK MODIFICATION.--Mothers who have to raise
their children on artificial food should understand the elementary
principles of milk modification. They should know, for example, that the
one object of milk modification is to render it as nearly an exact
substitute for mother's milk, according to the age of the child, as is
possible. If we could do this with scientific exactness, artificial
feeding would be a simple process. We cannot, however; nor has there
ever been devised a method by which we may hope successfully to
duplicate mother's milk. It is a comparatively simple matter for the
efficient chemist to analyze the breast milk of any nursing mother; and
it is quite possible to duplicate the milk according to the analysis,
with chemical exactness, but the two fluids will not be the same. There
is present in the mother's milk something which synthetic chemistry
cannot discover. This something is nature's secret,--it is akin to the
life-giving principle which is contained in the germinal fluid, and in
the hen's egg. We cannot therefore hope to build up an artificial food
that contains this mysterious life-giving principle which is the secret
of the efficiency of maternal milk,--we can only hope to approximate
it. It is possible that we might be successful so far as its nursing
efficiency is concerned, if all children were alike, if all children
were of a uniform standard of health. As a matter of fact, no two babies
are exactly alike. And while the mother of each child undoubtedly
secretes a milk suitable to the degree of healthfulness of her own
child, the same milk might not be equally suitable to another child. The
milk, therefore, that is manufactured to agree with an average mother's
milk is dependent for its success upon the vitality of the child to
which it is fed. If that child is not a well child, according to an
accepted standard, the milk will not agree with it, even though it is
the best possible substitute for an average breast milk.
We have consequently two factors to consider in successful or efficient
artificial feeding:
1. Our inability to duplicate exactly mother's milk.
2. The lack of a uniform health standard in children.
It is the lack of a uniform health standard in children that gives to
artificial feeding all its difficulties. It renders the successful
artificial feeding of children a personal or individual problem. Some
children,--those who approximate a standard of health for their age; in
other words, "well" children,--thrive on a milk modification that
experience has taught us is suitable for well children of their age.
Others, and they are in the majority, have to be fed on a modification
which actual test proves to agree with their digestive capabilities.
Every artificially fed child therefore must be studied from its own
individual standpoint. A certain modification of milk may not agree with
a child fed every two and one-half hours, which will be found to agree
if fed in the same quantity, to the same child, every three hours. The
slightest change, a change which would seem to be so insignificant in
itself as not to justify serious consideration, may mean the difference
between normal healthfulness and constant ill health. A food that is too
strong for a child's digestive ability, and which causes vomiting,
colic, and diarrhea, may be rendered exactly right by the slightest
modification one of its constituents. To effect such a change quickly
and successfully, one must be trained to interpret the symptoms
correctly and to know how to make the change in the modification of the
milk. Mothers cannot be expected to possess this degree of skill: they
should therefore refrain from experimenting, because an experiment on a
baby is not only dangerous, but ethically it is criminal. Call the
family physician; put the burden on his shoulder.
It is this element of uncertainty in our ability to effect a standard
modification of milk that has afforded manufacturers the rich
opportunity of putting on the market various baby foods for which much
is claimed. These foods are really substitutes for the inefficiency of
the average mother. There is no real justification for their use. If all
mothers were clean, faithful, and efficient, there is no reason why each
one could not be taught to modify cow's milk to suit her child, just as
satisfactorily, or more so, than a manufacturer who never saw her child.
The manufacturers, however, do the work, and the naturally ignorant or
lazy and inefficient mother, is willing to pay for the extra cost of
labor, to save herself the trouble on the one hand, and to subject her
child to a series of experiments in order to discover the manufactured
food that is particularly adapted to her particular baby on the other
hand. We believe that most mothers have never considered the question
from this standpoint; that most mothers adopt this method of artificial
feeding at the direct suggestion of their family physician, and are not,
therefore, responsible. These foods do not contain the nutritional
elements necessary to healthy growth; or as they exist in normal breast
milk; or as they can be approximated in ordinary milk modification at
home. Proprietary foods are of decidedly poor value in infant nutrition,
and should not be used. They have a value, however, in certain diseased
conditions, but within a very small range. As a food for a healthy
growing infant, they should not be used, and when the average physician
appreciates this fact, and so instructs the mothers of the country, it
will be to the distinct advantage of the race in every respect.
Proprietary foods to which fresh cow's milk is added, are not foods at
all,--they depend upon the milk so far as any nutritional value is
concerned; and it would be far safer to modify at home a good milk than
to buy a proprietary food, the analysis of which cannot be depended
upon. The credit for the fat, healthy babies we see advertised does not
belong to the manufacturers, but to the cow whose milk you add to the
manufacturer's sugar.
The proprietary beef foods are also valueless as infant foods. In
certain illnesses, when we want a mild stimulant, a teaspoonful or two
in hot water may have a certain value, but that is all. The beef juice
of home manufacture is much more valuable.
DIFFERENCE BETWEEN HUMAN AND COW'S MILK.--The composition of cow's milk
is as follows:
Fat (represented by cream) 4%
Sugar 4%
Proteids (represented by curd) 4%
The composition of an average human breast milk is as follows:
Fat 4%
Sugar 7%
Proteids 1-1/2%
It will be observed from a comparison of the above tables that cow's
milk is much richer in proteids (the substances which form with water
the curd of sour milk) than is human milk. If one remembers that cow's
milk is manufactured by nature primarily for the feeding of calves, not
for babies, and that the stomach of a calf is intended to exist
exclusively on vegetable products, and that nature is preparing it for
this purpose, and feeds it a food when young that will enable it to grow
so as to be adapted for that purpose, one can understand that the
problem of the modification of cow's milk to suit the stomach of a baby
is not by any means a simple matter. Since the proteids are so much in
excess in cow's milk, we must dilute cow's milk with twice its bulk or
more of water to render it fit food for a new born baby. If we dilute
cow's milk to this extent to get the proteid percentage right, we
immediately disarrange the percentage of the cream or fat. We overcome
this difficulty by taking the cream from the top of the bottle and
diluting it because it is richer in fat and does not need so much
dilution. This is the explanation of the so-called "top-milk feeding."
The percentage of sugar represents another problem. The percentage of
sugar in cow's milk compared with the sugar in human milk is deficient,
so we add milk-sugar to the cow's milk to make up the deficient
percentage.
There is yet another feature which we must rectify; cow's milk is acid,
while human milk is alkaline. To overcome this difference we add
lime-water. We must also take into consideration that cow's milk is
ordinarily full of germs, while human milk is free from them; to
overcome this danger we resort to heating the milk to a degree which
experience has taught us will kill all germs. Cooked milk is not as
wholesome as uncooked milk, and it has a tendency to cause constipation.
We have to a certain extent overcome the need for cooking all milk for
babies, as will be noted later, but in summer time, unless the milk is
known to be pure and free from germs, it is advisable to sterilize it.
UTENSILS NECESSARY FOR HOME MODIFICATION OF MILK
One dozen round, eight-ounce nursing bottles.
One dozen black rubber nipples.
One eight-ounce measuring glass or graduate.
One brush for cleaning bottles.
One two-quart glass preserve jar for mixing the various ingredients.
One one-ounce Chapin dipper, for removing the top-milk.
One glass funnel.
A detailed description of the proper kinds of bottles and nipples will
be found elsewhere. The measuring glass or graduate should be
wide-mouthed. It is not safe to spoon the top-milk off, nor is it safe
to pour it out. Absorbent cotton should be provided to close the nursing
bottles when filled and left standing in the ice box.
ARTIFICIAL FEEDING FROM BIRTH TO THE TWELFTH MONTH
The following formulas for the different ages may be found useful for
well babies:
From the third to the tenth day:
Milk (top 16 oz.) 3 ounces.
Lime-water 1/2 ounce.
Milk-sugar 1 ounce.
Boiled water to make 16 ounces.
Ten feedings in twenty-four hours; 1-1/2 to 2 ounces at each feeding.
From the tenth to the twenty-first day:
Milk (top 16 oz.) 6 ounces.
Lime-water 1-1/2 ounces.
Milk-sugar 1-1/2 ounces.
Water to make 24 ounces.
Nine to ten feedings in twenty-four hours; 1-1/2 to 2 ounces at each
feeding.
From third to the sixth week:
Milk (top 16 oz.) 10 ounces.
Lime-water 2-1/2 ounces.
Milk-sugar 2 ounces.
Water to make 32 ounces.
Eight to nine feedings in twenty-four hours; 2 or 3 ounces at each
feeding.
From sixth week to the third month:
Milk (top 16 oz.) 12 ounces.
Milk-sugar 2 ounces.
Lime-water 3 ounces.
Water to make 32 ounces.
Seven to eight feedings in twenty-four hours; 2-1/2 to 4 ounces at each
feeding.
From third to fifth month:
After this age two bottles of milk are required, 16 ounces being taken
from the top of each bottle and mixed.
Milk (top 16 oz.) 18 ounces.
Milk-sugar 2 ounces.
Lime-water 4 ounces.
Water to make 40 ounces.
Six feedings in twenty-four hours; 4 to 5 ounces at each feeding.
From the fifth to the seventh month:
Milk (top 16 oz.) 21 ounces.
Milk-sugar 2 ounces.
Lime-water 5 ounces.
Water to make 42 ounces.
Six feedings in twenty-four hours; 5 to 7 ounces at each feeding.
From the seventh to the ninth month:
Milk (top 16 oz.) 27 ounces.
Milk-sugar 2-1/2 ounces.
Lime-water 6 ounces.
Water to make 48 ounces.
Five to seven feedings in twenty-four hours; 6 to 8 ounces at each
feeding.
From the ninth to the twelfth month:
Milk (top 16 oz.) 35 ounces.
Milk-sugar 2-1/2 ounces.
Lime-water 6 ounces.
Water to make 56 ounces.
Five to six feedings in twenty-four hours; 7 to 9 ounces at each
feeding.
It will be observed that 16 ounces of top-milk is used to make the
various formulas from. This means that the mother will dip off, with a
Chapin dipper, 16 ounces from the top of a bottle of milk which has
stood for four or five hours to allow the cream to rise; she will then
mix this and take from the mixture the number of ounces called for in
the formula she is using according to the age of the child. The ordinary
milk that is delivered in New York City may be assumed to have stood the
four or five hours necessary. This may not be so, however, in the
country, as it is frequently delivered there as soon as it is milked. In
such cases the mother will permit it to stand in the ice box until the
cream has risen.
When the mother is about to make the mixture called for in feeding from
the third to the fifth month she will observe that 18 ounces of milk is
called for. Now since she only uses 16 ounces of the top-milk from one
bottle this will not be enough. She must therefore use 16 ounces from
two bottles of milk; this she will mix together and from this mixture
she will take the 18 ounces wanted. Whatever milk is left over may be
used for ordinary table purposes.
EASY BOTTLE-FEEDING METHOD
The following formulas and instructions for bottle-feeding are taken
from the Rules for the Care of Infants and Young Children which are used
by Dr. Kerley at the out-patient department of the Babies' Hospital and
give the simplest and easiest means of bottle-feeding:
BOTTLE-FEEDING.--The bottle should be thoroughly cleansed with
borax and hot water (one teaspoonful of borax to a pint of
water) and boil before using. The nipple should be turned
inside out, scrubbed with a brush, using hot borax water. The
brush should be used for no other purpose. The bottle and
nipple should rest in plain boiled water until wanted. Never
use grocery milk. Use only bottled milk which is delivered
every morning. From May 1st to October 1st the milk should be
boiled five minutes immediately after receiving. Children of
the same age vary greatly as to the strength and amount of food
required. A mixture, when prepared, should be put in a covered
glass fruit-jar and kept on the ice. For the average baby the
following mixture will be found useful:
"For a child under six weeks of age: Nine ounces of milk,
twenty-seven ounces of barley-water, four teaspoonfuls of
granulated sugar. Feed from two to three ounces at two and
one-quarter hour intervals, nine feedings in twenty-four hours.
"Sixth to the twelfth week: Twelve ounces milk, twenty-four
ounces barley-water, five teaspoonfuls sugar. Feed from three
to four ounces at each feeding.
"Third to the sixth month: Eighteen ounces of milk, thirty
ounces of barley-water, six teaspoonfuls of sugar. Feed four to
six ounces at three-hour intervals, seven feedings in
twenty-four hours.
"Sixth to the ninth month: Twenty-four ounces milk, twenty-four
ounces barley-water, six teaspoonfuls granulated sugar. Feed
six to eight ounces at three-hour intervals, six feedings in
twenty-four hours.
"Ninth to twelfth month: Thirty-eight ounces milk, twelve
ounces barley-water, six teaspoonfuls of granulated sugar. Feed
seven to nine ounces at three and one-half hour intervals, five
feedings in twenty-four hours."
BARLEY-WATER.--The barley-water used in the above formulas may be made
in the following way: To two teaspoonfuls of pearl barley, add one quart
of water, and boil continuously for six hours, keeping the quantity up
to a quart by the addition of water; strain through coarse muslin. The
barley will be better if it is soaked for a number of hours, or over
night, before cooking. The water in which it is soaked is not used.
An equally good barley-water may be made in an easier way by using
Robinson's prepared barley. This may be procured in the drug stores. It
is only necessary to take one even tablespoonful of this barley to
twelve ounces of water and cook for twenty minutes.
CONDENSED MILK.--When the mother cannot afford to buy bottled milk from
the wagon, when she has no ice-chest and cannot afford to buy ice, she
should not attempt cow's-milk feeding, but may use canned condensed milk
as a substitute during the hot months only. The can, when opened, should
be kept in the coolest place in the apartment, carefully wrapped in
clean white paper or in a clean towel. The feeding hours are the same as
for fresh cow's milk:
"Under three months of age: Condensed milk one-half to one teaspoonful;
barley-water, two to four ounces.
"Third to sixth month: Condensed milk, one to two teaspoonfuls;
barley-water, four to six ounces.
"Sixth to ninth month: Condensed milk, two to three teaspoonfuls;
barley-water, six to eight ounces.
"Ninth to twelfth month: Condensed milk, three teaspoonfuls;
barley-water, eight to nine ounces."
OBJECTIONS TO CONDENSED MILK FEEDING.--Condensed milk is not to be
recommended as a permanent food where good cow's milk can be obtained.
In most cases it should be used as the sole food for a few weeks only.
It may be used when the digestion is impaired for some reason. If the
symptoms are intestinal it will be more apt to agree than if they are
caused by stomach ailments. The symptoms of intestinal disturbances
are,--colic, flatulence (gas), curds or specks in the stools,
constipation or diarrhea. It will not be found suitable if the child is
simply vomiting.
The objections to condensed milk are: It is very rich in sugar and very
deficient in proteids and fat. Children fed on condensed milk often gain
very rapidly in weight but have little strength or resistance. They do
not fight disease well for this reason; they are apt to develop rickets
and scurvy.