Chapter 68

How soon should a child stop nursing from a bottle? If the child is well this should be begun at the end of the first year, and after it is fourteen months old, it should not have the bottle except at the night feeding.

What is the objection to longer bottle nursing? They become attached to the bottle and refuse solid food when it is proper to give it. They get the bottle habit; also, it is troublesome and unnecessary. Then they will not take milk in the future, when the bottle is finally taken from them; an exclusive milk diet for children of two to three years old often results in poor nutrition and anemia.

Give the process of training a child to give up the bottle? There is little trouble if it is begun at the right time; pour the milk in a small cup or glass and the child will drink little by little. Give only a small portion of the food in this way, at first, and the balance from the bottle. The child will in a few weeks time learn to drink out of the cup without difficulty. If the child is two or three years old, take the bottle away entirely and let the child get hungry, and give it only milk in the cup and nothing else. Some children may go for a day without food, but hunger will master them finally. As soon as he has learned to drink milk from his cup, cereals and other solid foods are gradually added to his dietary and the child has not only been taught to give up his bottle, but he has also a training which is often necessary.

Can you give a baby just weaned as strong cows' milk as one of the same age who has been fed upon cows' milk from birth? Not generally; it would be almost certain to cause indigestion. You must remember that the change in food is a great one, and the feeding should be begun with a weak milk and increased gradually in strength as the baby becomes accustomed to the cows' milk.

What are the proper proportions for an infant weaned at four or five months? About the same as that given to a healthy bottle-fed baby of two months, except the quantity should be larger. The food can be gradually increased, in most cases, so that by the end of two or three weeks the usual strength can be given.

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What strength is given to a bottle-fed baby of two months? From the top of a quart bottle of pure milk, that has stood from three to six hours, skim carefully off the top six ounces and then pour off three ounces of milk and mix them with the top milk (first skimmed off) making nine ounces in all; add to this nine ounces twenty-four ounces of boiled water in which you should have dissolved four teaspoonfuls of granulated sugar, or six or seven teaspoonfuls of milk sugar; add a pinch of salt and a pinch of bicarbonate of soda, or else two ounces of lime water.

Give the proper proportion for a baby who is weaned at nine or ten months? About the same as for a bottle-fed baby of four or five months. The increase to be as above given.

What is the formula for a bottle-fed baby of four months? For a healthy baby, six ounces of top milk skimmed from the top of a quart bottle of milk, six ounces of milk, then poured off, twenty-four ounces of barley or oatmeal gruel, six teaspoonfuls of milk sugar or three of granulated sugar, a pinch of salt and a pinch of bicarbonate of soda or if lime-water is used instead take one ounce of lime-water to each twenty of the milk or gruel. He should have four ounces of this mixture every three hours up to ten p. m., and then one meal at about two a. m.; none until six or seven a. m.

Will a child lose weight when placed upon this diet? It will often do so for a week or more, but he will soon gain gradually and regularly.

SPECIAL MONTHLY RULES FOR A BOTTLE-FED BABY.

Formula of food.--For the first month: skim off carefully the top six ounces from a quart bottle of pure milk, add to this twenty-four ounces of boiled water, in which water three teaspoonfuls of granulated or six teaspoonfuls of milk sugar have been dissolved, and then add a pinch of soda, or else one and one-half ounces of lime-water. Mix all these ingredients thoroughly, and then pour the correct quantity into each of ten clean nursing bottles. Tightly cork these bottles with clean cotton, and they can all be pasteurized or heated to a temperature of 155 degrees F. (Some say higher).

What strength is given to a bottle-fed baby of two months? From the top of a quart bottle of pure milk that has stood from three to six to eight hours, skim carefully off the top six ounces and then pour off three ounces of milk and mix them with the top milk (first skimmed off) making nine ounces in all; add to the nine ounces, twenty-four ounces of boiled water in which you should have dissolved four teaspoonfuls of granulated sugar, or six or seven teaspoonfuls of milk sugar; add a pinch of salt and a pinch of bicarbonate of soda, or two ounces of lime-water.

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Formula for the third month.--(This is often used), Carefully skim off the top six ounces from a quart bottle of pure milk, then pour off six ounces of milk, twelve ounces in all, and now add twelve ounces of boiled water in which three teaspoonfuls of granulated or six of milk sugar have been dissolved, with a pinch of soda or else two ounces of lime-water; add then twelve ounces of barley or oatmeal gruel, divide into eight bottles, pasteurize, etc.; cool quickly and place where the temperature is 50 degrees F., until meal time, when one of the bottles should be warmed by placing it in warm water. Pour a little out in a spoon to test the warmth, etc.; when the milk is lukewarm remove the cotton cork and attach the rubber nipple. He should be fed regularly and equally every three hours up to ten p. m., then have one at two or three a. m., and nothing until seven a. m. He should get three and one-half to four ounces at each meal, so that much should be put in each bottle.

What is the formula for a bottle-fed baby of four months? For a healthy baby, six ounces of top milk skimmed from the top of a quart bottle of milk, six ounces of milk then poured off, twenty-four ounces of barley or oatmeal gruel, six teaspoonfuls of milk sugar or three of granulated sugar, a pinch of salt and a pinch of bicarbonate of soda; or if lime-water is used instead, take one ounce of lime-water to each twenty of the milk and gruel. He should have four or five ounces of this mixture every three hours up to 10 p. m., then one meal at about 2 a. m. None until 6 or 7 a. m.

Will a child lose weight when placed upon this diet? It will often do so for a week or more, but he will soon gain gradually and regularly.

Formula for the fifth month.--Skim off the top six ounces as before, then pour off nine ounces of milk and mix it with the top-milk, add twenty-four ounces of barley or oatmeal gruel, a pinch of salt, four teaspoonfuls of granulated or seven of milk sugar, a pinch of bicarbonate of soda and proceed as before. He should be fed every three hours during the day until 10 p. m. Give five to six and one-half ounces at each meal, making six meals in the whole twenty-four hours.

Formula for sixth month.--Six ounces of the top-milk skimmed off from a quart of pure milk, ten ounces of milk then poured off. Twenty-four ounces of barley or oatmeal gruel, in which has been thoroughly dissolved four teaspoonfuls of granulated or seven of milk sugar, a pinch of bicarbonate of soda, and a pinch of salt. Pasteurized as before, etc. Give baby from four to six ounces at each meal every three hours up to 9 or 10 p. m. If the day is exceedingly warm, pour out one or even two ounces from each bottle of the regular mixture and substitute boiled water for it. If the baby is inclined to vomit, it will be better during the hot weather to use less of the top milk, four, or five ounces instead of six or eight, and add so much more gruel. Barley gruel is better than oatmeal gruel unless baby is constipated. Again if the baby has delicate digestive organs, one meal each day during the very hot weather, can be made of mutton broth prepared as follows: Cut up one pound of neck of mutton, one pint of cold water and a pinch of salt; this is cooked very slowly for three hours until half a pint is left, adding a little water from time to time as it boils away; strain through muslin and allow to cool, and when cool take off all of the fat. Add this to an equal quantity of barley water and feed lukewarm to the baby from the nursing bottle. These measures may ward off summer complaint and assist in teething.

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Formula for the seventh month.--From a quart of pure milk carefully skim off the top six ounces, pour off fifteen ounces of the milk and add twenty-one ounces of barley or oatmeal gruel to which has been added dissolved four teaspoonfuls of granulated or seven of milk sugar, a pinch of bicarbonate of soda. Give six or seven ounces at each meal and six meals in twenty-four hours.

Formula for the eighth month.--Skim six ounces of top-milk as before directed, pour off seventeen ounces of milk, add twenty-one ounces of barley or oatmeal gruel, four of granulated or seven teaspoonfuls of milk sugar, a pinch of salt and bicarbonate of soda. Give six and one-half to seven ounces every three hours up to 10 p. m.

Formula for the ninth month.--Use six ounces of top-milk skimmed off as before, twenty ounces of milk poured off, twenty-two ounces of either barley or oatmeal gruel, a pinch of bicarbonate of soda and salt added to the gruel, and five teaspoonfuls of granulated or eight of milk sugar dissolved in boiled water and put in the gruel. Give seven or eight ounces of this every three hours up to 10 p. m.

Formula for tenth month.--The milk in a quart bottle is stirred and thirty ounces of this is taken and twenty ounces of either barley or oatmeal gruel is added to it, to which three teaspoonfuls of granulated or seven of milk sugar, a pinch of salt and a pinch of bicarbonate of soda have been added. Feed the child every three and a half hours up to 10 p. m., making five meals in twenty-four hours, and seven to eight ounces at each meal.

Formula for eleventh month.--Stir up the entire quart of milk, add thirteen ounces barley or oatmeal gruel and to this add one tablespoonful of granulated or two of milk sugar dissolved in boiled water, a pinch of salt and a pinch of bicarbonate of soda. Treat as used; eight or nine ounces are given at each feeding, and five feedings given during the twenty-four hours.

Formula for twelfth month.--Stir up the entire quart of milk; add eleven ounces of gruel, one tablespoonful of granulated or two of milk sugar, a pinch of salt and bicarbonate of soda. The child should now have five regular meals daily, arranged about as follows: Six a. m., nine ounces of this modified milk; 8 a. m., teaspoonful of prune jelly or strained juice of an orange; 10 a. m., seven ounces of the modified milk and two tablespoonfuls of a well cooked cereal; 2 p. m., five ounces of beef juice or six ounces of mutton or chicken broth, or else a coddled egg (alternate on different days), five or six ounces of modified milk and a small piece of zwieback; 6 p. m., nine ounces of modified milk; 10 p. m., ten ounces of modified milk.

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BARLEY AND OATMEAL GRUELS.

How is barley gruel made? Rub up one teaspoonful of the flour with a little cold water, and then stir this into a pint of boiling water, add a pinch of salt and boil it fifteen minutes, strain if it is at all lumpy.

How is oatmeal gruel made? In the same way, but use two teaspoonfuls of the flour.

SPECIAL RULES OF FEEDING AND NURSING FOR EACH MONTH IN CONNECTION WITH THE FORMULA GIVEN.

How can milk be pasteurized? A regular pasteurizer can be bought for three dollars; or the bottles, ten or less, can be placed in a pot partly filled with water which is rapidly brought to the boiling point about 155 degrees F. These bottles are filled with each regular feeding before being put in the water. The milk should not boil. Then remove the pot from the fire and allow the bottles to stand in it for one-half hour, then take them out and cool them as quickly as possible by allowing first warm and then cold water to run over the outside of the bottles; when they are cold, place them on ice or where the temperature is about 50 degrees F., and keep them until meal-time. Then one of the bottles is placed in warm water until the milk is lukewarm, the cork can then be removed and the nipple applied. These ten bottles were equally filled with the modified milk as prepared under the formula for the first month.

How much modified milk should be placed in each bottle? For the first week of life one to two and one-half ounces are placed in each of the ten bottles, and two or three and one-half ounces for the last two weeks of the first month.

What should be done if the baby vomits or has curds in his stools? Use a little less cream and a little more water. Remember, two tablespoonfuls equal one ounce.

What kind of bottles should be used? Round cylindrical bottles with the ounces marked on them.

What color of nipples? Black rubber nipples.

How should the bottle be treated when emptied? Rinse it out with cold water and then allow it to stand full of cold water with a pinch of soda or borax in it.

How should the bottles be prepared before the food for the whole day is put in them and pasteurized, etc.? They should be thoroughly rinsed in hot soap suds, and then rinsed and boiled in clear water for ten minutes.

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What about the nipples? Rinse them first in cold then in hot water and allow them to stand in a covered cup of boric acid solution or borax water solution one teaspoonful to a pint of water. Once or twice each day they should be turned inside out and scrubbed with a brush and water. The hole in the nipple should be only large enough for a rather coarse needle to go through. The hole in the nipple can be made by such a needle heated red hot and then run through the nipple.

When can you begin to add barley and oatmeal gruel to the baby's milk? In the third month. The gruel should be made daily. If the child is not constipated use barley gruel; if constipated use the oatmeal gruel.

If you cannot get the flour, how can you prepare the gruel from the grain? Take two teaspoonfuls of barley or three of oatmeal and allow it to soak over night in cold water; add one quart of cold water the next morning and boil steadily down to a pint, (for about four hours), then strain through muslin.

Do some physicians advise feeding nursing babies one or two meals daily, beginning the fourth month? Yes.

What strength should it be? Use the formula for bottle-fed babies of the first month and the same amounts.

How can you calculate the amount necessary? Take one-eighth or one-fourth either for one or two meals daily of the separate ingredients mentioned in the formula for the first month.

Following order may be as follows: First give baby three ounces of the formula, and if all goes well in a day or two give him three and one-half ounces and miss one meal at the breast. After one week if the baby is well suited, give him three ounces of the formula for the two-months-old baby; wait a few days, then give him four ounces of this formula at the one meal. Then in a week's time if all goes well, give him four ounces of the formula for the three month's baby. Use this for one week, and then give him four and one-half ounces of the same formula. If after another week is past, there are no signs of indigestion, give him four ounces of the four-month formula, and if he enjoys this very much wait for a day or two and then increase the amount to four and one-half ounces of the same formula, and then to five ounces; as he grows older give him of the same formula as the bottle-fed infant of the same age, and the same amount at the one feeding; if he vomits or has curds in his stools or colic keep him on a weak formula longer than formerly advised.

If you have fed a breast-fed baby one meal a day from the bottle when can he be given two feedings from the bottle? During the tenth month.

COWS' MILK.--Does cows' milk contain all the elements present in the mother's milk? Yes, but in different proportions.

Why not use prepared foods? They are not thought so good, and are more likely to produce poor nutrition.

What is, the difference between cows' milk and mothers' milk? Cows' milk contains nearly three times as much casein (curd) or cheesy matter, and only about one-half as much sugar.

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What kind of cows should be selected? They should be healthy and the milk should be clear and fresh.

Is it best to select Jersey cows? The milk from Jersey and Alderney cows is generally too rich; common grade cows are best.

Should the milk be from one cow? It should be from the mixed or herd milk since that varies little from day to day.

How fresh should the milk be? In winter it should not be used after it is forty-eight hours old; in summer not after it is twenty-four hours old, and sometimes it is unsafe in a shorter time.

How should the milk be cared for at the dairies? It must be kept clean and free from being contaminated. Cows, milkers and stables must all be kept clean, and the milk must be carried in sealed bottles; those that handle the milk must not be near a contagious disease; all milk pails, bottles, cans, etc., used for the milk must be steamed and boiled before being used.

Should it be immediately cooled after leaving the cows? Yes, and kept at a temperature of about 50 degrees F.

How should the family care for it after it is delivered fresh from the cows? Strain it for infants through a thick layer of absorbent cotton or through several thicknesses of cheese-cloth into quart jars or milk bottles, covered and cooled immediately. This is best done by placing the bottles in ice water or cool spring water that comes up to their necks and allow them to remain there at least one-half hour. What you wish to use for the children who drink plain milk you may pour into one-half pint bottles, and these should be placed in an ice chest or in the coolest possible place. The first rapid cooling is very important and adds greatly to the keeping qualities of the milk, for the milk loses its heat quickly when cooled in water, but very slowly when it is simply placed in a cold room. After standing for four or five hours or longer, the top milk can be strained off; the cream may be removed after waiting twelve to sixteen hours.

How should it be cared for when received in bottles? The temperature of the milk is always raised during the delivery, so it should be cooled as before described. If it was bottled at a dairy the cream or top milk can be removed in an hour or two.

How should milk and cream be cared for by the family when purchased in bulk? This milk should never be used for infants, as it is liable to be contaminated. Both cream and milk should at once be poured into vessels, covered and kept in a cool place. There will not be much cream or top milk upon such milk.

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How should refrigerators be treated? The inner portion should be of metal. An ordinary metal refrigerator, as sold, if encased in a wooden box makes the best kind. A covering of felt and heavy quilting can be made for the refrigerator which can be removed easily when wet or soiled--it must be kept absolutely clean. The compartments for the milk should be so arranged that the milk bottles be either in contact with the ice or near it. The supply of ice should always be abundant, or the temperature of the milk will not be low enough. The temperature should not be higher than 50 degrees F.; it is oftener 60 to 65 degrees F. To tell the temperature, use a nursery thermometer and this should be used from time to time to know what temperature the milk is in. Milk is often spoiled in too warm temperatures in refrigerators, and also in unclean refrigerators. Many cases of sickness are caused by it. The refrigerator should carry a temperature of near 50 degrees F., and be absolutely clean, and the compartment for the milk should be absolutely separated from other food compartments.

MODIFIED COWS' MILK.

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.