Chapter 69

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.

FOOD FOR HEALTHY INFANTS.--FOR EARLY MONTHS.

These directions, etc., are for healthy infants. Directions for such as are suffering from digestive disturbances will be given later. I have in preceding pages given formulas for feeding children. I give these additional, because not all children can be fed the same way and it may be well to have the two sets of formulas.

What important parts are to be remembered when we are modifying cow's milk for the early month's feeding? That sugar is the most easily digested, fat comes next, while the proteids (curd) are the most difficult.

What relation should the fat and proteids bear to each other during the earlier periods? Usually in healthy infants the fat (cream) should be three times the proteids (curds). Some healthy infants do not digest fat so well and they should have only twice as much fat as proteids (curds--skim-milk).

What per cent milk must be used to obtain three times as much fat as proteids? Ten per cent milk.

How can we obtain ten per cent milk? As top milk, described on another page, or by using plain milk and ordinary cream (sixteen per cent), in equal parts mixed; or it may be obtained directly from the milk laboratories.

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Which is better to do, use the top-milk or mix plain milk and ordinary cream? If the milk is fresh from the cows, it is best then to use the top-milk, because the food can then be made up after it is only a few hours old.

If one uses bottled milk, in cities, the upper third may be used, but if milk and cream are bought separately it is usually more convenient to mix these, as cream will not rise uniformly upon the milk a second time.

What per cent milk must be used to obtain twice as much fat as proteids? Use for dilution a seven per cent milk, that is, milk containing seven per cent fat, as in this milk the fat is just twice the proteids.

How is this obtained? Same as top-milk, described on another page; or by mixing three parts of plain milk and one part of ordinary cream (sixteen per cent), or by obtaining it directly from the milk laboratories.

How should we prepare the food for the early months? Granted you make up twenty ounces at a time, first obtain the ten per cent, or seven per cent, milk to be used, then take the number of ounces of this called for in the formula desired. One must remember that to make twenty ounces of food one ounce of milk sugar (or three even tablespoonfuls) and one ounce of lime-water must be used. The rest of the food is boiled water and the per cent milk.

FIRST SERIES--Five formulas for early months for ten per cent milk: Formulas. 1 2 3 4 5 10 per cent milk 2 oz. 3 oz. 4 oz. 5 oz. 6 oz. *Milk Sugar 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. Lime-water 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. Boiled water 17 oz. 16 oz. 15 oz. 14 oz. 13 oz. ----- ----- ----- ----- ----- 20 oz. 20 oz. 20 oz. 20 oz. 20 oz.

*The milk sugar takes no space as it is always dissolved in the boiled water.

How can we strengthen this food? By gradually increasing the milk (top milk) and decreasing the amount of water.

SECOND SERIES--Of five formulas for the early months from the seven per cent milk. This is weaker in fat (cream), etc., about one-third:

Formulas. 1 2 3 4 5 7 per cent, milk 2 oz. 3 oz. 4 oz. 5 oz. 6 oz. Milk Sugar 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. Lime-water 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. Boiled water 17 oz. 16 oz. 15 oz. 14 oz. 13 oz. ----- ----- ----- ----- ----- Food 20 oz. 20 oz. 20 oz. 20 oz. 20 oz.

How can I decide which series of formulas to use? A strong child with good digestion can be given from the first series, ten per cent milk.

A smaller, weaker child, and whose digestion is not so good, or with one who has tried the first series and did not do well, should use the second series of formulas.

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What is the reason the food is made so weak at first? The infant's stomach is made to digest mother's milk, not cows' milk, so we must begin with weak cows' milk, and the infant's stomach can thus be trained to digest it. Strong milk would be very liable to seriously upset the child's digestion.

How rapidly can I increase the food in strength, that is, go from formula 1 to 2, 3, 4, and 5, of either series? This can not be told, absolutely. It depends upon the infant, how it bears the food. Usually you can begin on formula one on the second day, formula two on the fourth day; three, after seven or ten days, but after that make the increase slower. If the infant is large, strong and of good digestion, he may be able to take of formula five by the time he is three or four weeks old. A weak child, or one with feeble digestion must go much slower, and such an one may not reach formula five until it is three or four months old. Mothers should remember it is safer to increase the strength of the food very gradually; some infants should have an increase of only one-half ounce instead of one ounce; thus: three to three and one-half ounces, etc. Two or three days should be allowed at least between each increase of food.

May I not go by a general rule in increasing the food? Yes, increase the food when the infant is not satisfied, but is digesting well.

How does an infant show this? He drains the bottle hungrily and cries when it is taken away. He may begin to fret a half hour or so before the time for the next feeding. He often sucks his fingers immediately after feeding.

If I wish to prepare more than 20 ounces of food, what proportions shall I use? To make 25 ounces, add one-fourth more of each ingredient. To make 30 ounces, add one-half more of each ingredient. To make 35 ounces, add three-fourths more of each ingredient. To make 40 ounces, double each ingredient.

For example, 25 ounces of food would call for--2-1/2 ounces of milk; 1-1/4 ounces of milk sugar; 1-1/4 ounces of lime-water; 21-1/4 ounces of boiled water.

For 30 ounces of food, proportions would be--Milk, 3 ounces; milk sugar, 1-1/2 ounces; lime-water, 1-1/2 ounces; boiled water, 25-1/2 ounces.

How much more should be made at one time? Five ounces may be made, but the first few days only two or three ounces of the additional should be given; four ounces the next two days, and after two days more may give the five ounces additional that has been made; that is, twenty-five ounces in all.

How much increase can be given at each feeding? Not more than one-quarter of an ounce.

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FOOD FOR HEALTHY INFANTS DURING THE LATER MONTHS.

How long shall I continue this proportion, that is, the fat three times the proteids (curd)--skim-milk? Usually for three or four months.

What changes shall I then make in the food? After you are using formula five of the first series; that is, six ounces of the ten per cent milk in twenty ounces of milk, increase the fat slowly, for the proportion of fat (three per cent), is near the limit for healthy children.

How then shall I strengthen the milk? By raising the percentage of proteids (curds, skim-milk).

How can I do this? Use the formulas derived from the seven per cent milk and discontinue the ten per cent milk.

THIRD SERIES.--Five formulas for seven per cent milk for the later months-- Formulas. 1 2 3 4 5 7 per cent milk 7 oz. 8 oz. 9 oz. 10 oz. 11 oz. *Milk Sugar 1 oz. 1 oz. 1 oz. 3/4 oz. 1/2 oz. Lime-water 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. Boiled water 12 oz. 11 oz. 10 oz. 4 oz. 3 oz. Barley Gruel 0 oz. 0 oz. 0 oz. 5 oz. 5 oz. ----- ----- ----- ----- ----- 20 oz. 20 oz. 20 oz. 20 oz. 20 oz.

*(As the milk sugar is dissolved in the boiled water the quantity is twenty ounces instead of twenty-one.) Oatmeal gruel can be substituted for barley gruel if there is constipation. To increase the food to twenty-five, thirty, or thirty-five ounces increase the milk ingredients by 1/4, 1/2, 3/4 and for forty ounces using two times as much.

How shall I increase the food during this period? Beginning with formula one of this series, which should usually follow five of the first or second series, you can usually make the increase in ten days to No. 2; in two weeks you can use No. 3; but proceed more slowly to four or five when you have reached them. The same formula may be continued sometimes for three or four months with no other change, except an increase in the quantity of the food, that is from twenty ounces to twenty-five, etc.

Is it necessary or important to reduce the proportion of fat as it is at first, reduced in passing from formula five of the first series to formula one of the third series? It is not necessary.

How much is this reduction? From 3 to 2.50 per cent.

How much increase of fat is there from the fifth formula of the second series to the first formula of the third series? From 2.00 to 2.50 per cent.

Can the first decrease be avoided? Yes, by taking off at first the upper thirteen ounces as top-milk, and using in a twenty-ounce mixture seven ounces of this in place of formula No. 1, and also by using for the next increase the upper fifteen ounces as top-milk--taking of this eight ounces in a twenty-ounce mixture in place of formula No. 2. Then follow three of this third series. This is only done when you think the formulas two and three of the third series do not give enough fat.

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Can I add any other food about the sixth or seventh months? Yes, foods in the form of gruel, and have this take the place of part of the boiled water and part of the sugar. Oatmeal and barley gruels can be added.

Can I make further changes at ten or eleven months? The proteids (skim-milk) may be further increased, sugar and lime-water reduced until plain milk is given.

How can I do this? Give at first one feeding of plain milk and barley gruel daily; later two feedings, then three feedings, etc. For example, suppose one infant was being fed with modified milk as formula 4 or 5, series 3, six feedings daily. The plain milk diluted with boiling water would take the place of one such feeding at first, then two, three, four, etc., feedings. Such changes to be made at intervals of two weeks. Proportions of milk and barley gruel should be, at first, about five and one-half ounces milk, two and one-half ounces barley gruel; later six ounces milk, three ounces barley gruel and then seven ounces milk, two ounces barley gruel until plain milk is alone used, and this can usually be reached at twelve to thirteen months. For five months' infants a pinch of soda may be added to each feeding when the lime-water is omitted. It is not generally necessary, however.

Do some infants dislike the milk after the milk sugar has been omitted? Yes; for such 1/4 to 1/2 teaspoonful of granulated sugar may be added for a time to each feeding and gradually reduced.

RULES FOR USING THESE FORMULAS.

They are only for healthy infants. Begin always with a weak formula, especially with an infant previously nursed at the breast, with one just weaned and with infants who have poor digestive powers, or whose digestive powers are unknown. Should the first formula tried be too weak the food can be strengthened every three or four days until the right formula is found. If the food is made too strong at first an attack of indigestion is liable to follow.

How shall I increase the strength of the food? This should be done very gradually. Do not advance more than one formula in the given series. It is frequently better to make the increase in half steps. Say when it is from three to four, give three and one-half, and then four.

How rapidly can I increase the quantity of food? This should not be more than one-fourth ounce in each feeding, one to one and one-half to two ounces daily.

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When should the amount of food be increased? An increase may be necessary every few days in the early weeks, but the same formula is often continued for two or three months during the later months.

What signs in the infant demand an increase? The infant is not satisfied, does not gain in weight, but it has good digestion--that is, it does not vomit and has good stools.

When should I not increase the food? So long as the child is satisfied, gains four to six ounces weekly, even when the quantity and strength of the food is considerably below the average.

Should you then increase the food if the child seems somewhat hungry, but still gains from eight to ten ounces weekly? It is not always a safe rule to be guided by the appetite.

How can I know whether to increase the strength or the quantity of the food? In the early weeks it is well first to increase the strength, the next time the quantity of the food, then the strength, then the quantity, etc. The quantity chiefly should be increased after the fourth or fifth month.

Should a slight stomach discomfort or disturbance follow after the food has been strengthened, what shall I do? If the disturbance is marked and continues and the infant does not seem able to accustom itself to the new food, you should go back to the weaker one and the next increase should be smaller.

Should I be worried if the gain in weight for the first few weeks of artificial feeding is slight, or even no gain? Not as a rule; if the infant loses no weight, sleeps well, is comfortable, does not suffer from vomiting, nausea, colic, you can feel sure the baby is doing well and is becoming used to his new food. As his appetite improves and his digestion is stronger the food may be increased every few days. Then the weight will soon increase.

Is constipation likely to occur from such a weak food? This is very often seen owing to the fact of their being little residue in the bowels, so if he has a daily stool, even if it is small and dry, it need not cause worry as it soon passes away with the using of stronger food.

What circumstances indicate that the food should be reduced? When the child becomes ill from any causes, or when there are any marked symptoms of indigestion.

How can I reduce the food? If there is but a slight disturbance and the daily food has been prepared, pour off one-third from each bottle just before each feeding and replace this quantity of food with boiled water; if the disturbance is more severe, immediately dilute the food at least one-half and also reduce, at the same time the quantity given; for a severe attack of indigestion, omit the regular food altogether and give only boiled water until a doctor has been called.

How shall I return to the original formula after it has been reduced for a disturbance of digestion? The increase must be very gradual after the immediate reduction. After a severe attack of indigestion, the milk should not be made more than one-fifth the original strength, and ten days or two weeks should elapse before the original strength food is given and, as stated, there should be a gradual slow increase.

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ABOUT ADDING OTHER FOODS TO MILK.

How long shall I continue the modified milk? Usually for about six months; but if the infant is doing well you can continue it for ten or eleven months. If the infant has trouble in digesting cows' milk other foods can be added at three or four months or even at the beginning.

What food can I first use? Barley, oatmeal, arrowroot, and farina.

Is it better to make them from the flour? Yes, they are more simple to prepare from the flour.

How shall I cook them? Cook them separately, and when used they take the place of some of the boiled water.

(For another way, see former pages.)

How shall I prepare barley gruel water? Take one teaspoonful of the flour and rub it up 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 lumpy. Oatmeal gruel is made the same way, only using two teaspoonfuls instead of one.

Barley Jelly.--One rounded tablespoonful of the flour, mixed with a little cold water, is added to one pint of boiling water containing a pinch of salt; cook twenty minutes in a double boiler and strain. A thinner gruel (barley water) is made by using half of the quantity of flour.

How much of the gruel can I use? If prepared by the last method one-sixth to one-half the total quantity of food; if the barley water is used it can be used in greater quantity if desired, as it is weaker by half.

Which one shall I use? Barley and oatmeal are generally used; oatmeal is more laxative.

What is their value as infant foods? Their chief value is to prevent the curd from coagulating in the stomach in hard masses, thus rendering it more digestible.

Would you advise this addition for all infants? No, for it does not agree with them all, and so it cannot be recommended for all infants.

Can I give anything more during the first year? Beef juice, white of an egg, and orange juice.

How and when may I use the beef juice? It may be begun at ten or eleven months in infants who are strong and thriving well. Two teaspoonfuls may be given daily, diluted with same amount of water, fifteen minutes before the midday feeding; in two weeks it may be doubled; and six teaspoonfuls can be given, in four weeks. Two or three tablespoonfuls is all that can be given a child of one year.

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Is beef juice of value in delicate pale infants? Yes, of much value, and it is more important for them, and it may sometimes be given them at five or six months in one-half the quantity mentioned.

When shall I give the white of egg (albumen) or albumin water? When the conditions are similar to those requiring beef juice especially in infants who digest the proteids (curd) with difficulty. You can give the one-half of the white of one egg at six months, and soon the entire white of one egg can be given.

What is the best way of preparing this? By coddling the egg.

Describe the way of preparation? Place a fresh egg with the shell on in boiling water and immediately remove all from the fire. The egg cooks slowly in the water for seven or eight minutes as the water gradually cools, and the white part becomes like jelly. Give the white with only a pinch of salt--it can be easily separated from the yolk.

When can I give orange juice? Usually about the eleventh or twelfth month, and it should be given about one hour before the feeding. You can begin with two teaspoonfuls at first, then one tablespoonful at a time, and later three or four tablespoonfuls. Orange juice is very good when constipation exists--strain it always, and it must be always fresh and sweet.

OVER NURSING.