The Care and Feeding of Children Part 13

COMMON MISTAKES IN MILK MODIFICATION AND INFANT FEEDING

I. In using modifications made from top-milk, much confusion arises from the notion that top-milk is a single definite thing, whereas its composition depends upon a great variety of conditions and, unless all these are known, it is impossible to tell how strong it is. Directions for the removal of top-milk should be explicitly followed (see page 63), or the results will be very different from those expected.

II. In formulas calling for a certain number of ounces of top-milk of any given strength, the mistake is made of removing only the number of ounces needed for the formula. The proper way is to remove the amount required to secure a top-milk of the desired strength and then to take of this the number of ounces needed in the formula.

III. A rich Jersey milk is used as if it were ordinary milk. The formulas given in this book are chiefly calculated on the basis of a good average milk which contains about 4 per cent fat. Many persons have the idea that the richer the milk, the more rapidly the child will gain in weight, and hence the superiority of such milk for infant feeding. While it is true that some children taking a very rich milk may, for a time, gain rapidly in weight, yet sooner or later, serious disturbances of digestion are nearly always produced.

IV. The food is increased too rapidly, particularly after some disturbance of digestion. If, in an infant three or four months old, an attack of somewhat acute indigestion occurs, the food should seldom be given in full strength before two weeks. The increase in the diet should be made very gradually, the steps being made only one half those indicated in the series of formulas on pages 70 and 71.

Otherwise it generally happens that the attack of indigestion is very much prolonged and much loss in weight occurs.

V. When symptoms of indigestion occur, the food is not reduced rapidly enough. Indigestion usually means that the organs are, for the time, unequal to the work imposed. If the food is immediately reduced by one half, the organs of digestion soon regain their power and the disturbance is short. In every case the amount of reduction should depend upon the degree of the disturbance.

PREPARATION OF COW'S MILK AT HOME

_What articles are required for the preparation of cow's milk at home?_

Feeding-bottles, rubber nipples, an eight-ounce graduated measuring gla.s.s, a gla.s.s or agate funnel, bottle brush, cotton, alcohol lamp or, better, a Bunsen gas burner, a tall quart cup for warming bottles of milk, a pitcher for mixing the food, a wide-mouth bottle for boric acid and one for bicarbonate of soda, and a pasteurizer. Later, a double boiler for cooking cereals will be needed.

_What bottles are to be preferred?_

A cylindrical graduated bottle with a rather wide neck, so as to admit of easy was.h.i.+ng, and one which contains no angles or corners. A single size holding eight ounces is quite sufficient for use during the first year. All complicated bottles are bad, being difficult to clean. One should have as many bottles in use as the child takes meals a day.

_How should bottles be cared for?_

As soon as they are emptied they should be rinsed with cold water and allowed to stand filled with water to which a little bicarbonate of soda has been added. Before the milk is put into them they should be thoroughly washed with a bottle brush and hot soap-suds and then placed for twenty minutes in boiling water.

_What sort of nipples should be used?_

Only simple straight nipples which slip over the neck of the bottle.

Those with a rubber or gla.s.s tube are too complicated and very difficult to keep clean. Nipples made of black rubber are to be preferred. The hole in the nipple should not be so large that the milk will run in a stream, but just large enough for it to drop rapidly when the bottle with the nipple attached is inverted.

_How should nipples be cared for?_

New nipples should be boiled for five minutes; but it is unnecessary to repeat this every day as they soon become so soft as to be almost useless. After using, nipples should be carefully rinsed in cold water and kept in a covered gla.s.s containing a solution of borax or boric acid. At least once a day they should be turned wrong side out and thoroughly washed with soap and water.

_What sort of cotton should be used?_

The refined non-absorbent cotton is rather better for stoppering bottles, but the ordinary absorbent cotton will answer every purpose.

_Which is better, the Bunsen burner or the alcohol lamp?_

If there is gas in the house, the Bunsen burner is greatly to be preferred, being cheaper, simpler, and much safer than the alcohol lamp. If the lamp is used, it should stand upon a table covered with a plate of zinc or tin, or upon a large tin tray. The French pattern of alcohol lamp is the best.

_Give the directions for preparing the food according to any of the above formulas._

The nurse's hands, bottles, tables, and all utensils should be scrupulously clean. First dissolve the milk sugar in boiling water, filtering if necessary. Then add the milk and cream and lime-water, mixing the whole in a pitcher. A sufficient quant.i.ty of food for twenty-four hours is always to be prepared at one time. This is then divided into the number of feedings required for the day, each feeding being put in a separate bottle, and the bottle stoppered with cotton.

The bottles should then be cooled rapidly by standing, first in tepid then in cold water, and afterward placed in an ice chest. If the milk is to be pasteurized or sterilized, this should precede the cooling.

DIRECTIONS FOR FEEDING INFANTS

_How should the bottle be prepared at feeding time?_

It should be taken from the ice chest, and warmed by standing in warm water which is deep enough to cover the milk in the bottle; it should then be thoroughly shaken and the nipple adjusted; the nurse should see that the hole in the nipple is not too large nor too small.

_How may the temperature of the milk be tested?_

Never by putting the nipple in the nurse's mouth. Before adjusting the nipple, a teaspoonful may be poured from the bottle and tasted, or a few drops may be poured through the nipple upon the inner surface of the wrist, where it should feel quite warm but never hot; or a thermometer may be placed in the water in which the bottle stands. A dairy thermometer should be used, and the temperature of the water should be between 98 and 105 F.

_What is a simple contrivance for keeping the milk warm during feeding?_

A small flannel bag with a draw string may be slipped over the bottle.

_In what position should an infant take its bottle?_

For the first two or three months it is better, except at night, when it may be undesirable to take the infant from its crib, that it be held on the nurse's arm during the feeding; later it may lie on its side in the crib provided the bottle is held by the nurse until it has been emptied; otherwise a young infant readily falls into the bad habit of alternately sucking and sleeping, and often will be an hour or more over its bottle.

_How much time should be allowed for one feeding?_

Never more than twenty minutes. The bottle should then be taken away and not given until the next feeding time. Under no circ.u.mstances should an infant form the habit of sleeping with the nipple in its mouth. A sleepy infant should be kept awake by gentle shaking until the food is taken, or the bottle should be removed altogether.

_Should an infant be played with soon after feeding?_

On no account; such a thing frequently causes vomiting and sometimes indigestion. After every feeding the infant should be allowed to lie quietly in its crib, and disturbed as little as possible.

INTERVALS OF FEEDING

_How often should a baby be fed during the first month?_

Every two hours during the day and twice during the night, or ten feedings during the twenty-four hours.

_At what age may the interval be made two and a half hours?_

Usually at five or six weeks.

_When may it be increased to three hours?_

Usually at two months.

_Why should not a child be fed more frequently?_

It takes the stomach nearly two hours to digest a meal at two months, and about two and a half hours at five or six months, and if the meals are too near together the second one is given before the first has been digested and vomiting and indigestion result. The meals should be far enough apart to give the stomach a little time for rest just before each feeding.

_Schedule for Feeding Healthy Infants during the First Year_

------------------------------------------------------------------- AGE. Interval Night No. of Quant.i.ty Quant.i.ty between feedings feedings for one for 24 meals, (10 P.M. in 24 feeding. hours.

by day. to 7 A.M.). hours.