The Mother and Her Child

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Place the peptonizing powder (it is procurable in tubes or tablets
from the drug store) in a small amount of milk, and after being well
dissolved, put into the bottle or pitcher with the plain or modified
milk, after which the whole is shaken up together. The bottle is then
put into a large pitcher containing water heated to about 110 deg. F. or
as warm as would bear the hand comfortably, and left for ten or twenty
minutes (if the milk is to be partially peptonized). To completely
peptonize the milk, two hours are required. Either of these formulas
is only used on the advice of a physician.

BUTTERMILK

In many cases of chronic intestinal indigestion, buttermilk is used in
place of the milk. It is prepared as follows: After the cream has been
taken from the milk and it has been allowed to come to a boil, it is
cooled to just blood heat. A buttermilk tablet, having first been
dissolved in a teaspoonful of sterile water, is now stirred into the
quart of warmed, skimmed milk and allowed to stand at room temperature
for twenty-four hours at which time it should look like a smooth
custard. With a sterile whip this is now beaten and is ready for the
sugar and the boiled water which is added according to the written
prescription from the doctor.

CONDENSED MILK

Under no circumstances should condensed milk be used as the sole food
of the baby for more than one month. Children often gain upon it, but
as a rule they have little resistance, and they are very prone to
develop rickets and oftentimes scurvy; and, as noted elsewhere, orange
juice should always be administered at least once during the
twenty-four hours as long as condensed milk is used.

Of all the brands of condensed milk, those only should be selected
which contain little or no cane sugar. Perhaps the "Peerless Brand" of
evaporated milk is the most reliable and in the preparation of food
from this evaporated milk the same amount of sugar, etc., should be
added as we do in the preparation of "whole milk" or "top milk."

We do not in any way advise the use of condensed milk. Fresh milk
should always be used where it is obtainable, but in traveling it
sometimes has to be used. Holt says, "It should be diluted twelve
times for an infant under one month and six to ten times for those who
are older."

Malted milk is a preparation suitable in some cases where fresh cow's
milk is not obtainable. Even better than condensed milk, this food
will be found serviceable in traveling, or in instances where only
very bad cow's milk is within reach.

SPECIAL FOODS

Most patent foods are made up of starches and various kinds of sugars,
and some of them have dried milk or dried egg albumin added. Many
flours under fanciful names are sold on the market today. For
instance, one flour with a very fanciful name is simply the old
fashioned "flour ball" that our great, great grandmothers made; and,
by the way, perhaps there is no flour for which we are more grateful
in the preparation of infant food than the flour ball which is
prepared as follows: A pound of flour is tied tightly in a cheesecloth
and is put into a kettle of boiling water which continues to boil for
five or six hours, at the end of which time the cheesecloth is
removed and the hard ball, possibly the size of an orange, is placed
on a pie pan and allowed slowly to dry out in a low temperatured oven.
At the end of two or three hours, the ball, having sufficiently dried,
has formed itself into a thick outer peel which is removed, while the
heart which is very hard and thoroughly dry, is now grated on a clean
grater, and this flour has perhaps helped more specialists to serve
more sick babies than any other form of starch known. It is used just
as any other flour is used--wet up into a paste, made into a gruel,
which is boiled for twenty minutes before it is added to the milk.

Whey is sometimes used in the preparation of sick babies' food and is
prepared as follows:

To a pint of fresh lukewarm cow's milk are added two teaspoons of
essence of pepsin, liquid rennet or a junket tablet. It is
stirred for a moment, then allowed to stand until firmly
coagulated, which is then broken up and the whey strained off
through a muslin.

The heavy proteins remain in the curd, and the protein that goes
through with the whey is chiefly the lactalbumin.

CHAPTER XIX

THE FEEDING PROBLEM

A friend of ours who presides over a court of domestic relations in a
large city, recently told us that he believed much trouble was caused
in families--many divorces, occasioned, and many desertions
provoked--because improperly fed babies were cross and irritable and
so completely occupied the time of the mother, who, herself, knew
nothing about mothercraft or the art of infant feeding. Consequently,
the home was neglected and unhappy, quarreling abounded and failure,
utter failure, resulted. The children were constantly cross, and so
much of the mother's time was consumed in caring for these irritable,
half-fed babies, that the home was disheveled, the meals never ready,
the husband's home-coming was a dreaded occurrence, and he,
endeavoring to seek rest and relaxation, usually sought for it in the
poolroom or the saloon, with the usual climax which never fails to
bring the time-honored results of debauch--despair and desertion.

In the beginning of this book we paid our respects to the present-day
educational system which does not provide an adequate compulsory
course in which all women could be given at least a working knowledge
of home making and the care and feeding of the babies; so that
statement need not be repeated in this chapter. But we wish to add, in
passing, that ignorance is the basis and the foundation of more
unhappy homes, broken promises, panicky divorces, and shattered hopes,
as well as of more deaths during the first year of infancy, than any
other cause. And in speaking of its relationship to babycraft, we
believe that ignorance concerning normal stools, how many times a day
the bowels should move; how much a baby's stomach holds; how often he
should be fed, etc.--I say it is ignorance of these essential details
that lies at the bottom of many problems which come up during the
first year, particularly the "feeding problem."

INFANT WELFARE

In the city of Chicago at the time of this writing, the Infant Welfare
Association maintains over twenty separate stations where meetings are
held for mothers, where lectures are delivered on the care and feeding
of babies. Babies are brought to these stations week in and week out;
they are weighed and measured and, if bottle-fed, nurses are sent to
the homes to teach the mother how properly to modify the milk in
accordance with the physician's orders. The health authorities of our
city also maintain several such stations where mothers and babies may
have this efficient help. A corps of nurses are employed to carry out
the instructions and to follow up the mothers and the babies in their
homes, and thus the death rate has been greatly reduced, not only in
our city but in all such cities where baby stations have been
instituted. In a certain ward in Philadelphia the death rate was
reduced forty-four per cent in one year after the baby stations were
established.

CHOOSING A FORMULA

There are three classes of infants who require weak-milk mixtures to
begin with: namely, the baby who has been previously nursed and whose
mother's milk has utterly failed; the baby just weaned; and the infant
whose power to digest is low. If these children were six months old,
and the formula best suited to them is unknown, we must begin with a
formula suited to a two- or three-month-old child and quickly work up
to the six-month formula, which may often be accomplished within two
or three days.

THE BOTTLE-FED BABY

When a baby is getting on well with his food, he should show the
following characteristics: He should have a good appetite; should have
no vomiting or gas; he should cry but little; and he should sleep
quietly and restfully. His bowels should move once or twice in
twenty-four hours. His stool should be a pasty homogeneous mass. He
should possess a clear skin and good color. He should show some gain
each week--from four to eight ounces--and he should also show mental
development.

As long as a baby appears happy and gains from four to eight ounces a
week and seems comfortable and well satisfied, the feeding mixture
should not be changed or increased.

MAKE CHANGES GRADUALLY

In our experience with the artificial feeding of infants, we have come
to look upon the practice of gradually changing the food formula as
the most important element in successful baby feeding.

We recall one mother in the suburbs who came to us with her baby who
had been feeding on a certain proprietary food. She declared that it
"just couldn't take cow's milk." She admitted "it was not doing well,"
and so she would like to have help. The baby was old enough, had it
been normal, to have been taking whole milk for some time. We recall
our having the mother prepare the proprietary food just as she had
been used to preparing it, and each day we had her throw away one-half
ounce and put in one-half ounce of whole milk, this mixture she fed
the baby for two days.

The next time, we had her take out one ounce of the mixture and put in
one ounce of whole milk, which we fed the baby for three successive
days; and then one and one-half ounces were substituted which was fed
to the baby for four days; and thus we carefully, slowly, and
gradually withdrew the proprietary food and substituted fresh,
certified cow's milk. It took us a month to complete the change, but
we are glad to add that it was done without in the least disturbing
the child.

Now, had the change been made abruptly--in a day or two, or three
days--the baby would probably have been completely upset, while both
the mother and the doctor would have been greatly discouraged. Many
mothers and even some physicians have jumped from one baby food to
another baby food; they have tried this and they have tried that,
until the poor child, having been the victim of a number of such
dietetic experiments, finally succumbed.

We cannot urge too strongly the fact that, as a rule, whenever a
change is made from one food to another, it should be done gradually,
unless it be the change of a single element such as that of a very
high per cent of cream found in top milk mixtures, when it seems to be
a troublesome element in the milk. No bad effects will follow the
quick change to skimmed milk with added sugar, starches, etc; but in
changing from a proprietary food to a milk mixture, the change should
always be made gradually, the quantity of the new food being increased
gradually. Milk should be increased by quarter (1/4) ounce additions,
and it should not be increased more than one ounce in one week; while
the mixture should not be increased as long as the baby is gaining
satisfactorily. A wise mother and an experienced physician can usually
see at a glance when a child is doing well--by the color and
consistency of the stools, the child's appetite, his sleep, and his
general disposition.

COMMON MISTAKES IN FORMULAS

First and foremost, we believe a great mistake is often made in using
too heavy cream mixtures; babies as a rule do not stand the use of too
high a percentage of cream. Formulas that call for whole milk should
contain four per cent fat or cream; and while babies often gain
rapidly on the higher percentage of cream found in a rich Jersey milk,
nevertheless, sooner or later serious disturbances of digestion
usually occur. Herd milk is, therefore, better for the babies because
in the "whole milk" of the herd of Holsteins we have only about four
per cent fat.

Another common mistake is too heavy feeding at the time of an attack
of indigestion; even the usual feeding may be too heavy during this
time of indisposition. It is not at all uncommon for us to dilute
baby's food to one-third its strength at the time of an acute illness.

Still another trouble maker is dirt--dirt on the dish-towel, dirt on
the nipple, dirt in the milk, dirt on the mother's hands. Dirt is an
ever present evil and an endless trouble maker, as evidenced by stool
disturbances, indigestion, fretful days, and sleepless nights. A dirty
refrigerator is another factor which has been responsible for much
illness and distress.

Indigestion is often brought on because a nurse, caretaker, or
possibly the mother, not wishing to go down to the refrigerator in the
middle of the night, brings up the food early in the evening and
allows it to become warm--to remain in a thermos bottle--and we are
sure that had they been able to see the enormous multiplication of
germs because of this warm temperature, they would never have given
occasion for such an increase in bacteria just to save themselves a
trifle of inconvenience.

Still another common mistake is to use one formula too long; a feeding
mixture which was good for four or possibly six weeks, must be changed
as the child grows older and his requirements become greater. Let the
weight, stools, general disposition and sleep of the child be your
guides, and with these in mind errors in feeding can be quickly
detected and minor mistakes speedily rectified.

SYMPTOMS OF DISSATISFACTION

Some of the pointed questions which are put to a young mother who
brings her child into the office of the baby specialist, are the
following:

Does the baby seem satisfied after his feeding?
Does he suck his fist?
How much does he gain each week in weight?
Does he sleep well?
Does the baby vomit?
What do his bowel movements look like?
Will you please send a stool to the office?

With the intelligent answers to these questions--after knowing the
birth weight and the age of the child and its general nervous
disposition--the physician can formulate some conclusion as to the
babe's general condition and can usually find a feeding formula that
will make him grow.

Vomiting, restlessness, sleeplessness and the condition of the
bowels, are the telltales which indicate whether or not the food is
being assimilated; and the stools may vary all the way from hard
bullet-like lumps to a green diarrhea.

Babies do not thrive well in large institutions where the food is so
often made up in a wholesale manner, for the simple reason that the
food elements are not suited to the need of each individual baby. Some
infants are unable to digest raw milk, and for them sterilized or
boiled milk should be tried; others require a fat-free mixture such as
skimmed milk, while still others may need buttermilk for a short time.
Babies require individual care, particularly in their food, and the
good or bad results are plainly shown in the stools, weight, sleep,
etc.

FLATULENCE

Flatulence is an excessive formation of gas in the stomach and bowels
leading to distension of the abdomen and the belching of gas, and
often the bringing up of a sour, pungent, watery fluid.

Flatulence is seen in infants suffering from intestinal indigestion
and the food is nearly always at fault. This condition is the result
of the faulty digestion of the sugar and starches--particularly the
starch--which should be immediately reduced. In such conditions the
addition of a slight amount of some alkaline (such as soda, magnesia
or lime water) to the food often produces good results. Great patience
must be exercised with a child that suffers from flatulence, for
immediate improvement can hardly be expected; time is required for the
restoration of good digestion.

VOMITING

Vomiting is perhaps more often the result of over feeding or too
frequent feeding than anything else. A healthy, breast-fed baby may
now and then regurgitate a bit, but it simply spills over because it
is too full. We do not refer to this as vomiting, we refer to the
belching up or vomiting of very sour or acrid milk which leaves a sour
odor on the clothing. This can all usually be rectified by lengthening
the intervals from two to three hours and preventing bolting of food
by getting a nipple whose hole is not so large. Too much cream in the
food will also sometimes cause vomiting.

Too frequent feeding at night is another cause of vomiting. When the
stomach is full, the failure to lay the baby down quietly, as is so
often seen in those homes where bouncing and jolting are practiced,
may also result in vomiting.

Vomiting may be the first sign of many acute illnesses such as scarlet
fever, measles, pneumonia, whooping cough, etc.

The treatment for acute vomiting is simple. All foods should be
withheld--nothing but plain, sweetened water should be administered,
while it is often advisable to give a dose of castor oil. A physician
should be called at once if the vomiting continues, and not until the
vomiting has entirely ceased for a number of hours and water is easily
retained, should food be given, and even then it should be begun on
very weak mixtures.

OVER-FEEDING

The size of the child's stomach should be the guide to the quantity of
food given, and attention is called to the table given in a previous
chapter. All food taken in excess of his needs lies in his stomach and
intestines only to ferment and cause wind and colic. The symptoms of
over-feeding are restlessness, sleeplessness, stationary weight (or
loss in weight), and oftentimes these very symptoms are interpreted by
the mother as sufficient evidence that the baby needs more food; and
so the reader can see the terrible havoc which is soon wrought where
such ignorance reigns.

WEIGHT

The weighing time should immediately follow a bowel movement and just
before a feeding time; then, and only then, we have the real weight of
baby, as a retained bowel movement may often add from four to five
ounces to the child's weight. There should be a careful record of each
weighing, for there may develop a great difference if different
members of the family endeavor to keep the weight in their minds. The
normal baby should gain four to eight ounces a week up to six months,
and from then on the weekly gain is from two to four ounces; in other
words, by six months the baby should double his birth weight and at
the end of a year his weight should be three times the birth weight. A
stationary or diminishing weight demands careful attention; a good
doctor should be called at once. Likewise, a very rapid increase in
weight is not to be desired, as we do not want a fat baby, but we do
desire a well-proportioned and alert baby, and, as someone has said,
it is better to have little or no gain during the excessive heat than
to upset the digestion by over-feeding, designed to keep the baby
gaining.

In weighing, usually the outside garments are removed, leaving on a
shirt, band, diaper, and stockings with the necessary pins; the little
fellow thus protected is placed into the weighing basket and at each
successive weighing, these same clothes or others just like them are
always included in the weight, and it should be so reported to the
physician.

THE STOOLS

In the chapter "Baby's Early Care," the first stools were described in
detail, and there we learned that the dark, tarry, meconium stools are
quickly changed within a week to the normal canary-yellow stool,
having the odor of sour milk.

The bottle-fed babies' stools differ somewhat in appearance; they are
thicker and a lighter color, but should always be homogeneous if the
food is well digested. They do not have nearly the number of bowel
movements each day that the breast-fed baby does. If a bottle-fed
baby's bowels move once a day and he seems perfectly well otherwise,
we are satisfied. And curds (white lumps), or mucus (sedimentary,
slimy phlegm), indicate that the food is not well digested.

BOTTLE FEEDING AND CONSTIPATION

A bottle baby may be constipated because the proteins are too high,
the fat too high, the food of an insufficient quantity or quality, or
the milk have been boiled, while weak babies really may lack the
muscular power to produce a bowel movement. With the help of your
physician endeavor to arrive at the cause of the constipation, and,
if the baby is two or three months old, from one to two teaspoons of
unsweetened prune juice may be administered. Milk of magnesia may be
added to the food (leaving out the lime water), or a gluten
suppository may be used.

The change from milk sugar to malt sugar has helped many infants;
while the giving of orange juice (after six months) is very beneficial
in many cases. A small amount of sweet oil may be injected into the
rectum which will lubricate the hard lumps and thus favor comfortable
evacuation. The periodicity of the bowel movement (at definite times
each day) is a matter of great importance. Immediately after a meal,
if the child is old enough, he should be placed on the toilet chair. A
bit of cotton, well anointed with vaseline and inserted into the
rectum just before meals, will often aid in producing a bowel movement
shortly after the meal has been taken.

Abdominal massage should be administered in all instances of
constipation, beginning with light movements and gradually increasing,
with well-oiled hands.

DIARRHOEA

Diarrhoea usually accompanies acute intestinal indigestion and is so
often associated with the common disorders of infancy that we refer
the reader to the chapter "Common Disorders of Infancy." Dark stools
should always be saved for the physician to observe, as they
frequently contain blood. Stools full of air bubbles with pungent sour
odor show fermentation; in which cases the starches should be reduced,
if not entirely taken away from the food mixtures. Green stools mean
putrefaction from filth-germs; a thorough cleansing of the bowel
should be immediately followed by a reduction in the strength of the
food and the boiling of the milk.

REGULATION OF THE STOOLS

At a certain time each day the napkin should be removed and the child
should be held out over a small jar. It is surprising to note how
quickly and readily the little fellow cooperates. Diaper experiences
may be limited to much less than a year if the mother has patience
enough and the baby has the normal intelligence to enter into this
regulation regime. We recall one caretaker who complained bitterly
because the child under her care constantly wet his diaper; so the
caretaker was instructed to keep a daily schedule of the baby's
actions for five days; and, to her surprise, she discovered that the
baby urinated about the same time each day. A regularity was also
noted concerning the bowel movements.

The variations in the time of the urinations were only fifteen or
twenty minutes, so nearly did the kidneys act at the same time each
day. The caretaker was instructed to remove the diaper and hold the
baby out at the earliest occurrence on the daily schedule, and, to the
astonishment of the entire family, no further accidents occurred, and
the child soon acquired the habit of letting them understand when he
was about to wet his diaper. Bowel movements may be regulated more
easily than the urination. After the child is about a year old, very
few accidents should occur.

MIXED FEEDING

In many instances, and particularly if the infant is under six months
of age, and where he has had to have additional feeding from the
bottle--under such circumstances the breast milk may be continued as
"partial feeding," at least until the baby has reached his ninth or
tenth month, at which time it may be wholly discontinued.

At each nursing time the baby empties both breasts, and the amount he
draws may readily be estimated by carefully weighing him before and
after each nursing. By referring to the directions in a previous
chapter, the quantity of food needed for his size and age may be
determined; while the deficit is made up from a bottle of milk
containing properly modified cow's milk.

If the mother's health admits, or if the breasts continue to secrete a
partial meal for the babe, mixed feeding should be continued until
after the ninth or tenth month, when it can gradually be reduced from
four or five times each day to once or twice a day, until it is
finally omitted altogether. In the meantime, the baby is gradually
getting stronger food and at eleven or twelve months the little fellow
is able to subsist and thrive upon whole milk.

INFANT FEEDING PUZZLES

It is very difficult to explain how some babies thrive on some certain
food while others grow thin and speedily go into a decline on the same
regime. The hereditary tendencies and predispositions undoubtedly have
a great deal to do with such puzzling cases.

Again, sometimes a slight variation in technic or some other trifling
error in connection with the preparation of the baby's food, may be
more or less responsible for the variation in the results obtained. No
two mothers will prepare food exactly alike even when both are
following the same printed directions and these slight discrepancies
are enough to upset some delicately balanced baby.

On the other hand, some babies are born with such strong digestive
powers and such a powerful constitution that they are easily able to
survive almost any and all blunders as regards artificial feeding,
while at the same time they also manifest the ability to surmount a
score of other obstacles which the combined ignorance and carelessness
of their parents or caretakers unknowingly place in the pathway of
early life which these little folks must tread.

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