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 gla.s.s 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 quant.i.ty up to a quart by the addition of water; strain through coa.r.s.e 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 subst.i.tute 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.

CHAPTER XX

ARTIFICIAL FEEDING--CONTINUED

How to Prepare Milk Mixtures--Sterilizing the Food for the Day's Feeding--How to Test the Temperature of the Food for Baby--When to Increase the Quality or Quant.i.ty of Food--Food Allowable During the First Year in Addition to Milk--Beef Juice--White of Egg--Orange Juice--Peptonized Milk--The Hot or Immediate Process--The Cold Process--Partially Peptonized Milk--Completely Peptonized Milk--Uses of Peptonized Milk--Objections to Peptonized Milk--What a Mother Should Know About Baby's Feeding Bottle and Nipple--Should a Mother Put Her Baby on Artificial Food if Her Supply of Milk, During the First Two Weeks is not Quite Enough to Satisfy it--Certain Conditions Justify the Adoption of Artificial Feeding from the Beginning--Mothers' Mistakes in the Preparation of Artificial Food--Feeding During the Second Year--Sample Meals for a Child Three Years of Age--The Diet of Older Children--Meats, Vegetables, Cereals, Bread, Desserts--Fruits.

HOW TO PREPARE MILK MIXTURES

The mother should always remember, that the secret of success in raising a baby efficiently on artificial food is to be cleanly and to be exact.

The bottles and the nipples must be scrupulously clean; the hands of the mother must be clean; the water used must be boiled and each ingredient must be measured exactly.

First dissolve the sugar in the boiled water, which must be the exact quant.i.ty; then remove the top-milk and measure the exact amount wanted in the graduate, pour into the jar, add the water and sugar mixture, and finally the lime water.

It is always desirable to make the entire quant.i.ty for the day at one time. After the total quant.i.ty has been mixed in the jar, fill each bottle with the amount for each feeding, put in a cotton stopper, and place the bottles in the ice box.

In measuring the sugar, it should be remembered that two scant dipperfuls equal one ounce by weight of the sugar.

When each individual bottle is to be filled, do it with the aid of the gla.s.s funnel which has been previously sterilized.

STERILIZING THE FOOD FOR THE DAY'S FEEDING.--The simplest method is to place the two-quart jar containing the milk mixture for the next twenty-four hours' feeding upon a saucer in the bottom of an open pan, and then to pour enough tepid water into the pan (outside of the jar) until it will come up as high as the milk level. The water in the pan is then brought slowly to the boiling point. The pan is then moved to the back of the stove and left for half an hour. The jar is then removed and rapidly cooled by allowing cool water to flow over the outside; the individual bottles filled and put in the ice box.

It is always wise to taste the milk before making up the day's feeding to be sure it is not sour. The milk from a herd of good cows is always better than the milk from one cow no matter how good that one cow may be.

When about to feed the baby, the bottle is taken out of the ice box and heated to the desired temperature in a water bath. The temperature of the milk can be tested by allowing a few drops to fall on the wrist; it should feel warm, not hot; it should not be tasted by putting the bottle to the mouth of the nurse, or mother, as it may become infected by doing so. A flannel cover, or bag, should be made to fit the bottle and it should be put on while the baby is nursing so that the milk may retain its heat. The baby must not be disturbed while nursing, nor should he be jounced or carried around after nursing. These habits cause vomiting and indigestion. He should be put in his crib.

WHEN TO INCREASE THE QUALITY OR QUANt.i.tY OF FOOD.--Children of the same age may have different digestive abilities. A strong, robust child may be permitted to take a richer quality of milk than a weak, puny infant of the same age. If the quality or quant.i.ty of each feeding is too weak or small for the baby he will be dissatisfied and he will cry after the feeding. In such cases, if the bowel discharges are natural and yellow without curds or white specks, and if he is not gaining sufficiently in weight, the next stronger formula may be tried. If it is decided to put him on the stronger mixture, it is wise to cut the quant.i.ty down for a day or two in order to test out his digestive ability. If the stools remain good after three days, the quant.i.ty may be slowly increased until the amount in the recipe is allowed. It is a much more serious risk to overfeed the baby than to underfeed him. If too large a quant.i.ty is given, he may vomit it at once, or he may develop colic with intestinal indigestion. Such babies lose weight, become fretful and irritable, even though the appet.i.te may remain good. If too strong a quality is given he may vomit sour, b.u.t.tery-smelling milk, or have colic, and pa.s.s curds in the stool. If this happens it may be necessary to go back to a weak formula and work up from that standard. This is always a tedious and anxious experience and may lay the foundation for digestive disturbances for a long time. Don't be too anxious to increase the quality, or quant.i.ty, of your baby's food. It is much better to go slow and have a well baby, than to try to force matters and get into all kinds of trouble. No science calls for more elementary common sense, than the science of infant therapy.

Digestive disturbances incident to this period are fully explained in the chapter on Diseases of Children.

FOOD ALLOWABLE DURING THE FIRST YEAR, IN ADDITION TO MILK

About the twelfth month the baby should receive plain milk mixtures instead of the top-milk heretofore used in making up the food. At first the milk may be plain milk from an ordinary bottle shaken up. Of this he may take five ounces, to which may be added three ounces of barley water. The barley water may be gradually withdrawn, an ounce at a time, replacing this amount with milk, until the child is taking eight ounces of milk and two ounces of barley water. Later plain mixed milk will be suitable for a child about the fourteenth month.

Barley water may be added to the milk at any time after the third month in place of the plain boiled water in the preceding formulas. It is advisable to do this if there is any trouble with digestion, or if there are curds in the stools. Some children take more kindly to barley water than plain water at a very early age.

BEEF JUICE.--The juice squeezed from broiled steak may be given a child at about the eighth or ninth month, or, in cases of anemia, earlier than this. It is given before the milk feeding, diluted with an equal amount of water. At first a teaspoonful of the extracted juice should be given with the same quant.i.ty of water; increase every four days until at the end of two or three weeks two tablespoonfuls are given.

WHITE OF EGG.--Place an egg in boiling water and allow the water to cool with an egg in it. In ten minutes the white of the egg will be coagulated and ready for use. It may be used in place of the beef juice if the latter does not agree and may be begun at the sixth month and given once daily. One-half of the white of the egg should be tried, then at the end of a week, if it agrees with the child, the whole white of one egg may be given.

ORANGE JUICE.--This juice has a good effect on the bowels and may be given even to very young children who are disposed to be constipated. It is also of benefit in counteracting the effect of boiled milk. The juice should be extracted from fresh oranges and strained. One teaspoonful may be given at first one hour before a feeding. The amount may be increased until four teaspoonfuls, or one tablespoonful, are given daily.

PEPTONIZED MILK.--The object of peptonization of milk is partly or wholly to digest the casein, or curd, of the milk before feeding.

Fairchild's Peptonizing Powder is used for this purpose. The powder is put up in tubes, and instructions are furnished in each box as to its use.

There are two methods of using the powders:

THE HOT OR IMMEDIATE PROCESS.--Fifteen minutes before feeding add from one-eighth to one-quarter of the contents of a tube to the milk mixture in the nursing bottle ready for use. The bottle is then put in water at a temperature of from 110 to 120 F., and allowed to remain in the water for fifteen minutes. The amount of the powder used and the temperature of the water depend upon the amount of milk in the nursing bottle.

THE COLD PROCESS.--Four ounces of cold water are put into a clean quart bottle and the powder from one of the tubes. Shake the mixture thoroughly until the powder is dissolved. Add a pint of cold fresh milk, shake the bottle again and place directly on ice. When any of this milk is used the bottle should be again shaken and put immediately back on ice.

If necessary this process may be modified so that partially or completely peptonized milk may be made.

PARTIALLY PEPTONIZED MILK.--Put four ounces of water and a whole tube of powder into a clean pan and stir well; add a pint of cold milk and heat to the boiling point, stirring the mixture all the time. There should be enough heat to bring the milk to the boiling point in ten minutes. Allow the mixture to cool somewhat and strain into a clean jar, cork tightly and keep in a cool place. Shake the jar before and after using any of the contents.

If partially peptonized milk is properly prepared it should not become bitter.

COMPLETELY PEPTONIZED MILK.--Put four ounces of cold water and the powder contained in one of the tubes into a clean quart bottle and shake thoroughly. Add a pint of cold fresh milk and shake again; then place the bottle in a pan of warm water about 115 F., or not too hot to place the hand in comfortably. Keep the bottle in the water bath for thirty minutes; then place the bottle directly on ice.

USES OF PEPTONIZED MILK.--Partially peptonized milk is useful in young infants who have difficulty in digesting the curd of milk. Completely peptonized milk is frequently used during attacks of indigestion. It is used also to tide a delicate infant over a period when for some reason the digestive apparatus refuses to digest and a.s.similate even dilute mixtures. It is of value also in acute or chronic illness when the child has to be fed through a tube. When it is necessary to feed per r.e.c.t.u.m peptonized foods are often selected in preference to others.