OBJECTIONS TO PEPTONIZED MILK.--Complete peptonization of milk renders the milk bitter. For this reason many children will not take it. Very young children whose sense of taste is not developed may be induced to take it after a few days. It is not wise to continue its use long because the function of the stomach will become accustomed to the use of predigested food and refuse to work when called upon. If it is used for a number of weeks it is wise to stop it gradually in order to permit the stomach to resume its function in a normal way.

WHAT A MOTHER SHOULD KNOW ABOUT BABY'S FEEDING BOTTLE AND NIPPLE.--In the first place, always buy round bottles,--round everywhere, inside and out,--there should be no corners anywhere. The reason for this is, that bottles that are round everywhere, are easily cleaned, and can be thoroughly cleaned, and having no corners they do not lend themselves to collecting dirt and bacteria. When these bottles are first bought they should be boiled. After each feeding they should be thoroughly washed with soap or washing powder. A long-handled bottle brush should be used to help clean the bottle. After the bottle has been thoroughly rinsed a number of times with hot water, it should be set aside filled with warm water into which one teaspoonful of bicarbonate of soda has been put.

Before filling them with the freshly prepared food each morning the bottles should be boiled. Every mother with a bottle-fed baby should buy a dozen bottles, all of the same kind and size to begin with. This is a great advantage for a number of important reasons, two or three of which I will mention:

1st. Having enough bottles means that each bottle will be used once only during the twenty-four hours; there is less chance therefore of a bottle being cleaned carelessly.

2nd. Having a fresh bottle for each feeding permits all of the food for twenty-four hours being made at one time. This ensures uniformity of quality of each feeding.

3rd. By cleaning all the bottles at one time (previous to filling) it is more apt to be done thoroughly; and by making all the food for a day at one time it is more apt to be correct than if each feeding was made separately.

The baby's nipple should be made of plain black rubber. It should not be too thick because it is necessary to turn it inside out in order to clean it thoroughly. The hole in the nipple should not be too large--if the child can empty the bottle in less time than fifteen minutes the hole is too large. If the milk drops out but does not run it is about right. Don't buy nipples too long or too large. A long nipple tends to gag the child and cause vomiting. A large nipple prevents the child from sucking properly and usually allows the food to be taken too quickly and with air, which causes colic and indigestion. It is well to have always half a dozen nipples of the right kind on hand. When new, nipples should be boiled before using. After each feeding the nipple should be washed in borax and water on both sides, then it should be put in a dish containing fresh, cold, borax water and left there until again required.

A large portion of the success of raising healthy, bottle-fed babies is in being everlastingly clean in the details of caring for the bottles and nipples which are in daily use.

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?--This is a question that cannot be answered by a simple yes or no. A great deal depends upon circ.u.mstances, and these circ.u.mstances must be weighed and counterweighed before an answer is given. It is a serious matter, in our judgment it is a criminal proceeding for a physician to advise the use of an artificial food without exhausting every aid and means to preserve and increase the mother's milk. This is a subject in need of earnest missionaries in all walks of life, and it should be the duty of every woman's club and gathering to voice the conviction of the highest womanhood by advocating the use of mother's milk with every child born.

A woman who can and will not nurse her own child is scarcely deserving of the name of mother.

It does not seem quite human to deprive a baby of the milk which rightfully belongs to it; yet in certain walks of life this is not an uncommon procedure. On the other hand the percentage of women able to nurse their children is decreasing. This is especially true as applied to cities, though it is also true, in a less degree, in the rural districts. One eminent authority states that less than twenty-five per cent. of the well-to-do mothers, who have earnestly and intelligently attempted to nurse their babies, succeed in doing so for a period longer than three months. This authority also says: "An intellectual city mother who is able to nurse her child successfully for the entire first year is almost a phenomenon." Women nowadays have so many diversified interests, that the primal duty of maternal nursing is not at all a fashionable function. If, however, the mother is willing, and has conscientiously tried to nurse her baby, and after seven or eight days it is found that she has not enough milk to satisfy it, and if the quality seems to be good, some expedient should be immediately adopted to tide the condition over until the mother resumes her customary household routine. The safest expedient under these circ.u.mstances is to alternate the feedings; one feeding from both b.r.e.a.s.t.s of the mother, and the next an artificial food. Some arrangement of this kind is the just and the safest way, because a very large percentage of mothers suffer from inactivity while lying in bed after a confinement. This inactivity expresses itself in a failure of some of the organs to perform their duty properly. This may affect the quant.i.ty, and sometimes the quality, of the milk, but it is, as a rule, quickly rectified as soon as the mother is up and active.

If, however, the milk is still found to be inadequate after she is up and has resumed her usual habits, and if her health is good, and she is eating well, it is distinctly best to put the child exclusively on an artificial diet.

CERTAIN CONDITIONS JUSTIFY THE ADOPTION OF ARTIFICIAL FEEDING FROM THE BEGINNING

1st. Woman suffering with any wasting disease such a cancer or tuberculosis. (One of these days, and very soon we hope, it will be legally impossible for a tubercular or cancerous patient to become a mother.)

2nd. When a mother is the victim of any of the serious childbed complications such as convulsions, kidney disease, extensive loss of blood or blood poisoning, or runs a high temperature because of some disease occurring at the same time as the confinement, as, for example, appendicitis, scarlet fever, typhoid fever, etc.

3rd. Epilepsy, ch.o.r.ea, insanity, are also conditions which render artificial feeding necessary.

It is much wiser immediately to put the child on artificial feeding if there is a justifiable reason for it than to experiment, because any experiment at this time is almost certain not to be in favor of the child. Artificial feeding is a comparatively easy and successful problem, provided it is begun with healthy digestive organs. If you keep the child at the breast of a mother whose milk is inadequate in quant.i.ty or quality, or both, for two or three days, and then begin artificial feeding, the child's stomach is already unable to perform its duty, and you have to treat it with the greatest degree of care and attention, and probably begin with a weak food, until you regain the lost ground.

MOTHERS' MISTAKES IN THE PREPARATION OF ARTIFICIAL FOOD.--Another interesting condition which is quite common, is the tendency on the part of the mother to fail to follow instructions correctly,--even though written or printed,--regarding the preparation of the baby's food. When the baby is not thriving and gaining steadily in weight, or is fretty and cries a good deal, and does not rest and sleep peacefully, something, of course, is wrong. If, after a careful physical examination of the child, nothing is found to justify these symptoms, a physician invariably finds, if he questions the mother closely, that she has mistaken the instructions and is preparing the food wrongly.

Infinite care in every little detail is the price of success in raising babies as well as in every other field of human endeavor. Revise carefully your method of preparing baby's food if there is any trouble such as is described above. Despite your absolute a.s.surance that you are making no mistake, do not be surprised to find that you are not following directions to the letter, and because of this unintentional mistake, your negligence is responsible for your baby's condition. Go over the instructions with your husband, and let him follow your method of preparation, as you repeat it. He may detect the mistake if any exists,--two heads are always better than one. So important is this matter that the following two actual cases will demonstrate how easy it is to make a mistake, despite the absolute confidence of the mother, in each case, that she was following the printed directions correctly:

I was called to see a baby whose mother informed me that it was having a great deal of trouble. It was apparently not thriving; its bowels were bad; it constantly cried, and seemed to be suffering from colic and indigestion. The mother stated that it lay with its legs constantly drawn up and pa.s.sed enormous quant.i.ties of gas. The baby certainly looked sick. It had been a small baby at birth; and at three months it weighed only six pounds. After a careful examination, I could find nothing in the physical condition of the child itself, which satisfactorily explained the condition, and had made up my mind that the food upon which it was being exclusively fed, and upon which it had been fed since birth, was not agreeing with it. Before recommending a change of food, I asked the mother to state in detail just how she prepared it.

The directions printed on the can in which the food was bought called for so many ounces of a certain quality of "top milk." She thought this meant simply so many ounces off the top of a bottle of milk, which, of course, meant that she was feeding her baby exclusively a very rich cream and absolutely no milk. The result was that the baby--small and weak to begin with--could not digest this rich mixture, so it gradually lost vitality, as the mother kept increasing the strength of the food, according to the age, as directed by the instructions, until it was completely knocked out. I pointed out her mistake and suggested a change in her methods; she was instructed to use the formula for a child of two months, instead of the one for three months, as she was doing. The child immediately began to pick up and in the course of six weeks was entirely cured, and had gained considerably in weight. This mother was a careful, clean, painstaking, attentive nurse, and it was a long time before she forgave herself for the mistake. The mistake here was a little matter, but the results were big and convincing.

The second case was that of a child of about the same age, but in this instance it had been a robust, healthy child when born, and of normal weight and size. The mother nursed it for about one month, when her milk failed, and it was put upon a well-known, patent barley preparation. The food seemed to agree with it for a time, but, as the mother explained, the child soon seemed to be dissatisfied at each feeding,--it gave her the impression that it was not getting enough to eat, so she increased the quant.i.ty. Despite this increase of food, it was apparent that the baby was getting weaker, and more and more irritable, and sleepless, until there was no rest night or day for the mother or baby. About this time the child began to "swell up" as if dropsical; it lost its healthy color and looked as if made of wax. It was very evident that the child was being starved, yet this scarcely seemed probable when the actual quant.i.ty of food consumed was considered. The directions on the can of this food, called for a certain amount of the barley powder to be mixed with boiled water; and in an additional paragraph it was directed to mix this with a certain amount of milk. When I requested the mother to state how she prepared the food, I was astonished to learn that she had evidently never read the second paragraph of the directions. She was feeding her baby on barley powder and boiled water,--an excellent starvation diet. When her attention was called to the grave carelessness she had been guilty of, she was the most contrite mother I ever knew. As soon as the milk was added to the food the baby immediately began to thrive was very soon a robust, healthy infant.

Of course these were errors of bad judgment and gross negligence of which few mothers would be guilty, but these types of mistakes come to the attention of physicians frequently, and emphasize the need of constant vigilance in every detail in the management of babies if we wish to achieve success.

FEEDING DURING THE SECOND YEAR

At the beginning of the second year the child should be fed at the following hours, 6 and 10 A. M., 2, 6, and 10 P. M.

Early in the second year the child should be taught to drink from a cup.

A proper diet for a child of twelve months, of average development, would be as follows:

6 A. M. Milk and barley water, or milk and oat gruel, in the proportion of seven ounces of milk to three ounces of the diluent.

9 A. M. The juice of an orange (strained).

10 A. M. The same as at 6 A. M.

2 P. M. Chicken broth with rice or stale bread crumbs, six ounces; or a light boiled egg mixed with stale bread crumbs; or beef juice, three ounces. Milk and gruel same as at 6 A. M., but four ounces only.

6 P. M. Two tablespoonfuls of cereal jelly in eight ounces of milk; a piece of stale bread and b.u.t.ter. (The jelly is made by cooking the cereal for three hours the day before it is wanted; it should then be strained through a colander; oatmeal, barley, or wheat may be used.)

10 P. M. Same as at 6 A. M.

About the fifteenth month the cereals may be given much thicker and fed with a spoon. The child can at this time take a number of various fruit juices. Orange juice is the best. Carefully strained juice of ripe peaches, strawberries, raspberries, may be given in reasonable amounts, one or two tablespoonfuls, once daily. Custard, cornstarch, plain rice pudding, junket, wheatena, cornmeal, hominy, oatmeal, zwieback, bran biscuit, each with b.u.t.ter, may be added in reasonable quant.i.ties between the eighteenth and twenty-fourth months. When cereals are given they should be thoroughly cooked, usually for three hours, and strained. When apple sauce is given to a child about the second year it should contain very little sugar and baked apples should be fed without cream. Water must be given to the child between meals especially during the summer.

It should be boiled and cooled kept in a cool place. The following schedule for a child about the third year const.i.tutes a good average diet for a healthy child:

TABLE OF STANDARDS

(As Adopted and Copyrighted by the American Medical Society)

PHYSICAL DEVELOPMENT

[Transcriber's Note: The ages were difficult to read and may not all be correct.]

Age in Months Weight Height Circ.u.mference of head Circ.u.mference of chest Circ.u.mference of abdomen Lat. Diameter of chest Chest front to back Length of arm Length of leg ------------------------------------------------------------------------------- lbs. in. in. in. in. in. in. in. in.

6 17 27 17-1/2 17-1/2 17-1/2 5 4-1/2 10 10 9 19 28 18 18 18 5 4-1/2 11 11 12 20 29 18-1/2 18-1/2 18-1/2 5 4-3/4 12 12-1/2 16 23 30 18-1/2 18-1/2 18-1/2 5-1/2 5 12-1/2 13-1/2 21 24 31 18-1/2 19-1/2 19-1/4 6 5 14 15 24 25 32 19 20 19-1/2 6 5 14-1/2 15-1/2 28 27 33-1/2 19 20 19-1/2 6 5 14-3/4 15-3/4 32 29 35 19-1/2 20-1/2 19-1/2 6-1/4 5-1/2 14-3/4 15-3/4 36 32 36-1/2 20 21 20 6-1/4 5-1/2 15 16-1/2 ===============================================================================

MENTAL DEVELOPMENT

Attention, facial expression, irritability and disposition should be considered.

Six Months

Child sits unsupported for a few minutes.... Balances head....

Eye follows a bright object.... Looks in direction of an unexpected sound.... Child seizes an object and holds it....

Twelve Months

Stands and walks with support.... Makes a few sounds, such as mam-mam, da-da, co-oo.... Plays with toys.... Attempts to use paper and pencil.... Shows interest in pictures.... Clings to mother....

Eighteen Months

Child walks and runs alone.... Says a few words, such as Mama, Papa, Baby.... Points to common objects in pictures....

Imitates a few simple movements, such as placing hands on head or clapping hands....