1. Progressive loss in weight.

2. A bad diarrhea of long standing; one which does not yield to the usual remedies, at least not as long as the baby continues to feed from the breast. These diarrheas are especially serious when accompanied by a steady loss in weight.

3. Excessive vomiting accompanied by progressive loss in weight.

THE WET NURSE

Because of the rarity of good, healthy wet nurses, it is always better to attempt to feed the baby with scientifically modified milk (not proprietary foods), good, clean, cow's milk properly modified to suit the weight and age of the child. We put weight first, for we prepare food for so many pounds of baby rather than for the number of months old he is.

If modified food has failed and the best specialist within your reach orders a wet nurse; she must have the following qualifications:

1. She must be free from tuberculosis and syphilis.

2. She should be between twenty and thirty years of age.

3. She should abstain from all stimulants.

4. She should be amiable, temperate, and should sense her responsibility.

If an unmarried mother of her first child is engaged as a wet nurse, she should not be "stuffed" or allowed to overeat, which is commonly the result of moving her from her lower life into more comfortable surroundings, or given ale or beer to increase her milk. She should continue her normal eating, take light exercise, which does not mean the scrubbing of floors or doing the family washing, and live under the same hygienic regime outlined for the nursing mother. Should she be the mother of the second or third illegitimate child, then she is quite likely to be mentally deficient and she should not be engaged.

Her own babe will have to be fed artificially as very few mothers can endure the strain of two suckling children.

The baby's own mother should keep general supervision and not turn her babe entirely over to the care of the wet nurse. Remember always that no one in the wide world will ever take the same mother interest in your offspring that can spring from your own mother heart.

CHAPTER XVI

THE BOTTLE-FED BABY

In taking up the subject of the bottle-fed baby, we must repeat that the only perfect baby food on earth is the milk that comes from the breast of a healthy mother.

But sudden illness, accident, chronic maladies, or possibly the death of the mother, often throw the helpless babes out into a world of many sorts and kinds of artificial foods--foods that are prepared by modifying cow's, a.s.s', or goat's milk; foods arranged by the addition to the milk of various specially prepared cereals, alb.u.mens or malted preparations, otherwise known as "proprietary foods." We shall endeavor, then, in this chapter and in that on "the feeding problem,"

to lay down certain general suggestions to both the nurse and the mother, which may a.s.sist them in their effort to select the food which will more nearly simulate nature's wondrous mother-food, and which will, at the same time, be best suited to some one particular baby.

THE HOURLY SCHEDULE

The normal baby, from birth to six months, should receive properly prepared nourishment every three hours, beginning the day usually at six A. M., the last feeding being at nine P. M. During the early weeks an additional bottle is given at midnight, but this is usually discarded at four months, at which time the last feeding should be given at about ten instead of at nine at night.

Should the baby continue to awaken during the night before six in the morning, unless he is under weight, a bottle of warm, boiled, unsweetened water should be given.

QUANt.i.tY OF FOOD

The quant.i.ty of food to be given is always determined by the size of the baby's stomach, which, of course, depends somewhat upon the age of the child; for instance, the stomach of the average baby one week old holds about one ounce, while at the age of three months the stomach holds five ounces; so it would not only be folly to give two ounces at one week and seven ounces at three months, but it would also be very detrimental to the babe, causing severe symptoms due to the overloading of the stomach.

Careful study of the size of the stomach at different ages in infancy, together with the quant.i.ty of milk drawn from the breast by a nursing baby, has led to the following conclusions regarding the capacity of the baby's stomach:

AGE QUANt.i.tY

1--4 weeks 1--2 ounces 4 weeks--3 months 2--4 ounces 3 months--6 months 4--6 ounces 6 months--1 year 6--8 ounces

REFRIGERATOR NECESSITY

It is highly important that the day's feedings be kept in a cold place, free from the odors of other foods as well as free from dust, flies, and filth. In order that this may be accomplished, the well-protected bottles, each containing its baby-meal, are placed in a covered pail containing ice and water. This covered receptacle is now put in an ice box; and, in order that our most economical reader--one who may feel that she cannot afford to keep up the daily expense of the family refrigerator--may herself prepare a simple home refrigerator, the following directions are given (Fig. 9).

HOMEMADE ICE BOX

Procure a wooden box about eighteen inches square and sixteen or eighteen inches deep and put four inches of sawdust into the bottom; now fill in the s.p.a.ce between a ten-quart pail, which is set in the middle of the box with more sawdust. A cover for the box is now lined with two or three inches of newspaper, well tacked on, and is fastened to the box by hinges. We are now ready for the inside pail of ice, into which is carefully placed the well-protected bottles of milk, all of which is then set into the ten-quart pail in the box.

Five cents worth of ice each day will keep baby's food cool, clean, and provide protection against the undue growth of germs.

[Ill.u.s.tration: Fig. 9. Homemade Ice Box]

PREPARING THE BOTTLE

At each feeding hour, one of baby's bottled meals is taken from the ice box and carefully dipped in and out of a deep cup of hot water. A very convenient receptacle is a deep, quart aluminum cup, which may be readily carried about. The hot water in the cup should amply cover the milk in the bottle (Fig. 10).

To test the warmth allow a few drops to fall on the inner side of the arm, where it should feel quite warm, never hot. A baby's clean woolen stocking is now drawn over the bottle, which keeps it warm during the feeding. No matter how great the danger of offending a fond grandparent or a much adored friend never allow anyone to put the nipple in her mouth to make the test for warmth of baby's food.

There are many contrivances, both electrical and alcoholic, for heating baby's bottle, many of which are both convenient and inexpensive.

POSITION DURING FEEDING

And now we realize that we are about to advise against the time-honored injunction which has been handed down from "Grandma This"

and "Mother That" to all young mothers who have lived in their neighborhoods: "My dear young mother, if you can't nurse your precious infant, you can at least 'mother it' at the nursing time by holding it in your arms and gently rocking it to and fro as you hold the bottle to its lips." This so-called "mothering" has resulted in regurgitation, belching, and numerous other troubles, as well as the formation of the "rocking habit."

A young mother came running into my office one day saying: "Doctor, it won't work, the food's all wrong; my baby is not going to live, for he throws up his food nearly all the time." We arranged to be present when the next feeding time came and watched the proceedings. A dear old friend had told her "she must 'mother' her baby at the nursing time," and so she had held the child in a semi-upright position as she endeavored to hold the bottle as near her own breast as was possible.

The hole in the nipple was a bit large, which occasioned the subsequent bolting of the food, and then to continue the "mothering"

she swayed him to and fro, all of which was interrupted suddenly by the vomiting of a deluge of milk.

[Ill.u.s.tration: Fig. 10. Heating the Bottle]

I drew the shade in an adjoining room, opened the windows, and into a comfortable carriage-bed I placed the baby on his side. Seating myself beside him I held the warm, bottled meal as he nursed. Several times I took it from his mouth, or so tipped it that "bolting" was impossible.

Gradually, carefully, and slowly, I took the empty bottle away from the sleepy babe, and as I closed the door the mother said in anxious amazement: "He won't forget I'm his mother if I don't hold him while he nurses?" You smile as I smiled at this girl-mother's thought; but, nevertheless there are many like her--anxious, well-meaning, but ignorant.

The infant stomach is little more than a tube, easily emptied if the baby's position is not carefully guarded after nursing. No bouncing, jolting, patting, rocking, or throwing should take place either just before, during, or immediately after meals.

TIME ALLOWANCE FOR ONE FEEDING

From twelve to twenty minutes is long enough time to spend at a bottle meal. The nipple hole may have to be made larger, or a new nipple with a smaller hole may have to be purchased. When new, you should be able to just see a glimmer of light through the hole, and if the infant is too weak to nurse hard, or the hole too small, it may be made larger by a heated hatpin run from the inside of the nipple out; great care must be taken, else you will do it too well. If the nipple hole is too large, bolting is the sure result; while too small a hole results in crying and anger on the part of the hungry child, because he has to work too hard to get his meal.

AFTER THE FEED