We have seen some mothers, in their anxiety to prevent the sucking in of air from the emptied bottle, rush in and jerk the nipple from the going-to-sleep babe so forcibly that all thoughts of sleep vanished and a crying spell was initiated. The tactful mother is the quiet one who slowly, quietly, draws the empty bottle with its "much loved nipple" from the lips. If you observe that the babe is going to sleep, with an occasional superficial draw at the nipple, wait a moment; he will drop it himself, and you can pick it up as you quietly leave the room. In all instances, whether it be indoors or out of doors, arrange the babe in a comfortable sleeping position, remembering that nursing is warm exercise and the babe gets uncomfortably sweaty if overbundled, especially about the head and neck. No one should unnecessarily touch the babe immediately after feeding; even his diaper may be changed without awakening him while he is thus lying quietly in his bed.

INTERVALS BETWEEN MEALS

The three-hour interval is reckoned from the beginning of the meal, and not from its close. More than two hours is spent in the stomach digestion, and any food or sweetened water which may enter between meals only tends to cause indigestion and other disturbances. And that this important organ may have a bit of rest, we fix the interval at three hours, which in our experience and that of many other physicians, has yielded good results. As a rule we have no regurgitation and no sour babies on the three-hour schedule. Sick babies, very weak babies, and their feeding time, will be discussed in a later chapter.

ADDITIONAL FOODS

At six months, and often as early as four, in cases of constipation, unsweetened, well-strained prune juice may be given, beginning with one-half teaspoon one hour before the afternoon feed and increasing it daily until two tablespoons are taken. At six months, both orange juice and vegetable broths are given, whose vegetable salts add a very important food element to the baby's diet--an element which our grandmothers thought could only be obtained through the time-honored "bacon rind" of by-gone days.

Orange juice is also unsweetened and well strained, and is administered in increasing amounts, beginning with one-half teaspoon one hour before the afternoon feeding, until the juice of a whole orange is greedily enjoyed by the time of the first birthday. The vegetable juices are obtained from cut-up spinach, carrots, tomatoes, and potatoes, strained, with a flavor of salt and onion--really a bouillon--and is given just before the bottle at the six P. M.

feeding. They are also begun in teaspoon amounts.

FOOD FOR THE TRAVELING BABE

Baby travel should be reduced to a sheer necessity; never should the babe be subjected to the exposure of disease germs, the change of food, the possibilities of draughts and chilling, for merely a pleasure trip--the risks are too great and the possibilities of future trouble too far reaching.

If you are in touch with the milk laboratory of a large city, you will find that they make a specialty of preparing feedings which are good for a number of days for the traveling baby, and we strongly advise that their preparations be accepted; but in the event of not being in touch with such a laboratory we suggest the making of a carrying ice-box covered with wicker, which must be kept replenished with ice.

Food kept in such a device may be kept fresh for twenty-four to forty-eight hours. Plans other than the laboratory preparations or the ice-box are risky, and should not be depended upon.

Many of our railway dining cars now pick up fresh, certified milk at stations along the line for use on their tables, and where such is the case fresh preparations of milk may be made on a trans-continental trip by the aid of an alcohol stove. Malted milk may also be used, provided you have accustomed the baby to its use a week before leaving home, by the gradual subst.i.tution of a fourth to a half ounce each day in the daily food; all of which, of course, should be done under your physician's direction.

If possible, leave baby at home in his familiar, comfortable environment in the care of a trained nurse and a trusted relative, and under the supervision of the baby's own physician. He is much better off, much more contented, and we are all aware of the fact that contentment and familiarity of sights and people promote good appet.i.te, good digestion, and happiness--the very essentials of success in baby feeding. We speak touchingly and sympathetically to the mother who must leave her babe; and likewise we wish to cheer her as we remind her that by wireless messages and night letters it is possible to keep in touch with loved ones though a thousand miles away.

The sanitation and modification of cow's milk, as well as stools, etc., are taken up in later chapters.

RULES FOR THE BOTTLE-FED

1. Never play with a baby during or right after a meal.

2. Lay the baby on his side when nursing the bottle.

3. Three full hours should intervene between feedings.

4. Don't give the food too hot--it should just be warm.

5. Make the test for warmth on the inner side of your arm.

6. Give a drink of water between each meal if awake.

7. Never save the left-overs for baby.

8. If possible, give three feedings each day in the cool air, with baby comfortably warm.

9. Do not jump, bounce, pat, or rock baby during or after meals.

10. Never coax baby to take more than he wants, or needs.

11. No solid foods are given the first year.

12. Orange juice may be given at six months; while, after four months, unsweetened prune juice is better than medicine for the bowels.

CHAPTER XVII

MILK SANITATION

Cow's milk, like mother's milk, is made up of solids and water. In a previous chapter we learned that in one-hundred parts of mother's milk, eighty-seven parts were water and thirteen parts were solid.

These thirteen parts of solids consist of sugar, proteins, and salts; this is likewise the case with cow's milk, except that in the case of the cow's milk, the sugar is decreased while the proteins are increased as will be noted by the accompanying comparative a.n.a.lysis:

MOTHER'S MILK

Fat % 4.00 Sugar 7.00 Proteins 1.50 Salts 0.20 Water 87.30 ------ % 100.00

COW'S MILK

Fat % 4.00 Sugar 4.50 Proteins 3.50 Salts 0.75 Water 87.25 ----- % 100.00

Mother's milk is absolutely sterile, that is, free from the presence of germs; on the other hand, cow's milk is anything but sterile--the moment it leaves the udder it begins to acc.u.mulate numerous bacteria, all of which multiply very rapidly. Cow's milk is generally twenty-four to forty-eight hours old before it can possibly reach the baby. It is just as important to keep in mind these facts of milk contamination--dirt, filth, flies, and bacteria--as it is to plan for the modification of cow's milk for the purpose of making it more nearly resemble mother's milk. While mother's milk has about the same percentage of fat as cow's milk, it is almost twice as rich in sugar, and has only one-fourth to one-third as much protein. This protein is vastly different from that found in cow's milk, which you recall has a tough curd, as seen in cottage cheese. While mother's milk contains a small amount of casein similar to that found in the cheese of the cow's milk, the princ.i.p.al protein const.i.tuent is of another kind (lactalb.u.min), and is much more easy of digestion than the casein of cow's milk.

This is a most important point to remember, because the baby's stomach is not at first adapted to the digestion of the heavier and tougher protein curds of cow's milk. It requires time to accustom the infant stomach to perform this heavier work of digestion. There are a number of factors which must be borne in mind in the modification of milk, whether it be cow's milk, or goat's milk (for many European physicians use goat's milk entirely in the artificial feeding of infants): namely, the cleanliness of the milk, the acidity of milk, the difference in the curd, the percentage of sugar, and the presence of bacteria.

SUGAR

In the modification of cow's milk, sugar must be added to make up for the sugar which is decreased when the water was added to reduce the protein. There are several sorts of sugar used in the modification of milk. These sugars are not added to sweeten the milk alone, but to furnish a very important element needed for the growth of the baby.

Sugar is the one element which the infant requires in the largest amount.

Milk sugar is probably most universally used in the modification of milk, but a good grade of milk sugar is somewhat expensive, costing from thirty to sixty cents a pound, and this places it beyond the reach of many mothers. It is added to the food mixtures in the proportion of one ounce to every twenty ounces of food. Cane sugar (table sugar) may also be used, but it must be clean and of good quality. It is used in rather less quant.i.ty than that of milk sugar, usually from one-half to one-third of an ounce by measure to each twenty ounces of food. Dextri-maltose (malt sugar) is very easy of digestion and may be used in the modification of milk. Maltose seems to help the children to gain more rapidly in weight than when only milk or cane sugar is used. It is also exceedingly useful in constipation, as its action is more laxative than any of the other sugars; but it should not be given to children who vomit habitually or have loose stools.

ACIDITY

Like mother's milk, the cow's milk is neutral as it comes from the udder; but, on standing, it quickly changes, soon becoming slightly acid, as shown by testing with blue litmus paper. In fact, what is known as ordinarily fresh milk, if subjected to the litmus paper test, always gives an acid reaction. This acidity is neutralized by adding lime water to the formula in the proportion of one ounce to each twenty-ounce mixture. Ordinary baking soda is sometimes prescribed by physicians in place of the lime water. In the event of obstinate constipation, milk of magnesia is sometimes added to the day's feedings.

CREAM

There may be procured in any large city an instrument called the cream gauge, which registers approximately (not accurately) the richness of milk. Some milk, even though rich, parts with its cream very slowly; while some poor milk allows nearly all the cream quickly to rise to the surface. We know of no way for the mother to determine the amount of cream (without the cream gauge) except by the color and richness of the milk. In cities it is very convenient to send a specimen of the milk to the laboratories to be examined by experts, who will gladly render a report to both physician and mother.

The lactometer is a little instrument used to estimate the specific gravity of milk. An ordinary urinometer such as used by physicians in estimating the specific gravity of urine may also be used. The specific gravity of cow's milk should not register below 1028 or above 1033.

[Ill.u.s.tration: Fig. 11. A Sanitary Dairy

_Courtesy of Lakewood Farm_

_Courtesy of Lakewood Farm_]

HERD MILK

Milk from a single cow is not to be desired for baby's food because of its liability to vary from day to day, not to mention the danger of the cow's becoming sick. Authorities have agreed that herd milk of Holstein or ordinary grade cows is best for infant feeding. This mixed-herd milk contains just about the proper percentage of fat; whereas, if Jersey milk must be used, some of the cream should be taken away. Our milk should come from healthy cows which have been tested for tuberculosis at least every three months.