Part 24
18. Refrigeration.
BOTTLES AND NIPPLES
There is but one bottle which can be thoroughly washed and cleaned, and that is the wide-mouthed bottle. It should hold eight ounces and should have the scale in ounces blown in the side (Fig. 10). The nipple for this bottle is a large, round breast from which projects a short, conical nipple, which more nearly resembles the normal breast than do the old-fashioned nipples so frequently seen on the small-necked nursing bottles. There is a great advantage in this, in that the baby cannot grasp the nipple full length and thus cause gagging. These bottles and nipples are known as the "Hygeia," and have proven to be a great source of comfort to the baby as well as to the mother or nurse whose duty it is to keep them clean. There are a number of other nursing bottles on the market, which, if they are used, must be thoroughly cleansed with a special bottle brush each day. The neck is small and the nipple is small and great care must be taken in the cleansing of both of them.
CARE OF BOTTLES AND NIPPLES
When there is a bottle for each individual feeding in the day, immediately after each nursing both bottle and nipple should be rinsed in cold water and left standing, filled with water, until the bottles for one day's feeding have all been used. The nipples should be scrubbed, rinsed, and wiped dry and kept by themselves until their boiling preparation for the following day's feeding.
[Ill.u.s.tration: Fig. 12. Articles Needed for Baby's Feeding]
If the same bottle is to be used for the successive feedings during the day, it should be rinsed, washed with soap and water, and both bottle and nipple placed in cold water and brought quickly to the boiling point and allowed to boil for fifteen minutes. No bottles or nipples must ever be used after a mere rinsing; boiling, preceded by a thorough washing in soap and water, must take place before they are used a second time.
New nipples are often hard and need to be softened, which is readily done by either prolonged boiling or rubbing them in the hands.
All new bottles should be annealed by placing them on the stove in a dishpan of cold water and allowing them to boil for twenty minutes, and then allowing them to remain in the water until they are cold.
When bottles are treated in this manner they do not break so readily when being filled with boiling water or hot food.
PREPARING THE FOOD
In a large preserving kettle place all the utensils needed in the preparation of the food--pitcher, spoon, fork, measuring gla.s.s, bottles, nipples, cheesecloth for straining, agate cup, wire strainer, in fact everything that is to be used in the preparation of the food.
Now fill the kettle with cold water and place over the gas and allow to boil for fifteen minutes. On a well-scrubbed worktable place a clean dish towel, and on this put the utensils and the bottles right side up. The nipples on being taken out of the boiling water will dry of themselves; they should be placed in a gla.s.s-covered jar until they are needed for each individual feeding, the nipples not being placed on the bottles as they go to the ice box.
Having been given your formula by your physician, proceed in the following way. Suppose we were preparing the food for a normal two-months old baby that weighed ten pounds, with the prescription as follows:
BABY SMITH.
R_{x}
Whole Milk ounces 11 Cane Sugar level tablespoons 2 Boiled Water ounces 12 Lime Water ounces 1 Amount at Each Feeding ounces 3 Number of Bottles 7 Interval Between Feedings hours 3
DETAILS OF PREPARATION
Two level tablespoons of cane sugar are placed in the agate cup and dissolved in a small amount of boiling water. The solution should be perfectly clear, and if it does not clear up put it over the heat for a few moments.
This is now turned into the eight-ounce measuring gla.s.s which is then filled with boiling water and emptied into the two-quart pitcher. We need four and one-half more ounces of boiling water to complete the prescription requirement of twelve and one-half ounces.
The bottle of milk, if properly certified, need not be pasteurized; but if it is not, it should have been previously pasteurized while the utensils were boiling according to the suggestions found in the chapter on "milk sanitation." The top of the milk bottle should be thoroughly rinsed and wiped dry, and after a thorough shaking of the milk, the cover is removed with the sterile fork and eleven ounces are measured out by measuring gla.s.s and poured into the pitcher. All is now stirred together with an ounce of lime water, which should never look murky, but should be as clear as the clearest water and should always be kept in the ice box when not in use.
The sterile cheesecloth which has been boiled for fifteen minutes is now put over the nose of the pitcher, the contents of which is accurately measured into the seven clean, empty bottles, each containing three and one-half ounces. Over the top of each of the nursing bottles is placed a generous piece of waxed paper which is held down by a rubber band. Each meal for the day is now contained in a separate bottle, and all are placed in a covered pail of water containing ice, and put in the ice box.
If the prescription for the baby's food contains gruel, it is prepared in the following manner:
Suppose the baby is eight months old and the prescription called for two level tablespoons of flour and eight ounces of boiled water. The two level tablespoons of flour, whether it be wheat (ordinary bread flour), or barley flour, are put into a cup and stirred up with cold water, just as you would stir up a thickening for gravy; now measure out eight ounces of water and allow it to come to a boil in the inner pan of the double boiler, into which the thin paste is stirred until it comes to a boil. After boiling for twenty minutes, remeasure in the measuring gla.s.s and what water has been lost by evaporation must be added to complete accurately the prescription requirement of eight ounces; this is now added to the other ingredients of the prescription.
TABLE FOR INFANT FEEDING
We now offer a monthly schedule--a table which is the result of our experience in feeding hundreds of babies in various sections of Chicago. It is not a schedule for the sick baby, but it is a carefully tabulated outline for the normal, healthy, average child ranging from one week to one year in age. In offering this table we remind the mother, if the baby is six months old and not doing well on the food it is getting and a change is desired by both mother and physician, that it is far better to begin with the second or third month's prescription and quickly work up to the sixth month's. This change may often be accomplished in two or three days.
In all large cities there are to be found milk laboratories which make it their business to fill prescriptions for the modification of milk under the direction of baby specialists. This milk can be absolutely relied upon. In specialized diet kitchens in many large hospitals, these feeding prescriptions also may be filled.
ARTIFICIAL FEEDING SCHEDULE
==========+========+=======+=======+=======+========+=======+========+ Age
Amount
Baby's
Whole
Cane
Wheat
Boiled
Lime
at
Weight
Milk
Sugar
Flour
Water
Water
Feeding
----------
--------
-------
-------
-------
--------
-------
--------
Level
Level
Pounds
Ounces
Table-
Table-
Ounces
Ounces
Ounces
spoon
spoon
----------
--------
-------
-------
-------
--------
-------
--------
1 week
7
2
1
5
1
----------
--------
-------
-------
-------
--------
-------
--------
2 weeks
7
4
1
9
2
----------
--------
-------
-------
-------
--------
-------
--------
3 weeks
7
7
2
10
2
----------
--------
-------
-------
-------
--------
-------
--------
4 weeks
8
9
2
11
1
3
----------
--------
-------
-------
-------
--------
-------
--------
2 months
10
11
2
12
1
3
----------
--------
-------
-------
-------
--------
-------
--------
3 months
12
15
2
15
1
4
----------
--------
-------
-------
-------
--------
-------
--------
4 months
13
18
2
1
13
1
5
----------
--------
-------
-------
-------
--------
-------
--------
5 months
14
21
2
1
13
1
6
----------
--------
-------
-------
-------
--------
-------
--------
6 months
15
23
2
1
10
1
7
----------
--------
-------
-------
-------
--------
-------
--------
7 months
16
25
2
1
8
1
7
----------
--------
-------
-------
-------
--------
-------
--------
8 months
17
27
1
2
8
1
7
----------
--------
-------
-------
-------
--------
-------
--------
9 months
18
29
1
2
8
2
7
----------
--------
-------
-------
-------
--------
-------
--------
10 months
19
30
2
8
2
8
----------
--------
-------
-------
-------
--------
-------
--------
11 months
20
31
2
8
2
9
----------
--------
-------
-------
-------
--------
-------
--------
12 months
21
32
7
2
9
----------
--------
-------
-------
-------
--------
-------
--------
18 months
24
36
12
----------+--------+-------+-------+-------+--------+-------+--------+
==========+=========+==========+=========+==========+======== Age
Number
Interval
Soups
Total
of
Between
Fruit
and
Daily
Feedings
Feedings
Juices
Broths
Calories ----------
---------
----------
---------
----------
--------
in 24
Hours
Hours
----------
---------
----------
---------
----------
-------- 1 week
8
3
112 ----------
---------
----------
---------
----------
-------- 2 weeks
7
3
184 ----------
---------
----------
---------
----------
-------- 3 weeks
7
3
267 ----------
---------
----------
---------
----------
-------- 4 weeks
7
3
309 ----------
---------
----------
---------
----------
-------- 2 months
7
3
351 ----------
---------
----------
---------
----------
-------- 3 months
7
3
447 ----------
---------
----------
---------
----------
-------- 4 months
6
3
553 ----------
---------
----------
---------
----------
-------- 5 months
6
3
628 ----------
---------
----------
---------
----------
-------- 6 months
5
4
one
one
680
teaspoon
tablespoon
----------
---------
----------
---------
----------
-------- 7 months
5
4
two
732
teaspoons
cup
----------
---------
----------
---------
----------
-------- 8 months
5
4
one-half
767
orange
cup
----------
---------
----------
---------
----------
-------- 9 months
5
4
one
854
orange
cup
----------
---------
----------
---------
----------
-------- 10 months
5
4
one
875
orange
cup
----------
---------
----------
---------
----------
-------- 11 months
5
5
one
1
906
orange
cup
----------
---------
----------
---------
----------
-------- 12 months
5
5
one
1 cup
orange
arrowroot
950
cracker
----------
---------
----------
---------
----------
-------- 18 months
3
6
toast, gravies, baked
potato and apple, etc.
Note 1 ounce of whole milk equals 21 calories 1 level tablespoon of cane sugar equals 60 calories 1 level tablespoon of milk sugar equals 45 calories 1 level tablespoon of flour equals 25 calories The juice of 1 average orange equals 75 calories 1 cup of average bouillon equals about 100 calories
(This table is calculated on the basis of about 45 calories for each pound of baby weight)
TOP-MILK FORMULA
Top milk is the upper layer of milk which has been removed after standing a certain number of hours in a milk bottle or any other tall vessel with straight sides. It contains most of the cream and varying amounts of milk. It may be removed by a small cream dipper which holds one ounce, or it may be taken off with a siphon, but it should never be poured off. To obtain seven per cent top milk which is the one most ordinarily used in the preparation of top milk formulas, we take off varying amounts--according to the quality of the milk--which Doctor Holt describes as follows:
From a rather poor milk, by removing the upper eleven ounces from a quart, or about one-third the bottle.
From a good average milk, by removing the upper sixteen ounces, or one-half the bottle.
From a rich Jersey milk, by removing the upper twenty-two ounces, or about two-thirds the bottle.
Cream is often spoken of as if it were the fat in milk. It is really the part of the milk which contains most of the fat and is obtained by skimming, after the milk has stood usually for twenty-four hours; this is known as "gravity cream." It is also obtained by an apparatus called a separator; this is known as "centrifugal cream," most of the cream now sold in cities being of this kind. The richness of any cream is indicated by the amount of fat it contains.
The usual gravity cream sold has from sixteen to twenty per cent fat.
The cream removed from the upper part (one-fifth) of a bottle of milk has about sixteen per cent fat. The usual centrifugal cream has eighteen to twenty per cent fat. The heavy centrifugal cream has thirty-five to forty per cent fat.
The digestibility of cream depends much upon circ.u.mstances. Many serious disturbances of digestion are caused by cream.
It is convenient in calculation to make up twenty ounces of food at a time. The first step is to obtain the seven per cent milk, then to take the number of ounces that are called for in the formula desired.
One should not make the mistake of taking from the top of the bottle only the number of ounces needed in the formula, as this may be quite a different per cent of cream and give quite a different result.
There will be required in addition, one ounce of milk sugar and one ounce of lime water in each twenty ounces. The rest of the food will be made up of boiled water.
These formulas written out would be as follows:
FORMULA FROM SEVEN PER CENT MILK
I II III IV V VI VII VIII IX Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz.
7 per cent milk 2 3 4 5 6 7 8 9 10 Milk sugar 1 1 1 1 1 Lime water 1 1 1 1 1 1 1 1 1 Boiled water 17 16 15 14 13 12 11 10 9 --- --- --- --- --- --- --- --- --- 20 20 20 20 20 20 20 20 20
The approximate composition of these formulas expressed in percentages are as follows:
