Chapter II (6)

What per cent milk must be used to obtain twice as much fat as proteids? Use for dilution a seven per cent milk, that is, milk containing seven per cent fat, as in this milk the fat is just twice the proteids.

How is this obtained? Same as top-milk, described on another page; or by mixing three parts of plain milk and one part of ordinary cream (sixteen per cent), or by obtaining it directly from the milk laboratories.

How should we prepare the food for the early months? Granted you make up twenty ounces at a time, first obtain the ten per cent, or seven per cent, milk to be used, then take the number of ounces of this called for in the formula desired. One must remember that to make twenty ounces of food one ounce of milk sugar (or three even tablespoonfuls) and one ounce of lime-water must be used. The rest of the food is boiled water and the per cent milk.

FIRST SERIES--Five formulas for early months for ten per cent milk:
Formulas. 1 2 3 4 5
10 per cent milk 2 oz. 3 oz. 4 oz. 5 oz. 6 oz.
*Milk Sugar 1 oz. 1 oz. 1 oz. 1 oz. 1 oz.
Lime-water 1 oz. 1 oz. 1 oz. 1 oz. 1 oz.
Boiled water 17 oz. 16 oz. 15 oz. 14 oz. 13 oz.
----- ----- ----- ----- -----
20 oz. 20 oz. 20 oz. 20 oz. 20 oz.

*The milk sugar takes no space as it is always dissolved in the boiled water.

How can we strengthen this food? By gradually increasing the milk (top milk) and decreasing the amount of water.

SECOND SERIES--Of five formulas for the early months from the seven per cent milk. This is weaker in fat (cream), etc., about one-third:

Formulas. 1 2 3 4 5
7 per cent, milk 2 oz. 3 oz. 4 oz. 5 oz. 6 oz.
Milk Sugar 1 oz. 1 oz. 1 oz. 1 oz. 1 oz.
Lime-water 1 oz. 1 oz. 1 oz. 1 oz. 1 oz.
Boiled water 17 oz. 16 oz. 15 oz. 14 oz. 13 oz.
----- ----- ----- ----- -----
Food 20 oz. 20 oz. 20 oz. 20 oz. 20 oz.

How can I decide which series of formulas to use? A strong child with good digestion can be given from the first series, ten per cent milk.

A smaller, weaker child, and whose digestion is not so good, or with one who has tried the first series and did not do well, should use the second series of formulas.

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What is the reason the food is made so weak at first? The infant's stomach is made to digest mother's milk, not cows' milk, so we must begin with weak cows' milk, and the infant's stomach can thus be trained to digest it. Strong milk would be very liable to seriously upset the child's digestion.

How rapidly can I increase the food in strength, that is, go from formula 1 to 2, 3, 4, and 5, of either series? This can not be told, absolutely. It depends upon the infant, how it bears the food. Usually you can begin on formula one on the second day, formula two on the fourth day; three, after seven or ten days, but after that make the increase slower. If the infant is large, strong and of good digestion, he may be able to take of formula five by the time he is three or four weeks old. A weak child, or one with feeble digestion must go much slower, and such an one may not reach formula five until it is three or four months old. Mothers should remember it is safer to increase the strength of the food very gradually; some infants should have an increase of only one-half ounce instead of one ounce; thus: three to three and one-half ounces, etc. Two or three days should be allowed at least between each increase of food.

May I not go by a general rule in increasing the food? Yes, increase the food when the infant is not satisfied, but is digesting well.

How does an infant show this? He drains the bottle hungrily and cries when it is taken away. He may begin to fret a half hour or so before the time for the next feeding. He often sucks his fingers immediately after feeding.

If I wish to prepare more than 20 ounces of food, what proportions shall I use? To make 25 ounces, add one-fourth more of each ingredient. To make 30 ounces, add one-half more of each ingredient. To make 35 ounces, add three-fourths more of each ingredient. To make 40 ounces, double each ingredient.

For example, 25 ounces of food would call for--2-1/2 ounces of milk; 1-1/4 ounces of milk sugar; 1-1/4 ounces of lime-water; 21-1/4 ounces of boiled water.

For 30 ounces of food, proportions would be--Milk, 3 ounces; milk sugar, 1-1/2 ounces; lime-water, 1-1/2 ounces; boiled water, 25-1/2 ounces.

How much more should be made at one time? Five ounces may be made, but the first few days only two or three ounces of the additional should be given; four ounces the next two days, and after two days more may give the five ounces additional that has been made; that is, twenty-five ounces in all.

How much increase can be given at each feeding? Not more than one-quarter of an ounce.

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FOOD FOR HEALTHY INFANTS DURING THE LATER MONTHS.

How long shall I continue this proportion, that is, the fat three times the proteids (curd)--skim-milk? Usually for three or four months.

What changes shall I then make in the food? After you are using formula five of the first series; that is, six ounces of the ten per cent milk in twenty ounces of milk, increase the fat slowly, for the proportion of fat (three per cent), is near the limit for healthy children.

How then shall I strengthen the milk? By raising the percentage of proteids (curds, skim-milk).

How can I do this? Use the formulas derived from the seven per cent milk and discontinue the ten per cent milk.

THIRD SERIES.--Five formulas for seven per cent milk for the later months--
Formulas. 1 2 3 4 5
7 per cent milk 7 oz. 8 oz. 9 oz. 10 oz. 11 oz.
*Milk Sugar 1 oz. 1 oz. 1 oz. 3/4 oz. 1/2 oz.
Lime-water 1 oz. 1 oz. 1 oz. 1 oz. 1 oz.
Boiled water 12 oz. 11 oz. 10 oz. 4 oz. 3 oz.
Barley Gruel 0 oz. 0 oz. 0 oz. 5 oz. 5 oz.
----- ----- ----- ----- -----
20 oz. 20 oz. 20 oz. 20 oz. 20 oz.

*(As the milk sugar is dissolved in the boiled water the quantity is twenty ounces instead of twenty-one.) Oatmeal gruel can be substituted for barley gruel if there is constipation. To increase the food to twenty-five, thirty, or thirty-five ounces increase the milk ingredients by 1/4, 1/2, 3/4 and for forty ounces using two times as much.

How shall I increase the food during this period? Beginning with formula one of this series, which should usually follow five of the first or second series, you can usually make the increase in ten days to No. 2; in two weeks you can use No. 3; but proceed more slowly to four or five when you have reached them. The same formula may be continued sometimes for three or four months with no other change, except an increase in the quantity of the food, that is from twenty ounces to twenty-five, etc.

Is it necessary or important to reduce the proportion of fat as it is at first, reduced in passing from formula five of the first series to formula one of the third series? It is not necessary.

How much is this reduction? From 3 to 2.50 per cent.

How much increase of fat is there from the fifth formula of the second series to the first formula of the third series? From 2.00 to 2.50 per cent.

Can the first decrease be avoided? Yes, by taking off at first the upper thirteen ounces as top-milk, and using in a twenty-ounce mixture seven ounces of this in place of formula No. 1, and also by using for the next increase the upper fifteen ounces as top-milk--taking of this eight ounces in a twenty-ounce mixture in place of formula No. 2. Then follow three of this third series. This is only done when you think the formulas two and three of the third series do not give enough fat.

[584 MOTHERS' REMEDIES.]

Can I add any other food about the sixth or seventh months? Yes, foods in the form of gruel, and have this take the place of part of the boiled water and part of the sugar. Oatmeal and barley gruels can be added.

Can I make further changes at ten or eleven months? The proteids (skim-milk) may be further increased, sugar and lime-water reduced until plain milk is given.

How can I do this? Give at first one feeding of plain milk and barley gruel daily; later two feedings, then three feedings, etc. For example, suppose one infant was being fed with modified milk as formula 4 or 5, series 3, six feedings daily. The plain milk diluted with boiling water would take the place of one such feeding at first, then two, three, four, etc., feedings. Such changes to be made at intervals of two weeks. Proportions of milk and barley gruel should be, at first, about five and one-half ounces milk, two and one-half ounces barley gruel; later six ounces milk, three ounces barley gruel and then seven ounces milk, two ounces barley gruel until plain milk is alone used, and this can usually be reached at twelve to thirteen months. For five months' infants a pinch of soda may be added to each feeding when the lime-water is omitted. It is not generally necessary, however.

Do some infants dislike the milk after the milk sugar has been omitted? Yes; for such 1/4 to 1/2 teaspoonful of granulated sugar may be added for a time to each feeding and gradually reduced.

RULES FOR USING THESE FORMULAS.

They are only for healthy infants. Begin always with a weak formula, especially with an infant previously nursed at the breast, with one just weaned and with infants who have poor digestive powers, or whose digestive powers are unknown. Should the first formula tried be too weak the food can be strengthened every three or four days until the right formula is found. If the food is made too strong at first an attack of indigestion is liable to follow.

How shall I increase the strength of the food? This should be done very gradually. Do not advance more than one formula in the given series. It is frequently better to make the increase in half steps. Say when it is from three to four, give three and one-half, and then four.

How rapidly can I increase the quantity of food? This should not be more than one-fourth ounce in each feeding, one to one and one-half to two ounces daily.

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When should the amount of food be increased? An increase may be necessary every few days in the early weeks, but the same formula is often continued for two or three months during the later months.

What signs in the infant demand an increase? The infant is not satisfied, does not gain in weight, but it has good digestion--that is, it does not vomit and has good stools.

When should I not increase the food? So long as the child is satisfied, gains four to six ounces weekly, even when the quantity and strength of the food is considerably below the average.

Should you then increase the food if the child seems somewhat hungry, but still gains from eight to ten ounces weekly? It is not always a safe rule to be guided by the appetite.

How can I know whether to increase the strength or the quantity of the food? In the early weeks it is well first to increase the strength, the next time the quantity of the food, then the strength, then the quantity, etc. The quantity chiefly should be increased after the fourth or fifth month.

Should a slight stomach discomfort or disturbance follow after the food has been strengthened, what shall I do? If the disturbance is marked and continues and the infant does not seem able to accustom itself to the new food, you should go back to the weaker one and the next increase should be smaller.

Should I be worried if the gain in weight for the first few weeks of artificial feeding is slight, or even no gain? Not as a rule; if the infant loses no weight, sleeps well, is comfortable, does not suffer from vomiting, nausea, colic, you can feel sure the baby is doing well and is becoming used to his new food. As his appetite improves and his digestion is stronger the food may be increased every few days. Then the weight will soon increase.

Is constipation likely to occur from such a weak food? This is very often seen owing to the fact of their being little residue in the bowels, so if he has a daily stool, even if it is small and dry, it need not cause worry as it soon passes away with the using of stronger food.

What circumstances indicate that the food should be reduced? When the child becomes ill from any causes, or when there are any marked symptoms of indigestion.

How can I reduce the food? If there is but a slight disturbance and the daily food has been prepared, pour off one-third from each bottle just before each feeding and replace this quantity of food with boiled water; if the disturbance is more severe, immediately dilute the food at least one-half and also reduce, at the same time the quantity given; for a severe attack of indigestion, omit the regular food altogether and give only boiled water until a doctor has been called.

How shall I return to the original formula after it has been reduced for a disturbance of digestion? The increase must be very gradual after the immediate reduction. After a severe attack of indigestion, the milk should not be made more than one-fifth the original strength, and ten days or two weeks should elapse before the original strength food is given and, as stated, there should be a gradual slow increase.

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ABOUT ADDING OTHER FOODS TO MILK.

How long shall I continue the modified milk? Usually for about six months; but if the infant is doing well you can continue it for ten or eleven months. If the infant has trouble in digesting cows' milk other foods can be added at three or four months or even at the beginning.

What food can I first use? Barley, oatmeal, arrowroot, and farina.

Is it better to make them from the flour? Yes, they are more simple to prepare from the flour.

How shall I cook them? Cook them separately, and when used they take the place of some of the boiled water.

(For another way, see former pages.)

How shall I prepare barley gruel water? Take one teaspoonful of the flour and rub it up with a little cold water, and then stir this into a pint of boiling water; add a pinch of salt and boil it fifteen minutes; strain if it is lumpy. Oatmeal gruel is made the same way, only using two teaspoonfuls instead of one.

Barley Jelly.--One rounded tablespoonful of the flour, mixed with a little cold water, is added to one pint of boiling water containing a pinch of salt; cook twenty minutes in a double boiler and strain. A thinner gruel (barley water) is made by using half of the quantity of flour.

How much of the gruel can I use? If prepared by the last method one-sixth to one-half the total quantity of food; if the barley water is used it can be used in greater quantity if desired, as it is weaker by half.

Which one shall I use? Barley and oatmeal are generally used; oatmeal is more laxative.

What is their value as infant foods? Their chief value is to prevent the curd from coagulating in the stomach in hard masses, thus rendering it more digestible.

Would you advise this addition for all infants? No, for it does not agree with them all, and so it cannot be recommended for all infants.

Can I give anything more during the first year? Beef juice, white of an egg, and orange juice.

How and when may I use the beef juice? It may be begun at ten or eleven months in infants who are strong and thriving well. Two teaspoonfuls may be given daily, diluted with same amount of water, fifteen minutes before the midday feeding; in two weeks it may be doubled; and six teaspoonfuls can be given, in four weeks. Two or three tablespoonfuls is all that can be given a child of one year.

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Is beef juice of value in delicate pale infants? Yes, of much value, and it is more important for them, and it may sometimes be given them at five or six months in one-half the quantity mentioned.

When shall I give the white of egg (albumen) or albumin water? When the conditions are similar to those requiring beef juice especially in infants who digest the proteids (curd) with difficulty. You can give the one-half of the white of one egg at six months, and soon the entire white of one egg can be given.

What is the best way of preparing this? By coddling the egg.

Describe the way of preparation? Place a fresh egg with the shell on in boiling water and immediately remove all from the fire. The egg cooks slowly in the water for seven or eight minutes as the water gradually cools, and the white part becomes like jelly. Give the white with only a pinch of salt--it can be easily separated from the yolk.

When can I give orange juice? Usually about the eleventh or twelfth month, and it should be given about one hour before the feeding. You can begin with two teaspoonfuls at first, then one tablespoonful at a time, and later three or four tablespoonfuls. Orange juice is very good when constipation exists--strain it always, and it must be always fresh and sweet.

OVER NURSING.

Mothers who have a very large supply of milk are very likely to overfeed their babies if the milk is of good quality. This will drain the mother's strength. Some mothers allow their babies to nurse to relieve the uncomfortable feeling. If the infant vomits the surplus immediately they are not injured. Where the baby does not vomit, the surplus food passes into the bowels and causes colic and green and yellow gassy stools. If the mother's milk is too rich, only, and not too much and the baby vomits, this can be corrected by giving the baby some boiled water before each meal. The baby will not nurse so much then.

OVER-FEEDING.

What do you mean by this term? The infant gets too much food, and this is chiefly done at night.

Can I depend upon the infant's natural desire for food as to the quantity to be given? Not always, the habit of over-eating is frequently acquired, and is frequently seen in infants with a good digestion.

What harm results from over-feeding an infant? The food lies in the stomach or bowels, undigested, ferments, and causes gas and colic, and if the over-feeding is long continued, serious trouble arises. The baby becomes restless, fretful, irritable, sleeps badly, stops gaining weight and may lose weight.

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LOSS OF APPETITE.

What may cause this? Over-feeding or the use of milk too rich in fat.

What can I do for this trouble? If the child is well, offer food to him at regular hours only. Do not coax or force him to eat even though he takes only one-half or one-third of his usual quantity. Lengthen the intervals between the feedings. It may be necessary with a child under a year old to reduce the number of feedings to three or four in twenty-four hours. Give water at more frequent intervals, weaken instead of strengthening the food.

FOODS FOR SPECIAL CONDITIONS.

Some infants with weak digestive powers, and those suffering from various forms of indigestion, have often much trouble in digesting the fat of milk. To meet such troubles a series of formulas are given obtained from plain milk.

FOURTH SERIES-Formulas containing four per cent fat: 1 2 3 4 5 6 7 8 Plain Milk 5 oz. 6 oz. 7 oz. 8 oz. 9 oz. 10 oz. 12 oz. 14 oz. *Milk Sugar 1 oz 1 oz. 1 oz. 1 oz 3/4 oz. 3/4 oz. 1/2 oz. 1/2 oz. Lime-water 1 oz. l oz. 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. 1 oz. Boiled water 14 oz. 13 oz. 12 oz. 7 oz. 6 oz. 5 oz. 2 oz. 0 oz. Barley Gruel. 0 oz. 0 oz. 0 oz. 4 oz. 4 oz. 4 oz. 5 oz. 5 oz. ----- ----- ----- ----- ----- ----- ----- ----- 20 oz. 20 oz. 20 oz. 20 oz. 20 oz. 20 oz. 20 oz. 20 oz.

*(Milk sugar is not counted in totals.) If more than twenty ounces are needed get the proportions by adding one-fourth, one-half, three-quarters, or double each ingredient.

Why does an infant so often vomit some of its food soon after feeding? The quantity may be too large or too rich food, the baby may feed too fast, the hole in the nipple may be too large, the clothing too tight, or you may press upon its stomach in moving the baby.

What are the causes of and changes needed for stomach troubles? It is usually a symptom of indigestion and is frequently caused by too much fat or sugar.

How can I remedy this? Reduce the fat or sugar, and increase the lime-water. Avoid the formulas made from the top-milk, or cream and milk. Those made from the seven per cent milk are not so likely to cause trouble; but you had better, if the symptoms are severe, use formulas of the fourth series.

What symptoms indicate that the baby is getting too much fat (cream)? Vomiting and yellow, foul, greasy, or ropy stools.

How much shall I reduce the milk sugar? Use only one-half ounce to twenty ounces of food or leave it out altogether.

How shall I know when to reduce the sugar, etc.? When there is excessive formation of gas in the stomach, causing distention and pain, or belchings of gas, and often a sour stomach. Reduce the amount of sugar and increase the lime-water one and one-half to two ounces in twenty ounces of food, increase intervals between the meats one-half hour and give less quantity.

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What food usually causes habitual colic? This is due to gas accumulating in the bowels, and is usually caused by the want of digestion of the proteids (curd).

How shall I overcome this? Use a weaker formula. Use formula 4 or 3 of first series; or use partially pasteurized milk, or use barley water instead of plain water.

If curds regularly or frequently appear in the stools, what changes shall I make? This usually accompanies colic, so use means just described--reduce the proteids (skim milk).

How shall I modify the milk for chronic constipation? This is difficult to overcome, and it is more frequent when infants are fed upon a plain milk diet, variously diluted, than when seven or ten per cent milk is used and diluted to a greater degree. But you cannot use food containing more than four per cent fat, that is, eight ounces of ten per cent milk or twelve ounces of seven per cent milk in twenty ounces of food. In some cases ordinary brown sugar in one-half the quantity can take the place of milk sugar, or Mellin's food, malted milk or cereal milk can be used in the place of the milk sugar. Milk of magnesia can be used for lime-water as before directed. Orange juice can be given to infants over nine months old.

What modifications should I make in very hot weather? The proportion of fat (top-milk or milk and cream mixed) should be less and when it is very hot, for a short period, it should be much less. Use seven per cent milk in place of ten per cent, that is, formulas from the second series, or plain milk, in place of the seven per cent milk, fourth series.

If a child has good digestion, but gains very little or no weight, what changes in the food should I make? Increase the quantity of the food if the child seems hungry; or increase the strength of the food, if the child will not take a greater quantity; do not coax or force the baby to eat, give him more sleep; fresh air, etc.

If there is no modified milk that will agree with the baby, what shall I do? If the infant is under four or five months old, a wet nurse would likely succeed. If a wet nurse cannot be obtained or if the child is older use some of the substitutes for cows' milk, like Borden's Eagle Brand, canned or condensed milk. This is better to use when the trouble is in the bowels and shows colic, gas, curds in the stools, constipation, or diarrhea. If it is due to indigestion it shows in vomiting, etc.

How shall I use condensed milk? The directions are on the bottle. But if the baby is three or four months old, and has symptoms of indigestion, dilute its food with sixteen parts of boiled water, or sometimes barley water if there is no constipation. As the symptoms improve it can be made stronger, one to fourteen, one to twelve one to ten, one to eight, such changes to be made gradually.

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How long can I use the condensed milk? Generally for a few weeks only as the sole food, then give one feeding a day of modified milk, for instance, No. 3 or 4 of the series; later two feedings and gradually increase until the milk feeding is entirely used.

Why can I not continue to use condensed milk? It is very low in fat and proteids and has much sugar in it; children who take this food for sometime often gain rapidly in strength and weight, yet have not much resistance, and they are very prone to develop rickets and scurvy.

Suppose baby is teething, has a cold, sore throat, etc., what change shall I make? Dilute the food for two or three feedings by using boiled water in place of an ounce or two of food; this much to be removed from the bottle before being given; if it is necessary to continue for several days, use a weaker formula.

What changes shall I make in this for serious acute sickness? For, diseases with fever like measles, bronchitis, pneumonia, etc., dilute the food and reduce the fat (cream from top-milk). Give the food at regular intervals, but not so often. Do not force food in the early part of acute sickness.

Suppose baby has acute gastritis, what changes shall I make? Stop all food and give boiled water, only, for ten or more hours, then try barley water or whey, but do not give any milk for at least twenty-four hours after all vomiting has ceased. When you again begin the modified milk use a small quantity with a low proportion of fat, and you can secure this by using a formula from the fourth series. You may also double the proportion of lime-water.

If baby is attacked with intestinal indigestion accompanied by loose bowels, what food shall I give? If it has but two or three passages daily, lower the proportion of fat (cream, etc.), in the manner above directed, and boil the milk for five minutes. Dilute it still more if curds are present in the stools.

But suppose the attack is more severe? If there is fever and the passages smell badly and are more frequent, stop all milk and use the diet given for acute gastritis. (Acute indigestion).

Do other conditions besides the food influence digestion? Yes, use proper clothing, keep warm feet, regular habits, fresh air. Clean bottles and food, given at proper intervals and temperature, quiet surroundings and absence of excitement are needed.

What common mistakes are often made in modifying milk and feeding infants? Never fail to follow the directions given for removing the top-milk. Remove all the top-milk of any given strength in making a formula, and not only the number of ounces needed for the formula. By using rich Jersey milk as if it were more common milk. The formulas given are based upon about four per cent fat. Food is very often increased too rapidly, particularly after stomach and bowel indigestion. The food in an infant of three or four months old attacked by acute indigestion should seldom be given in full strength for two weeks afterwards, only half steps should be taken like two to two and one-half, etc. Another mistake, when indigestion symptoms show the food is not reduced quickly enough; reduce the food immediately by at least one-half.

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How to prepare cows' milk at home; what is needed? Feeding bottles, rubber nipples, an eight-ounce graduated measuring glass, a glass funnel, a brush for bottles, cotton, alcohol lamp, a tall quart cup for warming bottles of milk, a pitcher for mixing food, a wide mouthed bottle of boric acid and one of bicarbonate of soda, a pasteurizer, and later a double boiler for cooking cereals will be needed.

What kind of bottles shall I buy? A cylindrical graduated bottle with a wide neck holding about 8 ounces. This makes washing them easier. You should have as many bottles for use as the baby takes meals a day (ten at first).

How shall I care for the bottles? Rinse them, as soon as the child is through nursing, with cold water, and let stand filled with cold water and a little bicarbonate of soda in the water. Before using them again wash them thoroughly with the bottle brush and hot soap suds and place them for twenty minutes in boiling water.

What kind of nipples are best? Straight ones which slip over the neck of the bottle, of black rubber, and the hole should only be large enough for the milk to drop rapidly when the bottle is held upside down.

How shall I care for the nipples? Boil new ones for five minutes at first. After using rinse them carefully in cold water and keep them covered in a glass containing a solution of borax or boric acid. Turn them inside out once a day and wash thoroughly with soap and water.

(There is a slight difference in the directions given by different authorities as to cleaning bottles and nipples, but the general way is the same.)

What kind of cotton shall I use for corking the bottles? Refined non-absorbent cotton is best, but the ordinary absorbent cotton will do.

Which is the best--an alcohol lamp, or the Bunsen burner? The Bunsen burner is the best, cheaper and simpler if there is gas in the house. Should you use the lamp, put it upon a table covered with a plate of zinc or tin, or upon a large tin tray. The French pattern is the best.

Give special directions now for preparing the food according to any of the given formulas? The hands must be clean, as well as everything else--food and utensils. First dissolve the milk sugar in boiling water, filtering, if necessary, then add to the boiled water and sugar the milk, cream, and lime-water, mixing all in the pitcher; a sufficient quantity for twenty-four hours is always prepared at one time. Divide this in equal quantities into the number of feedings for the twenty-four hours and cork the bottles with the cotton cork and cool the bottles rapidly, after having been pasteurized by standing first in tepid and then in cold water, and then place in an ice chest at 50 degrees F.

[592 MOTHERS' REMEDIES]

FEEDING DIRECTIONS.

How shall I prepare the bottle at feeding time? Take one from the ice chest, warm it by placing it in warm water deep enough to cover the milk in the bottle. Then thoroughly shake it, remove the cotton cork, and adjust the nipple.

How shall I know that the temperature of the milk is correct? Pour a teaspoonful from the bottle before adjusting the nipple, and taste it, or pour a few drops through the nipple upon the inner surface of the wrist. It should feel quite warm, but not quite hot; or a baby thermometer may be placed in the water where the milk stands, and the temperature should be between 98 and 100 degrees F.

How can I keep the milk warm while the baby is feeding? Slip over the bottle a warm flannel bag with a draw-string.

What position should a child be in when feeding? During the first few months, except at night, it had better be held in the arms; later it can lie on its side in the crib, but the bottle must then be held by the nurse until it is emptied, or the baby will nurse and sleep, and nurse and sleep, etc.

How much time shall I give the baby for one feeding? Not longer than twenty minutes. Take the bottle away then and do not give it until the next feeding. Keep a sleepy baby awake, when well, until the food is taken, or remove the bottle.

Can I play with the baby after feeding? Never. It may cause vomiting and indigestion. Baby should lie quietly and sleep if possible, or at least not be disturbed.

FEEDING INTERVALS.

How often shall I nurse or feed baby during the first month? Ten times in twenty-four hours at intervals of two hours during the day and two times at night.

Why can I not feed baby oftener? Because it takes nearly two hours to digest a meal at two months, about two and one-half hours at five or six months, and if another meal is given before the former meal is digested, vomiting and indigestion will result. The following schedule is given by one authority on children for healthy infants for the first year:

Night No. Quantity Quantity Interval feedings of for for between 10 P. M. feedings one 24 meals to in 24 feeding, hours, by day. 7 A. M. hours. ounces. ounces. 2d to 7th day 2 hrs. 2 10 1 to 1-1/2 10 to 15 2d to 3rd week 2 hrs. 2 10 1-1/2 to 3 15 to 30 4th to 5th week 2 hrs. 1 10 2-1/2 to 3-1/2 25 to 35 6th to 8th week 2-1/2 hrs. 1 8 3 to 5 24 to 40 3d to 5th Month 3 hrs. 1 7 4 to 6 28 to 42 5th to 9th month 3 hrs. 0 6 5 to 7-1/2 30 to 45 9th to 12th month 4 hrs. 0 5 7 to 9 35 to 45

This schedule is for healthy children. The smaller amounts are required by smaller children with weak digestion; the larger amounts are required by large children with strong digestion. The interval is from the beginning of one feeding to the beginning of the next feeding.

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How soon can I make the intervals at two and one-half hours? Generally at five or six weeks.

When may I increase it to three hours? Usually at eight weeks or two months.

When should I lengthen the interval between feedings? When there is poor stomach digestion.

How is this shown? By habitual vomiting or regurgitation of food long after nursing is finished; also when the baby has a very poor appetite so that it always leaves some of its food.

When can I shorten the intervals? It is not generally advisable to feed any baby oftener than given by this schedule.

REGULAR FEEDING.

How can I teach baby to take regular meals? By commencing at birth to feed at exactly regular hours every day.

Shall I awaken baby to feed it? Yes, for a few days. In a short time he will waken at the same hours himself.

Should this regularity extend through the night? Only up to nine or ten o'clock. After ten let him sleep as long as he will.

How soon can baby go without food from 10 p. m. to 7 a. m.? At four months usually and always at five or six months; night feeding causes restlessness and poor sleep.

STERILIZED MILK.

What do you mean by sterilizing milk? It means to heat milk so as to destroy the germs.

Does cows' milk contain germs? Yes, even if it is handled faultlessly; but when carelessly handled the number of germs is enormous.

Are all of the germs injurious? Most are harmless or cause only the souring of the milk.

What other germs are occasionally present? Typhoid fever, diphtheria, scarlet fever, cholera, tuberculosis and many forms of diarrhea germs.

Do I need to sterilize milk under all circumstances? When you cannot obtain it fresh in warm weather. Hence during warm weather in cities and towns; when you do not know that the cows are healthy or that the milk has been cleanly handled; when milk is kept over twenty-four hours, especially if there is no ice at hand. When there are epidemics of typhoid fever, scarlet fever, diphtheria, or any form of bowel disease accompanied by diarrhea.

How many methods of heating milk are there? First, sterilizing, in which the milk is heated to 212 degrees F., for one hour or one and one-half hours. Second, pasteurizing, when you heat the milk to 155 degrees or 170 degrees F. for thirty minutes.

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Will the temperature of 155 degrees F. for one-half hour be sufficient to kill the germs of the diseases mentioned above? Generally.

How long will milk so treated keep on ice? Heated to 212 degrees F. for an hour will keep for two or three weeks; that heated (pasteurized) to 155 degrees F. will keep for two or three days.

Is cows' milk as digestible when sterilized? No, and it should be modified for infant feeding the same as milk not heated.

When milk is heated for an hour to 212 degrees F. (sterilization), is it injured in any way? It is rendered harder to digest, and is more constipating; scurvy may be caused if it is used as the sole food for a long time. It is so objectionable that the method is not recommended for general use.

When should I heat it 212 degrees F.? For use on long journeys of days traveling. Then you should heat for one hour upon two successive days, leaving the cotton stoppers in the bottles.

Does heating milk to 155 degrees F. for one-half hour injure it in any way? It does not affect the taste or make it more constipating. The unfavorable effects, if any, are slight. Get clean and fresh milk and the effects will be really of no account.

What pasteurizer would you recommend. Freeman's or Walker-Gordon.

What shall I do with the milk after it has been pasteurized? Cool it quickly by placing the bottles in cold water--never leave them in the room where pasteurized, and never place them, when warm, in an ice chest.

Why this caution? Because it requires from two to four hours to cool them in the air, or in the ice box, and during that time a good many undeveloped germs may mature and injure the keeping properties of the milk. You can cool the bottles of milk in cool water in from ten to twenty minutes if you change the water frequently, or if ice is put into the water.

What is modified milk of the laboratories? It is milk containing fat, sugar, proteids, etc., in definite proportions put up, usually, according to a physician's directions.

PEPTONIZED MILK.

What is peptonized milk? Milk that has been partially digested.

What part of the milk has been digested? The proteids (curd).

Does this alter its taste? No, if it is peptonized for only ten minutes, but if it is fully peptonized the milk has a bitter taste.

How can the bitter taste be avoided in partly peptonized milk? At the end of ten or fifteen minutes place the milk in a sauce-pan and raise it quickly to the boiling point; this kills the ferment so that the milk will not become bitter when it is warmed for feeding; or the milk can be cooled rapidly by placing the bottles first in cool and then in ice water; but in this way the ferment is not destroyed, and the milk may become bitter when warmed for feeding.

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How is milk peptonized? By the action of a peptonizing powder composed of a digestive agent known as the extractum pancreatis and bicarbonate of soda. This is added to the plain or diluted milk. This agent can be bought in tubes or tablets, and is the active ingredient of the peptogenic powder.

Will you describe the process? Place the plain or modified milk in a clean glass jar or bottle, and then rub up the peptonizing powder or tablet with a tablespoonful of milk, and add it to the milk and shake the bottle. Place the bottle in a large pitcher or basin of water of about 110 degrees F., or as warm as the hand can bear comfortably, and allow it to remain for ten to twenty minutes if you wish to peptonize the milk but partially; or if you wish it completely peptonized let it remain for two hours.

Is it better to peptonize the whole day's supply, or each bottle separately just before feeding? If you peptonize the whole day's supply at once raise the milk to the boiling point after it has been peptonized; if only the one feeding do not peptonize it more than ten minutes before feeding for the ferment will work while the child is feeding. It can be done either way.

Is not the completely peptonized milk distasteful? Not so in the case of young infants; older infants will take a few feedings without objection, but it cannot be used for children much older than five months.

How much of the agent should be used? For a single feeding of four ounces one may use one-eighth of a tube with a weak formula of milk or one-sixth with a stronger formula. For one pint of plain milk five grains of the extract and fifteen grains of bicarbonate of soda will be needed. This amount is usually put up in one tube or tablet. Less will be required in weaker formulas of modified milk.

What advantages has peptonized milk? Partially peptonized milk assists greatly in digesting the curd of milk. Young infants sometimes have trouble in digesting the curd. When completely peptonized it is good in attacks of acute indigestion.

How long may I give it? It may be used for a few days when completely peptonized; when partially peptonized it can be used for two or three months, and when you wish to give other food, leave off its use gradually by shortening the time of peptonizing and lessening the quantity of the powder used.

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FEEDING DURING THE SECOND YEAR

How many meals should a child have during the second year? Five.

Shall I prepare the milk for all day at one time? It is better to prepare the milk for all day during the second and third years. If you wish to modify it by adding cream, water, etc., prepare as done during the first year, and later when only plain milk is used, the quantities needed for the different feedings should be put into one or two bottles, pasteurized or not as necessary. In this way the different feedings are kept separate. Prepare the food as soon as possible in the morning alter the milk has been received.

FOR A HEALTHY CHILD OF TWELVE MONTHS.

6:30 a. m. or 7:00 a. m.--Milk, six to seven ounces, diluted with two or three ounces of barley or oatmeal gruel, and taken from a cup after thirteen months.

9:00 a. m.--One to two ounces of orange juice.

10:00 a. m.--Milk two parts, oatmeal or barley gruel one part, and from ten to twelve ounces in all may be given in a cup.

2 :00 p. m.--One or two ounces of beef juice, or the white of one egg, slightly cooked, and later an entire egg or mutton or chicken broth, four to six ounces.

6:00 p. m.--Same as 10 a. m.

10:00 p. m.--Same as at 6:30 a. m., except the milk can be taken from the bottle.

How long can this schedule be given? Until the fourteenth or fifteenth month, and then you can give the cereals thicker and with a spoon.

Can I give other fruit juices at fourteen or fifteen months? Orange juice is the best, but the juice of ripe peaches, red raspberries or strawberries in the order given, is good. Strain all carefully through muslin, for the pulp or seeds might cause serious trouble. You may now give one to four tablespoonfuls of the orange or peach juice, and about one-half the quantity of the others.

When shall I give the fruit juices? One hour before the second meal.

What diet shall I give between fourteenth and eighteenth months?

6:00 to 6:30 a. m.--Eight to ten ounces of plain milk from a cup.

8:00 to 9:00 a. m.--Juice of one-half orange strained.

10:00 a. m.--One, or later two or three tablespoonfuls of oatmeal or barley jelly, hominy cooked at least three hours, and on which you may put a little top-milk; a pinch of salt; no sugar and cup--about six ounces--of milk to drink; crisp dry toast, one piece.

2:00 p. m.--Beef juice one to two ounces, a soft boiled; coddled or poached egg, and a tablespoonful of boiled rice, or mutton or chicken broth, four ounces; one or two pieces of stale bread or zwieback; and if most of the teeth are present, one scant teaspoonful of scraped rare beef, slowly increased to one tablespoonful, alternating with two ounces of beef juice and a salt-boiled or coddled egg. (Some advise a little prune jelly, apple sauce, a baked apple or junket as a dessert). No milk, but little water can be taken.

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6:00 p. m.--Two tablespoonfuls of thoroughly cooked farina, or cream of wheat or granum, or arrow-root, on which is a little top-milk; salt, but no sugar, and eight ounces of warm milk which may be taken from the bottle.

10:00 p. m.--Warmed milk and eight to twelve ounces if necessary, by bottle.

How shall I prepare the beef? Take round or sirloin steak and scrape it with a large spoon on both sides, so that you obtain the pulp only, salt it a little, and place it with a very tiny piece of butter in a saucer, cover it with another saucer, remove the cover from the boiling teakettle, and place the saucer in its place; let it steam until it is just heated through, as it must look rare when done, Give at first one teaspoonful and gradually work up to one tablespoonful, but do not begin this diet in midsummer. Give baby plenty of water to drink between meals, boil and cool.

A diet for the eighteenth month to end of twenty-fourth month? Follow the same order. For most children milk at 10 p. m. is desirable; but if a child sleeps during the whole night it is not necessary to wake it at 10 p. m. for the feeding.

6:00 or 6:30 a. m.--Warmed milk ten to twelve ounces.

9:00 a. m.--Two or three ounces of fruit juices.

10:00 a. m.--Cereals similar to the last schedule; they need not be strained, but well cooked; crisp, dry bread, zwieback, warmed milk one cup.

2 :00 p. m.--Beef juice and one egg or broth and meat; beef-steak, mutton chop or roast beef scraped, very stale bread or two pieces of zwieback; one or two tablespoonfuls of prune pulp, or baked apple and water, but no milk.

6:00 p. m.--Farina, cream of wheat, or arrow-root well cooked with milk, salt, but no sugar; or milk or stale bread and milk.

10:00 p. m.--If required, ten to twelve ounces of pure milk.

What fruits may I give during this period? If the child has a weak stomach, only the fruit juices mentioned, but strong children may have in addition, baked apple, apple-sauce and prune pulp. Stew the dried prunes without sugar until they are very soft, and put all the fruit through a strainer thus removing all the skin; you may give one to two tablespoonfuls of this at one time. No cream should be given with the baked apple, and very little sugar with the apple-sauce These are very good for constipation, Remember to give water freely between the feedings, especially in warm weather. From one to three ounces may be given at one time either with a spoon, glass or bottle. Boil the water daily and cool. Do not allow it to stand in the room, but give fresh water to the child each time.

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SCHEDULE FOR THREE-YEAR-OLD CHILD.

7:30 a. m.--Cereal well cooked (over night) or at least for three hours, A larger variety of food can now be given and given as before with thin cream, salt, but little sugar. One glass of warm milk, a soft boiled, coddled or poached egg; bread very stale or dry, one slice with butter.

10:00 a. m.--One cup of warm milk, with a cracker or a piece of stale bread and butter.

2:00 p. m.--Soup, four ounces, or two ounces of beef juice. Meat: chop, steak, roast beef, lamb or chicken; white potato, baked or boiled rice. Green vegetables: Tips of asparagus, string beans, peas, spinach, all cooked until they are very soft, mashed or preferably put through a sieve, and only one to two teaspoonfuls at first. Desserts: Cooked fruit, baked or stewed apple, stewed prunes, water, but no milk.

6:00 p. m.--Cereal: Farina, cream of wheat, or arrow-root, cooked for at least one-half hour with plenty of salt, but no sugar; or milk toast; or old bread and milk or stale or dry bread and butter and a glass of milk.

BABY'S SECOND SUMMER.

Nearly all mothers dread baby's second summer. If the baby is born at such a time that he cuts his double teeth during the hot weather, and if it is attended by indigestion and fever, there is really some cause for worry, because the digestive organs during the hot weather are more difficult to manage than during the colder months; otherwise, if you feed your baby carefully and properly, and with the regularity that you did in the early months, there is no reason to dread the second summer, Mistakes are made by mothers and grandparents especially. They permit the child to come to the table and eat of the food prepared for adults. Sometimes it is only a little, but that little will gradually grow larger; and even that little may be enough to upset baby for weeks and then the illness that follows is in reality due to the parents' own foolishness when it is laid to the credit of the second summer, or regarded as "a mysterious dispensation of Providence." Do not give anything to baby between its regular meals but water; crackers, zwieback, and bread are prohibited between.

DIET OF OLDER CHILDREN-FOURTH TO TENTH YEAR.

Give the largest meal at midday and a light supper at night, very much like that recommended for the third year. For a few years you can give milk once between breakfast and dinner, or dinner and supper, and permit no other food between meals, but give water freely.

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MILK AND CREAM.

What part of the diet should milk form now? Nothing can take its place, and it should be an important part of the diet. Most children can take and digest milk.

Why is this of so much advantage? Because it possesses a higher nutritive value than any other food, for the amount of work required of the digestive organs, and it is very especially adapted to a child's diet. It must be clean and fresh and not too rich.

What essential point should I consider in its use? The Jersey cow gives too rich milk, and it must be greatly diluted. Children who digest milk with difficulty should take it diluted about four parts milk, one part water, a little salt or bicarbonate of soda should be added. Do not give milk at meals when fruits, especially if they are sour, are allowed.

How much milk can I allow to advantage? For an average child with good digestion, you can allow one and one-half pints to one quart daily, including what is also used upon cereals and in other ways. Two quarts are too much, for a mixed diet will do better.