YOUR BABY’S FOOD
Proper feeding is probably the most decisive single factor in the routine care of the baby.
In order that the food shall be satisfactory, it must be not only suitable in composition for the individual baby, but it must be clean, fresh and at the right temperature; given in suitable amounts and at suitable intervals; it must be given properly—not too fast nor too slowly and it must be given under favorable conditions. Moreover, as has been stated, the baby, himself, must be kept in a general condition which will promote the digestion and assimilation of the food that is given to him. Fresh air, suitable clothing, an even body temperature, gentle handling, proper bathing, regular sleep, freedom from excitement, fatigue, and irritation all promote the baby’s ability to use his food to advantage. Reverse conditions all work against it. Accordingly, the actual value of the baby’s food to him will be largely dependent upon the care that you give him.
There are three methods of nourishing the baby: by breast feeding, by artificial feeding and by a combination of the two, termed mixed or supplementary feeding.
Breast Feeding. From all standpoints, maternal nursing, under normal conditions, is the most satisfactory method of nourishing a baby. If the breast milk is suitable it meets all of the baby’s requirements and the proportion and character of its constituents are exactly suited to his digestive powers. In order for maternal nursing to be entirely satisfactory, the condition of both mother and baby must be favorable. The preparation and care of the mother have been described: her general condition and state of nutrition; the care and condition of her nipples, flat or retracted nipples being· brought out if possible, and if not, the nursing facilitated by the use of a shield. As to the baby, if his diaper is wet or soiled, it should be changed before he is put to the breast, partly to make him comfortable and partly to avoid disturbing him for this after his feeding; and his mouth is gently swabbed with boric-soaked cotton, if your doctor so orders.[[2]]
[2]. Boracic acid solution is made by adding one teaspoonful of the crystals to one cup (half-pint) of boiling water.
Although nursing is an instinct, the baby may have to learn how to nurse or to acquire the habit, this being one reason for putting him to the breast during those first two or three days when he obtains little or no actual food, as was explained in Chapter IX. As he expresses the milk by squeezing and suction made possible only when the nipple is well back in his mouth, he must take into his mouth practically the entire colored area which surrounds the nipple. To do this he lies in the curve of his mother’s arm as she turns slightly to one side, and holds her breast away from his nostrils in order that he may breathe freely.
Sometimes, even when other conditions are favorable, the baby is unable to nurse because of some physical disability. He may be too feeble, may have a cleft palate or find suckling painful because of an injury to the mucous membrane which occurred when his mouth was wiped out just after birth. The manner in which the baby nurses, therefore, may be significant and should be described to the doctor if there is any difficulty.
When the baby has finished nursing he should be taken up very gently, held upright against the shoulder for a moment or two, to help him bring up gas if he has any, and then placed in his crib and left to sleep. If he is nursing satisfactorily, he will be sleepy and contented afterwards and will sleep for two or three hours; he will seem generally good-humored and comfortable while awake; he will have good color; gain weight steadily and have two or three normal bowel movements daily. The normal stool in breast-fed babies is bright yellow, smooth and has no evidences of undigested food.
If the baby is not being adequately nourished, he will present exactly the opposite picture, in some or all of these respects. He will be unwilling to stop nursing after the normal length of time and will give evidence of being not satisfied when taken from the breast. He may be listless and fretful and sleep badly. He will not gain weight as he should and he may vomit or have colic after nursing.
To ascertain whether or not such a baby is getting enough milk it is customary to weigh him, without undressing him, before and after each nursing. Each fluid ounce of milk will increase his weight one ounce. If the baby is not obtaining a normal amount of milk at each nursing, he is often given enough modified milk after each meal to supply the shortage, but at the same time an effort is made to increase the supply of breast milk by improving the mother’s personal hygiene, as described in Chapter IX.
The amount which the baby needs at each feeding varies, not only according to his weight and age, but also according to his vigor and activity and therefore must be estimated for each baby. A very general estimate of the amount taken by the average, well baby at each feeding, is about as follows:
| First week | 1½ | to 2½ | ounces |
| Second and third week | 2 | to 4 | ounces |
| Fourth to ninth week | 3 | to 4½ | ounces |
| Tenth week to fifth month | 3½ | to 5 | ounces |
| Fifth to seventh month | 4½ | to 6½ | ounces |
| Seventh to twelfth month | 6½ | to 9 | ounces |
Artificial Feeding. There is no entirely adequate substitute for satisfactory maternal nursing, and any other food that is given to the young baby is at best a makeshift. Considering the baby’s delicacy, therefore, and his urgent needs, no pains should be spared to make any artificial food that is given to him, as satisfactory as possible. And no matter what it costs, he should have only the freshest, cleanest and purest milk that can be bought.
In preparing and giving artificial food it must be borne in mind that normal breast milk has the following characteristics:
1. It is exactly right in quantity, quality and proportion. 2. It is fresh, clean and sweet. 3. It is free from bacteria. 4. It tends to protect the baby from infection. 5. It definitely protects him from certain nutritional diseases.
Cows’ milk, suitably modified, is apparently the best available substitute for mother’s milk, but it must first meet certain requirements and then be handled with scrupulous cleanliness and care, if it is to be satisfactory.
The requirements are that the milk shall be:
1. Whole milk. It must not be altered by the removal of cream nor the addition of such preservatives as salicylic acid, formaldehyde or boracic acid.
All of this means that the milk must come from a herd of healthy, tuberculin-tested cows. The milk from a single cow may vary markedly from day to day but that from several cows is nearly constant. The stables and the cows must be kept clean, the udders carefully washed before each milking; the milkers themselves must wear freshly washed clothing, scrub their hands thoroughly and milk into sterile receptacles; the milk must be immediately covered and cooled to a temperature of 45° F. or 50° F. and kept there.
Milk produced under such conditions is usually described as “certified milk” and is often prescribed as infant food without being pasteurized or sterilized. But if there is any doubt about the source of the milk and the method of its handling, it should be strained into a clean receptacle through filter paper or a thick layer of absorbent cotton and subsequently boiled or pasteurized.
Whether certified or not, the milk should invariably be placed in the refrigerator, or some other place which has a temperature of 50° F., as soon as it is received, and it must be kept cool and clean.
Keeping milk cool means keeping it at a temperature of 50° F. Keeping it clean implies cleanliness not alone of the milk itself but of your hands and the utensils that you use as well as the destruction of disease germs by pasteurization or sterilization. Among the germs which are likely to be present in infected milk are those that cause diarrhea, sore throats, typhoid fever, diphtheria and scarlet fever.
When the doctor makes out the formula for the baby’s milk, he will adjust the proportions of the different ingredients to the baby’s immediate needs and digestive powers. But his careful estimations will be set at naught unless you are absolutely accurate in preparing and giving the milk. Your invariable responsibility in connection with the baby’s milk, therefore, is to keep it cool and clean and be accurate.
You will appreciate the necessity for modifying cows’ milk before giving it to your baby if you will note the differences between mother’s milk and cows’ milk as indicated by the following table and consider, too, why Nature has made these differences:
| Mother’s Milk | Cows’ Milk | |||||||
|---|---|---|---|---|---|---|---|---|
| Fats | 3.5 | to | 4. | per cent | 3.5 | to | 4. | per cent |
| Sugar | 6.5 | to | 7.5 | per cent | 4.5 | to | 4.75 | per cent |
| Proteins | 1. | to | 1.5 | per cent | 3.5 | to | 4. | per cent |
| Salts | .2 | per cent | .7 | to | .75 | per cent | ||
| Water | 87. | to | 88. | per cent | 87. | per cent | ||
The various tissues of the body and the bony skeleton are built by the proteins and salt. Accordingly Nature supplies these in greater abundance to the baby calf, who grows so fast as to double his birth weight in about forty-seven days, than to the baby boy who scarcely doubles his birth weight within 180 days. The calf begins life with a physical need for the large amount of proteins and salts which are present in cows’ milk and with digestive organs that can cope with them, but the baby needs less, can digest less and, therefore, should be given less. There are of course, other and finer differences between the two milks and an attempt is sometimes make to meet these. For example, mother’s milk is slightly alkaline and cows’ milk slightly acid and the curd of cows’ milk is larger, tougher and harder to digest than that formed by mother’s milk. Some doctors add lime water to cows’ milk, before giving it to the baby, to make it alkaline and have the curd made softer, finer and more digestible by boiling.
Articles Needed in Preparing the Baby’s Food. A complete equipment for preparing and giving the baby’s milk should be assembled, kept in a clean place, separate from utensils in general use, and never put to any other service. A satisfactory outfit for this purpose comprises the following articles:
One dozen graduated nursing bottles.
One dozen nipples.
Clean, new corks or a package of sterile, non-absorbent cotton for stoppers.
Bottle brush.
Covered kettle, capacity one gallon, for boiling bottles and possibly pasteurizing milk.
Pasteurizer or wire bottle rack.
Small kettle, about one quart size.
Graduated pint or quart measuring glass.
Pitcher, two-quart size.
Long-handled spoon for mixing.
Funnel.
Measuring spoons—table and tea sizes.
Double boiler.
Thermometer which will register at least 212° F.
Cream dipper (if ordered).
Two small covered jars for sterile and used nipples.
Sugar (lactose, maltose or cane sugar according to orders).
Lime water (if ordered).
Utensils of enamel or aluminum ware are probably the most satisfactory ones to use as they are easily kept clean, while bottles with wide mouths and curved bottoms and inner surfaces can be thoroughly washed more easily than those with small necks and sharp corners. Nipples that can be turned inside out to be washed should be selected as it is almost impossible to clean thoroughly those with tubes or narrow necks. New bottles will be rendered less breakable if placed in cold water, which is gradually heated, allowed to boil for half an hour and cooled before the bottles are removed.
The bottles should be rinsed with cold water after each feeding and then carefully washed and scrubbed with the bottle brush in hot soapsuds or borax water, containing two tablespoonfuls to the pint. They may be kept full of water while not in use or rinsed with hot water and stood upside down until they are all boiled on the following morning, preparatory to being filled with the freshly prepared milk. The baby’s bottles should never be washed in dishwater nor dried on a towel. The nipples should be rinsed in cold water, turned inside out and scrubbed with a brush, in hot soapsuds or borax water; rinsed and placed in a jar ready to be boiled with the bottles.
Preparing the Milk. The full quantity of milk which the baby will take in the course of twenty-four hours is prepared at one time and the prescribed amount for each feeding poured into as many separate bottles as there will be feedings.
You should begin by assembling on a table everything that you will use in preparing the milk formula, as the nurse has in Fig. [47]. Boil for five minutes all of the articles that will come in contact with the milk, including the full number of bottles and nipples and the jars in which the nipples are kept; remove them with the long-handled spoon without touching the edges or inner surfaces, dropping the nipples into one of the sterile jars.
Wash the mouth of the milk bottle before removing the cap and pour the amount which the formula calls for into the sterile pitcher. To this is added the sterile water in which the sugar has been dissolved in the measuring glass and then the potato or barley water, the lime water or soda solution as ordered. This mixture is thoroughly stirred and the amount for one feeding at a time, measured in the measuring glass and poured into the specified number of bottles, which are then stoppered.
Fig. 47.—Preparing the baby’s milk. (From a photograph taken at Johns Hopkins Hospital.)
If certified milk is used for the milk mixture it is often given to the baby without being pasteurized, in which case the bottles are placed in the refrigerator as soon as they are filled and stoppered. Very frequently, however, the milk is sterilized or pasteurized. You will feel surer of keeping the mouths of the bottles clean if you cover them with squares of gauze or muslin before they are sterilized, holding the caps in place with tapes or rubber bands.
Pasteurization as applied to infant feeding consists of heating the milk to 140–165° F. and keeping it at that temperature for 20 to 30 minutes.
There are many excellent pasteurizers for home use on the market, but entirely satisfactory results may be obtained by improvising one from the wire bottle rack seen in Fig. [47], and the large kettle already provided. One method is to place the rack, containing the bottles, in the kettle which is filled with cold water to a level a little above the top of the milk in the bottles, and allow the water to come to the boiling point. The kettle is removed from the fire, covered tightly and the bottles allowed to stand in the hot water for twenty minutes. Cold water is then run into the kettle to cool the milk gradually and avoid breaking the bottles, after which they are placed in the refrigerator, well or spring-house and kept at a temperature of 50° F. until they are taken out, one at a time, for feedings. If a wire rack is not available the bottles may be stood on a saucer or a thick pad of folded newspapers in the bottom of the kettle.
Pasteurization does not destroy all germs that may be in the milk, but it kills the more important ones and apparently impairs the nutritive and protective properties of the milk less than boiling. However, pasteurized milk must be kept cold and must be used within twenty-four hours, for the aging of milk is quite as undesirable as souring.
Scalding is another method of destroying germs in milk. The milk is placed in an open vessel and the temperature raised to about 180° F., or until bubbles appear around the edge and the milk steams in the center, after which it is cooled and kept at a temperature of 50° F.
Many doctors prefer to have the baby’s milk boiled, since boiling insures absolute sterilization and also renders the curd more digestible. Other changes are produced by boiling, however, which make it important to add orange juice and cod-liver oil to the baby’s diet at an early date, as will be explained in the next chapter.
Milk may be boiled directly over the flame for a time varying from three to forty-five minutes, or it may be placed in a double boiler, the water in the lower receptacle being cold, and allowed to remain until the water has boiled from six to forty-five minutes.
When milk is boiled or scalded, the other ingredients are added beforehand, as a rule, after which it is measured and poured into the bottles. Or the milk mixture may be poured into the bottles as for pasteurization and the bottles kept in the actively boiling water for any desired length of time.
All of these points, however, are definitely specified by the doctor.
Giving the Baby His Bottle. At feeding time, the bottle should be taken from the refrigerator, the stopper removed and a sterile nipple taken up by the margin and put on the bottle without touching the mouthpiece. The milk is brought to a temperature of about 100° F. by standing the bottle in a deep cup or kettle of warm water and placing it on the fire. The temperature of the milk may be tested by dropping a few drops on the inner side of the wrist or forearm where it should feel warm but not hot. This dropping will also indicate if the hole in the nipple is of the proper size to allow the milk to drop rapidly in clean drops but not to pour. If the hole is too small, the drops will be small and infrequent and the baby will be obliged to work too hard to obtain it; while if the hole is too large the baby will feed too rapidly and may have colic as a result. If the hole is too large the nipple will have to be discarded; if too small or if there is no hole, one of the proper size may be made by piercing the nipple with a heated darning needle or small steel knitting needle.
Fig. 48.—Proper position in which to hold baby and bottle during feeding.
Fig. 49.—Holding the baby upright immediately after feeding, and gently patting his back to help him bring up air in order to prevent colic.
The baby’s diaper should be changed if it is soiled or wet before he is given the bottle and he should be held comfortably on your arm, in a reclining position, while you hold the bottle with your free hand as shown by the nurse in Fig. [48]. The bottle should be inclined sufficiently to keep the neck full of milk; otherwise the baby may draw in air as he nurses. He should be kept awake while feeding but he should be allowed to pause every three or four minutes in order not to take his milk too rapidly. Not less than ten nor more than twenty minutes is devoted to a feeding, as a rule, and if the baby refuses a part of his milk, it should be thrown away; never warmed over for another time.
After being fed, the baby should be held upright against your shoulder for a moment or two, as in Fig. [49], and ever so gently patted on the back to help bring up any air which he may have swallowed. He should on no account be rocked nor played with after taking the bottle, but should be placed gently in his crib, warm and dry and left alone to sleep. Turning him or moving him about even to the extent of changing his diaper at this time may cause vomiting.
The evidences of satisfactory and unsatisfactory feeding in the bottle-fed baby are about the same as in the baby who is fed at the breast, except that the gain in weight on artificial food may be a little slower and less steady than on maternal nursing; the stools have a characteristic sour odor; are a little lighter in color and may contain white lumps of undigested fat; are usually dryer than in breast feeding and may be formed, in even a very young baby.
Many doctors feel that all babies, whether breast-fed or on the bottle, require a certain amount of cool boiled water to drink between feedings. A small amount is given at first and gradually increased according to the doctor’s instructions, and it may be given from a bottle, a medicine dropper or poured slowly from the tip of a teaspoon.
I feel sure that you have realized, long before this, that the entire question of planning the baby’s food is such an important and complicated matter that it cannot with safety to the baby be undertaken by any one but your doctor. Unexpected situations do arise, however, when the doctor is not within immediate reach and the mother has to plan the baby’s food, temporarily, to the best of her ability.
Should you find yourself in such an emergency, you will find help in the milk formulas contained in a pamphlet issued by the American Medical Association, remembering that they are intended for the average, normal baby and are not necessarily suitable for all babies. A large, vigorous baby may need more food and a small, frail baby have to take less than the amounts specified in the following directions:[[3]]
[3]. From “Save The Babies” by Dr. L. Emmet Holt and Dr. H. K. L. Shaw. Copied by courtesy of The American Medical Association.
“The simplest plan is to use whole milk (from a shaken bottle) which is to be diluted according to the child’s age and digestion.
“Beginning on the third day, the average baby should be given 3 ounces of milk daily, diluted with seven ounces of water. To this should be added one tablespoonful of lime water and 2 level teaspoonfuls of sugar. This should be given in 7 feedings.
“At one week, the average child requires 5 ounces of milk daily, which should be diluted with 10 ounces of water. To this should be added 1½ even tablespoonfuls of sugar and one ounce of lime water. This should be given in 7 feedings.
“The milk should be increased by ½ ounce about every 4 days.
“The water should be increased by ½ ounce about every 8 days.
“At 3 months the average child requires 16 ounces of milk daily, which should be diluted with 16 ounces of water. To this should be added 3 tablespoonfuls of sugar and 2 ounces of lime water. This should be given in 6 feedings.
“The milk should be increased by ½ ounce about every 6 days.
“The water should be reduced by ½ ounce about every 2 weeks.
“At 6 months the average child requires 24 ounces of milk daily, which should be diluted with 12 ounces of water. To this should be added 2 ounces of lime water and 3 even tablespoonfuls of sugar. This should be given in 5 feedings.
“The amount of milk should be increased by ½ ounce every week.
“The milk should be increased only if the child is hungry and digesting his food well. It should not be increased unless he is hungry, nor if he is suffering from indigestion even though he seems hungry.
“At 9 months, the average child requires 30 ounces of milk daily, which should be diluted with 10 ounces of water. To this should be added 2 even tablespoonfuls of sugar and 2 ounces of lime water. This should be given in 5 feedings.
“The sugar added may be milk sugar or, if this cannot be obtained, cane (granulated) sugar or maltose (malt sugar).
“At first plain water should be used to dilute the milk.
“At 3 months, sometimes earlier, weak barley water may be used in the place of plain water; it is made with ½ level tablespoonful of barley flour to 16 ounces of water and cooked 20 minutes.
“At 6 months the barley flour may be increased to 1½ even tablespoonfuls, cooked in the 12 ounces of water.
“At 9 months, the barley flour may be increased to 3 level tablespoonfuls, cooked in the 10 ounces of water.
“A very large baby may require a little more milk than that allowed in these formulas. A small delicate baby will require less than the milk allowed in the formulas.”
These formulas may be tabulated as shown on p. [177].
Mixed Feeding. Under some conditions the breast-fed baby is given also a certain amount of modified milk, and this combination of natural and artificial feeding is termed mixed or supplementary feeding.
A deficiency in the breast milk, ascertained by weighing the baby before and after each nursing, may be supplied by following each nursing with a bottle feeding; or for some reason, one or two breast feedings, in the course of the day are sometimes replaced by entire bottle feedings. In any case the milk mixture to be used as supplementary feeding is prepared with exactly the same painstaking care as is the milk for entire artificial feeding.
If supplementary food is given because of an inadequate supply of breast milk, it is of great importance that the baby be put to the breast regularly, no matter how little food he obtains, for his suckling is the best possible means of stimulating the breasts to secrete more milk, and of equal importance is the fact that they will tend to dry up if the baby nurses less than about five times in twenty-four hours. Moreover, even a little breast milk is valuable to him and he should have the benefit of all there is to be had.
| Age | Milk | Water | Barley Water | Lime Water | Sugar | No. of feedings | Hours | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Day | Night | |||||||||||||
| 3–7 | days | 3 | ozs. | 7 | ozs. | ½ | ozs. | 2 | teaspoons | 7 | 6–9–12–3–6 | 10–2 | ||
| 2d | week | 5 | „ | 10 | „ | 1 | „ | 1½ | tablespoons | 7 | 6–9–12–3–6 | 10–2 | ||
| 3d | „ | 6 | „ | 10½ | „ | 1 | „ | 1½ | „ | 7 | 6–9–12–3–6 | 10–2 | ||
| 1 | month | 7 | „ | 11 | „ | 1 | „ | 2 | „ | 7 | 6–9–12–3–6 | 10–2 | ||
| 2 | „ | 11 | „ | 13 | „ | 1½ | „ | 2½ | „ | 7 | 6–9–12–3–6 | 10–2 | ||
| 3 | „ | 16 | „ | 16 | ozs. | 2 | „ | 3 | „ | 7 | 6–9–12–3–6 | 10–2 | ||
| 4 | „ | 19 | „ | 15 | „ | 2 | „ | 3 | „ | 6 | 6–9–12–3–6 | 10 | ||
| 5 | „ | 21½ | „ | 14 | „ | 2 | „ | 3 | „ | 6 | 6–9–12–3–6 | 10 | ||
| 6 | „ | 24 | „ | 12 | „ | 2 | „ | 3 | „ | 5 | 6–10–2–6 | 10 | ||
| 7 | „ | 26 | „ | 12 | „ | 2 | „ | 3 | „ | 5 | 6–10–2–6 | 10 | ||
| 8 | „ | 28 | „ | 11 | „ | 2 | „ | 2½ | „ | 5 | 6–10–2–6 | 10 | ||
| 9 | „ | 30 | „ | 10 | „ | 2 | „ | 2 | „ | 5 | 6–10–2–6 | 10 | ||
An entire bottle feeding is sometimes given to a baby who is nursing satisfactorily at the breast, in order to give his mother an opportunity to take longer outings than are possible between the regular nursings. And sometimes it is to the mother’s advantage, and therefore to the baby’s, to give him a bottle during the night and thus allow her to sleep undisturbed.