PUTTING FOODS TOGETHER
Whole milk contains 4 per cent fat, and must be thoroughly shaken before it is measured, for otherwise one child will get all the fat and another all the skimmed milk.
Fat-free, or skimmed milk, contains about 0.1 per cent fat. The cream has been removed by a siphon or centrifuge. If unable to get a fat-free milk from a dairy, the cream can be removed from a quart of whole milk quite easily with a siphon.
Sugars and flours should be weighed when used, for they vary greatly in volume.
In using flour ball or imperial granum, the flour must be mixed with water or cereal water, to make a smooth paste and brought to a boil. If the milk is to be boiled also, add the milk to the paste and boil all together. Cool and strain.
All baby feedings should be strained, as tiny lumps of food will clog the rubber nipple and the nurse may think the baby is not taking its feedings well. The following is a typical formula:
| Whole milk | 15 oz. | } | 5×6×4 |
| Barley water | 15 oz. | ||
| Sugar | ½ oz. | ||
| Flour ball | ½ oz. | ||
| Boil two minutes. |
Weigh the sugar and flour ball and make a paste with the barley water. Shake the whole milk, measure out 15 oz. in the graduate, and add the barley water mixture. Boil two minutes. Cool in running water, strain bottle and put on ice. The figures at the side mean that five feedings of six ounces each are to be given at four-hour intervals.
It is necessary to cool all feedings as soon as modified, and keep them on ice for preservation until used.
The only accurate way is to make up the whole quantity for twenty-four hours, put into separate bottles the exact amount of each feeding and give at the time ordered, after the bottle has been properly warmed. In warming the food, care must be used to get it neither too hot nor too cold; 100° F., or when it feels warm to the back of the hand, is about right. The child should be held in the arms while taking the bottle.
A buttermilk feeding must not be heated to more than 100° F. because it curdles and can not be used.
The rubber nipples should be washed thoroughly after use, boiled once a day, and kept in boric acid solution.
The necessary articles for home modification of milk can be obtained anywhere. One set of utensils should be kept for this purpose exclusively and boiled each time before the food is prepared. A list is convenient:
A 16 ounce glass graduate.
One tablespoon and one teaspoon may be used for measuring purposes, if unable to get a satisfactory scale.
1 2–quart aluminum cooking dish.
1 long-handled aluminum spoon.
1 fine wire mesh strainer, thirty holes to the inch.
1 dozen bottles, 5 ounce size if the child is small, and 10 ounce if the child takes large feedings.
The bottles should have wide mouths, straight sides, and round bottoms, which clean easily. Paper caps or corks that fit tightly should be used instead of cotton stoppers. Close rubber caps are best, for, as the milk cools, a vacuum is created, the rubber is drawn in and the milk remains air-tight until opened. If infants are kept on a milk diet alone for too long at a time, they do not thrive so well, hence as early as six months, other things may be given. At this stage, the most desirable additions to the food would be cereal, farina or cream of wheat, orange juice, vegetable broth, toast crumbs, etc. The administration of orange juice should be started when the child is only a few weeks old.
The quantity of all these foods may be increased as the child gets older, and by the end of a year the diet is broadened still further. Beside a quart of whole milk, it may have thickened soups, vegetables, such as cauliflower, spinach, carrots, creamed celery and a little baked potato. Fruits, orange juice, grape fruit juice, prune sauce, apple sauce and scraped apple may be given, but no bread. In place of bread, use toast, Huntley and Palmer wafers and biscuits, and soda or oatmeal crackers. Sweet desserts should be avoided, but flavored junket or simple custard is unobjectionable.
No meats are permitted until the child is eighteen months old, except, perhaps, a little crisp bacon, or a bone to suck.
None of these supplemental foods should be given between meals, but always at the feeding hour. The above list supplies a dietary so varied that no child will tire of it.
In reporting the condition of the infant to the physician, the following form may be used to advantage. It is a clear cut, concise summary of what he wishes to know.
Infant’s Daily Report
1. Food: Does baby take it all? Is he satisfied? 2. Bowel movements: How many in last 24 hours? What is the color? Are they hard, soft, or watery? Any odor? Any curds? Any slime? Any blood? Any colic? Much gas? 3. Does baby vomit? When? How much? 4. Does baby sleep well? Is he good natured? 5. Any fever? What is the weight?
Significant Symptoms and Conditions.—In an artificially fed baby, the normal condition of the bowels is constipation. The stools are formed, alkaline in reaction, rather hard, and usually only one a day.
The stools should have a characteristic color, according to the food taken. Thus:
Sugar or starch will color the movement a dark brown, like vaseline.
Too much fat gives a pale yellow stool, almost white, like putty.
Eiweiss feedings show as a pale yellow, somewhat like the fatty stools, but constipated.
Barley water gives a brown liquid stool.
Starvation stools are thin, slimy, dark brown or green.
The consistency of the movements is also important.
Too much sugar or starch means diarrhœa, with thin, green, acid stools, and much gas and regurgitation, or, sometimes foamy, mucous discharges.
Diarrhœa may also be due to indigestion. Mucus in the stools usually signifies intestinal irritation.
Constipation may exceed the normal limits of the artificially fed child when the food contains too much fat.
Bad odors of the stools result from putrefaction.
Colic means imperfect digestion with gas. There is less colic when the intervals between the feedings are lengthened.
Curds are of two kinds. The soft friable ones due to fat, and the hard bean-like masses of protein. Curds occur with feedings of raw milk only, and though associated with symptoms of indigestion, they signify overfeeding. If the sugar content of the food is low, the child will gain very slowly.
Vomiting is an important phenomenon. It may be due to overfeeding, to excess of sugar or fat in the food, or to pyloric stenosis. Excess of fat is shown by vomiting and regurgitation of small quantities of food one or two hours after feeding. It may be associated with constipation.
If vomiting occurs immediately after feeding, it is probably due to the taking of an excessive amount, or to the too rapid ingestion of the regular bottle. If the vomiting takes place later than twenty minutes after feeding, it is probably pathological. It may be the result of indigestion, meningitis, or of pyloric stenosis (q. v.).
For the first weeks of life, mother’s milk should be obtained at all hazards, if possible, but if this is not to be had, the artificial feedings may be started.
A desirable milk modification for the first weeks of life should begin with a low food value. For example, a child one week old weighing seven pounds, should start on a formula like this:
| Whole milk | 7 oz. |
| Water | 7 oz. |
| Cane sugar | ½ oz. |
| Boil two minutes. |
This will make seven feedings of 2 oz. each, and one is given every three hours with one feeding omitted at night.
Cane sugar is less liable to produce colic than sugar of milk.
Lime water, or sodium citrate may be added, if the child vomits, or if other indications arise. Both are alkalies.
The strength of the mixture, as well as the quantity, must be increased as the child gets older and it is seen that the formula will agree.
The percentage of protein is kept down by dilution, with plain or cereal water, while fats (as cream) and sugars are added to make up the strength lost by the dilution.
CHAPTER XXIII
CLEANLINESS AND STERILIZATION
The nurse is called to a case on account of her special qualifications, but also she should lead her patient in all things, even in gentility. It is her part to anticipate the wants of the patient, and regard it as a reproach if the patient has to remind her that it is time for food, medicine, bath, or for child to come to the breast. Regularity, promptness, and thoughtfulness must be supreme. Be on hand when the doctor calls and stay until he goes. Be as cheerful as Mark Tapley, however dreary the prospect, and do not make noises either by the swish of overstarched skirts, the squeak of shoes, or the moving of equipment. Above all things, the nurse must keep her patient’s room, her patient, and her own person rigorously clean. She should not allow her hands to touch infectious material without protection by rubber gloves. This is as necessary for her own safety as for the patient and family. Her hands should be manicured frequently, her hair shampooed at short intervals, and her teeth kept in order. If the hands get hard, take a teaspoonful of sodium carbonate and one of chloride of lime, mix in the palm of the hand with enough water to make a cream, and rub well into palms and about the nails. Rinse in clean water. (Weir.)
The nurse’s dress should be neat, always mended, and carefully adjusted. The nurse who is slovenly in appearance will be slovenly in her mind and slovenly in her work. She should not wear her uniform on the street. It is bad taste, unprofessional, and unsanitary.
She should bathe at least three times a week. There is always some odor of perspiration about the body, and especially around the axillary spaces which are filled with hair. Nothing is more offensive and nauseating than being leaned over and waited on by a person who has a strong body smell.
The prodigal use of warm water and soap will aid, but there are large sebaceous glands in the armpits and their decomposing excretions are retained by the hair so lastingly that more radical measures are necessary. The axillæ should be shaved at least once a month, and then the soap and water becomes more efficacious. After thorough cleansing, the armpits should be dredged with Babcock’s Motiya powder, and the annoying and offensive odor will disappear.
If the patient is a refined and dainty woman, who may happen to be afflicted with the same misfortune, she will be deeply grateful to the nurse who tells her how to get rid of it.
That some doctors, unfortunately, have strong odors about the person—the mixed effluvia of tobacco, alcohol, bad teeth, and uncleanliness—is no excuse for the nurse. The doctor should know better, but at all events, his offense rarely needs to be suffered more than a few minutes at a time, while the nurse is in constant attendance.
The trained nurse should be polite to, but not familiar with servants, as she is looked upon as the highest type of the professionally educated gentlewoman, and she must be constantly alert that her reputation in this respect is not diminished.