If he 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 not being satisfied when taken from his mother. 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 food will increase his weight one ounce. If the baby is not getting a normal amount of milk at each nursing he is often given enough modified milk after each meal to supply the deficit, but at the same time an effort is made to increase the supply of breast milk by improving the mother’s personal hygiene.
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 must always be figured for the individual 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 which is given to him as satisfactory as possible. In preparing and giving artificial food it must be borne in mind that normal breast milk:
1. Is exactly right in quantity, quality and proportion. 2. Is fresh, clean and sweet. 3. Is free from bacteria. 4. Tends to protect the baby from infection. 5. 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 at all 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. 2. Its composition must not vary greatly from day to day. 3. It must be clean and free from disease germs; other organisms should not be present in excessive numbers. 4. It must be fresh: less than 24 hours old when it is delivered.
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.