Fig. 170.—Holding the baby upright and gently patting his back to bring up air immediately after feeding.
After being fed, the baby should be held upright against the nurse’s shoulder for a moment or two (Fig. [170]), 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 or 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.
It is fairly generally agreed 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.
Ingredients of the Baby’s Food. In referring to the ingredients of the baby’s food we cannot use the terms “sugar” or “milk” as though they indicated definite and unvarying materials.
There are three kinds of sugar which are commonly used in modified milk: cane or granulated sugar; lactose or milk sugar and maltose. Cane sugar, the one most widely used, is the least expensive of the three and it apparently is satisfactory for most babies. Lactose is fairly expensive and while it causes diarrhea in some babies, others digest it more easily than cane sugar. Lactose is lighter than cane sugar, three spoonfuls being equal in weight to two of cane sugar. The maltose-dextrine preparations are easily digested and somewhat laxative. Some babies gain more rapidly when maltose constitutes part of the sugar in their food than when only lactose is used.
The question of milk is somewhat complicated and though the doctor will specify what percentage of fat shall be in the milk which is used in each case, the nurse must know how to obtain it from the milk at her disposal. If the formula is made up with “whole milk,” which contains 4 per cent. fat, the bottle in which it was delivered should be turned upside down and shaken vigorously in order that the cream which has risen to the top may be redistributed evenly throughout the fluid.
If the doctor employs what is termed “percentage feeding,” he may use whole milk, skimmed milk, or top milk. What he is endeavoring to do is to prepare a food which contains definite known percentages of the different ingredients, fat, carbohydrates and protein. Where a mixture is desired which contains more fat than it does protein, the milk to be employed is obtained by discarding a certain amount from the bottom of the jar of milk, the remainder being then called “top milk.” When he wishes the fat to be lower than the protein percentage, he discards some of the top milk in the jar, using the rest, which is then a partially skimmed milk. The upper 2 ounces in a quart bottle of milk contains 24 per cent. fat; the upper 8 ounces is 12 per cent. fat; the upper 16 ounces is 8 per cent. fat and the upper 24 ounces is 5 per cent. fat. If the formula calls for 6 ounces of the upper 8 ounces of milk, therefore, the nurse will see that it is very important that she remove the full 8 ounces and use 6 ounces of the milk which she has removed and not simply take the upper 6 ounces, as this would contain a higher percentage of fat than is ordered. (Figs. [171], [172], Dr. Griffith’s tables of fat percentages.)
Top milk may be removed by tipping the bottle gradually and slowly pouring the designated amount into a measuring glass, or it may be removed by pushing a cream dipper, especially made for this purpose and holding one ounce, down into the bottle until the cream flows in. Another method is to syphon off the lower milk through a bent glass tube, leaving in the bottle the desired amount of top milk.