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diff --git a/15484.txt b/15484.txt new file mode 100644 index 0000000..1d3cafd --- /dev/null +++ b/15484.txt @@ -0,0 +1,5111 @@ +Project Gutenberg's The Care and Feeding of Children, by L. Emmett Holt + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: The Care and Feeding of Children + A Catechism for the Use of Mothers and Children's Nurses + +Author: L. Emmett Holt + +Release Date: March 27, 2005 [EBook #15484] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK THE CARE AND FEEDING OF CHILDREN *** + + + + +Produced by Juliet Sutherland and the PG Online Distributed +Proofreading Team. + + + + + + +THE CARE AND FEEDING OF CHILDREN + + +A CATECHISM FOR THE USE OF MOTHERS +AND CHILDREN'S NURSES + +By + +L. EMMETT HOLT, M.D., LL.D. + +PROFESSOR OF DISEASES OF CHILDREN IN THE COLLEGE OF +PHYSICIANS AND SURGEONS (COLUMBIA UNIVERSITY) + +ATTENDING PHYSICIAN TO THE BABIES' HOSPITAL AND THE +FOUNDLING HOSPITAL, NEW YORK + + +Fourth Edition, Revised and Enlarged + + +NEW YORK AND LONDON +D. APPLETON AND COMPANY + +1907 + + +COPYRIGHT, 1894, 1897, 1903, 1906 +By D. APPLETON AND COMPANY + + +[Transcriber's Note: The text scans did not include a Table of +Contents so the following has been added for the convenience of +the reader.] + + +CONTENTS + +I. THE CARE OF CHILDREN + +Bathing +Genital Organs +Eyes +Mouth +Skin +Clothing +Napkins +Nursery +Airing +Weight, Growth, and Development +Dentition + + +II. INFANT FEEDING + +Nursing +Weaning +Artificial Feeding +Selection and Care of Milk Used for Infant Feeding +Modification of Cow's Milk +Food for Healthy Infants--The Early Months +Food for Healthy Infants--The Later Months +General Rules for Guidance in the Use of the Formulas Given +Addition of Other Foods to Milk +Overfeeding +Loss of Appetite +Changes in Food Required by Special Symptoms or Conditions +Common Mistakes in Milk Modification and Infant Feeding +Preparation of Cow's Milk at Home +Directions for Feeding Infants +Intervals of Feeding +Regularity in Feeding +Sterilized Milk +Modified Milk of the Milk Laboratories +Peptonized Milk +Feeding During the Second Year +Feeding During the Third Year + + +III. THE DIET OF OLDER CHILDREN + +Milk and Cream +Eggs +Meats and Fish +Vegetables +Cereals +Broths and Soups +Bread, Crackers, and Cakes +Desserts +Fruits +Indigestion in Older Children +General Rules to be Observed in Feeding +Food Formulas + + +IV. MISCELLANEOUS + +Bowels +Sleep +Exercise +Cry +Lifting Children +Temperature +Nervousness +Toys +Kissing +Convulsions +Foreign Bodies +Colic +Earache +Croup +Contagious Diseases +Scurvy +Constipation +Diarrhoea +Bad Habits +Vaccination +Weight Charts + + + +THE CARE AND FEEDING OF CHILDREN + + + + +PART I + +THE CARE OF CHILDREN + + +BATHING + +_At what age may a child be given a full tub bath?_ + +Usually when ten days old; it should not be given before the cord has +come off. + +_How should the bath be given?_ + +It should not be given sooner than one hour after feeding. The room +should be warm; if possible there should be an open fire. The head and +face should first be washed and dried; then the body should be soaped +and the infant placed in the tub with its body well supported by the +hand of the nurse. The bath should be given quickly, and the body +dried rapidly with a soft towel, but with very little rubbing. + +_At what temperature should the bath be given?_ + +For the first few weeks at 100 deg. F.; later, during early infancy, at +98 deg. F.; after six months, at 95 deg. F.; during the second year, from 85 deg. +to 90 deg. F. + +_With what should the bath be given?_ + +Soft sponges are useful for bathing the body, limbs and scalp. There +should be a separate wash-cloth for the face and another for the +buttocks. + +_What are the objections to bath sponges?_ + +When used frequently, they become very dirty and are liable to cause +infection of the eyes, mouth or genital organs. + +_Under what circumstances should the daily tub bath be omitted?_ + +In the case of very feeble or delicate infants on account of the +exposure and fatigue, and in all forms of acute illness except by +direction of the physician. In eczema and many other forms of skin +disease much harm is often done by bathing with soap and water, or +even with water alone. + + +GENITAL ORGANS + +_How should the genital organs of a female child be cleansed?_ + +Best with fresh absorbent cotton and tepid water, or a solution of +boric acid, two teaspoonfuls to the pint. This should be done +carefully at least once a day. If any discharge is present, the +boric-acid solution should invariably be used twice a day. Great care +is necessary at all times to prevent infection which often arises from +soiled napkins. + +_How should the genital organs of a male child be cleansed?_ + +In infancy and early childhood the foreskin should be pushed back at +least twice a week while the child is in his bath, and the parts thus +exposed washed gently with absorbent cotton and water. + +If the foreskin is tightly adherent and cannot readily be pushed back, +the physician's attention should be called to it. The nurse or mother +should not attempt forcible stretching. + +_When is circumcision advisable?_ + +Usually, when the foreskin is very long and so tight that it cannot be +pushed back without force; always, when this condition is accompanied +by evidences of local irritation or difficulty in passing water. + + +EYES + +_How should the eyes of a little baby be cleansed?_ + +With a piece of soft linen or absorbent cotton and a lukewarm solution +of salt or boric acid,--one half of an even teaspoonful to one pint of +water. + +_If pus appears in the eyes, what should be done?_ + +They should be cleansed every hour with a solution of boric acid (ten +grains to one ounce of water). If the lids stick together, a little +vaseline from a tube should be rubbed upon them at night. If the +trouble is slight, this treatment will control it; if it is severe, a +physician should be called immediately, as delay may result in loss of +eyesight. + + +MOUTH + +_How is an infant's mouth to be cleansed?_ + +An excellent method is by the use of a swab made by twisting a bit of +absorbent cotton upon a wooden toothpick. With this the folds between +the gums and lips and cheeks may be gently and carefully cleansed +twice a day unless the mouth is sore. It is not necessary after every +feeding. The finger of the nurse, often employed, is too large and +liable to injure the delicate mucous membrane. + +_What is sprue?_ + +It appears on the lips and inside the cheeks like little white threads +or flakes. It is also called thrush. In bad cases it may cover the +tongue and the whole of the inside of the mouth. + +_How should a mouth be cleansed when there is sprue?_ + +It should be washed carefully after every feeding or nursing with a +solution of borax or bicarbonate of soda (baking soda), one even +teaspoonful to three ounces of water, and four times a day the +boric-acid solution mentioned should be used. + + +SKIN + +_How should the infant's skin be cared for to prevent chafing?_ + +First, not too much nor too strong soap should be used; secondly, +careful rinsing of the body; thirdly, not too vigorous rubbing, either +during or after the bath; fourthly, the use of dusting powder in all +the folds of the skin,--under the arms, behind the ears, about the +neck, in the groin, etc. This is of the utmost importance in very fat +infants. + +_If the skin is very sensitive and chafing easily produced, what +should be done?_ + +No soap should be used, but bran or salt baths given instead. + +_How should a bran bath be prepared?_ + +One pint of wheat bran should be placed in a bag of coarse muslin or +cheese-cloth, and this put in the bath water. It should then be +squeezed for five minutes until the water resembles a thin porridge. + +_How should a salt bath be prepared?_ + +A teacupful of common salt or sea salt should be used to each two +gallons of water. + +_How should the buttocks be cared for?_ + +This is the most common place for chafing, as the parts are so +frequently wet and soiled; hence the utmost pains should be taken that +all napkins be removed as soon as they are wet or soiled, and the +parts kept scrupulously clean. + +_If the parts have become chafed, what should be done?_ + +Only bran and salt baths should be used, and in very severe cases even +these may have to be omitted for a day or two. The parts may be +cleansed with sweet oil and a little absorbent cotton, and the skin +kept covered with a dusting powder composed of starch two parts, boric +acid one part. + +_What is prickly heat, and how is it produced?_ + +It consists of fine red pimples, and is caused by excessive +perspiration and the irritation of flannel underclothing. + +_How should it be treated?_ + +Muslin or linen should be put next to the skin; the entire body should +be sponged frequently with equal parts of vinegar and water, and +plenty of the starch and boric-acid powder mentioned should be used. + + +CLOTHING + +_What are the most essential things in the clothing of infants?_ + +That the chest shall be covered with soft flannel, the limbs well +protected but not confined, and the abdomen supported by a broad +flannel band, which should be snug but not too tight. It is important +that the clothing should fit the body. If it is too tight it +interferes with the free movements of the chest in breathing, and by +pressing upon the stomach sometimes causes the infant to vomit soon +after swallowing its food. If the clothing is too loose it is soon +thrown into deep folds or bunches, which cause much discomfort. No +pins should be used, but, instead all bands about the body should be +basted. The petticoats should be supported by shoulder straps. + +_How should the infant be held during dressing and undressing?_ + +Nothing is more awkward than to attempt to dress a young baby in a +sitting posture. It should lie upon the nurse's lap until quite old +enough to sit alone, the clothing being drawn over the child's feet, +not slipped over the head. + +_Of what use is the band?_ + +It protects the abdomen, but its most important use is to support the +abdominal walls in very young infants, and in this way to prevent the +occurrence of rupture. + +_How long is this band required?_ + +The snug flannel band, not usually more than four months. In healthy +infants this may then be replaced by the knitted band, which may be +worn up to eighteen months. The band is an important article of dress +in the case of thin infants whose abdominal organs are not +sufficiently protected by fat. With such, or with those prone to +diarrhoea, it is often advisable to continue the band until the third +year. + +_What changes are to be made in the clothing of infants in the +summer?_ + +Only the thinnest gauze flannel undershirts should be worn, and +changes in temperature should be met by changes in the outer garments. +The greatest care should be taken that children are not kept too hot +in the middle of the day, while extra wraps should be used morning and +evening, especially at the seashore or in the mountains. + +_Should older children be allowed to go with their legs bare?_ + +If strong and well there is no objection to this in very hot weather. +In cold weather, however, it is doubtful if any children are benefited +by it, particularly in a changeable climate like that of New York. +Many delicate children are certainly injured by such attempts at +hardening. + +_What sort of underclothing should be worn during cold weather?_ + +Never the heaviest weight, even in winter. Four grades are usually +sold, the next to the heaviest being thick enough for any child. + +_Do little children require as heavy flannels as older people?_ + +Not as a rule. They usually live in a warm nursery; their circulation +is active; and they always perspire easily during their play. When +they go out of doors, the addition of coats and leggings renders thick +flannels unnecessary. + +_Are not many little children clothed too thinly for the ordinary +house?_ + +Very few. The almost invariable mistake made in city homes is that of +excessive clothing and too warm rooms. These two things are among the +most frequent reasons for their taking cold so easily. + + +NAPKINS + +_How should napkins be taken care of?_ + +They should he immediately removed from the nursery when soiled or +wet. Soiled napkins should be kept in a receptacle with a tight cover, +and washed as soon as possible. + +_Should napkins which have been only wet be used a second time without +washing?_ + +It is no doubt better to use only fresh napkins, but there is no +serious objection to using them twice unless there is chafing of the +skin. Clean napkins, changed as soon as wet or soiled, are of much +importance in keeping the skin healthy. + +_What are the important things to be observed in washing napkins?_ + +Soiled napkins should not be allowed to dry, but should receive a +rough washing at once; they should then be kept in soak in plain water +until a convenient time for washing,--at least once every day,--when +they should be washed in hot suds and boiled at least fifteen minutes. +Afterward they should be very thoroughly rinsed or they may irritate +the skin, and ironed without starch or blueing. They should never be +used when clamp. + + +NURSERY + +_What are the essentials in a good nursery?_ + +The furnishings should be very simple, and unnecessary hangings and +upholstered furniture should be excluded. As large a room as possible +should be selected--one that is well ventilated, and always one in +which the sun shines at some part of the day, as it should be +remembered that an average child spends here at least three fourths of +its time during the first year. The nursery should have dark shades at +the windows, but no extra hangings or curtains; about the baby's crib +nothing but what can be washed should be allowed. The air should be +kept as fresh and as pure as possible. There should be no plumbing no +drying of napkins or clothes, no cooking of food, and no gas burning +at night. A small wax night-light answers every purpose. + +_How should a nursery be heated?_ + +Best by an open fire; next to this by a Franklin stove. The ordinary +hot-air furnace of cities has many objections, but it is not so bad as +steam heat from a radiator in the room. A gas stove is even worse than +this, and should never be used, except, perhaps, for a few minutes +during the morning bath. + +_At what temperature should a nursery be kept during the day?_ + +Best, 66 deg. to 68 deg. F., measured by a thermometer hanging three feet from +the floor. Never should the temperature be allowed to go above 70 deg. F. + +_At what temperature during the night?_ + +During the first two or three months, not below 65 deg. F. After three +months the temperature may go as low as 55 deg. F. After the first year it +may be 50 deg. or even 45 deg. F. + +_At what age may the window be left open at night?_ + +Usually after the third month, except when the outside temperature is +below freezing point. + +_How often should the nursery be aired?_ + +At least twice a day--in the morning after the child's bath, and again +in the evening before the child is put to bed for the night. This +should be done thoroughly, and the child should be removed meanwhile +to another apartment. It is well to air the nursery whenever the child +is out of the room. + +_What symptoms are seen in a child who is kept in too hot a room?_ + +It becomes pale, loses appetite, shows symptoms of indigestion, +occasionally vomits, stops gaining in weight, perspires very much, and +takes cold easily because of this and also because of the great +difference between the indoor and outdoor temperatures. Its condition +may be such as to lead one to suspect very serious illness. + + +AIRING + +_How early may airing indoors he commenced and how long may it be +continued?_ + +Airing in the room may be begun, even in cold weather, when the child +is one month old, at first for only fifteen minutes at a time. This +period may be gradually lengthened by ten or fifteen minutes each day +until it is four or five hours. This airing may be continued in almost +all kinds of weather. + +_Is there not great danger of a young baby's taking cold when aired in +this manner?_ + +Not if the period is at first short and the baby accustomed to it +gradually. Instead of rendering the child liable to take cold, it is +the best means of preventing colds. + +_How should such an airing be given?_ + +The child should be dressed with bonnet and light coat as if for the +street and placed in its crib or carriage which should stand a few +feet from the window All the windows are then thrown wide open, but +the doors closed to prevent draughts. Screens are unnecessary. + +_At what age may a child go out of doors?_ + +In summer, when one week old; in spring and fall, usually at about one +month; in winter, when about three months old, on pleasant days, being +kept in, the sun and out of the wind. + +_What are the best hours for airing out of doors?_ + +In summer and early autumn a child may be out almost any time between +seven in the morning and sunset; in winter and early spring, a young +child only between 10 or 11 A.M. and 3 P.M., although this depends +somewhat upon the climate. In New York and along the Atlantic coast +the early mornings are apt to be damp and the afternoons raw and +cloudy. + +_On what kind of days should a baby not go out?_ + +In sharp winds, when the ground is covered with melting snow, and when +it is extremely cold. A child under four months old should not usually +go out if the thermometer is below freezing point; nor one under eight +months old if it is below 20 deg. F. + +_What are the most important things to be attended to when the child +is out in its carriage?_ + +To see that the wind never blows in its face, that its feet are +properly covered and warm, and that the sun is never allowed to shine +directly into its eyes when the child is either asleep or awake. + +_Of what advantage to the child is going out?_ + +Fresh air is required to renew and purify the blood, and this is just +as necessary for health and growth as proper food. + +_What are the effects produced in infants by fresh air?_ + +The appetite is improved, the digestion is better, the cheeks become +red, and all signs of health are seen. + +_Is there any advantage in having a child take its airing during the +first five or six months in the nurse's arms?_ + +None whatever. A child can be made much more comfortable in a baby +carriage, and can be equally well protected against exposure by +blankets and the carriage umbrella. + +_What are the objections to an infant's sleeping out of doors?_ + +There are no real objections. It is not true that infants take cold +more easily when asleep than awake, while it is almost invariably the +case that those who sleep out of doors are stronger children and less +prone to take cold than others. + +_What can be done for children who take cold upon the slightest +provocation?_ + +They should be kept in cool rooms, especially when asleep They should +not wear such heavy clothing that they are in a perspiration much of +the time. Every morning the body, particularly the chest and back, +should be sponged with cold water (50 deg. to 60 deg. F.). + +_How should this cold sponge bath be given?_ + +The child should stand in a tub containing a little warm water, and a +large bath sponge filled with cold water should be squeezed two or +three times over the body. This should be followed by a vigorous +rubbing with a towel until the skin is quite red. This may be used at +three years, and often at two years. For infants a little higher +temperature (65 deg. to 70 deg.) may be used. + + +WEIGHT, GROWTH, AND DEVELOPMENT + +_Of what importance is the weight of the child?_ + +Nothing else tells so accurately how well it is thriving. + +During the first year a record of the weight is almost indispensable; +throughout childhood it is of much interest and is the best guide to +the physical condition. It will well repay any mother or nurse to keep +such a record. + +_How frequently should a child be weighed?_ + +Every week during the first six months, and at least once in two weeks +during the last six months of the first year. During the second year a +child should be weighed at least once a month. + +_How rapidly should an infant gain in weight during the first year?_ + +There is usually a loss during the first week of from four to eight +ounces; after this a healthy child should gain from four to eight +ounces a week up to about the sixth month. From six to twelve months +the gain is less, usually from two to four ounces a week. + +_Is it to be expected that bottle-fed infants will gain as rapidly as +those who are nursed?_ + +They seldom do so during the first month; after that time under +favourable circumstances the gain is usually quite as regular, and +during the latter half of the first year it is likely to be more +continuous than in a nursing infant, because the latter usually loses +weight at the time of weaning. + +_Why do they not gain so rapidly at first?_ + +It takes a few weeks for the stomach to become accustomed to cow's +milk, and until this is accomplished it is necessary to make the milk +very weak or the child's digestion will be upset. + +_For a child of average weight at birth (seven to seven and a half +pounds) what should be the weight at the different periods during the +first year?_ + +At three months it should be twelve to thirteen pounds; at six months, +fifteen to sixteen pounds; at nine months, seventeen to eighteen +pounds; at one year, twenty to twenty-two pounds. At five months a +healthy child will usually double its weight, and at twelve months it +will nearly treble its weight. + +_Do all healthy infants gain steadily in weight during the first +year?_ + +As a rule they do; yet it is seldom the case that one gains every week +for the entire year. With most infants there are from time to time +periods of a few weeks in which no gain is made. These are more often +seen from the seventh to the tenth month and frequently occur when the +child is cutting teeth, sometimes during very hot weather. + +_Is it true that every infant who gains rapidly in weight is thriving +normally?_ + +Not invariably. Some who are fed upon prepared infant foods increase +rapidly in weight but not in strength, nor in their development in +other respects. + +_Is the weight of as much value in the second year as a guide to the +child's condition?_ + +After the first year, the gain in weight is seldom continuous; there +are many interruptions, some depend on season, and others often occur +without apparent cause. + +_At what age should the fontanel close?_ + +The average is about eighteen months. It seldom closes earlier than +fourteen months, and it should not be open at two years. + +_At what age should a child hold up its head?_ + +As a rule during the fourth month, and often during the third month, +the head can be held erect when the body is supported. + +_When does an infant first laugh aloud?_ + +Usually from the third to the fifth month. + +_When does it begin to reach for toys and handle them?_ + +Usually from the fifth to the seventh month. + +_At what age should a child be able to sit and to stand alone?_ + +At seven or eight months a healthy child is usually able to sit erect +and support the body. During the ninth and tenth months are usually +seen the first attempts to bear the weight upon the feet, and at +eleven or twelve months most children can stand with assistance. + +_When should a child walk alone?_ + +The first attempts are generally seen in the twelfth or thirteenth +month. At fifteen or sixteen months the average child is able to run +alone. + +_What conditions postpone these events?_ + +Prematurity, a very delicate constitution, any severe or prolonged +illness, and especially chronic disturbances of digestion making +feeding difficult. A common cause of late sitting, standing, or +walking is rickets. + +_Should a child be urged to walk?_ + +Never; he is usually quite willing to do so as soon as his muscles and +bones are strong enough. None of the contrivances for teaching +children to walk are to be advised. + +_When do children begin to talk?_ + +Generally at one year a child can say "papa" and "mamma" or other +single words. At the end of the second year the average child is able +to put words together in short sentences. + +_If at two years the child makes no attempt to speak, what should be +suspected?_ + +Either that the child is a deaf-mute or that it is mentally deficient, +although this is occasionally seen in children who are only very +backward. + + _Table showing the Average Weight, Height, and + Circumference of Head and Chest of Boys_[1] + + At birth Weight 7-1/2 pounds. + Height 20-1/2 inches. + Chest 13-1/2 " + Head 14 " + + One year Weight 21 pounds. + Height 29 inches. + Chest 18 " + Head 18 " + + Two years Weight 26-1/2 pounds. + Height 32-1/2 inches. + Chest 19 " + Head 19 " + + Three years Weight 31 pounds. + Height 35 inches. + Chest 20 " + Head 19-1/2 " + + Four years Weight 35 pounds. + Height 38 inches. + Chest 20-3/4 " + Head 19-3/4 " + + Five years Weight 41 pounds. + Height 41-1/2 inches. + Chest 21-1/2 " + Head 20-1/2 " + + Six years Weight 45 pounds. + Height 44 inches. + Chest 23 " + + Seven years Weight 49-1/2 pounds. + Height 46 inches. + Chest 23-1/2 " + + Eight years Weight 54-1/2 pounds. + Height 48 inches. + Chest 24-1/2 " + + Nine years Weight 60 pounds. + Height 50 inches. + Chest . 25 " + + Ten years Weight 66-1/2 pounds. + Height 52 inches. + Chest 26 " + + The above weights are with ordinary house clothes. + + [1] Weights for the first four years are without clothes. + + The weight of girls is on the average about one pound less than + boys. They are about the same in height. + + Charts showing weight curve for the first year, and from one year + to fourteen years are given at the end of this book. + + +DENTITION + +_How many teeth are there in the first set?_ + +Twenty. + +_What is the time of their appearance?_ + +The two central lower teeth are usually the first to appear, and come +from the fifth to the ninth month; next are the four upper central +teeth, which come from the eighth to the twelfth month. The other two +lower central teeth and the four front double teeth come from the +twelfth to the eighteenth month. Then follow the four canine teeth, +the two upper ones being known as the "eye teeth," and the two lower +as the "stomach teeth"; they generally come between the eighteenth and +the twenty-fourth month. The four back double teeth, which complete +the first set, come between the twenty-fourth and thirtieth month. + + At one year a child usually has six teeth. + At one and a half years, twelve teeth. + At two years, sixteen teeth. + At two and a half years, twenty teeth. + +_What are the causes of variation?_ + +The time of appearance of the teeth varies in different families; in +some they come very early, in others much later. The teeth may come +late as a result of prolonged illness and also from rickets. + +_What symptoms are commonly seen with teething?_ + +In healthy children there is very often fretfulness and poor sleep for +two or three nights; there may be loss of appetite, so that only one +half the usual amount of food is taken; there is salivation or +drooling, and often slight fever; there may be some symptoms of +indigestion, such as vomiting or the appearance of undigested food in +the stools. In delicate children all these symptoms may be much more +severe. + +_How long do these symptoms last?_ + +Usually only three or four days; but there may be no gain in weight +for two or three weeks. + +_What is the cause of most of the other symptoms attributed to +teething?_ + +Nearly all of them come from indigestion due to bad feeding. + + + + +PART II + +INFANT FEEDING + + +_What is the best infant food?_ + +Mother's milk. + +_Of what is mother's milk composed?_ + +Thirteen parts solids and eighty-seven parts water. + +_What are the solids?_ + +Fat, sugar, proteids, and salts. + +_What is the fat?_ + +The cream. + +_What is the sugar?_ + +It is lactose, or milk sugar. + +_What are the proteids?_ + +The curd of the milk. + +_Are all these elements necessary?_ + +Yes; we cannot expect to rear a healthy infant unless they are all in +his food. + +_Of what use is the fat?_ + +It is needed for the growth of the bones, the nerves, the fat of the +body, and the production of heat. + +_Of what use is the sugar?_ + +It is needed for the production of heat, and to make fat in the body. + +_Of what use are the proteids?_ + +They are needed for the growth of the cells of the body, such as those +of the blood, the various organs, and the muscles. + +_Of what use are the salts?_ + +Particularly for the growth of bone. + +_Of what use is the water?_ + +By means of the water the food is kept in a state of minute +subdivision or in solution, so that the delicate organs of a young +infant can digest it. It is also necessary to enable the body to get +rid of its waste. + + +NURSING + +_Should all mothers attempt to nurse their children?_ + +As a rule they should do so, but there are many conditions when they +should not. + +_What are the most important ones?_ + +If the mother has or has had tuberculosis or any other serious chronic +disease, or is herself in very delicate health, she should not try. +She is likely soon to fail in nourishing her child, and the attempt +may do herself much harm as well as injure the child. + +_How often should infants be nursed during the first two days of +life?_ + +Usually only four or five times daily, since there is very little milk +secreted at this time. + +_When does the milk come in abundance?_ + +Usually on the third day, sometimes not until the fourth or fifth day. + +_Should the infant be fed anything additional during the first two +days?_ + +Usually not; if much food were necessary, we may be sure Nature would +have provided it. Water, however, should be given regularly. + +_How frequently should an infant be nursed during the first week?_ + +After the third day, every two hours during the day and twice during +the night. The frequency during the rest of the first year is given in +the following table: + + ------------------------------------------------------------------ + PERIOD. Nursings in Interval Night nursings + 24 hours. by day. (10 P.M. to 6 A.M.). + ------------------------------------------------------------------ + 1st and 2d day 4 6 hours. 1 + 3 days to 6 weeks 10 2 " 2 + 6 weeks to 3 months 8 2-1/2 " 2 + 3 to 5 months 7 3 " 1 + 5 to 12 months 6 3 " 0 + ------------------------------------------------------------------ + +_How long should the child be kept at the breast for one nursing?_ + +Not over twenty minutes. + +_Should the child take both breasts at one nursing?_ + +If the milk is very abundant one breast may be sufficient, otherwise +both breasts may be taken. + +_What are the important things to be attended to in nursing?_ + +First, regularity; it is just as important as in the case of +bottle-feeding. Secondly, the nipples should be kept clean by being +washed after every nursing. + +_What should be the diet of a nursing mother?_ + +She should have a simple but generous diet with plenty of fluids; +three regular meals may be given and gruel, milk, or cocoa at bed-time +and sometimes between meals. She may take eggs, cereals, most soups, +and nearly all vegetables, avoiding sour fruits, salads, pastry, and +most desserts. Meat should not be taken more than twice daily, and in +many cases but once. She should take but little tea or coffee, and +ordinarily no wine or beer. + +_Are fruits likely to disturb a nursing infant?_ + +Sour fruits in some cases may do so, but sweet fruits and most cooked +fruits are useful. + +_What else is important in the life of the nursing mother?_ + +She should lead a simple natural life; should have regular out-of-door +exercise, preferably walking or driving, as soon after her confinement +as her condition will permit. She should have regular movements from +the bowels daily. She should be as free as possible from unnecessary +cares and worry; her rest at night should be disturbed as little as +possible; she should lie down for at least one hour in the middle of +the day. + +_Does the nervous condition of the mother affect the milk?_ + +Very much more than her diet; worry, anxiety, fatigue, loss of sleep, +household cares, social dissipation etc., have more than anything else +to do with the failure of the modern mother as a nurse. Uncontrolled +emotions, grief, excitement, fright, passion, may cause milk to +disagree with the child; at times they may excite acute illness, and +at other times they may cause a sudden and complete disappearance of +the milk. + +_Does menstruation affect the milk?_ + +In nearly all cases the quantity of milk is lessened so that the +infant is not satisfied and may gain less in weight or not at all. In +many cases the quality of the milk is also affected to such a degree +as to cause slight disturbances of digestion, such as restlessness, +colic, and perhaps some derangement of the bowels. In a few, attacks +of acute indigestion are excited. + +_Is regular menstruation a reason for stopping nursing?_ + +Not invariably; as a rule both functions do not go on together. But if +the child is gaining regularly in weight between the periods, nursing +may be continued indefinitely, although it may be well to feed the +infant wholly or in part during the first day or two that the mother +is unwell. + +_What symptoms indicate that a nursing infant is well nourished?_ + +The child has a good colour, sleeps for two or three hours after +nursing, or, if awake, is quiet, good-natured, and apparently +comfortable. It has normal movements of the bowels and gains steadily +in weight. + +_What symptoms indicate that a child who is nursing is not properly +nourished?_ + +It does not gain and may even lose in weight. It no longer exhibits +its usual energy and playfulness, but is either listless and +indifferent or cross, fretful and irritable, and is apt to sleep +poorly. It grows pale and anaemic and its tissues become soft and +flabby. When the milk is scanty it will often nurse a long time at the +breasts, sometimes three quarters of an hour, before stopping. At +other times it may take the breast for a moment only, and then turn +away in apparent disgust. + +_What should be done when such symptoms appear?_ + +This depends upon the severity of the symptoms and how long they have +lasted. If the child has made no gain for three or four weeks, or is +losing weight, immediate weaning will probably be necessary; in any +case, other food in addition to the breast milk should be given at +once. One may begin by alternating the nursing and the bottle-feeding +and increase the number of bottle-feedings as may be indicated by the +results. + +_Is there any objection to a baby being partly nursed and partly fed?_ + +None whatever; it is often better from the outset to feed the baby +during the night, in order not to disturb the mother's rest. + +_What symptoms indicate that the mother's milk disagrees with the +child?_ + +The child suffers from almost constant discomfort sleeps; little and +then restlessly, cries a great deal, belches gas from the stomach, and +passes much by the bowels, or if not passed, the gas accumulates and +causes abdominal distention and colicky pain. There may be vomiting, +but more often the trouble is intestinal. Sometimes the bowels are +constipated, but usually the movements are frequent, loose, green, +contain mucus and are passed with much gas. + +_What should be done under these circumstances?_ + +If the symptoms have persisted for two or three weeks and the child is +not gaining in weight, there is little chance of improvement, and the +child should be taken from the breast at once. If there is some gain +in weight, one may try for a little longer, endeavouring to improve +the mother's milk by rest, fresh air, careful diet, etc. However, one +should always realize that the trouble is with the milk, not with the +child. + +_What changes should be made if a nursing infant habitually vomits?_ + +If this occurs soon after nursing, the infant has usually taken too +much and the time of nursing should be shortened, or one breast may be +given instead of two; the nursing should also be interrupted by +occasional rests, so that the milk is not taken too fast. + +If the vomiting occurs some time after nursing and is repeated, it is +a sign of indigestion; often because the milk is too rich in fat. The +intervals between nursings should then be lengthened; the breast milk +may be diluted by giving one or two tablespoonfuls of plain boiled +water, lime-water, or barley-water, five or ten minutes before +nursing; the mother should eat less hearty food, especially less meat. + +_What should be done if the infant has frequent or habitual colic?_ + +This is usually because the milk is too rich in proteids; the mother +should take more out-of-door exercise, eat less meat, and seek to +control her emotions; all causes of worry should be removed. + +_Can constipation in a nursing infant be controlled through the +mother's milk?_ + +Only to a limited extent. It is important that the mother's bowels be +regular and her digestion good. An increase in the meat and milk of +her diet is sometimes beneficial. + + +WEANING + +_At what age should the child be weaned from the breast?_ + +Usually weaning should be begun at nine or ten months by substituting +one feeding a day for one nursing, later two feedings, and thus +gradually the child is to be taken from the breast altogether. + +_What is the principal reason for weaning earlier?_ + +The most important one is that the child is not thriving--not gaining +in weight and not progressing normally in its development. Serious +illness of the mother, or pregnancy, may make weaning necessary. + +_At what age should the weaning be completed?_ + +Generally at one year. In summer it may sometimes be advisable to +nurse an infant a little longer rather than wean in warm weather; but +even then the dangers of weaning are much less than those of +continuing to nurse, as is so often done, after the milk has become +very scanty and poor in quality. + +_When should a child who is weaned from the breast be taught to drink +from the cup, and when to take the bottle?_ + +If weaning is done as early as the eighth or ninth month it is better +to give the bottle; if from the tenth to the twelfth month the infant +should be taught to drink or be fed with a spoon. + +_How may some of the difficulties in weaning be overcome?_ + +By feeding every nursing infant once a day or by giving it water +regularly from a feeding-bottle. It then becomes accustomed to the +bottle. This is a matter of great convenience during the whole period +of nursing when the mother or nurse is from necessity away from the +child for a few hours; when more feeding is required at weaning time +the child does not object. + +_When should a child be weaned from the bottle?_ + +With children who are not ill, weaning from the bottle should +invariably be begun at the end of the first year, and after a child is +thirteen or fourteen months old the bottle should not be given except +at the night feeding. + +_Is there any objection to the child's taking the bottle until it is +two or three years old?_ + +There are no advantages and some serious objections. Older children +often become so attached to the bottle that only with the greatest +difficulty can they be made to give it up. Frequently they will refuse +all solid food, and will take nothing except from the bottle so long +as it is given, and when finally at three or four years, it is taken +away, they will not touch milk during the rest of their childhood. The +difficulty is here that children form the "bottle habit." This habit +is troublesome, unnecessary, and should by all means be prevented. An +exclusive diet of milk for children of two or three years often +results in anaemia and malnutrition. + +_How should one train a child to do without the bottle?_ + +This is usually very easy if it is begun at one year. The milk should +be poured into a tiny glass or cup and little by little the child is +taught to drink; at first only a small portion of the food is taken in +this way, the balance being given from the bottle; but in the course +of a few weeks the average infant learns to drink from a cup without +difficulty, and all the food can be so given. + +If the child is two or more years old, the only effective means of +weaning from the bottle is through hunger. The bottle should be taken +away at once and entirely, and nothing allowed except milk from a cup +until the child takes this willingly. Sometimes a child will go an +entire day without food, occasionally as long as two days, but one +should not be alarmed on this account and yield. This is a matter of +the child's will and not of his digestion, and when once he has been +conquered it is seldom that any further trouble is experienced. As +soon as a child has learned to drink his milk from a cup, cereals and +other solid foods may gradually be added to the diet. The educational +value of such training is not the least important consideration. + +_Can a baby just weaned take cow's milk of the same proportions as one +of the same age who has had cow's milk from birth?_ + +Very rarely; to give a baby who has had nothing but the breast from +birth, plain cow's milk, or even that milk which a bottle-fed baby of +the same age might take, is almost certain to cause indigestion. The +change in the food is quite a marked one, and should be made gradually +by beginning with a very weak milk and increasing its strength as the +baby becomes accustomed to take cow's milk. + +_What would be the proper proportions for an infant weaned at four or +five months?_ + +About the same as for a healthy bottle-fed infant of two months; the +quantity of course should be larger. The food can in most cases be +gradually increased so that in two or three weeks the usual strength +for the age can be taken. + +_What would be the proper proportions for an infant weaned at nine or +ten months?_ + +About the same as for a bottle-fed infant at four or five months, to +be increased as indicated above. + +_Will not a child lose in weight when placed upon so low a diet?_ + +Very often it will do so for the first week or two, but after that +will gain quite regularly; the acute indigestion, however, which +generally accompanies the use of stronger milk will, in most cases, +cause a greater loss. + + +ARTIFICIAL FEEDING + +_What foods contain all the elements present in mother's milk?_ + +The milk of other animals,--cow's milk being the only one which is +available for general use. + +_Is it not possible for infants to thrive upon other foods than those +containing fresh milk?_ + +They may do so for a time, but never permanently. The long-continued +use of other foods as the sole diet is attended with great risk. + +_What are the dangers of such foods?_ + +Frequently scurvy is produced (see page 141), often rickets, and in +other cases simply a condition of general malnutrition,--the child +does not thrive, is pale, and its muscles are soft and flabby. + + +THE SELECTION AND CARE OF MILK USED FOR INFANT FEEDING + +_What are the essential points in milk selected for the feeding of +infants?_ + +That it comes from healthy cows, and that it is clean and fresh. + +_Is it not important to select a rich milk?_ + +By no means; in fact the very rich milk of highly bred Jerseys and +Alderneys has not been found nearly so satisfactory in infant feeding +as that from some other herds, such, for example, as the common "grade +cows." + +_Which is the better, milk from one cow or the mixed milk of several +cows?_ + +The mixed, or "herd milk," is usually to be preferred since it varies +little from day to day; while that from a single cow may vary +considerably. + +_How fresh is it important that cow's milk should be for the best +results in infant feeding?_ + +This depends very much upon the season, and how carefully milk is +handled. As ordinarily handled at the dairy and in the home, milk +should not be used for infants in winter after it is forty-eight hours +old; in summer not after it is twenty-four hours old, and it may be +unsafe in a much shorter time. When handled with especial care milk +may be safe for a longer time. + +_What are the two essentials in handling milk?_ + +1. That it be kept clean and free from contamination. This +necessitates that cows, stables, and milkers be clean, and that +transportation be in sealed bottles; also that those who handle the +milk do not come in contact with any contagious disease. All +milk-pails, bottles, cans, and other utensils with which the milk +comes in contact should be sterilized shortly before they are used, +by steam or boiling water. + +2. That it be cooled immediately after leaving the cows, and kept at +as low a temperature as possible; to be efficient this should not be +above 50 deg. F. + +Milk produced under hygienic conditions and handled with special care +is sold in bottles in a number of cities under the name of +"certified," "guaranteed," or "inspected" milk. When available such +milk should be used for infants. Of course the extra care bestowed in +its production and transportation increases the cost of the milk, but +the best will usually be found in the end to be the cheapest. + +_How should milk be handled in the home when obtained fresh from the +cows?_ + +That to be used for infants should be strained through a thick layer +of absorbent cotton or several thicknesses of cheese-cloth into quart +glass jars or milk bottles which should be covered and cooled +immediately best by placing the bottles quite up to their necks in ice +water or cold spring water, where they should stand for at least half +an hour. That required for children who take plain milk may now be +poured into half-pint bottles, stopped with cotton, and put in the +ice-chest, or the coolest place possible. This first rapid cooling is +very important and adds much to the keeping qualities of the milk. +Milk loses its heat very quickly when cooled in water, but very slowly +when it is simply placed in a cold room. After standing four or five +hours the top-milk may be removed; after twelve to sixteen hours the +cream may be removed. + +_How should milk be handled when bottled milk is purchased?_ + +It should be cooled as just described, as its temperature is usually +somewhat raised during transportation If it has been bottled at a +dairy, the cream or the top-milk may be removed after an hour or so. + +_How should milk and cream be handled when they are purchased in +bulk?_ + +Such milk should never be used for infants when it is possible to +obtain bottled milk, as it is much more liable to contamination. Both +cream and milk should be poured at once into covered vessels and kept +in the coolest place possible. The cream and top-milk will seldom rise +upon such milk with any satisfactory regularity. + +_What are the important things to be secured in nursery +refrigerators?_ + +Absolute cleanliness is essential; hence the inner portion should be +of metal. Those made entirely of metal are unsatisfactory as in them +the ice melts very quickly. If the ordinary metal refrigerator sold is +encased in a wooden box, we have the best form. Another easy way of +securing the same result Is to make for the refrigerator a covering or +"cosey" of felt or heavy quilting, which can be easily removed when +wet or soiled. + +The compartments of the refrigerator should be so arranged that the +bottles of milk are either in contact with the ice or very near it. +The supply of ice should be abundant. Often the amount of ice is so +small, and the bottles so far away, that the temperature of the milk +is never below 60 deg. or 65 deg. F. To be really effective a refrigerator +should have a temperature where the milk is placed of not over 50 deg. F. +The temperature should be tested with the nursery thermometer from +time to time to ascertain what results are being obtained. Spoiled +milk owing to a faulty refrigerator is to be blamed for many attacks +of acute illness among infants. Next to the feeding-bottles it is the +one thing in the nursery which should receive the closest attention. + + +THE MODIFICATION OF COW'S MILK + +_Can cow's milk be fed to infants without any changes?_ + +No; for although it contains similar elements to those in mother's +milk, they are not identical, and they are not present in the same +proportions. + +_Is this a matter of much importance?_ + +It is of the greatest importance. There are few infants who can digest +cow's milk unless it is changed. To change cow's milk so as to make it +more nearly resemble mother's milk is called _modifying_ cow's milk. + +_How is this milk whose proportions have been changed distinguished +from the original unchanged milk?_ + +The changed milk is usually called "modified milk"? the original +unchanged milk is known as "plain milk," "whole milk," "straight +milk," or is referred to simply as "milk." + +_What are the principal differences between cow's milk and mother's +milk?_ + +Cow's milk has a little more than half as much sugar; it has nearly +three times as much proteids and salts; its proteids are different and +much more difficult of digestion; its reaction is decidedly acid, that +of mother's milk is faintly acid or neutral. + +_Are there any other important things to be considered?_ + +Yes; mother's milk is always fed fresh and is practically sterile. +Cow's milk is generally kept twenty-four hours and sometimes much +longer. It is always to a greater or less degree contaminated by dirt +and germs, the number of which increases rapidly (1) with the age of +the milk; (2) in proportion to amount of the dust or dirt which enters +it; (3) with any increase in the temperature at which the milk is +kept. + +It is just as important for success in infant feeding that these +conditions receive attention as that the proportions of the different +elements of the milk are right. + +_How is the acidity of cow's milk overcome?_ + +By the addition of lime-water or bicarbonate of soda. If lime-water is +used, one ounce to twenty ounces of food is generally required; if +soda is used, twenty grains to twenty ounces of food. + +If there is a tendency to constipation the milk of magnesia +(Phillips's) may be used; from one half to one teaspoonful being added +to each twenty ounces of food. + +_How is the sugar best increased?_ + +By adding milk sugar to the food; one ounce to each twenty ounces of +food will give the proper quantity for the first three or four months. +This will make the proportion about the same (between 6 and 7 per +cent) as in mother's milk. + +_How should the sugar be prepared?_ + +Simply dissolved in boiled water; if the solution is not clear, or if +there is a deposit after standing, it should be filtered by pouring +through a layer of absorbent cotton, half an inch thick, which is +placed in an ordinary funnel. + +_Will not cane (granulated) sugar answer as well?_ + +Not as a rule; however, there are many infants who get on very well +when cane sugar is used. It has the advantage of being much cheaper. A +good grade of milk sugar is somewhat expensive, costing from +twenty-five to sixty cents a pound, and cheap samples are apt to +contain impurities. + +_If cane sugar is used, what amount should be added?_ + +Considerably less than of the milk sugar. Usually about half the +quantity (half an ounce to twenty ounces of food) is as much as most +infants can digest If the same quantity is used as of the milk sugar, +the food is made unduly sweet, and the sugar is likely to ferment in +the stomach and cause colic. + +_Is not the purpose of the sugar to sweeten the food in order to make +it palatable?_ + +Not at all; although it does that, its real use is to furnish one of +the essential elements needed for the growth of the body, and the one +that is required by young infants in the largest quantity. + +_How do we know that this is so?_ + +By the fact that in good breast milk the amount of sugar is greater +than that of the fat, proteids, and salts combined. + +_We have seen that cow's milk has nearly three times as much proteids +(curd) and salts as mother's milk. How are these to be diminished?_ + +By diluting the milk. + +_Will it be sufficient to dilute the milk twice (i.e., add two parts +of water to one part of milk)?_ + +Not for a very young infant. Although this will give about the +quantity of proteids present in mother's milk, the proteids of cow's +milk are so much more difficult for the infant to digest, that in the +beginning it should be diluted five or six times for most infants. + +_If cow's milk is properly diluted and lime-water and sugar added does +it then resemble mother's milk?_ + +No; the mixture contains too little fat. + +_What is the easiest way of overcoming this?_ + +By increasing the fat in the milk before dilution. It may be done by +using top-milk or a mixture of milk and cream. + +_What is top-milk?_ + +It is the upper layer of milk removed after standing a certain number +of hours in a milk bottle, glass jar, or any tall vessel with straight +sides. It contains most of the cream and some of the milk just below. + +The strength of the top-milk is measured by the fat it contains--e.g., +a 10-per-cent milk contains 10 per cent fat; 7-per-cent milk contains +7 per cent fat, etc. These are the two strengths of top milk most used +in infant feeding. + +_On what does the percentage of fat in top-milk depend?_ + +1. On the length of time the milk has stood. + +2. On the manner in which the top-milk is removed. + +3. On the number of ounces removed. + +4. On the richness of the milk used. + +Unless these are known it is impossible to say even approximately how +strong in fat the top-milk is. + +_When and how should top-milk be removed?_ + +If milk fresh from the cow, or before the cream has risen, is put into +bottles and rapidly cooled, the top-milk may be removed in as short a +time as four hours. In the case of bottled milk it makes little +difference if it stands a longer time, even until the next day. The +best means of removing it is by a small cream-dipper[2] holding one +ounce; although it may be taken off by a spoon or siphon. It should +not be poured off. + + [2] Obtained from any of the Walker-Gordon milk laboratories, + from James Dougherty, No. 411 West 59th Street, New York, and + from many druggists. Price, 20 cents. + +_How can we obtain a 10-per-cent top-milk with the different kinds of +cow's milk?_ + +From a rather poor milk (containing 3--3-1/2 per cent fat) by removing +the upper eight ounces from a quart, or one fourth. + +From a good average milk (containing 4 per cent fat) by removing the +upper eleven ounces from a quart, or about one third. + +From a rich Jersey milk (containing 5--5-1/2 per cent fat) by removing +the upper sixteen ounces, or one half. + +_How can we obtain a 7-per-cent top-milk with the different kinds of +cow's milk?_ + +From a rather poor milk, by removing the upper eleven ounces from a +quart, about one third. + +From a good average milk, by removing the upper sixteen ounces, or one +half. + +From a rich Jersey milk, by removing the upper twenty-two ounces, or +about two thirds. + +[Illustration: The percentage of fat in the different layers of milk +of good average quality.] + +_What is cream?_ + +Cream is often spoken of as if it were the fat in milk. It is really +the part of the milk which contains most of the fat. It differs from +milk chiefly in containing much more fat. + +_In what ways is cream now obtained?_ + +(1) By skimming, after the milk has stood usually for twenty-four +hours? this is known as "gravity cream." (2) By an apparatus known as +a separator; this is known as "centrifugal cream"; most of the cream +now sold in cities is of this kind. The richness of any cream is +indicated by the amount of fat it contains. + +The usual gravity cream sold has from 16 to 20 per cent fat. The cream +removed from the upper part (one fifth) of a bottle of milk has about +16 per cent fat. The usual centrifugal cream has 18 to 20 per cent +fat. The heavy centrifugal cream has 35 to 40 per cent fat. + + +FOOD FOR HEALTHY INFANTS[3]--THE EARLY MONTHS + + [3] The directions and formulas given in the following pages + are intended only for guidance in feeding children who + are not suffering from any special disturbance of digestion; + directions for such conditions are given in a later chapter. + +_What are the most important points to be remembered in modifying +cow's milk for feeding during the early months?_ + +That of the different ingredients of milk the sugar is most easily +digested; the fat is next; while the proteids are the most difficult. + +_What relation should the fat bear to the proteids during this +period?_ + +For most infants with good digestion the best results are obtained +when the fat is three times the proteids. However, this is not true of +all. There are many healthy infants who are unable to digest this +proportion of fat, and who do much better when the fat is made only +twice the proteids. + +_How can one obtain formulas in which the fat is three times the +proteids?_ + +By using for dilution a 10-per-cent milk (i.e., milk containing 10 per +cent fat) which serves as the primary formula from which all the other +formulas of this series are derived. + +In 10-per-cent milk the fat is just three times the proteids. + +_How can one get the 10-per-cent milk?_ + +(1) As top-milk, as described on page 64; or, (2) by mixing equal +parts of plain milk and ordinary cream (containing about 16 per cent +fat); (3) from any of the milk laboratories it may be ordered +directly. + +_Is it better to obtain the 10-per-cent milk by using a mixture of +milk and cream, or as top-milk?_ + +If one can get milk fresh from the cows, the top-milk is to be +preferred on account of freshness. The food can then be made up when +the milk is but a few hours old. In cities, if one uses bottled milk, +the upper third may also be used. But if one buys milk and cream +separately, it is usually more convenient to mix these, as the cream +will not rise upon milk a second time with any uniformity. + +_How can one obtain formulas in which the fat is twice the +proteids?_ + +By using for dilution a 7-per-cent milk (i.e., milk containing 7 per +cent fat) which serves as the primary formula from which all the other +formulas of this series are derived. + +In 7-per-cent milk the fat is just twice the proteids. + +_How can one get the 7-per-cent milk?_ + +(1) As top-milk, as described on page 64; or, (2) by mixing three +parts of milk and one part of ordinary (16 per cent) cream; (3) from +any of the milk laboratories it may be obtained directly. As in the +case of 10-per-cent milk, the top-milk is generally to be preferred to +a mixture of milk and cream. + +_How should the food be prepared during the early months?_ + +It is convenient in calculation to make up twenty ounces of food at a +time. The first step is to obtain the 10-per-cent milk or the +7-per-cent milk to be used as the primary formula. Then to take the +number of ounces of this that are called for in the formula desired. + +Note.--One should not make the mistake of taking from the top of the +bottle only the number of ounces needed in the formula as this may +give quite a different result. + +There will be required in addition one ounce of milk sugar[4] and one +ounce of lime-water in each twenty ounces. The rest of the food will +be made up of boiled water. + + [4] If the milk sugar be measured in the milk-dipper, two scant + dipperfuls may be calculated as one ounce. If measured in a + tablespoon, three even tablespoonfuls may be calculated as one + ounce. + +These formulas written out would be as follows: + + _First Series_ + + _Formulas for the Early Months from 10-per-cent Milk_ + + ----------------------------------------------------------- + I. II. III. IV. V. + ----------------------------------------------------------- + 10-per-cent milk 2 oz. 3 oz. 4 oz. 5 oz. 6 oz. + Milk sugar 1 " 1 " 1 " 1 " 1 " + Lime-water 1 " 1 " 1 " 1 " 1 " + Boiled water 17 " 16 " 15 " 14 " 13 " + ----------------------------------------------------------- + 20 oz. 20 oz. 20 oz. 20 oz. 20 oz. + ----------------------------------------------------------- + +As the milk sugar dissolves in the water the total in each column +will be exactly twenty ounces. The food is strengthened by gradually +increasing the milk and reducing the water. + +The approximate composition of these formulas expressed in percentages +is as follows: + + ---------------------------------------- + FORMULA. Fat. Sugar. Proteids. + ---------------------------------------- + I. 1.00 5.50 0.33 + II. 1.50 6.00 0.50 + III. 2.00 6.00 0.66 + IV. 2.50 6.00 0.80 + V. 3.00 6.50 1.00 +------------------------------------------ + + _Second Series_ + + _Formulas for the Early Months from 7-per-cent Milk_ + + ----------------------------------------------------------- + I. II. III. IV. V. + ----------------------------------------------------------- + 7-per-cent milk 2 oz. 3 oz. 4 oz. 5 oz. 6 oz. + Milk sugar 1 " 1 " 1 " 1 " 1 " + Lime-water 1 " 1 " 1 " 1 " 1 " + Boiled water 17 " 16 " 15 " 14 " 13 " + ----------------------------------------------------------- + 20 oz. 20 oz. 20 oz. 20 oz. 20 oz. + ----------------------------------------------------------- + +The approximate composition of these formulas expressed in percentages +is as follows: + + ---------------------------------------- + FORMULA. Fat. Sugar. Proteids. + ---------------------------------------- + I. 0.70 5.50 0.35 + II. 1.00 6.00 0.50 + III. 1.40 6.00 0.70 + IV. 1.75 6.00 0.87 + V. 2.00 6.50 1.00 +------------------------------------------ + +_How is one to decide whether to use the First or the Second Series of +formulas?_ + +With a large, strong child, having a good digestion one should use the +First Series. With a smaller, less vigorous child, whose digestion is +not so good, or with one who does not do well upon the First Series, +the Second Series should be used. + +_Why is it necessary to make the food so weak at first?_ + +Because the infant's stomach is intended to digest breast milk, not +cow's milk; but if we begin with a very weak cow's milk the stomach +can be gradually trained to digest it. If we began with a strong milk +the digestion might be seriously upset. + +_How rapidly can the food be increased in strength from Formula I to +II, from II to III, etc.?_ + +No absolute rule can be given. Usually we begin with I on the second +day; II on the fourth day; III at one week or ten days; but after that +make the increase more slowly. A large infant with a strong digestion +will bear a rather rapid increase and may be able to take V by the +time it is three or four weeks old. A child with a feeble digestion +must go much slower and may not reach V before it is three or four +months old. + +It is important with all children that the increase in the food be +made very gradually. It may be best with many infants to increase the +milk by only half an ounce in twenty ounces of food, instead of one +ounce at a time as indicated in the tables. Thus from 3 ounces, the +increase would be to 31/2 ounces; from 4 ounces to 41/2 ounces, etc. At +least two or three days should be allowed between each increase in the +strength of the food. + +_What general rule can be given for increasing the food?_ + +To increase when the infant is not satisfied but is digesting well. + +_How does an infant show that he is not satisfied?_ + +He drains the bottle eagerly and cries when it is taken away. He often +forms the habit of sucking his fingers immediately after. He begins to +fret half an hour or an hour before the next feeding is due. + +_In the series of formulas given in the table the quantities are +mentioned for making only twenty ounces of food. How should it be +prepared when more than this quantity is needed?_ + +It is equally convenient to make up 25 ounces, 30 ounces, 35 ounces, +or 40 ounces at a time. + + To make-- + + 25 ounces of any formula add one quarter more of each ingredient. + 30 " " one half " " + 35 " " three quarters " " + 40 " " twice as much " " + +Thus 25 ounces of Formula I would be obtained by using 21/2 ounces of +milk, 11/4 ounces of sugar and lime-water, 211/4 ounces of water; 30 +ounces of the same would require 3 ounces milk, 11/2 ounces lime-water +and sugar, and 251/2 ounces water; 35 ounces would require 31/2 ounces +milk, 13/4 ounces lime-water and sugar, and 293/4 ounces water. The amount +of water need not be calculated in any case, but after measuring +carefully the other ingredients enough water should be added to bring +the total up to the amount required. + +_How great an increase in the quantity should be made at one time?_ + +One may make up five ounces additional food; but the first two days +only two or three ounces of the additional amount should be given; the +next two days, four ounces; after two days more, the five ounces may +be given. + +The increase in the quantity given at a single feeding should not be +more than a quarter of an ounce. + + +FOOD FOR HEALTHY INFANTS--THE LATER MONTHS + +_How long should the fat be as much as three times the proteids?_ + +This is seldom of advantage longer than three or four months. + +_What changes should then be made in the milk?_ + +After Formula V of the First Series (6 ounces of 10-per-cent milk in +20 ounces of food) has been reached, the fat should be increased very +slowly for this proportion (3 per cent) is near the limit for most +healthy children. The milk should now be strengthened chiefly by +raising the percentage of proteids. + +_How is this accomplished?_ + +The 10-per-cent milk and the formulas derived from it should now be +discontinued, and those made from 7-per-cent milk used. + + _Third Series_ + + _Formulas for the Later Months from 7-per-cent Milk_ + + ----------------------------------------------------------- + I. II. III. IV. V. + ----------------------------------------------------------- + 7-per-cent milk 7 oz. 8 oz. 9 oz. 10 oz. 11 oz. + Milk sugar 1 " 1 " 1 " 3/4 " 1/2 " + Lime-water 1 " 1 " 1 " 1 " 1 " + Boiled water 12 " 11 " 10 " 4 " 3 " + Barley gruel 0 " 0 " 0 " 5 " 5 " + ----------------------------------------------------------- + 20 oz. 20 oz. 20 oz. 20 oz. 20 oz. + ----------------------------------------------------------- + +Since the sugar dissolves, the total will be twenty ounces in each +column. + +Of any of the formulas, 25 ounces is made by using one quarter more +of each ingredient; 30 ounces, by using one half more; 35 ounces, by +using three quarters more; 40 ounces, by using twice as much, exactly +as described in the First Series on page 73. + +The approximate composition of these formulas expressed in percentages +is as follows: + + ---------------------------------------- + FORMULA. Fat. Sugar. Proteids. + ---------------------------------------- + I. 2.50 6.50 1.25 + II. 2.80 6.50 1.40 + III. 3.15 7.00 1.55 + IV. 3.50 6.00 1.75 + V. 4.00 6.00 2.00 +------------------------------------------ + +_How should the food be increased during this period?_ + +Beginning with I of this Series, which should usually follow V of the +First or Second Series (pages 70, 71), the increase may generally be +made in a week or ten days to II; in about two weeks more to III; now +more slowly to IV and V. When IV or V has been reached, the same +formula may sometimes be continued for three or four months with no +other change than an increase in the quantity. + +_In passing from Formula V of the First Series to Formula I of the +Third Series the proportion of fat is at first reduced. Is this +necessary or important?_ + +No; it only happens to come so in simplifying the calculation. It may +be avoided by taking off at first the upper 13 ounces as top-milk and +using 7 ounces of this in a 20-ounce mixture, in place of Formula I; +and by using for the next increase the upper 15 ounces as top-milk, +taking of this 8 ounces in a 20-ounce mixture in place of Formula II. +Then should follow Formula III. + +_What further addition may be made to the food of the later months?_ + +Usually about the sixth or seventh month, farinaceous food in the form +of gruel may be added, this taking the place of part of the water and +part of the sugar. + +_What changes may be made in the food when the infant has reached the +age of ten or eleven months?_ + +The proteids may be still further increased, and the sugar and the +lime-water reduced until plain milk is given. + +_How may this best be done?_ + +At first one feeding a day of plain milk and barley gruel may be +given; later, two feedings; then three feedings, etc. Let us suppose +an infant to be taking such a modified milk as Formula IV or V (page +76), six feedings a day. The plain milk diluted only with barley gruel +would at first replace one of these feedings; then two, three, four, +etc., these changes being made at intervals of about two weeks. The +proportions of the milk and barley gruel should at first be about +5-1/2 ounces milk, 2-1/2 ounces barley; later, 6 ounces milk, 3 ounces +barley; still later, 7 ounces milk, 2 ounces barley, until finally +plain milk is given to drink and the cereals given separately with a +spoon. This is reached with most infants at fourteen or fifteen +months; with many at twelve or thirteen months. Other forms of +farinaceous food may of course be used in the place of the barley, and +in the same proportions. + +With some infants the addition of a pinch of bicarbonate of soda may +be advantageously made to each milk-feeding when the lime-water is +omitted, but with most this is unnecessary. + +If the infant strongly objects to the taste of the milk when the milk +sugar has been omitted, a small quantity (one fourth to one half +teaspoonful) of granulated sugar may for a time be added to each +feeding, then gradually reduced. + + +GENERAL RULES FOR GUIDANCE IN THE USE OF THE FORMULAS GIVEN + +It should again be emphasized that these formulas are not intended for +sick children nor for those suffering from any marked symptoms of +indigestion. For such infants special rules are given later. + +_What should be the guide in deciding upon a formula with which to +begin for a child who is to be artificially fed?_ + +The age and the weight are of some importance, but the best guide is +the condition of the child's digestive organs. One should always begin +with a weak formula, particularly, (1) with an infant previously +breast fed; (2) with one just weaned, as a child who has never had +cow's milk must at first have weaker proportions than the age and the +weight would seem to indicate; (3) with infants whose power of +digestion is unknown. If the first formula tried is weaker than the +child can digest, the food can be strengthened every three or four +days until it is found what the child is able to take. On the +contrary, if the food is made too strong at first, an attack of +indigestion will probably follow. + +_How should the food be increased in strength?_ + +The first essential is that it be done very gradually; abruptly +increasing the food usually causes a disturbance of digestion. + +It is never wise to advance more rapidly in strengthening the food +than from one formula to the next one in any of the series given; with +many infants it is better to make the steps of increase only half as +great as those indicated (page 72). + +_How rapidly should the food be increased in quantity?_ + +The increase should not be more than a quarter of an ounce in each +feeding; or from one and a half to two ounces in a day. + +_When should the food be increased?_ + +In the early weeks an increase may be necessary every few days; in the +later months sometimes the same formula may be continued for two or +three months. It is, however, impossible to give a definite rule as to +time. One cannot say with any child that an increase is to be made +every week or every two weeks. A much better guide are the conditions +present. + +The signs indicating that the food should be increased are, that the +infant is not satisfied, not gaining in weight, but is digesting well, +i.e., not vomiting, and having good stools. One should not increase +the food, however, so long as the child seems perfectly satisfied and +is gaining from four to six ounces a week, even though both the +quantity and the strength of the food are considerably below the +average; nor should the food be increased if the child is gaining from +eight to ten ounces a week, even if he seems somewhat hungry. The +appetite is not always a safe guide to follow. + +_How can one know whether the strength or the quantity of the food +should be increased?_ + +In the early weeks it is well first to increase the strength of the +food, the next time to increase the quantity, then the strength again, +etc. After the fourth or fifth month, the quantity, chiefly, should be +increased. + +_If a slight disturbance or discomfort occurs after the food has been +strengthened, is it best to go back to the weaker formula or to +persist with the new one?_ + +Symptoms of minor discomfort are seen for a day or two with many +infants after an ordinary increase in food; but in most cases an +infant soon becomes accustomed to the stronger food and is able to +digest it. If, however, the symptoms of disturbance are marked, one +should promptly go back to the weaker formula. The next increase +should be a smaller one. + +_Should one be disturbed if for the first two or three weeks of +artificial feeding the gain in weight is very slight or even if there +is none?_ + +Not as a rule. If the infant does not lose weight, is perfectly +comfortable, sleeps most of the time, and does not suffer from any +symptoms of indigestion, such as colic, vomiting, etc., one may be +sure that all is going well and that the infant is becoming used to +his new food. As the child's appetite improves and his digestion is +stronger, the food may be increased every few days and very soon the +gain in weight will come and will then be continuous. If, however, the +scales are watched too closely and, because there is only a slight +gain in weight or none at all, the food is rapidly increased, an acute +disturbance of digestion is pretty certain to follow. + +_Is not constipation likely to occur if the child is on a very weak +food?_ + +It is very often seen and is due simply to the small amount of residue +in the intestine. Under these circumstances, if the bowels move once +every day, one should not be disturbed even when the movements are +small and somewhat dry. As the food is gradually strengthened, this +constipation soon passes off; while if injections, suppositories, or +cathartics are used to produce freer movements, the functions of the +bowels are likely to be disturbed. + +_Under what circumstances should the food be reduced?_ + +Whenever the child becomes ill from any cause whatever, or whenever +any marked symptoms of indigestion arise. + +_How may this be done?_ + +If the disturbance is only a moderate one and the food has been made +up for the day, one third may be poured off from the top of each +bottle just before it is given, and this quantity of food replaced by +the same amount of boiled water. + +If the disturbance is more severe, the food should be immediately +diluted by at least one half and at the same time the quantity given +should be reduced. + +For a severe acute attack of indigestion the regular food should be +omitted altogether and only water given until the doctor has been +called. + +_If the food has been reduced for a disturbance of digestion, how +should one return to the original formula?_ + +While the reduction of the food should be immediate and considerable, +the increase should be very gradual. After a serious attack of acute +indigestion, when beginning with milk again, it should not be made +more than one fifth the original strength, and from ten days to two +weeks should pass before the child is brought back to his original +food, which should be done very gradually. It is surprising how long a +time is required with young infants before they completely recover +from an attack of acute indigestion, even though it did not seem to be +very severe. The second disturbance always comes from a slighter cause +than the first one. + + +THE ADDITION OF OTHER FOODS TO MILK + +_How long should modified milk be continued without the addition of +other food?_ + +This depends upon circumstances; usually, for about six months; but if +the infant is thriving satisfactorily the milk may be used alone for +ten or eleven months; with some infants who have especial difficulty +in digesting cow's milk, it is advisable to begin the use of other +food at three or four months or even from the outset. + +_What is the first thing to be used with milk?_ + +Farinaceous food in some form, usually as a gruel. + +_How are these gruels made?_ + +They may be made directly from the grains or from some of the prepared +flours (page 149). The flours are usually to be preferred as being +more simple of preparation. + +_How should they be used in making the food?_ + +They should be cooked separately, rather than with the milk; when the +food is mixed, they take the place of a portion of the water in the +formulas given on pages 70 and 71. + +_How much of the gruel should be used?_ + +If it is prepared as recommended on page 149, it may make according to +circumstances from one sixth to one half the total quantity of food. + +_Which of the farinaceous foods are to be preferred?_ + +Those most used are barley, oatmeal, arrowroot, and farina. There is +not much difference in their nutritive value; oatmeal gruel is +somewhat more laxative. + +_What value do these substances possess as infant foods?_ + +Some of the starch is digested and absorbed; but the chief value of +gruels is believed to be that when added to milk they render the curd +more easily digested by preventing it from coagulating in the stomach +in large tough masses. This is certainly true with many infants, but +there are others who are not at all benefited, and not a few young +infants whose digestion is made distinctly worse by the use of +farinaceous food, particularly when employed in considerable quantity. +The addition of gruels to milk for all infants is not to be +recommended. + +_What further additions may be made to the diet of healthy infants +during the first year?_ + +Beef juice, the white of egg, and orange juice. + +_How and when may beef juice be used?_ + +With infants who are strong and thriving satisfactorily it may be +begun at ten or eleven months; two teaspoonfuls may be given daily, +diluted with the same quantity of water, fifteen minutes before the +midday feeding; in two weeks the quantity may be doubled; and in four +weeks six teaspoonfuls may be given. The maximum quantity at one year +should not be more than two or three tablespoonfuls. + +With delicate infants who are pale and anaemic, beef juice is more +important, and it may often be wisely begun at five or six months in +half the quantities mentioned. + +_When should white of egg be used?_ + +Under the same conditions as beef juice, particularly with infants who +have difficulty in digesting the proteins (curd) of milk. At six +months half the white of one egg may be given at one time, and soon +after this the entire white of one egg. The best in manner of cooking +is the "coddled", egg (see page 151). + +_When should orange juice be begun?_ + +Usually about the eleventh or twelfth month; it should be given about +one hour before the feeding; two teaspoonfuls at first, then one +tablespoonful at a time, and later three or four tablespoonfuls. It is +particularly useful when there is constipation. It should always be +strained, and care should be taken that it is sweet and fresh. + + +OVERFEEDING + +_What is meant by overfeeding?_ + +Giving an infant too much food; either too much at one time or too +frequently. Overfeeding is sometimes practised during the day, but is +chiefly done at night. + +_Is not an infant's natural desire for food a proper guide as to the +quantity given?_ + +The appetite of a perfectly normal infant usually is; but overeating +is a habit gradually acquired and may continue until twice as much +food as is proper is taken in the twenty-four hours. This habit is +most frequently seen in infants whose digestion is not quite normal; +because of the temporary relief from discomfort experienced by taking +food into the stomach, they often appear to be hungry the greater part +of the time, especially at night. + +_What are the causes of overfeeding?_ + +The most common one is the habit of watching the weight too closely, +and the conviction on the part of the mother or nurse that because a +child is not so large nor gaining so rapidly as some other infant of +the same age, more food or stronger food should be given. + +_What harm results from overfeeding?_ + +All food taken in excess of what a child can digest becomes a burden +to him. The food lies in the stomach or bowels undigested, ferments, +and causes wind and colic. When overfeeding is longer continued, +serious disturbances of digestion are soon produced. The infant is +restless, fretful, constantly uncomfortable, sleeps badly, and stops +gaining and may even lose in weight. Such symptoms may lead to the +mistaken conclusion that too little food is given, and it is +accordingly increased, when it should be diminished. One of the +results of long-continued overfeeding is dilatation or stretching of +the stomach. + +_What should guide one as to the quantity of food to be given to any +infant??_ + +(1) The size of the infant's stomach at the different months; (2) the +amount of milk which the healthy nursing infant gets; (3) the +quantities with which most children do best. The table of quantities +and intervals of feeding, on page 108, gives the average figures +derived from these sources. It is seldom wise to go beyond the limits +there stated; nor should one insist upon giving any fixed amount if it +is clearly more than the child wants or can be made to take except by +continued coaxing. + + +LOSS OF APPETITE + +_What is to be done when without any other signs of illness a child's +appetite gradually fails?_ + +This is often the result of a long period of overfeeding or the use of +milk too rich in fat. If in all other respects the child seems well +and simply does not want his food, it should be offered at regular +hours, but not more frequently; on no account should he be coaxed, +much less forced, to eat, even though he takes only one half or one +third the usual quantity. The intervals between feedings should not be +shortened but rather lengthened. Often, with a child a year old, it is +necessary to reduce the number of feedings to four or even three in +twenty-four hours. Water, however, may be offered at more frequent +intervals. The food should be weakened rather than strengthened. No +greater mistake can be made than, because so little is taken, coaxing +or forcing food at short intervals through fear lest the child may +lose weight. + + +THE CHANGES IN THE FOOD REQUIRED BY SPECIAL SYMPTOMS OR CONDITIONS + +Infants with weak digestion and those suffering from various forms of +indigestion have often especial trouble in digesting the fat of milk. +To meet the needs of such there is required a series of formulas in +which the fat is lower than in those already given. + +These formulas are obtained from plain milk. + + _Fourth Series_ + + _Formulas from Plain Milk (containing 4-per-cent Fat)_ + + --------------------------------------------------------- + I. II. III. IV. V. VI. VII. VIII. + --------------------------------------------------------- + + Plain milk 5oz. 6oz. 7oz. 8oz. 9oz. 10oz 12oz. 14oz. + Milk sugar 1 " 1 " 1 " 1 " 3/4 " 3/4 " 1/2 " 1/2 " + Lime-water. 1 " 1 " 1 " 1 " 1 " 1 " 1 " 1 " + Boiled water 14 " 13 " 12 " 7 " 6 " 5 " 2 " 0 " + Barley gruel 0 " 0 " 0 " 4 " 4 " 4 " 5 " 5 " + --------------------------------------------------------- + 20 20 20 20 20 20 20 20 + oz. oz. oz. oz. oz. oz. oz. oz. + --------------------------------------------------------- + +When larger quantities than 20 ounces are required they are calculated +in the same manner as described on page 73 in speaking of 10-per-cent +milk. + +The approximate composition of the formulas of the Fourth Series +expressed in percentages is as follows: + + ---------------------------------------- + FORMULA. Fat. Sugar. Proteids. + ---------------------------------------- + I. 1.00 6.00 0.90 + II. 1.20 6.00 1.00 + III. 1.40 6.50 1.20 + IV. 1.60 6.50 1.40 + V. 1.80 6.00 1.60 + VI. 2.00 6.00 1.80 + VII. 2.40 5.50 2.10 + VIII. 2.80 5.50 2.50 + ---------------------------------------- + +_Why is it that an infant so often vomits some of its food within a +few moments after finishing its bottle?_ + +Usually because the quantity is too large. Sometimes it is due to the +fact that the food is taken too rapidly, from too large a hole in the +nipple. It may be due to too tight clothing, or to moving the child +about in such a way as to press upon the stomach. + +_What are the principal causes of, and the changes in the food +required by habitual vomiting, regurgitation, or spitting up of small +quantities of food between feedings, often repeated many times a day?_ + +This is always a symptom of gastric indigestion, and a most +troublesome one. In such conditions the fat and often the sugar also +should be reduced and the lime-water increased. + +Formulas made from rich top-milk or milk and cream are to be avoided. +Those made from 7-per-cent milk are less likely to be the cause of +trouble than those from 10-per-cent milk; but if the symptoms are at +all severe it is better to use instead of these the formulas of the +Fourth Series derived from plain milk. + +Reduction in the sugar may be made by adding only one half ounce of +milk sugar to each twenty ounces of the food; in severe cases the +sugar may be omitted altogether. + +It is often advisable to double the amount of lime-water--i.e., use +two ounces to each twenty ounces of food. + +The malted foods and all other foods containing much sugar usually +aggravate the symptoms. + +The intervals between meals should generally be half an hour longer, +and sometimes an hour longer, than when digestion is normal. + +The quantity given at a feeding should generally be less than with a +normal digestion. Usually a smaller quantity of a strong food succeeds +better than a larger quantity of a weak food. + +_What are the causes of, and food changes required by a constant and +excessive formation of gas in the stomach, leading to distention and +pain, or eructations (belching) of gas and often of a sour, watery +fluid?_ + +This is often associated with habitual vomiting, and is due to similar +causes, but particularly to the sugar, which should be greatly reduced +or omitted entirely. + +_What changes should be made when there is habitual colic?_ + +This is generally due to an accumulation of gas in the intestines +which forms there because the proteids (curd) of the milk are not +digested. They should be reduced by using in the early months a weaker +formula--i.e., instead of Formula V of the First or Second Series, IV +might be used, or, for a short time, even III. The proteids may be +reduced in the middle period by using weaker formulas If we desire to +reduce the proteids without reducing the fat, we may change from the +Second to the First Series. + +Another means of relieving habitual colic is the use of partially +peptonized milk (page 115); still another the dilution with +barley-water instead of plain water. + +_What change should be made if curds appear in the stools regularly or +frequently?_ + +This is usually associated with habitual colic, and has to be managed +exactly like that condition, by the means just described. + +_How should the milk be modified for chronic constipation?_ + +The constipation of the first weeks of life has been already referred +to (page 82); it usually disappears as the food is gradually +strengthened in all its proportions. + +Habitual constipation at a later period is difficult to overcome by +diet alone. It sometimes depends upon the fact that the proteids are +too high, and sometimes that the fat is too low. Hence it is more +frequent when infants are fed upon plain milk variously diluted (page +90), then when 7-per-cent or 10-per-cent milk is used, and diluted to +a greater degree. But it is not desirable to use a top-milk containing +more than ten per cent fat for this purpose, nor is it wise to carry +the fat in the food above 4 per cent (i.e., 8 ounces of 10-per-cent +milk, or 12 ounces of 7-per-cent milk, in a 20-ounce mixture) or other +disturbances of digestion may be produced. + +In some cases the use, in place of milk sugar, of ordinary brown +sugar, in half the quantity, is of assistance; or of some of the +malted foods (Mellin's food, malted milk, cereal milk) also in the +place of milk sugar. + +The substitution of the milk of magnesia for the lime-water as +recommended on page 60 will often be found useful. + +To infants over nine months old, orange juice may be given. + +_What special modifications are required during very hot weather?_ + +During the warm season it is well to make the proportion of fat less +than during cold weather. During short periods of excessive heat it +should be much less. The fat is reduced by using 7-per-cent milk in +place of 10-per-cent (i.e., the Second instead of the First Series of +formulas, page 71), or plain milk in place of the 7-per-cent milk in +the Second and Third Series (page 90). At such times also the usual +food should be diluted, and water should be given freely between the +feedings. + +_What changes should be made in the food of a child who, with all the +signs of good digestion, gains very little or not at all in weight?_ + +If the child seems hungry the quantity of food may be increased; but +if the child will not readily take any more in quantity the strength +may be increased by the use of the next higher formula. One should, +however, be extremely careful under these circumstances not to coax or +force a child; for this plan is almost certain to cause disturbance of +digestion and actual loss in weight. A better policy is that of +looking after the other factors in the child's life,--the care, sleep, +fresh air, etc., for with these rather than with the food the trouble +often lies. + +_What should be done with infants who in spite of all variations in +the milk continue to have symptoms of indigestion and do not thrive?_ + +Except inmates of institutions who form a class by themselves, most +infants who receive proper care thrive upon milk if the proportions +suited to the digestion are given. Still there are some who do not. +The nutrition of such is always a matter of difficulty. + +If a wet-nurse is available the employment of one is the thing most +likely to succeed, particularly if the infant is under four or five +months old. + +If the infant is older, or if a wet-nurse cannot be obtained, some of +the substitutes for fresh cow's milk may be tried. One of the best is +condensed milk, Borden's Eagle brand, canned, being preferred. This is +more likely to agree if the symptoms are chiefly intestinal (colic, +flatulence, curds in the stools, constipation or diarrhoea) than if +they are chiefly gastric (vomiting, regurgitation, etc.). + +_How should condensed milk be used?_ + +For an infant three or four months old with symptoms of indigestion, +it should at first be diluted with 16 parts of boiled water, or, +sometimes preferably, with barley-water. With improvement in the +symptoms the dilution may be made 1 to 14, 1 to 12, 1 to 10, and 1 to +8, these changes being gradually made. The intervals between feedings +and the quantities for one feeding are given on page 108. + +_How long should condensed milk be continued?_ + +In most cases it should be used as the sole food for a few weeks only. +Afterward, one feeding a day of a weak formula of modified milk (e.g., +No. III or IV of the Second Series, page 71) may be given; later two +feedings, and thus gradually the number of milk feedings is increased +until the child is taking only modified milk. + +Condensed milk is not to be recommended as a permanent food where good +fresh cow's milk can be obtained. + +_What are the objections to its use?_ + +It is very low in fat and proteids, and high in sugar. This accounts +for its easy digestibility, and also explains why children reared upon +it often gain very rapidly in weight, yet have as a rule but little +resistance. They are very prone to develop rickets and sometimes +scurvy. + +_Are the proprietary infant foods open to the same objections as +condensed milk?_ + +They are. What has been said of condensed milk applies equally well to +most of those that are sold in the market as substitutes for milk. + +_What changes in the food are required by slight indisposition?_ + +For slight general disturbances such as dentition, colds, sore +throats, etc., it is usually sufficient simply to dilute the food. If +this is but for two or three feedings, it is most easily done by +replacing with boiled water an ounce or two of the food removed from +the bottle just before it is given; if for several days, a weaker +formula should be used. + +_What changes should be made for a serious acute illness?_ + +For such attacks as those of pneumonia, bronchitis measles, etc., +attended with fever, the food should be diluted and the fat reduced as +described on page 95. It should be given at regular intervals, rather +less frequently than in health. Water should be given freely between +the feedings. Food should not be forced in the early days of an acute +illness, since the loss of appetite usually means an inability to +digest much food. + +_What immediate changes should be made in the food when the child is +taken with an acute attack of gastric indigestion with repeated +vomiting, fever, pain, etc.?_ + +All milk should be stopped at once, and only boiled water given for +ten or twelve hours; afterward barley-water or whey may be tried, but +no milk for at least twenty-four hours after the vomiting has ceased. +When beginning with modified milk the quantity should be small and the +fat low, which may be secured by the use of the Fourth Series of +formulas in the place of the First or Second Series. The proportion of +lime-water may be doubled. + +_What changes should be made for an attack of intestinal indigestion +attended by looseness of the bowels?_ + +If this is not severe (only two or three passages daily) the fat +should be lowered in the manner stated just above, and the milk should +be boiled for five minutes. If curds are present in the stools, it may +be still further diluted. + +If the diarrhoeal attack is more severe, and attended by fever and +foul-smelling movements of greater frequency, all milk should be +stopped immediately and the diet mentioned just above under the head +of acute disturbances of the stomach should be employed. + +_What changes in the food should be made when the child seems to have +very little appetite and yet is not ill?_ + +The number of feedings should be reduced, the interval being +lengthened by one hour or even more. No greater mistake can be made +than to offer food every hour or two to an infant who is not hungry. +Such a course only prolongs and aggravates the disturbance. + +_What other conditions besides the food greatly Influence the child's +digestion?_ + +Proper clothing, warm feet, regular habits, fresh air, clean bottles, +and food given at the proper temperature are all quite as important as +the preparation of the food; quiet peaceful surroundings and absence +of excitement are also essential to good digestion. + + +COMMON MISTAKES IN MILK MODIFICATION AND INFANT FEEDING + +I. In using modifications made from top-milk, much confusion arises +from the notion that top-milk is a single definite thing, whereas its +composition depends upon a great variety of conditions and, unless all +these are known, it is impossible to tell how strong it is. Directions +for the removal of top-milk should be explicitly followed (see page +63), or the results will be very different from those expected. + +II. In formulas calling for a certain number of ounces of top-milk of +any given strength, the mistake is made of removing only the number of +ounces needed for the formula. The proper way is to remove the amount +required to secure a top-milk of the desired strength and then to take +of this the number of ounces needed in the formula. + +III. A rich Jersey milk is used as if it were ordinary milk. The +formulas given in this book are chiefly calculated on the basis of a +good average milk which contains about 4 per cent fat. Many persons +have the idea that the richer the milk, the more rapidly the child +will gain in weight, and hence the superiority of such milk for infant +feeding. While it is true that some children taking a very rich milk +may, for a time, gain rapidly in weight, yet sooner or later, serious +disturbances of digestion are nearly always produced. + +IV. The food is increased too rapidly, particularly after some +disturbance of digestion. If, in an infant three or four months old, +an attack of somewhat acute indigestion occurs, the food should seldom +be given in full strength before two weeks. The increase in the diet +should be made very gradually, the steps being made only one half +those indicated in the series of formulas on pages 70 and 71. +Otherwise it generally happens that the attack of indigestion is very +much prolonged and much loss in weight occurs. + +V. When symptoms of indigestion occur, the food is not reduced rapidly +enough. Indigestion usually means that the organs are, for the time, +unequal to the work imposed. If the food is immediately reduced by one +half, the organs of digestion soon regain their power and the +disturbance is short. In every case the amount of reduction should +depend upon the degree of the disturbance. + + +PREPARATION OF COW'S MILK AT HOME + +_What articles are required for the preparation of cow's milk at +home?_ + +Feeding-bottles, rubber nipples, an eight-ounce graduated measuring +glass, a glass or agate funnel, bottle brush, cotton, alcohol lamp or, +better, a Bunsen gas burner, a tall quart cup for warming bottles of +milk, a pitcher for mixing the food, a wide-mouth bottle for boric +acid and one for bicarbonate of soda, and a pasteurizer. Later, a +double boiler for cooking cereals will be needed. + +_What bottles are to be preferred?_ + +A cylindrical graduated bottle with a rather wide neck, so as to admit +of easy washing, and one which contains no angles or corners. A single +size holding eight ounces is quite sufficient for use during the first +year. All complicated bottles are bad, being difficult to clean. One +should have as many bottles in use as the child takes meals a day. + +_How should bottles be cared for?_ + +As soon as they are emptied they should be rinsed with cold water and +allowed to stand filled with water to which a little bicarbonate of +soda has been added. Before the milk is put into them they should be +thoroughly washed with a bottle brush and hot soap-suds and then +placed for twenty minutes in boiling water. + +_What sort of nipples should be used?_ + +Only simple straight nipples which slip over the neck of the bottle. +Those with a rubber or glass tube are too complicated and very +difficult to keep clean. Nipples made of black rubber are to be +preferred. The hole in the nipple should not be so large that the milk +will run in a stream, but just large enough for it to drop rapidly +when the bottle with the nipple attached is inverted. + +_How should nipples be cared for?_ + +New nipples should be boiled for five minutes; but it is unnecessary +to repeat this every day as they soon become so soft as to be almost +useless. After using, nipples should be carefully rinsed in cold water +and kept in a covered glass containing a solution of borax or boric +acid. At least once a day they should be turned wrong side out and +thoroughly washed with soap and water. + +_What sort of cotton should be used?_ + +The refined non-absorbent cotton is rather better for stoppering +bottles, but the ordinary absorbent cotton will answer every purpose. + +_Which is better, the Bunsen burner or the alcohol lamp?_ + +If there is gas in the house, the Bunsen burner is greatly to be +preferred, being cheaper, simpler, and much safer than the alcohol +lamp. If the lamp is used, it should stand upon a table covered with a +plate of zinc or tin, or upon a large tin tray. The French pattern of +alcohol lamp is the best. + +_Give the directions for preparing the food according to any of the +above formulas._ + +The nurse's hands, bottles, tables, and all utensils should be +scrupulously clean. First dissolve the milk sugar in boiling water, +filtering if necessary. Then add the milk and cream and lime-water, +mixing the whole in a pitcher. A sufficient quantity of food for +twenty-four hours is always to be prepared at one time. This is then +divided into the number of feedings required for the day, each feeding +being put in a separate bottle, and the bottle stoppered with cotton. +The bottles should then be cooled rapidly by standing, first in tepid +then in cold water, and afterward placed in an ice chest. If the milk +is to be pasteurized or sterilized, this should precede the cooling. + + +DIRECTIONS FOR FEEDING INFANTS + +_How should the bottle be prepared at feeding time?_ + +It should be taken from the ice chest, and warmed by standing in warm +water which is deep enough to cover the milk in the bottle; it should +then be thoroughly shaken and the nipple adjusted; the nurse should +see that the hole in the nipple is not too large nor too small. + +_How may the temperature of the milk be tested?_ + +Never by putting the nipple in the nurse's mouth. Before adjusting the +nipple, a teaspoonful may be poured from the bottle and tasted, or a +few drops may be poured through the nipple upon the inner surface of +the wrist, where it should feel quite warm but never hot; or a +thermometer may be placed in the water in which the bottle stands. A +dairy thermometer should be used, and the temperature of the water +should be between 98 deg. and 105 deg. F. + +_What is a simple contrivance for keeping the milk warm during +feeding?_ + +A small flannel bag with a draw string may be slipped over the bottle. + +_In what position should an infant take its bottle?_ + +For the first two or three months it is better, except at night, when +it may be undesirable to take the infant from its crib, that it be +held on the nurse's arm during the feeding; later it may lie on its +side in the crib provided the bottle is held by the nurse until it has +been emptied; otherwise a young infant readily falls into the bad +habit of alternately sucking and sleeping, and often will be an hour +or more over its bottle. + +_How much time should be allowed for one feeding?_ + +Never more than twenty minutes. The bottle should then be taken away +and not given until the next feeding time. Under no circumstances +should an infant form the habit of sleeping with the nipple in its +mouth. A sleepy infant should be kept awake by gentle shaking until +the food is taken, or the bottle should be removed altogether. + +_Should an infant be played with soon after feeding?_ + +On no account; such a thing frequently causes vomiting and sometimes +indigestion. After every feeding the infant should be allowed to lie +quietly in its crib, and disturbed as little as possible. + + +INTERVALS OF FEEDING + +_How often should a baby be fed during the first month?_ + +Every two hours during the day and twice during the night, or ten +feedings during the twenty-four hours. + +_At what age may the interval be made two and a half hours?_ + +Usually at five or six weeks. + +_When may it be increased to three hours?_ + +Usually at two months. + +_Why should not a child be fed more frequently?_ + +It takes the stomach nearly two hours to digest a meal at two months, +and about two and a half hours at five or six months, and if the meals +are too near together the second one is given before the first has +been digested and vomiting and indigestion result. The meals should be +far enough apart to give the stomach a little time for rest just +before each feeding. + +_Schedule for Feeding Healthy Infants during the First Year_ + + ------------------------------------------------------------------- + AGE. Interval Night No. of Quantity Quantity + between feedings feedings for one for 24 + meals, (10 P.M. in 24 feeding. hours. + by day. to 7 A.M.). hours. +--------------------------------------------------------------------- + Hours. Ounces. Ounces. +2d to 7th day 2 2 10 1 -1-1/2 10-15 +2d and 3d weeks 2 2 10 1-1/2 - 3 15-30 +4th and 5th weeks 2 1 10 2-1/2 - 3-1/2 25-35 +6th to 8th week 2-1/2 1 8 3 - 5 24-40 +3d to 5th month 3 1 7 4 - 6 28-42 +5th to 9th month 3 0 6 5 - 7-1/2 30-45 +9th to 12th month 4 0 5 7 - 9 35-45 +--------------------------------------------------------------------- + +This schedule gives the averages for healthy children The smaller +quantities are those required by small children whose digestion is not +very vigorous. The larger quantities are those required by large +children with strong digestion; in very few cases will it be advisable +to go above these figures. + +The interval is reckoned from the beginning of one feeding to the +beginning of the next one. + +_When should the interval between the feedings be lengthened?_ + +When there is gastric indigestion as shown by habitual vomiting or the +regurgitation of food long after the bottle is finished; also when the +appetite is very poor so that the infant regularly leaves some of its +food. + +_When should the interval between the feedings be shortened?_ + +This is done much too frequently; it is rarely advisable to feed any +infant, except one seriously ill, oftener than the time put down in +the schedule. + + +REGULARITY IN FEEDING + +_How can a baby be taught to be regular in its habits of eating and +sleeping?_ + +By always feeding at regular intervals and putting to sleep at exactly +the same time every day and evening. + +_When should regular training be begun?_ + +During the first week of life. + +_Should a baby be wakened to be nursed or fed if sleeping quietly?_ + +Yes, for a few days. This will not be required long, for with regular +feeding an infant soon wakes regularly for its meal, almost upon the +minute. + +_Should regularity in feeding be kept up at night as well as during +the day?_ + +Only up to nine or ten o'clock; after that time a baby should be +allowed to sleep as long as it will. + +_At what age may a well baby go without food from 10 P.M. to 6 or 7 +A.M.?_ + +Usually at four months, and always at five or six months. Night +feeding is one of the most frequent causes of wakefulness and +disturbed sleep. + + +STERILIZED MILK + +_What is meant by sterilizing milk?_ + +Heating milk for the purpose of destroying germs. + +_Does all cows milk contain germs?_ + +Yes; even when handled most carefully, milk contains many germs; but +when carelessly handled, and in summer, the number is enormous. While +most of these are harmless or cause only the souring of milk, others +are occasionally present which may produce serious diseases such as +typhoid fever, diphtheria scarlet fever, cholera, tuberculosis, and +many forms of diarrhoea. + +_Under what circumstances is it necessary to sterilize milk?_ + +1. In warm weather when it cannot be obtained fresh; hence always in +cities and towns during the summer. + +2. When one cannot be certain that the cows are healthy, or that the +milk has been carefully handled. + +3. When the milk is to be kept for any considerable time (i.e., over +twenty-four hours), especially if no ice can be had. + +4. During epidemics of typhoid fever, scarlet fever, diphtheria, or +any form of diarrhoeal disease. + +_What are the two methods of heating milk?_ + +The first is known as _sterilizing_, in which the milk is heated to +212 deg. F. for one hour or one hour and a half; the second is known as +_pasteurizing_, in which the milk is heated to 155 deg. or 170 deg. F. for +thirty minutes. A temperature of 155 deg. F. continued for thirty minutes +is sufficient to kill the germs of the diseases above referred to. + +_Will milk which has been thus treated keep indefinitely?_ + +No; for although all the living germs may be killed, there are many +undeveloped germs, or spores, which are not destroyed, and which soon +grow into living germs. Milk heated to 212 deg. F. for an hour will keep +upon ice for two or three weeks; that heated to 155 deg. F. for two or +three days. + +_Is milk which has been sterilized always a safe food?_ + +No; for the reason that the milk may be so old, so dirty, and so +contaminated before sterilizing that it may be still unfit for food, +though it contains no living germs. + +_Is cow's milk rendered more digestible by being heated in this way?_ + +Sterilizing milk does not improve its digestibility but rather the +contrary. Sterilized milk should be modified for infant feeding in the +same way as milk which has not been heated. + +_Is milk in any way injured by heating to 212 deg. F. for an hour?_ + +There is abundant evidence that milk is rendered less digestible by +such heating; also that it is more constipating, and that for some +children its nutritive properties are interfered with, so that it may +cause scurvy; this, however, is not seen unless it is continued as the +sole food for a long period. These objections are of so much +importance that this plan of heating milk is not to be recommended for +general use. + +_When is it advantageous to heat milk to 212 deg. F.?_ + +For use upon long journeys, such as crossing the ocean. Milk should +then be heated for one hour upon two successive days, without removing +the cotton stoppers from the bottles. + +_Is milk in any way injured by heating to 155 deg. F. for thirty minutes?_ + +This point is not yet definitely settled. Such heating does not affect +the taste of milk and does not render it more constipating. The +unfavourable effects; if there are any, are so slight that they need +not deter one from the use of pasteurized milk, even for long periods. +The preference, however, should always be given to milk which is so +clean and so fresh as not to require any heating. + +_How should milk be pasteurized?_ + +A convenient form of apparatus is that known as Freeman's +pasteurizer[5]; another is the Walker-Gordon pasteurizer.[6] + + [5] This can be obtained at 411 West Fifty-ninth Street, New + York, with bottles and full directions; a tin one, at a cost of + $3.50, and a copper one, which is much more durable, for $7.00. + + [6] Obtained at the same prices from any of the Walker-Gordon + milk laboratories. + +_How should milk be cooled after pasteurizing?_ + +Always by placing the bottles in cold water, so as to cool them +rapidly; never by letting them stand at the temperature of the room, +or by placing them, when warm, in an ice box. + +_Why is this precaution necessary?_ + +Cooling in the air or in an ice box requires from two to four hours, +and during that time a great many of the undeveloped germs may mature +and greatly injure the keeping properties of the milk. In the cold +water, milk can be cooled in from ten to twenty minutes if the water +is frequently changed, or if ice is added to the water. + + +MODIFIED MILK OF THE MILK LABORATORIES + +_What is "modified milk" of the milk laboratories?_ + +It is milk containing definite proportions of the fat, sugar, +proteids, etc., put up usually according to the prescription of a +physician, who indicates how much of the different elements he +desires. The most reliable are the laboratories of the Walker-Gordon +Company, which has branches in many of the large cities of the United +States. + +This is an excellent method of having milk prepared since it can be +done with greater care and cleanliness than are possible in most +homes. It is besides a great convenience if circumstances make it +impossible to prepare the milk properly at home. + +The laboratory should be used for infant feeding only by one who is +somewhat familiar with this method of ordering milk. + + +PEPTONIZED MILK + +_What is peptonized milk?_ + +Milk in which the proteids (curd) have been partially digested. + +_How is this accomplished?_ + +By the action of a peptonizing powder which is composed of a digestive +agent known as the extractum pancreatis and bicarbonate of soda, which +is added to the plain or diluted milk. This is sold in tubes or in +tablets, and it is the active ingredient of the peptogenic milk +powder. + +_Describe the process._ + +The plain or modified milk is placed in a clean glass jar or bottle, +and the peptonizing powder, which is first rubbed up with a +tablespoonful of the milk, is added and the bottle shaken. The bottle +is then placed in a large pitcher or basin containing water kept at +the temperature of about 110 deg. F., or as warm as the hand can bear +comfortably, and left for ten to twenty minutes if the milk is to be +partially peptonized; for two hours if it is to be completely +peptonized. + +_What taste has partially peptonized milk?_ + +None, if peptonizing is continued for only ten minutes, but at the end +of twenty minutes it begins to be bitter, when the process of +digestion has gone further. + +_How is the bitter taste avoided in partially peptonized milk?_ + +At the end of ten or fifteen minutes the milk may be placed in a +saucepan and quickly raised to boiling point; this kills the ferment, +so that the milk will not become bitter when warmed a second time. Or, +the milk may be rapidly cooled by placing the bottles first in cool +and then in ice water; in this way the ferment is not destroyed, and +the milk may become bitter when warmed for feeding. + +_Should the whole day's supply be peptonized at once, or each bottle +separately just before the feeding?_ + +Either plan may be followed. If the former, it is better to raise the +milk to boiling point after peptonizing; if the latter, it should not +be peptonized more than ten minutes, for it will continue to peptonize +while it is being taken by the child. + +_Is not the bitter taste of completely peptonized milk a great +obstacle to its use?_ + +Not in the case of young infants; one under four or five months old +will usually take it without any objection after two or three +feedings; but it cannot often be used for those who are much older. + +_How much of the peptonizing powder should be used?_ + +There are required for one pint of plain milk, five grains of the +extractum pancreatis and fifteen grains of bicarbonate of soda. This +quantity is usually put up in a single tube or tablet. In the formulas +previously given, less than this will be required; for the weaker +formulas, one half or one third of the powder mentioned will be +sufficient for one pint of food. For a single feeding of four ounces, +one may use one eighth of a tube with a weak formula, or one sixth of +a tube with a stronger formula. + +_What are the advantages of peptonized milk?_ + +Partially peptonized milk is useful for young infants who have great +difficulty in digesting the curd of milk, sometimes even when diluted +as already described; completely peptonized milk, during acute attacks +of indigestion. + +_For how long a period may the use of peptonized milk be continued?_ + +Completely peptonized milk may be used for a few days, or at most a +few weeks; partially peptonized milk may be used for two or three +months, but not indefinitely; it should be left off gradually by +shortening the time of peptonizing, and lessening the amount of the +powder used. + + +FEEDING DURING THE SECOND YEAR + +_How many meals are required during the second year?_ + +It is usually better to continue five meals throughout the second +year. Some children will sleep from 6 P.M. to 6 A.M. without waking, +but unless there is a feeding at 10 P.M. children are apt to wake very +early in the morning. + +_Should each feeding be prepared at the time it is given, or all +feedings at one time, as during the first year?_ + +During the second and third years it is better to prepare the milk for +the entire day at one time. If it is to be modified by adding cream, +water, etc., it is done as during the first year. + +Later, when only plain milk is used, the quantities needed for the +different feedings should be put into one or into two bottles, which +then may be pasteurized or not as may be necessary. In this way the +different feedings are kept separate, and the day's supply of milk is +not disturbed every time the child is fed, as otherwise is +unavoidable. The food should be prepared as soon as possible after the +daily milk supply is delivered in the morning. + +_Give a proper diet for an average healthy child of twelve months._ + +6.30 A.M. Milk, six to seven ounces; diluted with barley or oat + gruel, two to three ounces; after the thirteenth + month, taken from a cup. + + 9 A.M. Orange juice, one to two ounces. + + 10 A.M. Milk, two parts; oatmeal or barley gruel, one part; + from ten to twelve ounces in all may be allowed; + it should be given from a cup. + + 2 P.M. Beef juice, one to two ounces; + or, the white of one egg, slightly cooked; later, the + entire egg; + or, mutton or chicken broth, four to six ounces. + Milk and gruel in proportions above given, four to + six ounces. + + 6 P.M. Same as at 10 A.M. + + 10 P.M. Same as at 6.30 A.M., except that the milk may be + given from the bottle. + +_How long may this schedule be followed?_ + +Usually until the fourteenth or fifteenth month. After this time the +cereals may be given much thicker and fed from a spoon. + +_May any other fruit juices be given at this period?_ + +Orange juice is the best; next to this the juice of fresh ripe +peaches, red raspberries or strawberries. All these should be strained +very carefully through muslin to make sure that the child gets none of +the pulp or seeds, either of which may cause serious disturbance. Of +the orange or peach juice, from one to four tablespoonfuls may be +allowed at one time; of the others about half the quantity. The fruit +juice is best given one hour before the second feeding. + +_When should a child be weaned from its bottle?_ + +Most children can and should be taught to take their food from the cup +or spoon by the time they are thirteen months old; but it is +convenient to give the 10 P.M. feeding from the bottle during the +greater part of the second year (see page 52). + +_Give a proper diet for an average child from the fourteenth to the +eighteenth month._ + +The bottle should not be given except at night. Cereals may now form +an important part of the diet. They should be very thoroughly cooked, +usually for three hours, and strained. + +The daily schedule should be about as follows: + +6.30 A.M. Milk, warmed, eight to ten ounces, given from a cup. + + 9 A.M. Fruit juice, one to three ounces. + + 10 A.M. Cereal: one, later two or three, tablespoonfuls of oatmeal + hominy or wheaten grits, cooked for at + least three hours; upon this from one to two + ounces of thin cream, or milk and cream, with + plenty of salt, but without sugar. + Crisp dry toast, one piece; + or, unsweetened zwieback; + or, one Huntley and Palmer breakfast biscuit. + Milk, warmed, six to eight ounces, from a cup. + + 2 P.M. Beef juice, one to two ounces; and one egg (soft + boiled, poached or coddled); and boiled rice, one + tablespoonful; + or, broth (mutton or chicken), four ounces; one or + two Huntley and Palmer breakfast biscuits, or + zwieback; and (if most of the teeth are present) + rare scraped meat, at first one teaspoonful, gradually + increasing to one tablespoonful. + + 6 P.M. Cereal: two tablespoonfuls of farina, cream of wheat, + or arrowroot, cooked for at least one half hour, + with milk, plenty of salt, but without sugar. + Milk, warmed, eight to ten ounces, given from a cup. + + 10 P.M. Milk, warmed, eight to ten ounces, which may be + given from a bottle. + +_Give a proper diet for an average child from the eighteenth month to +the end of the second year._ + +The same order of meals as for the months just preceding should be +followed. For most children milk at 10 P.M. is desirable. There are +many, however who sleep regularly from 6 P.M. until 6 A.M. without +food; for such the night feeding should, of course, not be insisted +upon. + +The daily schedule should be about as follows: + +6.30 A.M. Milk, warmed, ten to twelve ounces, given from cup. + + 9 A.M. Fruit juice, two to three ounces. + + 10 A.M. Cereals: similar to those given from the fourteenth + to the eighteenth month; they need not be + strained although they should be cooked and + served in the same way. + Crisp dry bread, zwieback, or Huntley and Palmer + biscuits, without butter. + Milk, warmed, one cup. + + 2 P.M. Beef juice and one egg; + or, broth and meat; care being taken that the + meat is always rare and scraped or very finely + divided; beefsteak, mutton chop, or roast beef + may be given. + Very stale bread, or two pieces of zwieback. + Prune pulp or baked apple, one to two tablespoonfuls. + Water; no milk. + + 6 P.M. Cereal: farina, cream of wheat, or arrowroot, cooked + for at least one half hour, with milk, plenty of + salt, but without sugar. + or, milk toast or stale bread and milk. + + 10 P.M. If required, ten to twelve ounces of plain milk. + +_What fruits may be given at this period?_ + +If the child has a feeble digestion, only the fruit juices previously +allowed; strong children may have in addition prune pulp, baked apple, +and applesauce. The prune pulp is prepared by stewing the dried prunes +without sugar until they are very soft, and removing all the skin by +putting the fruit through a strainer; of this from one to two +tablespoonfuls may be given at one time. The baked apple should be +given without cream, and the applesauce should have very little sugar. + +_How and when should water be given?_ + +Throughout the second year water should be given freely between the +feedings, especially in warm weather; from one to three ounces may be +given at one time, either from a spoon, a glass, or a bottle. The +water should be boiled daily and then cooled. It should not be allowed +to stand in the room, but fresh water should be put into the bottle +each time. + + +FEEDING DURING THE THIRD YEAR + +_What changes may be made in the diet during the third year?_ + +The night feeding at 10 P.M. should be omitted. A greater quantity of +solid food may be allowed, particularly at the mid-day meal. It is not +advisable to begin potato and other vegetables until this age is +reached. Three regular meals should be given and milk once besides, +either between the breakfast and dinner or dinner and supper, +whichever is the longer interval. Water should be allowed freely +between meals. + +_What would be a proper schedule for an average child during the third +year?_ + +7.30 A.M. Cereal: cooked (preferably over night) for three + hours, although a somewhat larger variety may + be given than during the second year; given as + before with milk or thin cream, salt, but very + little sugar. + Warm milk, one glass. + A soft egg, poached, boiled or coddled. + Bread, very stale or dry, one slice, with butter. + + 10 A.M. Warm milk, one cup, with a cracker or piece of very + stale bread and butter. + + 2 P.M. Soup, four ounces; + or, beef juice, two ounces. + Meat: chop, steak, roast beef or lamb or chicken. + A baked white potato; + or, boiled rice. + Green vegetable: asparagus tips, string beans, peas, + spinach; all to be cooked until very soft, and + mashed, or preferably put through a sieve; at + first, one or two teaspoonfuls. + Dessert: cooked fruit--baked or stewed apple, stewed + prunes. + Water; no milk. + + 6 P.M. Cereal: farina, cream of wheat, or arrowroot, cooked + for at least one half hour, with plenty of salt, + but without sugar; + or, milk toast; + or, bread and milk; + or, stale or dry bread and butter and a glass of milk. + + + + +PART III + +THE DIET OF OLDER CHILDREN (FOURTH TO TENTH YEAR) + + +Throughout this period the largest meal should always be in the middle +of the day, and a light supper given, very much like that described +for the third year. During the first half of this period, milk may be +allowed once either between breakfast and dinner or dinner and supper; +no other eating between meals should be permitted, but water should be +allowed freely. + + +MILK AND CREAM + +_What part of the diet should milk form during childhood?_ + +It should form a very important part up to the tenth year; nothing can +take its place. There are comparatively few children who cannot take +and digest milk if it is properly fed. + +_Why is milk so advantageous?_ + +Because no food that we possess has so high a nutritive value as milk, +for the amount of work required of the organs of digestion. It is, +therefore, peculiarly adapted to the diet of the child. + +_What are the essential points in the use of milk?_ + +It should be clean and fresh, but not too rich. It is a mistake to +select for any children the rich milk of a Jersey herd and use it as +though it were an ordinary milk. For children who have difficulty in +digesting milk, it should be somewhat diluted, i.e., one part of water +to four parts of milk, or salt or bicarbonate of soda should be added. +It is also important not to give milk at meals when fruits, especially +sour fruits, are allowed. + +_How much milk may advantageously be given?_ + +The average child with good digestion should take from one and one +half pints to one quart of milk daily, this including not only what +the child drinks but what is served upon cereals and in other ways. It +is seldom wise to allow a child to take as much as two quarts daily, +as a more mixed diet for most children is better. + +_To what extent may cream be used?_ + +Older children do not require so large a proportion of fat in their +food as do infants, and the use of cream, especially very rich cream, +often results in disturbances of digestion. The use of too much or too +rich cream is a common cause of the coated tongue, foul breath and +pale gray stools, often called "biliousness." + +_Is not cream useful in overcoming the constipation of children?_ + +With infants it is valuable to a certain point, but with older +children only to a limited degree, and if such symptoms as those above +described are present, cream should not be given. + + +EGGS + +_To what extent may eggs be used in the diet of this period?_ + +They form a most valuable food. It is essential that they should be +fresh and only slightly cooked, soft boiled, poached or coddled; fried +eggs should never be given and all omelets are objectionable. + +_Which is more digestible, the white or yolk of the egg?_ + +For the great majority of children, the white of the egg. This forms +one of the most digestible proteids we possess, and can be used, even +in the latter part of the first year, with advantage. + +_Is it not true that eggs often cause "biliousness"?_ + +Very seldom, if fed as above advised. This is an old prejudice but has +little basis in fact. + +_How often may eggs be given?_ + +Most children from four to ten years old will take one egg for +breakfast and another for supper for an indefinite period with relish +and benefit. There are, however, some few who have a peculiar +idiosyncrasy as regards eggs and cannot take them at all. + + +MEAT AND FISH + +_What meats may be given to young children?_ + +The best are beefsteak, mutton-chop, roast beef, roast lamb, broiled +chicken and certain delicate fish, such as shad or bass. + +_What are the important points to be considered in giving meat to +children?_ + +Most meats should be rare and either scraped or very finely divided, +as no child can be trusted to chew meat properly. Meats are best +broiled or roasted, but should not be fried. + +_How often should meat be given?_ + +At this period, only once a day, at the mid-day meal. + +_Is not the excessive nervousness of many modern children due to the +giving of meat, or at least aggravated by its use?_ + +There is little ground for such a belief, unless an excessive amount +of meat is given. Certainly cutting off meat from the diet of nervous +children seldom produces any striking benefit. + +_What meats should be forbidden to young children?_ + +Ham, bacon, sausage, pork, liver, kidney, game and all dried and +salted meats, also cod, mackerel and halibut; all of these are best +withheld until the child has passed the tenth year. + +_Are not gravies beneficial and nutritious?_ + +The beef juice, or so-called "platter gravy," from a roast is +exceedingly nutritious and desirable, but many of the thickened +gravies are much less digestible and are too often given in excess; +only a small quantity should be allowed. They should not form an +important part of the meal. + + +VEGETABLES + +_What vegetables may be used at this period?_ + +White potatoes may be given first. These should preferably be baked or +boiled and mashed, but never fried. They should be served with beef +juice or with cream rather than with butter. + +Of the green vegetables, the best are peas, spinach, asparagus tips, +string beans, stewed celery, young beets, or carrots, and squash. +Baked sweet potato, turnips, boiled onions and cauliflower, all well +cooked, may be given after the sixth or seventh year in moderate +amount. + +The principal trouble in the digestion of vegetables is due to +imperfect cooking. It is, in fact, almost impossible to cook them too +much; they should also be very finely mashed. They form a valuable +addition to the diet after three years, although the amount at first +given should be small, one or two teaspoonfuls. They greatly aid in +securing regularity of the bowels. Because small particles are seen in +the stools, it is not to be inferred that they are causing disturbance +and should, therefore, be stopped, but only that they should be more +thoroughly cooked and more finely divided before being given. + +_Is it safe to use canned vegetables for children?_ + +Many of the best brands of canned vegetables are quite safe and some, +such as peas and asparagus, can be used with advantage. They are +frequently better than stale green vegetables often sold in the +markets. + +_What vegetables should not be given to young children?_ + +None of those which are eaten raw, such as celery, radishes, onions, +cucumbers, tomatoes or lettuce. Certain others, even when well cooked, +should not be allowed; as corn, lima beans, cabbage, egg plant. None +of these should be given until a child has passed the age of ten +years. + +_Are vegetable salads to be given?_ + +As a rule salads of all kinds should be omitted until a child has +passed the tenth year. Salads are difficult to digest and a cause of +much disturbance in children of all ages. + + +CEREALS + +_What are the most important points in selecting and preparing +cereals?_ + +The important things are that they are properly cooked and not used in +excess. The ready-to-serve cereals should never be chosen for +children, nor should a child, because he is fond of cereals, be +allowed to make his entire meal of them, taking two or three +saucerfuls at a feeding. + +Many of the partially cooked preparations of oatmeal and wheat are +excellent, but should be cooked for a much longer time than is stated +upon the package, usually three or four times as long. Digestibility +is chiefly a matter of proper cooking. Most of the grains,--oatmeal, +hominy, rice, wheaten grits,--require at least three hours' cooking in +a double boiler in order to be easily digested. The prepared +flours,--corn starch, arrowroot, barley,--should be cooked at least +twenty minutes. I know of no preparation in the modern market which +requires no cooking, which is to be recommended for children. + +_How are cereals to be given?_ + +Usually with milk or a mixture of milk and cream; always with an +abundance of salt and with very little or no sugar, one half +teaspoonful on a saucerful of cereal should be the limit. + +Cereals should not be served with syrups or butter and sugar. + + +BROTHS AND SOUPS + +_What broths and soups are to be recommended?_ + +Meat broths are generally to be preferred to vegetable broths,--mutton +or chicken being usually most liked by children. Nearly all plain +broths may be given. Those thickened with rice, barley or corn starch +form a useful variety, especially with the addition of milk. + +Vegetable purees of peas, spinach, celery or asparagus may be used for +children over seven years old. Tomato soup should not be given to +young children. + + +BREAD, CRACKERS AND CAKES + +_What forms of breadstuffs are best suited to young children?_ + +Fresh bread should not be given, but stale bread cut thin and freshly +dried in the oven until it is crisp is very useful, also zwieback, the +unsweetened being preferred. Oatmeal, graham or gluten crackers and +the Huntley and Palmer breakfast biscuits, stale rolls, or corn bread +which has been split and toasted or dried till crisp, form a +sufficient variety for most children. + +_What breadstuffs should be forbidden?_ + +All hot breads, all fresh rolls, all buckwheat and other griddle +cakes, all fresh sweet cakes, especially those covered with icing and +those containing dried fruits. A stale lady-finger or piece of sponge +cake is about as far in the matter of cakes as it is wise to go with +children up to seven or eight years old. + + +DESSERTS + +_What desserts may be given to young children?_ + +Mistakes are more often made here than in any other part of the +child's diet. Up to six or seven years, only junket, plain rice +pudding without raisins, plain custard and, not more than once a week, +a small amount of ice cream. + +_What should be especially forbidden?_ + +All pies, tarts and pastry of every description, jam, syrups and +preserved fruits; nuts, candy and dried fruits. + +_Does "a little" do any harm?_ + +Yes, in that it develops a taste for this sort of food, after which +plainer food is taken with less relish. Besides the "little" is very +apt soon to become a good deal. + +_Does not the child's instinctive craving for sweets indicate his need +of them?_ + +That a child likes or craves sweets is the usual excuse of an +indulgent parent. Every child likes his own way, but that is no reason +why he should not be trained to obedience and self-control; a child's +fondness for sweets can hardly be considered a normal instinct. As a +matter of fact, supported by everyday experience, no causes are +productive of more disorders of digestion than the free indulgence in +desserts and sweets by young children. It is a constantly increasing +tendency, not easily controlled as a child grows older; and in early +childhood, the only safe rule is to give none at all. + + +FRUITS + +_Are fruits an essential or important part of the diet?_ + +They are a very important part and should be begun in infancy. They +are particularly useful for the effect they have upon the bowels. It +is important that they should be selected with care and given with +much discretion, especially in cities. In the country where fruit is +absolutely fresh, a somewhat greater latitude may be allowed than is +given below. + +_What fruits may safely be given to children up to five years old?_ + +As a general rule, only cooked fruits and the juices of fresh fruits. + +_What fruit juices may be used?_ + +That from sweet oranges is the best, but the fresh juice of grape +fruit, peaches, strawberries and raspberries may also be used. + +_What stewed fruits may be given?_ + +Stewed or baked apples, prunes, pears, peaches and apricots. + +_What raw fruits are to be particularly avoided with young children?_ + +The pulp of oranges or grape fruit, also cherries, berries, bananas +and pineapple. + +_What precautions should be emphasized regarding the use of fruits?_ + +That they should be used with greater care in hot weather and with +children who are prone to attacks of intestinal indigestion. + +_What symptoms indicate that fruits should be avoided?_ + +A tendency to looseness of the bowels with the discharge of mucus, or +frequent attacks of abdominal pain or stomach ache. + +_Is there any special choice of meals at which fruit should be given?_ + +The fruit juice given early in the morning, upon an empty stomach, +works more actively upon the bowels than if it is given later in the +day. + +It is not, as a rule, wise to give cream or milk with sour fruits. +Usually the fruit is best given at the mid-day meal, as a dessert, at +a time when no milk is taken. It is in all cases important that the +quantity of fruit should be moderate. + +_What besides water and milk should a child be allowed to drink and +what should be forbidden?_ + +Tea, coffee, wine, beer and cider in all quantities and in all forms +should be forbidden to young children below puberty. Cocoa which is +made very weak, i.e., almost all milk, is often useful as a hot drink. +Lemonade, soda-water, etc., should if possible be deferred until the +tenth year. A free indulgence in things of this kind should never be +permitted with children of seven or eight years. + + +INDIGESTION IN OLDER CHILDREN + +_What are the different ways in which indigestion shows itself in +children?_ + +First, in acute disturbances which last for a few days only; and, +secondly, in chronic disturbances which may continue for weeks or +months. + +_Which of the two forms of indigestion is more likely to impair +seriously the health of the child?_ + +Chronic indigestion; for since the cause is not recognized it often +goes on for months and even years unchecked. + +_What are the symptoms of acute indigestion?_ + +These are familiar and easily recognized. They are vomiting, pain, +undigested movements from the bowels, often fever and considerable +prostration. + +Such attacks are usually traceable to their proper cause, the removal +of which is followed by prompt recovery. + +_What are the common causes of acute indigestion?_ + +This is frequently due to overeating, to indulgence in some special +article of improper food, or to eating heartily when overtired. Acute +indigestion often marks the beginning of some acute general illness. + +_How should acute indigestion be managed?_ + +One should bear in mind that for the time being the digestive organs +have stopped work altogether. The important thing, therefore, is to +clear out from the intestines all undigested food by some active +cathartic, such as castor oil. The stomach has usually emptied itself +by vomiting. All food should be stopped for from twelve to thirty-six +hours, according to the severity of the attack, only water being +given. + +_At the end of this time is it safe to begin with the former diet?_ + +No; for such a procedure is almost certain to cause another attack of +indigestion. At first only broth, thin gruel, very greatly diluted +milk, or whey should be given. The diet may be very slowly but +gradually increased as the child's appetite and digestion improve, but +in most cases a week or ten days should elapse before the full diet is +resumed. + +_What are the symptoms of chronic indigestion?_ + +These, although familiar, are not so easily distinguished and are very +often attributed to the wrong cause. There are usually general +symptoms such as indisposition, disturbed sleep, grinding of the +teeth, fretfulness, languor, loss of weight and anaemia. There are +besides local symptoms: flatulence, abdominal pain, abdominal +distention, constipation, or looseness of the bowels with mucus in the +stools, foul breath, coated tongue, loss of appetite, or an abnormal +capricious appetite. Such symptoms are often wrongly ascribed to +intestinal worms. + +_What are the common causes of chronic indigestion?_ + +This is generally the result of a bad system of feeding, either the +prolonged use of improper food or of improper methods of feeding. + +Examples of bad methods of feeding are, coaxing or forcing to eat, +rapid eating with insufficient mastication eating between meals, +allowing a child to have his own way in selecting his food, as when he +lives largely upon a single article of diet. Things to be considered +under the head of improper food are, indulgence in sweets, desserts, +etc., the use of imperfectly cooked foods, especially cereals and +vegetables, and of raw or stale fruits. + +_Is it not true that a diet or a special article of food which does +not make a child ill is proof that such a diet or such a food is +proper for a child?_ + +By no means; with many people the only guide In feeding children is +that the article in question did not make the children sick, therefore +it is allowable. This is a very bad principle. A better one is to +adopt such a diet as will nourish the child's body with the least +possible tax upon his digestive organs; in other words, to exclude +articles which experience has shown to be injurious to most children. + +_How should chronic indigestion be managed?_ + +This is a much more difficult matter than the treatment of acute +indigestion, for, as it is usually the result of the prolonged use of +improper food or of an improper method of feeding, a cure can be +accomplished only by a discovery and removal of the cause. + +_Is chronic indigestion curable?_ + +In the vast majority of cases it is so, but only by faithfully +observing for a long period the rules for simple feeding laid down +elsewhere. One of the greatest' difficulties in the way of recovery is +that parents and nurses are unwilling to follow a restricted diet long +enough to secure a complete cure, or to change radically their methods +of feeding, but expect the child to recover by simply taking medicine. + +_For how long a period is it necessary to continue very careful +feeding?_ + +In any case it must be done for several months; with most children for +two or three years; with some, throughout childhood, for with them the +slightest deviation from established rules is sure to provoke a +relapse. + +_Is not medicine useful?_ + +It is undoubtedly of assistance for the relief of some symptoms, but +the essential thing is proper feeding, without which nothing permanent +can be accomplished. + + +GENERAL RULES TO BE OBSERVED IN FEEDING + +Bad habits of eating are readily acquired but difficult to break. + +Young children should not be allowed to play with their food, nor +should the habit be formed of amusing or diverting them while eating, +because by these means more food is taken. + +Older children should not be permitted to make an entire meal of one +thing, no matter how proper this may be. + +Children, who are allowed to have their own way in matters of eating +are very likely to be badly trained in other respects; while those who +have been properly trained in matters of eating can usually be easily +trained to do anything else that is important. + +Learning to eat proper things in a proper way forms therefore a large +part of a child's early education. If careful training in these +matters is begun at the outset and continued, the results will well +repay the time and effort required. + +Whether the child feeds himself or is fed by the nurse, the following +rules should be observed: + +1. Food at regular hours only; nothing between meals. + +2. Plenty of time should be taken. On no account should the child bolt +his food. + +3. The child must be taught to chew his food. Yet no matter how much +pains are taken in this respect, mastication is very imperfectly done +by all children; hence up to the seventh year at least, all meats +should be very finely cut, all vegetables mashed to a pulp, and all +grains cooked very soft. + +4. Children should not be continually urged to eat if they are +disinclined to do so at their regular hours of feeding, or if the +appetite is habitually poor, and under no circumstances should a child +be forced to eat. + +5. Indigestible food should never be given to tempt the appetite when +the ordinary simple food is refused? food should not be allowed +between meals because it is refused at meal-time. + +6. One serious objection to allowing young children highly seasoned +food, entrees, jellies, pastry, sweets, etc., even in such small +amounts as not to upset the digestion, is that children thus indulged +soon lose appetite for the simple food which previously was taken with +relish. + +7. If there is any important article of a simple diet such as milk, +meat, cereals, or vegetables, which a child habitually refuses, this +should always be given first at the meal and other food withheld until +it is disposed of. Children so readily form habits of eating only +certain things and refusing others that such an inclination should be +checked early. + +8. If an infant refuses its food altogether, or takes less than usual, +the food should be examined to see if this is right. Then the mouth +should be inspected to see if it is sore. If neither of these things +is the cause, the food should be taken away and not offered again +until the next feeding time comes. + +9. In any acute illness the amount of food should be much reduced and +the food made more dilute than usual. If there is fever, no solid food +should be given. If the child is already upon a milk diet, this should +be diluted, and in some cases partially peptonized. + +10. In very hot weather the same rules hold, to give less food, +particularly less solid food, and more water. + + +FOOD FORMULAS + +_Beef Juice._--One pound of rare round steak, cut thick, slightly +broiled, and the juice pressed out by a lemon-squeezer, or, better, a +meat-press. From two to four ounces of juice can generally be +obtained. This, seasoned with salt, may be given cold, or warmed by +placing the cup which holds it in warm water. It should not be heated +sufficiently to coagulate the albumin which is in solution, and which +then appears as flakes of meat floating in the fluid. + +_Beef Juice by the Cold Process._--One pound of finely chopped round +steak, six ounces of cold water, a pinch of salt; place in a covered +jar and stand on ice or in a cold place, five or six hours or +overnight. It is well to shake occasionally. This is now strained and +all the juice squeezed out by placing the meat in coarse muslin and +twisting it very hard. It is then seasoned and fed like the above. + +Beef juice so made is not quite as palatable as that prepared from +broiled steak, but it is even more nutritious, and is more economical, +as fully twice as much juice, can be obtained from a given quantity of +meat. Beef juice prepared in either of these ways is greatly to be +preferred to the beef extracts sold. + +_Mutton Broth._--One pound of finely chopped lean mutton, including +some of the bone, one pint cold water, pinch of salt. Cook for three +hours over a slow fire down to half a pint, adding water if necessary; +strain through muslin, and when cold carefully remove the fat, adding +more salt if required. It may be fed warm, or cold in the form of a +jelly. + +A very nutritious and delicious broth is made by thickening this with +cornstarch or arrowroot, cooking for ten minutes and then adding three +ounces of milk, or one ounce and a half of thin cream, to a half pint +of broth. + +_Chicken, Veal, and Beef Broths._--These are made and used in +precisely the same manner as mutton broth. + +_Meat Pulp._--A rare piece of round or sirloin steak, the outer part +having been cut away, is scraped or shredded with a knife; one +teaspoonful to one tablespoonful may be given, well salted, to a child +of eighteen months. Scraping is much better than cutting the meat +fine. + +For this on a large scale, as in institutions, a Hamburg-steak cutter +may be employed. + +_Junket, or Curds and Whey._--One pint of fresh cow's milk, warmed; +pinch of salt; a teaspoonful of granulated sugar; add two teaspoonfuls +of Fairchild's essence of pepsin, or liquid rennet, or one junket +tablet dissolved in water; stir for a moment, and then allow it to +stand at the temperature of the room for twenty minutes, or until +firmly coagulated; place in the ice box until thoroughly cold. For +older children this may be seasoned with grated nutmeg. + +_Whey._--The coagulated milk prepared as above is broken up with a +fork and the whey strained off through muslin. It is best given cold. +If some stimulant is desired, sherry wine in the proportion of one +part to twelve, or brandy one part to twenty-four, may be added. Whey +is useful in many cases of acute indigestion. + +_Barley Jelly from the Grains._--Three tablespoonfuls of pearl barley; +soak overnight, then place this in one quart of fresh water; add pinch +of salt, and cook in double boiler steadily for four hours down to one +pint, adding water from time to time; strain through muslin. When cold +this makes a rather thick jelly. If a thinner gruel (barley water) is +desired, one half the quantity of barley should be used. + +_Oat, Wheat, or Rice Jelly._--These are prepared from oatmeal, wheaten +grits, and rice grains in the same manner as the barley jelly. + +_Barley Jelly from the Flour._--Either Robinson's patent barley or +prepared barley flour of the Health Food Company may be used. One +rounded tablespoonful of the flour, thoroughly blended with a little +cold water, is added, stirring, to one pint of boiling water +containing a pinch of salt; cook for twenty minutes in a double +boiler, and strain. This makes a jelly of about the consistency of +that made from the grains as above. It is essentially the same in +composition, and much less trouble to prepare. A thinner gruel (barley +water) is made by using half the quantity of flour. + +When this is to be mixed with milk, it is well to add the milk to the +barley gruel before removing from the fire, and stir two or three +minutes, or until the milk has nearly reached the boiling point, when +it should be removed and bottled. + +_Oat or Wheat Jelly from the Flour._--These are made from the prepared +oat flour of the Health Food Company or Hubbell's prepared wheat +flour. They are used like the barley. + +_Imperial Granum._--This is prepared and used in precisely the same +way as the barley flour above mentioned, the gruel being mixed with +milk before it is removed from the fire. + +_Albumin Water._--The white of one fresh egg; half a pint of cold +water; pinch of salt; teaspoonful of brandy. This should be shaken +thoroughly and fed cold either with a spoon or from a bottle. It is +useful in cases of vomiting, and can sometimes be retained by a very +irritable stomach. + +_Lime-water._--One heaping teaspoonful of slaked lime; one quart +boiled or distilled water; place in a corked bottle and shake +thoroughly two or three times during the first hour. The lime should +then be allowed to settle, and after twenty-four hours the upper clear +fluid carefully poured or siphoned off for use. + +_Dried Bread._--Either stale or fresh bread may be used; it is cut in +thin slices and placed in the oven, with the door open, and quickly +dried until it is crisp, but not browned. It is in many respects +preferable to crackers for little children. + +_Coddled Egg._--A fresh egg, shell on, is placed in boiling water +which is immediately after removed from the fire. The egg then cooks +slowly in the water, which gradually cools, for seven or eight +minutes, when the white should be about the consistency of jelly. For +a delicate digestion the white only should be given, with salt; it can +be easily separated from the yolk. + + + + +PART IV + +MISCELLANEOUS + + +THE BOWELS + +_How many movements daily should an infant have during the first few +weeks of life?_ + +Usually two or three a day for the first week, and then one or two +each day. + +_How many after a child is a month old?_ + +A healthy child should have at least one movement each day; many have +two and some more than two; but it is the character of the stools +rather than their number which is to be taken as the evidence of +perfect digestion. + +_What is the appearance of a healthy movement of a child who is taking +nothing but milk?_ + +It is soft, yellow, and smooth, containing no lumps. + +_When are the stools dark brown or black?_ + +While taking bismuth, iron, and sometimes when taking much meat or +beef juice; also while taking many of the prepared foods. They may be +dark brown or black from blood. This last is a condition which may +indicate serious illness. + +_How may a child be trained to be regular in the action of its +bowels?_ + +By endeavouring to have them move at exactly the same time every day. + +_At what age may an infant be trained in this way?_ + +Usually by the second month if training is begun early. + +_What is the best method of training?_ + +A small chamber, about the size of a pint bowl, is placed between the +nurse's knees, and upon this the infant is held, its back being +against the nurse's chest and its body firmly supported. This should +be done twice a day, after the morning and afternoon feedings, and +always at the same hour. At first there may be necessary some local +irritation, like that produced by tickling the anus or introducing +just inside the rectum a small cone of oiled paper or a piece of soap, +as a suggestion of the purpose for which the baby is placed upon the +chamber; but in a surprisingly short time the position is all that is +required. With most infants, after a few weeks the bowels will move as +soon as the infant is placed on the chamber. + +_What advantage has such training?_ + +It forms the habit of having the bowels move regularly at the same +hour, which is a matter of great importance in infancy and makes +regularity in childhood much easier. It also saves the nurse much +trouble and labour. + + +SLEEP + +_Should a child sleep in the same bed with its mother or nurse?_ + +Under no circumstances, if this can possibly be avoided. Very young +infants have often been smothered by their mothers, by overlying +during sleep. If the infant sleeps with the mother, there is always +the temptation to frequent nursing at night, which is injurious to +both mother and child. Older children also should, if possible, have +separate beds; many contagious diseases and bad habits are contracted +by children sleeping together. + +_How should an infant's bed be prepared?_ + +The mattress should be firm but soft, the pillow very thin, and the +covering not excessive. A baby should not be allowed to sleep always +in the same position, but should be changed from side to side. Hair +pillows are useful in summer and for children who perspire very much. + +_How much sleep is natural for a newly born baby?_ + +A baby with a good digestion and proper food will usually sleep at +this period about nine tenths of the time. + +_How much should a baby sleep at six months?_ + +About two thirds of the time. + +_Up to what age should an older child take a nap during the day?_ + +Always until four years old, and if possible longer. + +_At what age may an infant go all night without feeding?_ + +At five months a child should not be fed or nursed between 10 P.M. and +6 A.M. At two years a child can easily go from 6 P.M. to 6 A.M. +without feeding. + +_How should a baby be put to sleep?_ + +The room should be darkened and quiet, the child's hunger satisfied, +and the child made generally comfortable and laid in its crib while +awake. + +_Is rocking necessary?_ + +By no means. It is a habit easily acquired, but hard to break, and a +very useless and sometimes injurious one. The same may be said of +sucking a rubber nipple, or "pacifier," and all other devices for +putting children to sleep. + +_What are the principal causes of disturbed sleep?_ + +As quiet peaceful sleep is a sign of perfect health, disorders of +sleep may be produced by almost anything which is wrong with the +child. + +1. Habitual disturbance of sleep in infants is most frequently +associated with the food or feeding. It may be from the discomfort of +chronic indigestion due to improper food. In bottle-fed infants it is +often the result of overfeeding; in those who are nursed it is often +due to hunger. A common cause is frequent night feeding; an infant who +is fed three or four times during the night is almost invariably a bad +sleeper. + +2. Disturbed sleep or sleeplessness may be due to causes purely +nervous. Such are bad habits acquired by faulty training; as when the +nursery is lighted and the child taken from its crib whenever it wakes +or cries; or when some of the contrivances for inducing sleep have +been used. Any excitement or romping play just before bedtime, and +fears aroused by pictures or stories, are frequent causes. Children +who inherit from their parents a nervous constitution are especially +likely to suffer thus. + +3. There may be physical discomfort from cold feet, insufficient or +too much clothing, or want of fresh air in the sleeping room. + +4. Interference with breathing due to obstruction from large tonsils +or adenoids. These cause great restlessness and lead a child to assume +many different postures during sleep, often lying upon the face or +upon the hands and knees. + +5. Chronic pains or frequently recurring night pains may be causes of +disordered sleep, when a child wakes with a sudden sharp cry. In +infants this is most often due to scurvy, sometimes to syphilis. In +older children it may be the earliest symptom of disease of the hip or +spine. + +6. Sleeplessness and disturbed sleep are frequent whenever the general +condition falls much below a healthy standard; e.g., in infants who +are not thriving and in children suffering from marked anaemia. + +_How are children who sleep too little, or whose sleep is constantly +disturbed, to be treated?_ + +Never by the use of soothing sirups or other medicines. Successful +treatment consists in the discovery and removal of the cause. + +_Do children ever sleep too much?_ + +It is doubtful if healthy children ever do. Excessive sleep is an +important symptom of some diseases of the brain. Otherwise it seldom +if ever occurs unless soothing sirups or other drugs have been given. + + +EXERCISE + +_Is exercise important for infants?_ + +It is as necessary for them as for older children. + +_How is it obtained?_ + +A young baby gets its exercise by screaming, waving its arms, kicking, +etc. The clothing should not be so tight as to make these movements +impossible. At least twice a day the infant should be allowed for +fifteen or twenty minutes the free use of its limbs by permitting it +to lie upon a bed in a warm room, with all clothing except the shirt, +stockings, and napkin removed. Later, when in short clothes, the baby +may be put upon a thick blanket or quilt laid upon the floor, and be +allowed to tumble about at will. A nursery fence two feet high, made +to surround a mattress, is an excellent device and makes a convenient +box stall for the young animal, where it can learn to use both its +arms and legs without the danger of injury. Only by exercise such as +this do the muscles have an opportunity to develop properly. + + +THE CRY + +_When is crying useful?_ + +In the newly born infant the cry expands the lungs, and it is +necessary that it should be repeated for a few minutes every day in +order to keep them well expanded. + +_How much crying is normal for a very young baby?_ + +From fifteen to thirty minutes a day is not too much. + +_What is the nature of this cry?_ + +It is loud and strong. Infants get red in the face with it; in fact, +it is a scream. This is necessary for health. It is the baby's +exercise. + +_When is a cry abnormal?_ + +When it is too long or too frequent. The abnormal cry is rarely +strong, often it is a moaning or a worrying cry, sometimes only a +feeble whine. + +_What are the causes of such crying?_ + +Pain, temper, hunger, illness, and habit. + +_What is the cry of pain?_ + +It is usually strong and sharp, but not generally continuous. It is +accompanied by contraction of the features, drawing up of the legs, +and other symptoms of distress. + +_What is the cry of hunger?_ + +It is usually a continuous, fretful cry, rarely strong and lusty. + +_What is the cry of temper?_ + +It is loud and strong and accompanied by kicking or stiffening of the +body, and is usually violent. + +_What is the cry of illness?_ + +There is usually more of fretfulness and moaning than real crying, +although crying is excited by very slight causes. + +_What is the cry of indulgence or from habit?_ + +This is often heard even in very young infants, who cry to be rocked, +to be carried about, sometimes for a light in the room, for a bottle +to suck, or for the continuance of any other bad habit which has been +acquired. + +_How can we be sure that a child is crying to be indulged?_ + +If it stops immediately when it gets what it wants, and cries when it +is withdrawn or withheld. + +_What should be done if a baby cries at night?_ + +One should get up and see that the child is comfortable--the clothing +smooth under the body, the hands and feet warm, and the napkin not wet +or soiled. If all these matters are properly adjusted and the child +simply crying to be taken up, it should not be further interfered +with. If the night cry is habitual some other cause should be sought +(see page 121). + +_How is an infant to be managed that cries from temper, habit, or to +be indulged?_ + +It should simply be allowed to "cry it out." This often requires an +hour, and in extreme cases, two or three hours. A second struggle will +seldom last more than ten or fifteen minutes, and a third will rarely +be necessary. Such discipline is not to be carried out unless one is +sure as to the cause of the habitual crying. + +_Is it likely that rupture will be caused from crying?_ + +Not in young infants if the abdominal band is properly applied, and +not after a year under any circumstances. + + +LIFTING CHILDREN + +_How should a young baby be lifted from its bed?_ + +The right hand should grasp the clothing below the feet, and the left +hand should be slipped beneath the infant's body to its head. It is +then raised upon the left arm. + +_What is the advantage of this?_ + +The entire spine is supported, and no undue pressure is made upon the +chest or abdomen, as often happens if the baby is grasped around the +body or under the arms. + +_How should a child old enough to run about be lifted?_ + +Always by placing the hands under the child's arms, and never by the +wrists. + +_What injury may be inflicted by lifting the child by the wrists or +hands?_ + +Often serious injury is done to the elbow or shoulder joints. + + +THE TEMPERATURE + +_What is the normal temperature of an infant?_ + +The normal temperature varies more than in adults. In the rectum it +usually fluctuates between 98 deg. and 99.5 deg. F.; a rectal temperature of +97.5 deg. F. or of 100.5 deg. F. is of no importance whatever unless it +continues. + +_Where should the temperature of infants and young children be taken?_ + +The rectum is altogether the best place, and next to this the groin. +The rectal temperature is from half a degree to a degree higher than +that in the groin. + +_How long should the thermometer be left in place to take the +temperature?_ + +Two minutes in the rectum, and five minutes in the groin. + +_Is the temperature of a young child a good guide as to the severity +of its symptoms in illness?_ + +As a rule it is. A temperature of 100 deg. to 102 deg. F. commonly means a mild +illness, and one of 104 deg. F. or over a serious one. The duration of the +fever is, however, even more important than the height of the +temperature. It should be remembered that in all young children slight +causes often produce a high temperature which lasts for a few hours; +one should not therefore be unduly alarmed unless the temperature +continues high, or is accompanied by other important signs of illness. + +_Is not a high temperature a more serious symptom in a young child +than in an adult?_ + +The opposite is rather the case. Young children are extremely +sensitive to conditions which produce fever, and the thermometer often +gives an exaggerated idea of the severity of the symptoms. A cause +which in an adult might produce a temperature of 102 deg. F. or 103 deg. F., +in a young child would very likely be accompanied by a temperature of +104 deg. or 105 deg. F. + + +NERVOUSNESS + +_What are the principal causes of excessive nervousness in infants and +young children, and what can be done to prevent this?_ + +The most important cause is the delicate structure of the brain at +this time, and its rapid growth. It grows as much during the first +year as during all the rest of life. This requires quiet and peaceful +surroundings. Infants who are naturally nervous should be left much +alone, should see but few people, should be played with very little, +and should never be quieted with soothing sirups or the "pacifier." + +_At what age may playing with babies be begun?_ + +Babies under six months old should never be played with; and the less +of it at any time the better for the infant. + +_What harm is done by playing with very young babies?_ + +They are made nervous and irritable, sleep badly and suffer from +indigestion and in many other respects. + +_When may young children be played with?_ + +If at all, in the morning, or after the midday nap; but never just +before bedtime. + + +TOYS + +_What points should guide one in selecting toys and playthings for an +infant?_ + +The instinct in a baby to put everything into the mouth is so strong +that nothing should be given that cannot be safely treated in this +way. Hence one should choose things which are smooth, those which can +be easily washed, and those which cannot be swallowed. + +One should avoid (1) toys with sharp points or corners; (2) those with +loose parts that might be detached or broken off and swallowed; (3) +small objects which might be swallowed or pushed into the nose or ear, +such as coins, marbles, and safety-pins, also beads and buttons unless +strung upon a stout cord; (4) painted toys; (5) those covered with +hair or wool. Infants have often been severely injured by swallowing +what they have pulled off from their small toy animals. + +_What points are to be considered in selecting the toys and playthings +of a child over two years old?_ + +It should be remembered that toys are not merely a source of +amusement, but that they have an educational value as well. Those are +therefore to be preferred the use of which develops the child's +imagination, and with which he can be taught to amuse himself. For +boys nothing can surpass blocks, toy soldiers, balls, engines, and +cars; and for girls, dolls and housekeeping sets. The complicated +mechanical toys now so much in vogue give only a momentary pleasure, +and as soon as the wonder at their operation has worn off, they have +lost interest for the child except that which he gets in breaking them +to see how the thing worked. + +_What important things can be taught children with their toys and how +may this be done?_ + +The imagination may be developed, and children may be trained to +habits of neatness, order and regularity and to concentration of mind. + +To this end toys should be kept in an orderly way upon a shelf in the +nursery or in a closet, never piled in a miscellaneous heap in the +corner of the room. Children should select their toys and play with +one thing at a time, which they should be taught to put away in its +place before another is given. They should never be allowed to have a +dozen things strewn about the room at one time, with none of which +they are occupied. + + +KISSING + +_Are there any valid objections to kissing infants?_ + +There are many serious objections. Tuberculosis, diphtheria, and many +other grave diseases may be communicated in this way. The kissing of +infants upon the mouth by other children, by nurses, or by people +generally, should under no circumstances be permitted. Infants should +be kissed, if at all, upon the cheek or forehead, but the less even of +this the better. + + +CONVULSIONS + +_What should be done for a child in convulsions before a doctor +arrives?_ + +Keep the child perfectly quiet with ice at the head, put the feet in a +mustard bath, and roll the entire body in large towels which have been +dipped in mustard water (two heaping tablespoonfuls of mustard to one +quart of tepid water), and have plenty of hot water and a bath tub at +hand, so that the doctor can give a hot bath if he thinks it +advisable. + +_When is a hot bath useful?_ + +If the convulsions have continued until the pulse is weak, the face +very pale, the nails and lips blue, and the feet and hands cold, the +hot bath will be useful by bringing blood to the surface and relieving +the heart, lungs, and brain. + +_How should the bath be given?_ + +The temperature should not be over 106 deg. F.; this should always be +tested by a thermometer if one can be obtained. Without this +precaution, in the excitement of the moment, infants have frequently +been put into baths so hot that serious and even fatal burns have been +produced. If no thermometer is available the nurse may plunge her arm +to the elbow into the water. It should feel warm, but not so hot as to +be at all uncomfortable. One half a teacupful of powdered mustard +added to the bath often adds to its efficacy. + + +FOREIGN BODIES + +_What should be done if a foreign body has been swallowed?_ + +First, examine the throat with the finger to see if it has lodged +there, and if so remove it. If it has passed from the throat it has +usually gone into the stomach. + +_What should be done in this case?_ + +Give the child plenty of dry food, like bread, potato, etc., but under +no circumstances either an emetic or cathartic. An infant may have its +usual food. + +_What harm would a cathartic do?_ + +It is likely to hurry the foreign body too rapidly through the +intestine and in this way do harm; otherwise it becomes coated with +fecal matter and passes the intestine usually without doing injury. + +_What should be done if a child gets a foreign body into the ear?_ + +Unless this can easily be removed with the fingers it should not be +meddled with, for it is likely to be pushed farther into the ear. The +child should be taken to a physician. + +_What should be done if there is a foreign body in the nose?_ + +The child should blow his nose strongly while the empty nostril is +compressed. Unless this removes it a physician should be called. +Meddlesome interference is always harmful. + + +COLIC + +_What are the symptoms of colic?_ + +There is a strong, hard cry, which comes suddenly and returns every +few minutes. With this there is drawing up of the feet, contraction of +the muscles of the face, and other signs of pain. The abdomen is +usually tense and hard. + +_What should be done for a baby with colic?_ + +First, see that the feet are warm. Place them against a hot-water bag, +or hold them before an open fire; apply a hot flannel to the abdomen, +or let the child lie upon its stomach across a hot-water bag. If the +colic continues, a half teacupful of warm water containing ten drops +of turpentine may be injected into the bowels with a syringe; at the +same time the abdomen should be gently rubbed so as to start the wind. +If the gas is in the stomach, half of a soda mint tablet may be given +in a tablespoonful of very warm water. + + +EARACHE + +_What are the symptoms of earache?_ + +The pain is generally severe and accompanied by a sharp scream; the +child often puts the hand to the affected ear, or cries whenever it is +touched. The pain is likely to be prolonged and continuous. + +_How should a child with earache be treated?_ + +The ear should be irrigated with a solution of boric acid (twenty +grains to the ounce) as warm as can be borne. Dry heat may then be +applied in several ways. The ear having been first covered with +cotton, a small hot-water bag or one filled with hot salt or bran, may +be bound over it with a bandage; or a small butter plate heated in hot +water may be used in the same way. The hot-water bag may be held +against the ear or the child may lie with his head upon it. The use of +such substances as oil and laudanum in the ear is not to be +recommended. + + +CROUP + +_What are the symptoms of croup?_ + +There is a hollow, dry, barking cough, with some difficulty in +breathing. + +_When is this likely to come on?_ + +Usually at night. + +_Is simple croup dangerous?_ + +The ordinary croup of infants is spasmodic croup, and is very rarely +dangerous, although the symptoms seem very alarming. + +_What are the symptoms?_ + +In a mild attack there is simply noisy breathing, especially on +drawing in the breath, with a tight, barking, or croupy cough. In a +severe attack the child's breathing is more noisy and becomes +difficult. + +_What is the dangerous form of croup?_ + +Membranous croup, which is the same thing as diphtheria of the larynx. + +_How does this develop?_ + +Gradually; very rarely does it come on suddenly. + +_What should be done for a baby who has spasmodic croup?_ + +The room should be very warm, hot cloths or poultices should be +applied over the throat, and either a croup kettle or an ordinary +tea-kettle kept boiling in the room. This is more efficacious if the +child is placed in a tent made by a raised umbrella with a sheet +thrown over it, and the steam introduced beneath the tent. If the +symptoms are urgent, ten drops of the sirup of ipecac should be given +every fifteen minutes until free vomiting occurs. Whenever the +symptoms reach a point where breathing becomes difficult, a doctor +should be summoned without delay. + + +CONTAGIOUS DISEASES + +_What are the first symptoms of measles?_ + +Measles comes on rather gradually with cough, sneezing, watery eyes +and nose, much like an ordinary cold in the head. The eruption appears +after three or four days, first upon the face and neck as small red +spots, and spreads slowly over the body. + +_Is measles a serious disease?_ + +In infants and during the winter season it is likely to be very +serious on account of the danger of bronchitis and pneumonia, which +frequently accompany it. In children over four years old it is +generally not severe. No child should be voluntarily exposed to this +disease, and particularly one who is delicate or prone to disease of +the lungs should be protected against it. + +_When and how is measles contagious?_ + +Measles may readily be conveyed from the very beginning of the +catarrh, two or three days before any eruption is present. It is not +often carried by healthy persons. Its poison does not cling long to a +sick room. + +_What is German measles?_ + +German measles, or rubella, is a distinct disease and has nothing to +do with ordinary measles. It is extremely rare for a child to be much +sick with it. There is usually a very extensive eruption which may +cover the body, but few other symptoms. + +_What are the first symptoms of scarlet fever?_ + +Generally it comes suddenly, with vomiting, high fever, and sore +throat. The eruption usually appears within twenty-four hours as a red +blush, first upon the neck and chest, and spreads rapidly. + +_When and how is scarlet fever contagious?_ + +Scarlet fever is only slightly contagious for the first one or two +days of the attack. It is most contagious at the height of the disease +and during desquamation. It may be carried by healthy persons and by +the clothing or bedding from the sick room. + +_How does whooping-cough begin?_ + +For a week or ten days it cannot be distinguished from an ordinary +cold on the chest. Then the attacks of coughing gradually become more +severe and vomiting may follow. After a severe coughing fit the breath +is caught with a peculiar noise known as the "whoop." + +_How does chicken-pox begin?_ + +It usually comes out gradually, as widely scattered pimples over the +scalp, face, and body, many of which soon become small vesicles, +resembling tiny blisters. There is itching and local discomfort but +little fever, and the child rarely seems to be very ill. + +_How does diphtheria begin?_ + +Sometimes suddenly, but usually gradually, with sore throat and +swelling of the glands of the neck, with white patches upon the +tonsils, or a free discharge which may be bloody, from the nostrils. + +_How does mumps begin?_ + +As a swelling upon the jaw, beneath the ear. As it increases it +extends forward upon the cheek and backward behind the ear. It affects +one or both sides. + +Mumps is not very common in young children, and in them it is usually +mild. After twelve or thirteen years it is likely to be more severe. + +_How long after exposure do the first symptoms appear in the different +diseases?_ + +In scarlet fever in from three to five days, rarely later than a week; +in measles in from nine to fourteen days, occasionally as late as +twenty days; in whooping-cough in from one to two weeks; in +chicken-pox in from fourteen to sixteen days; in German measles in +from ten to sixteen days. In diphtheria the time varies much; it may +be only one day, and it may be one or two weeks. In mumps it is +usually a little less than three weeks, the average being twenty days. + +_Which of these diseases are most contagious?_ + +Measles and chicken-pox are very contagious, and very few children who +have not had them can come near a person suffering from either disease +without taking it. Whooping-cough is almost as contagious as measles, +and for young babies even more so. A very close exposure is not +necessary in the case of either of these diseases, and whooping-cough +can undoubtedly be contracted in the open air. Scarlet fever and +diphtheria are much less contagious; for both of these a pretty close +exposure is necessary. + +_How long should a child with any of these diseases be kept away from +other children?_ + +With measles, for two weeks after the rash has gone; with scarlet +fever, for at least four weeks after the rash has gone, and longer if +the peeling is not over or if the ears are running; with +whooping-cough, for two months, or so long as the paroxysmal cough +continues; with chicken-pox, until all crusts have fallen off, or for +about three weeks after the eruption appears; with German measles for +one week after the eruption has faded; with diphtheria, at least ten +days after the throat is well in a very mild case, and four weeks if +the case has been severe; with mumps for one week after the swelling +has gone. + +_What should be done when a child shows the first symptoms of serious +illness?_ + +The child should be put to bed. If it is an infant the food should be +diluted to one half the usual strength; if an older child, only fluid +food should be given. If the child seems feverish, take the +temperature If the bowels are constipated, give a teaspoonful of +castor oil; but no other medicine without the doctor's orders. Send +for the doctor at once, and until he comes carefully exclude all other +children from the room. + +_By what nursery training may the examination and treatment of sick +children he made much easier?_ + +By teaching all children to gargle, to show the throat, to take pills, +and by constantly teaching them to regard the doctor as the child's +best friend, and his visits as a great treat. On no account should a +child be frightened into obedience by threats of what the doctor will +do. + +With care and patience most children may be taught to gargle and take +pills at four or five years, and to show the throat willingly at two +or three. All these matters should be made a part of the child's +education. + + +SCURVY + +_What is scurvy and how is it produced?_ + +Scurvy is a disease of general nutrition, usually caused by the +long-continued use of improper food. Most of the cases come from the +use of the prepared infant's foods sold in the stores, especially when +they are given without fresh milk; occasionally the use of condensed +milk and of sterilized milk is followed by scurvy; sometimes it is +seen when, owing to feeble digestion, it has been necessary to make +cow's milk very weak for a long time. + +_What symptoms are seen in an infant with scurvy?_ + +At first there is only indefinite and occasional soreness in the legs +so that the child cries out when handled. As this soreness becomes +more severe the child is often thought to have rheumatism. The gums +swell and are of a deep purple colour. There may be bleeding from the +gums, nose, bowels, or black-and-blue spots may be seen upon the legs. +The ankles and knees may swell. The child grows very pale, loses +appetite and weight, and sleeps badly. + +_What should be done when an infant shows signs of scurvy?_ + +The diet should at once be changed to fresh milk, properly modified +according to the child's digestion, but not sterilized or pasteurized. +The juice of a sweet orange should be given, best about an hour before +the feeding. At first one or two teaspoonfuls, four or five times a +day; later, more may be given if the symptoms are not improved. + +Properly treated an infant with scurvy generally recovers promptly and +completely. If not recognised, or untreated, it may cause death. + + +CONSTIPATION + +_When it is necessary to move the bowels immediately, what are some of +the easiest methods?_ + +An injection of one tablespoonful of sweet oil may be given, or half a +teaspoonful of glycerine in one tablespoonful of water, or a teacupful +of tepid soap and water, or a glycerine suppository. None of these +should be continued excepting under the physician's directions. + +_What sort of a syringe is to be preferred for giving an injection to +an infant?_ + +The bulb syringe is the simplest; this consists of an oval bulb of +soft rubber and a soft rubber or a hard rubber tip. It holds one or +two ounces. + +_What is the most essential thing in preventing or overcoming +constipation?_ + +The formation of the habit of having the bowels move every day +regularly at the same hour, and proper early training (see page 156). + +_What is the best hour?_ + +In most cases immediately after the first meal in the morning. + +_What are some simple means by which constipation may be relieved?_ + +The best are diet, suppositories, and massage. + +The changes to be made in the milk of constipated infants have been +mentioned on page 82. The addition to the milk of some of the malted +foods, such as Mellin's food or malted milk, is sometimes useful. For +little children the fruit juices are particularly beneficial when +given half an hour or more before the first morning feeding, with half +a glass of water. + +For older children the amount of white bread, toast, and potato, +should be reduced, and green vegetables oatmeal, and Graham bread +given, with plenty of fruit twice a day. Raw scraped apples are +sometimes of more value than any other fruit. + +The best suppositories for continuous use are probably the gluten +suppositories of the Health Food Company. One should be given the +first thing in the morning. They act rather slowly, usually in about +two hours. In obstinate cases one may also be used at bedtime. +Glycerine suppositories act more quickly, but are too irritating for +regular use. + +Massage consists in rubbing the abdomen, which may be done in one of +two ways: Beginning at the right groin, the hand is carried up to the +ribs, then across to the opposite side, then around to the left groin. +The abdomen is stroked gently at first, and afterward deeper pressure +used as the child becomes accustomed to it. The second method is by +rubbing the deeper parts with a circular movement--the fingers not +moving upon the skin--making a series of small circles, beginning at +the right groin and following the same course as described above. +Either method should be employed for six or eight minutes twice a day, +at almost any regular time, except soon after a meal. + + +DIARRHOEA + +_In case a child is taken with diarrhoea, what should be done?_ + +With a moderate looseness of the bowels in an older child, solid food +should be stopped, and boiled milk given diluted with gruel; the child +should be kept perfectly quiet, as walking about always aggravates +such a disturbance. If the symptoms are more severe and attended by +fever and vomiting, all milk should be stopped at once, and only +broth, barley water, or some thin gruel given. Some cathartic, usually +castor oil, is required with a severe attack. + +If the patient is an infant, the milk should be diluted and especially +should the fat be reduced (see page 76). In severe attacks with +vomiting or frequent foul stools, all food should be stopped for at +least twelve hours and all milk for a longer time, and the bowels +freely moved by a cathartic. + +_Why is a cathartic necessary if the movements are already frequent?_ + +Such movements are nearly always due to an irritation in the bowel, +set up by the fermenting food which has not been digested. The +diarrhoea is Nature's effort to get rid of the irritant. Nothing to +stop the movements should be given until the bowels have been +thoroughly cleared by the treatment mentioned. + + +BAD HABITS + +_What are the most common bad habits of young children?_ + +Sucking, nail-biting, dirt-eating, bed-wetting, and masturbation. + +_What do children suck?_ + +Most frequently the thumbs or fingers, sometimes the clothing or +blanket; often the "pacifier" or rubber nipple. + +_When is this habit most frequently seen?_ + +It begins in quite early infancy, and if not broken may last until +children are six or seven years old. + +_Is the sucking habit a harmful one?_ + +When persisted in it may produce a misshapen mouth or fingers. It +constantly stimulates the flow of saliva and certainly aggravates +disturbances of digestion during which the sucking habit is likely to +be practised. It may lead to thrush or other forms of infection of the +mouth. It is not necessary as a means of quieting a child, though it +may in some degree cover up the consequences of bad feeding or bad +training. On no account should the habit of sucking the "pacifier" be +allowed as a means of putting children to sleep, or of quieting them +while restless from dentition or indigestion. + +_How is the sucking habit to be controlled?_ + +One should be sure in the first place that the constant sucking of +fingers is not due to hunger from insufficient food. Sucking of the +hands may often be controlled by wearing mittens or fastening the +hands to the sides during sleep. In more obstinate cases it may be +necessary to confine the elbow by small pasteboard splints to prevent +the child from bending the arm so as to get the hand to the mouth. + +_When are nail-biting and dirt-eating seen, and how are they to be +controlled?_ + +These habits belong especially to children over three years old. They +are seen particularly in those who are excessively nervous or whose +general health is below par; sometimes in those who develop serious +nervous diseases later in life. Children with such tendencies should +be closely watched, and every means used to break up these habits +early. Dirt-eating is a morbid craving which is rarely seen in a +normal child. + +_At what age may a child generally be expected to go without wetting +the bed during the night?_ + +Usually at two and a half years, if it is taken up late in the +evening. Some children acquire control of the bladder at night when +two years old, and a few not until three years. After three years +habitual bed-wetting is abnormal. + +_How should a young child addicted to bed-wetting be managed?_ + +At three or four years of age, punishments are sometimes useful, +especially when it seems to depend more upon the child's indifference +than anything else. They are of no value in older children, rewards +being much more efficacious. In all cases one should give a child +plenty of milk and water early in the day, but no fluids after 4 P.M., +the supper being always of solid or semi-solid food. The child +should be taken up regularly at ten o'clock or thereabouts. It often +happens that the formation or continuance of the habit is due to the +child being in poor general condition, to some irritation in the +urine, or in the genital organs. Unless the simple means mentioned are +successful the child should be placed under the charge of a physician. + +_What is masturbation?_ + +It is the habit of rubbing the genital organs with the hands, with the +clothing, against the bed, or rubbing the thighs together. Sometimes +the child sits upon the floor, crosses its thighs tightly and rocks +backward and forward. Many of these things are passed over lightly and +are regarded for months as simply a "queer trick" of the child. It may +be seen at any age, even in those not more than a year old, and in +both sexes. + +_How should such a child be treated?_ + +Masturbation is the most injurious of all the bad habits, and should +be broken up just as early as possible. Children should especially be +watched at the time of going to sleep and on first waking. Punishments +and mechanical restraint are of little avail except with infants. With +older children they usually make matters worse. Rewards are much more +efficacious. It is of the utmost importance to watch the child +closely, to keep his confidence, and by all possible means to teach +self-control. + +Some local cause of irritation is often present, which can be removed. +Medical advice should at once be sought. + + +VACCINATION + +_Nowadays when small-pox occurs so seldom is it necessary to have +every child vaccinated?_ + +It should by all means be done. It is only by the practice of general +vaccination that small-pox is kept down. In countries or in +communities where vaccination is neglected, frightful outbreaks of +small-pox occur every now and then just as in olden times. + +_What is the best time for vaccination?_ + +The time usually selected is from the third to the sixth month. It may +be deferred in a very delicate child who is not likely to be exposed +to small-pox, or in a child suffering from any form of skin disease. + +_Which is preferable for vaccination, the arm or the leg?_ + +The part which can be most easily protected and kept at rest is to be +chosen. In infants who do not yet walk or creep, the leg is to be +preferred? in older children, in most circumstances, the arm. If older +children are vaccinated on the leg, they should not be allowed to walk +much while the vaccination is active. + +_When should vaccination be repeated?_ + +An unsuccessful vaccination proves nothing and should be repeated in +two or three weeks. If success fully vaccinated in infancy, a child +should invariably be revaccinated before puberty. If exposed or likely +to be exposed to small-pox at any time vaccination should be repeated. + +[Illustration: Weight chart for the first year; the curved line +indicates the average rate of gain.] + +[Illustration: Weight chart, one to fourteen years. The upper line +indicates the average for boys; the lower (dotted) line that for +girls.] + + + + + +End of Project Gutenberg's The Care and Feeding of Children, by L. 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