PART III CARE OF CHILDREN (Part 2)

overcome in part if the hole in the nipple is made very small, or if a bit of Sanitary ., . . , . , and other sponge or absorbent cotton is placed in the top so precauti oris that the baby will have to pull with some effort and digestion^ will get the milk by the drop instead of in a steady J^0™8' stream. If this device is used great care must be taken to keep the sponge clean. It must be thoroughly washed each time, and often replaced. The absorb- ent cotton is safer because it is thrown away each time. His feeding ought to last twenty minutes, and with the ordinary nursing bottle he will generally take the Twenty necessary amount in half the time, while the breasts the baby's secrete enough between feedings so that it will require time1"8 that amount of time for a baby to empty them. PREPARED FOODS There is no question about the superiority of cows' milk over the various prepared foods. The difference in price should not be considered, because it will be The paid back many times over in the increased strength of foods'"6 the child. The preparations made on so large a scale l*^iormh lack uniformity, and deviate somewhat from year to year. The percentage of sugars and fats is estimated 304 CARE OF CHILDREN on the product as put on the market, but after dilution for the infant's feeding, there is great danger that there may not be the proper amount of nutriment for his needs. At all events, a scientific preparation of cows' Scientific milk with regard to the age, digestion and develop- tionof ment.of a child must of necessity be a superior food, better food and the home modification as well furnishes a better quality of nutriment. It is too often a question of the ease of preparation which is responsible for the choice of one of the patent foods as a substitute for mother's . milk. The number of these foods on the market is almost beyond conception. It is very difficult to choose be- tween them, and quite impossible to make any state- ment that a baby will thrive on one and will not on another. If it is impossible to get good herd's milk, if the or if for some reason its use is not practicable, one foods must of these preparations must be tried, and it is far better be used tQ fegfa suc\l experimenting while part of the nourish- ment still comes from the mother. Condensed milk is advocated by many authorities, and in many cases it seems to be an ideal food. Its its care preparation, with boiled water, is simple, and it is easy to obtain and to preserve, which makes it especially valuable in summer. If it is used, the can should never be left exposed to the air, but should be kept in the ice-box or a cool place, with a tightly fitting cover over it. In the process of condensing one of the important Loss in constituents of the milk is lost. This is concerned in the which formation of bone tissue, and is one cause for rickets bonkeetissue m babies who are fed exclusively on it. For this rea- son, the question arises as to whether it is well for the baby to be kept altogether on this food. It also seems sometimes as if a condensed milk baby had less re- Condensed milk and INFANT FEEDING 305 sistance and succumbed to illness more easily than one fed upon cows' milk. POINTS TO BE NOTED If a baby has to be brought up on a bottle, and the first food chosen does not seem to provide proper nour- ishment, experiments will have to be tried, and this must be done with no nervous agitation as to imme- diate results. The greatest care should always be taken with the bottles, nipples, and utensils generally, which are used Sanitary in preparing the food, and then the chances of trouble bottles, during hot weather will be lessened by half. If thiSandPeS' is done the difficulties are being narrowed down to the utensils combination that the child needs, and intelligent re- gard to the indications of trouble will help in the choice. If the baby vomits and the milk is curdled and sour, what sour it probably means that the acid needs to be correct- ^°™lting ed, and an addition of lime-water is made to the food, indicate or a teaspoon of it is given just before each feeding. Sour vomiting may also indicate too much fat. If he does not gain in weight, but seems well, the percentage of sugar and fat may need to be increased. What other If, on the other hand, with the lack of gain, the flesh may indi- seems soft and flabby, if he is fretful, and if the move- cate ments of the bowels show undigested curds of milk, the tissue-building properties are not being taken into the system properly, and the stomach is not able to manage its share of the digestion. This means that further dilution or a predigestion of the milk may be necessary, though the latter should not be long-con- tinued, since if the organs of digestion are not given enough to do they do not develop properly. The distinction between vomiting and regurgita- tion should be remembered. When the stomach is 306 CARE OF CHILDREN Distinction filled too full, it literally runs over, which is quite a vomiting different matter from the throwing out of food that gintat[ofUr" has been actecl uPon b>' the digestive fluids. Milk which is regurgitated is unchanged in odor and ap- pearance, and is thrown up very shortly after a feed- ing. The temperature of the food makes a difference in ufrToTthe t^ie ease °^ digestion. It should be about body heat, baby's food between 98° and 99° F., and should be brought to Never put the nipple of the baby's bottle in your mouth Stomach of Infant Five Days Old (Natural Size) that point by putting the bottle into hot water. It is easily tested by allowing the milk to trickle over the hand. The nipple should never be put into the mouth of the mother or nurse. It is, in the first place, taking an unfair advantage of the helpless baby to subject him to treatment that a grown-up person would resent; and there is besides the more serious ill — the danger of communicating the germs of disease. A baby is very susceptible, and a mild disorder in the adult may be re- produced as an acute condition in the child. The gums and teeth are rarely in a state of absolute cleanliness, INFANT FEEDING 307 and it is impossible not to transfer micro-organisms if the nipple is not thoroughly washed. It is rather important that the size of a baby's stomach should be taken into consideration when the amount of the feeding is being decided upon. At birth the capacity is from five-sixths to one ounce ; at the end of the first month it has increased to two and a half ounces ; twenty weeks finds it holding three ounces and six-tenths, and at the end of the year it holds eight ounces. These dimensions should be kept in mind in feeding a bottle baby, for the tendency is always toward over- feeding. It requires about an hour to digest the milk, so the two-hour interval gives the stomach sufficient time for digestion and for rest be- tween feedings. The subject of feeding in disease will be taken up in a later chapter. A baby will generally lose in weight for the first five days or a week after birth. Then he should average a gain of a quarter of a pound a week, for five or six months. The more a child weighs at first, the more he loses as a rule, a seven-pound baby often holding his own when one of ten pounds will drop to seven. Steady decrease in weight after the first week means a lack in nourishment. For this reason the advice of some authorities, that the amount of a baby's feedings should be what he can and will take, may be accepted with limitations. If he is overfed, the surplus will flow back — regurgitate, to be sure; but first it will Sizes of the baby's stomach Tendency to over- feeding Glass Cylinder Showing the Capacity of the Stomach What the baby's gain in weight should be What de- crease in weight means 308 CARE OF CHILDREN distend the stomach and cause uncomfortable feelings, which will be strenuously resented. This is not de- sirable, and it seems better to plan a Schedule for the first week Between the first and sixth week From six weeks to ten months SCHEDULE FOR FEEDING A definite schedule allows us to approximate the amounts given as the changes are made from week to week. In general, then, for the first week, a baby should be fed every two hours, an ounce — two tablespoons at a feeding. There should be ten of these feedings given during the twenty-four hours, and the whole amount taken in that time should be ten ounces. Between the first and sixth weeks the intervals may be lengthened to two and one-half hours, and the amount is then gradually increased to two ounces. This brings up the total to from twelve to sixteen ounces, and there need be only nine feedings in the twenty-four hours. From six weeks to ten months, the baby will need nourishment every three hours, but the amounts of the feedings increase, and the number decreases, till from four ounces we have come to eight, and we are giving only five instead of seven in the twenty-four hours. This means that the night is entirely unbroken, from six to six, or whatever hour may be chosen for the morning meal. To sum up, then, we may represent it all by the following schedule : Age Intervals 2 hours 2% " 3 " 3 " 3 " 3 " No. IN 24 hour; 10 9 to 8 7 to 6 6 6 5 Amount at each feed Amount in 24 hours i week i to 6 weeks 6 to 12 " 5 months 6 " io " 1 ounce i}£ to 2 ounces 3 to 4 5 6 8 10 ounces 12 to 16 " 21 to 24 " 30 36 40 . INFANT FEEDING 309 It must be understood that this is not absolute. Some authorities advocate giving the baby two ounces Variations for his first feeding, and some vary the total amounts guide or the intervals in such a way that the results are slightly different, but this is reliable for a guide, and that is all one needs. Observation will teach one what the deficiencies are. Proper treatment of a child requires above all cool judgment, rational thought, and the intention of fair Proper play. Emergencies that arise are often alarming only of a child because they are not met with the good sense of a J2J-SS? steadv brain, and if the reason that is required in all thought * and j usl other problems of life were used with regard to the puzzles in feeding, in hygiene, and in physical and moral training which come up during the life of a child, we should have men and women in the coming generations who would be more evenly developed physically and nervously and who would have a saner outlook upon life in general. MEASURES FOR THE HOUSEHOLD i teaspoon about a dram i tablespoon about half an ounce i wineglass about two ounces i teacup about four ounces i coffee-cup or i drinking glass . . about eight ounces rational t tice II DIETARIES Digestion— Needs of the Child— Diet Lists from Eleven Months to Three Years and a Half— Sweets for Children— Family Breakfast- Family Dinner— Supper— The Child at Table The ali- mentary canal T DIGESTION HE digestive apparatus consists of a long tube of varying shape and size, which passes through the body, the entrance being the mouth and the exit the rectum. There is no direct communication be- tween this tube and the rest of the body, though there are intimate relations through the blood-stream which gathers its nourishment from the food after it has been chemically treated in this natural laboratory. In the feeding of both children and., adults, better results can be attained if there is a little recognition of the processes that are going on in the digestive tract. The digestion of foods means the reducing of them by the action of the digestive fluids into such a con- foodmeans dition that the nutrient substances they contain may be taken up by the blood-stream, and thus distributed to the various tissues of the body. Digestion begins in the mouth, and is assisted by Digestion a chemical substance contained in the saliva, and by the the mouth mechanical act of grinding, by the teeth and turning over and over by the tongue and cheeks. In this way the food is reduced to a pulp and thoroughly exposed to the action of this digestive fluid. The chemical action of the saliva is upon the starches, which that fluid converts into sugar and puts into soluble form. (310) What di DIETARIES 311 Such substances as bread, cereals, and potatoes then need to be thoroughly masticated in order that their digestion may be begun. In the stomach, which is the next portion of the What part tube, the gullet being simply the passage into it, the f00d the starches undergo no change, but it is such foods as ^"^ milk, lean meat, and white of egg which are treated uP°n by the gastric fluid. The fats and the starches which have escaped the action of the saliva, together with whatever the What 1 1,,- i work the stomach has not acted upon, are thoroughly digested intestinal in the intestines, where also most of the absorption 3^°° takes place. The residue — the waste matter which Phshes is of no service to the system — passes along and is thrown out in the daily evacuation from the bowels. NEEDS OF THE CHILD As long as the digestion of a little child is normal it is unwise to give it any amount of starches to dis- pose of. They will pass on to the intestines entirely unchanged, and it is better to put more of the work upon the stomach. Milk contains all the constituents needed by the Do not tissues, and does not require any digestion in the fhiM solid mouth. When this is understood it is readily seen food until how absolutely unwise it is to give a child solid food teeth to until he has a sufficient number of teeth to masticate STfooV properly. Bread and potato can be made soft enough for a baby to swallow long before he has teeth, but to give them before he can chew means that they hardly come into contact with the saliva at all. There may be some action, because the chemical which saliva contains is very powerful, but Nature's pro- visions are generally to be trusted, and when the 312 CARE OF CHILDREN system needs the varied dietary, the teeth, the mechanical aids to digestion, will be ready. In illness it sometimes becomes necessary for the When ill- stomach to be temporarily relieved of its work, and change then we are glad to know what to eliminate from the of diet diet in order to throw the task of digestion upon the intestines alone. As long as a child is nursing, up to the tenth month at least, there is no need of variation in diet, provided the health remains good. If he is a breast- fed baby he has already begun to have at least part of his feedings from outside sources, so that his food is not all of exactly the same quality. After the tenth month he can be given broths or Proper beef-juice occasionally, and by the time he is a year aro IT °^ ^e can ^ave °lu^e a ^ew changes from the regular food for milk diet. Between the eleventh and twelfth months after he he should be weaned from the bottle by being given months old 'it only for the first and last meals. He should on no account be nursed from the breast after he is a year old. The mother's milk is no longer suitable food, and will not supply him with the constituents needed by the blood for the building up of the tissues. The bones should be growing firmer, so that the weight of the body can be borne, and the necessary material for this work can be better supplied by other foods. The quality of the blood also becomes impoverished if the mother's milk is the only food. There may be exceptional cases where the milk remains rich and abundant enough, but as a rule the mother's system is depleted by the long strain, and the milk is poorer in quantity and quality. Changes in a child's diet should be made very slowly, and he should be watched carefully after each change, to see if it agrees with him. One addi- DIETARIES 313 tion only should be made at a time. If the mother Changes in has decided to introduce broth into his bill of fare, should be she should substitute a portion of that for one of °nt;n** the milk feedings and let that suffice for the first day, unless the occasion is one of illness, when it is neces- sary to eliminate the milk. She can then observe the effect of the change on the child, and regulate the next feedings accord- The 1mo,tJ" & & er should inglv. It must be remembered, too, in giving broths, watch