The Care and Feeding of Children / A Catechism for the Use of Mothers and Children's Nurses

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 anæmic 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 anæmia 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° 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° or 65° F. To be really effective a refrigerator should have a temperature where the milk is placed of not over 50° 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.

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—3½ 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—5½ 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.

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

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.

These formulas written out would be as follows:

First Series

Formulas for the Early Months from 10-per-cent Milk

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:

Second Series

Formulas for the Early Months from 7-per-cent Milk

The approximate composition of these formulas expressed in percentages is as follows:

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 3½ ounces; from 4 ounces to 4½ 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 ounces of any formula add one half more of each ingredient.
35 ounces of any formula add three quarters more of each ingredient.
40 ounces of any formula add twice as much more of each ingredient.

Thus 25 ounces of Formula I would be obtained by using 2½ ounces of milk, 1¼ ounces of sugar and lime-water, 21¼ ounces of water; 30 ounces of the same would require 3 ounces milk, 1½ ounces lime-water and sugar, and 25½ ounces water; 35 ounces would require 3½ ounces milk, 1¾ ounces lime-water and sugar, and 29¾ 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 Early Months from 7-per-cent Milk

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.