What to eat and when

To sterilize the milk it should be heated to 212 F., that temperature being maintained for ten minutes or longer.

Many physicians consider pasteurization the better process. In this the milk is heated to from 150 to 165 F. and kept at that temperature for from twenty to thirty minutes. Boiling produces chemical changes, such as converting the milk-sugar into caramel, etc., while pasteurizing does not.

After pasteurization or sterilization, the milk should be quickly cooled to a temperature of 40 F. or lower and kept, until used, in bottles corked with non-absorbent cotton.

Sterilized or pasteurized milk does not keep as well as raw milk probably on account of the change in the ferments which destroy bacteria; therefore the baby’s milk should be pasteurized fresh every day.

Freeman’s pasteurizer is a very satisfactory and simple device. It consists of a metal pail into which is fitted a rack with a separate cylinder for each bottle. This holds just enough cold water to surround the bottle and keep it from cracking through a sudden change of temperature. The pail, containing a certain amount of water, is placed on the stove, the water is heated to the boiling point, the pail being then removed. The rack of bottles containing the milk preparation, with corks of non-absorbent cotton, is placed in it and the lid applied. The apparatus is placed away from a direct current of air for about forty-five minutes.

As the water in the pail cools, the milk in the bottles grows warm until both are at the same temperature. After forty-five minutes, cold water is turned into the pail to cool the bottles rapidly. They are then kept on ice until again warmed ready for use.

This is the simplest and best way to pasteurize milk and the expense is small.

Improvised apparatus may be used, but it requires much more labor and is not as satisfactory.

All milk should be sterilized or pasteurized before being used as a food for infants.

The following table shows an analysis of milks and infant foods helpful in the selection of a food to supply deficiencies indicated by a chemical analysis of the infant.

COMPARATIVE ANALYSIS OF MILKS AND INFANT FOODS (COMPILED)

(Percentage of Composition of the Dry Substance)

The following table from Holt shows at a glance the comparative average composition of human and cow’s milk:

HUMAN AND COW’S MILK COMPARED

Barley, rice, oatmeal, corn meal and soy-bean flour are generally used. If the grains of the cereals are used, they must be cooked from three to four hours.

As a rule, cereal gruels are made by cooking the flour and water for from fifteen to twenty minutes. Two ounces to the quart is about as strong as plain gruels can be made.

Dextrinized gruels may be made as high as eight ounces to the quart. Four level tablespoonfuls of the cereal flour weigh one ounce.

As the soy bean contains no starch, it does not thicken when cooking.

About 1 level tablespoonful to 3 ounces of soy-bean flour are used to the quart. One or 2 tablespoonfuls of barley, oat, or wheat gruel may be added before cooking to increase the nutritive value. One ounce of soy-bean flour, or 2 ounces of barley flour, to 1 quart of water makes a very good standard gruel. It contains 2 per cent. protein, 0.6 per cent. fat, 5.1 per cent. carbohydrates, giving a food value of ten calories per ounce, just one-half the value of milk. In certain forms of intestinal trouble in which cow’s milk is not assimilated, this gruel is valuable used with condensed milk.

Malted gruels are made by adding 1 teaspoonful of good malt extract or diastase to a cereal gruel after it has been cooled. It should be stirred in very thoroughly.

In artificial feeding “spitting” is usually an annoying symptom that does not indicate anything more serious than an overloaded stomach. This condition is usually relieved by lengthening the feeding intervals to four hours.

On the other hand, vomiting usually indicates something more serious in a bottle-fed baby, especially if it is very persistent. It is usually a sign that cow’s milk, or the preparation of it, is not agreeing with the infant. It also indicates a digestive disturbance that should be treated only by the physician, who will probably change the formula.

Occasional vomiting is sometimes due to too rich food and too frequent feeding. Lengthening the feeding hours and decreasing the amount of fat in the mixture will usually eliminate the trouble.

This is the most common of all of baby’s troubles. It is often due to too rapid feeding either from the breast or bottle, and when there is a tendency to colic, the feeding should be slower. The baby should not be fed while it is suffering from colic, even though it seems that the drinking of warm milk relieves it temporarily. Hot water should be given every half-hour or hour until relieved. If the baby seems cold, hot water slightly sweetened, and a hot bath, should be given at once. A hot-water bottle may be placed near it as well.

In colic there is severe pain in the abdomen, which is swollen and hard. Sudden and violent crying is usually a symptom of colic, which often ceases very suddenly after the emission of gas from the mouth or bowels.

If the baby seems exhausted, the physician should be summoned at once, but these suggestions may be helpful until the physician arrives.

When colic is very frequent in a bottle-fed baby, the food should be modified.

The character of the stools depends primarily on the composition of the food. They are varied according to the digestive powers of the infant, and according to the amount and rapidity of absorption of the products of digestion. The amount of absorption depends to a considerable extent on the rapidity with which the contents pass through the intestinal tract.

The nature of the food, of course, influences the character of the stools. The examination of the stools is of the greatest aid in determining whether or not any given food element is properly digested and assimilated, and, in many diseased conditions, in telling what element is at fault. This, however, can only be determined by analysis, but a little information on this subject will be of value to the mother or nurse.

During the first few weeks or months of life, the breast-fed infant has three or four stools daily. These are of about the consistency of thick pea soup and are golden yellow. The number of stools gradually diminishes to two or three in the twenty-four hours, and the consistency becomes more salve-like.

It is not uncommon for thriving breast-fed babies to have a large number of stools of diminished consistency and of a brownish color; in such instances, the examination of the breast milk will show that the proteins are high.

It is best not to pay too much attention to the stools if the baby is gaining in weight and appears well. It is not unusual to find many soft fine curds and sometimes mucus in the stools of healthy breast-fed babies.

It is not only unnecessary, but decidedly wrong to wean a baby simply because the stools are abnormal, if it is doing well in other ways. The breast-fed infant will often go weeks or months without a normal stool and yet thrive perfectly. On the other hand, if a baby has such stools when it is taking cow’s milk it is a decided evidence of malnutrition.

Infants that are thriving on cow’s milk have, as a general rule, fewer movements in the twenty-four hours than do breast-fed babies and these movements are firmer in consistency.

Constipation seems to be the chief difficulty in artificial feeding, due usually to the poor absorption of fat, or the low percentage necessary to prevent indigestion. If the constipation is not severe, the substitution of oatmeal for barley water in the mixture will usually relieve the trouble.

If the constipation is severe, causing occasional attacks of colic or straining at stool, it is sometimes advisable to give a little higher percentage of fat in the mixture, but this should be done very cautiously and usually on the advice of the physician.

If, however, this does not relieve the trouble, the best plan is to substitute one of the dextrin-maltose mixtures for milk-sugar or cane-sugar. The malt itself is not especially laxative but it prevents the excessive fermentation which usually occurs when the bowels are very costive.

Two, three, or more green and loose evacuations, even though they may contain whitish particles of undigested fat, are of no great significance in the breast-fed infant, but should be regarded as danger signals in bottle-fed babies.

Even a mild attack of diarrhea is usually a symptom of fat-dyspepsia which, if taken in time, may usually be promptly checked.

A dose of castor-oil at the beginning of the attack may relieve any irritation that might have caused the trouble.

It is best to omit all food for at least twenty-four hours. Plain water should be given very freely and occasionally barley water, if the baby is hungry. After that it is best to start with a mixture low in fat. Skimmed milk or boiled milk free from all fat, diluted with cereal water, may be given at regular intervals.

Should slight diarrheal attacks continue, or should the stools be of a diarrheal character, the wisest plan is to substitute a dextrin-maltose mixture for the sugar, as malt decidedly favors fat absorption.

In almost every case of infantile diarrhea it is advisable to consult the physician, especially if there is considerable restlessness and rise in temperature.

Diarrhea is more frequent in summer among bottle-fed babies, as the heat often promotes the growth of germs in the milk. Therefore to sterilize or pasteurize milk during the heated months is especially necessary.

A chill, due to insufficient clothing, will sometimes cause diarrhea. The abdomen, arms, and legs should be kept warm by close-fitting garments of soft wool.

In treating anemia in infants, as in adults, the cause should be removed by correcting any errors in diet and treating any other physical deficiencies.

The cause of infantile anemia is an insufficient absorption of iron from the food.

The amount of iron in both human milk and cow’s milk is small and is insufficient for the needs of the growing infant. However, Nature has deposited enough iron in the liver of the new-born infant to last until it can digest foods which contain iron in sufficient amounts. The iron in human milk is apparently more easily retained than that in the milk of animals.

The iron content of human milk is dependent on the general condition of the mother. It is higher in healthy individuals and lower in those under par.

Anemia in infants is apt to become severe and often take on a pernicious form. A prolonged intestinal disturbance often brings on anemia, and not infrequently anemia is due to a deficiency of protein in the food.

The treatment consists largely of additions or changes in the diet, depending on the age of the infant. Purées of vegetables that contain much iron, such as spinach and carrots, and also fruit juices, are valuable and in proper proportions can be added to the diet after the age of six months. It is best that the physician decide on the advisability of this as it will depend on the general condition of the infant.

Rickets, a chronic impairment of nutrition, affects not only the bones, but all of the tissues of the body, particularly the nervous system. Artificial feeding is the chief cause of rickets on account of the poor absorption of fats, and often because of protein starvation.

Prepared foods, on account of their large percentage of starch and their lack of protein and butter-fat are frequently the cause of rickets.

In addition to its fuel value, milk-fat contains the elements which promote growth.

As previously stated, the infant requires a certain percentage of protein, fat, and mineral for the blood and tissue building and the growth of the bones. In artificial feeding, the preparations given are often deficient in these important elements.

Climate and poor hygienic surroundings sometimes cause rickets in breast-fed babies, probably on account of the lowered vitality of the mother and the child and consequently poor digestion and assimilation, but it is most frequently found in babies improperly fed.

Dr. Winfield S. Hall says:

Rickets is a chronic condition, while scurvy is an acute disease.

This difficulty is considered as entirely due to improper feeding and therefore must be overcome by a change of diet. Recovery is usually very rapid when the child is properly fed.

Pains and tenderness about the joints, particularly of the legs, are the usual symptoms, causing the baby to cry when it is lifted or moved about. The gums sometimes become swollen and bleed. In almost every case it is found that infants suffering from scurvy have been on a continuous diet of prepared foods like malted milk, condensed milk, or boiled milk which Dr. Hall terms “dead food,” presumably on account of a lack of the life-giving proteins and butter-fat.

When boiled milk has been used, the change should be made to pasteurized milk or raw milk if it can be secured clean and fresh. If prepared foods have been given, the amount should be greatly decreased and replaced by a cow’s-milk preparation in which a small percentage of the prepared food may be included, or, better still, omitted entirely, if a cow’s-milk preparation including a good substantial gruel will agree.

In scurvy, orange juice or other fruit juices should be given, from 1 to 4 ounces a day, according to the age. Orange juice is particularly valuable, 2 or 3 teaspoonfuls being given before each feeding.

A lack of fresh air often aids in producing scurvy.

After the baby has reached the age of one year, we often feel that it is not necessary to be so careful of its diet. However, the number of deaths due to digestive disturbances caused by improper feeding during the second year is significant.

After the child is a year old it should be given solid food very gradually to develop its digestive functions as well as its teeth. A soft-boiled egg or a little beef juice may be added to the diet. Until the appearance of the anterior molar teeth, however, the child’s diet should be confined largely to milk. A thin slice of buttered bread or a little plain rice or rice pudding, a soda cracker or bread crumbs in milk may be given. The year-old child may also begin to drink cow’s milk. One or two glasses a day may be given, until the child is at least 13 or 14 years old.

Good judgment should be used in feeding children, as habits and tastes are being formed, and whether they are normal or abnormal will depend on the kind of food given and when.

Four meals a day, at regular intervals, and nothing but water between these intervals, is considered the best plan.

Dry toast, zwieback, and crackers may be gradually added to the diet, also well-cooked cereals, like cream of wheat, rice, and oatmeal. The oatmeal should be strained the first few months it is given. Very little sugar should be added to the cereals, as children very quickly cultivate a desire for sweets, rejecting other more nourishing foods, and too much sugar is apt to disturb the digestion. It is best during the first few months that no sugar be added to cereals.

The amount of whole milk, or milk diluted with barley or oatmeal gruel, should be limited to one quart when the other foods are given.

Beef juice (from one to two ounces), mutton broth, chicken broth, and cereal broths may be given after the age of one year; not more than two ounces at first, gradually increasing in a few months’ time to four ounces. This is best given at the beginning of the noon feeding. These broths have little nutritive value, but usually stimulate the appetite for other foods.

The child must build muscle, bone, and sinew, and more protein is required as soon as he begins to walk. Milk, eggs, and cereals will furnish this. The heavier protein diet is best given at eighteen months to two years, in eggs, cooked soft. An egg may be given every other day, soft boiled for about two minutes, or coddled for four minutes. At the age of two years an egg may be given every day. These soft-cooked eggs are best when mixed with broken dry toast or broken whole wheat or Graham crackers, because if dry food is served with them they will be better masticated, hence more saliva be mixed with them.

The habit of thorough mastication should be cultivated at this period.

Oatmeal, thoroughly cooked, and shredded wheat, with cream and sugar, ripe fruit, bread and butter, milk, soft-cooked eggs (poached or boiled), constitute a rational diet at this age.

Bread is better broken in milk because the chewing movements mix the saliva with the milk and smaller curds are formed as the milk enters the stomach.

Custard may after two years be added to the diet, also baked or mashed potato, plain boiled macaroni, also a little butter on the potato, toast, or bread.

Also after the age of eighteen months, a small quantity of very lean meat, like scraped or chopped beef or lamb, or finely minced chicken, may be given once a day.

Also well-cooked and mashed vegetables like peas, spinach, carrots, and asparagus tips. For the first few months these should be strained.

Some fruit should also be given each day, orange juice, apple sauce, or the pulp of stewed prunes; the latter especially is valuable when the bowels are inclined to be constipated.

Tea, coffee, and cocoa are absolutely objectionable, and before the age of two years no kind of candy should be given.

One of the most important things to teach the child, when it is taking foods other than milk, is thorough mastication, not only to assist the proper growth of the teeth, but to prevent the digestive disturbances that invariably occur from the bolting of food, and children are especially liable to do this.

Dry toast and zwieback compel mastication and strengthen the gums. These should be given in the hand, a piece at mealtime and occasionally between meals, if the child seems hungry. The child will then gradually get into the habit of chewing other solid foods when they are given.

If the child is hungry between meals, he should be fed at a regular period, midway between breakfast and luncheon and between luncheon and the evening meal. The food should be dry (toast or a dry cracker) to induce thorough and slow mastication.

Many object to “piecing” between meals, but if this piecing be done at hours as regular as his meal hour, and the food be dry and well masticated, it will readily digest and will not interfere with his meals. The growing child needs more frequent meals than the adult. His stomach is not so large, he is active in outdoor exercise, and eliminates waste freely. He also requires much heat and energy. The active child at outdoor play uses almost as much energy as the laboring man.

Many mothers are in doubt as to whether the baby’s food should be salted. It is necessary to add a very little salt to the food for the baby; broths should be seasoned slightly and a pinch of salt added to potatoes and eggs. Cereals and vegetables are cooked in water to which a little salt has been added.

Experienced observers of children and their ailments and diseases have said that more babies are killed by overfeeding than by underfeeding. Especially in summer, when the child’s condition reflects that of the mother, too much food will cause indigestion, irritation of the stomach, and diarrhea.

Often the child is fretful because it is too warm or is thirsty. It will often be benefited by giving it less food and more water. This fretful mind affects the child’s digestion just as it affects the digestion of the mother.

If a healthy child refuses good, wholesome food because it wishes some other than what is offered it, it is not hungry and doesn’t need the food.

The growing child craves sweets, but a child should not be given candy whenever it wants it during the day. Candy or sugar is quickly converted into heat and is best eaten immediately following a meal. Sugar may be spread on bread for the four o’clock lunch or a little candy may be eaten at this time. Two or three pieces of candy an inch square are sufficient.