“The mother is the natural guardian of her child; no other influence can compare with hers in its value in safeguarding infant life.”—Sir Arthur Newsholme.

Before undertaking the care of the new baby, suppose we stop for a moment, and consider just what he represents; what he has been through; what struggles and dangers are ahead of him; what are the weaknesses of his equipment to meet these perils and what must be the character of your service to him if you are to do quite all in your power to help him safely over this hazardous period of early infancy.

At the time of birth, the baby makes the most complete and abrupt change in his surroundings and condition that he will make during his entire lifetime.

For nine months he has existed under ideal conditions; he has been safeguarded from injury; kept at the temperature which was best for him, and above all, has been furnished with exactly the proper amount and character of nourishment necessary for his growth and development. Suddenly he emerges from this completely protecting environment into a more or less hostile world, where he must assume the task of living, with a frail little body that in many respects is only imperfectly developed. And yet the baby must not only continue the bodily functions and activities that were begun during his intra-uterine life, but must develop certain functions which were imperfect and even establish others which were performed for him.

You will recall that while within the uterus, the baby received his nourishment and oxygen and gave up waste material through the placenta. Accordingly, his organs of digestion, respiration and excretion are imperfectly developed at birth and are capable of functioning only within very narrow limits at first.

His respirations are usually established immediately after birth, when he cries vigorously, for his lungs are thereby filled with air. The other functions are established more gradually and the care of the baby must be such that the immature, unused organs will have their development promoted through activity and yet not be overtaxed.

The Baby’s Condition at Birth. The newborn baby boy weighs from seven and a quarter to seven and a half pounds and is about twenty inches long, girl babies being perhaps a little smaller. His body is well rounded and his flesh firm. The skin is a deep pink, or even red, and is covered with the cheesy substance called vernix caseosa, which is likely to be thickly deposited over the back and in folds of the skin and creases, as in the thighs and under the arms. Some babies still have, when born, the fine downy hair on parts or all of the body, that they had before birth.

The head and abdomen are relatively large, the chest narrow and the limbs short. The legs are so markedly bowed that the soles of the baby’s feet may nearly or quite face each other, but they finally assume a normal position. The bones are still soft and the entire body is, therefore, very flexible. Some of the bones which unite later in life and make the adult skeleton firm and rigid, are separate at birth.

Most newborn babies have faded blue eyes, the permanent color appearing gradually, but the amount and color of the hair varies greatly, some babies being bald, while others have abundant hair from the beginning.

The shape of the baby’s head is often badly distorted at birth, being so long from chin to crown that the mother is deeply concerned. But you may rest quite assured that even though badly misshapen, your baby’s head in the course of a few days will assume the lovely, rounded contour so characteristic of babyhood. The temporary deformity of the head is caused by a molding and overlapping of the bones of the skull as it is forced through the narrow part of the pelvis, the inlet, that we learned about in Chapter III. About the middle of the top of the head you will be able to feel a soft, diamond shaped spot and farther back another soft spot, smaller than the one in front and somewhat triangular in its outline. These soft places are openings between the bones of the skull and are called the anterior and posterior fontanelles. They always may be felt on the new baby’s head.

Growth and Development. The physical progress which is made during the first year by average, normal babies who are satisfactorily nourished and cared for is fairly uniform and the average rate of this progress is somewhat as follows:

Weight. There is a loss in weight of 6 to 10 ounces during the first week of life, after which the baby usually gains from 4 to 8 ounces each week, during the first five months. From this time the gain is only about half as rapid, or at the rate of 2 to 4 ounces weekly. At six months, therefore, the average baby weighs from 15 to 16 pounds, or double the normal birth weight of 7½ pounds, and at twelve months he weighs from 20 to 22 pounds, or three times the average birth weight. Fig. 41 gives an idea of how the baby’s weight drops during the first week and the rate of the normal weekly gain afterwards, during the first year.

The weight is perhaps the most valuable single index to the baby’s condition that we have, but at the same time it must be remembered that a baby whose food contains an excess of sugar or starch may be of normal weight, or over, but be incompletely nourished and very susceptible to infection, while other babies who are small and gain slowly are sometimes very well and vigorous. Moreover, quite commonly there are periods in the lives of entirely normal babies during which there is little or no gain in weight. This may occur during the period from the seventh to the tenth month, for example, or in very warm weather. But the doctor is likely to want to watch the baby’s weight, for when studied in conjunction with other conditions it gives a certain amount of information about the baby’s general state and progress.

Height. The height of the average baby at birth is about 20 inches, though boys may measure a little more and girls a little less; at six months it is about 25 inches and 28 or 29 inches at the end of a year.

Head and Chest. The circumferences of the head and chest are about the same at birth, the chest being possibly a little the smaller of the two. Both measure about 13½ inches, gradually increasing to about 16½ inches in six months and to 18 inches by the end of the first year.

Fontanelles. The posterior fontanelle, the one at the crown of the head, usually closes in six or eight weeks but the larger, anterior fontanelle is not entirely closed until the baby is about eighteen or twenty months old.

Teeth. Although it occasionally happens that a baby has one or two teeth at birth, the average infant has none until the sixth or seventh month, when the two lower, central incisors appear. After a pause of a few weeks the two upper, central incisors come through, followed by the two lateral incisors in the upper jaw. At the end of the first year, therefore, the average baby has six teeth, or eight if the lower lateral incisors have appeared by the first birthday, as they sometimes do. This is the usual course of dentition, during the first year, as shown in Fig. 42, but there are wide variations among entirely well and normal babies, the first tooth sometimes not appearing before the tenth, eleventh or even twelfth month. As a rule, however, an entire lack of teeth by the time the baby is a year old is regarded as an evidence of faulty nutrition.

The baby who is properly fed and cared for, cuts his teeth with little or no trouble, in spite of the widely current but seriously mistaken belief that a teething baby is a sick baby. We have no way of estimating the number of babies who die, needlessly, as a result of this dangerous conviction, for if the baby is sick while teething, the trouble is all too often accepted as a normal occurrence and is not given the attention it needs until too late. Frail, delicate babies may have convulsions each time that a tooth is cut and if a baby is having digestive trouble, this is likely to grow worse while he is teething. But cutting teeth is a normal process and the healthy, properly fed baby suffers little or no inconvenience while it is in progress.

Stools and Urine. During the first two or three days the stools are of dark green, tarry material called meconium. In the course of two or three days they begin to grow lighter and shortly the normal stools appear, these being bright yellow in color, of a smooth, pasty consistency and having a characteristic odor. During the first month or six weeks the baby’s bowels may move three or four times daily, but after this they usually move but once or twice in the course of twenty-four hours. As the nourishment is increased, the stools grow somewhat darker and firmer and finally become formed.

The newborn baby’s bladder usually contains urine and this may be passed immediately after birth or not until several hours later. After the first urination the bladder may be emptied five or six times a day or oftener.

The Cord. Within a few days after birth the stump of the umbilical cord that is attached to the baby’s navel, begins to shrivel and turn black and a red line appears where the cord joins the abdomen. By the eighth or tenth day, as a rule, the cord has shrunken to a dry, black string, when it drops off and leaves an ulcer or small red area which heals entirely in the course of a few days. Figs. 43, 44, 45 and 46 show these progressive changes.

Skin. The soft, downy hair that may be remaining on the surface of the body usually disappears by the end of the first week and there is often a scaling of the skin which lasts for two or three weeks, while a delicate pink tint replaces the deeper color of the skin in the course of ten days or two weeks. The baby does not perspire until after the first month, ordinarily, when a very slight perspiration begins, gradually increasing until by the time the baby is a few months old he is perspiring freely.

Tears. There are no tears at birth and opinions differ as to whether they appear in the course of two or three weeks or three or four months. The absence of tears is one reason for bathing the baby’s eyes so carefully during the early days and weeks, for if dust or other foreign material gets into the eyes it is not washed out by tears as it is after their flow is established.

General Behavior. During the first few weeks the average baby sleeps most of the time; that is, from 19 to 21 hours daily. He gradually sleeps less, as the special senses develop and will sometimes lie quietly for an hour or more with his eyes open, sleeping only 16 or 18 hours, daily, at six months and 14 to 16 hours at the end of a year.

The baby begins to make noises and “coo” at about two months and to utter various vowel sounds when about six months old. By the end of a year these indefinite noises and sounds become distinct words. At about the fourth month he grasps at objects and smiles, and very soon even laughs. He holds up his head at about the third or fourth month; sits up and also begins to creep at six or seven months, while sometime between the ninth and twelfth months he will stand while holding on to something secure and begin to walk with assistance.

These degrees of development at different ages are not to be taken as the only measure of normal progress, for some well babies mature more rapidly and many others more slowly than at the rate which is found to be average. In addition to these fairly specific evidences of the baby’s condition and progress, such as weight, height, strength and muscular development, there are other and less definite indications of his well-being which should be taken into account.

The baby who is well and is being properly fed in all respects, will have good color; his flesh will be firm; he will take his nourishment with a certain amount of eagerness and seem satisfied afterwards. He will sleep for two or three hours after each feeding; will sleep quietly at night and while awake, unless he is wet or uncomfortable for some other good reason, he will seem contented, good-natured and happy.

You have seen how the average, well baby grows and develops, provided he is given proper care. I want you now to have just a glimpse of the other side of the question, so that you may realize what happens to the unfortunate little citizens who are not given such care. This glimpse will make you realize more than ever, how worth while are all of the precautions that you take for your baby.

It is estimated that out of every 1000 babies born alive, in this country, 40 die during the first month of life, and that more than as many again, or about 85 all told, perish before reaching the first birthday.

So hazardous is this period of early infancy, in the United States, that our annual loss of baby life is between seven and eight times as great as was the yearly loss of our young men in the war, for upwards of 200,000 babies less than a year old die each year. That the first month is more dangerous than any which follow is shown by the fact that about 100,000 of these baby deaths occur during the first four weeks of life. The tragedy of these figures is made darker by the fact that at least half of the babies who are lost die from preventable causes. In other words, they die from lack of proper care.

That is the point of this for you. These babies die, not by an act of Providence, but from lack of care—not the difficult, complicated care needed by sick babies but just the everyday care which any mother may give—the care that keeps well babies well.

That is what you are going to do—keep your well baby well. And you are going to be surprised to find how easy it is, after all, to say nothing of the pleasure of it, for the thing very nearly sums itself up into feeding your baby as the doctor orders and keeping him clean in every particular. Bear these two factors in mind for errors in feeding and lack of cleanliness are the underlying causes of the vast majority of baby ills.

You will often feel a little like Alice in Wonderland, who found, one time, that she had to keep running very fast to stay where she was, for you will not be able to relax in a single detail of your baby’s care if you are to keep him well. With him, as with you, or anyone else, the satisfactory use of even ideal food is largely dependent upon the general condition and mode of living, and we find accordingly, that the question of keeping the baby well finally resolves itself into the following common sense requirements:

1.

Proper food.

2.

Fresh air.

3.

Regularity in the daily routine care.

4.

Cleanliness of food, clothing and surroundings.

5.

Preservation of an even body temperature.

6.

Adequate rest and sleep.

7.

Periodic consultations with your doctor.

Carve these principles into the tablets of your brain and you cannot fail to give your baby the kind of care that is literally life-saving. I am going to describe the tiny, intimate details of this care, for I think this will help you, in the beginning at least, but if you will keep these fundamentals in mind and use good common sense you really need not read another word about baby care, for they give it all in a nutshell.

Let me warn you emphatically against making the very serious mistake of acting upon the advice of friends or relatives, no matter how many children they have had. These counselors are just as dangerous for babies as they are for expectant mothers, so beware of them!

“Is it not preposterous,” says Herbert Spencer, “that the fate of a new generation should be left to the chance of unreasoning custom, impulse, fancy, joined with the suggestions of ignorant nurses and the prejudiced counsel of grandmothers? To tens of thousands that are killed, add hundreds of thousands that survive with feeble constitutions, and millions that grow up with constitutions not so strong as they should be, and you have some idea of the curse inflicted on their offspring by parents ignorant of the laws of life.”

It is a very wise precaution to have your doctor see the baby every week or ten days during the first three months and once a month during the remainder of the year. Not because he is fragile or ill. Not at all. You consult your doctor in order to be sure that you are keeping your baby well.

Did you ever hear of the Chinese custom of paying the doctor as long as one is well, but not paying for attention during illness? It isn’t so very heathenish—that idea of paying for the skillful care that will prevent illness.

In addition to taking the general precaution of seeing your doctor periodically, about the baby, be sure to consult him about anything that you do not understand or about any new condition that arises. You will find any number of persons who are ready and eager to advise you, but your doctor is the only one whose advice it is safe for you to follow.

The Daily Schedule. The importance of regularity in the daily routine of the baby’s care cannot be stressed too often nor too insistently. No matter how well he is nursed in other respects, nor how skillfully the doctor directs his care, the baby cannot be expected to progress satisfactorily if his life is not absolutely regular.

Begin by arranging a daily program for the feedings, fresh air, bath, sleep and exercise and then allow nothing to interfere with your carrying it out.

The hours for the nursings, which vary with different doctors, will constitute the greater part of this daily schedule. For a baby on four hour feedings, for example, some such program as the following may be arranged, while for a baby on a three hour schedule a slightly different program may be arranged.

YOUR BABY’S FOOD

Proper feeding is probably the most decisive single factor in the routine care of the baby.

In order that the food shall be satisfactory, it must be not only suitable in composition for the individual baby, but it must be clean, fresh and at the right temperature; given in suitable amounts and at suitable intervals; it must be given properly—not too fast nor too slowly and it must be given under favorable conditions. Moreover, as has been stated, the baby, himself, must be kept in a general condition which will promote the digestion and assimilation of the food that is given to him. Fresh air, suitable clothing, an even body temperature, gentle handling, proper bathing, regular sleep, freedom from excitement, fatigue, and irritation all promote the baby’s ability to use his food to advantage. Reverse conditions all work against it. Accordingly, the actual value of the baby’s food to him will be largely dependent upon the care that you give him.

There are three methods of nourishing the baby: by breast feeding, by artificial feeding and by a combination of the two, termed mixed or supplementary feeding.

Breast Feeding. From all standpoints, maternal nursing, under normal conditions, is the most satisfactory method of nourishing a baby. If the breast milk is suitable it meets all of the baby’s requirements and the proportion and character of its constituents are exactly suited to his digestive powers. In order for maternal nursing to be entirely satisfactory, the condition of both mother and baby must be favorable. The preparation and care of the mother have been described: her general condition and state of nutrition; the care and condition of her nipples, flat or retracted nipples being· brought out if possible, and if not, the nursing facilitated by the use of a shield. As to the baby, if his diaper is wet or soiled, it should be changed before he is put to the breast, partly to make him comfortable and partly to avoid disturbing him for this after his feeding; and his mouth is gently swabbed with boric-soaked cotton, if your doctor so orders.^[2]

Although nursing is an instinct, the baby may have to learn how to nurse or to acquire the habit, this being one reason for putting him to the breast during those first two or three days when he obtains little or no actual food, as was explained in Chapter IX. As he expresses the milk by squeezing and suction made possible only when the nipple is well back in his mouth, he must take into his mouth practically the entire colored area which surrounds the nipple. To do this he lies in the curve of his mother’s arm as she turns slightly to one side, and holds her breast away from his nostrils in order that he may breathe freely.

Sometimes, even when other conditions are favorable, the baby is unable to nurse because of some physical disability. He may be too feeble, may have a cleft palate or find suckling painful because of an injury to the mucous membrane which occurred when his mouth was wiped out just after birth. The manner in which the baby nurses, therefore, may be significant and should be described to the doctor if there is any difficulty.

When the baby has finished nursing he should be taken up very gently, held upright against the shoulder for a moment or two, to help him bring up gas if he has any, and then placed in his crib and left to sleep. If he is nursing satisfactorily, he will be sleepy and contented afterwards and will sleep for two or three hours; he will seem generally good-humored and comfortable while awake; he will have good color; gain weight steadily and have two or three normal bowel movements daily. The normal stool in breast-fed babies is bright yellow, smooth and has no evidences of undigested food.

If the baby is not being adequately nourished, he will present exactly the opposite picture, in some or all of these respects. He will be unwilling to stop nursing after the normal length of time and will give evidence of being not satisfied when taken from the breast. He may be listless and fretful and sleep badly. He will not gain weight as he should and he may vomit or have colic after nursing.

To ascertain whether or not such a baby is getting enough milk it is customary to weigh him, without undressing him, before and after each nursing. Each fluid ounce of milk will increase his weight one ounce. If the baby is not obtaining a normal amount of milk at each nursing, he is often given enough modified milk after each meal to supply the shortage, but at the same time an effort is made to increase the supply of breast milk by improving the mother’s personal hygiene, as described in Chapter IX.

The amount which the baby needs at each feeding varies, not only according to his weight and age, but also according to his vigor and activity and therefore must be estimated for each baby. A very general estimate of the amount taken by the average, well baby at each feeding, is about as follows:

Artificial Feeding. There is no entirely adequate substitute for satisfactory maternal nursing, and any other food that is given to the young baby is at best a makeshift. Considering the baby’s delicacy, therefore, and his urgent needs, no pains should be spared to make any artificial food that is given to him, as satisfactory as possible. And no matter what it costs, he should have only the freshest, cleanest and purest milk that can be bought.

In preparing and giving artificial food it must be borne in mind that normal breast milk has the following characteristics:

1.

It is exactly right in quantity, quality and proportion.

2.

It is fresh, clean and sweet.

3.

It is free from bacteria.

4.

It tends to protect the baby from infection.

5.

It definitely protects him from certain nutritional diseases.

Cows’ milk, suitably modified, is apparently the best available substitute for mother’s milk, but it must first meet certain requirements and then be handled with scrupulous cleanliness and care, if it is to be satisfactory.

The requirements are that the milk shall be:

1.

Whole milk. It must not be altered by the removal of cream nor the addition of such preservatives as salicylic acid, formaldehyde or boracic acid.

2.

Its composition must not vary greatly from day to day.

3.

It must be clean and free from disease germs; other organisms should not be present in excessive numbers.

4.

It must be fresh; less than 24 hours old when it is delivered.

All of this means that the milk must come from a herd of healthy, tuberculin-tested cows. The milk from a single cow may vary markedly from day to day but that from several cows is nearly constant. The stables and the cows must be kept clean, the udders carefully washed before each milking; the milkers themselves must wear freshly washed clothing, scrub their hands thoroughly and milk into sterile receptacles; the milk must be immediately covered and cooled to a temperature of 45° F. or 50° F. and kept there.

Milk produced under such conditions is usually described as “certified milk” and is often prescribed as infant food without being pasteurized or sterilized. But if there is any doubt about the source of the milk and the method of its handling, it should be strained into a clean receptacle through filter paper or a thick layer of absorbent cotton and subsequently boiled or pasteurized.

Whether certified or not, the milk should invariably be placed in the refrigerator, or some other place which has a temperature of 50° F., as soon as it is received, and it must be kept cool and clean.

Keeping milk cool means keeping it at a temperature of 50° F. Keeping it clean implies cleanliness not alone of the milk itself but of your hands and the utensils that you use as well as the destruction of disease germs by pasteurization or sterilization. Among the germs which are likely to be present in infected milk are those that cause diarrhea, sore throats, typhoid fever, diphtheria and scarlet fever.

When the doctor makes out the formula for the baby’s milk, he will adjust the proportions of the different ingredients to the baby’s immediate needs and digestive powers. But his careful estimations will be set at naught unless you are absolutely accurate in preparing and giving the milk. Your invariable responsibility in connection with the baby’s milk, therefore, is to keep it cool and clean and be accurate.

You will appreciate the necessity for modifying cows’ milk before giving it to your baby if you will note the differences between mother’s milk and cows’ milk as indicated by the following table and consider, too, why Nature has made these differences:

The various tissues of the body and the bony skeleton are built by the proteins and salt. Accordingly Nature supplies these in greater abundance to the baby calf, who grows so fast as to double his birth weight in about forty-seven days, than to the baby boy who scarcely doubles his birth weight within 180 days. The calf begins life with a physical need for the large amount of proteins and salts which are present in cows’ milk and with digestive organs that can cope with them, but the baby needs less, can digest less and, therefore, should be given less. There are of course, other and finer differences between the two milks and an attempt is sometimes make to meet these. For example, mother’s milk is slightly alkaline and cows’ milk slightly acid and the curd of cows’ milk is larger, tougher and harder to digest than that formed by mother’s milk. Some doctors add lime water to cows’ milk, before giving it to the baby, to make it alkaline and have the curd made softer, finer and more digestible by boiling.

Articles Needed in Preparing the Baby’s Food. A complete equipment for preparing and giving the baby’s milk should be assembled, kept in a clean place, separate from utensils in general use, and never put to any other service. A satisfactory outfit for this purpose comprises the following articles:

Utensils of enamel or aluminum ware are probably the most satisfactory ones to use as they are easily kept clean, while bottles with wide mouths and curved bottoms and inner surfaces can be thoroughly washed more easily than those with small necks and sharp corners. Nipples that can be turned inside out to be washed should be selected as it is almost impossible to clean thoroughly those with tubes or narrow necks. New bottles will be rendered less breakable if placed in cold water, which is gradually heated, allowed to boil for half an hour and cooled before the bottles are removed.

The bottles should be rinsed with cold water after each feeding and then carefully washed and scrubbed with the bottle brush in hot soapsuds or borax water, containing two tablespoonfuls to the pint. They may be kept full of water while not in use or rinsed with hot water and stood upside down until they are all boiled on the following morning, preparatory to being filled with the freshly prepared milk. The baby’s bottles should never be washed in dishwater nor dried on a towel. The nipples should be rinsed in cold water, turned inside out and scrubbed with a brush, in hot soapsuds or borax water; rinsed and placed in a jar ready to be boiled with the bottles.

Preparing the Milk. The full quantity of milk which the baby will take in the course of twenty-four hours is prepared at one time and the prescribed amount for each feeding poured into as many separate bottles as there will be feedings.

You should begin by assembling on a table everything that you will use in preparing the milk formula, as the nurse has in Fig. 47. Boil for five minutes all of the articles that will come in contact with the milk, including the full number of bottles and nipples and the jars in which the nipples are kept; remove them with the long-handled spoon without touching the edges or inner surfaces, dropping the nipples into one of the sterile jars.

Wash the mouth of the milk bottle before removing the cap and pour the amount which the formula calls for into the sterile pitcher. To this is added the sterile water in which the sugar has been dissolved in the measuring glass and then the potato or barley water, the lime water or soda solution as ordered. This mixture is thoroughly stirred and the amount for one feeding at a time, measured in the measuring glass and poured into the specified number of bottles, which are then stoppered.

If certified milk is used for the milk mixture it is often given to the baby without being pasteurized, in which case the bottles are placed in the refrigerator as soon as they are filled and stoppered. Very frequently, however, the milk is sterilized or pasteurized. You will feel surer of keeping the mouths of the bottles clean if you cover them with squares of gauze or muslin before they are sterilized, holding the caps in place with tapes or rubber bands.

Pasteurization as applied to infant feeding consists of heating the milk to 140–165° F. and keeping it at that temperature for 20 to 30 minutes.

There are many excellent pasteurizers for home use on the market, but entirely satisfactory results may be obtained by improvising one from the wire bottle rack seen in Fig. 47, and the large kettle already provided. One method is to place the rack, containing the bottles, in the kettle which is filled with cold water to a level a little above the top of the milk in the bottles, and allow the water to come to the boiling point. The kettle is removed from the fire, covered tightly and the bottles allowed to stand in the hot water for twenty minutes. Cold water is then run into the kettle to cool the milk gradually and avoid breaking the bottles, after which they are placed in the refrigerator, well or spring-house and kept at a temperature of 50° F. until they are taken out, one at a time, for feedings. If a wire rack is not available the bottles may be stood on a saucer or a thick pad of folded newspapers in the bottom of the kettle.

Pasteurization does not destroy all germs that may be in the milk, but it kills the more important ones and apparently impairs the nutritive and protective properties of the milk less than boiling. However, pasteurized milk must be kept cold and must be used within twenty-four hours, for the aging of milk is quite as undesirable as souring.

Scalding is another method of destroying germs in milk. The milk is placed in an open vessel and the temperature raised to about 180° F., or until bubbles appear around the edge and the milk steams in the center, after which it is cooled and kept at a temperature of 50° F.

Many doctors prefer to have the baby’s milk boiled, since boiling insures absolute sterilization and also renders the curd more digestible. Other changes are produced by boiling, however, which make it important to add orange juice and cod-liver oil to the baby’s diet at an early date, as will be explained in the next chapter.

Milk may be boiled directly over the flame for a time varying from three to forty-five minutes, or it may be placed in a double boiler, the water in the lower receptacle being cold, and allowed to remain until the water has boiled from six to forty-five minutes.

When milk is boiled or scalded, the other ingredients are added beforehand, as a rule, after which it is measured and poured into the bottles. Or the milk mixture may be poured into the bottles as for pasteurization and the bottles kept in the actively boiling water for any desired length of time.

All of these points, however, are definitely specified by the doctor.

Giving the Baby His Bottle. At feeding time, the bottle should be taken from the refrigerator, the stopper removed and a sterile nipple taken up by the margin and put on the bottle without touching the mouthpiece. The milk is brought to a temperature of about 100° F. by standing the bottle in a deep cup or kettle of warm water and placing it on the fire. The temperature of the milk may be tested by dropping a few drops on the inner side of the wrist or forearm where it should feel warm but not hot. This dropping will also indicate if the hole in the nipple is of the proper size to allow the milk to drop rapidly in clean drops but not to pour. If the hole is too small, the drops will be small and infrequent and the baby will be obliged to work too hard to obtain it; while if the hole is too large the baby will feed too rapidly and may have colic as a result. If the hole is too large the nipple will have to be discarded; if too small or if there is no hole, one of the proper size may be made by piercing the nipple with a heated darning needle or small steel knitting needle.

The baby’s diaper should be changed if it is soiled or wet before he is given the bottle and he should be held comfortably on your arm, in a reclining position, while you hold the bottle with your free hand as shown by the nurse in Fig. 48. The bottle should be inclined sufficiently to keep the neck full of milk; otherwise the baby may draw in air as he nurses. He should be kept awake while feeding but he should be allowed to pause every three or four minutes in order not to take his milk too rapidly. Not less than ten nor more than twenty minutes is devoted to a feeding, as a rule, and if the baby refuses a part of his milk, it should be thrown away; never warmed over for another time.

After being fed, the baby should be held upright against your shoulder for a moment or two, as in Fig. 49, and ever so gently patted on the back to help bring up any air which he may have swallowed. He should on no account be rocked nor played with after taking the bottle, but should be placed gently in his crib, warm and dry and left alone to sleep. Turning him or moving him about even to the extent of changing his diaper at this time may cause vomiting.

The evidences of satisfactory and unsatisfactory feeding in the bottle-fed baby are about the same as in the baby who is fed at the breast, except that the gain in weight on artificial food may be a little slower and less steady than on maternal nursing; the stools have a characteristic sour odor; are a little lighter in color and may contain white lumps of undigested fat; are usually dryer than in breast feeding and may be formed, in even a very young baby.

Many doctors feel that all babies, whether breast-fed or on the bottle, require a certain amount of cool boiled water to drink between feedings. A small amount is given at first and gradually increased according to the doctor’s instructions, and it may be given from a bottle, a medicine dropper or poured slowly from the tip of a teaspoon.

I feel sure that you have realized, long before this, that the entire question of planning the baby’s food is such an important and complicated matter that it cannot with safety to the baby be undertaken by any one but your doctor. Unexpected situations do arise, however, when the doctor is not within immediate reach and the mother has to plan the baby’s food, temporarily, to the best of her ability.

Should you find yourself in such an emergency, you will find help in the milk formulas contained in a pamphlet issued by the American Medical Association, remembering that they are intended for the average, normal baby and are not necessarily suitable for all babies. A large, vigorous baby may need more food and a small, frail baby have to take less than the amounts specified in the following directions:^[3]