The Care and Feeding of Children - L. Emmett Holt (chrysanthemum read aloud .TXT) 📗

At what age may a well baby go without food from 10 P.M. to 6 or 7 A.M.?

Usually at four months, and always at five or six months. Night feeding is one of the most frequent causes of wakefulness and disturbed sleep.

What is meant by sterilizing milk?

Heating milk for the purpose of destroying germs.

Does all cows milk contain germs?

Yes; even when handled most carefully, milk contains many germs; but when carelessly handled, and in summer, the number is enormous. While most of these are harmless or cause only the souring of milk, others are occasionally present which may produce serious diseases such as typhoid fever, diphtheria scarlet fever, cholera, tuberculosis, and many forms of diarrhoea.

Under what circumstances is it necessary to sterilize milk?

1. In warm weather when it cannot be obtained fresh; hence always in cities and towns during the summer.

2. When one cannot be certain that the cows are healthy, or that the milk has been carefully handled.

3. When the milk is to be kept for any considerable time (i.e., over twenty-four hours), especially if no ice can be had.

4. During epidemics of typhoid fever, scarlet fever, diphtheria, or any form of diarrhoeal disease.

What are the two methods of heating milk?

The first is known as sterilizing, in which the milk is heated to 212° F. for one hour or one hour and a half; the second is known as pasteurizing, in which the milk is heated to 155° or 170° F. for thirty minutes. A temperature of 155° F. continued for thirty minutes is sufficient to kill the germs of the diseases above referred to.

Will milk which has been thus treated keep indefinitely?

No; for although all the living germs may be killed, there are many undeveloped germs, or spores, which are not destroyed, and which soon grow into living germs. Milk heated to 212° F. for an hour will keep upon ice for two or three weeks; that heated to 155° F. for two or three days.

Is milk which has been sterilized always a safe food?

No; for the reason that the milk may be so old, so dirty, and so contaminated before sterilizing that it may be still unfit for food, though it contains no living germs.

Is cow's milk rendered more digestible by being heated in this way?

Sterilizing milk does not improve its digestibility but rather the contrary. Sterilized milk should be modified for infant feeding in the same way as milk which has not been heated.

Is milk in any way injured by heating to 212° F. for an hour?

There is abundant evidence that milk is rendered less digestible by such heating; also that it is more constipating, and that for some children its nutritive properties are interfered with, so that it may cause scurvy; this, however, is not seen unless it is continued as the sole food for a long period. These objections are of so much importance that this plan of heating milk is not to be recommended for general use.

When is it advantageous to heat milk to 212° F.?

For use upon long journeys, such as crossing the ocean. Milk should then be heated for one hour upon two successive days, without removing the cotton stoppers from the bottles.

Is milk in any way injured by heating to 155° F. for thirty minutes?

This point is not yet definitely settled. Such heating does not affect the taste of milk and does not render it more constipating. The unfavourable effects; if there are any, are so slight that they need not deter one from the use of pasteurized milk, even for long periods. The preference, however, should always be given to milk which is so clean and so fresh as not to require any heating.

How should milk be pasteurized?

A convenient form of apparatus is that known as Freeman's pasteurizer[5]; another is the Walker-Gordon pasteurizer.[6]

How should milk be cooled after pasteurizing?

Always by placing the bottles in cold water, so as to cool them rapidly; never by letting them stand at the temperature of the room, or by placing them, when warm, in an ice box.

Why is this precaution necessary?

Cooling in the air or in an ice box requires from two to four hours, and during that time a great many of the undeveloped germs may mature and greatly injure the keeping properties of the milk. In the cold water, milk can be cooled in from ten to twenty minutes if the water is frequently changed, or if ice is added to the water.

What is "modified milk" of the milk laboratories?

It is milk containing definite proportions of the fat, sugar, proteids, etc., put up usually according to the prescription of a physician, who indicates how much of the different elements he desires. The most reliable are the laboratories of the Walker-Gordon Company, which has branches in many of the large cities of the United States.

This is an excellent method of having milk prepared since it can be done with greater care and cleanliness than are possible in most homes. It is besides a great convenience if circumstances make it impossible to prepare the milk properly at home.

The laboratory should be used for infant feeding only by one who is somewhat familiar with this method of ordering milk.

What is peptonized milk?

Milk in which the proteids (curd) have been partially digested.

How is this accomplished?

By the action of a peptonizing powder which is composed of a digestive agent known as the extractum pancreatis and bicarbonate of soda, which is added to the plain or diluted milk. This is sold in tubes or in tablets, and it is the active ingredient of the peptogenic milk powder.

Describe the process.

The plain or modified milk is placed in a clean glass jar or bottle, and the peptonizing powder, which is first rubbed up with a tablespoonful of the milk, is added and the bottle shaken. The bottle is then placed in a large pitcher or basin containing water kept at the temperature of about 110° F., or as warm as the hand can bear comfortably, and left for ten to twenty minutes if the milk is to be partially peptonized; for two hours if it is to be completely peptonized.

What taste has partially peptonized milk?

None, if peptonizing is continued for only ten minutes, but at the end of twenty minutes it begins to be bitter, when the process of digestion has gone further.

How is the bitter taste avoided in partially peptonized milk?

At the end of ten or fifteen minutes the milk may be placed in a saucepan and quickly raised to boiling point; this kills the ferment, so that the milk will not become bitter when warmed a second time. Or, the milk may be rapidly cooled by placing the bottles first in cool and then in ice water; in this way the ferment is not destroyed, and the milk may become bitter when warmed for feeding.

Should the whole day's supply be peptonized at once, or each bottle separately just before the feeding?

Either plan may be followed. If the former, it is better to raise the milk to boiling point after peptonizing; if the latter, it should not be peptonized more than ten minutes, for it will continue to peptonize while it is being taken by the child.

Is not the bitter taste of completely peptonized milk a great obstacle to its use?

Not in the case of young infants; one under four or five months old will usually take it without any objection after two or three feedings; but it cannot often be used for those who are much older.

How much of the peptonizing powder should be used?

There are required for one pint of plain milk, five grains of the extractum pancreatis and fifteen grains of bicarbonate of soda. This quantity is usually put up in a single tube or tablet. In the formulas previously given, less than this will be required; for the weaker formulas, one half or one third of the powder mentioned will be sufficient for one pint of food. For a single feeding of four ounces, one may use one eighth of a tube with a weak formula, or one sixth of a tube with a stronger formula.

What are the advantages of peptonized milk?

Partially peptonized milk is useful for young infants who have great difficulty in digesting the curd of milk, sometimes even when diluted as already described; completely peptonized milk, during acute attacks of indigestion.

For how long a period may the use of peptonized milk be continued?

Completely peptonized milk may be used for a few days, or at most a few weeks; partially peptonized milk may be used for two or three months, but not indefinitely; it should be left off gradually by shortening the time of peptonizing, and lessening the amount of the powder used.

How many meals are required during the second year?

It is usually better to continue five meals throughout the second year. Some children will sleep from 6 P.M. to 6 A.M. without waking, but unless there is a feeding at 10 P.M. children are apt to wake very early in the morning.

Should each feeding be prepared at the time it is given, or all feedings at one time, as during the first year?

During the second and third years it is better to prepare the milk for the entire day at one time. If it is to be modified by adding cream, water, etc., it is done as during the first year.

Later, when only plain milk is used, the quantities needed for the different feedings should be put into one or into two bottles, which then may be pasteurized or not as may be necessary. In this way the different feedings are kept separate, and the day's supply of milk is not disturbed every time the child is fed, as otherwise is unavoidable. The food should be prepared as soon as possible after the daily milk supply is delivered in the morning.

Give a proper diet for an average healthy child of twelve months.