The Care and Feeding of Children - L. Emmett Holt (chrysanthemum read aloud .TXT) 📗
- Author: L. Emmett Holt
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(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 MilkAs 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.
The approximate composition of these formulas expressed in percentages is as follows:
How should the food be increased during this period?
Beginning with I of this Series, which should usually follow V of the First or Second Series (pages 70, 71), the increase may generally be made in a week or ten days to II; in about two weeks more to III; now more slowly to IV and V. When IV or V has been reached, the same formula may sometimes be continued for three or four months with no other change than an increase in the quantity.
In passing from Formula V of the First Series to Formula I of the Third Series the proportion of fat is at first reduced. Is this necessary or important?
No; it only happens to come so in simplifying the calculation. It may be avoided by taking off at first the upper 13 ounces as top-milk and using 7 ounces of this in a 20-ounce mixture, in place of Formula I; and by using for the next increase the upper 15 ounces as top-milk, taking of this 8 ounces in a 20-ounce mixture in place of Formula II. Then should follow Formula III.
What further addition may be made to the food of the later months?
Usually about the sixth or seventh month, farinaceous food in the form of gruel may be added, this taking the place of part of the water and part of the sugar.
What changes may be made in the food when the infant has reached the age of ten or eleven months?
The proteids may be still further increased, and the sugar and the lime-water reduced until plain milk is given.
How may this best be done?
At first one feeding a day of plain milk and barley gruel may be given; later, two feedings; then three feedings, etc. Let us suppose an infant to be taking such a modified milk as Formula IV or V (page 76), six feedings a day. The plain milk diluted only with barley gruel would at first replace one of these feedings; then two, three, four, etc., these changes being made at intervals of about two weeks. The proportions of the milk and barley gruel should at first be about 5½ ounces milk, 2½ ounces barley; later, 6 ounces milk, 3 ounces barley; still later, 7 ounces milk, 2 ounces barley, until finally plain milk is given to drink and the cereals given separately with a spoon. This is reached with most infants at fourteen or fifteen months; with many at twelve or thirteen months. Other forms of farinaceous food may of course be used in the place of the barley, and in the same proportions.
With some infants the addition of a pinch of bicarbonate of soda may be advantageously made to each milk-feeding when the lime-water is omitted, but with most this is unnecessary.
If the infant strongly objects to the taste of the milk when the milk sugar has been omitted, a small quantity (one fourth to one half teaspoonful) of granulated sugar may for a time be added to each feeding, then gradually reduced.
GENERAL RULES FOR GUIDANCE IN THE USE OF THE FORMULAS GIVEN
It should again be emphasized that these formulas are not intended for sick children nor for those suffering from any marked symptoms of indigestion. For such infants special rules are given later.
What should be the guide in deciding upon a formula with which to begin for a child who is to be artificially fed?
The age and the weight are of some importance, but the best guide is the condition of the child's digestive organs. One should always begin with a weak formula, particularly, (1) with an infant previously breast fed; (2) with one just weaned, as a child who has never had cow's milk must at first have weaker proportions than the age and the weight would seem to indicate; (3) with infants whose power of digestion is unknown. If the first formula tried is weaker than the child can digest, the food can be strengthened every three or four days until it is found what the child is able to take. On the contrary, if the food is made too strong at first, an attack of indigestion will probably follow.
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