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It will be noted from this table that the ratio of the sweetened condensed milk to evaporated milk is 1 to 3, and that its dilution is variable according to the age of the infant.
These formulæ have a general composition as follows:
It will be noted that the preparations after the first week approximate in composition “mother's milk,” except that they are deficient in fats. However, fats in the Tropies are not as essential as they are in a colder climate. Moreover, there is a slightly reduced percentage in the sugar content; but as saccharose has much more sweetening power than lactose, this proved ample in quantity. The only elements absent were the vitamins. These were supplied by the use of orange juice. Beginning about the seventh day 10 drops of this were given each morning before the first feeding and the quantity gradually increased so that at the end of the first month a teaspoonful was given daily, and the quantity increased at the rate of a teaspoonful a month, so that at the end of the year the child was getting 1ounces daily. If orange juice is not available, the juice of the lemon or lime can be used, but these are not as agreeable to the infant. Other fresh-fruit juices may also be substituted.
It has been found that tomato juice is equally serviceable. Canned tomato juice is also efficacious. Vitamin C is generally destroyed by heat, but the acids present in tomato juice increase its stability so that canned tomato juice can be used if other sources of fresh vitamins are unobtainable.
It was found advisable also to add from one to two teaspoon fuls of limewater to each bottle of milk just before feeding. It serves the double purpose of, first, neutralizing the acidity normally present in cow's milk, and, second, it prevents the milk clots in the child's stomach from becoming too firm. Hence they are more digestible. When constipation was present the limewater was replaced by milk of magnesia in one or two of the feedings.
After the child is 4 months old barley water, in whole or in part, can be gradually substituted for the water in the formula, and at the age of 9 months some oatmeal jelly can be added instead of barley water. Not all children, however, can tolerate oatmeal jelly, as its protein is more stimulating, and liable to cause skin irritation.
This method of feeding proved entirely satisfactory for more than 90 per cent of the infants. It was initiated about 1908, and is at present used in Panama and in all tropical countries where the United Fruit Co. operates, as well as in other localities.
The formula is prepared as follows: The amount of milk necessary for the entire day is made in the morning. Enough boiling water should be added to the measured amount of sweetened condensed milk to thoroughly dissolve it. Then the measured quantity of unsweetened milk is stirred in and sufficient boiling water added to make the desired quantity for the day. To this is added a few grains of salt, and the milk is divided into as many sterile nursing bottles as there are feedings for the day. Each one is then lightly corked with sterile absorbent cotton and placed in a cool place until ready for use. All that is necessary then is to place a bottle in a pan of warm water, leave it there till the desired temperature is reached, add from 1 to 2 teaspoonfuls of limewater, adjust the nipple, and it is ready for the baby.
A few children have an idiosyncrasy for cane sugar, as it is much more fermentable than milk sugar. When this is found to be the case the formula can be made from the evaporated milks, and some other form of sugar added in proper amount. The next table (6), formula "B,” shows how to prepare an infant's food from evaporated milk, with the necessary amount of sugar to be added to each day's feeding
TABLE 6.-Formula “B."
The added sugar may be milk sugar, cane sugar, or dextri-maltose. Lactose, or milk sugar, has the same fuel value as saccharose, or cane sugar. It is more expensive (about $0.30 per pound) but is not so prone to fermentation. It therefore agrees better with most babies.
Dextri-maltose (according to Chapin and Pisek): “ This is a preparation of malt sugar consisting of maltose, 51 per cent; dextrin, 47 per cent; sodium chlorid, 2 per cent. Each ounce has a food value of 110 calories. It is a readily absorbable sugar containing no cellulose, fats, or proteins. It often agrees better than milk or cane sugar, and is especially indicated in infants in whom it is desired to get an increase in weight without causing sugar disturbance."
The method of preparing formula “B” is the same as that for formula“ A,” with the exception that no unsweetened condensed milk is used. The measured quantity of sugar is dissolved in hot water before adding it to the measured quantity of evaporated milk. Otherwise the method of preparation is the same.
Certain precautions are necessary in the use of evaporated milk. The sweetened condensed milk has sufficient sugar to preserve it, and if protected from insects will keep indefinitely.
Êvaporated milk, on the other hand, after the can is opened is subject to decomposition almost as readily as fresh milk. A fresh can should be opened daily and the unused portion devoted to other domestic purposes, unless placed on ice in a suitable container and covered with sterile cotton or gauze. The mother or nurse who is preparing the milk should always taste it after the can is opened to see that no bacterial decomposition has taken place.
Powdered milks are now being used in the Tropics, and they form a very satisfactory means of preparing infant's food. The writer has had some experience with the brand “Klim," and can recommend its use for infant feeding. Following along the same lines of preparation as devised in Tables 4 and 6 (formulæ “A” and “B”), Table 7, formula “ C,” shows how to prepare the infant's food from powdered milk. Klim has the advantage, in a warm climate, of keeping three to four months, and the manufacturers claim that the vitamins are not destroyed in the process of preparation. However, as some of this milk is prepared in the winter months when the cattle are stable fed, the vitamin content is likely to be low, and the addition of fruit juices should be supplemented as in feeding by the other formulae.
TABLE 7.--Formula “ C."
1 Tablespoonfuls. NOTE.
4 levelteaspoonfals (Klin) 1 level tablespoonful. 2 level tablespoonfuls (Klim) - 1 ounce by measure. 4 level tablespoonfuls (Klim) =lounce by weight.
9 level teaspoonfuls of milk-sugar-- 1 ounce by weight. (In the preparation of all of the above formule, an 8-ounce gra luate saves time.)
Formula “C” is prepared as follows: The measured quantity of sugar (lactose, saccharose, or dextri-maltose) should be added to the measured quantity of warm water, and after solution the meas. ured quantity of milk powder stirred in and dissolved.
Table 8 shows the composition of these formulæ, and, as can be seen, the protein and sugar contents are about the same as human
milk, but they are deficient in butterfats. This, as stated above, is not so necessary in warm climates, as in cold climates when it might be necessary to add fats in the form of fresh cream or codliver oil.
TABLE 8.---Analysis of the formula in Table 7, formula “C,” based on analysis
[Butterfat, 28 ; protein, 26.74; milk sugar, 38; ash, 5.76; water, 1.50.)
FOOD REQUIREMENTS FROM 10 OR 12 TO 15 MONTHS.
Some children are as advanced at 10 months as others are at 12 months, or even more so, and a supplemental supply of food is indicated, particularly in the form of protein for tissue building. The first meal of the day, therefore, 6.30 a. m., when the digestive powers are vigorous, may consist of part of the yolk of a coddled egg mixed with the crumbs of rusk, zwiebach, toasted crackers, or well-toasted stale bread, and this can be supplemented with milk. The amount of egg can be gradually increased until the whole egg is taken at a meal. The egg is coddled by placing it in a pan of boiling water removed from the fire and left for 8 or 10 minutes, when the contents jelly. The second meal, about 10.30 a. m., should consist of one of the formulae. The third, about 1.30 p. m., should consist of a well-cooked cereal, or stale bread toasted with milk, and milk to drink. This may Le alternated with a good vegetable soup thickened with crumbs, as in the morning meal, and supplemented with milk. The fourth meal, about 5.30 p. m., should be the milk formula, and this can be repeated about 9.30 or 10 p. m. Some children do not require the last bottle and will sleep the entire night.
During this period the child should be gradually weaned from the bottle and taught to drink from a cup and eat with a spoon.
The sweet condensed milk in formula "A" should be gradually replaced by the evaporated milk, or the supplemental sugar in formula "B" or "C" should be gradually lessened so that at the end of the fifteenth month the milk used with the meals should be natural and unsweetened.
FROM THE FIFTEENTH TO EIGHTEENTH MONTH.
The 1.30 o'clock meal may consist of scraped beef, minced chicken, or shredded fish, with mealy baked or boiled potato and butter. This may be supplemented by milk or water.
After the eighteenth month a light general diet can be introduced consisting of well-ripened or cooked fruits, plain milk, well-cooked cereals, toasted stale bread and butter, coddled eggs, minced chicken, vegetable or meat soups, underdone meats, shredded fish, mealy potatoes, purée of vegetables, custards, and simple puddings.
The evening meal should always be light, consisting of bread or cereals with milk, and possibly stewed fruit with bread and butter. Cereals made from the whole grains, such as rolled oats, cracked or shredded wheat, corn meal, etc., are to be preferred.
As these methods of infant feeding have proved so successful in the Tropics, there is no reason why they should not prove perfectly satisfactory in more northern latitudes, particularly among the poor of our large cities where fresh cow's milk is expensive and the cheaper grades subject to putrefactive changes.
Sweetened condensed milk.-Retails in New York markets at a rate of 1} cents per ounce in 15-ounce tins.
Evaporated milk.-Retails at three-fourths cent per ounce in 16ounce tins.
“Klim.”— Retails at 70 cents per pound in 1-pound tins. Fortyeight ounces of the strongest preparation of formula “A” costs approximately 11 cents. This is a quart and one-half, or at the rate of about 7 cents per quart. There is no fresh cow's milk in the city that can be obtained for less than 10 cents per quart, and this is third-grade milk, not suitable for the feeding of infants. Further, it has to be modified and kept on ice. Fifty ounces of the strongest preparation of formula “B” costs approximately 124 cents, or with the added milk sugar, 8 cents per quart. Fifty ounces of the strongest preparation of formula “C” costs approximately, with the added milk sugar, 12 cents per quart.
If some enterprising milk manufacturer would increase the sugar content of milk to 10 per cent by the addition of milk sugar, cane sugar, or dextri-maltose, and then evaporate it down to 40 per cent and put it up in cans of 4, 8, 12, and 16 ounces, it would simplify greatly the problem of infant feeding by these methods. All then that would be necessary to do would be to dilute the preparation with water, according to the age of the child, and there would be practically no loss in the unused milk after the second week from an open can.
The evaporated or condensed milk would then have, when concentrated, approximately 25 per cent of sugar. This diluted five times would give 5 per cent, and diluted four times would give 64 per cent,
5 which is about the amount present in human milk.
If the butterfat could be increased to 5 per cent before being evaporated the result should be ideal.
The same could probably be done in the manufacture of powdered milk.
SYMPTOMS THAT WORRY MOTHERS. Crying.--A child may cry continuously because of hunger, thirst, colic, earache, headache, teething, or pain from the onset of an acute disease such as pleurisy, pneumonia, meningitis, rickets, etc.