The Care and Feeding of Children, L. Emmett Holt [phonics books .txt] 📗

the bowels, or if not passed, the gas accumulates and causes abdominal distention and colicky pain. There may be vomiting, but more often the trouble is intestinal. Sometimes the bowels are constipated, but usually the movements are frequent, loose, green, contain mucus and are passed with much gas.

What should be done under these circumstances?

If the symptoms have persisted for two or three weeks and the child is not gaining in weight, there is little chance of improvement, and the child should be taken from the breast at once. If there is some gain in weight, one may try for a little longer, endeavouring to improve the mother's milk by rest, fresh air, careful diet, etc. However, one should always realize that the trouble is with the milk, not with the child.

What changes should be made if a nursing infant habitually vomits?

If this occurs soon after nursing, the infant has usually taken too much and the time of nursing should be shortened, or one breast may be given instead of two; the nursing should also be interrupted by occasional rests, so that the milk is not taken too fast.

If the vomiting occurs some time after nursing and is repeated, it is a sign of indigestion; often because the milk is too rich in fat. The intervals between nursings should then be lengthened; the breast milk may be diluted by giving one or two tablespoonfuls of plain boiled water, lime-water, or barley-water, five or ten minutes before nursing; the mother should eat less hearty food, especially less meat.

What should be done if the infant has frequent or habitual colic?

This is usually because the milk is too rich in proteids; the mother should take more out-of-door exercise, eat less meat, and seek to control her emotions; all causes of worry should be removed.

Can constipation in a nursing infant be controlled through the mother's milk?

Only to a limited extent. It is important that the mother's bowels be regular and her digestion good. An increase in the meat and milk of her diet is sometimes beneficial.

 

WEANING

At what age should the child be weaned from the breast?

Usually weaning should be begun at nine or ten months by substituting one feeding a day for one nursing, later two feedings, and thus gradually the child is to be taken from the breast altogether.

What is the principal reason for weaning earlier?

The most important one is that the child is not thriving—not gaining in weight and not progressing normally in its development. Serious illness of the mother, or pregnancy, may make weaning necessary.

At what age should the weaning be completed?

Generally at one year. In summer it may sometimes be advisable to nurse an infant a little longer rather than wean in warm weather; but even then the dangers of weaning are much less than those of continuing to nurse, as is so often done, after the milk has become very scanty and poor in quality.

When should a child who is weaned from the breast be taught to drink from the cup, and when to take the bottle?

If weaning is done as early as the eighth or ninth month it is better to give the bottle; if from the tenth to the twelfth month the infant should be taught to drink or be fed with a spoon.

How may some of the difficulties in weaning be overcome?

By feeding every nursing infant once a day or by giving it water regularly from a feeding-bottle. It then becomes accustomed to the bottle. This is a matter of great convenience during the whole period of nursing when the mother or nurse is from necessity away from the child for a few hours; when more feeding is required at weaning time the child does not object.

When should a child be weaned from the bottle?

With children who are not ill, weaning from the bottle should invariably be begun at the end of the first year, and after a child is thirteen or fourteen months old the bottle should not be given except at the night feeding.

Is there any objection to the child's taking the bottle until it is two or three years old?

There are no advantages and some serious objections. Older children often become so attached to the bottle that only with the greatest difficulty can they be made to give it up. Frequently they will refuse all solid food, and will take nothing except from the bottle so long as it is given, and when finally at three or four years, it is taken away, they will not touch milk during the rest of their childhood. The difficulty is here that children form the "bottle habit." This habit is troublesome, unnecessary, and should by all means be prevented. An exclusive diet of milk for children of two or three years often results in anæmia and malnutrition.

How should one train a child to do without the bottle?

This is usually very easy if it is begun at one year. The milk should be poured into a tiny glass or cup and little by little the child is taught to drink; at first only a small portion of the food is taken in this way, the balance being given from the bottle; but in the course of a few weeks the average infant learns to drink from a cup without difficulty, and all the food can be so given.

If the child is two or more years old, the only effective means of weaning from the bottle is through hunger. The bottle should be taken away at once and entirely, and nothing allowed except milk from a cup until the child takes this willingly. Sometimes a child will go an entire day without food, occasionally as long as two days, but one should not be alarmed on this account and yield. This is a matter of the child's will and not of his digestion, and when once he has been conquered it is seldom that any further trouble is experienced. As soon as a child has learned to drink his milk from a cup, cereals and other solid foods may gradually be added to the diet. The educational value of such training is not the least important consideration.

Can a baby just weaned take cow's milk of the same proportions as one of the same age who has had cow's milk from birth?

Very rarely; to give a baby who has had nothing but the breast from birth, plain cow's milk, or even that milk which a bottle-fed baby of the same age might take, is almost certain to cause indigestion. The change in the food is quite a marked one, and should be made gradually by beginning with a very weak milk and increasing its strength as the baby becomes accustomed to take cow's milk.

What would be the proper proportions for an infant weaned at four or five months?

About the same as for a healthy bottle-fed infant of two months; the quantity of course should be larger. The food can in most cases be gradually increased so that in two or three weeks the usual strength for the age can be taken.

What would be the proper proportions for an infant weaned at nine or ten months?

About the same as for a bottle-fed infant at four or five months, to be increased as indicated above.

Will not a child lose in weight when placed upon so low a diet?

Very often it will do so for the first week or two, but after that will gain quite regularly; the acute indigestion, however, which generally accompanies the use of stronger milk will, in most cases, cause a greater loss.

 

ARTIFICIAL FEEDING

What foods contain all the elements present in mother's milk?

The milk of other animals,—cow's milk being the only one which is available for general use.

Is it not possible for infants to thrive upon other foods than those containing fresh milk?

They may do so for a time, but never permanently. The long-continued use of other foods as the sole diet is attended with great risk.

What are the dangers of such foods?

Frequently scurvy is produced (see page 141), often rickets, and in other cases simply a condition of general malnutrition,—the child does not thrive, is pale, and its muscles are soft and flabby.

 

THE SELECTION AND CARE OF MILK USED FOR INFANT FEEDING

What are the essential points in milk selected for the feeding of infants?

That it comes from healthy cows, and that it is clean and fresh.

Is it not important to select a rich milk?

By no means; in fact the very rich milk of highly bred Jerseys and Alderneys has not been found nearly so satisfactory in infant feeding as that from some other herds, such, for example, as the common "grade cows."

Which is the better, milk from one cow or the mixed milk of several cows?

The mixed, or "herd milk," is usually to be preferred since it varies little from day to day; while that from a single cow may vary considerably.

How fresh is it important that cow's milk should be for the best results in infant feeding?

This depends very much upon the season, and how carefully milk is handled. As ordinarily handled at the dairy and in the home, milk should not be used for infants in winter after it is forty-eight hours old; in summer not after it is twenty-four hours old, and it may be unsafe in a much shorter time. When handled with especial care milk may be safe for a longer time.

What are the two essentials in handling milk?

1. That it be kept clean and free from contamination. This necessitates that cows, stables, and milkers be clean, and that transportation be in sealed bottles; also that those who handle the milk do not come in contact with any contagious disease. All milk-pails, bottles, cans, and other utensils with which the milk comes in contact should be sterilized shortly before they are used, by steam or boiling water.

2. That it be cooled immediately after leaving the cows, and kept at as low a temperature as possible; to be efficient this should not be above 50° F.

Milk produced under hygienic conditions and handled with special care is sold in bottles in a number of cities under the name of "certified," "guaranteed," or "inspected" milk. When available such milk should be used for infants. Of course the extra care bestowed in its production and transportation increases the cost of the milk, but the best will usually be found in the end to be the cheapest.

How should milk be handled in the home when obtained fresh from the cows?

That to be used for infants should be strained through a thick layer of absorbent cotton or several thicknesses of cheese-cloth into quart glass jars or milk bottles which should be covered and cooled immediately best by placing the bottles quite up to their necks in ice water or cold spring water, where they should stand for at least half an hour. That required for children who take plain milk may now be poured into half-pint bottles, stopped with cotton, and put in the ice-chest, or the coolest place possible. This first rapid cooling is very important and adds much to the keeping qualities of the milk. Milk loses its heat very quickly when cooled in water, but very slowly when it is simply placed in a cold room. After standing four or five hours the top-milk may be removed; after twelve to sixteen hours the cream may be removed.

How should milk be handled when bottled milk is purchased?

It should be cooled as just described, as its temperature is usually somewhat raised during transportation If it has been bottled at a dairy, the cream or the top-milk may be removed after an hour or so.

How should milk and cream be handled when they are purchased in bulk?

Such milk should never be used