In taking up this part of our study on nutrition, there are several points to be kept in mind by the nurse: (1) that it will be difficult, if not impossible, to understand the metabolic changes taking place in abnormal conditions unless those occurring in the normal human body are understood; (2) that certain diseases are due directly to errors in diet; (3) that in other diseases, diet plays the chief part both in the bringing about and in the relieving of the conditions; (4) whereas there are certain other diseases not affected by diet, save in so far as well or poorly selected and prepared food always affects the individual, whether normal or abnormal, and that in the latter conditions the organism is more susceptible to bad influences. This being the case it behooves the nurse to examine herself to find whether or not she understands the fundamental principles underlying the nutrition of the human body, that she may efficiently deal with the changes which occur more or less when the body is attacked by disease. We include normal infant feeding in this section, because in no other age is it quite so necessary for care to be observed in formulating and carrying out a diet. Errors during this period may only appear to exert a local influence, causing disturbance which may readily be relieved, but the danger is in laying too little stress upon these disturbances, forgetting that the delicate organism of a child may be permanently injured by a constant disregard of nature’s mandates. In the words of the old adage, the pitcher may go once too often to the well, and an injured digestive apparatus is even more difficult to mend than the proverbial pitcher. Age and Weight.—As has already been stated, there are certain points to be kept in mind in attempting to provide an adequate diet for the human machine; First, the age and weight. The gain during infancy should be steady—an allowance of 40 calories per pound of body weight to cover the energy requirements and 4 protein calories per pound to cover the nitrogen needs. During the second and third years the energy requirements will be covered by 30 to 40 calories per pound and the nitrogen needs by 3 to 4 protein calories per pound. From the fifth to the eighth year the nitrogen needs continue to be covered by 3 to 4 protein calories per pound and the energy requirements by 35 to 37 calories per pound during the fifth year; 32 to 34 calories per pound during the seventh year. After the body has reached its full development its requirements will be met if sufficient protein is provided to cover its maintenance needs and if the energy calories are regulated according to the amount of exercise taken, keeping in mind that the energy requirements of a man at rest (sitting) will be about 2,000 calories per day and that exercise, especially that taken in the open air, raises the energy needs of the body. Daily Gain.—In estimating the relative daily gain in body weight of children of different ages, Mendel TABLE
NORMAL INFANT FEEDINGMuch has been written in the past few years on the care and feeding of infants and children. This is well, since statistics show an alarming increase in the rate of infant mortality during the early years of life, and anything which can be done to check this lamentable and often avoidable waste of valuable life should be resorted to with care and attention. Food for Infants.—The natural food of all young mammals is the milk of their own mother. The rate of growth and development differs in every species; the calf, for example, doubles birth weight much more quickly than does the baby of the same age. However, the milk of the cow, which meets the needs of the calf perfectly, falls short of meeting the requirements of the infant, whose rate of growth is not nearly so rapid. For this reason if for no other, it would be advisable to give the baby its natural food rather than to attempt a substitute which is, at best, a poor one. Weight.—The average infant weighs from six to seven pounds at birth. This weight should be doubled in the first five or six months of life and tripled by the end of the first year. The most important business, then, in the life of the child during the early years is growth and development. To achieve this properly the baby’s habits must be adjusted to his needs. Regularity in Feeding.—He must have the proper food and enough of it, and have it given at regular intervals, The Bowels.—The bowels should move several times a day, the stools being smooth and of a yellowish color, of the consistency of pea soup. After the first month, twice a day is about the normal number of stools for the healthy baby. The infant should be placed upon a vessel held in the lap of the nurse at regular times, preferably right before the morning bath, and in the evening. In this way regularity in evacuating the bowels is obtained, and a habit formed which will prove valuable through life. The Bath.—The daily bath is likewise necessary for the health and comfort of all babies; so, too, are fresh air and sunshine. As has already been stated, breast milk is much better for babies than cow’s milk or any artificial food. There is something in the mother’s milk which gives strength and resistance to the baby which is absolutely lacking in any other food no matter how carefully it is selected and prepared, and for this reason young mothers must be prevailed upon to nurse their babies whenever it is possible for them to do so. When circumstances, such as having to be away all day at work, make it impossible for a mother to nurse her baby at regular intervals, she can be taught how necessary are two or three breast feedings a day to the future welfare of her child. When social reasons or lack of desire on the part of the mother make her unwilling to nurse her baby, it is the part of the nurse to lay the case before her and let her judge whether or not she is willing to accept the responsibility of bringing into the world a Habits of Mother.—The mother must be taught how to efficiently nurse her baby; she must keep in mind that upon her good health and temperate habits depend the health and comfort of her baby. It devolves upon her to provide food efficient in quality and quantity. To do this, her own diet must be simple and wholesome. The nursing mother must remember that she has to provide, not only for her own maintenance and energy requirements, but also for the infant whose fuel requirements are ever demanding more food to provide for its rapid growth. Food and Its Relation to Milk.—It is believed that two calories of food extra are necessary to produce one calorie of milk, and since a month-old baby requires 2? ounces of mother’s milk to every pound of his body weight, and one ounce of mother’s milk will yield 20 calories, it is clearly seen that the mother will have to increase her diet to cover the requirements of the baby. For example, if the baby weighed 12 pounds, he would require 28 ounces of milk in 24 hours, or 560 calories. Thus if it requires two calories of extra food to make one calorie of milk, the mother’s diet would have to provide 1,120 calories extra, or about as much food as would fulfill the needs of a laboring man, 3,000 to 3,500 calories, even if she were doing practically no actual work; while if she were actively employed and doing a certain amount of physical labor, her rations would have to approximate those of a man doing heavy muscular work (about 3,500 to 4,000 calories per day). Breast Milk versus Cow’s Milk.—Consensus of opinion shows that breast-fed infants require less energy than the ones who must be nourished artificially. This is probably due largely to the fact that the constituents of human milk are in a more available form than those in cow’s milk, the Rules and Regulations.—It is not possible to lay down hard and fast laws to cover the subject of infant feeding. The food must be adapted to the individual needs of the baby in question. The nurse must see that the milk is obtained from a responsible dealer, certified milk being of course the safest. The bottles of milk should be wiped off carefully and placed directly on the ice as soon as they are received. The milk generally used in infant feeding has a fat content of 4%. That having a higher percentage of fat is technically cream. The following table showing the TABLE
Seven per cent. (7%) cream is obtained from the upper 16 ounces of a quart bottle of milk which has been allowed to stand undisturbed for six hours. The upper third of the bottle contains 10% fat, while the whole fat layer from the quart bottle, regardless of the number of ounces, contains about 16% of fat. Methods of Artificial Feeding.—The use of whole milk, top milk, or skimmed milk, diluted with water, and either milk sugar, malt sugar, or sucrose (cane sugar) added, is the method of feeding most commonly used, and upon it are based the formulas universally advised by infant specialists. There are cases in which simple dilution is not advisable. In premature or very young infants, for example, the whey mixtures have been found to give the best results. In toxic diarrheas, where the putrefactive bacteria make the use of all but the minimum amount of protein inadvisable, the above method is contraindicated, as it is likewise in cases where vomiting of casein curd is a prominent feature. The Use of Alkalies.—There are many cases in which Amount and Type of Alkali Used.—The amount of alkali The addition of any alkali to the formula is resorted to if the symptoms indicate the need for it, but the type and quantity is entirely within the province of the physician, not the nurse. The Addition of Sugar.—Lactose is the form in which the carbohydrates are found in milk, and it has been a general rule to employ this sugar in making up the sugar content of a formula, using from 6 to 7% of the mixture in this form to cover the necessary energy requirements of the infant. Other sugars are used, however; and of late years malt sugar has been widely employed for this purpose. The form now generally accepted is known as dextri-maltose, which is a combination of dextrin and maltose, both of which are readily acted upon by the sugar-splitting enzymes of the digestive juices. In digestion, lactose or milk sugar is split to dextrose and galactose and utilized in the body, both as a source of energy and as a food for the lactic acid bacteria which are active in the small intestine. Malted Foods.—The addition of malted foods or malt sugar to the food of infants tends to bring about a more rapid gain, both in energy and in body weight, than is generally the case where other sugars are used. This sugar is used as a substitute for milk sugar in many formulas, especially in those cases in which the casein of cow’s milk needs to be made more digestible in form. Malt sugar is indicated in the following conditions: Malt sugar (dextri-maltose) is contraindicated to a slight degree in cases “of simple acute diarrhea where lactose, by supplying fermentative media, more easily restores the normal bacterial balance.” Diluents.—Barley and oatmeal water are used as diluents to the amount of one-fourth or more of the mixture. Oatmeal water or jelly is used more during the winter months than in the hot summer months. As the fat content of the oatmeal gives it a more laxative effect, it is undesirable to use it at the season in which the summer diarrheas are prevalent. Barley water has something of a colloidal action upon the casein, causing the curds to be finer and less tough in character. Both barley and oatmeal water are used in place of plain water for babies when this colloidal effect upon the curd of the milk is desired, also where the weight of the infant shows a disposition to remain stationary, especially where there are no other symptoms to account for the lack of gain. Whey is used with babies who cannot digest the insoluble protein of cow’s milk. This is often the case in premature babies and is manifested by a persistent vomiting of curd. The energy requirements are obtained by the addition of cream and lactose to the whey. Buttermilk Mixtures and “Eiweissmilch.”—It is often found desirable to use some other form of milk than whole, top, or even skimmed milk, and for this purpose lactic acid, milk and the albumen or “Eiweissmilch” are substituted. In the buttermilk mixtures the precipitation of the casein is brought about by lactic acid bacilli (Bulgarian culture). This prevents the coagulation of the casein into tough curds. Lactose buttermilk or lactic acid milk is used in the feeding of infants who have persistent green stools, and in cases of Buttermilk is more difficult to administer to babies than formulas made from plain milk by reason of its flavor. However, the results are remarkable in the above-mentioned conditions. “Eiweissmilch” is used in atrophic cases where there are bad green stools. “Homogenized Milk.”—Dr. Ladd of the Children’s Hospital in Boston has presented many cases of infants who showed an intolerance for butter fat. These cases he has treated with formulas containing foreign fat, usually olive oil. This milk is subjected to a treatment which brings about a more complete emulsification of the fat than is possible in cow’s milk, causing it to resemble in character the quality of the mother’s milk. Homogenized milk has been used with success in cases where it was impossible to supply the infant with breast milk. The process is accomplished by the use of an apparatus known as an “homogenizer” Technique of Milk Modification.—The absolute necessity for cleanliness has already been dwelt upon in respect to milk, and in infant feeding the vigilance which must be observed in the preparation of the food cannot be too strongly emphasized. The milk itself must be of known purity. Where there is any uncertainty about its source, it The morning is the best time in which to prepare the baby’s food; the milk has not stood too long and it is easier to regulate the feedings if a fresh start is made each morning. Let the bottles and the rubber corks with which they must be stopped be boiled and cooled while the milk mixture is being prepared. Preparation of Diluents.—If barley or oatmeal water is to be used as a diluent, let that be prepared first, that it may be cool before adding it to the milk. Cover the table with a clean cloth or oilcloth, upon this place the pitcher in which the milk is to be modified, have the funnel, milk dipper, and spoon which are to be used boiled with the bottles, cover the mouth of the pitcher with a clean square of gauze or cheesecloth, read the formula carefully and measure the sugar, dextri-maltose, lactose, Mellin’s Food, or cane sugar as directed and place it in a clean glass; now measure the diluent, water, oatmeal water, barley water, or whey; use part of this diluent to dissolve the sugar. Measuring Milk according to Percentage of Fat.—Now dip off the required layer of top milk, that is, the layer Pasteurizing the Milk.—The corks are then adjusted, the bottles placed in the pasteurizer Amount Given at Each Feeding.—At birth a baby will usually take from one half to one ounce at each feeding, this amount is increased at the rate of a quarter of an ounce each week until the baby is receiving eight ounces at each feeding. Or the food is measured to allow of from one ounce to an ounce and a half more than the child’s age in months. For example a baby six months old would receive from Method of Calculation of Formula.—The calculation of a formula consists in determining the amount (in grams or ounces), of the various constituents contained in the formula when the percentage of each is known. Or, in determining its percentage composition when the amount of fat, protein, carbohydrate and diluent is given. There are certain inaccuracies in all simple methods of calculation and the use of the Babcock tester to determine the fat content in the milk to be used, is advised in all milk or formula rooms. The following method of calculation has been found satisfactory, and the nurse must master it in order to intelligently carry out the directions of the pediatrist. Determining the Composition of Formula. It is always essential before beginning the calculation of the formula, to know what percentages of fat, sugar, and protein it is to contain, and the amount to be given in twenty-four hours; it is also necessary to know how much lime water is to be added if this substance is to form a part of the formula. Suppose a thirty-two-ounce mixture is to be made containing 3% of fat, 6% of sugar, 2% of protein, and lime water sufficient to equal 25% of the cream and skimmed milk in the mixture. The fat in the food must be derived from cream, since it is the only substance containing fat to be used in the formula. If the food was composed entirely of gravity cream it would contain 16% of fat. Since it is to contain but 3% of fat it is evident that only 3/16 of the mixture must be gravity cream, 3/16 of thirty-two ounces is six ounces. Six ounces of gravity cream will, therefore, provide the 3% of fat desired in the mixture. The gravity cream contains protein as well as fat. There are six ounces of gravity cream in the thirty-two-ounce mixture. The protein content of gravity cream is 3.2%. The protein content of a thirty-two-ounce mixture containing six ounces of gravity cream is evidently 6/32 of 3.2% or 0.60%. Two per cent protein is, however, desired in the mixture. The gravity cream has provided only 0.60%. One and forty hundredths per cent of protein, the difference between the percentage of protein desired and that furnished by the gravity cream, must be obtained in some other way. It must be obtained, moreover, from some substance which does not contain fat. Skimmed milk is such a substance. Skimmed milk contains 3.2% protein. In order to get 1.40 per cent in the mixture by the Both gravity cream and skimmed milk contain 4.50% milk sugar. Twenty ounces of gravity and skimmed milk are required to furnish the desired percentages of fat and protein. These twenty ounces in a thirty-two-ounce mixture must add 20/32 or 4.50% of sugar to the mixture. Twenty thirty-seconds of 4½ or 20/32 of 9/2 = 180/64, or practically 3% of milk sugar. It is, however, desired to have 6% of milk sugar in the mixture. That is, 3% more of milk sugar is required. This additional sugar must be added in the form of dry milk sugar. Three per cent of thirty-two ounces is 3/100 of thirty-two. This will give the amount of sugar desired in ounces. The sugar is to be measured in rounded tablespoonfuls, or half ounces. If the figures given above are multiplied by two, the result will be the number of rounded tablespoonfuls needed. That is, 3/100 of 32 × 2 = 192/100 rounded tablespoonfuls, or for all practical purposes, two rounded tablespoonfuls. It is also desired to have the amount of lime water in the mixture equal to 25% of the cream and milk in the mixture. There are twenty ounces of cream and milk in the mixture. Twenty-five per cent of twenty ounces is five ounces. Five ounces of lime water must therefore be added. The total quantity of the mixture is to be thirty-two ounces. The milk sugar goes into solution and, therefore, does not add to this quantity. The difference between thirty-two and twenty-five ounces is seven ounces. Seven ounces of water must, therefore, be added to make up the quantity desired. Changing the Formula.—It is often found necessary to change the formula when using artificial feeding for Morse and Talbot’s Method.—Suppose that a baby is taking a food made up of—
“The barley water is made with two teaspoonfuls of barley flour in a pint of water. The total quantity of the mixture is 48 ounces. Gravity cream contains 16% fat. Twelve ounces of gravity cream in a 48-ounce mixture will give, therefore, 12/48 of 16% of fat, or 4% fat. Both gravity cream and skimmed milk contain 3.20% protein. There are 30 ounces of gravity cream and skimmed milk in the mixture; 30 ounces in a 48-ounce mixture will give 30/48 of 3.20% of protein, or 2.00% of protein. Both gravity cream and skimmed milk also contain 4.50% of sugar. Thirty ounces of gravity cream and skimmed milk in a 48-ounce mixture will therefore furnish 30/48 of 4½ which is the same as 30/48 of 9/2 or almost 3.00% of milk sugar. Four rounded tablespoonfuls of milk sugar are equal to two ounces. Two ounces of sugar in a 48-ounce mixture is equal to 2/48 of 100% or 4%. The total percentage of sugar is, therefore, 7%. Two teaspoonfuls of barley flour in a pint of water makes a 1.50% decoction of starch. Twelve ounces of barley water of this strength in a 48-ounce mixture will give 12/48 of 1.50% or about 0.35% starch. There are six ounces of limewater in the mixture and 30 ounces of gravity cream and skimmed milk. 6/30 of 100% is 20%. The If, therefore, the nurse will follow out the plan suggested by Drs. Morse and Talbot, it should be a simple matter to change the percentage of any of the food constituents in any formula. The following schemes for feeding well babies are included to facilitate the work in the home. A nurse may teach the mother the manner in which these schemes are used, keeping in mind that there can be no iron clad rule for feeding all babies. No nurse should recommend a formula without directions from a physician. And no formula should be changed without his permission. The following milk formulas are used in the Nathan Straus Pasteurized Milk Laboratories of New York: Formula No. 1.—Infants from 1st to 4th week, by A. R. Green. 24 ounces of mixture divided into 8 feedings of three ounces each, fed at intervals of 2½ hours: ¾ oz. 16% cream Formula No. 2.—Infants 1st to 3d month, by Dr. R. G. Freeman. 1½ oz. 16% cream Divided into 6 feedings of 3 oz. each, fed 3 hours apart. 18 oz. full milk Divided into 6 feedings of 6 ounces each, fed at intervals of 3 hours. Formula No. 4.—Infants 3d to 7th month, by Dr. A. Jacobi. 18 oz. full milk Divided into 6 feedings of 6 ounces each, fed at intervals of 3 hours. Formula No. 5.—Infants 7th to 9th month, by Dr. A. Jacobi. 2½ oz. full milk Divided into 5 feedings of 6 ounces each, fed at intervals of 3½ hours. SCHEME FOR FEEDING NORMAL INFANTS(First Year) Scheme based on Holt and Shaw’s “Save the Babies.” Pub. by Am. Med. Ass’n. Whole Milk Method
At the beginning of 7th or 8th month, or earlier if necessary, it is advisable to add orange juice, giving from 1-2 tablespoonfuls between the two morning feedings. After the 4th month it is well to eliminate the night feeding between 10 P.M. and 6 A.M. At end of 11th month add 1-2 pieces of stale bread, toast or zwieback. Part of soft-cooked egg may be given every other day at noon meal by end of 11th month. The orange juice may be increased to 3 tbs. if bowels are not loose. The strained cereal should be given twice daily by the end of the first year, and the milk should be undiluted at this time unless the digestion of the infant forbids. Cooled boiled water should be given several times each day between feedings. Babies cry from thirst as well as from hunger. SCHEME 2For Feeding Well BabiesScheme based on Dr. Richard M. Smith’s “The Baby’s First Two Years.” A full-term baby will usually take a formula made as follows:
After 3d day increase cream and milk at the rate of 1 ounce each week, and sugar 1 tsp. every other day until at one month the baby will be receiving a formula such as—
From this point the formula may be increased by adding 2 ounces of skimmed milk each month until the baby is eight months old. For each ounce of milk added, an equal amount of water should be omitted. The sugar in the formula should be reduced one half tbs. every three months. At six months the baby would be taking—
At eight months— This amount will not be found sufficient in quantity for a twenty-four-hour mixture for children of this age. Increasing the amount of the last formula in the same proportion, it will be—
At this age the formula usually may be changed so as to be made from whole milk instead of cream and skimmed milk. The formula may be made as follows:
From this point on the formula may be increased by replacing the boiled water with whole milk, two ounces each month up to thirteen months. At this age the boiled water may be omitted from the formula one ounce each week. Beginning at the age of eight months the sugar may be eliminated from the formula, one tablespoonful each month. Barley Water.—At the age of five months, or at any time thereafter, barley water may be substituted for boiled water in the formula. Lime Water.—It is frequently found to be advisable to add lime water. It is not necessary in every instance, but should be given if the baby is inclined to spit up, or in cases where the stools are too frequent in number and are slightly green in color. Determining the Fuel Value of a Formula.—The computation of the fuel value of a formula is very essential since the growth and development of the infant depends largely upon whether or not its energy expenditures are well covered. The method is simple, requiring the same methods used in the computing of other dietaries. Take the formula just calculated, its fuel value would be estimated as follows: Thirty-two ounces are equal to 960 grams. In each 100 grams there would be 3 grams of fat, 2 grams of protein and 6 grains of sugar. Hence in 9.6 one-hundred-calorie portions there would be 9.6 × 3—28.8 grams of fat, 9.6 × 2—19.2 grams of protein, and 9.6 × 6—57.6 grams of sugar, in a thirty-two-ounce mixture. To determine the fuel value of the formula, these results must be multiplied by their physiological fuel factors, 9 and 4 and 4 respectively. Thus:
Scheme for Adding Solids to Infants’ Diet.— From 9th to 15th month:
From 15 months to 2½ years:
From 3 to 6 years:
Vegetable Soup
Finely divide the vegetables. Add the vegetables, barley and rice to 2 qts. of water. Boil down to 1 qt., cooking 3 hours. Add pinch of salt. Pass through fine sieve. Morse and Talbot advise baked potato, plain boiled macaroni, rice and wheat germ, bread and butter, baked custard, plain blanc-mange, and plain boiled tapioca to be given when the child is 1½ years old. When the child is nearly two years old they add meat in the most digestible forms, such as the white meat of chicken, lamb or mutton chops, and scraped beef. The following dietary is suggested for a child two years old: “Whole milk, butter, mutton broth, chicken broth, beef juice, soft-cooked eggs, dropped eggs, white meat of chicken, lamb or mutton chops, scraped beef, French bread, stale bread, toasted bread, whole wheat bread, milk toast, zwieback, plain white crackers, plain Educator crackers, barley, jelly, oatmeal, cream of wheat, wheat germ, Ralston’s Farina, rice, baked potato, plain boiled macaroni, orange juice, baked apples, stewed prune pulp and juice, junket, baked custard, cornstarch pudding, plain blanc-mange, plain tapioca. It is not advisable, as a rule, to begin green vegetables until the baby is 2½ years old.” It will be seen in the foregoing dietaries how authorities differ in their beliefs as to the requirements of the child. The dietaries included in this text are selected from those used in different parts of the country by physicians who THE FEEDING OF PREMATURE INFANTSThe digestion of premature infants is naturally not as strong as that of infants born at term. Very little is positively known, but the consensus of opinion goes to show that in the majority of cases the tolerance for sugar is greater than that of either the proteins or fats. The loss of heat is relatively greater in proportion to its surface area in small than in large bodies. This is a well-known fact, hence the premature baby must require more food in proportion to its weight than the baby who is born at the normal time. Then, too, as the premature infant is thinner he does not keep warm like the older infant, and this must be taken into consideration in feeding him. Breast milk is of course by far the best food for such babies, not only because its constituents are in a more available form for the feeble digestive organs, but because the mother’s milk furnishes a resistance which is lacking in even the most carefully modified of milk formulas. Energy Requirements of Premature Infants.—Experiments made upon premature infants have proved that the caloric needs of these babies are greater than in the case of full-time babies; that is, they require more per kilogram of body weight. According to Morse, Necessary Dilution.—Even breast milk must be diluted with an equal amount of water or a 3% sugar solution. The amount of milk should be increased and the amount of dilution decreased until the undiluted breast milk is given in four or five days. Like older babies, the next best food for premature babies is the properly modified cow’s milk, but the utmost care will have to be observed, as these babies are more easily upset than older and stronger ones. Premature Infant Feeding.—The following method of feeding may be suggested, keeping in mind that it is an easy matter to increase the strength of a mixture if the baby shows the need of such an increase. The premature baby is rarely strong enough to take the breast. Method of Administering Milk.—The most satisfactory method of administering the food in such cases is by means of the Brick feeder, which consists of a graduated glass tube, open at either end. On the small end is placed a small nipple like those seen on medicine droppers; this one is perforated and goes into the mouth of the baby. A large rubber finger cot is attached to the other end of the tube. The milk is forced into the mouth by pressing the finger cot. In case the infant is too feeble even for this method of feeding, the desired amount is dropped into the mouth from a medicine dropper; 5 c.c. (about 1 dram or 1 teaspoonful) of diluted milk being given at each feeding. This amount is increased gradually from day to day. Whey Mixtures.—Whey mixtures have been found to meet the needs of premature infants more efficiently than ordinary mixtures. As the proteins in whey are in a more digestible form, they throw less work on the immature The following formulas
or
PROPRIETARY FOODSA word as to the use of Proprietary Infant Foods: These prepared foods may be classified under four heads, as follows: (1) condensed milks; (2) malted foods, those consisting chiefly of carbohydrates in the form of maltose and dextrins; (3) those consisting almost entirely of starch, and (4) those composed partly of soluble and partly of insoluble carbohydrates. (1) Condensed milk may be sweetened or unsweetened. These milks are never given undiluted, the directions calling for one part condensed milk to nine parts water, which gives a mixture containing 0.90% fat, 5.49% sugar, and 0.80% protein if “Eagle Brand” Condensed Milk is used. (2) Malted Foods: Mellin’s Food and malted milk are examples of this group. These foods contain the carbohydrates in soluble form and when added to milk make an acceptable addition, as they furnish the carbohydrates in the most digestible form. When fed alone, diluted only (3) Imperial Granum is an example of this group, and there are several others with similar compositions. These foods are very much like wheat flour which has been subjected to heat, changing to a small extent the starch to dextrose and dextrin. (4) NestlÉ’s Food, Eskay’s Albumenized Food, and Allenbury’s Food are examples of this group, each containing sugar and a percentage of starch. Upon dilution with water, the amount of fat in the mixture is just a trace. Incomplete Foods as a Source of Danger.—The ease with which the majority of these foods are prepared and the way in which they agree with the baby constitute the chief danger of their use. If they are added to milk, with the exception of the condensed milk, they result in a modified milk containing the carbohydrates in a more or less digested form. But they are expensive, and give no better result as a rule than a carefully modified milk containing a cereal gruel. The giving of foods like malted milk alone is dangerous because they are deficient in some of the most necessary constituents, and babies fed in this way, while growing fat, are apt to have soft or brittle bones and muscular tissue higher in fat and water than in protein, so that they do not grow and develop in a normal way, and when they are attacked by the diseases so prevalent in the early years of life, they succumb rapidly, because the resistance given by a properly modified food is lacking. Condensed milks act in a like manner. That is, in the sweetened milks the carbohydrate content is far in excess of the needs, and the proteins and fats are deficient, so that while the baby fattens he does not receive the building foods commensurate with his body requirements. SUMMARYBreast Milk as a Food.—The superiority of breast milk over any other known food cannot be too strongly emphasized. Regularity in Feeding.—The absolute need for regularity in feeding—“feeding by the clock” and not by guess or when the baby cries. Indications of Health.—The normal growth and development to be used as guides as to the physical well-being of the infant; also as an indication of the use of the proper modification of milk for the individual needs of the child. Dilution.—The amount of dilution necessary—cereal waters, whey, etc.—to increase the digestibility and nutrient values of the formula. The Addition of Alkali.—The addition of alkalies to milk formulas to accomplish a like purpose. Milk Sugar, Malt Sugar, Cane Sugar.—The use of the different sugars, namely, dextri-maltose, lactose, or cane sugar under various circumstances as the condition of the infant demands. Substitutes for Whole Milk.—The substitution of different milk, such as lactic acid milk, Bulgarian culture buttermilk, Eiweissmilch, cream and whey mixtures, as the individual needs of the infant demand. Technique of Milk Modifications.—The absolute need Percentage Computation.—A knowledge of percentage, that an accurate computation of a formula may be accomplished. Preparation of Food.—A sufficient knowledge of food preparation to enable the nurse to prepare any food which may be deemed necessary by the physician for the welfare of the child. Water.—The importance of giving the baby water aside from that used in modifying the milk. Many babies cry from thirst when they are believed to be crying from hunger or temper. Increasing the Diet.—The necessity for increasing the amount and strength of the formula with the age, growth, and development of the child by the addition of solid food as soon as the physician deems it advisable. Feeding Premature Infants.—The method of feeding a premature infant differs from that employed in feeding an infant born at term: (a) because its development has not progressed so far; (b) because its digestive apparatus being more or less immature, food handled with ease by an older baby will be totally unfit for the premature one, both as to quality and quantity. Wet Nurse.—The advisability of procuring a wet nurse when the mother is unable to nurse the infant, (a) on account of the more digestible character of the food constituents, especially the proteins, in mother’s milk over those of cow’s milk; (b) on account of the resistance furnished by the natural food which has been proved to be very much greater than that furnished by any other food, no matter how carefully the modification of the milk is made. Premature Infants.—Their caloric needs are greater than in full-term babies, hence their food must be adjusted to meet these needs. PROBLEMS(a) Write a formula for a two months’ old infant weighing twelve pounds, which contains 3% fat, 2% protein, and 6% sugar. (b) Change this formula so that it will contain 3% fat, 1.5% protein, and 6% sugar. (c) Write a formula for an eight months’ old baby, using whole milk instead of cream and skimmed milk. (d) Write a formula for a premature baby containing 1% fat, 4% sugar, and 0.25% protein (allowing 30 calories per pound of body weight). FOOTNOTES: |