In taking up the subject of the bottle-fed baby, we must repeat that the only perfect baby food on earth is the milk that comes from the breast of a healthy mother.

But sudden illness, accident, chronic maladies, or possibly the death of the mother, often throw the helpless babes out into a world of many sorts and kinds of artificial foods—foods that are prepared by modifying cow's, ass', or goat's milk; foods arranged by the addition to the milk of various specially prepared cereals, albumens or malted preparations, otherwise known as "proprietary foods." We shall endeavor, then, in this chapter and in that on "the feeding problem," to lay down certain general suggestions to both the nurse and the mother, which may assist them in their effort to select the food which will more nearly simulate nature's wondrous mother-food, and which will, at the same time, be best suited to some one particular baby.

THE HOURLY SCHEDULE

The normal baby, from birth to six months, should receive properly prepared nourishment every three hours, beginning the day usually at six a. m., the last feeding being at nine p. m. During the early weeks an additional bottle is given at midnight, but this is usually discarded at four months, at which time the last feeding should be given at about ten instead of at nine at night.

Should the baby continue to awaken during the night before six in the morning, unless he is under weight, a bottle of warm, boiled, unsweetened water should be given.

QUANTITY OF FOOD

The quantity of food to be given is always determined by the size of the baby's stomach, which, of course, depends somewhat upon the age of the child; for instance, the stomach of the average baby one week old holds about one ounce, while at the age of three months the stomach holds five ounces; so it would not only be folly to give two ounces at one week and seven ounces at three months, but it would also be very detrimental to the babe, causing severe symptoms due to the overloading of the stomach.

Careful study of the size of the stomach at different ages in infancy, together with the quantity of milk drawn from the breast by a nursing baby, has led to the following conclusions regarding the capacity of the baby's stomach:

REFRIGERATOR NECESSITY

It is highly important that the day's feedings be kept in a cold place, free from the odors of other foods as well as free from dust, flies, and filth. In order that this may be accomplished, the well-protected bottles, each containing its baby-meal, are placed in a covered pail containing ice and water. This covered receptacle is now put in an ice box; and, in order that our most economical reader—one who may feel that she cannot afford to keep up the daily expense of the family refrigerator—may herself prepare a simple home refrigerator, the following directions are given (Fig. 9).

HOMEMADE ICE BOX

Procure a wooden box about eighteen inches square and sixteen or eighteen inches deep and put four inches of sawdust into the bottom; now fill in the space between a ten-quart pail, which is set in the middle of the box with more sawdust. A cover for the box is now lined with two or three inches of newspaper, well tacked on, and is fastened to the box by hinges. We are now ready for the inside pail of ice, into which is carefully placed the well-protected bottles of milk, all of which is then set into the ten-quart pail in the box. Five cents worth of ice each day will keep baby's food cool, clean, and provide protection against the undue growth of germs.

PREPARING THE BOTTLE

At each feeding hour, one of baby's bottled meals is taken from the ice box and carefully dipped in and out of a deep cup of hot water. A very convenient receptacle is a deep, quart aluminum cup, which may be readily carried about. The hot water in the cup should amply cover the milk in the bottle (Fig. 10).

To test the warmth allow a few drops to fall on the inner side of the arm, where it should feel quite warm, never hot. A baby's clean woolen stocking is now drawn over the bottle, which keeps it warm during the feeding. No matter how great the danger of offending a fond grandparent or a much adored friend never allow anyone to put the nipple in her mouth to make the test for warmth of baby's food.

There are many contrivances, both electrical and alcoholic, for heating baby's bottle, many of which are both convenient and inexpensive.

POSITION DURING FEEDING

And now we realize that we are about to advise against the time-honored injunction which has been handed down from "Grandma This" and "Mother That" to all young mothers who have lived in their neighborhoods: "My dear young mother, if you can't nurse your precious infant, you can at least 'mother it' at the nursing time by holding it in your arms and gently rocking it to and fro as you hold the bottle to its lips." This so-called "mothering" has resulted in regurgitation, belching, and numerous other troubles, as well as the formation of the "rocking habit."

A young mother came running into my office one day saying: "Doctor, it won't work, the food's all wrong; my baby is not going to live, for he throws up his food nearly all the time." We arranged to be present when the next feeding time came and watched the proceedings. A dear old friend had told her "she must 'mother' her baby at the nursing time," and so she had held the child in a semi-upright position as she endeavored to hold the bottle as near her own breast as was possible. The hole in the nipple was a bit large, which occasioned the subsequent bolting of the food, and then to continue the "mothering" she swayed him to and fro, all of which was interrupted suddenly by the vomiting of a deluge of milk.

I drew the shade in an adjoining room, opened the windows, and into a comfortable carriage-bed I placed the baby on his side. Seating myself beside him I held the warm, bottled meal as he nursed. Several times I took it from his mouth, or so tipped it that "bolting" was impossible. Gradually, carefully, and slowly, I took the empty bottle away from the sleepy babe, and as I closed the door the mother said in anxious amazement: "He won't forget I'm his mother if I don't hold him while he nurses?" You smile as I smiled at this girl-mother's thought; but, nevertheless there are many like her—anxious, well-meaning, but ignorant.

The infant stomach is little more than a tube, easily emptied if the baby's position is not carefully guarded after nursing. No bouncing, jolting, patting, rocking, or throwing should take place either just before, during, or immediately after meals.

TIME ALLOWANCE FOR ONE FEEDING

From twelve to twenty minutes is long enough time to spend at a bottle meal. The nipple hole may have to be made larger, or a new nipple with a smaller hole may have to be purchased. When new, you should be able to just see a glimmer of light through the hole, and if the infant is too weak to nurse hard, or the hole too small, it may be made larger by a heated hatpin run from the inside of the nipple out; great care must be taken, else you will do it too well. If the nipple hole is too large, bolting is the sure result; while too small a hole results in crying and anger on the part of the hungry child, because he has to work too hard to get his meal.

AFTER THE FEED

We have seen some mothers, in their anxiety to prevent the sucking in of air from the emptied bottle, rush in and jerk the nipple from the going-to-sleep babe so forcibly that all thoughts of sleep vanished and a crying spell was initiated. The tactful mother is the quiet one who slowly, quietly, draws the empty bottle with its "much loved nipple" from the lips. If you observe that the babe is going to sleep, with an occasional superficial draw at the nipple, wait a moment; he will drop it himself, and you can pick it up as you quietly leave the room. In all instances, whether it be indoors or out of doors, arrange the babe in a comfortable sleeping position, remembering that nursing is warm exercise and the babe gets uncomfortably sweaty if overbundled, especially about the head and neck. No one should unnecessarily touch the babe immediately after feeding; even his diaper may be changed without awakening him while he is thus lying quietly in his bed.

INTERVALS BETWEEN MEALS

The three-hour interval is reckoned from the beginning of the meal, and not from its close. More than two hours is spent in the stomach digestion, and any food or sweetened water which may enter between meals only tends to cause indigestion and other disturbances. And that this important organ may have a bit of rest, we fix the interval at three hours, which in our experience and that of many other physicians, has yielded good results. As a rule we have no regurgitation and no sour babies on the three-hour schedule. Sick babies, very weak babies, and their feeding time, will be discussed in a later chapter.

ADDITIONAL FOODS

At six months, and often as early as four, in cases of constipation, unsweetened, well-strained prune juice may be given, beginning with one-half teaspoon one hour before the afternoon feed and increasing it daily until two tablespoons are taken. At six months, both orange juice and vegetable broths are given, whose vegetable salts add a very important food element to the baby's diet—an element which our grandmothers thought could only be obtained through the time-honored "bacon rind" of by-gone days.

Orange juice is also unsweetened and well strained, and is administered in increasing amounts, beginning with one-half teaspoon one hour before the afternoon feeding, until the juice of a whole orange is greedily enjoyed by the time of the first birthday. The vegetable juices are obtained from cut-up spinach, carrots, tomatoes, and potatoes, strained, with a flavor of salt and onion—really a bouillon—and is given just before the bottle at the six p. m. feeding. They are also begun in teaspoon amounts.

FOOD FOR THE TRAVELING BABE

Baby travel should be reduced to a sheer necessity; never should the babe be subjected to the exposure of disease germs, the change of food, the possibilities of draughts and chilling, for merely a pleasure trip—the risks are too great and the possibilities of future trouble too far reaching.

If you are in touch with the milk laboratory of a large city, you will find that they make a specialty of preparing feedings which are good for a number of days for the traveling baby, and we strongly advise that their preparations be accepted; but in the event of not being in touch with such a laboratory we suggest the making of a carrying ice-box covered with wicker, which must be kept replenished with ice. Food kept in such a device may be kept fresh for twenty-four to forty-eight hours. Plans other than the laboratory preparations or the ice-box are risky, and should not be depended upon.

Many of our railway dining cars now pick up fresh, certified milk at stations along the line for use on their tables, and where such is the case fresh preparations of milk may be made on a trans-continental trip by the aid of an alcohol stove. Malted milk may also be used, provided you have accustomed the baby to its use a week before leaving home, by the gradual substitution of a fourth to a half ounce each day in the daily food; all of which, of course, should be done under your physician's direction.

If possible, leave baby at home in his familiar, comfortable environment in the care of a trained nurse and a trusted relative, and under the supervision of the baby's own physician. He is much better off, much more contented, and we are all aware of the fact that contentment and familiarity of sights and people promote good appetite, good digestion, and happiness—the very essentials of success in baby feeding. We speak touchingly and sympathetically to the mother who must leave her babe; and likewise we wish to cheer her as we remind her that by wireless messages and night letters it is possible to keep in touch with loved ones though a thousand miles away.

The sanitation and modification of cow's milk, as well as stools, etc., are taken up in later chapters.

RULES FOR THE BOTTLE-FED

1. Never play with a baby during or right after a meal.

2. Lay the baby on his side when nursing the bottle.

3. Three full hours should intervene between feedings.

4. Don't give the food too hot—it should just be warm.

5. Make the test for warmth on the inner side of your arm.

6. Give a drink of water between each meal if awake.

7. Never save the left-overs for baby.

8. If possible, give three feedings each day in the cool air, with baby comfortably warm.

9. Do not jump, bounce, pat, or rock baby during or after meals.

10. Never coax baby to take more than he wants, or needs.

11. No solid foods are given the first year.

12. Orange juice may be given at six months; while, after four months, unsweetened prune juice is better than medicine for the bowels.