The Care and Feeding of Children by L. Emmett Holt (epub read online books .TXT) 📖
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What are the important things to be secured in nursery refrigerators?
Absolute cleanliness is essential; hence the inner portion should be of metal. Those made entirely of metal are unsatisfactory as in them the ice melts very quickly. If the ordinary metal refrigerator sold is encased in a wooden box, we have the best form. Another easy way of securing the same result Is to make for the refrigerator a covering or "cosey" of felt or heavy quilting, which can be easily removed when wet or soiled.
The compartments of the refrigerator should be so arranged that the bottles of milk are either in contact with the ice or very near it. The supply of ice should be abundant. Often the amount of ice is so small, and the bottles so far away, that the temperature of the milk is never below 60° or 65° F. To be really effective a refrigerator should have a temperature where the milk is placed of not over 50° F. The temperature should be tested with the nursery thermometer from time to time to ascertain what results are being obtained. Spoiled milk owing to a faulty refrigerator is to be blamed for many attacks of acute illness among infants. Next to the feeding-bottles it is the one thing in the nursery which should receive the closest attention.
THE MODIFICATION OF COW'S MILK
Can cow's milk be fed to infants without any changes?
No; for although it contains similar elements to those in mother's milk, they are not identical, and they are not present in the same proportions.
Is this a matter of much importance?
It is of the greatest importance. There are few infants who can digest cow's milk unless it is changed. To change cow's milk so as to make it more nearly resemble mother's milk is called modifying cow's milk.
How is this milk whose proportions have been changed distinguished from the original unchanged milk?
The changed milk is usually called "modified milk"? the original unchanged milk is known as "plain milk," "whole milk," "straight milk," or is referred to simply as "milk."
What are the principal differences between cow's milk and mother's milk?
Cow's milk has a little more than half as much sugar; it has nearly three times as much proteids and salts; its proteids are different and much more difficult of digestion; its reaction is decidedly acid, that of mother's milk is faintly acid or neutral.
Are there any other important things to be considered?
Yes; mother's milk is always fed fresh and is practically sterile. Cow's milk is generally kept twenty-four hours and sometimes much longer. It is always to a greater or less degree contaminated by dirt and germs, the number of which increases rapidly (1) with the age of the milk; (2) in proportion to amount of the dust or dirt which enters it; (3) with any increase in the temperature at which the milk is kept.
It is just as important for success in infant feeding that these conditions receive attention as that the proportions of the different elements of the milk are right.
How is the acidity of cow's milk overcome?
By the addition of lime-water or bicarbonate of soda. If lime-water is used, one ounce to twenty ounces of food is generally required; if soda is used, twenty grains to twenty ounces of food.
If there is a tendency to constipation the milk of magnesia (Phillips's) may be used; from one half to one teaspoonful being added to each twenty ounces of food.
How is the sugar best increased?
By adding milk sugar to the food; one ounce to each twenty ounces of food will give the proper quantity for the first three or four months. This will make the proportion about the same (between 6 and 7 per cent) as in mother's milk.
How should the sugar be prepared?
Simply dissolved in boiled water; if the solution is not clear, or if there is a deposit after standing, it should be filtered by pouring through a layer of absorbent cotton, half an inch thick, which is placed in an ordinary funnel.
Will not cane (granulated) sugar answer as well?
Not as a rule; however, there are many infants who get on very well when cane sugar is used. It has the advantage of being much cheaper. A good grade of milk sugar is somewhat expensive, costing from twenty-five to sixty cents a pound, and cheap samples are apt to contain impurities.
If cane sugar is used, what amount should be added?
Considerably less than of the milk sugar. Usually about half the quantity (half an ounce to twenty ounces of food) is as much as most infants can digest If the same quantity is used as of the milk sugar, the food is made unduly sweet, and the sugar is likely to ferment in the stomach and cause colic.
Is not the purpose of the sugar to sweeten the food in order to make it palatable?
Not at all; although it does that, its real use is to furnish one of the essential elements needed for the growth of the body, and the one that is required by young infants in the largest quantity.
How do we know that this is so?
By the fact that in good breast milk the amount of sugar is greater than that of the fat, proteids, and salts combined.
We have seen that cow's milk has nearly three times as much proteids (curd) and salts as mother's milk. How are these to be diminished?
By diluting the milk.
Will it be sufficient to dilute the milk twice (i.e., add two parts of water to one part of milk)?
Not for a very young infant. Although this will give about the quantity of proteids present in mother's milk, the proteids of cow's milk are so much more difficult for the infant to digest, that in the beginning it should be diluted five or six times for most infants.
If cow's milk is properly diluted and lime-water and sugar added does it then resemble mother's milk?
No; the mixture contains too little fat.
What is the easiest way of overcoming this?
By increasing the fat in the milk before dilution. It may be done by using top-milk or a mixture of milk and cream.
What is top-milk?
It is the upper layer of milk removed after standing a certain number of hours in a milk bottle, glass jar, or any tall vessel with straight sides. It contains most of the cream and some of the milk just below.
The strength of the top-milk is measured by the fat it contains—e.g., a 10-per-cent milk contains 10 per cent fat; 7-per-cent milk contains 7 per cent fat, etc. These are the two strengths of top milk most used in infant feeding.
On what does the percentage of fat in top-milk depend?
1. On the length of time the milk has stood.
2. On the manner in which the top-milk is removed.
3. On the number of ounces removed.
4. On the richness of the milk used.
Unless these are known it is impossible to say even approximately how strong in fat the top-milk is.
When and how should top-milk be removed?
If milk fresh from the cow, or before the cream has risen, is put into bottles and rapidly cooled, the top-milk may be removed in as short a time as four hours. In the case of bottled milk it makes little difference if it stands a longer time, even until the next day. The best means of removing it is by a small cream-dipper[2] holding one ounce; although it may be taken off by a spoon or siphon. It should not be poured off.
How can we obtain a 10-per-cent top-milk with the different kinds of cow's milk?
From a rather poor milk (containing 3—3½ per cent fat) by removing the upper eight ounces from a quart, or one fourth.
From a good average milk (containing 4 per cent fat) by removing the upper eleven ounces from a quart, or about one third.
From a rich Jersey milk (containing 5—5½ per cent fat) by removing the upper sixteen ounces, or one half.
How can we obtain a 7-per-cent top-milk with the different kinds of cow's milk?
From a rather poor milk, by removing the upper eleven ounces from a quart, about one third.
From a good average milk, by removing the upper sixteen ounces, or one half.
From a rich Jersey milk, by removing the upper twenty-two ounces, or about two thirds.
The percentage of fat in the different layers of milk
of good average quality.
What is cream?
Cream is often spoken of as if it were the fat in milk. It is really the part of the milk which contains most of the fat. It differs from milk chiefly in containing much more fat.
In what ways is cream now obtained?
(1) By skimming, after the milk has stood usually for twenty-four hours? this is known as "gravity cream." (2) By an apparatus known as a separator; this is known as "centrifugal cream"; most of the cream now sold in cities is of this kind. The richness of any cream is indicated by the amount of fat it contains.
The usual gravity cream sold has from 16 to 20 per cent fat. The cream removed from the upper part (one fifth) of a bottle of milk has about 16 per cent fat. The usual centrifugal cream has 18 to 20 per cent fat. The heavy centrifugal cream has 35 to 40 per cent fat.
FOOD FOR HEALTHY INFANTS[3]—THE EARLY MONTHS
What are the most important points to be remembered in modifying cow's milk for feeding during the early months?
That of the different ingredients of milk the sugar is most easily digested; the fat is next; while the proteids are the most difficult.
What relation should the fat bear to the proteids during this period?
For most infants with good digestion the best results are obtained when the fat is three times the proteids. However, this is not true of all. There are many healthy infants who are unable to digest this proportion of fat, and who do much better when the fat is made only twice the proteids.
How can one obtain formulas in which the fat is three times the proteids?
By using for dilution a 10-per-cent milk (i.e., milk containing 10 per cent fat) which serves as the primary formula from which all the other formulas of this series are derived.
In 10-per-cent milk the fat is just three times the proteids.
How can one get the 10-per-cent milk?
(1) As top-milk, as described on page 64; or, (2) by mixing equal parts of plain milk and ordinary cream (containing about 16 per cent fat); (3) from any of the milk laboratories it may be ordered directly.
Is it better to obtain the 10-per-cent milk by using a mixture of milk and cream, or as top-milk?
If one can get milk fresh from the cows, the top-milk is to be preferred on account of freshness. The food can then be made up when the milk is but a few hours old. In cities, if one uses bottled milk, the upper third may also be used. But if one buys milk and cream separately, it is usually more convenient to mix these, as the cream will not rise upon milk a second time with any uniformity.
How can one obtain formulas in which the fat is twice the proteids?
By using for dilution a 7-per-cent milk (i.e., milk containing 7 per cent fat) which serves as the primary formula from which all the other formulas of this series are derived.
In 7-per-cent milk the fat is just twice the proteids.
How
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