,,the ,,care ,,and ,,feeding ,,of ,,children ,a ,,catechism ,,for ,,the ,,use ,,of ,,mothers ,,and ,,children',s ,,nurses ,by ,l4 ,,emmett ,,holt1 ,m4,d41 ,,ll4,d4 ,,professor ,,of ,,diseases ,,of ,,children ,,in ,,the ,,college ,,of ,,physicians ,,and ,,surgeons 7,,columbia ,,university7 ,,attending ,,physician ,,to ,,the ,,babies' ,,hospital ,,and ,,the ,,foundling ,,hospital1 ,,new ,,york ,fourth ,edition1 ,revised and ,enlarged ,,new ,,york ,,and ,,london ,d4 ,,appleton ,,and ,,company #aijg ,,copyright1 #ahid1 #ahig1 #aijc1 #aijf ,by ,d4 ,,appleton ,,and ,,company ,transcriber's ,note3 ,the text scans did not include a ,table of ,contents so the following has been added for the convenience of the reader4 ,,contents ,i4 ,,the ,,care ,,of ,,children ,bathing ,genital ,organs ,eyes ,mouth ,skin ,clothing ,napkins ,nursery ,airing ,weight1 ,growth1 and ,development ,dentition ,,ii4 ,,infant ,,feeding ,nursing ,weaning ,artificial ,feeding ,selection and ,care of ,milk ,used for ,infant ,feeding ,modification of ,cow's ,milk ,food for ,healthy ,infants--,the ,early ,months ,food for ,healthy ,infants--,the ,later ,months ,general ,rules for ,guidance in the ,use of the ,formulas ,given ,addition of ,other ,foods to ,milk ,overfeeding ,loss of ,appetite ,changes in ,food ,required by ,special ,symptoms or ,conditions ,common ,mistakes in ,milk ,modification and ,infant ,feeding ,preparation of ,cow's ,milk at ,home ,directions for ,feeding ,infants ,intervals of ,feeding ,regularity in ,feeding ,sterilized ,milk ,modified ,milk of the ,milk ,laboratories ,peptonized ,milk ,feeding ,during the ,second ,year ,feeding ,during the ,third ,year ,,iii4 ,,the ,,diet ,,of ,,older ,,children ,milk and ,cream ,eggs ,meats and ,fish ,vegetables ,cereals ,broths and ,soups ,bread1 ,crackers1 and ,cakes ,desserts ,fruits ,indigestion in ,older ,children ,general ,rules to be ,observed in ,feeding ,food ,formulas ,,iv4 ,,miscellaneous ,bowels ,sleep ,exercise ,cry ,lifting ,children ,temperature ,nervousness ,toys ,kissing ,convulsions ,foreign ,bodies ,colic ,earache ,croup ,contagious ,diseases ,scurvy ,constipation ,diarrhoea ,bad ,habits ,vaccination ,weight ,charts ,,the ,,care ,,and ,,feeding ,,of ,,children ,,part ,i ,,the ,,care ,,of ,,children ,,bathing ,at what age may a child be given a full tub bath8 ,usually when ten days old2 it should not be given before the cord has come off4 ,how should the bath be given8 ,it should not be given sooner than one hour after feeding4 ,the room should be warm2 if possible there should be an open fire4 ,the head and face should first be washed and dried2 then the body should be soaped and the infant placed in the tub with its body well supported by the hand of the nurse4 ,the bath should be given quickly1 and the body dried rapidly with a soft towel1 but with very little rubbing4 ,at what temperature should the bath be given8 ,for the first few weeks at #ajj deg4 ,f42 later1 during early infancy1 at #ih deg4 ,f42 after six months1 at #ie deg4 ,f42 during the second year1 from #he deg4 to #ij deg4 ,f4 ,with what should the bath be given8 ,soft sponges are useful for bathing the body1 limbs and scalp4 ,there should be a separate wash-cloth for the face and another for the buttocks4 ,what are the objections to bath sponges8 ,when used frequently1 they become very dirty and are liable to cause infection of the eyes1 mouth or genital organs4 ,under what circumstances should the daily tub bath be omitted8 ,in the case of very feeble or delicate infants on account of the exposure and fatigue1 and in all forms of acute illness except by direction of the physician4 ,in eczema and many other forms of skin disease much harm is often done by bathing with soap and water1 or even with water alone4 ,,genital ,,organs ,how should the genital organs of a female child be cleansed8 ,best with fresh absorbent cotton and tepid water1 or a solution of boric acid1 two teaspoonfuls to the pint4 ,this should be done carefully at least once a day4 ,if any discharge is present1 the boric-acid solution should invariably be used twice a day4 ,great care is necessary at all times to prevent infection which often arises from soiled napkins4 ,how should the genital organs of a male child be cleansed8 ,in infancy and early childhood the foreskin should be pushed back at least twice a week while the child is in his bath1 and the parts thus exposed washed gently with absorbent cotton and water4 ,if the foreskin is tightly adherent and cannot readily be pushed back1 the physician's attention should be called to it4 ,the nurse or mother should not attempt forcible stretching4 ,when is circumcision advisable8 ,usually1 when the foreskin is very long and so tight that it cannot be pushed back without force2 always1 when this condition is accompanied by evidences of local irritation or difficulty in passing water4 ,,eyes ,how should the eyes of a little baby be cleansed8 ,with a piece of soft linen or absorbent cotton and a lukewarm solution of salt or boric acid1--one half of an even teaspoonful to one pint of water4 ,if pus appears in the eyes1 what should be done8 ,they should be cleansed every hour with a solution of boric acid 7ten grains to one ounce of water74 ,if the lids stick together1 a little vaseline from a tube should be rubbed upon them at night4 ,if the trouble is slight1 this treatment will control it2 if it is severe1 a physician should be called immediately1 as delay may result in loss of eyesight4 ,,mouth ,how is an infant's mouth to be cleansed8 ,an excellent method is by the use of a swab made by twisting a bit of absorbent cotton upon a wooden toothpick4 ,with this the folds between the gums and lips and cheeks may be gently and carefully cleansed twice a day unless the mouth is sore4 ,it is not necessary after every feeding4 ,the finger of the nurse1 often employed1 is too large and liable to injure the delicate mucous membrane4 ,what is sprue8 ,it appears on the lips and inside the cheeks like little white threads or flakes4 ,it is also called thrush4 ,in bad cases it may cover the tongue and the whole of the inside of the mouth4 ,how should a mouth be cleansed when there is sprue8 ,it should be washed carefully after every feeding or nursing with a solution of borax or bicarbonate of soda 7baking soda71 one even teaspoonful to three ounces of water1 and four times a day the boric-acid solution mentioned should be used4 ,,skin ,how should the infant's skin be cared for to prevent chafing8 ,first1 not too much nor too strong soap should be used2 secondly1 careful rinsing of the body2 thirdly1 not too vigorous rubbing1 either during or after the bath2 fourthly1 the use of dusting powder in all the folds of the skin1--under the arms1 behind the ears1 about the neck1 in the groin1 etc4 ,this is of the utmost importance in very fat infants4 ,if the skin is very sensitive and chafing easily produced1 what should be done8 ,no soap should be used1 but bran or salt baths given instead4 ,how should a bran bath be prepared8 ,one pint of wheat bran should be placed in a bag of coarse muslin or cheese-cloth1 and this put in the bath water4 ,it should then be squeezed for five minutes until the water resembles a thin porridge4 ,how should a salt bath be prepared8 ,a teacupful of common salt or sea salt should be used to each two gallons of water4 ,how should the buttocks be cared for8 ,this is the most common place for chafing1 as the parts are so frequently wet and soiled2 hence the utmost pains should be taken that all napkins be removed as soon as they are wet or soiled1 and the parts kept scrupulously clean4 ,if the parts have become chafed1 what should be done8 ,only bran and salt baths should be used1 and in very severe cases even these may have to be omitted for a day or two4 ,the parts may be cleansed with sweet oil and a little absorbent cotton1 and the skin kept covered with a dusting powder composed of starch two parts1 boric acid one part4 ,what is prickly heat1 and how is it produced8 ,it consists of fine red pimples1 and is caused by excessive perspiration and the irritation of flannel underclothing4 ,how should it be treated8 ,muslin or linen should be put next to the skin2 the entire body should be sponged frequently with equal parts of vinegar and water1 and plenty of the starch and boric-acid powder mentioned should be used4 ,,clothing ,what are the most essential things in the clothing of infants8 ,that the chest shall be covered with soft flannel1 the limbs well protected but not confined1 and the abdomen supported by a broad flannel band1 which should be snug but not too tight4 ,it is important that the clothing should fit the body4 ,if it is too tight it interferes with the free movements of the chest in breathing1 and by pressing upon the stomach sometimes causes the infant to vomit soon after swallowing its food4 ,if the clothing is too loose it is soon thrown into deep folds or bunches1 which cause much discomfort4 ,no pins should be used1 but1 instead all bands about the body should be basted4 ,the petticoats should be supported by shoulder straps4 ,how should the infant be held during dressing and undressing8 ,nothing is more awkward than to attempt to dress a young baby in a sitting posture4 ,it should lie upon the nurse's lap until quite old enough to sit alone1 the clothing being drawn over the child's feet1 not slipped over the head4 ,of what use is the band8 ,it protects the abdomen1 but its most important use is to support the abdominal walls in very young infants1 and in this way to prevent the occurrence of rupture4 ,how long is this band required8 ,the snug flannel band1 not usually more than four months4 ,in healthy infants this may then be replaced by the knitted band1 which may be worn up to eighteen months4 ,the band is an important article of dress in the case of thin infants whose abdominal organs are not sufficiently protected by fat4 ,with such1 or with those prone to diarrhoea1 it is often advisable to continue the band until the third year4 ,what changes are to be made in the clothing of infants in the summer8 ,only the thinnest gauze flannel undershirts should be worn1 and changes in temperature should be met by changes in the outer garments4 ,the greatest care should be taken that children are not kept too hot in the middle of the day1 while extra wraps should be used morning and evening1 especially at the seashore or in the mountains4 ,should older children be allowed to go with their legs bare8 ,if strong and well there is no objection to this in very hot weather4 ,in cold weather1 however1 it is doubtful if any children are benefited by it1 particularly in a changeable climate like that of ,new ,york4 ,many delicate children are certainly injured by such attempts at hardening4 ,what sort of underclothing should be worn during cold weather8 ,never the heaviest weight1 even in winter4 ,four grades are usually sold1 the next to the heaviest being thick enough for any child4 ,do little children require as heavy flannels as older people8 ,not as a rule4 ,they usually live in a warm nursery2 their circulation is active2 and they always perspire easily during their play4 ,when they go out of doors1 the addition of coats and leggings renders thick flannels unnecessary4 ,are not many little children clothed too thinly for the ordinary house8 ,very few4 ,the almost invariable mistake made in city homes is that of excessive clothing and too warm rooms4 ,these two things are among the most frequent reasons for their taking cold so easily4 ,,napkins ,how should napkins be taken care of8 ,they should he immediately removed from the nursery when soiled or wet4 ,soiled napkins should be kept in a receptacle with a tight cover1 and washed as soon as possible4 ,should napkins which have been only wet be used a second time without washing8 ,it is no doubt better to use only fresh napkins1 but there is no serious objection to using them twice unless there is chafing of the skin4 ,clean napkins1 changed as soon as wet or soiled1 are of much importance in keeping the skin healthy4 ,what are the important things to be observed in washing napkins8 ,soiled napkins should not be allowed to dry1 but should receive a rough washing at once2 they should then be kept in soak in plain water until a convenient time for washing1--at least once every day1--when they should be washed in hot suds and boiled at least fifteen minutes4 ,afterward they should be very thoroughly rinsed or they may irritate the skin1 and ironed without starch or blueing4 ,they should never be used when clamp4 ,,nursery ,what are the essentials in a good nursery8 ,the furnishings should be very simple1 and unnecessary hangings and upholstered furniture should be excluded4 ,as large a room as possible should be selected--one that is well ventilated1 and always one in which the sun shines at some part of the day1 as it should be remembered that an average child spends here at least three fourths of its time during the first year4 ,the nursery should have dark shades at the windows1 but no extra hangings or curtains2 about the baby's crib nothing but what can be washed should be allowed4 ,the air should be kept as fresh and as pure as possible4 ,there should be no plumbing no drying of napkins or clothes1 no cooking of food1 and no gas burning at night4 ,a small wax night-light answers every purpose4 ,how should a nursery be heated8 ,best by an open fire2 next to this by a ,franklin stove4 ,the ordinary hot-air furnace of cities has many objections1 but it is not so bad as steam heat from a radiator in the room4 ,a gas stove is even worse than this1 and should never be used1 except1 perhaps1 for a few minutes during the morning bath4 ,at what temperature should a nursery be kept during the day8 ,best1 #ff deg4 to #fh deg4 ,f41 measured by a thermometer hanging three feet from the floor4 ,never should the temperature be allowed to go above #gj deg4 ,f4 ,at what temperature during the night8 ,during the first two or three months1 not below #fe deg4 ,f4 ,after three months the temperature may go as low as #ee deg4 ,f4 ,after the first year it may be #ej deg4 or even #de deg4 ,f4 ,at what age may the window be left open at night8 ,usually after the third month1 except when the outside temperature is below freezing point4 ,how often should the nursery be aired8 ,at least twice a day--in the morning after the child's bath1 and again in the evening before the child is put to bed for the night4 ,this should be done thoroughly1 and the child should be removed meanwhile to another apartment4 ,it is well to air the nursery whenever the child is out of the room4 ,what symptoms are seen in a child who is kept in too hot a room8 ,it becomes pale1 loses appetite1 shows symptoms of indigestion1 occasionally vomits1 stops gaining in weight1 perspires very much1 and takes cold easily because of this and also because of the great difference between the indoor and outdoor temperatures4 ,its condition may be such as to lead one to suspect very serious illness4 ,,airing ,how early may airing indoors he commenced and how long may it be continued8 ,airing in the room may be begun1 even in cold weather1 when the child is one month old1 at first for only fifteen minutes at a time4 ,this period may be gradually lengthened by ten or fifteen minutes each day until it is four or five hours4 ,this airing may be continued in almost all kinds of weather4 ,is there not great danger of a young baby's taking cold when aired in this manner8 ,not if the period is at first short and the baby accustomed to it gradually4 ,instead of rendering the child liable to take cold1 it is the best means of preventing colds4 ,how should such an airing be given8 ,the child should be dressed with bonnet and light coat as if for the street and placed in its crib or carriage which should stand a few feet from the window ,all the windows are then thrown wide open1 but the doors closed to prevent draughts4 ,screens are unnecessary4 ,at what age may a child go out of doors8 ,in summer1 when one week old2 in spring and fall1 usually at about one month2 in winter1 when about three months old1 on pleasant days1 being kept in1 the sun and out of the wind4 ,what are the best hours for airing out of doors8 ,in summer and early autumn a child may be out almost any time between seven in the morning and sunset2 in winter and early spring1 a young child only between #aj or #aa ,a4,m4 and #c ,p4,m41 although this depends somewhat upon the climate4 ,in ,new ,york and along the ,atlantic coast the early mornings are apt to be damp and the afternoons raw and cloudy4 ,on what kind of days should a baby not go out8 ,in sharp winds1 when the ground is covered with melting snow1 and when it is extremely cold4 ,a child under four months old should not usually go out if the thermometer is below freezing point2 nor one under eight months old if it is below #bj deg4 ,f4 ,what are the most important things to be attended to when the child is out in its carriage8 ,to see that the wind never blows in its face1 that its feet are properly covered and warm1 and that the sun is never allowed to shine directly into its eyes when the child is either asleep or awake4 ,of what advantage to the child is going out8 ,fresh air is required to renew and purify the blood1 and this is just as necessary for health and growth as proper food4 ,what are the effects produced in infants by fresh air8 ,the appetite is improved1 the digestion is better1 the cheeks become red1 and all signs of health are seen4 ,is there any advantage in having a child take its airing during the first five or six months in the nurse's arms8 ,none whatever4 ,a child can be made much more comfortable in a baby carriage1 and can be equally well protected against exposure by blankets and the carriage umbrella4 ,what are the objections to an infant's sleeping out of doors8 ,there are no real objections4 ,it is not true that infants take cold more easily when asleep than awake1 while it is almost invariably the case that those who sleep out of doors are stronger children and less prone to take cold than others4 ,what can be done for children who take cold upon the slightest provocation8 ,they should be kept in cool rooms1 especially when asleep ,they should not wear such heavy clothing that they are in a perspiration much of the time4 ,every morning the body1 particularly the chest and back1 should be sponged with cold water 7#ej deg4 to #fj deg4 ,f474 ,how should this cold sponge bath be given8 ,the child should stand in a tub containing a little warm water1 and a large bath sponge filled with cold water should be squeezed two or three times over the body4 ,this should be followed by a vigorous rubbing with a towel until the skin is quite red4 ,this may be used at three years1 and often at two years4 ,for infants a little higher temperature 7#fe deg4 to #gj deg47 may be used4 ,,weight1 ,,growth1 ,,and ,,development ,of what importance is the weight of the child8 ,nothing else tells so accurately how well it is thriving4 ,during the first year a record of the weight is almost indispensable2 throughout childhood it is of much interest and is the best guide to the physical condition4 ,it will well repay any mother or nurse to keep such a record4 ,how frequently should a child be weighed8 ,every week during the first six months1 and at least once in two weeks during the last six months of the first year4 ,during the second year a child should be weighed at least once a month4 ,how rapidly should an infant gain in weight during the first year8 ,there is usually a loss during the first week of from four to eight ounces2 after this a healthy child should gain from four to eight ounces a week up to about the sixth month4 ,from six to twelve months the gain is less1 usually from two to four ounces a week4 ,is it to be expected that bottle-fed infants will gain as rapidly as those who are nursed8 ,they seldom do so during the first month2 after that time under favourable circumstances the gain is usually quite as regular1 and during the latter half of the first year it is likely to be more continuous than in a nursing infant1 because the latter usually loses weight at the time of weaning4 ,why do they not gain so rapidly at first8 ,it takes a few weeks for the stomach to become accustomed to cow's milk1 and until this is accomplished it is necessary to make the milk very weak or the child's digestion will be upset4 ,for a child of average weight at birth 7seven to seven and a half pounds7 what should be the weight at the different periods during the first year8 ,at three months it should be twelve to thirteen pounds2 at six months1 fifteen to sixteen pounds2 at nine months1 seventeen to eighteen pounds2 at one year1 twenty to twenty-two pounds4 ,at five months a healthy child will usually double its weight1 and at twelve months it will nearly treble its weight4 ,do all healthy infants gain steadily in weight during the first year8 ,as a rule they do2 yet it is seldom the case that one gains every week for the entire year4 ,with most infants there are from time to time periods of a few weeks in which no gain is made4 ,these are more often seen from the seventh to the tenth month and frequently occur when the child is cutting teeth1 sometimes during very hot weather4 ,is it true that every infant who gains rapidly in weight is thriving normally8 ,not invariably4 ,some who are fed upon prepared infant foods increase rapidly in weight but not in strength1 nor in their development in other respects4 ,is the weight of as much value in the second year as a guide to the child's condition8 ,after the first year1 the gain in weight is seldom continuous2 there are many interruptions1 some depend on season1 and others often occur without apparent cause4 ,at what age should the fontanel close8 ,the average is about eighteen months4 ,it seldom closes earlier than fourteen months1 and it should not be open at two years4 ,at what age should a child hold up its head8 ,as a rule during the fourth month1 and often during the third month1 the head can be held erect when the body is supported4 ,when does an infant first laugh aloud8 ,usually from the third to the fifth month4 ,when does it begin to reach for toys and handle them8 ,usually from the fifth to the seventh month4 ,at what age should a child be able to sit and to stand alone8 ,at seven or eight months a healthy child is usually able to sit erect and support the body4 ,during the ninth and tenth months are usually seen the first attempts to bear the weight upon the feet1 and at eleven or twelve months most children can stand with assistance4 ,when should a child walk alone8 ,the first attempts are generally seen in the twelfth or thirteenth month4 ,at fifteen or sixteen months the average child is able to run alone4 ,what conditions postpone these events8 ,prematurity1 a very delicate constitution1 any severe or prolonged illness1 and especially chronic disturbances of digestion making feeding difficult4 ,a common cause of late sitting1 standing1 or walking is rickets4 ,should a child be urged to walk8 ,never2 he is usually quite willing to do so as soon as his muscles and bones are strong enough4 ,none of the contrivances for teaching children to walk are to be advised4 ,when do children begin to talk8 ,generally at one year a child can say papa and mamma or other single words4 ,at the end of the second year the average child is able to put words together in short sentences4 ,if at two years the child makes no attempt to speak1 what should be suspected8 ,either that the child is a deaf-mute or that it is mentally deficient1 although this is occasionally seen in children who are only very backward4 ,table showing the ,average ,weight1 ,height1 and ,circumference of ,head and ,chest of ,boys#a ,at birth ,weight #g-a_/b pounds4 ,height #bj-a_/b inches4 ,chest #ac-a_/b ,head #ad ,one year ,weight #ba pounds4 ,height #bi inches4 ,chest #ah ,head #ah ,two years ,weight #bf-a_/b pounds4 ,height #cb-a_/b inches4 ,chest #ai ,head #ai ,three years ,weight #ca pounds4 ,height #ce inches4 ,chest #bj ,head #ai-a_/b ,four years ,weight #ce pounds4 ,height #ch inches4 ,chest #bj-c_/d ,head #ai-c_/d ,five years ,weight #da pounds4 ,height #da-a_/b inches4 ,chest #ba-a_/b ,head #bj-a_/b ,six years ,weight #de pounds4 ,height #dd inches4 ,chest #bc ,seven years ,weight #di-a_/b pounds4 ,height #df inches4 ,chest #bc-a_/b ,eight years ,weight #ed-a_/b pounds4 ,height #dh inches4 ,chest #bd-a_/b ,nine years ,weight #fj pounds4 ,height #ej inches4 ,chest 4 #be ,ten years ,weight #ff-a_/b pounds4 ,height #eb inches4 ,chest #bf ,the above weights are with ordinary house clothes4 #a ,weights for the first four years are without clothes4 ,the weight of girls is on the average about one pound less than boys4 ,they are about the same in height4 ,charts showing weight curve for the first year1 and from one year to fourteen years are given at the end of this book4 ,,dentition ,how many teeth are there in the first set8 ,twenty4 ,what is the time of their appearance8 ,the two central lower teeth are usually the first to appear1 and come from the fifth to the ninth month2 next are the four upper central teeth1 which come from the eighth to the twelfth month4 ,the other two lower central teeth and the four front double teeth come from the twelfth to the eighteenth month4 ,then follow the four canine teeth1 the two upper ones being known as the eye teeth1 and the two lower as the stomach teeth2 they generally come between the eighteenth and the twenty-fourth month4 ,the four back double teeth1 which complete the first set1 come between the twenty-fourth and thirtieth month4 ,at one year a child usually has six teeth4 ,at one and a half years1 twelve teeth4 ,at two years1 sixteen teeth4 ,at two and a half years1 twenty teeth4 ,what are the causes of variation8 ,the time of appearance of the teeth varies in different families2 in some they come very early1 in others much later4 ,the teeth may come late as a result of prolonged illness and also from rickets4 ,what symptoms are commonly seen with teething8 ,in healthy children there is very often fretfulness and poor sleep for two or three nights2 there may be loss of appetite1 so that only one half the usual amount of food is taken2 there is salivation or drooling1 and often slight fever2 there may be some symptoms of indigestion1 such as vomiting or the appearance of undigested food in the stools4 ,in delicate children all these symptoms may be much more severe4 ,how long do these symptoms last8 ,usually only three or four days2 but there may be no gain in weight for two or three weeks4 ,what is the cause of most of the other symptoms attributed to teething8 ,nearly all of them come from indigestion due to bad feeding4 ,,part ,,ii ,,infant ,,feeding ,what is the best infant food8 ,mother's milk4 ,of what is mother's milk composed8 ,thirteen parts solids and eighty-seven parts water4 ,what are the solids8 ,fat1 sugar1 proteids1 and salts4 ,what is the fat8 ,the cream4 ,what is the sugar8 ,it is lactose1 or milk sugar4 ,what are the proteids8 ,the curd of the milk4 ,are all these elements necessary8 ,yes2 we cannot expect to rear a healthy infant unless they are all in his food4 ,of what use is the fat8 ,it is needed for the growth of the bones1 the nerves1 the fat of the body1 and the production of heat4 ,of what use is the sugar8 ,it is needed for the production of heat1 and to make fat in the body4 ,of what use are the proteids8 ,they are needed for the growth of the cells of the body1 such as those of the blood1 the various organs1 and the muscles4 ,of what use are the salts8 ,particularly for the growth of bone4 ,of what use is the water8 ,by means of the water the food is kept in a state of minute subdivision or in solution1 so that the delicate organs of a young infant can digest it4 ,it is also necessary to enable the body to get rid of its waste4 ,,nursing ,should all mothers attempt to nurse their children8 ,as a rule they should do so1 but there are many conditions when they should not4 ,what are the most important ones8 ,if the mother has or has had tuberculosis or any other serious chronic disease1 or is herself in very delicate health1 she should not try4 ,she is likely soon to fail in nourishing her child1 and the attempt may do herself much harm as well as injure the child4 ,how often should infants be nursed during the first two days of life8 ,usually only four or five times daily1 since there is very little milk secreted at this time4 ,when does the milk come in abundance8 ,usually on the third day1 sometimes not until the fourth or fifth day4 ,should the infant be fed anything additional during the first two days8 ,usually not2 if much food were necessary1 we may be sure ,nature would have provided it4 ,water1 however1 should be given regularly4 ,how frequently should an infant be nursed during the first week8 ,after the third day1 every two hours during the day and twice during the night4 ,the frequency during the rest of the first year is given in the following table3 ---------------------------------------- -------------------------- ,,period4 ,nursings in ,interval ,night nursings #bd hours4 by day4 7#aj ,p4,m4 to #f ,a4,m474 ---------------------------------------- -------------------------- #ast and #b;d day #d #f hours4 #a #c days to #f weeks #aj #b #b #f weeks to #c months #h #b-a_/b #b #c to #e months #g #c #a #e to #ab months #f #c #j ---------------------------------------- -------------------------- ,how long should the child be kept at the breast for one nursing8 ,not over twenty minutes4 ,should the child take both breasts at one nursing8 ,if the milk is very abundant one breast may be sufficient1 otherwise both breasts may be taken4 ,what are the important things to be attended to in nursing8 ,first1 regularity2 it is just as important as in the case of bottle-feeding4 ,secondly1 the nipples should be kept clean by being washed after every nursing4 ,what should be the diet of a nursing mother8 ,she should have a simple but generous diet with plenty of fluids2 three regular meals may be given and gruel1 milk1 or cocoa at bed-time and sometimes between meals4 ,she may take eggs1 cereals1 most soups1 and nearly all vegetables1 avoiding sour fruits1 salads1 pastry1 and most desserts4 ,meat should not be taken more than twice daily1 and in many cases but once4 ,she should take but little tea or coffee1 and ordinarily no wine or beer4 ,are fruits likely to disturb a nursing infant8 ,sour fruits in some cases may do so1 but sweet fruits and most cooked fruits are useful4 ,what else is important in the life of the nursing mother8 ,she should lead a simple natural life2 should have regular out-of-door exercise1 preferably walking or driving1 as soon after her confinement as her condition will permit4 ,she should have regular movements from the bowels daily4 ,she should be as free as possible from unnecessary cares and worry2 her rest at night should be disturbed as little as possible2 she should lie down for at least one hour in the middle of the day4 ,does the nervous condition of the mother affect the milk8 ,very much more than her diet2 worry1 anxiety1 fatigue1 loss of sleep1 household cares1 social dissipation etc41 have more than anything else to do with the failure of the modern mother as a nurse4 ,uncontrolled emotions1 grief1 excitement1 fright1 passion1 may cause milk to disagree with the child2 at times they may excite acute illness1 and at other times they may cause a sudden and complete disappearance of the milk4 ,does menstruation affect the milk8 ,in nearly all cases the quantity of milk is lessened so that the infant is not satisfied and may gain less in weight or not at all4 ,in many cases the quality of the milk is also affected to such a degree as to cause slight disturbances of digestion1 such as restlessness1 colic1 and perhaps some derangement of the bowels4 ,in a few1 attacks of acute indigestion are excited4 ,is regular menstruation a reason for stopping nursing8 ,not invariably2 as a rule both functions do not go on together4 ,but if the child is gaining regularly in weight between the periods1 nursing may be continued indefinitely1 although it may be well to feed the infant wholly or in part during the first day or two that the mother is unwell4 ,what symptoms indicate that a nursing infant is well nourished8 ,the child has a good colour1 sleeps for two or three hours after nursing1 or1 if awake1 is quiet1 good-natured1 and apparently comfortable4 ,it has normal movements of the bowels and gains steadily in weight4 ,what symptoms indicate that a child who is nursing is not properly nourished8 ,it does not gain and may even lose in weight4 ,it no longer exhibits its usual energy and playfulness1 but is either listless and indifferent or cross1 fretful and irritable1 and is apt to sleep poorly4 ,it grows pale and anaemic and its tissues become soft and flabby4 ,when the milk is scanty it will often nurse a long time at the breasts1 sometimes three quarters of an hour1 before stopping4 ,at other times it may take the breast for a moment only1 and then turn away in apparent disgust4 ,what should be done when such symptoms appear8 ,this depends upon the severity of the symptoms and how long they have lasted4 ,if the child has made no gain for three or four weeks1 or is losing weight1 immediate weaning will probably be necessary2 in any case1 other food in addition to the breast milk should be given at once4 ,one may begin by alternating the nursing and the bottle-feeding and increase the number of bottle-feedings as may be indicated by the results4 ,is there any objection to a baby being partly nursed and partly fed8 ,none whatever2 it is often better from the outset to feed the baby during the night1 in order not to disturb the mother's rest4 ,what symptoms indicate that the mother's milk disagrees with the child8 ,the child suffers from almost constant discomfort sleeps2 little and then restlessly1 cries a great deal1 belches gas from the stomach1 and passes much by the bowels1 or if not passed1 the gas accumulates and causes abdominal distention and colicky pain4 ,there may be vomiting1 but more often the trouble is intestinal4 ,sometimes the bowels are constipated1 but usually the movements are frequent1 loose1 green1 contain mucus and are passed with much gas4 ,what should be done under these circumstances8 ,if the symptoms have persisted for two or three weeks and the child is not gaining in weight1 there is little chance of improvement1 and the child should be taken from the breast at once4 ,if there is some gain in weight1 one may try for a little longer1 endeavouring to improve the mother's milk by rest1 fresh air1 careful diet1 etc4 ,however1 one should always realize that the trouble is with the milk1 not with the child4 ,what changes should be made if a nursing infant habitually vomits8 ,if this occurs soon after nursing1 the infant has usually taken too much and the time of nursing should be shortened1 or one breast may be given instead of two2 the nursing should also be interrupted by occasional rests1 so that the milk is not taken too fast4 ,if the vomiting occurs some time after nursing and is repeated1 it is a sign of indigestion2 often because the milk is too rich in fat4 ,the intervals between nursings should then be lengthened2 the breast milk may be diluted by giving one or two tablespoonfuls of plain boiled water1 lime-water1 or barley-water1 five or ten minutes before nursing2 the mother should eat less hearty food1 especially less meat4 ,what should be done if the infant has frequent or habitual colic8 ,this is usually because the milk is too rich in proteids2 the mother should take more out-of-door exercise1 eat less meat1 and seek to control her emotions2 all causes of worry should be removed4 ,can constipation in a nursing infant be controlled through the mother's milk8 ,only to a limited extent4 ,it is important that the mother's bowels be regular and her digestion good4 ,an increase in the meat and milk of her diet is sometimes beneficial4 ,,weaning ,at what age should the child be weaned from the breast8 ,usually weaning should be begun at nine or ten months by substituting one feeding a day for one nursing1 later two feedings1 and thus gradually the child is to be taken from the breast altogether4 ,what is the principal reason for weaning earlier8 ,the most important one is that the child is not thriving--not gaining in weight and not progressing normally in its development4 ,serious illness of the mother1 or pregnancy1 may make weaning necessary4 ,at what age should the weaning be completed8 ,generally at one year4 ,in summer it may sometimes be advisable to nurse an infant a little longer rather than wean in warm weather2 but even then the dangers of weaning are much less than those of continuing to nurse1 as is so often done1 after the milk has become very scanty and poor in quality4 ,when should a child who is weaned from the breast be taught to drink from the cup1 and when to take the bottle8 ,if weaning is done as early as the eighth or ninth month it is better to give the bottle2 if from the tenth to the twelfth month the infant should be taught to drink or be fed with a spoon4 ,how may some of the difficulties in weaning be overcome8 ,by feeding every nursing infant once a day or by giving it water regularly from a feeding-bottle4 ,it then becomes accustomed to the bottle4 ,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 hours2 when more feeding is required at weaning time the child does not object4 ,when should a child be weaned from the bottle8 ,with children who are not ill1 weaning from the bottle should invariably be begun at the end of the first year1 and after a child is thirteen or fourteen months old the bottle should not be given except at the night feeding4 ,is there any objection to the child's taking the bottle until it is two or three years old8 ,there are no advantages and some serious objections4 ,older children often become so attached to the bottle that only with the greatest difficulty can they be made to give it up4 ,frequently they will refuse all solid food1 and will take nothing except from the bottle so long as it is given1 and when finally at three or four years1 it is taken away1 they will not touch milk during the rest of their childhood4 ,the difficulty is here that children form the bottle habit4 ,this habit is troublesome1 unnecessary1 and should by all means be prevented4 ,an exclusive diet of milk for children of two or three years often results in anaemia and malnutrition4 ,how should one train a child to do without the bottle8 ,this is usually very easy if it is begun at one year4 ,the milk should be poured into a tiny glass or cup and little by little the child is taught to drink2 at first only a small portion of the food is taken in this way1 the balance being given from the bottle2 but in the course of a few weeks the average infant learns to drink from a cup without difficulty1 and all the food can be so given4 ,if the child is two or more years old1 the only effective means of weaning from the bottle is through hunger4 ,the bottle should be taken away at once and entirely1 and nothing allowed except milk from a cup until the child takes this willingly4 ,sometimes a child will go an entire day without food1 occasionally as long as two days1 but one should not be alarmed on this account and yield4 ,this is a matter of the child's will and not of his digestion1 and when once he has been conquered it is seldom that any further trouble is experienced4 ,as soon as a child has learned to drink his milk from a cup1 cereals and other solid foods may gradually be added to the diet4 ,the educational value of such training is not the least important consideration4 ,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 birth8 ,very rarely2 to give a baby who has had nothing but the breast from birth1 plain cow's milk1 or even that milk which a bottle-fed baby of the same age might take1 is almost certain to cause indigestion4 ,the change in the food is quite a marked one1 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 milk4 ,what would be the proper proportions for an infant weaned at four or five months8 ,about the same as for a healthy bottle-fed infant of two months2 the quantity of course should be larger4 ,the food can in most cases be gradually increased so that in two or three weeks the usual strength for the age can be taken4 ,what would be the proper proportions for an infant weaned at nine or ten months8 ,about the same as for a bottle-fed infant at four or five months1 to be increased as indicated above4 ,will not a child lose in weight when placed upon so low a diet8 ,very often it will do so for the first week or two1 but after that will gain quite regularly2 the acute indigestion1 however1 which generally accompanies the use of stronger milk will1 in most cases1 cause a greater loss4 ,,artificial ,,feeding ,what foods contain all the elements present in mother's milk8 ,the milk of other animals1--cow's milk being the only one which is available for general use4 ,is it not possible for infants to thrive upon other foods than those containing fresh milk8 ,they may do so for a time1 but never permanently4 ,the long-continued use of other foods as the sole diet is attended with great risk4 ,what are the dangers of such foods8 ,frequently scurvy is produced 7see page #ada71 often rickets1 and in other cases simply a condition of general malnutrition1--the child does not thrive1 is pale1 and its muscles are soft and flabby4 ,,the ,,selection ,,and ,,care ,,of ,,milk ,,used ,,for ,,infant ,,feeding ,what are the essential points in milk selected for the feeding of infants8 ,that it comes from healthy cows1 and that it is clean and fresh4 ,is it not important to select a rich milk8 ,by no means2 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 herds1 such1 for example1 as the common grade cows4 ,which is the better1 milk from one cow or the mixed milk of several cows8 ,the mixed1 or herd milk1 is usually to be preferred since it varies little from day to day2 while that from a single cow may vary considerably4 ,how fresh is it important that cow's milk should be for the best results in infant feeding8 ,this depends very much upon the season1 and how carefully milk is handled4 ,as ordinarily handled at the dairy and in the home1 milk should not be used for infants in winter after it is forty-eight hours old2 in summer not after it is twenty-four hours old1 and it may be unsafe in a much shorter time4 ,when handled with especial care milk may be safe for a longer time4 ,what are the two essentials in handling milk8 #a4 ,that it be kept clean and free from contamination4 ,this necessitates that cows1 stables1 and milkers be clean1 and that transportation be in sealed bottles2 also that those who handle the milk do not come in contact with any contagious disease4 ,all milk-pails1 bottles1 cans1 and other utensils with which the milk comes in contact should be sterilized shortly before they are used1 by steam or boiling water4 #b4 ,that it be cooled immediately after leaving the cows1 and kept at as low a temperature as possible2 to be efficient this should not be above #ej deg4 ,f4 ,milk produced under hygienic conditions and handled with special care is sold in bottles in a number of cities under the name of certified1 guaranteed1 or inspected milk4 ,when available such milk should be used for infants4 ,of course the extra care bestowed in its production and transportation increases the cost of the milk1 but the best will usually be found in the end to be the cheapest4 ,how should milk be handled in the home when obtained fresh from the cows8 ,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 water1 where they should stand for at least half an hour4 ,that required for children who take plain milk may now be poured into half-pint bottles1 stopped with cotton1 and put in the ice-chest1 or the coolest place possible4 ,this first rapid cooling is very important and adds much to the keeping qualities of the milk4 ,milk loses its heat very quickly when cooled in water1 but very slowly when it is simply placed in a cold room4 ,after standing four or five hours the top-milk may be removed2 after twelve to sixteen hours the cream may be removed4 ,how should milk be handled when bottled milk is purchased8 ,it should be cooled as just described1 as its temperature is usually somewhat raised during transportation ,if it has been bottled at a dairy1 the cream or the top-milk may be removed after an hour or so4 ,how should milk and cream be handled when they are purchased in bulk8 ,such milk should never be used for infants when it is possible to obtain bottled milk1 as it is much more liable to contamination4 ,both cream and milk should be poured at once into covered vessels and kept in the coolest place possible4 ,the cream and top-milk will seldom rise upon such milk with any satisfactory regularity4 ,what are the important things to be secured in nursery refrigerators8 ,absolute cleanliness is essential2 hence the inner portion should be of metal4 ,those made entirely of metal are unsatisfactory as in them the ice melts very quickly4 ,if the ordinary metal refrigerator sold is encased in a wooden box1 we have the best form4 ,another easy way of securing the same result ,is to make for the refrigerator a covering or cosey of felt or heavy quilting1 which can be easily removed when wet or soiled4 ,the compartments of the refrigerator should be so arranged that the bottles of milk are either in contact with the ice or very near it4 ,the supply of ice should be abundant4 ,often the amount of ice is so small1 and the bottles so far away1 that the temperature of the milk is never below #fj deg4 or #fe deg4 ,f4 ,to be really effective a refrigerator should have a temperature where the milk is placed of not over #ej deg4 ,f4 ,the temperature should be tested with the nursery thermometer from time to time to ascertain what results are being obtained4 ,spoiled milk owing to a faulty refrigerator is to be blamed for many attacks of acute illness among infants4 ,next to the feeding-bottles it is the one thing in the nursery which should receive the closest attention4 ,,the ,,modification ,,of ,,cow',s ,,milk ,can cow's milk be fed to infants without any changes8 ,no2 for although it contains similar elements to those in mother's milk1 they are not identical1 and they are not present in the same proportions4 ,is this a matter of much importance8 ,it is of the greatest importance4 ,there are few infants who can digest cow's milk unless it is changed4 ,to change cow's milk so as to make it more nearly resemble mother's milk is called modifying cow's milk4 ,how is this milk whose proportions have been changed distinguished from the original unchanged milk8 ,the changed milk is usually called modified milk8 the original unchanged milk is known as plain milk1 whole milk1 straight milk1 or is referred to simply as milk4 ,what are the principal differences between cow's milk and mother's milk8 ,cow's milk has a little more than half as much sugar2 it has nearly three times as much proteids and salts2 its proteids are different and much more difficult of digestion2 its reaction is decidedly acid1 that of mother's milk is faintly acid or neutral4 ,are there any other important things to be considered8 ,yes2 mother's milk is always fed fresh and is practically sterile4 ,cow's milk is generally kept twenty-four hours and sometimes much longer4 ,it is always to a greater or less degree contaminated by dirt and germs1 the number of which increases rapidly 7#a7 with the age of the milk2 7#b7 in proportion to amount of the dust or dirt which enters it2 7#c7 with any increase in the temperature at which the milk is kept4 ,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 right4 ,how is the acidity of cow's milk overcome8 ,by the addition of lime-water or bicarbonate of soda4 ,if lime-water is used1 one ounce to twenty ounces of food is generally required2 if soda is used1 twenty grains to twenty ounces of food4 ,if there is a tendency to constipation the milk of magnesia 7,phillips's7 may be used2 from one half to one teaspoonful being added to each twenty ounces of food4 ,how is the sugar best increased8 ,by adding milk sugar to the food2 one ounce to each twenty ounces of food will give the proper quantity for the first three or four months4 ,this will make the proportion about the same 7between #f and #g per cent7 as in mother's milk4 ,how should the sugar be prepared8 ,simply dissolved in boiled water2 if the solution is not clear1 or if there is a deposit after standing1 it should be filtered by pouring through a layer of absorbent cotton1 half an inch thick1 which is placed in an ordinary funnel4 ,will not cane 7granulated7 sugar answer as well8 ,not as a rule2 however1 there are many infants who get on very well when cane sugar is used4 ,it has the advantage of being much cheaper4 ,a good grade of milk sugar is somewhat expensive1 costing from twenty-five to sixty cents a pound1 and cheap samples are apt to contain impurities4 ,if cane sugar is used1 what amount should be added8 ,considerably less than of the milk sugar4 ,usually about half the quantity 7half an ounce to twenty ounces of food7 is as much as most infants can digest ,if the same quantity is used as of the milk sugar1 the food is made unduly sweet1 and the sugar is likely to ferment in the stomach and cause colic4 ,is not the purpose of the sugar to sweeten the food in order to make it palatable8 ,not at all2 although it does that1 its real use is to furnish one of the essential elements needed for the growth of the body1 and the one that is required by young infants in the largest quantity4 ,how do we know that this is so8 ,by the fact that in good breast milk the amount of sugar is greater than that of the fat1 proteids1 and salts combined4 ,we have seen that cow's milk has nearly three times as much proteids 7curd7 and salts as mother's milk4 ,how are these to be diminished8 ,by diluting the milk4 ,will it be sufficient to dilute the milk twice 7i4e41 add two parts of water to one part of milk78 ,not for a very young infant4 ,although this will give about the quantity of proteids present in mother's milk1 the proteids of cow's milk are so much more difficult for the infant to digest1 that in the beginning it should be diluted five or six times for most infants4 ,if cow's milk is properly diluted and lime-water and sugar added does it then resemble mother's milk8 ,no2 the mixture contains too little fat4 ,what is the easiest way of overcoming this8 ,by increasing the fat in the milk before dilution4 ,it may be done by using top-milk or a mixture of milk and cream4 ,what is top-milk8 ,it is the upper layer of milk removed after standing a certain number of hours in a milk bottle1 glass jar1 or any tall vessel with straight sides4 ,it contains most of the cream and some of the milk just below4 ,the strength of the top-milk is measured by the fat it contains--e4g41 a #aj-per-cent milk contains #aj per cent fat2 #g-per-cent milk contains #g per cent fat1 etc4 ,these are the two strengths of top milk most used in infant feeding4 ,on what does the percentage of fat in top-milk depend8 #a4 ,on the length of time the milk has stood4 #b4 ,on the manner in which the top-milk is removed4 #c4 ,on the number of ounces removed4 #d4 ,on the richness of the milk used4 ,unless these are known it is impossible to say even approximately how strong in fat the top-milk is4 ,when and how should top-milk be removed8 ,if milk fresh from the cow1 or before the cream has risen1 is put into bottles and rapidly cooled1 the top-milk may be removed in as short a time as four hours4 ,in the case of bottled milk it makes little difference if it stands a longer time1 even until the next day4 ,the best means of removing it is by a small cream-dipper#b holding one ounce2 although it may be taken off by a spoon or siphon4 ,it should not be poured off4 #b ,obtained from any of the ,walker-,gordon milk laboratories1 from ,james ,dougherty1 ,no4 #daa ,west #eith ,street1 ,new ,york1 and from many druggists4 ,price1 #bj cents4 ,how can we obtain a #aj-per-cent top-milk with the different kinds of cow's milk8 ,from a rather poor milk 7containing #c--c-a_/b per cent fat7 by removing the upper eight ounces from a quart1 or one fourth4 ,from a good average milk 7containing #d per cent fat7 by removing the upper eleven ounces from a quart1 or about one third4 ,from a rich ,jersey milk 7containing #e--e-a_/b per cent fat7 by removing the upper sixteen ounces1 or one half4 ,how can we obtain a #g-per-cent top-milk with the different kinds of cow's milk8 ,from a rather poor milk1 by removing the upper eleven ounces from a quart1 about one third4 ,from a good average milk1 by removing the upper sixteen ounces1 or one half4 ,from a rich ,jersey milk1 by removing the upper twenty-two ounces1 or about two thirds4 ,illustration3 ,the percentage of fat in the different layers of milk of good average quality4 ,what is cream8 ,cream is often spoken of as if it were the fat in milk4 ,it is really the part of the milk which contains most of the fat4 ,it differs from milk chiefly in containing much more fat4 ,in what ways is cream now obtained8 7#a7 ,by skimming1 after the milk has stood usually for twenty-four hours8 this is known as gravity cream4 7#b7 ,by an apparatus known as a separator2 this is known as centrifugal cream2 most of the cream now sold in cities is of this kind4 ,the richness of any cream is indicated by the amount of fat it contains4 ,the usual gravity cream sold has from #af to #bj per cent fat4 ,the cream removed from the upper part 7one fifth7 of a bottle of milk has about #af per cent fat4 ,the usual centrifugal cream has #ah to #bj per cent fat4 ,the heavy centrifugal cream has #ce to #dj per cent fat4 ,,food ,,for ,,healthy ,,infants#c--,,the ,,early ,,months #c ,the directions and formulas given in the following pages are intended only for guidance in feeding children who are not suffering from any special disturbance of digestion2 directions for such conditions are given in a later chapter4 ,what are the most important points to be remembered in modifying cow's milk for feeding during the early months8 ,that of the different ingredients of milk the sugar is most easily digested2 the fat is next2 while the proteids are the most difficult4 ,what relation should the fat bear to the proteids during this period8 ,for most infants with good digestion the best results are obtained when the fat is three times the proteids4 ,however1 this is not true of all4 ,there are many healthy infants who are unable to digest this proportion of fat1 and who do much better when the fat is made only twice the proteids4 ,how can one obtain formulas in which the fat is three times the proteids8 ,by using for dilution a #aj-per-cent milk 7i4e41 milk containing #aj per cent fat7 which serves as the primary formula from which all the other formulas of this series are derived4 ,in #aj-per-cent milk the fat is just three times the proteids4 ,how can one get the #aj-per-cent milk8 7#a7 ,as top-milk1 as described on page #fd2 or1 7#b7 by mixing equal parts of plain milk and ordinary cream 7containing about #af per cent fat72 7#c7 from any of the milk laboratories it may be ordered directly4 ,is it better to obtain the #aj-per-cent milk by using a mixture of milk and cream1 or as top-milk8 ,if one can get milk fresh from the cows1 the top-milk is to be preferred on account of freshness4 ,the food can then be made up when the milk is but a few hours old4 ,in cities1 if one uses bottled milk1 the upper third may also be used4 ,but if one buys milk and cream separately1 it is usually more convenient to mix these1 as the cream will not rise upon milk a second time with any uniformity4 ,how can one obtain formulas in which the fat is twice the proteids8 ,by using for dilution a #g-per-cent milk 7i4e41 milk containing #g per cent fat7 which serves as the primary formula from which all the other formulas of this series are derived4 ,in #g-per-cent milk the fat is just twice the proteids4 ,how can one get the #g-per-cent milk8 7#a7 ,as top-milk1 as described on page #fd2 or1 7#b7 by mixing three parts of milk and one part of ordinary 7#af per cent7 cream2 7#c7 from any of the milk laboratories it may be obtained directly4 ,as in the case of #aj-per-cent milk1 the top-milk is generally to be preferred to a mixture of milk and cream4 ,how should the food be prepared during the early months8 ,it is convenient in calculation to make up twenty ounces of food at a time4 ,the first step is to obtain the #aj-per-cent milk or the #g-per-cent milk to be used as the primary formula4 ,then to take the number of ounces of this that are called for in the formula desired4 ,note4--,one should not make the mistake of taking from the top of the bottle only the number of ounces needed in the formula as this may give quite a different result4 ,there will be required in addition one ounce of milk sugar#d and one ounce of lime-water in each twenty ounces4 ,the rest of the food will be made up of boiled water4 #d ,if the milk sugar be measured in the milk-dipper1 two scant dipperfuls may be calculated as one ounce4 ,if measured in a tablespoon1 three even tablespoonfuls may be calculated as one ounce4 ,these formulas written out would be as follows3 ,first ,series ,formulas for the ,early ,months from #aj-per-cent ,milk ---------------------------------------- ------------------- ,i4 ,,ii4 ,,iii4 ,,iv4 ,v4 ---------------------------------------- ------------------- #aj-per-cent milk #b oz4 #c oz4 #d oz4 #e oz4 #f oz4 ,milk sugar #a #a #a #a #a ,lime-water #a #a #a #a #a ,boiled water #ag #af #ae #ad #ac ---------------------------------------- ------------------- #bj oz4 #bj oz4 #bj oz4 #bj oz4 #bj oz4 ---------------------------------------- ------------------- ,as the milk sugar dissolves in the water the total in each column will be exactly twenty ounces4 ,the food is strengthened by gradually increasing the milk and reducing the water4 ,the approximate composition of these formulas expressed in percentages is as follows3 ---------------------------------------- ,,formula4 ,fat4 ,sugar4 ,proteids4 ---------------------------------------- ,i4 #a4jj #e4ej #j4cc ,,ii4 #a4ej #f4jj #j4ej ,,iii4 #b4jj #f4jj #j4ff ,,iv4 #b4ej #f4jj #j4hj ,v4 #c4jj #f4ej #a4jj ---------------------------------------- -- ,second ,series ,formulas for the ,early ,months from #g-per-cent ,milk ---------------------------------------- ------------------- ,i4 ,,ii4 ,,iii4 ,,iv4 ,v4 ---------------------------------------- ------------------- #g-per-cent milk #b oz4 #c oz4 #d oz4 #e oz4 #f oz4 ,milk sugar #a #a #a #a #a ,lime-water #a #a #a #a #a ,boiled water #ag #af #ae #ad #ac ---------------------------------------- ------------------- #bj oz4 #bj oz4 #bj oz4 #bj oz4 #bj oz4 ---------------------------------------- ------------------- ,the approximate composition of these formulas expressed in percentages is as follows3 ---------------------------------------- ,,formula4 ,fat4 ,sugar4 ,proteids4 ---------------------------------------- ,i4 #j4gj #e4ej #j4ce ,,ii4 #a4jj #f4jj #j4ej ,,iii4 #a4dj #f4jj #j4gj ,,iv4 #a4ge #f4jj #j4hg ,v4 #b4jj #f4ej #a4jj ---------------------------------------- -- ,how is one to decide whether to use the ,first or the ,second ,series of formulas8 ,with a large1 strong child1 having a good digestion one should use the ,first ,series4 ,with a smaller1 less vigorous child1 whose digestion is not so good1 or with one who does not do well upon the ,first ,series1 the ,second ,series should be used4 ,why is it necessary to make the food so weak at first8 ,because the infant's stomach is intended to digest breast milk1 not cow's milk2 but if we begin with a very weak cow's milk the stomach can be gradually trained to digest it4 ,if we began with a strong milk the digestion might be seriously upset4 ,how rapidly can the food be increased in strength from ,formula ,i to ,,ii1 from ,,ii to ,,iii1 etc48 ,no absolute rule can be given4 ,usually we begin with ,i on the second day2 ,,ii on the fourth day2 ,,iii at one week or ten days2 but after that make the increase more slowly4 ,a large infant with a strong digestion will bear a rather rapid increase and may be able to take ,v by the time it is three or four weeks old4 ,a child with a feeble digestion must go much slower and may not reach ,v before it is three or four months old4 ,it is important with all children that the increase in the food be made very gradually4 ,it may be best with many infants to increase the milk by only half an ounce in twenty ounces of food1 instead of one ounce at a time as indicated in the tables4 ,thus from #c ounces1 the increase would be to #ca_/b ounces2 from #d ounces to #da_/b ounces1 etc4 ,at least two or three days should be allowed between each increase in the strength of the food4 ,what general rule can be given for increasing the food8 ,to increase when the infant is not satisfied but is digesting well4 ,how does an infant show that he is not satisfied8 ,he drains the bottle eagerly and cries when it is taken away4 ,he often forms the habit of sucking his fingers immediately after4 ,he begins to fret half an hour or an hour before the next feeding is due4 ,in the series of formulas given in the table the quantities are mentioned for making only twenty ounces of food4 ,how should it be prepared when more than this quantity is needed8 ,it is equally convenient to make up #be ounces1 #cj ounces1 #ce ounces1 or #dj ounces at a time4 ,to make-- #be ounces of any formula add one quarter more of each ingredient4 #cj one half #ce three quarters #dj twice as much ,thus #be ounces of ,formula ,i would be obtained by using #ba_/b ounces of milk1 #aa_/d ounces of sugar and lime-water1 #baa_/d ounces of water2 #cj ounces of the same would require #c ounces milk1 #aa_/b ounces lime-water and sugar1 and #bea_/b ounces water2 #ce ounces would require #ca_/b ounces milk1 #ac_/d ounces lime-water and sugar1 and #bic_/d ounces water4 ,the amount of water need not be calculated in any case1 but after measuring carefully the other ingredients enough water should be added to bring the total up to the amount required4 ,how great an increase in the quantity should be made at one time8 ,one may make up five ounces additional food2 but the first two days only two or three ounces of the additional amount should be given2 the next two days1 four ounces2 after two days more1 the five ounces may be given4 ,the increase in the quantity given at a single feeding should not be more than a quarter of an ounce4 ,,food ,,for ,,healthy ,,infants--,,the ,,later ,,months ,how long should the fat be as much as three times the proteids8 ,this is seldom of advantage longer than three or four months4 ,what changes should then be made in the milk8 ,after ,formula ,v of the ,first ,series 7#f ounces of #aj-per-cent milk in #bj ounces of food7 has been reached1 the fat should be increased very slowly for this proportion 7#c per cent7 is near the limit for most healthy children4 ,the milk should now be strengthened chiefly by raising the percentage of proteids4 ,how is this accomplished8 ,the #aj-per-cent milk and the formulas derived from it should now be discontinued1 and those made from #g-per-cent milk used4 ,third ,series ,formulas for the ,later ,months from #g-per-cent ,milk ---------------------------------------- ------------------- ,i4 ,,ii4 ,,iii4 ,,iv4 ,v4 ---------------------------------------- ------------------- #g-per-cent milk #g oz4 #h oz4 #i oz4 #aj oz4 #aa oz4 ,milk sugar #a #a #a #c_/d #a_/b ,lime-water #a #a #a #a #a ,boiled water #ab #aa #aj #d #c ,barley gruel #j #j #j #e #e ---------------------------------------- ------------------- #bj oz4 #bj oz4 #bj oz4 #bj oz4 #bj oz4 ---------------------------------------- ------------------- ,since the sugar dissolves1 the total will be twenty ounces in each column4 ,of any of the formulas1 #be ounces is made by using one quarter more of each ingredient2 #cj ounces1 by using one half more2 #ce ounces1 by using three quarters more2 #dj ounces1 by using twice as much1 exactly as described in the ,first ,series on page #gc4 ,the approximate composition of these formulas expressed in percentages is as follows3 ---------------------------------------- ,,formula4 ,fat4 ,sugar4 ,proteids4 ---------------------------------------- ,i4 #b4ej #f4ej #a4be ,,ii4 #b4hj #f4ej #a4dj ,,iii4 #c4ae #g4jj #a4ee ,,iv4 #c4ej #f4jj #a4ge ,v4 #d4jj #f4jj #b4jj ---------------------------------------- -- ,how should the food be increased during this period8 ,beginning with ,i of this ,series1 which should usually follow ,v of the ,first or ,second ,series 7pages #gj1 #ga71 the increase may generally be made in a week or ten days to ,,ii2 in about two weeks more to ,,iii2 now more slowly to ,,iv and ,v4 ,when ,,iv or ,v has been reached1 the same formula may sometimes be continued for three or four months with no other change than an increase in the quantity4 ,in passing from ,formula ,v of the ,first ,series to ,formula ,i of the ,third ,series the proportion of fat is at first reduced4 ,is this necessary or important8 ,no2 it only happens to come so in simplifying the calculation4 ,it may be avoided by taking off at first the upper #ac ounces as top-milk and using #g ounces of this in a #bj-ounce mixture1 in place of ,formula ,i2 and by using for the next increase the upper #ae ounces as top-milk1 taking of this #h ounces in a #bj-ounce mixture in place of ,formula ,,ii4 ,then should follow ,formula ,,iii4 ,what further addition may be made to the food of the later months8 ,usually about the sixth or seventh month1 farinaceous food in the form of gruel may be added1 this taking the place of part of the water and part of the sugar4 ,what changes may be made in the food when the infant has reached the age of ten or eleven months8 ,the proteids may be still further increased1 and the sugar and the lime-water reduced until plain milk is given4 ,how may this best be done8 ,at first one feeding a day of plain milk and barley gruel may be given2 later1 two feedings2 then three feedings1 etc4 ,let us suppose an infant to be taking such a modified milk as ,formula ,,iv or ,v 7page #gf71 six feedings a day4 ,the plain milk diluted only with barley gruel would at first replace one of these feedings2 then two1 three1 four1 etc41 these changes being made at intervals of about two weeks4 ,the proportions of the milk and barley gruel should at first be about #e-a_/b ounces milk1 #b-a_/b ounces barley2 later1 #f ounces milk1 #c ounces barley2 still later1 #g ounces milk1 #b ounces barley1 until finally plain milk is given to drink and the cereals given separately with a spoon4 ,this is reached with most infants at fourteen or fifteen months2 with many at twelve or thirteen months4 ,other forms of farinaceous food may of course be used in the place of the barley1 and in the same proportions4 ,with some infants the addition of a pinch of bicarbonate of soda may be advantageously made to each milk-feeding when the lime-water is omitted1 but with most this is unnecessary4 ,if the infant strongly objects to the taste of the milk when the milk sugar has been omitted1 a small quantity 7one fourth to one half teaspoonful7 of granulated sugar may for a time be added to each feeding1 then gradually reduced4 ,,general ,,rules ,,for ,,guidance ,,in ,,the ,,use ,,of ,,the ,,formulas ,,given ,it should again be emphasized that these formulas are not intended for sick children nor for those suffering from any marked symptoms of indigestion4 ,for such infants special rules are given later4 ,what should be the guide in deciding upon a formula with which to begin for a child who is to be artificially fed8 ,the age and the weight are of some importance1 but the best guide is the condition of the child's digestive organs4 ,one should always begin with a weak formula1 particularly1 7#a7 with an infant previously breast fed2 7#b7 with one just weaned1 as a child who has never had cow's milk must at first have weaker proportions than the age and the weight would seem to indicate2 7#c7 with infants whose power of digestion is unknown4 ,if the first formula tried is weaker than the child can digest1 the food can be strengthened every three or four days until it is found what the child is able to take4 ,on the contrary1 if the food is made too strong at first1 an attack of indigestion will probably follow4 ,how should the food be increased in strength8 ,the first essential is that it be done very gradually2 abruptly increasing the food usually causes a disturbance of digestion4 ,it is never wise to advance more rapidly in strengthening the food than from one formula to the next one in any of the series given2 with many infants it is better to make the steps of increase only half as great as those indicated 7page #gb74 ,how rapidly should the food be increased in quantity8 ,the increase should not be more than a quarter of an ounce in each feeding2 or from one and a half to two ounces in a day4 ,when should the food be increased8 ,in the early weeks an increase may be necessary every few days2 in the later months sometimes the same formula may be continued for two or three months4 ,it is1 however1 impossible to give a definite rule as to time4 ,one cannot say with any child that an increase is to be made every week or every two weeks4 ,a much better guide are the conditions present4 ,the signs indicating that the food should be increased are1 that the infant is not satisfied1 not gaining in weight1 but is digesting well1 i4e41 not vomiting1 and having good stools4 ,one should not increase the food1 however1 so long as the child seems perfectly satisfied and is gaining from four to six ounces a week1 even though both the quantity and the strength of the food are considerably below the average2 nor should the food be increased if the child is gaining from eight to ten ounces a week1 even if he seems somewhat hungry4 ,the appetite is not always a safe guide to follow4 ,how can one know whether the strength or the quantity of the food should be increased8 ,in the early weeks it is well first to increase the strength of the food1 the next time to increase the quantity1 then the strength again1 etc4 ,after the fourth or fifth month1 the quantity1 chiefly1 should be increased4 ,if a slight disturbance or discomfort occurs after the food has been strengthened1 is it best to go back to the weaker formula or to persist with the new one8 ,symptoms of minor discomfort are seen for a day or two with many infants after an ordinary increase in food2 but in most cases an infant soon becomes accustomed to the stronger food and is able to digest it4 ,if1 however1 the symptoms of disturbance are marked1 one should promptly go back to the weaker formula4 ,the next increase should be a smaller one4 ,should one be disturbed if for the first two or three weeks of artificial feeding the gain in weight is very slight or even if there is none8 ,not as a rule4 ,if the infant does not lose weight1 is perfectly comfortable1 sleeps most of the time1 and does not suffer from any symptoms of indigestion1 such as colic1 vomiting1 etc41 one may be sure that all is going well and that the infant is becoming used to his new food4 ,as the child's appetite improves and his digestion is stronger1 the food may be increased every few days and very soon the gain in weight will come and will then be continuous4 ,if1 however1 the scales are watched too closely and1 because there is only a slight gain in weight or none at all1 the food is rapidly increased1 an acute disturbance of digestion is pretty certain to follow4 ,is not constipation likely to occur if the child is on a very weak food8 ,it is very often seen and is due simply to the small amount of residue in the intestine4 ,under these circumstances1 if the bowels move once every day1 one should not be disturbed even when the movements are small and somewhat dry4 ,as the food is gradually strengthened1 this constipation soon passes off2 while if injections1 suppositories1 or cathartics are used to produce freer movements1 the functions of the bowels are likely to be disturbed4 ,under what circumstances should the food be reduced8 ,whenever the child becomes ill from any cause whatever1 or whenever any marked symptoms of indigestion arise4 ,how may this be done8 ,if the disturbance is only a moderate one and the food has been made up for the day1 one third may be poured off from the top of each bottle just before it is given1 and this quantity of food replaced by the same amount of boiled water4 ,if the disturbance is more severe1 the food should be immediately diluted by at least one half and at the same time the quantity given should be reduced4 ,for a severe acute attack of indigestion the regular food should be omitted altogether and only water given until the doctor has been called4 ,if the food has been reduced for a disturbance of digestion1 how should one return to the original formula8 ,while the reduction of the food should be immediate and considerable1 the increase should be very gradual4 ,after a serious attack of acute indigestion1 when beginning with milk again1 it should not be made more than one fifth the original strength1 and from ten days to two weeks should pass before the child is brought back to his original food1 which should be done very gradually4 ,it is surprising how long a time is required with young infants before they completely recover from an attack of acute indigestion1 even though it did not seem to be very severe4 ,the second disturbance always comes from a slighter cause than the first one4 ,,the ,,addition ,,of ,,other ,,foods ,,to ,,milk ,how long should modified milk be continued without the addition of other food8 ,this depends upon circumstances2 usually1 for about six months2 but if the infant is thriving satisfactorily the milk may be used alone for ten or eleven months2 with some infants who have especial difficulty in digesting cow's milk1 it is advisable to begin the use of other food at three or four months or even from the outset4 ,what is the first thing to be used with milk8 ,farinaceous food in some form1 usually as a gruel4 ,how are these gruels made8 ,they may be made directly from the grains or from some of the prepared flours 7page #adi74 ,the flours are usually to be preferred as being more simple of preparation4 ,how should they be used in making the food8 ,they should be cooked separately1 rather than with the milk2 when the food is mixed1 they take the place of a portion of the water in the formulas given on pages #gj and #ga4 ,how much of the gruel should be used8 ,if it is prepared as recommended on page #adi1 it may make according to circumstances from one sixth to one half the total quantity of food4 ,which of the farinaceous foods are to be preferred8 ,those most used are barley1 oatmeal1 arrowroot1 and farina4 ,there is not much difference in their nutritive value2 oatmeal gruel is somewhat more laxative4 ,what value do these substances possess as infant foods8 ,some of the starch is digested and absorbed2 but the chief value of gruels is believed to be that when added to milk they render the curd more easily digested by preventing it from coagulating in the stomach in large tough masses4 ,this is certainly true with many infants1 but there are others who are not at all benefited1 and not a few young infants whose digestion is made distinctly worse by the use of farinaceous food1 particularly when employed in considerable quantity4 ,the addition of gruels to milk for all infants is not to be recommended4 ,what further additions may be made to the diet of healthy infants during the first year8 ,beef juice1 the white of egg1 and orange juice4 ,how and when may beef juice be used8 ,with infants who are strong and thriving satisfactorily it may be begun at ten or eleven months2 two teaspoonfuls may be given daily1 diluted with the same quantity of water1 fifteen minutes before the midday feeding2 in two weeks the quantity may be doubled2 and in four weeks six teaspoonfuls may be given4 ,the maximum quantity at one year should not be more than two or three tablespoonfuls4 ,with delicate infants who are pale and anaemic1 beef juice is more important1 and it may often be wisely begun at five or six months in half the quantities mentioned4 ,when should white of egg be used8 ,under the same conditions as beef juice1 particularly with infants who have difficulty in digesting the proteins 7curd7 of milk4 ,at six months half the white of one egg may be given at one time1 and soon after this the entire white of one egg4 ,the best in manner of cooking is the coddled1 egg 7see page #aea74 ,when should orange juice be begun8 ,usually about the eleventh or twelfth month2 it should be given about one hour before the feeding2 two teaspoonfuls at first1 then one tablespoonful at a time1 and later three or four tablespoonfuls4 ,it is particularly useful when there is constipation4 ,it should always be strained1 and care should be taken that it is sweet and fresh4 ,,overfeeding ,what is meant by overfeeding8 ,giving an infant too much food2 either too much at one time or too frequently4 ,overfeeding is sometimes practised during the day1 but is chiefly done at night4 ,is not an infant's natural desire for food a proper guide as to the quantity given8 ,the appetite of a perfectly normal infant usually is2 but overeating is a habit gradually acquired and may continue until twice as much food as is proper is taken in the twenty-four hours4 ,this habit is most frequently seen in infants whose digestion is not quite normal2 because of the temporary relief from discomfort experienced by taking food into the stomach1 they often appear to be hungry the greater part of the time1 especially at night4 ,what are the causes of overfeeding8 ,the most common one is the habit of watching the weight too closely1 and the conviction on the part of the mother or nurse that because a child is not so large nor gaining so rapidly as some other infant of the same age1 more food or stronger food should be given4 ,what harm results from overfeeding8 ,all food taken in excess of what a child can digest becomes a burden to him4 ,the food lies in the stomach or bowels undigested1 ferments1 and causes wind and colic4 ,when overfeeding is longer continued1 serious disturbances of digestion are soon produced4 ,the infant is restless1 fretful1 constantly uncomfortable1 sleeps badly1 and stops gaining and may even lose in weight4 ,such symptoms may lead to the mistaken conclusion that too little food is given1 and it is accordingly increased1 when it should be diminished4 ,one of the results of long-continued overfeeding is dilatation or stretching of the stomach4 ,what should guide one as to the quantity of food to be given to any infant88 7#a7 ,the size of the infant's stomach at the different months2 7#b7 the amount of milk which the healthy nursing infant gets2 7#c7 the quantities with which most children do best4 ,the table of quantities and intervals of feeding1 on page #ajh1 gives the average figures derived from these sources4 ,it is seldom wise to go beyond the limits there stated2 nor should one insist upon giving any fixed amount if it is clearly more than the child wants or can be made to take except by continued coaxing4 ,,loss ,,of ,,appetite ,what is to be done when without any other signs of illness a child's appetite gradually fails8 ,this is often the result of a long period of overfeeding or the use of milk too rich in fat4 ,if in all other respects the child seems well and simply does not want his food1 it should be offered at regular hours1 but not more frequently2 on no account should he be coaxed1 much less forced1 to eat1 even though he takes only one half or one third the usual quantity4 ,the intervals between feedings should not be shortened but rather lengthened4 ,often1 with a child a year old1 it is necessary to reduce the number of feedings to four or even three in twenty-four hours4 ,water1 however1 may be offered at more frequent intervals4 ,the food should be weakened rather than strengthened4 ,no greater mistake can be made than1 because so little is taken1 coaxing or forcing food at short intervals through fear lest the child may lose weight4 ,,the ,,changes ,,in ,,the ,,food ,,required ,,by ,,special ,,symptoms ,,or ,,conditions ,infants with weak digestion and those suffering from various forms of indigestion have often especial trouble in digesting the fat of milk4 ,to meet the needs of such there is required a series of formulas in which the fat is lower than in those already given4 ,these formulas are obtained from plain milk4 ,fourth ,series ,formulas from ,plain ,milk 7containing #d-per-cent ,fat7 ---------------------------------------- ----------------- ,i4 ,,ii4 ,,iii4 ,,iv4 ,v4 ,,vi4 ,,vii4 ,,viii4 ---------------------------------------- ----------------- ,plain milk #eoz4 #foz4 #goz4 #hoz4 #ioz4 #ajoz #aboz4 #adoz4 ,milk sugar #a #a #a #a #c_/d #c_/d #a_/b #a_/b ,lime-water4 #a #a #a #a #a #a #a #a ,boiled water #ad #ac #ab #g #f #e #b #j ,barley gruel #j #j #j #d #d #d #e #e ---------------------------------------- ----------------- #bj #bj #bj #bj #bj #bj #bj #bj oz4 oz4 oz4 oz4 oz4 oz4 oz4 oz4 ---------------------------------------- ----------------- ,when larger quantities than #bj ounces are required they are calculated in the same manner as described on page #gc in speaking of #aj-per-cent milk4 ,the approximate composition of the formulas of the ,fourth ,series expressed in percentages is as follows3 ---------------------------------------- ,,formula4 ,fat4 ,sugar4 ,proteids4 ---------------------------------------- ,i4 #a4jj #f4jj #j4ij ,,ii4 #a4bj #f4jj #a4jj ,,iii4 #a4dj #f4ej #a4bj ,,iv4 #a4fj #f4ej #a4dj ,v4 #a4hj #f4jj #a4fj ,,vi4 #b4jj #f4jj #a4hj ,,vii4 #b4dj #e4ej #b4aj ,,viii4 #b4hj #e4ej #b4ej ---------------------------------------- ,why is it that an infant so often vomits some of its food within a few moments after finishing its bottle8 ,usually because the quantity is too large4 ,sometimes it is due to the fact that the food is taken too rapidly1 from too large a hole in the nipple4 ,it may be due to too tight clothing1 or to moving the child about in such a way as to press upon the stomach4 ,what are the principal causes of1 and the changes in the food required by habitual vomiting1 regurgitation1 or spitting up of small quantities of food between feedings1 often repeated many times a day8 ,this is always a symptom of gastric indigestion1 and a most troublesome one4 ,in such conditions the fat and often the sugar also should be reduced and the lime-water increased4 ,formulas made from rich top-milk or milk and cream are to be avoided4 ,those made from #g-per-cent milk are less likely to be the cause of trouble than those from #aj-per-cent milk2 but if the symptoms are at all severe it is better to use instead of these the formulas of the ,fourth ,series derived from plain milk4 ,reduction in the sugar may be made by adding only one half ounce of milk sugar to each twenty ounces of the food2 in severe cases the sugar may be omitted altogether4 ,it is often advisable to double the amount of lime-water--i4e41 use two ounces to each twenty ounces of food4 ,the malted foods and all other foods containing much sugar usually aggravate the symptoms4 ,the intervals between meals should generally be half an hour longer1 and sometimes an hour longer1 than when digestion is normal4 ,the quantity given at a feeding should generally be less than with a normal digestion4 ,usually a smaller quantity of a strong food succeeds better than a larger quantity of a weak food4 ,what are the causes of1 and food changes required by a constant and excessive formation of gas in the stomach1 leading to distention and pain1 or eructations 7belching7 of gas and often of a sour1 watery fluid8 ,this is often associated with habitual vomiting1 and is due to similar causes1 but particularly to the sugar1 which should be greatly reduced or omitted entirely4 ,what changes should be made when there is habitual colic8 ,this is generally due to an accumulation of gas in the intestines which forms there because the proteids 7curd7 of the milk are not digested4 ,they should be reduced by using in the early months a weaker formula--i4e41 instead of ,formula ,v of the ,first or ,second ,series1 ,,iv might be used1 or1 for a short time1 even ,,iii4 ,the proteids may be reduced in the middle period by using weaker formulas ,if we desire to reduce the proteids without reducing the fat1 we may change from the ,second to the ,first ,series4 ,another means of relieving habitual colic is the use of partially peptonized milk 7page #aae72 still another the dilution with barley-water instead of plain water4 ,what change should be made if curds appear in the stools regularly or frequently8 ,this is usually associated with habitual colic1 and has to be managed exactly like that condition1 by the means just described4 ,how should the milk be modified for chronic constipation8 ,the constipation of the first weeks of life has been already referred to 7page #hb72 it usually disappears as the food is gradually strengthened in all its proportions4 ,habitual constipation at a later period is difficult to overcome by diet alone4 ,it sometimes depends upon the fact that the proteids are too high1 and sometimes that the fat is too low4 ,hence it is more frequent when infants are fed upon plain milk variously diluted 7page #ij71 then when #g-per-cent or #aj-per-cent milk is used1 and diluted to a greater degree4 ,but it is not desirable to use a top-milk containing more than ten per cent fat for this purpose1 nor is it wise to carry the fat in the food above #d per cent 7i4e41 #h ounces of #aj-per-cent milk1 or #ab ounces of #g-per-cent milk1 in a #bj-ounce mixture7 or other disturbances of digestion may be produced4 ,in some cases the use1 in place of milk sugar1 of ordinary brown sugar1 in half the quantity1 is of assistance2 or of some of the malted foods 7,mellin's food1 malted milk1 cereal milk7 also in the place of milk sugar4 ,the substitution of the milk of magnesia for the lime-water as recommended on page #fj will often be found useful4 ,to infants over nine months old1 orange juice may be given4 ,what special modifications are required during very hot weather8 ,during the warm season it is well to make the proportion of fat less than during cold weather4 ,during short periods of excessive heat it should be much less4 ,the fat is reduced by using #g-per-cent milk in place of #aj-per-cent 7i4e41 the ,second instead of the ,first ,series of formulas1 page #ga71 or plain milk in place of the #g-per-cent milk in the ,second and ,third ,series 7page #ij74 ,at such times also the usual food should be diluted1 and water should be given freely between the feedings4 ,what changes should be made in the food of a child who1 with all the signs of good digestion1 gains very little or not at all in weight8 ,if the child seems hungry the quantity of food may be increased2 but if the child will not readily take any more in quantity the strength may be increased by the use of the next higher formula4 ,one should1 however1 be extremely careful under these circumstances not to coax or force a child2 for this plan is almost certain to cause disturbance of digestion and actual loss in weight4 ,a better policy is that of looking after the other factors in the child's life1--the care1 sleep1 fresh air1 etc41 for with these rather than with the food the trouble often lies4 ,what should be done with infants who in spite of all variations in the milk continue to have symptoms of indigestion and do not thrive8 ,except inmates of institutions who form a class by themselves1 most infants who receive proper care thrive upon milk if the proportions suited to the digestion are given4 ,still there are some who do not4 ,the nutrition of such is always a matter of difficulty4 ,if a wet-nurse is available the employment of one is the thing most likely to succeed1 particularly if the infant is under four or five months old4 ,if the infant is older1 or if a wet-nurse cannot be obtained1 some of the substitutes for fresh cow's milk may be tried4 ,one of the best is condensed milk1 ,borden's ,eagle brand1 canned1 being preferred4 ,this is more likely to agree if the symptoms are chiefly intestinal 7colic1 flatulence1 curds in the stools1 constipation or diarrhoea7 than if they are chiefly gastric 7vomiting1 regurgitation1 etc474 ,how should condensed milk be used8 ,for an infant three or four months old with symptoms of indigestion1 it should at first be diluted with #af parts of boiled water1 or1 sometimes preferably1 with barley-water4 ,with improvement in the symptoms the dilution may be made #a to #ad1 #a to #ab1 #a to #aj1 and #a to #h1 these changes being gradually made4 ,the intervals between feedings and the quantities for one feeding are given on page #ajh4 ,how long should condensed milk be continued8 ,in most cases it should be used as the sole food for a few weeks only4 ,afterward1 one feeding a day of a weak formula of modified milk 7e4g41 ,no4 ,,iii or ,,iv of the ,second ,series1 page #ga7 may be given2 later two feedings1 and thus gradually the number of milk feedings is increased until the child is taking only modified milk4 ,condensed milk is not to be recommended as a permanent food where good fresh cow's milk can be obtained4 ,what are the objections to its use8 ,it is very low in fat and proteids1 and high in sugar4 ,this accounts for its easy digestibility1 and also explains why children reared upon it often gain very rapidly in weight1 yet have as a rule but little resistance4 ,they are very prone to develop rickets and sometimes scurvy4 ,are the proprietary infant foods open to the same objections as condensed milk8 ,they are4 ,what has been said of condensed milk applies equally well to most of those that are sold in the market as substitutes for milk4 ,what changes in the food are required by slight indisposition8 ,for slight general disturbances such as dentition1 colds1 sore throats1 etc41 it is usually sufficient simply to dilute the food4 ,if this is but for two or three feedings1 it is most easily done by replacing with boiled water an ounce or two of the food removed from the bottle just before it is given2 if for several days1 a weaker formula should be used4 ,what changes should be made for a serious acute illness8 ,for such attacks as those of pneumonia1 bronchitis measles1 etc41 attended with fever1 the food should be diluted and the fat reduced as described on page #ie4 ,it should be given at regular intervals1 rather less frequently than in health4 ,water should be given freely between the feedings4 ,food should not be forced in the early days of an acute illness1 since the loss of appetite usually means an inability to digest much food4 ,what immediate changes should be made in the food when the child is taken with an acute attack of gastric indigestion with repeated vomiting1 fever1 pain1 etc48 ,all milk should be stopped at once1 and only boiled water given for ten or twelve hours2 afterward barley-water or whey may be tried1 but no milk for at least twenty-four hours after the vomiting has ceased4 ,when beginning with modified milk the quantity should be small and the fat low1 which may be secured by the use of the ,fourth ,series of formulas in the place of the ,first or ,second ,series4 ,the proportion of lime-water may be doubled4 ,what changes should be made for an attack of intestinal indigestion attended by looseness of the bowels8 ,if this is not severe 7only two or three passages daily7 the fat should be lowered in the manner stated just above1 and the milk should be boiled for five minutes4 ,if curds are present in the stools1 it may be still further diluted4 ,if the diarrhoeal attack is more severe1 and attended by fever and foul-smelling movements of greater frequency1 all milk should be stopped immediately and the diet mentioned just above under the head of acute disturbances of the stomach should be employed4 ,what changes in the food should be made when the child seems to have very little appetite and yet is not ill8 ,the number of feedings should be reduced1 the interval being lengthened by one hour or even more4 ,no greater mistake can be made than to offer food every hour or two to an infant who is not hungry4 ,such a course only prolongs and aggravates the disturbance4 ,what other conditions besides the food greatly ,influence the child's digestion8 ,proper clothing1 warm feet1 regular habits1 fresh air1 clean bottles1 and food given at the proper temperature are all quite as important as the preparation of the food2 quiet peaceful surroundings and absence of excitement are also essential to good digestion4 ,,common ,,mistakes ,,in ,,milk ,,modification ,,and ,,infant ,,feeding ,i4 ,in using modifications made from top-milk1 much confusion arises from the notion that top-milk is a single definite thing1 whereas its composition depends upon a great variety of conditions and1 unless all these are known1 it is impossible to tell how strong it is4 ,directions for the removal of top-milk should be explicitly followed 7see page #fc71 or the results will be very different from those expected4 ,,ii4 ,in formulas calling for a certain number of ounces of top-milk of any given strength1 the mistake is made of removing only the number of ounces needed for the formula4 ,the proper way is to remove the amount required to secure a top-milk of the desired strength and then to take of this the number of ounces needed in the formula4 ,,iii4 ,a rich ,jersey milk is used as if it were ordinary milk4 ,the formulas given in this book are chiefly calculated on the basis of a good average milk which contains about #d per cent fat4 ,many persons have the idea that the richer the milk1 the more rapidly the child will gain in weight1 and hence the superiority of such milk for infant feeding4 ,while it is true that some children taking a very rich milk may1 for a time1 gain rapidly in weight1 yet sooner or later1 serious disturbances of digestion are nearly always produced4 ,,iv4 ,the food is increased too rapidly1 particularly after some disturbance of digestion4 ,if1 in an infant three or four months old1 an attack of somewhat acute indigestion occurs1 the food should seldom be given in full strength before two weeks4 ,the increase in the diet should be made very gradually1 the steps being made only one half those indicated in the series of formulas on pages #gj and #ga4 ,otherwise it generally happens that the attack of indigestion is very much prolonged and much loss in weight occurs4 ,v4 ,when symptoms of indigestion occur1 the food is not reduced rapidly enough4 ,indigestion usually means that the organs are1 for the time1 unequal to the work imposed4 ,if the food is immediately reduced by one half1 the organs of digestion soon regain their power and the disturbance is short4 ,in every case the amount of reduction should depend upon the degree of the disturbance4 ,,preparation ,,of ,,cow',s ,,milk ,,at ,,home ,what articles are required for the preparation of cow's milk at home8 ,feeding-bottles1 rubber nipples1 an eight-ounce graduated measuring glass1 a glass or agate funnel1 bottle brush1 cotton1 alcohol lamp or1 better1 a ,bunsen gas burner1 a tall quart cup for warming bottles of milk1 a pitcher for mixing the food1 a wide-mouth bottle for boric acid and one for bicarbonate of soda1 and a pasteurizer4 ,later1 a double boiler for cooking cereals will be needed4 ,what bottles are to be preferred8 ,a cylindrical graduated bottle with a rather wide neck1 so as to admit of easy washing1 and one which contains no angles or corners4 ,a single size holding eight ounces is quite sufficient for use during the first year4 ,all complicated bottles are bad1 being difficult to clean4 ,one should have as many bottles in use as the child takes meals a day4 ,how should bottles be cared for8 ,as soon as they are emptied they should be rinsed with cold water and allowed to stand filled with water to which a little bicarbonate of soda has been added4 ,before the milk is put into them they should be thoroughly washed with a bottle brush and hot soap-suds and then placed for twenty minutes in boiling water4 ,what sort of nipples should be used8 ,only simple straight nipples which slip over the neck of the bottle4 ,those with a rubber or glass tube are too complicated and very difficult to keep clean4 ,nipples made of black rubber are to be preferred4 ,the hole in the nipple should not be so large that the milk will run in a stream1 but just large enough for it to drop rapidly when the bottle with the nipple attached is inverted4 ,how should nipples be cared for8 ,new nipples should be boiled for five minutes2 but it is unnecessary to repeat this every day as they soon become so soft as to be almost useless4 ,after using1 nipples should be carefully rinsed in cold water and kept in a covered glass containing a solution of borax or boric acid4 ,at least once a day they should be turned wrong side out and thoroughly washed with soap and water4 ,what sort of cotton should be used8 ,the refined non-absorbent cotton is rather better for stoppering bottles1 but the ordinary absorbent cotton will answer every purpose4 ,which is better1 the ,bunsen burner or the alcohol lamp8 ,if there is gas in the house1 the ,bunsen burner is greatly to be preferred1 being cheaper1 simpler1 and much safer than the alcohol lamp4 ,if the lamp is used1 it should stand upon a table covered with a plate of zinc or tin1 or upon a large tin tray4 ,the ,french pattern of alcohol lamp is the best4 ,give the directions for preparing the food according to any of the above formulas4 ,the nurse's hands1 bottles1 tables1 and all utensils should be scrupulously clean4 ,first dissolve the milk sugar in boiling water1 filtering if necessary4 ,then add the milk and cream and lime-water1 mixing the whole in a pitcher4 ,a sufficient quantity of food for twenty-four hours is always to be prepared at one time4 ,this is then divided into the number of feedings required for the day1 each feeding being put in a separate bottle1 and the bottle stoppered with cotton4 ,the bottles should then be cooled rapidly by standing1 first in tepid then in cold water1 and afterward placed in an ice chest4 ,if the milk is to be pasteurized or sterilized1 this should precede the cooling4 ,,directions ,,for ,,feeding ,,infants ,how should the bottle be prepared at feeding time8 ,it should be taken from the ice chest1 and warmed by standing in warm water which is deep enough to cover the milk in the bottle2 it should then be thoroughly shaken and the nipple adjusted2 the nurse should see that the hole in the nipple is not too large nor too small4 ,how may the temperature of the milk be tested8 ,never by putting the nipple in the nurse's mouth4 ,before adjusting the nipple1 a teaspoonful may be poured from the bottle and tasted1 or a few drops may be poured through the nipple upon the inner surface of the wrist1 where it should feel quite warm but never hot2 or a thermometer may be placed in the water in which the bottle stands4 ,a dairy thermometer should be used1 and the temperature of the water should be between #ih deg4 and #aje deg4 ,f4 ,what is a simple contrivance for keeping the milk warm during feeding8 ,a small flannel bag with a draw string may be slipped over the bottle4 ,in what position should an infant take its bottle8 ,for the first two or three months it is better1 except at night1 when it may be undesirable to take the infant from its crib1 that it be held on the nurse's arm during the feeding2 later it may lie on its side in the crib provided the bottle is held by the nurse until it has been emptied2 otherwise a young infant readily falls into the bad habit of alternately sucking and sleeping1 and often will be an hour or more over its bottle4 ,how much time should be allowed for one feeding8 ,never more than twenty minutes4 ,the bottle should then be taken away and not given until the next feeding time4 ,under no circumstances should an infant form the habit of sleeping with the nipple in its mouth4 ,a sleepy infant should be kept awake by gentle shaking until the food is taken1 or the bottle should be removed altogether4 ,should an infant be played with soon after feeding8 ,on no account2 such a thing frequently causes vomiting and sometimes indigestion4 ,after every feeding the infant should be allowed to lie quietly in its crib1 and disturbed as little as possible4 ,,intervals ,,of ,,feeding ,how often should a baby be fed during the first month8 ,every two hours during the day and twice during the night1 or ten feedings during the twenty-four hours4 ,at what age may the interval be made two and a half hours8 ,usually at five or six weeks4 ,when may it be increased to three hours8 ,usually at two months4 ,why should not a child be fed more frequently8 ,it takes the stomach nearly two hours to digest a meal at two months1 and about two and a half hours at five or six months1 and if the meals are too near together the second one is given before the first has been digested and vomiting and indigestion result4 ,the meals should be far enough apart to give the stomach a little time for rest just before each feeding4 ,schedule for ,feeding ,healthy ,infants during the ,first ,year ---------------------------------------- --------------------------- ,,age4 ,interval ,night ,no4 of ,quantity ,quantity between feedings feedings for one for #bd meals1 7#aj ,p4,m4 in #bd feeding4 hours4 by day4 to #g ,a4,m474 hours4 ---------------------------------------- ----------------------------- ,hours4 ,ounces4 ,ounces4 #b;d to #gth day #b #b #aj #a -#a-a_/b #aj-ae #b;d and #c;d weeks #b #b #aj #a-a_/b - #c #ae-cj #dth and #eth weeks #b #a #aj #b-a_/b - #c-a_/b #be-ce #fth to #hth week #b-a_/b #a #h #c - #e #bd-dj #c;d to #eth month #c #a #g #d - #f #bh-db #eth to #ith month #c #j #f #e - #g-a_/b #cj-de #ith to #abth month #d #j #e #g - #i #ce-de ---------------------------------------- ----------------------------- ,this schedule gives the averages for healthy children ,the smaller quantities are those required by small children whose digestion is not very vigorous4 ,the larger quantities are those required by large children with strong digestion2 in very few cases will it be advisable to go above these figures4 ,the interval is reckoned from the beginning of one feeding to the beginning of the next one4 ,when should the interval between the feedings be lengthened8 ,when there is gastric indigestion as shown by habitual vomiting or the regurgitation of food long after the bottle is finished2 also when the appetite is very poor so that the infant regularly leaves some of its food4 ,when should the interval between the feedings be shortened8 ,this is done much too frequently2 it is rarely advisable to feed any infant1 except one seriously ill1 oftener than the time put down in the schedule4 ,,regularity ,,in ,,feeding ,how can a baby be taught to be regular in its habits of eating and sleeping8 ,by always feeding at regular intervals and putting to sleep at exactly the same time every day and evening4 ,when should regular training be begun8 ,during the first week of life4 ,should a baby be wakened to be nursed or fed if sleeping quietly8 ,yes1 for a few days4 ,this will not be required long1 for with regular feeding an infant soon wakes regularly for its meal1 almost upon the minute4 ,should regularity in feeding be kept up at night as well as during the day8 ,only up to nine or ten o'clock2 after that time a baby should be allowed to sleep as long as it will4 ,at what age may a well baby go without food from #aj ,p4,m4 to #f or #g ,a4,m48 ,usually at four months1 and always at five or six months4 ,night feeding is one of the most frequent causes of wakefulness and disturbed sleep4 ,,sterilized ,,milk ,what is meant by sterilizing milk8 ,heating milk for the purpose of destroying germs4 ,does all cows milk contain germs8 ,yes2 even when handled most carefully1 milk contains many germs2 but when carelessly handled1 and in summer1 the number is enormous4 ,while most of these are harmless or cause only the souring of milk1 others are occasionally present which may produce serious diseases such as typhoid fever1 diphtheria scarlet fever1 cholera1 tuberculosis1 and many forms of diarrhoea4 ,under what circumstances is it necessary to sterilize milk8 #a4 ,in warm weather when it cannot be obtained fresh2 hence always in cities and towns during the summer4 #b4 ,when one cannot be certain that the cows are healthy1 or that the milk has been carefully handled4 #c4 ,when the milk is to be kept for any considerable time 7i4e41 over twenty-four hours71 especially if no ice can be had4 #d4 ,during epidemics of typhoid fever1 scarlet fever1 diphtheria1 or any form of diarrhoeal disease4 ,what are the two methods of heating milk8 ,the first is known as sterilizing1 in which the milk is heated to #bab deg4 ,f4 for one hour or one hour and a half2 the second is known as pasteurizing1 in which the milk is heated to #aee deg4 or #agj deg4 ,f4 for thirty minutes4 ,a temperature of #aee deg4 ,f4 continued for thirty minutes is sufficient to kill the germs of the diseases above referred to4 ,will milk which has been thus treated keep indefinitely8 ,no2 for although all the living germs may be killed1 there are many undeveloped germs1 or spores1 which are not destroyed1 and which soon grow into living germs4 ,milk heated to #bab deg4 ,f4 for an hour will keep upon ice for two or three weeks2 that heated to #aee deg4 ,f4 for two or three days4 ,is milk which has been sterilized always a safe food8 ,no2 for the reason that the milk may be so old1 so dirty1 and so contaminated before sterilizing that it may be still unfit for food1 though it contains no living germs4 ,is cow's milk rendered more digestible by being heated in this way8 ,sterilizing milk does not improve its digestibility but rather the contrary4 ,sterilized milk should be modified for infant feeding in the same way as milk which has not been heated4 ,is milk in any way injured by heating to #bab deg4 ,f4 for an hour8 ,there is abundant evidence that milk is rendered less digestible by such heating2 also that it is more constipating1 and that for some children its nutritive properties are interfered with1 so that it may cause scurvy2 this1 however1 is not seen unless it is continued as the sole food for a long period4 ,these objections are of so much importance that this plan of heating milk is not to be recommended for general use4 ,when is it advantageous to heat milk to #bab deg4 ,f48 ,for use upon long journeys1 such as crossing the ocean4 ,milk should then be heated for one hour upon two successive days1 without removing the cotton stoppers from the bottles4 ,is milk in any way injured by heating to #aee deg4 ,f4 for thirty minutes8 ,this point is not yet definitely settled4 ,such heating does not affect the taste of milk and does not render it more constipating4 ,the unfavourable effects2 if there are any1 are so slight that they need not deter one from the use of pasteurized milk1 even for long periods4 ,the preference1 however1 should always be given to milk which is so clean and so fresh as not to require any heating4 ,how should milk be pasteurized8 ,a convenient form of apparatus is that known as ,freeman's pasteurizer#e2 another is the ,walker-,gordon pasteurizer4#f #e ,this can be obtained at #daa ,west ,fifty-ninth ,street1 ,new ,york1 with bottles and full directions2 a tin one1 at a cost of #c4ej1 and a copper one1 which is much more durable1 for #g4jj4 #f ,obtained at the same prices from any of the ,walker-,gordon milk laboratories4 ,how should milk be cooled after pasteurizing8 ,always by placing the bottles in cold water1 so as to cool them rapidly2 never by letting them stand at the temperature of the room1 or by placing them1 when warm1 in an ice box4 ,why is this precaution necessary8 ,cooling in the air or in an ice box requires from two to four hours1 and during that time a great many of the undeveloped germs may mature and greatly injure the keeping properties of the milk4 ,in the cold water1 milk can be cooled in from ten to twenty minutes if the water is frequently changed1 or if ice is added to the water4 ,,modified ,,milk ,,of ,,the ,,milk ,,laboratories ,what is modified milk of the milk laboratories8 ,it is milk containing definite proportions of the fat1 sugar1 proteids1 etc41 put up usually according to the prescription of a physician1 who indicates how much of the different elements he desires4 ,the most reliable are the laboratories of the ,walker-,gordon ,company1 which has branches in many of the large cities of the ,united ,states4 ,this is an excellent method of having milk prepared since it can be done with greater care and cleanliness than are possible in most homes4 ,it is besides a great convenience if circumstances make it impossible to prepare the milk properly at home4 ,the laboratory should be used for infant feeding only by one who is somewhat familiar with this method of ordering milk4 ,,peptonized ,,milk ,what is peptonized milk8 ,milk in which the proteids 7curd7 have been partially digested4 ,how is this accomplished8 ,by the action of a peptonizing powder which is composed of a digestive agent known as the extractum pancreatis and bicarbonate of soda1 which is added to the plain or diluted milk4 ,this is sold in tubes or in tablets1 and it is the active ingredient of the peptogenic milk powder4 ,describe the process4 ,the plain or modified milk is placed in a clean glass jar or bottle1 and the peptonizing powder1 which is first rubbed up with a tablespoonful of the milk1 is added and the bottle shaken4 ,the bottle is then placed in a large pitcher or basin containing water kept at the temperature of about #aaj deg4 ,f41 or as warm as the hand can bear comfortably1 and left for ten to twenty minutes if the milk is to be partially peptonized2 for two hours if it is to be completely peptonized4 ,what taste has partially peptonized milk8 ,none1 if peptonizing is continued for only ten minutes1 but at the end of twenty minutes it begins to be bitter1 when the process of digestion has gone further4 ,how is the bitter taste avoided in partially peptonized milk8 ,at the end of ten or fifteen minutes the milk may be placed in a saucepan and quickly raised to boiling point2 this kills the ferment1 so that the milk will not become bitter when warmed a second time4 ,or1 the milk may be rapidly cooled by placing the bottles first in cool and then in ice water2 in this way the ferment is not destroyed1 and the milk may become bitter when warmed for feeding4 ,should the whole day's supply be peptonized at once1 or each bottle separately just before the feeding8 ,either plan may be followed4 ,if the former1 it is better to raise the milk to boiling point after peptonizing2 if the latter1 it should not be peptonized more than ten minutes1 for it will continue to peptonize while it is being taken by the child4 ,is not the bitter taste of completely peptonized milk a great obstacle to its use8 ,not in the case of young infants2 one under four or five months old will usually take it without any objection after two or three feedings2 but it cannot often be used for those who are much older4 ,how much of the peptonizing powder should be used8 ,there are required for one pint of plain milk1 five grains of the extractum pancreatis and fifteen grains of bicarbonate of soda4 ,this quantity is usually put up in a single tube or tablet4 ,in the formulas previously given1 less than this will be required2 for the weaker formulas1 one half or one third of the powder mentioned will be sufficient for one pint of food4 ,for a single feeding of four ounces1 one may use one eighth of a tube with a weak formula1 or one sixth of a tube with a stronger formula4 ,what are the advantages of peptonized milk8 ,partially peptonized milk is useful for young infants who have great difficulty in digesting the curd of milk1 sometimes even when diluted as already described2 completely peptonized milk1 during acute attacks of indigestion4 ,for how long a period may the use of peptonized milk be continued8 ,completely peptonized milk may be used for a few days1 or at most a few weeks2 partially peptonized milk may be used for two or three months1 but not indefinitely2 it should be left off gradually by shortening the time of peptonizing1 and lessening the amount of the powder used4 ,,feeding ,,during ,,the ,,second ,,year ,how many meals are required during the second year8 ,it is usually better to continue five meals throughout the second year4 ,some children will sleep from #f ,p4,m4 to #f ,a4,m4 without waking1 but unless there is a feeding at #aj ,p4,m4 children are apt to wake very early in the morning4 ,should each feeding be prepared at the time it is given1 or all feedings at one time1 as during the first year8 ,during the second and third years it is better to prepare the milk for the entire day at one time4 ,if it is to be modified by adding cream1 water1 etc41 it is done as during the first year4 ,later1 when only plain milk is used1 the quantities needed for the different feedings should be put into one or into two bottles1 which then may be pasteurized or not as may be necessary4 ,in this way the different feedings are kept separate1 and the day's supply of milk is not disturbed every time the child is fed1 as otherwise is unavoidable4 ,the food should be prepared as soon as possible after the daily milk supply is delivered in the morning4 ,give a proper diet for an average healthy child of twelve months4 #f4cj ,a4,m4 ,milk1 six to seven ounces2 diluted with barley or oat gruel1 two to three ounces2 after the thirteenth month1 taken from a cup4 #i ,a4,m4 ,orange juice1 one to two ounces4 #aj ,a4,m4 ,milk1 two parts2 oatmeal or barley gruel1 one part2 from ten to twelve ounces in all may be allowed2 it should be given from a cup4 #b ,p4,m4 ,beef juice1 one to two ounces2 or1 the white of one egg1 slightly cooked2 later1 the entire egg2 or1 mutton or chicken broth1 four to six ounces4 ,milk and gruel in proportions above given1 four to six ounces4 #f ,p4,m4 ,same as at #aj ,a4,m4 #aj ,p4,m4 ,same as at #f4cj ,a4,m41 except that the milk may be given from the bottle4 ,how long may this schedule be followed8 ,usually until the fourteenth or fifteenth month4 ,after this time the cereals may be given much thicker and fed from a spoon4 ,may any other fruit juices be given at this period8 ,orange juice is the best2 next to this the juice of fresh ripe peaches1 red raspberries or strawberries4 ,all these should be strained very carefully through muslin to make sure that the child gets none of the pulp or seeds1 either of which may cause serious disturbance4 ,of the orange or peach juice1 from one to four tablespoonfuls may be allowed at one time2 of the others about half the quantity4 ,the fruit juice is best given one hour before the second feeding4 ,when should a child be weaned from its bottle8 ,most children can and should be taught to take their food from the cup or spoon by the time they are thirteen months old2 but it is convenient to give the #aj ,p4,m4 feeding from the bottle during the greater part of the second year 7see page #eb74 ,give a proper diet for an average child from the fourteenth to the eighteenth month4 ,the bottle should not be given except at night4 ,cereals may now form an important part of the diet4 ,they should be very thoroughly cooked1 usually for three hours1 and strained4 ,the daily schedule should be about as follows3 #f4cj ,a4,m4 ,milk1 warmed1 eight to ten ounces1 given from a cup4 #i ,a4,m4 ,fruit juice1 one to three ounces4 #aj ,a4,m4 ,cereal3 one1 later two or three1 tablespoonfuls of oatmeal hominy or wheaten grits1 cooked for at least three hours2 upon this from one to two ounces of thin cream1 or milk and cream1 with plenty of salt1 but without sugar4 ,crisp dry toast1 one piece2 or1 unsweetened zwieback2 or1 one ,huntley and ,palmer breakfast biscuit4 ,milk1 warmed1 six to eight ounces1 from a cup4 #b ,p4,m4 ,beef juice1 one to two ounces2 and one egg 7soft boiled1 poached or coddled72 and boiled rice1 one tablespoonful2 or1 broth 7mutton or chicken71 four ounces2 one or two ,huntley and ,palmer breakfast biscuits1 or zwieback2 and 7if most of the teeth are present7 rare scraped meat1 at first one teaspoonful1 gradually increasing to one tablespoonful4 #f ,p4,m4 ,cereal3 two tablespoonfuls of farina1 cream of wheat1 or arrowroot1 cooked for at least one half hour1 with milk1 plenty of salt1 but without sugar4 ,milk1 warmed1 eight to ten ounces1 given from a cup4 #aj ,p4,m4 ,milk1 warmed1 eight to ten ounces1 which may be given from a bottle4 ,give a proper diet for an average child from the eighteenth month to the end of the second year4 ,the same order of meals as for the months just preceding should be followed4 ,for most children milk at #aj ,p4,m4 is desirable4 ,there are many1 however who sleep regularly from #f ,p4,m4 until #f ,a4,m4 without food2 for such the night feeding should1 of course1 not be insisted upon4 ,the daily schedule should be about as follows3 #f4cj ,a4,m4 ,milk1 warmed1 ten to twelve ounces1 given from cup4 #i ,a4,m4 ,fruit juice1 two to three ounces4 #aj ,a4,m4 ,cereals3 similar to those given from the fourteenth to the eighteenth month2 they need not be strained although they should be cooked and served in the same way4 ,crisp dry bread1 zwieback1 or ,huntley and ,palmer biscuits1 without butter4 ,milk1 warmed1 one cup4 #b ,p4,m4 ,beef juice and one egg2 or1 broth and meat2 care being taken that the meat is always rare and scraped or very finely divided2 beefsteak1 mutton chop1 or roast beef may be given4 ,very stale bread1 or two pieces of zwieback4 ,prune pulp or baked apple1 one to two tablespoonfuls4 ,water2 no milk4 #f ,p4,m4 ,cereal3 farina1 cream of wheat1 or arrowroot1 cooked for at least one half hour1 with milk1 plenty of salt1 but without sugar4 or1 milk toast or stale bread and milk4 #aj ,p4,m4 ,if required1 ten to twelve ounces of plain milk4 ,what fruits may be given at this period8 ,if the child has a feeble digestion1 only the fruit juices previously allowed2 strong children may have in addition prune pulp1 baked apple1 and applesauce4 ,the prune pulp is prepared by stewing the dried prunes without sugar until they are very soft1 and removing all the skin by putting the fruit through a strainer2 of this from one to two tablespoonfuls may be given at one time4 ,the baked apple should be given without cream1 and the applesauce should have very little sugar4 ,how and when should water be given8 ,throughout the second year water should be given freely between the feedings1 especially in warm weather2 from one to three ounces may be given at one time1 either from a spoon1 a glass1 or a bottle4 ,the water should be boiled daily and then cooled4 ,it should not be allowed to stand in the room1 but fresh water should be put into the bottle each time4 ,,feeding ,,during ,,the ,,third ,,year ,what changes may be made in the diet during the third year8 ,the night feeding at #aj ,p4,m4 should be omitted4 ,a greater quantity of solid food may be allowed1 particularly at the mid-day meal4 ,it is not advisable to begin potato and other vegetables until this age is reached4 ,three regular meals should be given and milk once besides1 either between the breakfast and dinner or dinner and supper1 whichever is the longer interval4 ,water should be allowed freely between meals4 ,what would be a proper schedule for an average child during the third year8 #g4cj ,a4,m4 ,cereal3 cooked 7preferably over night7 for three hours1 although a somewhat larger variety may be given than during the second year2 given as before with milk or thin cream1 salt1 but very little sugar4 ,warm milk1 one glass4 ,a soft egg1 poached1 boiled or coddled4 ,bread1 very stale or dry1 one slice1 with butter4 #aj ,a4,m4 ,warm milk1 one cup1 with a cracker or piece of very stale bread and butter4 #b ,p4,m4 ,soup1 four ounces2 or1 beef juice1 two ounces4 ,meat3 chop1 steak1 roast beef or lamb or chicken4 ,a baked white potato2 or1 boiled rice4 ,green vegetable3 asparagus tips1 string beans1 peas1 spinach2 all to be cooked until very soft1 and mashed1 or preferably put through a sieve2 at first1 one or two teaspoonfuls4 ,dessert3 cooked fruit--baked or stewed apple1 stewed prunes4 ,water2 no milk4 #f ,p4,m4 ,cereal3 farina1 cream of wheat1 or arrowroot1 cooked for at least one half hour1 with plenty of salt1 but without sugar2 or1 milk toast2 or1 bread and milk2 or1 stale or dry bread and butter and a glass of milk4 ,,part ,,iii ,,the ,,diet ,,of ,,older ,,children 7,,fourth ,,to ,,tenth ,,year7 ,throughout this period the largest meal should always be in the middle of the day1 and a light supper given1 very much like that described for the third year4 ,during the first half of this period1 milk may be allowed once either between breakfast and dinner or dinner and supper2 no other eating between meals should be permitted1 but water should be allowed freely4 ,,milk ,,and ,,cream ,what part of the diet should milk form during childhood8 ,it should form a very important part up to the tenth year2 nothing can take its place4 ,there are comparatively few children who cannot take and digest milk if it is properly fed4 ,why is milk so advantageous8 ,because no food that we possess has so high a nutritive value as milk1 for the amount of work required of the organs of digestion4 ,it is1 therefore1 peculiarly adapted to the diet of the child4 ,what are the essential points in the use of milk8 ,it should be clean and fresh1 but not too rich4 ,it is a mistake to select for any children the rich milk of a ,jersey herd and use it as though it were an ordinary milk4 ,for children who have difficulty in digesting milk1 it should be somewhat diluted1 i4e41 one part of water to four parts of milk1 or salt or bicarbonate of soda should be added4 ,it is also important not to give milk at meals when fruits1 especially sour fruits1 are allowed4 ,how much milk may advantageously be given8 ,the average child with good digestion should take from one and one half pints to one quart of milk daily1 this including not only what the child drinks but what is served upon cereals and in other ways4 ,it is seldom wise to allow a child to take as much as two quarts daily1 as a more mixed diet for most children is better4 ,to what extent may cream be used8 ,older children do not require so large a proportion of fat in their food as do infants1 and the use of cream1 especially very rich cream1 often results in disturbances of digestion4 ,the use of too much or too rich cream is a common cause of the coated tongue1 foul breath and pale gray stools1 often called biliousness4 ,is not cream useful in overcoming the constipation of children8 ,with infants it is valuable to a certain point1 but with older children only to a limited degree1 and if such symptoms as those above described are present1 cream should not be given4 ,,eggs ,to what extent may eggs be used in the diet of this period8 ,they form a most valuable food4 ,it is essential that they should be fresh and only slightly cooked1 soft boiled1 poached or coddled2 fried eggs should never be given and all omelets are objectionable4 ,which is more digestible1 the white or yolk of the egg8 ,for the great majority of children1 the white of the egg4 ,this forms one of the most digestible proteids we possess1 and can be used1 even in the latter part of the first year1 with advantage4 ,is it not true that eggs often cause biliousness8 ,very seldom1 if fed as above advised4 ,this is an old prejudice but has little basis in fact4 ,how often may eggs be given8 ,most children from four to ten years old will take one egg for breakfast and another for supper for an indefinite period with relish and benefit4 ,there are1 however1 some few who have a peculiar idiosyncrasy as regards eggs and cannot take them at all4 ,,meat ,,and ,,fish ,what meats may be given to young children8 ,the best are beefsteak1 mutton-chop1 roast beef1 roast lamb1 broiled chicken and certain delicate fish1 such as shad or bass4 ,what are the important points to be considered in giving meat to children8 ,most meats should be rare and either scraped or very finely divided1 as no child can be trusted to chew meat properly4 ,meats are best broiled or roasted1 but should not be fried4 ,how often should meat be given8 ,at this period1 only once a day1 at the mid-day meal4 ,is not the excessive nervousness of many modern children due to the giving of meat1 or at least aggravated by its use8 ,there is little ground for such a belief1 unless an excessive amount of meat is given4 ,certainly cutting off meat from the diet of nervous children seldom produces any striking benefit4 ,what meats should be forbidden to young children8 ,ham1 bacon1 sausage1 pork1 liver1 kidney1 game and all dried and salted meats1 also cod1 mackerel and halibut2 all of these are best withheld until the child has passed the tenth year4 ,are not gravies beneficial and nutritious8 ,the beef juice1 or so-called platter gravy1 from a roast is exceedingly nutritious and desirable1 but many of the thickened gravies are much less digestible and are too often given in excess2 only a small quantity should be allowed4 ,they should not form an important part of the meal4 ,,vegetables ,what vegetables may be used at this period8 ,white potatoes may be given first4 ,these should preferably be baked or boiled and mashed1 but never fried4 ,they should be served with beef juice or with cream rather than with butter4 ,of the green vegetables1 the best are peas1 spinach1 asparagus tips1 string beans1 stewed celery1 young beets1 or carrots1 and squash4 ,baked sweet potato1 turnips1 boiled onions and cauliflower1 all well cooked1 may be given after the sixth or seventh year in moderate amount4 ,the principal trouble in the digestion of vegetables is due to imperfect cooking4 ,it is1 in fact1 almost impossible to cook them too much2 they should also be very finely mashed4 ,they form a valuable addition to the diet after three years1 although the amount at first given should be small1 one or two teaspoonfuls4 ,they greatly aid in securing regularity of the bowels4 ,because small particles are seen in the stools1 it is not to be inferred that they are causing disturbance and should1 therefore1 be stopped1 but only that they should be more thoroughly cooked and more finely divided before being given4 ,is it safe to use canned vegetables for children8 ,many of the best brands of canned vegetables are quite safe and some1 such as peas and asparagus1 can be used with advantage4 ,they are frequently better than stale green vegetables often sold in the markets4 ,what vegetables should not be given to young children8 ,none of those which are eaten raw1 such as celery1 radishes1 onions1 cucumbers1 tomatoes or lettuce4 ,certain others1 even when well cooked1 should not be allowed2 as corn1 lima beans1 cabbage1 egg plant4 ,none of these should be given until a child has passed the age of ten years4 ,are vegetable salads to be given8 ,as a rule salads of all kinds should be omitted until a child has passed the tenth year4 ,salads are difficult to digest and a cause of much disturbance in children of all ages4 ,,cereals ,what are the most important points in selecting and preparing cereals8 ,the important things are that they are properly cooked and not used in excess4 ,the ready-to-serve cereals should never be chosen for children1 nor should a child1 because he is fond of cereals1 be allowed to make his entire meal of them1 taking two or three saucerfuls at a feeding4 ,many of the partially cooked preparations of oatmeal and wheat are excellent1 but should be cooked for a much longer time than is stated upon the package1 usually three or four times as long4 ,digestibility is chiefly a matter of proper cooking4 ,most of the grains1--oatmeal1 hominy1 rice1 wheaten grits1--require at least three hours' cooking in a double boiler in order to be easily digested4 ,the prepared flours1--corn starch1 arrowroot1 barley1--should be cooked at least twenty minutes4 ,i know of no preparation in the modern market which requires no cooking1 which is to be recommended for children4 ,how are cereals to be given8 ,usually with milk or a mixture of milk and cream2 always with an abundance of salt and with very little or no sugar1 one half teaspoonful on a saucerful of cereal should be the limit4 ,cereals should not be served with syrups or butter and sugar4 ,,broths ,,and ,,soups ,what broths and soups are to be recommended8 ,meat broths are generally to be preferred to vegetable broths1--mutton or chicken being usually most liked by children4 ,nearly all plain broths may be given4 ,those thickened with rice1 barley or corn starch form a useful variety1 especially with the addition of milk4 ,vegetable purees of peas1 spinach1 celery or asparagus may be used for children over seven years old4 ,tomato soup should not be given to young children4 ,,bread1 ,,crackers ,,and ,,cakes ,what forms of breadstuffs are best suited to young children8 ,fresh bread should not be given1 but stale bread cut thin and freshly dried in the oven until it is crisp is very useful1 also zwieback1 the unsweetened being preferred4 ,oatmeal1 graham or gluten crackers and the ,huntley and ,palmer breakfast biscuits1 stale rolls1 or corn bread which has been split and toasted or dried till crisp1 form a sufficient variety for most children4 ,what breadstuffs should be forbidden8 ,all hot breads1 all fresh rolls1 all buckwheat and other griddle cakes1 all fresh sweet cakes1 especially those covered with icing and those containing dried fruits4 ,a stale lady-finger or piece of sponge cake is about as far in the matter of cakes as it is wise to go with children up to seven or eight years old4 ,,desserts ,what desserts may be given to young children8 ,mistakes are more often made here than in any other part of the child's diet4 ,up to six or seven years1 only junket1 plain rice pudding without raisins1 plain custard and1 not more than once a week1 a small amount of ice cream4 ,what should be especially forbidden8 ,all pies1 tarts and pastry of every description1 jam1 syrups and preserved fruits2 nuts1 candy and dried fruits4 ,does a little do any harm8 ,yes1 in that it develops a taste for this sort of food1 after which plainer food is taken with less relish4 ,besides the little is very apt soon to become a good deal4 ,does not the child's instinctive craving for sweets indicate his need of them8 ,that a child likes or craves sweets is the usual excuse of an indulgent parent4 ,every child likes his own way1 but that is no reason why he should not be trained to obedience and self-control2 a child's fondness for sweets can hardly be considered a normal instinct4 ,as a matter of fact1 supported by everyday experience1 no causes are productive of more disorders of digestion than the free indulgence in desserts and sweets by young children4 ,it is a constantly increasing tendency1 not easily controlled as a child grows older2 and in early childhood1 the only safe rule is to give none at all4 ,,fruits ,are fruits an essential or important part of the diet8 ,they are a very important part and should be begun in infancy4 ,they are particularly useful for the effect they have upon the bowels4 ,it is important that they should be selected with care and given with much discretion1 especially in cities4 ,in the country where fruit is absolutely fresh1 a somewhat greater latitude may be allowed than is given below4 ,what fruits may safely be given to children up to five years old8 ,as a general rule1 only cooked fruits and the juices of fresh fruits4 ,what fruit juices may be used8 ,that from sweet oranges is the best1 but the fresh juice of grape fruit1 peaches1 strawberries and raspberries may also be used4 ,what stewed fruits may be given8 ,stewed or baked apples1 prunes1 pears1 peaches and apricots4 ,what raw fruits are to be particularly avoided with young children8 ,the pulp of oranges or grape fruit1 also cherries1 berries1 bananas and pineapple4 ,what precautions should be emphasized regarding the use of fruits8 ,that they should be used with greater care in hot weather and with children who are prone to attacks of intestinal indigestion4 ,what symptoms indicate that fruits should be avoided8 ,a tendency to looseness of the bowels with the discharge of mucus1 or frequent attacks of abdominal pain or stomach ache4 ,is there any special choice of meals at which fruit should be given8 ,the fruit juice given early in the morning1 upon an empty stomach1 works more actively upon the bowels than if it is given later in the day4 ,it is not1 as a rule1 wise to give cream or milk with sour fruits4 ,usually the fruit is best given at the mid-day meal1 as a dessert1 at a time when no milk is taken4 ,it is in all cases important that the quantity of fruit should be moderate4 ,what besides water and milk should a child be allowed to drink and what should be forbidden8 ,tea1 coffee1 wine1 beer and cider in all quantities and in all forms should be forbidden to young children below puberty4 ,cocoa which is made very weak1 i4e41 almost all milk1 is often useful as a hot drink4 ,lemonade1 soda-water1 etc41 should if possible be deferred until the tenth year4 ,a free indulgence in things of this kind should never be permitted with children of seven or eight years4 ,,indigestion ,,in ,,older ,,children ,what are the different ways in which indigestion shows itself in children8 ,first1 in acute disturbances which last for a few days only2 and1 secondly1 in chronic disturbances which may continue for weeks or months4 ,which of the two forms of indigestion is more likely to impair seriously the health of the child8 ,chronic indigestion2 for since the cause is not recognized it often goes on for months and even years unchecked4 ,what are the symptoms of acute indigestion8 ,these are familiar and easily recognized4 ,they are vomiting1 pain1 undigested movements from the bowels1 often fever and considerable prostration4 ,such attacks are usually traceable to their proper cause1 the removal of which is followed by prompt recovery4 ,what are the common causes of acute indigestion8 ,this is frequently due to overeating1 to indulgence in some special article of improper food1 or to eating heartily when overtired4 ,acute indigestion often marks the beginning of some acute general illness4 ,how should acute indigestion be managed8 ,one should bear in mind that for the time being the digestive organs have stopped work altogether4 ,the important thing1 therefore1 is to clear out from the intestines all undigested food by some active cathartic1 such as castor oil4 ,the stomach has usually emptied itself by vomiting4 ,all food should be stopped for from twelve to thirty-six hours1 according to the severity of the attack1 only water being given4 ,at the end of this time is it safe to begin with the former diet8 ,no2 for such a procedure is almost certain to cause another attack of indigestion4 ,at first only broth1 thin gruel1 very greatly diluted milk1 or whey should be given4 ,the diet may be very slowly but gradually increased as the child's appetite and digestion improve1 but in most cases a week or ten days should elapse before the full diet is resumed4 ,what are the symptoms of chronic indigestion8 ,these1 although familiar1 are not so easily distinguished and are very often attributed to the wrong cause4 ,there are usually general symptoms such as indisposition1 disturbed sleep1 grinding of the teeth1 fretfulness1 languor1 loss of weight and anaemia4 ,there are besides local symptoms3 flatulence1 abdominal pain1 abdominal distention1 constipation1 or looseness of the bowels with mucus in the stools1 foul breath1 coated tongue1 loss of appetite1 or an abnormal capricious appetite4 ,such symptoms are often wrongly ascribed to intestinal worms4 ,what are the common causes of chronic indigestion8 ,this is generally the result of a bad system of feeding1 either the prolonged use of improper food or of improper methods of feeding4 ,examples of bad methods of feeding are1 coaxing or forcing to eat1 rapid eating with insufficient mastication eating between meals1 allowing a child to have his own way in selecting his food1 as when he lives largely upon a single article of diet4 ,things to be considered under the head of improper food are1 indulgence in sweets1 desserts1 etc41 the use of imperfectly cooked foods1 especially cereals and vegetables1 and of raw or stale fruits4 ,is it not true that a diet or a special article of food which does not make a child ill is proof that such a diet or such a food is proper for a child8 ,by no means2 with many people the only guide ,in feeding children is that the article in question did not make the children sick1 therefore it is allowable4 ,this is a very bad principle4 ,a better one is to adopt such a diet as will nourish the child's body with the least possible tax upon his digestive organs2 in other words1 to exclude articles which experience has shown to be injurious to most children4 ,how should chronic indigestion be managed8 ,this is a much more difficult matter than the treatment of acute indigestion1 for1 as it is usually the result of the prolonged use of improper food or of an improper method of feeding1 a cure can be accomplished only by a discovery and removal of the cause4 ,is chronic indigestion curable8 ,in the vast majority of cases it is so1 but only by faithfully observing for a long period the rules for simple feeding laid down elsewhere4 ,one of the greatest' difficulties in the way of recovery is that parents and nurses are unwilling to follow a restricted diet long enough to secure a complete cure1 or to change radically their methods of feeding1 but expect the child to recover by simply taking medicine4 ,for how long a period is it necessary to continue very careful feeding8 ,in any case it must be done for several months2 with most children for two or three years2 with some1 throughout childhood1 for with them the slightest deviation from established rules is sure to provoke a relapse4 ,is not medicine useful8 ,it is undoubtedly of assistance for the relief of some symptoms1 but the essential thing is proper feeding1 without which nothing permanent can be accomplished4 ,,general ,,rules ,,to ,,be ,,observed ,,in ,,feeding ,bad habits of eating are readily acquired but difficult to break4 ,young children should not be allowed to play with their food1 nor should the habit be formed of amusing or diverting them while eating1 because by these means more food is taken4 ,older children should not be permitted to make an entire meal of one thing1 no matter how proper this may be4 ,children1 who are allowed to have their own way in matters of eating are very likely to be badly trained in other respects2 while those who have been properly trained in matters of eating can usually be easily trained to do anything else that is important4 ,learning to eat proper things in a proper way forms therefore a large part of a child's early education4 ,if careful training in these matters is begun at the outset and continued1 the results will well repay the time and effort required4 ,whether the child feeds himself or is fed by the nurse1 the following rules should be observed3 #a4 ,food at regular hours only2 nothing between meals4 #b4 ,plenty of time should be taken4 ,on no account should the child bolt his food4 #c4 ,the child must be taught to chew his food4 ,yet no matter how much pains are taken in this respect1 mastication is very imperfectly done by all children2 hence up to the seventh year at least1 all meats should be very finely cut1 all vegetables mashed to a pulp1 and all grains cooked very soft4 #d4 ,children should not be continually urged to eat if they are disinclined to do so at their regular hours of feeding1 or if the appetite is habitually poor1 and under no circumstances should a child be forced to eat4 #e4 ,indigestible food should never be given to tempt the appetite when the ordinary simple food is refused8 food should not be allowed between meals because it is refused at meal-time4 #f4 ,one serious objection to allowing young children highly seasoned food1 entrees1 jellies1 pastry1 sweets1 etc41 even in such small amounts as not to upset the digestion1 is that children thus indulged soon lose appetite for the simple food which previously was taken with relish4 #g4 ,if there is any important article of a simple diet such as milk1 meat1 cereals1 or vegetables1 which a child habitually refuses1 this should always be given first at the meal and other food withheld until it is disposed of4 ,children so readily form habits of eating only certain things and refusing others that such an inclination should be checked early4 #h4 ,if an infant refuses its food altogether1 or takes less than usual1 the food should be examined to see if this is right4 ,then the mouth should be inspected to see if it is sore4 ,if neither of these things is the cause1 the food should be taken away and not offered again until the next feeding time comes4 #i4 ,in any acute illness the amount of food should be much reduced and the food made more dilute than usual4 ,if there is fever1 no solid food should be given4 ,if the child is already upon a milk diet1 this should be diluted1 and in some cases partially peptonized4 #aj4 ,in very hot weather the same rules hold1 to give less food1 particularly less solid food1 and more water4 ,,food ,,formulas ,beef ,juice4--,one pound of rare round steak1 cut thick1 slightly broiled1 and the juice pressed out by a lemon-squeezer1 or1 better1 a meat-press4 ,from two to four ounces of juice can generally be obtained4 ,this1 seasoned with salt1 may be given cold1 or warmed by placing the cup which holds it in warm water4 ,it should not be heated sufficiently to coagulate the albumin which is in solution1 and which then appears as flakes of meat floating in the fluid4 ,beef ,juice by the ,cold ,process4--,one pound of finely chopped round steak1 six ounces of cold water1 a pinch of salt2 place in a covered jar and stand on ice or in a cold place1 five or six hours or overnight4 ,it is well to shake occasionally4 ,this is now strained and all the juice squeezed out by placing the meat in coarse muslin and twisting it very hard4 ,it is then seasoned and fed like the above4 ,beef juice so made is not quite as palatable as that prepared from broiled steak1 but it is even more nutritious1 and is more economical1 as fully twice as much juice1 can be obtained from a given quantity of meat4 ,beef juice prepared in either of these ways is greatly to be preferred to the beef extracts sold4 ,mutton ,broth4--,one pound of finely chopped lean mutton1 including some of the bone1 one pint cold water1 pinch of salt4 ,cook for three hours over a slow fire down to half a pint1 adding water if necessary2 strain through muslin1 and when cold carefully remove the fat1 adding more salt if required4 ,it may be fed warm1 or cold in the form of a jelly4 ,a very nutritious and delicious broth is made by thickening this with cornstarch or arrowroot1 cooking for ten minutes and then adding three ounces of milk1 or one ounce and a half of thin cream1 to a half pint of broth4 ,chicken1 ,veal1 and ,beef ,broths4--,these are made and used in precisely the same manner as mutton broth4 ,meat ,pulp4--,a rare piece of round or sirloin steak1 the outer part having been cut away1 is scraped or shredded with a knife2 one teaspoonful to one tablespoonful may be given1 well salted1 to a child of eighteen months4 ,scraping is much better than cutting the meat fine4 ,for this on a large scale1 as in institutions1 a ,hamburg-steak cutter may be employed4 ,junket1 or ,curds and ,whey4--,one pint of fresh cow's milk1 warmed2 pinch of salt2 a teaspoonful of granulated sugar2 add two teaspoonfuls of ,fairchild's essence of pepsin1 or liquid rennet1 or one junket tablet dissolved in water2 stir for a moment1 and then allow it to stand at the temperature of the room for twenty minutes1 or until firmly coagulated2 place in the ice box until thoroughly cold4 ,for older children this may be seasoned with grated nutmeg4 ,whey4--,the coagulated milk prepared as above is broken up with a fork and the whey strained off through muslin4 ,it is best given cold4 ,if some stimulant is desired1 sherry wine in the proportion of one part to twelve1 or brandy one part to twenty-four1 may be added4 ,whey is useful in many cases of acute indigestion4 ,barley ,jelly from the ,grains4--,three tablespoonfuls of pearl barley2 soak overnight1 then place this in one quart of fresh water2 add pinch of salt1 and cook in double boiler steadily for four hours down to one pint1 adding water from time to time2 strain through muslin4 ,when cold this makes a rather thick jelly4 ,if a thinner gruel 7barley water7 is desired1 one half the quantity of barley should be used4 ,oat1 ,wheat1 or ,rice ,jelly4--,these are prepared from oatmeal1 wheaten grits1 and rice grains in the same manner as the barley jelly4 ,barley ,jelly from the ,flour4--,either ,robinson's patent barley or prepared barley flour of the ,health ,food ,company may be used4 ,one rounded tablespoonful of the flour1 thoroughly blended with a little cold water1 is added1 stirring1 to one pint of boiling water containing a pinch of salt2 cook for twenty minutes in a double boiler1 and strain4 ,this makes a jelly of about the consistency of that made from the grains as above4 ,it is essentially the same in composition1 and much less trouble to prepare4 ,a thinner gruel 7barley water7 is made by using half the quantity of flour4 ,when this is to be mixed with milk1 it is well to add the milk to the barley gruel before removing from the fire1 and stir two or three minutes1 or until the milk has nearly reached the boiling point1 when it should be removed and bottled4 ,oat or ,wheat ,jelly from the ,flour4--,these are made from the prepared oat flour of the ,health ,food ,company or ,hubbell's prepared wheat flour4 ,they are used like the barley4 ,imperial ,granum4--,this is prepared and used in precisely the same way as the barley flour above mentioned1 the gruel being mixed with milk before it is removed from the fire4 ,albumin ,water4--,the white of one fresh egg2 half a pint of cold water2 pinch of salt2 teaspoonful of brandy4 ,this should be shaken thoroughly and fed cold either with a spoon or from a bottle4 ,it is useful in cases of vomiting1 and can sometimes be retained by a very irritable stomach4 ,lime-water4--,one heaping teaspoonful of slaked lime2 one quart boiled or distilled water2 place in a corked bottle and shake thoroughly two or three times during the first hour4 ,the lime should then be allowed to settle1 and after twenty-four hours the upper clear fluid carefully poured or siphoned off for use4 ,dried ,bread4--,either stale or fresh bread may be used2 it is cut in thin slices and placed in the oven1 with the door open1 and quickly dried until it is crisp1 but not browned4 ,it is in many respects preferable to crackers for little children4 ,coddled ,egg4--,a fresh egg1 shell on1 is placed in boiling water which is immediately after removed from the fire4 ,the egg then cooks slowly in the water1 which gradually cools1 for seven or eight minutes1 when the white should be about the consistency of jelly4 ,for a delicate digestion the white only should be given1 with salt2 it can be easily separated from the yolk4 ,,part ,,iv ,,miscellaneous ,,the ,,bowels ,how many movements daily should an infant have during the first few weeks of life8 ,usually two or three a day for the first week1 and then one or two each day4 ,how many after a child is a month old8 ,a healthy child should have at least one movement each day2 many have two and some more than two2 but it is the character of the stools rather than their number which is to be taken as the evidence of perfect digestion4 ,what is the appearance of a healthy movement of a child who is taking nothing but milk8 ,it is soft1 yellow1 and smooth1 containing no lumps4 ,when are the stools dark brown or black8 ,while taking bismuth1 iron1 and sometimes when taking much meat or beef juice2 also while taking many of the prepared foods4 ,they may be dark brown or black from blood4 ,this last is a condition which may indicate serious illness4 ,how may a child be trained to be regular in the action of its bowels8 ,by endeavouring to have them move at exactly the same time every day4 ,at what age may an infant be trained in this way8 ,usually by the second month if training is begun early4 ,what is the best method of training8 ,a small chamber1 about the size of a pint bowl1 is placed between the nurse's knees1 and upon this the infant is held1 its back being against the nurse's chest and its body firmly supported4 ,this should be done twice a day1 after the morning and afternoon feedings1 and always at the same hour4 ,at first there may be necessary some local irritation1 like that produced by tickling the anus or introducing just inside the rectum a small cone of oiled paper or a piece of soap1 as a suggestion of the purpose for which the baby is placed upon the chamber2 but in a surprisingly short time the position is all that is required4 ,with most infants1 after a few weeks the bowels will move as soon as the infant is placed on the chamber4 ,what advantage has such training8 ,it forms the habit of having the bowels move regularly at the same hour1 which is a matter of great importance in infancy and makes regularity in childhood much easier4 ,it also saves the nurse much trouble and labour4 ,,sleep ,should a child sleep in the same bed with its mother or nurse8 ,under no circumstances1 if this can possibly be avoided4 ,very young infants have often been smothered by their mothers1 by overlying during sleep4 ,if the infant sleeps with the mother1 there is always the temptation to frequent nursing at night1 which is injurious to both mother and child4 ,older children also should1 if possible1 have separate beds2 many contagious diseases and bad habits are contracted by children sleeping together4 ,how should an infant's bed be prepared8 ,the mattress should be firm but soft1 the pillow very thin1 and the covering not excessive4 ,a baby should not be allowed to sleep always in the same position1 but should be changed from side to side4 ,hair pillows are useful in summer and for children who perspire very much4 ,how much sleep is natural for a newly born baby8 ,a baby with a good digestion and proper food will usually sleep at this period about nine tenths of the time4 ,how much should a baby sleep at six months8 ,about two thirds of the time4 ,up to what age should an older child take a nap during the day8 ,always until four years old1 and if possible longer4 ,at what age may an infant go all night without feeding8 ,at five months a child should not be fed or nursed between #aj ,p4,m4 and #f ,a4,m4 ,at two years a child can easily go from #f ,p4,m4 to #f ,a4,m4 without feeding4 ,how should a baby be put to sleep8 ,the room should be darkened and quiet1 the child's hunger satisfied1 and the child made generally comfortable and laid in its crib while awake4 ,is rocking necessary8 ,by no means4 ,it is a habit easily acquired1 but hard to break1 and a very useless and sometimes injurious one4 ,the same may be said of sucking a rubber nipple1 or pacifier1 and all other devices for putting children to sleep4 ,what are the principal causes of disturbed sleep8 ,as quiet peaceful sleep is a sign of perfect health1 disorders of sleep may be produced by almost anything which is wrong with the child4 #a4 ,habitual disturbance of sleep in infants is most frequently associated with the food or feeding4 ,it may be from the discomfort of chronic indigestion due to improper food4 ,in bottle-fed infants it is often the result of overfeeding2 in those who are nursed it is often due to hunger4 ,a common cause is frequent night feeding2 an infant who is fed three or four times during the night is almost invariably a bad sleeper4 #b4 ,disturbed sleep or sleeplessness may be due to causes purely nervous4 ,such are bad habits acquired by faulty training2 as when the nursery is lighted and the child taken from its crib whenever it wakes or cries2 or when some of the contrivances for inducing sleep have been used4 ,any excitement or romping play just before bedtime1 and fears aroused by pictures or stories1 are frequent causes4 ,children who inherit from their parents a nervous constitution are especially likely to suffer thus4 #c4 ,there may be physical discomfort from cold feet1 insufficient or too much clothing1 or want of fresh air in the sleeping room4 #d4 ,interference with breathing due to obstruction from large tonsils or adenoids4 ,these cause great restlessness and lead a child to assume many different postures during sleep1 often lying upon the face or upon the hands and knees4 #e4 ,chronic pains or frequently recurring night pains may be causes of disordered sleep1 when a child wakes with a sudden sharp cry4 ,in infants this is most often due to scurvy1 sometimes to syphilis4 ,in older children it may be the earliest symptom of disease of the hip or spine4 #f4 ,sleeplessness and disturbed sleep are frequent whenever the general condition falls much below a healthy standard2 e4g41 in infants who are not thriving and in children suffering from marked anaemia4 ,how are children who sleep too little1 or whose sleep is constantly disturbed1 to be treated8 ,never by the use of soothing sirups or other medicines4 ,successful treatment consists in the discovery and removal of the cause4 ,do children ever sleep too much8 ,it is doubtful if healthy children ever do4 ,excessive sleep is an important symptom of some diseases of the brain4 ,otherwise it seldom if ever occurs unless soothing sirups or other drugs have been given4 ,,exercise ,is exercise important for infants8 ,it is as necessary for them as for older children4 ,how is it obtained8 ,a young baby gets its exercise by screaming1 waving its arms1 kicking1 etc4 ,the clothing should not be so tight as to make these movements impossible4 ,at least twice a day the infant should be allowed for fifteen or twenty minutes the free use of its limbs by permitting it to lie upon a bed in a warm room1 with all clothing except the shirt1 stockings1 and napkin removed4 ,later1 when in short clothes1 the baby may be put upon a thick blanket or quilt laid upon the floor1 and be allowed to tumble about at will4 ,a nursery fence two feet high1 made to surround a mattress1 is an excellent device and makes a convenient box stall for the young animal1 where it can learn to use both its arms and legs without the danger of injury4 ,only by exercise such as this do the muscles have an opportunity to develop properly4 ,,the ,,cry ,when is crying useful8 ,in the newly born infant the cry expands the lungs1 and it is necessary that it should be repeated for a few minutes every day in order to keep them well expanded4 ,how much crying is normal for a very young baby8 ,from fifteen to thirty minutes a day is not too much4 ,what is the nature of this cry8 ,it is loud and strong4 ,infants get red in the face with it2 in fact1 it is a scream4 ,this is necessary for health4 ,it is the baby's exercise4 ,when is a cry abnormal8 ,when it is too long or too frequent4 ,the abnormal cry is rarely strong1 often it is a moaning or a worrying cry1 sometimes only a feeble whine4 ,what are the causes of such crying8 ,pain1 temper1 hunger1 illness1 and habit4 ,what is the cry of pain8 ,it is usually strong and sharp1 but not generally continuous4 ,it is accompanied by contraction of the features1 drawing up of the legs1 and other symptoms of distress4 ,what is the cry of hunger8 ,it is usually a continuous1 fretful cry1 rarely strong and lusty4 ,what is the cry of temper8 ,it is loud and strong and accompanied by kicking or stiffening of the body1 and is usually violent4 ,what is the cry of illness8 ,there is usually more of fretfulness and moaning than real crying1 although crying is excited by very slight causes4 ,what is the cry of indulgence or from habit8 ,this is often heard even in very young infants1 who cry to be rocked1 to be carried about1 sometimes for a light in the room1 for a bottle to suck1 or for the continuance of any other bad habit which has been acquired4 ,how can we be sure that a child is crying to be indulged8 ,if it stops immediately when it gets what it wants1 and cries when it is withdrawn or withheld4 ,what should be done if a baby cries at night8 ,one should get up and see that the child is comfortable--the clothing smooth under the body1 the hands and feet warm1 and the napkin not wet or soiled4 ,if all these matters are properly adjusted and the child simply crying to be taken up1 it should not be further interfered with4 ,if the night cry is habitual some other cause should be sought 7see page #aba74 ,how is an infant to be managed that cries from temper1 habit1 or to be indulged8 ,it should simply be allowed to cry it out4 ,this often requires an hour1 and in extreme cases1 two or three hours4 ,a second struggle will seldom last more than ten or fifteen minutes1 and a third will rarely be necessary4 ,such discipline is not to be carried out unless one is sure as to the cause of the habitual crying4 ,is it likely that rupture will be caused from crying8 ,not in young infants if the abdominal band is properly applied1 and not after a year under any circumstances4 ,,lifting ,,children ,how should a young baby be lifted from its bed8 ,the right hand should grasp the clothing below the feet1 and the left hand should be slipped beneath the infant's body to its head4 ,it is then raised upon the left arm4 ,what is the advantage of this8 ,the entire spine is supported1 and no undue pressure is made upon the chest or abdomen1 as often happens if the baby is grasped around the body or under the arms4 ,how should a child old enough to run about be lifted8 ,always by placing the hands under the child's arms1 and never by the wrists4 ,what injury may be inflicted by lifting the child by the wrists or hands8 ,often serious injury is done to the elbow or shoulder joints4 ,,the ,,temperature ,what is the normal temperature of an infant8 ,the normal temperature varies more than in adults4 ,in the rectum it usually fluctuates between #ih deg4 and #ii4e deg4 ,f42 a rectal temperature of #ig4e deg4 ,f4 or of #ajj4e deg4 ,f4 is of no importance whatever unless it continues4 ,where should the temperature of infants and young children be taken8 ,the rectum is altogether the best place1 and next to this the groin4 ,the rectal temperature is from half a degree to a degree higher than that in the groin4 ,how long should the thermometer be left in place to take the temperature8 ,two minutes in the rectum1 and five minutes in the groin4 ,is the temperature of a young child a good guide as to the severity of its symptoms in illness8 ,as a rule it is4 ,a temperature of #ajj deg4 to #ajb deg4 ,f4 commonly means a mild illness1 and one of #ajd deg4 ,f4 or over a serious one4 ,the duration of the fever is1 however1 even more important than the height of the temperature4 ,it should be remembered that in all young children slight causes often produce a high temperature which lasts for a few hours2 one should not therefore be unduly alarmed unless the temperature continues high1 or is accompanied by other important signs of illness4 ,is not a high temperature a more serious symptom in a young child than in an adult8 ,the opposite is rather the case4 ,young children are extremely sensitive to conditions which produce fever1 and the thermometer often gives an exaggerated idea of the severity of the symptoms4 ,a cause which in an adult might produce a temperature of #ajb deg4 ,f4 or #ajc deg4 ,f41 in a young child would very likely be accompanied by a temperature of #ajd deg4 or #aje deg4 ,f4 ,,nervousness ,what are the principal causes of excessive nervousness in infants and young children1 and what can be done to prevent this8 ,the most important cause is the delicate structure of the brain at this time1 and its rapid growth4 ,it grows as much during the first year as during all the rest of life4 ,this requires quiet and peaceful surroundings4 ,infants who are naturally nervous should be left much alone1 should see but few people1 should be played with very little1 and should never be quieted with soothing sirups or the pacifier4 ,at what age may playing with babies be begun8 ,babies under six months old should never be played with2 and the less of it at any time the better for the infant4 ,what harm is done by playing with very young babies8 ,they are made nervous and irritable1 sleep badly and suffer from indigestion and in many other respects4 ,when may young children be played with8 ,if at all1 in the morning1 or after the midday nap2 but never just before bedtime4 ,,toys ,what points should guide one in selecting toys and playthings for an infant8 ,the instinct in a baby to put everything into the mouth is so strong that nothing should be given that cannot be safely treated in this way4 ,hence one should choose things which are smooth1 those which can be easily washed1 and those which cannot be swallowed4 ,one should avoid 7#a7 toys with sharp points or corners2 7#b7 those with loose parts that might be detached or broken off and swallowed2 7#c7 small objects which might be swallowed or pushed into the nose or ear1 such as coins1 marbles1 and safety-pins1 also beads and buttons unless strung upon a stout cord2 7#d7 painted toys2 7#e7 those covered with hair or wool4 ,infants have often been severely injured by swallowing what they have pulled off from their small toy animals4 ,what points are to be considered in selecting the toys and playthings of a child over two years old8 ,it should be remembered that toys are not merely a source of amusement1 but that they have an educational value as well4 ,those are therefore to be preferred the use of which develops the child's imagination1 and with which he can be taught to amuse himself4 ,for boys nothing can surpass blocks1 toy soldiers1 balls1 engines1 and cars2 and for girls1 dolls and housekeeping sets4 ,the complicated mechanical toys now so much in vogue give only a momentary pleasure1 and as soon as the wonder at their operation has worn off1 they have lost interest for the child except that which he gets in breaking them to see how the thing worked4 ,what important things can be taught children with their toys and how may this be done8 ,the imagination may be developed1 and children may be trained to habits of neatness1 order and regularity and to concentration of mind4 ,to this end toys should be kept in an orderly way upon a shelf in the nursery or in a closet1 never piled in a miscellaneous heap in the corner of the room4 ,children should select their toys and play with one thing at a time1 which they should be taught to put away in its place before another is given4 ,they should never be allowed to have a dozen things strewn about the room at one time1 with none of which they are occupied4 ,,kissing ,are there any valid objections to kissing infants8 ,there are many serious objections4 ,tuberculosis1 diphtheria1 and many other grave diseases may be communicated in this way4 ,the kissing of infants upon the mouth by other children1 by nurses1 or by people generally1 should under no circumstances be permitted4 ,infants should be kissed1 if at all1 upon the cheek or forehead1 but the less even of this the better4 ,,convulsions ,what should be done for a child in convulsions before a doctor arrives8 ,keep the child perfectly quiet with ice at the head1 put the feet in a mustard bath1 and roll the entire body in large towels which have been dipped in mustard water 7two heaping tablespoonfuls of mustard to one quart of tepid water71 and have plenty of hot water and a bath tub at hand1 so that the doctor can give a hot bath if he thinks it advisable4 ,when is a hot bath useful8 ,if the convulsions have continued until the pulse is weak1 the face very pale1 the nails and lips blue1 and the feet and hands cold1 the hot bath will be useful by bringing blood to the surface and relieving the heart1 lungs1 and brain4 ,how should the bath be given8 ,the temperature should not be over #ajf deg4 ,f42 this should always be tested by a thermometer if one can be obtained4 ,without this precaution1 in the excitement of the moment1 infants have frequently been put into baths so hot that serious and even fatal burns have been produced4 ,if no thermometer is available the nurse may plunge her arm to the elbow into the water4 ,it should feel warm1 but not so hot as to be at all uncomfortable4 ,one half a teacupful of powdered mustard added to the bath often adds to its efficacy4 ,,foreign ,,bodies ,what should be done if a foreign body has been swallowed8 ,first1 examine the throat with the finger to see if it has lodged there1 and if so remove it4 ,if it has passed from the throat it has usually gone into the stomach4 ,what should be done in this case8 ,give the child plenty of dry food1 like bread1 potato1 etc41 but under no circumstances either an emetic or cathartic4 ,an infant may have its usual food4 ,what harm would a cathartic do8 ,it is likely to hurry the foreign body too rapidly through the intestine and in this way do harm2 otherwise it becomes coated with fecal matter and passes the intestine usually without doing injury4 ,what should be done if a child gets a foreign body into the ear8 ,unless this can easily be removed with the fingers it should not be meddled with1 for it is likely to be pushed farther into the ear4 ,the child should be taken to a physician4 ,what should be done if there is a foreign body in the nose8 ,the child should blow his nose strongly while the empty nostril is compressed4 ,unless this removes it a physician should be called4 ,meddlesome interference is always harmful4 ,,colic ,what are the symptoms of colic8 ,there is a strong1 hard cry1 which comes suddenly and returns every few minutes4 ,with this there is drawing up of the feet1 contraction of the muscles of the face1 and other signs of pain4 ,the abdomen is usually tense and hard4 ,what should be done for a baby with colic8 ,first1 see that the feet are warm4 ,place them against a hot-water bag1 or hold them before an open fire2 apply a hot flannel to the abdomen1 or let the child lie upon its stomach across a hot-water bag4 ,if the colic continues1 a half teacupful of warm water containing ten drops of turpentine may be injected into the bowels with a syringe2 at the same time the abdomen should be gently rubbed so as to start the wind4 ,if the gas is in the stomach1 half of a soda mint tablet may be given in a tablespoonful of very warm water4 ,,earache ,what are the symptoms of earache8 ,the pain is generally severe and accompanied by a sharp scream2 the child often puts the hand to the affected ear1 or cries whenever it is touched4 ,the pain is likely to be prolonged and continuous4 ,how should a child with earache be treated8 ,the ear should be irrigated with a solution of boric acid 7twenty grains to the ounce7 as warm as can be borne4 ,dry heat may then be applied in several ways4 ,the ear having been first covered with cotton1 a small hot-water bag or one filled with hot salt or bran1 may be bound over it with a bandage2 or a small butter plate heated in hot water may be used in the same way4 ,the hot-water bag may be held against the ear or the child may lie with his head upon it4 ,the use of such substances as oil and laudanum in the ear is not to be recommended4 ,,croup ,what are the symptoms of croup8 ,there is a hollow1 dry1 barking cough1 with some difficulty in breathing4 ,when is this likely to come on8 ,usually at night4 ,is simple croup dangerous8 ,the ordinary croup of infants is spasmodic croup1 and is very rarely dangerous1 although the symptoms seem very alarming4 ,what are the symptoms8 ,in a mild attack there is simply noisy breathing1 especially on drawing in the breath1 with a tight1 barking1 or croupy cough4 ,in a severe attack the child's breathing is more noisy and becomes difficult4 ,what is the dangerous form of croup8 ,membranous croup1 which is the same thing as diphtheria of the larynx4 ,how does this develop8 ,gradually2 very rarely does it come on suddenly4 ,what should be done for a baby who has spasmodic croup8 ,the room should be very warm1 hot cloths or poultices should be applied over the throat1 and either a croup kettle or an ordinary tea-kettle kept boiling in the room4 ,this is more efficacious if the child is placed in a tent made by a raised umbrella with a sheet thrown over it1 and the steam introduced beneath the tent4 ,if the symptoms are urgent1 ten drops of the sirup of ipecac should be given every fifteen minutes until free vomiting occurs4 ,whenever the symptoms reach a point where breathing becomes difficult1 a doctor should be summoned without delay4 ,,contagious ,,diseases ,what are the first symptoms of measles8 ,measles comes on rather gradually with cough1 sneezing1 watery eyes and nose1 much like an ordinary cold in the head4 ,the eruption appears after three or four days1 first upon the face and neck as small red spots1 and spreads slowly over the body4 ,is measles a serious disease8 ,in infants and during the winter season it is likely to be very serious on account of the danger of bronchitis and pneumonia1 which frequently accompany it4 ,in children over four years old it is generally not severe4 ,no child should be voluntarily exposed to this disease1 and particularly one who is delicate or prone to disease of the lungs should be protected against it4 ,when and how is measles contagious8 ,measles may readily be conveyed from the very beginning of the catarrh1 two or three days before any eruption is present4 ,it is not often carried by healthy persons4 ,its poison does not cling long to a sick room4 ,what is ,german measles8 ,german measles1 or rubella1 is a distinct disease and has nothing to do with ordinary measles4 ,it is extremely rare for a child to be much sick with it4 ,there is usually a very extensive eruption which may cover the body1 but few other symptoms4 ,what are the first symptoms of scarlet fever8 ,generally it comes suddenly1 with vomiting1 high fever1 and sore throat4 ,the eruption usually appears within twenty-four hours as a red blush1 first upon the neck and chest1 and spreads rapidly4 ,when and how is scarlet fever contagious8 ,scarlet fever is only slightly contagious for the first one or two days of the attack4 ,it is most contagious at the height of the disease and during desquamation4 ,it may be carried by healthy persons and by the clothing or bedding from the sick room4 ,how does whooping-cough begin8 ,for a week or ten days it cannot be distinguished from an ordinary cold on the chest4 ,then the attacks of coughing gradually become more severe and vomiting may follow4 ,after a severe coughing fit the breath is caught with a peculiar noise known as the whoop4 ,how does chicken-pox begin8 ,it usually comes out gradually1 as widely scattered pimples over the scalp1 face1 and body1 many of which soon become small vesicles1 resembling tiny blisters4 ,there is itching and local discomfort but little fever1 and the child rarely seems to be very ill4 ,how does diphtheria begin8 ,sometimes suddenly1 but usually gradually1 with sore throat and swelling of the glands of the neck1 with white patches upon the tonsils1 or a free discharge which may be bloody1 from the nostrils4 ,how does mumps begin8 ,as a swelling upon the jaw1 beneath the ear4 ,as it increases it extends forward upon the cheek and backward behind the ear4 ,it affects one or both sides4 ,mumps is not very common in young children1 and in them it is usually mild4 ,after twelve or thirteen years it is likely to be more severe4 ,how long after exposure do the first symptoms appear in the different diseases8 ,in scarlet fever in from three to five days1 rarely later than a week2 in measles in from nine to fourteen days1 occasionally as late as twenty days2 in whooping-cough in from one to two weeks2 in chicken-pox in from fourteen to sixteen days2 in ,german measles in from ten to sixteen days4 ,in diphtheria the time varies much2 it may be only one day1 and it may be one or two weeks4 ,in mumps it is usually a little less than three weeks1 the average being twenty days4 ,which of these diseases are most contagious8 ,measles and chicken-pox are very contagious1 and very few children who have not had them can come near a person suffering from either disease without taking it4 ,whooping-cough is almost as contagious as measles1 and for young babies even more so4 ,a very close exposure is not necessary in the case of either of these diseases1 and whooping-cough can undoubtedly be contracted in the open air4 ,scarlet fever and diphtheria are much less contagious2 for both of these a pretty close exposure is necessary4 ,how long should a child with any of these diseases be kept away from other children8 ,with measles1 for two weeks after the rash has gone2 with scarlet fever1 for at least four weeks after the rash has gone1 and longer if the peeling is not over or if the ears are running2 with whooping-cough1 for two months1 or so long as the paroxysmal cough continues2 with chicken-pox1 until all crusts have fallen off1 or for about three weeks after the eruption appears2 with ,german measles for one week after the eruption has faded2 with diphtheria1 at least ten days after the throat is well in a very mild case1 and four weeks if the case has been severe2 with mumps for one week after the swelling has gone4 ,what should be done when a child shows the first symptoms of serious illness8 ,the child should be put to bed4 ,if it is an infant the food should be diluted to one half the usual strength2 if an older child1 only fluid food should be given4 ,if the child seems feverish1 take the temperature ,if the bowels are constipated1 give a teaspoonful of castor oil2 but no other medicine without the doctor's orders4 ,send for the doctor at once1 and until he comes carefully exclude all other children from the room4 ,by what nursery training may the examination and treatment of sick children he made much easier8 ,by teaching all children to gargle1 to show the throat1 to take pills1 and by constantly teaching them to regard the doctor as the child's best friend1 and his visits as a great treat4 ,on no account should a child be frightened into obedience by threats of what the doctor will do4 ,with care and patience most children may be taught to gargle and take pills at four or five years1 and to show the throat willingly at two or three4 ,all these matters should be made a part of the child's education4 ,,scurvy ,what is scurvy and how is it produced8 ,scurvy is a disease of general nutrition1 usually caused by the long-continued use of improper food4 ,most of the cases come from the use of the prepared infant's foods sold in the stores1 especially when they are given without fresh milk2 occasionally the use of condensed milk and of sterilized milk is followed by scurvy2 sometimes it is seen when1 owing to feeble digestion1 it has been necessary to make cow's milk very weak for a long time4 ,what symptoms are seen in an infant with scurvy8 ,at first there is only indefinite and occasional soreness in the legs so that the child cries out when handled4 ,as this soreness becomes more severe the child is often thought to have rheumatism4 ,the gums swell and are of a deep purple colour4 ,there may be bleeding from the gums1 nose1 bowels1 or black-and-blue spots may be seen upon the legs4 ,the ankles and knees may swell4 ,the child grows very pale1 loses appetite and weight1 and sleeps badly4 ,what should be done when an infant shows signs of scurvy8 ,the diet should at once be changed to fresh milk1 properly modified according to the child's digestion1 but not sterilized or pasteurized4 ,the juice of a sweet orange should be given1 best about an hour before the feeding4 ,at first one or two teaspoonfuls1 four or five times a day2 later1 more may be given if the symptoms are not improved4 ,properly treated an infant with scurvy generally recovers promptly and completely4 ,if not recognised1 or untreated1 it may cause death4 ,,constipation ,when it is necessary to move the bowels immediately1 what are some of the easiest methods8 ,an injection of one tablespoonful of sweet oil may be given1 or half a teaspoonful of glycerine in one tablespoonful of water1 or a teacupful of tepid soap and water1 or a glycerine suppository4 ,none of these should be continued excepting under the physician's directions4 ,what sort of a syringe is to be preferred for giving an injection to an infant8 ,the bulb syringe is the simplest2 this consists of an oval bulb of soft rubber and a soft rubber or a hard rubber tip4 ,it holds one or two ounces4 ,what is the most essential thing in preventing or overcoming constipation8 ,the formation of the habit of having the bowels move every day regularly at the same hour1 and proper early training 7see page #aef74 ,what is the best hour8 ,in most cases immediately after the first meal in the morning4 ,what are some simple means by which constipation may be relieved8 ,the best are diet1 suppositories1 and massage4 ,the changes to be made in the milk of constipated infants have been mentioned on page #hb4 ,the addition to the milk of some of the malted foods1 such as ,mellin's food or malted milk1 is sometimes useful4 ,for little children the fruit juices are particularly beneficial when given half an hour or more before the first morning feeding1 with half a glass of water4 ,for older children the amount of white bread1 toast1 and potato1 should be reduced1 and green vegetables oatmeal1 and ,graham bread given1 with plenty of fruit twice a day4 ,raw scraped apples are sometimes of more value than any other fruit4 ,the best suppositories for continuous use are probably the gluten suppositories of the ,health ,food ,company4 ,one should be given the first thing in the morning4 ,they act rather slowly1 usually in about two hours4 ,in obstinate cases one may also be used at bedtime4 ,glycerine suppositories act more quickly1 but are too irritating for regular use4 ,massage consists in rubbing the abdomen1 which may be done in one of two ways3 ,beginning at the right groin1 the hand is carried up to the ribs1 then across to the opposite side1 then around to the left groin4 ,the abdomen is stroked gently at first1 and afterward deeper pressure used as the child becomes accustomed to it4 ,the second method is by rubbing the deeper parts with a circular movement--the fingers not moving upon the skin--making a series of small circles1 beginning at the right groin and following the same course as described above4 ,either method should be employed for six or eight minutes twice a day1 at almost any regular time1 except soon after a meal4 ,,diarrhoea ,in case a child is taken with diarrhoea1 what should be done8 ,with a moderate looseness of the bowels in an older child1 solid food should be stopped1 and boiled milk given diluted with gruel2 the child should be kept perfectly quiet1 as walking about always aggravates such a disturbance4 ,if the symptoms are more severe and attended by fever and vomiting1 all milk should be stopped at once1 and only broth1 barley water1 or some thin gruel given4 ,some cathartic1 usually castor oil1 is required with a severe attack4 ,if the patient is an infant1 the milk should be diluted and especially should the fat be reduced 7see page #gf74 ,in severe attacks with vomiting or frequent foul stools1 all food should be stopped for at least twelve hours and all milk for a longer time1 and the bowels freely moved by a cathartic4 ,why is a cathartic necessary if the movements are already frequent8 ,such movements are nearly always due to an irritation in the bowel1 set up by the fermenting food which has not been digested4 ,the diarrhoea is ,nature's effort to get rid of the irritant4 ,nothing to stop the movements should be given until the bowels have been thoroughly cleared by the treatment mentioned4 ,,bad ,,habits ,what are the most common bad habits of young children8 ,sucking1 nail-biting1 dirt-eating1 bed-wetting1 and masturbation4 ,what do children suck8 ,most frequently the thumbs or fingers1 sometimes the clothing or blanket2 often the pacifier or rubber nipple4 ,when is this habit most frequently seen8 ,it begins in quite early infancy1 and if not broken may last until children are six or seven years old4 ,is the sucking habit a harmful one8 ,when persisted in it may produce a misshapen mouth or fingers4 ,it constantly stimulates the flow of saliva and certainly aggravates disturbances of digestion during which the sucking habit is likely to be practised4 ,it may lead to thrush or other forms of infection of the mouth4 ,it is not necessary as a means of quieting a child1 though it may in some degree cover up the consequences of bad feeding or bad training4 ,on no account should the habit of sucking the pacifier be allowed as a means of putting children to sleep1 or of quieting them while restless from dentition or indigestion4 ,how is the sucking habit to be controlled8 ,one should be sure in the first place that the constant sucking of fingers is not due to hunger from insufficient food4 ,sucking of the hands may often be controlled by wearing mittens or fastening the hands to the sides during sleep4 ,in more obstinate cases it may be necessary to confine the elbow by small pasteboard splints to prevent the child from bending the arm so as to get the hand to the mouth4 ,when are nail-biting and dirt-eating seen1 and how are they to be controlled8 ,these habits belong especially to children over three years old4 ,they are seen particularly in those who are excessively nervous or whose general health is below par2 sometimes in those who develop serious nervous diseases later in life4 ,children with such tendencies should be closely watched1 and every means used to break up these habits early4 ,dirt-eating is a morbid craving which is rarely seen in a normal child4 ,at what age may a child generally be expected to go without wetting the bed during the night8 ,usually at two and a half years1 if it is taken up late in the evening4 ,some children acquire control of the bladder at night when two years old1 and a few not until three years4 ,after three years habitual bed-wetting is abnormal4 ,how should a young child addicted to bed-wetting be managed8 ,at three or four years of age1 punishments are sometimes useful1 especially when it seems to depend more upon the child's indifference than anything else4 ,they are of no value in older children1 rewards being much more efficacious4 ,in all cases one should give a child plenty of milk and water early in the day1 but no fluids after #d ,p4,m41 the supper being always of solid or semi-solid food4 ,the child should be taken up regularly at ten o'clock or thereabouts4 ,it often happens that the formation or continuance of the habit is due to the child being in poor general condition1 to some irritation in the urine1 or in the genital organs4 ,unless the simple means mentioned are successful the child should be placed under the charge of a physician4 ,what is masturbation8 ,it is the habit of rubbing the genital organs with the hands1 with the clothing1 against the bed1 or rubbing the thighs together4 ,sometimes the child sits upon the floor1 crosses its thighs tightly and rocks backward and forward4 ,many of these things are passed over lightly and are regarded for months as simply a queer trick of the child4 ,it may be seen at any age1 even in those not more than a year old1 and in both sexes4 ,how should such a child be treated8 ,masturbation is the most injurious of all the bad habits1 and should be broken up just as early as possible4 ,children should especially be watched at the time of going to sleep and on first waking4 ,punishments and mechanical restraint are of little avail except with infants4 ,with older children they usually make matters worse4 ,rewards are much more efficacious4 ,it is of the utmost importance to watch the child closely1 to keep his confidence1 and by all possible means to teach self-control4 ,some local cause of irritation is often present1 which can be removed4 ,medical advice should at once be sought4 ,,vaccination ,nowadays when small-pox occurs so seldom is it necessary to have every child vaccinated8 ,it should by all means be done4 ,it is only by the practice of general vaccination that small-pox is kept down4 ,in countries or in communities where vaccination is neglected1 frightful outbreaks of small-pox occur every now and then just as in olden times4 ,what is the best time for vaccination8 ,the time usually selected is from the third to the sixth month4 ,it may be deferred in a very delicate child who is not likely to be exposed to small-pox1 or in a child suffering from any form of skin disease4 ,which is preferable for vaccination1 the arm or the leg8 ,the part which can be most easily protected and kept at rest is to be chosen4 ,in infants who do not yet walk or creep1 the leg is to be preferred8 in older children1 in most circumstances1 the arm4 ,if older children are vaccinated on the leg1 they should not be allowed to walk much while the vaccination is active4 ,when should vaccination be repeated8 ,an unsuccessful vaccination proves nothing and should be repeated in two or three weeks4 ,if success fully vaccinated in infancy1 a child should invariably be revaccinated before puberty4 ,if exposed or likely to be exposed to small-pox at any time vaccination should be repeated4 ,illustration3 ,weight chart for the first year2 the curved line indicates the average rate of gain4 ,illustration3 ,weight chart1 one to fourteen years4 ,the upper line indicates the average for boys2 the lower 7dotted7 line that for girls4