INFANT FEEDING. THE subject of infant feeding, during both health and disease, is one of extreme importance, and one on which success in pediatric practice largely depends. Before taking up the study of infant feeding the student should read carefully the section on Milk. Infancy is that period of life dating from birth to about two and one-half years. Childhood is the period from two and onehalf years to puberty. The theory that infancy ends at two and one-half years is an arbitrary one. There are four methods of feeding infants: 1. Breast- or maternal feeding. 2. Wet-nursing. 3. Mixed feeding-i. e., breast-feeding supplemented by bottle-feeding. 4. Bottle- or artificial feeding. 1. Breast-feeding.-The milk from a healthy mother is by far the best nourishment for an infant during the first year of its life, and can not be fully replaced by any other form of feeding. Infants fed on the breast-milk of a healthy woman are stronger and better able to resist disease. While it is true that babies may be reared on artificial foods and remain healthy and grow strong, the percentage of robust bottle-fed babies is much smaller than that of healthy breast-fed infants. This is particularly true of the poorer classes, who often lack both the time and the intelligence required to rear a healthy infant by bottle-feeding. Contraindications to Maternal Nursing.—The following rules, adapted from Holt, will be found a reliable guide in determining whether or not a mother is fitted to nurse her child : 1. If the mother has tuberculosis in any form, latent or active, she should not nurse her child. A tuberculous mother not only exposes her child to infection, but hastens the progress of the disease in herself. If the mother has pulmonary tuberculosis, nursing is almost certain to prove fatal to her. 2. When the mother has had any serious complication, such as nephritis, convulsions, severe hemorrhage, or septic infection, during pregnancy or parturition, she should not be allowed to nurse her infant. 3. If the mother is choreic or epileptic, nursing is contraindicated. 4. If the mother is very feeble or has any serious chronic disease, the child will derive little, if any, benefit from breastfeeding and the mother will be greatly injured. 5. Nursing should not be attempted where experience has shown on two previous occasions, under favorable conditions, that the mother is unable to nourish her child. 6. When no milk is secreted, feeding is, of course, impossible. Good artificial feeding is to be preferred to poor breast-feeding. If artificial feeding must be resorted to, it is well to begin early, for the infant's digestive organs are then apt to be in comparatively good condition. The question has two sides, however, and must carefully be considered. Many mothers with an abundance of maternal love and manifold good intentions are often lacking in intelligence and can not be taught the proper care of an infant. If the prospective mother is under observation during pregnancy, the breasts should be carefully examined, and if the nipples are found to be short or retracted, measures should be taken to correct this condition. This may be done by exercising gentle traction upon the nipple daily. In extreme cases of retraction a breast-pump may be needed. During the entire nursing period the breasts should receive careful attention. Cleanliness is imperative, and after each nursing the breast should be carefully washed, preferably with a solution of boric acid. During the first forty-eight hours the child receives practically no nourishment from the breast, the only fluid secreted during this time being colostrum. This has a laxative effect upon the infant's bowels, emptying them of the dark brownish material, known as meconium, which has accumulated in the intestinal canal during uterine life. The child should, however, be put to the breast at regular intervals, so as to establish a free flow of milk; this generally begins on the third day, but is sometimes delayed. During the first two days of its existence the child gets about six ounces of colostrum a day, which is all that is needed. It may, however, be given a teaspoonful or two of warm boiled water or of a 5 per cent. solution of sugar of milk. In unusually robust but fretful children, or when there is fever, a small amount of nourishment may be required; this should be given according to the rules for artificial feeding. If the milk is delayed beyond forty-eight hours, it becomes necessary to feed the child by the bottle until the flow is established. The child should be put to the breast regularly, or the breast-pump may be used to stimulate the secretion of the milk. Fennel, catnip tea, and the like should be excluded from the child's dietary. (For a careful consideration of the question of feeding during early infancy, and for other questions concerning infant nutrition, the reader is referred to the excellent work of Czerny and Keller, Des Kindes-Ernährung und Ernährungs-Therapie.) Before entering upon a consideration of breast-feeding itself one or two points in connection with the subject must be explained. Many mothers do not nurse their infants because they have not been properly instructed as to the importance of doing it; others, because the matter is left to the nurse, who, after two or three trials, decides that the mother is incapable of nursing her baby; in the latter case the probabilities are that nothing is wrong with the mother. Often, too, the attending physician, especially if he is an obstetric specialist, is apt to give his attention wholly to the mother, leaving the child to the nurse's care. The mental attitude of the mother has a marked effect on the milk secretion, and if she has been properly instructed and encouraged beforehand, there is usually no difficulty. If, on the other hand, she has grave doubts as to her capability, and particularly if she hears both physician and nurse discuss her probable incompetency, the milk secretion may be inhibited. The mental condition of the mother is often affected as the result of weighing the child. It is very desirable that the child be weighed regularly and the weight recorded; but if the mother is at all nervous, or if the child is not doing well, the weighing should not be done by the mother or in her presence. A loss in weight, or even the fact that there is no material gain, may so affect the mental condition of the mother as to prove deleterious to the secretion of milk. With proper encouragement and by stimulating the breast by placing the child at it at regular intervals the flow of milk is promoted. The subject of the fitness of mothers for nursing their infants is receiving more attention of late years, and in Germany an attempt has been made to show that the daughters of alcoholic parents or ancestry are apt to be incapable of nursing their infants. While this has been proved statistically, an alcoholic ancestry is of so common occurrence that almost any existing evil might be attributed to it and its relationship proved. Breast-nursing often proves a failure because the mother does not understand how to give the breast to the child. With the increase in civilization there seems to be a diminution in instinct, and careful directions should be given in every case. The child should lie on the right or left arm, according to whether the child is to nurse at the right or at the left breast. If the mother is in a sitting posture, her body should be inclined slightly forward. With her free hand she should grasp the breast near the nipple between the first two fingers. If, owing to the free flow of milk, the child takes the milk too rapidly, this may be checked by slight pressure of the fingers. The child should nurse until satisfied. The contents of one breast are generally sufficient for one nursing, and the breasts should be used alternately. When satisfied, the infant will usually fall asleep at the breast. Under ordinary conditions the nursing should last for from about ten to twenty minutes. If the milk is taken too rapidly, vomiting may ensue immediately after or during feeding. If too much is taken, it is regurgitated almost immediately. If the infant consumes more than half an hour in nursing, the breast and the milk should be examined. As the infant grows older it requires and takes more food, and consequently will require a longer time to nurse than it did during the early days of life. The inculcation of good nursing-habits can not be too strongly insisted upon. Many attacks of indigestion, colic, and diarrhea may be traced to improper nursing. When good habits are once established, there is generally very little trouble, the success of the training depending largely on the manner in which it is done. Regular hours for feeding should be fixed and adhered to; and if the child is asleep at the feeding-hour, it may be aroused, for it will almost invariably go to sleep after nursing. After the last feeding, which should usually take place at 9 or 10 o'clock, the child should be quieted and allowed to sleep as long as it chooses. During the first month or two the infant will, as a rule, awaken between 1 or 2 o'clock and again at about 4 or 5 o'clock. After two or three months it will require but one night feeding, and after five months of age the average infant will sleep all night without nursing. When the change is being made and the child awakens for its accustomed nursing, it should be given a little warm water from a bottle and be quieted, but not taken up. Regular nursinghabits induce regular bowel movements and sleep, and the three combined insure health and comfort not only for the infant, but for the mother as well. A healthy child, if trained to do so, will sleep without rocking or coddling. Three things are, however, essential to secure success in this training: a satisfied appetite, dry napkins, and a quiet, darkened room. The infant must not be nursed each time it cries. If it has colic, the warm milk may soothe the child for a time, but later aggra vates the trouble, which in many cases is due to overfeeding or to too frequent feeding. The following table, from Holt, may be used as a guide in breast-feeding: Night nursing between 9 P. M. and 7 A. M. Intervals 2d 1 2 In case of sickness and when the infant is feeble and below the average, especial rules are required, and directions should be modified to suit each individual case. A good general rule is to feed the child according to the age to which the weight corresponds. The child's weight is the best index of its nutrition. During the first four months it may be weighed twice a week; after that time once a week is sufficient. The average minimum gain for an infant is four ounces a week. weight falls below this for several weeks consecutively, it is evident that something is wrong. During illness, of course, there may be no gain or loss according to the severity of the condition. If the When the breast milk is insufficient for, or unsuited to the needs of, the infant, it becomes fretful, colic occurs, and the babe appears to be "cross." Disturbances of the alimentary tract, diarrhea with greenish stools containing a large amount of mucus and undigested curds, take place at times. At times the stools are brownish, and contain mucus and numerous curds the size of a grain of wheat or larger. In other cases there may be chronic constipation with small, hard, dry stools. If the infant is getting too little milk, it is fretful and gains slowly or not at all, but there is rarely any disturbance of the stomach or bowels. In these cases the nursing is continued for over thirty minutes without satisfying the child, or it may nurse a minute or two and then refuse to nurse because the supply is so scanty. Where the breast milk is nearly normal in quantity and in quality, certain measures, which will be discussed further on, may be taken to augment the supply and enrich the quality, or it may be supplemented by artificial feeding. When the milk is very poor in quality, as, for example, when the specific gravity is from 1.015 to 1.025 and when only 2 or 3 per cent. of cream is present, the child should be weaned at once, for the condition is not amenable to treatment. Mother's milk may easily be tested by means of Holt's milk |