The Care and Feeding of Children Part 5

Usually only four or five times daily, since there is very little milk secreted at this time.

_When does the milk come in abundance?_

Usually on the third day, sometimes not until the fourth or fifth day.

_Should the infant be fed anything additional during the first two days?_

Usually not; if much food were necessary, we may be sure Nature would have provided it. Water, however, should be given regularly.

_How frequently should an infant be nursed during the first week?_

After the third day, every two hours during the day and twice during the night. The frequency during the rest of the first year is given in the following table:

------------------------------------------------------------------ PERIOD. Nursings in Interval Night nursings 24 hours. by day. (10 P.M. to 6 A.M.).

------------------------------------------------------------------ 1st and 2d day 4 6 hours. 1 3 days to 6 weeks 10 2 " 2 6 weeks to 3 months 8 2-1/2 " 2 3 to 5 months 7 3 " 1 5 to 12 months 6 3 " 0 ------------------------------------------------------------------

_How long should the child be kept at the breast for one nursing?_

Not over twenty minutes.

_Should the child take both b.r.e.a.s.t.s at one nursing?_

If the milk is very abundant one breast may be sufficient, otherwise both b.r.e.a.s.t.s may be taken.

_What are the important things to be attended to in nursing?_

First, regularity; it is just as important as in the case of bottle-feeding. Secondly, the nipples should be kept clean by being washed after every nursing.

_What should be the diet of a nursing mother?_

She should have a simple but generous diet with plenty of fluids; three regular meals may be given and gruel, milk, or cocoa at bed-time and sometimes between meals. She may take eggs, cereals, most soups, and nearly all vegetables, avoiding sour fruits, salads, pastry, and most desserts. Meat should not be taken more than twice daily, and in many cases but once. She should take but little tea or coffee, and ordinarily no wine or beer.

_Are fruits likely to disturb a nursing infant?_

Sour fruits in some cases may do so, but sweet fruits and most cooked fruits are useful.

_What else is important in the life of the nursing mother?_

She should lead a simple natural life; should have regular out-of-door exercise, preferably walking or driving, as soon after her confinement as her condition will permit. She should have regular movements from the bowels daily. She should be as free as possible from unnecessary cares and worry; her rest at night should be disturbed as little as possible; she should lie down for at least one hour in the middle of the day.

_Does the nervous condition of the mother affect the milk?_

Very much more than her diet; worry, anxiety, fatigue, loss of sleep, household cares, social dissipation etc., have more than anything else to do with the failure of the modern mother as a nurse. Uncontrolled emotions, grief, excitement, fright, pa.s.sion, may cause milk to disagree with the child; at times they may excite acute illness, and at other times they may cause a sudden and complete disappearance of the milk.

_Does menstruation affect the milk?_

In nearly all cases the quant.i.ty of milk is lessened so that the infant is not satisfied and may gain less in weight or not at all. In many cases the quality of the milk is also affected to such a degree as to cause slight disturbances of digestion, such as restlessness, colic, and perhaps some derangement of the bowels. In a few, attacks of acute indigestion are excited.

_Is regular menstruation a reason for stopping nursing?_

Not invariably; as a rule both functions do not go on together. But if the child is gaining regularly in weight between the periods, nursing may be continued indefinitely, although it may be well to feed the infant wholly or in part during the first day or two that the mother is unwell.

_What symptoms indicate that a nursing infant is well nourished?_

The child has a good colour, sleeps for two or three hours after nursing, or, if awake, is quiet, good-natured, and apparently comfortable. It has normal movements of the bowels and gains steadily in weight.

_What symptoms indicate that a child who is nursing is not properly nourished?_

It does not gain and may even lose in weight. It no longer exhibits its usual energy and playfulness, but is either listless and indifferent or cross, fretful and irritable, and is apt to sleep poorly. It grows pale and anaemic and its tissues become soft and flabby. When the milk is scanty it will often nurse a long time at the b.r.e.a.s.t.s, sometimes three quarters of an hour, before stopping. At other times it may take the breast for a moment only, and then turn away in apparent disgust.

_What should be done when such symptoms appear?_

This depends upon the severity of the symptoms and how long they have lasted. If the child has made no gain for three or four weeks, or is losing weight, immediate weaning will probably be necessary; in any case, other food in addition to the breast milk should be given at once. One may begin by alternating the nursing and the bottle-feeding and increase the number of bottle-feedings as may be indicated by the results.

_Is there any objection to a baby being partly nursed and partly fed?_

None whatever; it is often better from the outset to feed the baby during the night, in order not to disturb the mother's rest.

_What symptoms indicate that the mother's milk disagrees with the child?_

The child suffers from almost constant discomfort sleeps; little and then restlessly, cries a great deal, belches gas from the stomach, and pa.s.ses much by the bowels, or if not pa.s.sed, the gas acc.u.mulates and causes abdominal distention and colicky pain. There may be vomiting, but more often the trouble is intestinal. Sometimes the bowels are constipated, but usually the movements are frequent, loose, green, contain mucus and are pa.s.sed with much gas.

_What should be done under these circ.u.mstances?_

If the symptoms have persisted for two or three weeks and the child is not gaining in weight, there is little chance of improvement, and the child should be taken from the breast at once. If there is some gain in weight, one may try for a little longer, endeavouring to improve the mother's milk by rest, fresh air, careful diet, etc. However, one should always realize that the trouble is with the milk, not with the child.

_What changes should be made if a nursing infant habitually vomits?_

If this occurs soon after nursing, the infant has usually taken too much and the time of nursing should be shortened, or one breast may be given instead of two; the nursing should also be interrupted by occasional rests, so that the milk is not taken too fast.

If the vomiting occurs some time after nursing and is repeated, it is a sign of indigestion; often because the milk is too rich in fat. The intervals between nursings should then be lengthened; the breast milk may be diluted by giving one or two tablespoonfuls of plain boiled water, lime-water, or barley-water, five or ten minutes before nursing; the mother should eat less hearty food, especially less meat.

_What should be done if the infant has frequent or habitual colic?_

This is usually because the milk is too rich in proteids; the mother should take more out-of-door exercise, eat less meat, and seek to control her emotions; all causes of worry should be removed.

_Can constipation in a nursing infant be controlled through the mother's milk?_

Only to a limited extent. It is important that the mother's bowels be regular and her digestion good. An increase in the meat and milk of her diet is sometimes beneficial.

WEANING

_At what age should the child be weaned from the breast?_

Usually weaning should be begun at nine or ten months by subst.i.tuting one feeding a day for one nursing, later two feedings, and thus gradually the child is to be taken from the breast altogether.

_What is the princ.i.p.al reason for weaning earlier?_