4. Conditions That Affect The Mother's Milk

(a) Nervousness, worry, grief, insomnia, an erratic temperament, have a decided influence on the milk supply, and so on the baby. Erratic, nervous mothers will often have an abundance of milk one day and very little the next day, and the milk often leaves "all at once."

(b) Diet - The variations that can be produced in milk by diet are very limited, and of little therapeutic value.

(c) Menstruation apparently lessens the amount of milk, and so affects the baby in a small percentage of cases. It rarely is an indication to make any change in the regular order of nursing.

(d) Pregnancy often lessens materially the quantity of milk and possibly affects the quality, and then makes weaning desirable. It rarely occurs early in lactation, so weaning offers little difficulty.

5. Contraindications To Nursing

Absence of milk, and some deformity like inverted nipples that makes nursing impossible, are the only absolute contraindications. Tuberculosis is almost equally so. Syphilis is only a contraindication if the baby is free from it. In such conditions as anemia, nephritis, puerperal infections, mastitis, one must weigh all the circumstances. If the mother has an acute contagious disease, it is often safer to let the baby nurse - e.g., in measles, mumps, diphtheria, and even scarlet fever - than to subject it to the dangers of artificial feeding under unfavorable circumstances.

6. Weaning

There is no definite time at which a mother should stop nursing her baby, and weaning should always be very gradual, whenever possible (see mixed feeding). It is not best to feed a baby exclusively at the breast beyond the eighth or tenth month, even though the milk is abundant. Babies so fed commonly get pale, soft, less well nourished, probably because human milk contains too little iron for this period (Bunge). It is rarely desirable to continue breast feeding much beyond the first year, though many Oriental mothers nurse three and even four years. If weaning is sudden, the child should be placed at once on a small amount of modified cow's milk that is gradually increased to the necessary amount.

7. Additional Food During the First Year - The eighth or ninth month is about the average time when additional food should be given the healthy infant. Orange juice or other fruit juice can be given once or twice a day, about an hour before a feeding, gradually increasing from a teaspoonful to two tablespoonfuls a day. Beef juice, meat broths, or, better still, a little later, strained vegetable soup, can be given in increasing amounts up to four to six ounces a day. Rusk, zwieback, crackers, can be given in small amounts at the ninth month, and gradually increased. By the end of the first year the healthy baby should be able to have, further, well-cooked and mashed spinach, carrots and cauliflower; thoroughly cooked cereals, oatmeal, rice, wheat, etc.; a little crisp bacon, a bone to gnaw; baked apple or scraped raw apple; an occasional egg, bread and milk, etc. Four feedings a day is ample. At each meal the child can have its bottle or the breast, with some additional food as indicated. Nothing should be given between meals except water and the fruit juices.

8. Normal Development Of The Breast-Fed Infant

By the end of the fifth month the birth weight, seven to seven and a half pounds, is usually doubled, fourteen to fifteen pounds, and by the end of the first year trebled, twenty to twenty-one pounds. This means an unbroken gain of five to eight or more ounces a week during the first few months, and two to four ounces a week the last few months, with an average weekly gain of four ounces. The average birth length of 20.5 inches increases about eight inches during the first year. The first teeth appear at the sixth or seventh month, and there should be six at the end of the year.

9. Feces

During the first two or three days the baby has five or six greenish-black, tarry bowel movements, the so-called meconium, made up of swallowed amniotic fluid, intestinal secretions, epithelial cells, bile, etc. After this time they begin to turn yellow, and in a few days have their normal properties. The stools are then two or three in number daily, of a rich gold or egg-yellow color, are soft and mushy in consistency, acid in reaction, and have a slightly acid, not unpleasant odor. The gases present are hydrogen and CO2, and so are nearly odorless. The feces are composed of water, and solids made up of ten to thirty per cent fat, fatty acids, and soaps; about eight per cent salts; mucus, bile, epithelial cells, and intestinal secretions; and over fifty per cent bacteria. Quite frequently they contain an excess of mucus, and many fine, soft, yellowish curds, and are slightly green in color. Unless the baby shows other evidence of a food disorder, such bowel movements need give no concern, as they are quite consistent with normal development.

10. Wet Nursing

Under ideal conditions this is a nearly perfect substitute for maternal nursing. The nurse must be found to be healthy in every way, and tuberculosis, gonorrhea, especially if she is to nurse a female child, and syphilis are to be most carefully excluded. For the latter, the baby is by far the most important guide, as the mother will rarely show evidence of the disease, while the baby nearly always will after the first few weeks (Colles' Law). Her own baby, furthermore, is the best index of the nurse's ability to furnish an abundance of milk. She should be neither too young nor too old. A multipara is commonly preferable, because she has demonstrated her efficiency before. The age of her baby, as compared with that of the baby she is to nurse, is a matter of slight, if indeed of any, importance, except that one prefers to avoid the first month or two of lactation because of the possibility of syphilis. An examination of the milk is rarely of any practical value. The nurse should usually have her own baby with her, for the baby's sake, and to keep her from worry and lonesomeness, and also to make sure that the breasts are well emptied, so as to keep up a good flow of milk. If the babies differ in size and vigor, the breasts should be alternated so that both will be stimulated alike. If she is to pump or press out her milk, she must have her baby with her, because the breasts cannot be sufficiently emptied normally to keep up the necessary flow.