Vickipedia

WEA’NING, and FEEDING IN INFANCY. The propriety of mothers nursing their own children is now so universally acknowledged, that it is the duty of the physician less frequently to urge maternal nursing than to indicate those cases in which it becomes necessary to substitute another mode of rearing the infant. ‘ Women,’ says Dr. Maunsell, ‘who labor under any mortal or weakening disease—as phthisis, hæmorrhages, epilepsy—are obviously disqualified from the office of nurse. Some who are in other respects healthy, have breasts incapable of secreting a sufficient supply of milk. In other instances, the breast may perform its functions well, but the nipple may be naturally so small, or may be so completely obliterated by the pressure of tight stays, as not to admit of its being laid hold of by the child. These are actual physical hindrances to nursing. Again, women may, and, in the higher classes, frequently do, possess such extremely sensitive and excitable temperaments, as will render it imprudent for them to suckle their own children. Frightened and excited by every accidental change in the infant’s countenance, and inordinately moved by the common agitations of life, such persons are kept in a state of continual fever, which materially interferes with the formation of milk both as to quantity and quality. Women, also, who become mothers for the first time at a late period of life, have seldom the flexibility of disposition or the physical aptitude for the secretion of milk, required to constitute a good nurse.’—A Treatise on the Management and Diseases of Children, 4th ed., 1842, pp. 39. 40.

In ordinary cases, the child should be put to the breast as soon as the latter begins to contain anything; and when the secretion of milk lias fairly commenced, it will require no other food until the seventh or eighth month, provided the mother be a good nurse. During the first five or six months, the infant should be put to the breast at regular intervals of about four hours; afterwards, when the teeth are beginning to appear, the child need not suck more than four times in the twenty-four hours, some artificial food being given to it twice during the same period. This at first may consist of soft bread steeped in hot water, with the addition of sugar and cow’s milk; and subsequently a little broth, free from salt and vegetables, may be given once a day. The spoon is now the best medium o£ feeding, as the food should be more solid than could be drawn through the sucking-bottle. The time of weaning should be that indicated by nature, when, by providing the child with teeth, she furnishes it with the means of obtaining its nourishment from substances more solid than milk. If the infant has been gradually accustomed to a diminished supply of maternal and an increase of artificial food, weaning will be a comparatively easy process; and much of that suffering both to parent and child will be spared, which commonly ensues when a sudden change is made. In ordinary cases, the period of weaning varies from the seventh to the twelfth month; sometimes the child is kept at the breast for a much longer period, from the popular idea that lactation prevents pregnancy, but such unnaturally prolonged lactation is usually injurious to both mother and child.

In those cases in which it is inexpedient or impossible for a mother to suckle her own child, the choice of a wet-nurse becomes a subject of much importance. Upon this subject, Dr. Maunsell lays down the following important practical rules: ‘The great thing we have to look to is to ascertain that both the woman and her child are in good health; and of this we must endeavor to judge by the following signs: The woman’s general appearance and form should be observed, and they ought to be such as betoken a sound constitution. Her skin should be free from eruptions; her tongue clean, and indicating a healthy digestion; her gums and teeth sound and perfect; the breasts should be firm and well formed—not too large or flabby—and with perfect, well-developed nipples. We should see that the milk flows freely, upon slight pressure; and we should allow a little of it to remain in a glass in order that we may judge of its quality. It should be thin, and of a bluish-white color; sweet to the taste; and when allowed to stand, should throw up a considerable quantity of cream. A nurse should not be old, but it is better that she should have had one or two children before, as she will then be likely to have more milk, and may be supposed to have acquired experience in the management of infants. Having examined the mother, we must next turn to the child, which should be well nourished, clean and free from eruptions, especially on the head and buttocks. We should also carefully examine its mouth, to ascertain that it is free from sores or aphthæ. If both woman and child bear such an examination, we may with tolerable security pronounce the former to be likely to prove a good nurse.’—Op. cit., pp. 44, 45. In one respect, we differ from this eminent physician. He holds that ‘ the more recently the nurse’s own confinement has taken place, provided she has recovered from its effects, the better.’ Supposing a nurse is required for a new born infant, this rule holds good; but provided a nurse is required for an infant of three or four months old (for example), it is preferable to obtain a nurse whose milk is of that age. We believe it to be a general physiological law that the age of the milk should correspond to the age of the infant; that is to say, that an infant taken at any given age from its mother, before the normal period of weaning, should be provided with a nurse who was confined about the same time as its own mother.

A wet-nurse should be very much preferred to any kind of artificial feeding; but peculiar cases may occur in which it is impossible to procure a nurse; or an infant whose mother is incapable of nourishing it may be the subject of a disease that may be transmitted through the infant to the nurse. In these cases, a food must be provided as nearly as possible resembling the natural food; and this is naturally sought for among the food of animals. The milk of the cow is most commonly used, in consequence of its being the most easily obtained; but ass’s milk more nearly resembles human milk, as is shown from the following comparative analyses by Professor Playfair :

The most important difference between cow’s milk and woman’s milk is the great excess of casein in the former. The former fluid may, however, be made to resemble the latter in composition in either of the following ways : (1) On gently heating cow’s milk, a membrane of casein forms on-the surface; by removing two or

three of these membranes as they form, we can reduce the quantity of casein to the desired extent; or (2) we may dilute cow’s milk with twice its bulk of pure water, and add a little sugar. This food should be administered at a natural temperature (of about 98°) through a sucking-bottle; and as the child grows older, it will soon be able to take natural cow’s milk without inconvenience. The nature and importance of the mixture of milk and farinaceous food known as Liebig’s Soup for Children, are described under SOUP.

The rules regarding the times &c. of feeding are similar to those laid down for suckling. Assuming that the infant, whether brought up at the breast or artificially reared, has been safely weaned, we have to consider what rules should be laid clown regarding its food subsequently. For some months after weaning the food should consist principally of semi-fluid substances, such as milk thickened with baked flour, or pap, to which a little sugar should be added. Light broth’s may also be administered, especially in the occasional cases in which milk seems to disagree; and bread and butter may be tried in small quantity. We shall con-elude this article with the following ‘ model of a suitable diet for children,’ which cannot be too strongly impressed upon the minds of all young mothers. ‘A healthy child, of two or three years old, commonly awakes hungry and thirsty at five or six o’clock in the morning, sometimes even earlier. Immediately after awaking, a little bread and sweet milk should be given to it, or (when the child is too young to eat bread) a little bread-pap. The latter should be warm; but in the former case, the bread may be eaten from the hand, and the milk allowed to be drunk cold, as it is well at this meal to furnish no inducement for eating beyond that of hunger. After eating, the child will generally sleep again for an hour or two; and about nine o’clock it should get its second meal, of bread softened in hot water, which latter is to be drained off, and fresh milk and a little sugar added to the bread. Between one and two, the child may have dinner, consisting, at the younger ages, of beef, mutton, or chicken broth (deprived of all fat), and bread. When a sufficient number of teeth are developed to admit of chewing being performed, a little animal food, as chicken, roast, or broiled mutton, or beef, not too much dressed, should be allowed, with a potato or bread, and some fresh, well-dressed vegetable, as turnips or cauliflower. After dinner, some drink will be requisite; and a healthy child requires, and indeed wishes for nothing but water.

Light, fresh table-beer would not be injurious to a child of four or five years old, but it is unnecessary. Between six and seven o’clock, the child may have its last meal of bread steeped in water, &c., as at nine o’clock in the morning. A healthy child which lias been in the open air during the greater part of the day, will be ready for bed shortly after this last supply, and will require nothing more till next morning. Similar regimen and hours may be adopted throughout the whole period of childhood; only as the fourth or fifth year approaches, giving, for breakfast and supper, bread and milk without water, and either warmer cold, according to the weather or the child’s inclination. The supply of food upon first awakening in the morning may also be gradually discontinued, and breakfast be given somewhat earlier.’ —Op. cit., pp. 80, 81.