Fig. 115.—Proper position of mother while nursing child. (Witkowski.)
Care must be used that the child gets the nipple over the tongue and not under it. Many infants have to be taught to nurse. This may be due to a lack of strong animal instinct in many cases. There may be an abundance of milk and a good nipple, but the child will not learn to nurse without a vast expenditure of time, patience, and energy on the part of the nurse. Squeezing a little milk into the mouth or filling a nipple shield with milk will sometimes aid in educating the infant, or even starting the supply with a pump, as many nurses do, is advantageous. Certain drugs, like castor oil and turpentine, taken by the mother, may affect the taste of the milk, and be reason enough for the refusal of the child to take hold. Other drugs like mercury, arsenic, potassium iodide, and alcohol may go over in the milk to the nursing child.
If the child is weak or premature, the milk must be pumped from the breast and fed to it until strength comes. The difficulty about this is the bad habit acquired, but there is no way to avoid it.
A child should get at each feeding half an ounce of milk to each pound of weight. The capacity of the stomach at various months is given by Hirst as, first week, ½ oz.; second week, 2½ oz.; third and fourth week, 3 oz.; third month, 5 oz.; fifth month, 9 oz.; ninth month, 12½ oz. Holt says that the capacity at birth should be one ounce, and increase at the rate of an ounce a month up to the sixth month.
As hunger stimulates the gastric and salivary glands, so the sight of the child arouses some emotional center in the mother, which starts the milk, and the mouth of the child provides an additional stimulus of great power. About fourteen ounces is secreted by the seventh day, and after the second month the daily average rises to three or four pints. Milk secretion is favored by drugs and foods that raise the blood pressure and diminished by substances that lower the blood pressure.
There may be too little milk in the breasts, and if so, the child will lose weight daily; also the child will waken before nursing time, fret, refuse water, but greedily seize the nipple if it is presented. It will continue to nurse long after its time is up and cling and cry when removed. The breast itself may seem flabby and loose, and no milk, or very little, can be pressed from the nipple.
Normally, the breasts feel full and tense, both to patient and nurse, just before feeding time. The real test, however, is in taking the weight of the child before and after feeding. Where the milk is insufficient, the scales will not vary, and after a few repetitions the nurse can be certain. An infant should be handled as little as possible after feeding lest the milk be vomited.
Fig. 116.—Proper method of taking rectal temperature.