The successful training of a baby begins with the development of regular habits of nursing. The old-fashioned custom of allowing the baby to nurse whenever it cried, tacitly—and incorrectly—assumed that it could have no other sensation than hunger. As a matter of fact an infant may have pain from overfeeding. Again, it may be thirsty, or uncomfortable from the pricking of a pin, from the monotony of one position, from a soiled napkin, or from neglect of many simple details in its care. Any of these things make a baby cry, for it has no other means by which it can express disapproval.
So long as the breasts contain colostrum the nursings should be at least three hours apart during the day; at night it is preferable not to disturb the mother at all. As soon as milk appears the interval is usually shortened to two hours during the day. In many cases, however, the three-hour interval will be retained even after the milk appears, for otherwise the infant may not become hungry and will fail to nurse as strongly as it should. The following schedule is adapted to the average infant:
Age Interval During Total Number
the Day of Feedings
From 1st to 4th week 2 hours 9
" 4th " 8th " 2-1/2 " 8
" 2nd " 4th month 3 " 7
" 4th " 10th " 3 " 6
" 10th " 12th " 4 " 5
After the first few days most young infants require one feeding in the middle of the night, which is usually given about 2 A.M. The day feedings then begin at 6 A.M., and are repeated at regular intervals until 9 or 10 P.M. The daily bath should be scheduled so that a feeding will be due just after the bath has been completed. If asleep when the next succeeding feeding falls due, the infant should not be waked, but at other times nothing should interfere with the regularity of the schedule. Occasionally there may be difficulty in getting the child to nurse during the day, but it must be taught to do so; otherwise it will want to nurse throughout the night.
At no time should an infant remain in the bed with its mother after it has finished nursing; at night this rule must be rigidly enforced, for mothers have been known to fall asleep and smother the baby, an accident known as over-lying. Infants can frequently be trained to go without feeding in the middle of the night even when a month old; and such training is always advisable, since it affords the mother opportunity for six or eight hours' continuous sleep.
Before and after each nursing the mothers' nipple should be cleansed with a solution of boric acid made by placing a tablespoonful of the powder in a tumbler which is then filled with water. Such cleansing protects the breasts against infection, a complication which the nursing mother must spare no pains to prevent. Now and then, in spite of conscientious efforts to harden them, the nipples become sore. If they crack, the baby's mouth must not come in direct contact with them, since nursing with a cracked nipple is a common source of a gathered breast. Fortunately when a nipple cracks we may employ a shield, obtainable at any drug-store, which enables the infant to nurse without any danger to the mother. Most babies will take the shield as well as the breast itself; nevertheless, its use should be discontinued as soon as the nipple heals, for while the shield is used the secretion of milk is not stimulated as vigorously as when the infant nurses directly from the breast. In the rare cases in which the shield cannot be used satisfactorily the infant must be taken from the breast temporarily and given a bottle. Radical as this advice may appear, the mother must consent to follow it, for, as I have pointed out, to permit an infant to nurse a cracked nipple is extremely hazardous. When treatment is begun promptly the cracks will generally heal within twenty-four hours.
HYGIENE OF THE MOTHER.—Since the mammary glands manufacture their product from the constituents of the mother's blood and their activity is controlled by her nerves, it is clear that her physical condition and her state of mind will influence the secretion of milk. Intelligent women who understand this desire to know how they should live that they may best insure an ample supply of good milk. Fortunately the first important step toward success has been taken when a mother wishes to nurse her baby; but there are also necessary wholesome food, habits conducive to health, and a mind free from worry.
It is unfortunate that current beliefs throw many restrictions about nursing-mothers which are unreasonable and unsupported by scientific investigation. There was a time when mothers did not question their ability to nurse, they assumed this duty as a matter of course. Indeed, they were compelled to do so, since refined methods of artificial feeding had not as yet been devised. Among the agricultural class, even to-day, it is exceptional for mothers to fail to nurse their children, if they are provided with the ordinary comforts of life. But women who live at the higher tension of city life are frequently unsuccessful, because they are more inclined to be nervous or because they disregard, among other things, the need of fresh air, plain food, or regular habits. It is wrong to suppose that elaborate rules of conduct are necessary for nursing mothers; the instruction they require is simple and scarcely different from that to be given anyone who desires good health. If she lead a wholesome existence a woman will not only nurse her child successfully but will gain in strength.
Diet.—In manufacturing centers, where a large proportion of the women are employed in confining work, the percentage of mothers who are able to nurse their children is exceedingly small; consequently the infant mortality is very high. Better nourishment for the mother, it has seemed, would render her more capable of successful lactation, and would decrease or even eliminate badly executed artificial feeding, and would therefore reduce the death rate among the babies. In a few foreign cities the idea has been put into practice. Free restaurants have been established for working mothers, and they have thus been enabled to perform their maternal duties much more successfully. Incidentally it has been shown that nourishment may be supplied mother and infant at a smaller cost than proper artificial food for the infant alone.
The quantity of nourishment required by nursing mothers is not so large as might be expected, and in many instances it is over-feeding rather than under-feeding that must be guarded against. Very accurate observations have been made which indicate that during the early weeks of nursing no more food is needed than at other times; in all probability this remains true throughout the whole period of lactation. Over-eating, as many of us know, is a frequent cause of indigestion. It is of the first importance, therefore, that nursing mothers should not take more food than they can assimilate, for indigestion will provoke disturbances in the milk which in turn will make the baby uncomfortable. For a similar reason mothers should have their meals at regular intervals.