The ability is increased by a moderate, nutritious diet,[9] including cereals, milk, water (not exceeding an additional quart of liquid daily beyond the mother’s normal need); by quiet mind, outdoor living, moderate exercise; by regularity in nursing, and the complete emptying of a breast at a nursing. It is decreased by a contrary régime, by fatigue, nervousness, or by interrupting or discontinuing the effort to nurse.
Fats are increased by more nutritious diet; proteins, by diet and decreasing the intervals between nursings. Fat in the diet does not affect the proportion in the milk. Indoor life, with overfeeding and insufficient exercise, will unduly increase the proportion of protein and cause colic. A too hearty diet, especially if high in sugars and starches, will unduly increase the fat. Irregular nursing, nervousness, not completely emptying the breast, decreasing the liquids in the diet, will decrease the supply.
Every drop of the mother’s milk is of great value to the baby. If the quantity or quality is not sufficient, nursings should not be stopped, but one or more supplemented with modified milk, prescribed by the physician or dietitian, to furnish the balance. Contagious disease, except tuberculosis, is not necessarily a contraindication to nursing. Unless the milk disagrees with the baby, nursing need not be suspended during menstruation; otherwise, modified milk may be used temporarily, and the milk regularly withdrawn. Weaning should be done slowly, substituting one feeding for a nursing, and discontinuing other nursings at intervals of two or three days. In this way the baby is gradually accustomed to other food, and the mother’s milk gradually disappears. Reducing the diet and omitting liquids for a few days will stop the flow of milk.
While the mother is in bed no more food is needed than under ordinary circumstances, as the food requirement is low during rest and the quantity needed by the baby is very small (page 118). An excess of food is likely to produce indigestion and constipation, and actually interfere with nursing. Foods easily digested, laxative, rich in minerals (especially lime and iron) should be selected through the nursing period. The diet list as for children six to eight years of age is a desirable one to follow.[10] No patent nostrums should ever be experimented with; they are worthless when not harmful. Beer and all forms of alcohol are particularly to be avoided; they do not increase the amount of fluid more than would an equal quantity of water or milk; any increase they produce is of fluid, not of nutriment; the alcohol enters the baby’s system unchanged, and may injure his sensitive nerve cells. Doctor D. D. Bezzola, of Switzerland, who has made extensive studies of the effects of alcohol upon infancy, concludes: “The time may come when we shall see that every drop of alcohol taken by the parent means a drop of stupidity for the child.”[11] Malt liquors are apt to disturb the mother’s digestion and cause her to put on superfluous fat.
Constipation in the mother will produce constipation in the baby, and laxatives or drugs taken by the mother are likely to affect the baby. Anger, worry, excitement produce poisons that render the milk indigestible, even poisonous; if these are indulged in, the baby should be given only plain or barley water, and the milk withdrawn and thrown away for one or two nursings.
Before a nursing the mother should wash her hands thoroughly with soap and hot water, and then wash the nipples with a saturated boric solution. The feeding should be done in a quiet room where there is no noise or conversation to disturb the baby, and the mother should be composed and relaxed. After the feeding, give the baby a swallow of water to rinse out the mouth. Wash the nipple again with the boric solution and dry thoroughly with a clean towel. A triple fold of clean, sterilized gauze, or surgeon’s lint, should be pinned to the undervest, covering each nipple, thus protecting both the nipple and the clothing; this should be changed every day. Cleanliness will prevent thrush in the baby’s mouth, and local soreness and discomfort for the mother.
The quantity normal at a feeding will depend upon the baby’s age, and consequently the size of his stomach and the amount needed for his growth and maintenance. (See page [118].) The quantity taken at one feeding may be ascertained by weighing the baby just before and just after a feeding.
Until recently, two-hour intervals for feeding were prescribed for babies at one or two months, with two night feedings. Extensive studies in France and Germany (where the raising of babies for replenishing the army has made infant hygiene a subject of State investigation) have proven that babies usually thrive better on longer intervals, allowing time for the stomach to rest. Some continental specialists advise four-hour intervals from the beginning, and with some babies this is quite satisfactory. The Table on page [118] presents the more usual schedule now recommended. It provides for a three-hour schedule at the start, changing to four hours at five months, with no feeding after 10 P.M. The 10 P.M. feeding can usually be dropped with advantage at about nine months. To drop a feeding, substitute water for a few nights if the baby wakes or cries.
Regularity is of the greatest importance in the feeding. Clock schedule should be observed from the first day and maintained thereafter. The digestive system is much like a machine, pouring out its digestive fluids at regular habitual intervals, and doing good work so long as this regularity is respected and observed in the feeding. Feeding the baby whenever he cries produces indigestion, colic, irritability, self-indulgence.
Ten to fifteen minutes is the usual duration of a feeding. The first milk is thinner, the latter part of the nursing richer. Generally one breast is taken at a feeding, the other breast at the succeeding feeding; if the quantity in one is insufficient, both may be used at one feeding. Neither the mother nor the baby should go to sleep during the nursing. If the baby dawdles, the food may be taken away until the next time. He should stop a minute at the end of each five minutes, to rest and breathe. If he regurgitates or vomits up after nursing, he is being fed too much, or the intervals are too short.