In many cases a mother with the best intentions finds herself unable to supply a sufficient amount of breast nutriment for the infant. The defect may be either in the quantity or the quality of the milk. If the infant is always dissatisfied after a meal, always ravenous, and is not gaining weight, an examination of the breast milk is called for. If the quality is up to the average standard, then probably the quantity is at fault. The quantity may be increased by more suitable diet, or if necessary the number of breast feeds may be reduced. If the mother is healthy, the quality can usually be improved by attention to her diet and habits. Other causes may be present which demand some extra supply of food, such as the mother's absence at work, or the state of her health.
In such cases mixed feeding, i.e. partly breast milk and partly cows' milk, is to be encouraged. As a rule mothers are quite willing, nay anxious to adopt this method, especially amongst the lower classes. Possibly the present writer may have been unfortunate in his experience, but he has been much impressed by the frequency with which breast-feeding is stopped by medical advice. If there has been the slightest trouble with the infant's digestion, or if it is not thriving well, the first remedy suggested seems to have been to stop breast-feeding. Now, although healthy children can be reared on cows' milk, the infant who has to depend entirely on artificial feeding is heavily handicapped in the struggle for existence. The mortality statistics of breast-fed and bottle-fed infants show this clearly. Consequently it is of the greatest importance to encourage breast-feeding whenever possible and to search for and correct every other possible cause of failure before falling back on the breast milk as at fault and stopping the nursing. A popular prejudice against mixed feeding exists in some quarters, but experience has shown that it can be carried out with perfect safety and success. When mixed feeding is necessary the nature of the artificial substitute must be carefully thought out. In the case of infants under a month one will give a preference to peptonized milk or whey. The disadvantages of these as a whole diet do not apply when breast milk is also being used, and they supply a food very similar as regards digestibility to human milk. Less care in the preparation is required for condensed milk or dried milk, which will usually be well tolerated if given well diluted. After the age of one month cows' milk, modified as previously described, will be found perfectly efficient in most cases. Where special difficulties are met with in connexion with the digestion, the cows' milk must be given in greater dilution or citrate of soda may be added to the milk.