In the case of all healthy mothers, even when it is unlikely that the period of suckling will be long-continued, the full extent of this period should be utilised. Every day of suckling granted to the infant during the first few weeks of life is of immense service to it.
Maternal milk supplies an easily digested form of nourishment to the infant, and one which is specially designed to meet its needs until such time as an artificial diet can readily be made use of. The health of the mother during pregnancy and lactation is, consequently, of the greatest importance. During the first few days after birth a small amount of fluid, colostrum, is secreted by the maternal mammary glands. This fluid differs in composition from the later milk and serves as a preparation for its ingestion.
About the third day after birth the secretion of milk becomes established, and the process of suckling stimulates this secretion. So much is this the case that it is possible for a mother to suckle her infant for a much longer time than is good either for the health of her infant or herself.
Human milk is a fluid of varying composition, and for practical purposes the following figures suffice: -
2 per cent.
Mineral salts ....
The protein present is largely in the form of albumin, with caseinogen in half this quantity, this caseinogen being peculiar in that it yields no carbohydrate when split up by digestion,and contains no nuclein. It forms the curd when acted on by rennin.
Milk varies in quality during each ad of suckling; at its commencement the percentage of fat is low and of protein high, while towards the close the reverse is the case; and the frequency of suckling also affects the quality of the milk.
The diet of the mother and the condition of her general health naturally exert a most powerful influence on the composition of her milk. The nursing mother requires a liberal diet of plain food with abundance of milk; she should avoid alcohol, and as a rule all highly spiced or indigestible forms of food. It is possible for a mother in poor health to suckle and rear a healthy infant, yet such a condition is uncommon and the procedure usually inadvisable.
Transitory attacks of acute illness of minor degree have, as a rule, no marked effect upon the milk. If her condition demands it, there is no reason to hesitate in giving any drug to a nursing mother, as it is the long-continued administration of a drug which may injuriously affect the infant through the milk.
The return of menstruation is not uncommon during lactation, and, as a rule, this is an occurrence of no importance to either mother or child. It is not a sign of ill-health on the part of the mother, and though occasionally the child's digestion is disturbed at this period, yet partial or complete artificial feeding for the few days readily counteracts this, and weaning is never called for unless there are also definite signs of ill-health on the part of the mother or the child. Pregnancy may occur during lactation, though it is uncommon before the eighth month, and it is always advisable to commence weaning when this occurs.
Suckling is also contra-indicated when the mother is the subject of serious chronic, organic, or infective disease, of acute mammary affections, and, usually, of serious acute illness.
Wet-nursing is a custom little practised in this country. The social and other difficulties necessarily associated with the procedure are great; yet when these can be overcome, the advantage to the weakly or wasted infant of a diet of human milk is often very marked.
The capacity of the infant stomach is at birth about I fluid ounce; but as in early infancy the curd which is formed in the stomach by mother's milk is very soft and flocculent, and passes readily through the pylorus, a larger quantity than this can be taken at one feeding. At the age of six months the stomach capacity is about 6 ounces; but as, with advancing age, the secretory powers of the stomach have increased, and their reaction with the milk become somewhat more complicated as a provision for the development of the digestive powers, so the resulting curd becomes ever more solid, and passes less rapidly through the pylorus.
The infant demands that all its sustenance should be derived from its mother up till the close of the eighth month of life, while the value of maternal nursing is greatest in the early days and weeks.
It is important to determine periodically how an infant is thriving, and this is best done by ascertaining the weight of the child and keeping a record of it. When possible, it is well to weigh the infant weekly for the first six months, and every second week during the next six months. A record of continuous gain in weight does not necessarily mean that the infant is growing and developing satisfactorily, though for satisfactory growth and development increase of weight is essential. During the first week of life there is usually a loss of weight amounting to perhaps 6 ounces. Thereafter there is a steady gain in weight, interrupted at times it may be by slight functional disturbances. It is useful to remember that an average baby (7 1/2 lbs.) doubles its weight at six months (15 lbs.), and trebles it at twelve months (22 1/2 lbs.).
During the first two or three days of life the infant is put to the breast six-hourly as a rule, for a period of five to ten minutes at a time. It thereby obtains colostrum, and the process of suckling stimulates milk-secretion in the breasts. In addition small quantities of warm, boiled water should be given frequently.
The training of the infant should commence as soon as the maternal milk-secretion is established, and regularity in the occurrence of nursing periods and limitation of the time of nursing are, from the first, all-important.
During the first month the infant is given the breast at intervals of two hours during the day (eight nursing periods), and twice during the night Each nursing period is limited to fifteen minutes, and the infant should be wakened if necessary at the regular time.
During the second and third months the breast is given at intervals of two and a half hours during the day (seven nursing periods), and once at night. At this time the infant will sleep five or six hours at night without feeding. During the third, fourth, and fifth months the infant is given the breast at intervals of three hours during the day (six nursing periods), and once at night.
After the fifth month the breast is given at intervals of three hours during the day (six nursing periods), and it is unnecessary at night.
The plan of mixed feeding must be adopted when the maternal secretion of milk is insufficient, or when the state of her general health renders it inadvisable that she should bear the whole strain of nursing. In the early days of lactation a little artificial assistance such as this may serve to render full maternal suckling possible later. It is also not infrequently necessary, from social or other reasons, in cases where both mother and infant are healthy, to supplement mother's milk with artificial food. The mother may be able to suckle her child only during part of the day, or during the night and not during the day. Whatever the period of suckling be, the hours for feeding must be adhered to. The infant here begins with a milk-and-water mixture corresponding in strength to that for an infant four or six weeks younger, and this mixture is gradually strengthened till it is of suitable strength for the infant of that particular age (p. 242).
Weaning, when possible, should be a gradual process.
At the beginning of the ninth month one of the nursing periods in the morning is omitted and an artificial feed is substituted: after two or three days the substitution of another feed - in the afternoon - is made, and gradually the infant is entirely weaned from the maternal breast. It is always advisable during lactation to accustom the infant to the bottle - in case sudden weaning may at any time become necessary - by offering it once a day a bottle containing warm, boiled water.