ABC of Breastfeeding

From the first moment the infant is applied to the breast, it must be nursed upon a certain plan. This is necessary to the well-doing of the child, and will contribute essentially to preserve the health of the parent, who will thus be rendered a good nurse, and her duty at the same time will become a pleasure.

This implies, however, a careful attention on the part of the mother to her own health; for that of her child is essentially dependent upon it. Healthy, nourishing, and digestible milk can be procured only from a healthy parent; and it is against common sense to expect that, if a mother impairs her health and digestion by improper diet, neglect of exercise, and impure air, she can, nevertheless, provide as wholesome and uncontaminated a fluid for her child, as if she were diligently attentive to these important points. Every instance of indisposition in the nurse is liable to affect the infant.

And this leads me to observe, that it is a common mistake to suppose that, because a woman is nursing, she ought therefore to live very fully, and to add an allowance of wine, porter, or other fermented liquor, to her usual diet. The only result of this plan is, to cause an unnatural degree of fulness in the system, which places the nurse on the brink of disease, and which of itself frequently puts a stop to the secretion of the milk, instead of increasing it. The right plan of proceeding is plain enough; only let attention be paid to the ordinary laws of health, and the mother, if she have a sound constitution, will make a better nurse than by any foolish deviation founded on ignorance and caprice.

The following case proves the correctness of this statement:

A young lady, confined with her first child, left the lying-in room at the expiration of the third week, a good nurse, and in perfect health. She had had some slight trouble with her nipples, but this was soon overcome.

The porter system was now commenced, and from a pint to a pint and a half of this beverage was taken in the four and twenty hours. This was resorted to, not because there was any deficiency in the supply of milk, for it was ample, and the infant thriving upon it; but because, having become a nurse, she was told that it was usual and necessary, and that without it her milk and strength would ere long fail.

After this plan had been followed for a few days, the mother became drowsy and disposed to sleep in the daytime; and headach, thirst, a hot skin, in fact, fever supervened; the milk diminished in quantity, and, for the first time, the stomach and bowels of the infant became disordered. The porter was ordered to be left off; remedial measures were prescribed; and all symptoms, both in parent and child, were after a while removed, and health restored.

Having been accustomed, prior to becoming a mother, to take a glass or two of wine, and occasionally a tumbler of table beer, she was advised to follow precisely her former dietetic plan, but with the addition of half a pint of barley-milk morning and night. Both parent and child continued in excellent health during the remaining period of suckling, and the latter did not taste artificial food until the ninth month, the parent's milk being all-sufficient for its wants.

No one can doubt that the porter was in this case the source of the mischief. The patient had gone into the lying-in-room in full health, had had a good time, and came out from her chamber (comparatively) as strong as she entered it. Her constitution had not been previously worn down by repeated child-bearing and nursing, she had an ample supply of milk, and was fully capable, therefore, of performing the duties which now devolved upon her, without resorting to any unusual stimulant or support. Her previous habits were totally at variance with the plan which was adopted; her system became too full, disease was produced, and the result experienced was nothing more than what might be expected.

The plan to be followed for the first six months. Until the breast- milk is fully established, which may not be until the second or third day subsequent to delivery (almost invariably so in a first confinement), the infant must be fed upon a little thin gruel, or upon one third water and two thirds milk, sweetened with loaf sugar.

After this time it must obtain its nourishment from the breast alone, and for a week or ten days the appetite of the infant must be the mother's guide, as to the frequency in offering the breast. The stomach at birth is feeble, and as yet unaccustomed to food; its wants, therefore, are easily satisfied, but they are frequently renewed. An interval, however, sufficient for digesting the little swallowed, is obtained before the appetite again revives, and a fresh supply is demanded.

At the expiration of a week or so it is essentially necessary, and with some children this may be done with safety from the first day of suckling, to nurse the infant at regular intervals of three or four hours, day and night. This allows sufficient time for each meal to be digested, and tends to keep the bowels of the child in order. Such regularity, moreover, will do much to obviate fretfulness, and that constant cry, which seems as if it could be allayed only by constantly putting the child to the breast. A young mother very frequently runs into a serious error in this particular, considering every expression of uneasiness as an indication of appetite, and whenever the infant cries offering it the breast, although ten minutes may not have elapsed since its last meal. This is an injurious and even dangerous practice, for, by overloading the stomach, the food remains undigested, the child's bowels are always out of order, it soon becomes restless and feverish, and is, perhaps, eventually lost; when, by simply attending to the above rules of nursing, the infant might have become healthy and vigorous.

For the same reason, the infant that sleeps with its parent must not be allowed to have the nipple remaining in its mouth all night. If nursed as suggested, it will be found to awaken, as the hour for its meal approaches, with great regularity. In reference to night-nursing, I would suggest suckling the babe as late as ten o'clock p. m., and not putting it to the breast again until five o'clock the next morning. Many mothers have adopted this hint, with great advantage to their own health, and without the slightest detriment to that of the child. With the latter it soon becomes a habit; to induce it, however, it must be taught early.

The foregoing plan, and without variation, must be pursued to the sixth month.

After the sixth month to the time of weaning, if the parent has a large supply of good and nourishing milk, and her child is healthy and evidently flourishing upon it, no change in its diet ought to be made. If otherwise, however, (and this will but too frequently be the case, even before the sixth month) the child may be fed twice in the course of the day, and that kind of food chosen which, after a little trial, is found to agree best.

Sleep During Infancy and Childhood

During infancy.
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For three or four weeks after birth the infant sleeps more or less, day and night, only waking to satisfy the demands of hunger; at the expiration of this time, however, each interval of wakefulness grows longer, so that it sleeps less frequently, but for longer periods at a time.

This disposition to repose in the early weeks of the infant's life must not be interfered with; but this period having expired, great care is necessary to induce regularity in its hours of sleep, otherwise too much will be taken in the day-time, and restless and disturbed nights will follow. The child should be brought into the habit of sleeping in the middle of the day, before its dinner, and for about two hours, more or less. If put to rest at a later period of the day, it will invariably cause a bad night.

At first the infant should sleep with its parent. The low temperature of its body, and its small power of generating heat, render this necessary. If it should happen, however, that the child has disturbed and restless nights, it must immediately be removed to the bed and care of another female, to be brought to its mother at an early hour in the morning, for the purpose of being nursed. This is necessary for the preservation of the mother's health, which through sleepless nights would of course be soon deranged, and the infant would also suffer from the influence which such deranged health would have upon the milk.

When a month or six weeks has elapsed, the child, if healthy, may sleep alone in a cradle or cot, care being taken that it has a sufficiency of clothing, that the room in which it is placed is sufficiently warm, viz. 60 degrees, and the position of the cot itself is not such as to be exposed to currents of cold air. It is essentially necessary to attend to these points, since the faculty of producing heat, and consequently the power of maintaining the temperature, is less during sleep than at any other time, and therefore exposure to cold is especially injurious. It is but too frequently the case that inflammation of some internal organ will occur under such circumstances, without the true source of the disease ever being suspected. Here, however, a frequent error must be guarded against, that of covering up the infant in its cot with too much clothing throwing over its face the muslin handkerchief and, last of all, drawing the drapery of the bed closely together. The object is to keep the infant sufficiently warm with pure air; it therefore ought to have free access to its mouth, and the atmosphere of the whole room should be kept sufficiently warm to allow the child to breathe it freely: in winter, therefore, there must always be a fire in the nursery.

The child up to two years old, at least, should sleep upon a feather bed, for the reasons referred to above. The pillow, however, after the sixth month, should be made of horsehair; for at this time teething commences, and it is highly important that the head should be kept cool.

During childhood.
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Up to the third or fourth year the child should be permitted to sleep for an hour or so before its dinner. After this time it may gradually be discontinued; but it must be recollected, that during the whole period of childhood more sleep is required than in adult age. The child, therefore, should be put to rest every evening between seven and eight; and if it be in health it will sleep soundly until the following morning. No definite rule, however, can be laid down in reference to the number of hours of sleep to be allowed; for one will require more or less than another.Regularity as to the time of going to rest is the chief point to attend to; permit nothing to interfere with it, and then only let the child sleep without disturbance, until it awakes of its own accord on the following morning, and it will have had sufficient rest.

The amount of sleep necessary to preserve health varies according to the state of the body, and the habits of the individual. Infants pass much the greater portion of their time in sleep. Children sleep twelve or fourteen hours. The schoolboy generally ten. In youth, a third part of the twenty-four hours is spent in sleep. Whilst, in advanced age, many do not spend more than four, five, or six hours in sleep.

It is a cruel thing for a mother to sacrifice her child's health that she may indulge her own vanity, and yet how often is this done in reference to sleep. An evening party is to assemble, and the little child is kept up for hours beyond its stated time for retiring to rest, that it may be exhibited, fondled, and admired. Its usual portion of sleep is thus abridged, and, from the previous excitement, what little he does obtain, is broken and unrefreshing, and he rises on the morrow wearied and exhausted.

Once awake, it should not be permitted to lie longer in bed, but should be encouraged to arise immediately. This is the way to bring about the habit of early rising, which prevents many serious evils to which parents are not sufficiently alive, promotes both mental and corporeal health, and of all habits is said to be the most conducive to longevity.

A child should never be suddenly aroused from sleep; it excites the brain, quickens the action of the heart, and, if often repeated, serious consequences would result. The change of sleeping to waking should always be gradual.

The bed on which the child now sleeps should be a mattress: at this age a feather bed is always injurious to children; for the body, sinking deep into the bed, is completely buried in feathers, and the unnatural degree of warmth thus produced relaxes and weakens the system, particularly the skin, and renders the child unusually susceptible to the impressions of cold. Then, instead of the bed being made up in the morning as soon as vacated, and while still saturated with the nocturnal exhalations from the body, the bed-clothes should be thrown over the backs of chairs, the mattress shaken well up, and the window thrown open for several hours, so that the apartment shall be thoroughly ventilated. It is also indispensably requisite not to allow the child to sleep with persons in bad health, or who are far advanced in life; if possible, it should sleep alone.

Mother's Role in Combating Diseases of Children

The especial province of the mother is the prevention of disease, not its cure. When disease attacks the child, the mother has then a part to perform, which it is especially important during the epochs of infancy and childhood should be done well. I refer to those duties which constitute the maternal part of the management of disease.

Medical treatment, for its successful issue, is greatly dependent upon a careful, pains-taking, and judicious maternal superintendence. No medical treatment can avail at any time, if directions be only partially carried out, or be negligently attended to; and will most assuredly fail altogether, if counteracted by the erroneous prejudices of ignorant attendants. But to the affections of infancy and childhood, this remark applies with great force; since, at this period, disease is generally so sudden in its assaults, and rapid in its progress, that unless the measures prescribed are rigidly and promptly administered, their exhibition is soon rendered altogether fruitless.

The amount of suffering, too, may be greatly lessened by the thoughtful and discerning attentions of the mother. The wants and necessities of the young child must be anticipated; the fretfulness produced by disease, soothed by kind and affectionate persuasion; and the possibility of the sick and sensitive child being exposed to harsh and ungentle conduct, carefully provided against.

Again, not only is a firm and strict compliance with medical directions in the administration of remedies, of regimen, and general measures, necessary, but an unbiased, faithful, and full report of symptoms to the physician, when he visits his little patient, is of the first importance. An ignorant servant or nurse, unless great caution be exercised by the medical attendant, may, by an unintentional but erroneous report of symptoms, produce a very wrong impression upon his mind, as to the actual state of the disease. His judgment may, as a consequence, be biased in a wrong direction, and the result prove seriously injurious to the welldoing of the patient. The medical man cannot sit hour after hour watching symptoms; hence the great importance of their being faithfully reported. This can alone be done by the mother, or some person equally competent.

There are other weighty considerations which might be adduced here, proving how much depends upon efficient maternal management in the time of sickness; but they will be severally dwelt upon, when the diseases with which they are more particularly connected are spoken of.