The Nursing Mother
( Originally Published Early 1900's )
When the child is nursing the food is clean and practically sterile ; but even here care of the mother's person is of exceeding importance. The mother at this point is the preparatory laboratory for her child's food. She must keep herself in good condition; diet carefully, choosing foods that will keep her milk rich and abundant; exercise that will keep her own body functioning healthily and regularly; outdoor walks and airing that she may not fall into that worst of all plagues of motherhood, nervousness; sleep, that she may be fresh and resilient; avoiding undue excitement, anger, passion, and anxieties, because all these immediately react upon the food supply of the child and which may at any moment upset the digestion of the child. If she cares for herself in this manner, her food will be clean food in the sense that it comes to the child as it should come from a contented, happy, peaceful mother. She should keep her own diet simple, avoiding only sour fruits, pastry and salads. She should take plenty of milk or cocoa, especially at bedtime, and if the need exists, additionally at times. But plenty of fluids, nothing heavy that can clog the bowels and-cause disturbance to her. With these precautions she delivers the food to her child "clean." For it must be remembered here that she may dilute or corrupt the nature of her milk through her own habits, just as surely as in a later stage bottle-milk or other food may be tainted by careless handling from other sources.
The gain in weight is the test as to whether the nursing is successful and satisfactory. If the supply is not sufficient, the failure to gain will show it. Also the child will make manifestations which show that it is not gaining what it wants and needs. Where the lack is marked and careful effort fails to increase it, it should promptly be supplemented by bottle feeding, and there is no reason why both methods should not be employed. But it is necessary to carefully distinguish between scanty supply and milk that disagrees with the child, the latter being indicated by the nature of the stools of the child and sometimes by vomiting and sleeplessness and other symptoms of trouble in the intestines. There is usually no trouble in distinguishing the two.. For the ordinary casual disturbances of the stomach, a little lime water or barley water, allowing chance for recovery, will take care of it. It may be that the mother is eating too heavily. If an ordinarily healthy child refuses to nurse, something is wrong. It is best to call a physician. But in general, a healthy mother means a healthy child, and regularity in diet, exercise, air, and feeding, will keep a child healthy and make its progress regular and normal.
Nor should it be forgotten that a child often craves water as we do ourselves, but see that it is clean, sterilized—boiled is best—and given slowly. This will usually settle the question of gas and slight colic. Sometimes it may be necessary for the mother to take regular periods of rest, always seeing to it that this does not become heaviness and at the expense of proper exercise.
MILK AND OTHER FOODS
For the first year the food of the child is milk, and when the mother is not nursing her baby the matter at once becomes the subject of very careful preparation and direction. The milk problem throughout the country has in recent years grown more and more acute and hence it is necessary to have clear ideas about it. If a child is bottle-fed the care and cleanliness of the bottle, the preparation of the milk, the choice of the milk, and its care prior to use, are of great importance. Pasteurized milk should generally be used, and with a little care the pasteurizing apparatus can be kept in good condition and is easily obtained. A graduated bottle is best and one holding eight ounces is the best. There should be enough bottles for an entire day's feeding. The care of the bottles is a first consideration. After use they should be carefully rinsed and should be allowed to stand filled with water, then washed thoroughly with soap and a bottle brush and then placed for fifteen to twenty minutes in boiling water. Previous to use the milk should be kept in the 'ice chest and then warmed gradually and finally heated in water at a temperature of about 100 degrees.
FIRST YEAR FEEDING
The subject of feeding the young baby is not a matter of conjecture. When it is possible the baby should be nursed and the immense advantage which a breast fed baby has over others cannot well be exaggerated. Such a baby is immune from bowel difficulties which are almost sure to come to other babies, and is likely to be more regular in other respects.
The following is a good schedule for feeding the average infant during the first year :
The baby should not be urged to take more than it naturally desires. After the fifth month the period should be lengthened and the night feeding given up. The amount will increase and should follow the baby's inclination, always, however, guarding against over-feeding.
In using the various forms of cow's milk there are the questions of sterilizing to be faced and the process to be used is generally indicated by the forms used. As to pasteurizing, that is much better done at home than out of the home, because of the greater certainty of the process, which is comparatively simple and easily followed. Condensed and evaporated milks may be employed also, but when they are there must be supplied the elements which have been removed by the evaporation or the condensing. For example, evaporated milk usually requires the addition of sugar, about one to twenty ounces of food prepared. Milk sugar or maltose or cane sugar, better a mixture of all three, may be employed.
This indicates the schedule for the first year, and while it does not cover every case, it indicates very clearly the general course of feeding and the use of milk ; the physician or nurse can readily give the ordinary formulas which can be kept at hand and are easily followed.
By the time a child is a year old, the change in the diet begins to take on form, and at first there is the addition of an ounce or two of orange juice during the day and one ounce of beef juice. The meals are five in number and the last one, if at about ten o'clock at night, insures a long night's sleep. The milk is increased and the milk sugar is gradually omitted and broth may be added to one of the feedings, though this is to come gradually, and the child should begin to take his food from a cup. Also a spoon may be now employed to advantage for the cereal which the child begins to take and fruit juices are added. All such juices should be carefully strained and not be given in too large, though in sufficient, quantities, perhaps two or three tablespoonfuls at a time.
DIET DURING SECOND YEAR !
At 6:00 to 7:00—Milk, 8 ounces (1 cup).
At 9:00—Orange juice, 1 to 2 tablespoonfuls.
At 10:00—1. Cereal, 1 to 2 tablespoonfuls; oatmeal, Wheatena, Farina, Cream of Wheat (cooked 3 hours in double boiler). 2. Milk, 6 ounces (3/4 cup). 3.. Bread and butter, 1 small slice; whole wheat or white bread, stale or toasted; zwieback or graham crackers.
At 2:00-1. Soup, cream of vegetable, or broth (beef, mutton, chicken) ; or meat, scraped or chopped round steak, 1 table-spoonful (cooked dry in pan without grease or butter) ; or egg, soft boiled or poached. 2. Potato, mashed or boiled, 1 table-spoonful. 3. Green vegetable, 1 tablespoonful ; spinach, peas, carrots, stewed celery, Lima beans or string beans (all well cooked and strained or mashed). 4. Bread and butter, 1 small slice (from list given above). 5. Dessert, 1 to 2 tablespoonfuls; junket, cornstarch, or cooked fruit (apple sauce, stewed or baked apples, stewed prunes or stewed dried peaches).
At 6:00—1. Milk, 8 ounces. 2. Bread and butter, 1 small slice (from list given above). 3. Cereal, 1 tablespoonful (after 18 months). 4. Cooked fruit, 1 tablespoonful.
At 10:00—Milk, 8 ounces (until child is 18 months old). Water (boiled) may be given between meals.
Give only what is on this list.
From this point onward, using this schedule as a base, the diet expands slowly, adding fruits, always carefully chosen, baked apple, prunes and the like; but care should be taken not to use" sugar with them that the tonic effect of the fruit itself is not submerged. By this time more water is used and often a part of a baked potato may be given, and if meat is given it should always be rare, very finely divided and scraped, if possible. As stated in a previous section, the water given should be boiled and then cooled and should not be allowed to stand where the ordinary air of the room can reach it.
The most loving care needs proper direction, and if exercised without knowledge may often do harm. In this section some of the important things in which care should be exercised at this critical period of the child's existence in connection with its physical welfare are presented for study, and the study of these will lead the mother into many other realms of knowledge which will be of definite value to her in the rearing of her children.
The medical examination of children in our public schools is offensive to some parents, but we know how necessary and beneficial it is. The need for it, however, would be more than half done away with if all mothers were educated in the physical care of their children as she will be who uses this course.. Furthermore, the school medical inspection may sometimes be too late to cure the evil which ignorance may often allow to develop at home.