W. Grant Hague

Overfeeding Baby—Intervals of Feeding—How Long Should a Baby Stay at the Breast—Vomiting Between Feedings—Regularity of Feeding—Why is Regularity of Feeding Important—"A Baby Never Vomits"—What is the Significance of So-called Vomiting After Feedings—Mothers Milk That is Unfit for Baby—Fresh Air for Baby—Air Baths for Baby.

Overfeeding Baby.—Every nursing mother should have printed and hung up, so she may read it every time she nurses her child, the following motto: "DON'T OVERFEED BABY." Few, if any, babies die of willful starvation: many die as a result of overfeeding. Mistaken kindness and lack of judgment are responsible for one-half of all the troubles of infancy. Babies require much less than is constantly given them. The stomach of a baby at birth will not hold more than one ounce, which is two tablespoonfuls; and at two months it will not hold more than three tablespoonfuls; and at six months, six or seven tablespoonfuls. Read these quantities once again carefully and try to realize the significance of the smallness of them. A baby is just like a little pig; it will go on feeding as long as it is allowed. The baby does not reason; it has no judgment; it depends upon its mother's judgment. If the mother is false to the trust the baby overloads its stomach. A swollen, distended, overloaded stomach causes indigestion. A baby with indigestion is a colicky, fretty, sick baby. Overfeeding, therefore, is the beginning of lots of trouble to the mother, and needless pain and suffering and sickness to the baby. A simple matter, but it is one of the most difficult lessons nursing mothers have to learn.

Overfeeding is most apt to occur at night. Many mothers put the child to the nipple for its regular feeding and fall asleep; the child keeps on nursing at intervals until twice the proper quantity is taken; or she gives it the nipple or the bottle if it cries, without regard to whether it is the proper feeding time or not. The habit of overfeeding is very common in infants who are suffering from indigestion. They cry frequently, and are irritable most of the time; nothing seems to satisfy them but the nipple. Taking the warm milk into the stomach seems to allay the distress for the time being, so mothers get into the habit of quieting them in this way. The cry of the drinking man, whom we try to sober up, is: "Just one more drink and I'll quit." You give the drink and in a little while the demand is repeated. If the mother understood the seriousness of this practice of giving the child the nipple or bottle at irregular times, she would not do it.

Overfeeding an infant may lay the foundation for a lifelong ailment. The excess of food remains in the stomach or bowels undigested. If you remember that this mass of undigested matter is confined in a small space which is both warm and damp, it will be easily understood that putrefaction is the inevitable outcome. As a result of this putrefaction there are produced certain ptomaines and leucomaines. These poisons are carried through the body, causing "auto-intoxication" which upsets and irritates the child's nervous system and may cause very serious consequences, as it frequently produces sudden death from apoplexy and "heart failure" in the adult. These children are always restless, fretful, continually uncomfortable, sleepless and colicky. They lose weight, the stomach becomes distended and a gastritis or inflammation of the stomach results.

Frequently a mother with such a fretful baby, seeing her child getting thinner and thinner, will think that it is not getting enough to eat, and will proceed to add to the trouble by giving the child more to eat.

Mothers must therefore learn not to overfeed their infants; not to imagine that a failure to gain weight means the need of more food (if the quality of the food being given is wrong, will increasing the quantity of bad food do any good?); not to feed irregularly, no matter how insistent the child may be.

Intervals of Feeding.—The physician will give instructions regarding the feeding of the newly born baby for the first few days. After the first few days and up to the beginning of the third month, it should be fed every two hours from 7 a. m. until 9 p. m., and twice during the night between 9 p. m. and 7 a. m., when the regular two-hours' interval again begins for the following day. The two night feedings should be about 1 and 4:30 a. m.

After the third month, and up to the sixth month, feed every three hours and once during the night. From the sixth month until weaned, every three and one-half or four hours, and not at all during the night.

While it has been pointed out that regularity of feeding is absolutely essential, the above schedule is not to be regarded as an absolute guide. It is a general guide,—approximately it will be found correct in a large majority of cases. Each baby is a rule unto itself. The quantity of the mother's milk will dictate the interval after the first month and for each month as the baby grows. If a mother with no milk to spare, is nursing a big, strong, husky baby, the three-hour interval during the day may have to be shortened to two and one-half hours. As a rule, however, these exceptions are better regulated by attention to the time the baby is given at each nursing to fill its stomach.

How Long Should a Baby Stay at the Breast?—Babies differ as to their method of feeding; some of them seem to like to nurse a moment or two and then look around; others seem to regard nursing as a serious business, and resent any effort to take the nipple away until they have finished. A baby should be taught to nurse methodically; it should not be allowed to play the nipple. Let it fill its stomach and put it down as quickly as possible. A mother will very soon know just how long it takes the baby to fill its little stomach, and when she finds this out she should time it by the clock. When the supply of milk is sufficient, and the child is strong, and nurses freely, eight to twelve minutes are sufficient. After it is taken away from the breast it must be left quiet till the next feeding.

Other babies, according to the ability they evince to nurse, even when the milk runs freely, require a longer time,—from twelve to fifteen minutes. The rule, however, is never to allow them to nurse so long that when they are taken away the milk runs out of the mouth. If this occurs, cut down the length of time they are at the breast, and always time the length of feeding by the clock,—don't guess at it.

Children Who "Vomit" Between Feedings.—When a child habitually brings up food between feedings it is usually a symptom of gastric indigestion. In these cases it is advisable to add lime-water to each feeding, and to remove some of the fat in each feeding. If improvement does not follow remove more of the fat by removing some of the cream from the top of the bottle before shaking it.

Remove from the bottle four ounces of cream and shake before preparing the food from what is left. If the child improves after a few days remove only three ounces, then in a few days remove two ounces and later one ounce. After a time, sufficiently long to permit the stomach to become accustomed to the graded amounts of fat, the former diet of whole milk can be again resumed.

Never decrease the interval of feeding of a baby who is bringing up parts of its meal between feedings; it is frequently advisable to increase the interval. If a child is colicky and is bringing up lots of gas in addition to some food, one-half grain of benzoate of soda may be added to each ounce of food given and continued for a number of weeks if necessary. When the gas is located in the intestines and is not brought up, it must be made to pass downward. Attention to the bowels is of great importance in these cases and it may be necessary to peptonize the milk for some time. A reduction of the sugar and starch in the feeding frequently cures this condition. (See "Colic.")

There are children who continue to have symptoms of indigestion and who do not thrive despite various changes in the quantity and quality of the feedings. It may be necessary to obtain a wet nurse for them, as it is with "the delicate child." If a wet nurse cannot be obtained, or if the age will permit, a substitute may be tried. Borden's Eagle brand of condensed milk, canned, is probably the best substitute under these circumstances. Condensed milk should never be used as a continuous food; as a substitute, however, for a few weeks it is often invaluable. With an infant of three or four months it should be used at the beginning in the proportion of one ounce of the milk to sixteen ounces of plain boiled water or barley water. The proper quantity, whatever the child is taking (four or six ounces according to the age) at the time, can be taken from the sixteen ounces and fed to the child. As the symptoms improve the milk should be diluted less and less, 1 to 14, 1 to 10, and so on until the proper strength is reached. After the child has been on the condensed milk for a month it should be changed back to cow's milk, using of course a diluted formula until the child becomes accustomed to the change. Condensed milk, if used as a permanent food, will fatten babies, but their vitality is very deficient, the muscles flabby, and the resistance to disease exceedingly poor. They are apt to develop rickets and sometimes scurvy.

Regularity of Feeding.—One of the very first, and one of the most important factors in contributing to the good health and the comfort of a baby is absolute regularity in feeding. A regular interval of feeding is particularly essential during the first month of a baby's life.

Despite the explicit way in which young mothers are instructed in this respect, it is one of the disappointing incidents of the practice of medicine to observe how many of these mothers fail to heed the advice. We have personally tried to find an explanation for this astonishing carelessness, and have come to the conclusion that it is not due to intentional forgetfulness, but rather to an inexplicable failure to appreciate that the physician means exactly what he says.

If, for example, specific instructions are given to feed, or nurse, the child every two hours (and by "specific instructions" it is meant, that the physician takes time to explain in detail the instructions he gives—that the instructions are not incidental to the call, but part of the call;—that the advice is given not as a choice of what is desirable, but as an absolute rule to follow; and carefully explains why it is imperative to do as he says; and is satisfied the mother understands what he means) it would seem that there could be no possible reason why the directions should not be faithfully carried out. Yet such is not the case in many instances, and the excuses given by mothers for failure are so trivial and annoying that they show a failure to appreciate that they are dealing with a serious problem—a problem affecting human life. They fail to understand that fatal consequences may follow their negligence. They treat the baby problem exactly as they would a household incident, and as they do not consider it important whether the breakfast dishes are washed at 9 a. m. or at twelve noon, neither do they consider it important whether the baby is fed at 9 a. m. or an hour later. When mothers learn that the attention they must give their babies is essentially different from the attention they give ordinary household duties, the problem of raising children with success and comfort will be greatly simplified.

If the instructions are to feed the baby at certain intervals, do so at all hazards. To offer the foolish excuse that the baby was asleep when feeding time came, is no excuse at all; as a matter of fact the baby should be asleep at each feeding time, if it is healthy. Wake it and feed it, for, as will be shown later, it is the constant regularity that counts. It will be more difficult to institute regular feeding intervals during the first month, because a healthy baby is very difficult to wake up, even to be fed, during the first few weeks of life. It is absolutely essential, however, that it should be wakened: otherwise the tendency to overfill the stomach at the next feeding will lead to indigestion and colic.

Why is Regularity of Feeding Important?—Because a baby's stomach holds a very small quantity, and experience has taught us that a baby will thrive better on small quantities given frequently, rather than large quantities at longer intervals. The smaller the baby, the smaller the quantity to begin with. Some babies weigh from five to seven pounds at birth, while others weigh from nine to twelve pounds. It would be unreasonable to expect a very small baby to be able to hold and digest as much as a very large baby. Considerable common sense and the exercise of some judgment is therefore necessary on the part of the uninstructed mother, as to just the right quantity to give. Fortunately, a little experience will enable the observant mother quickly to solve this important problem. Nature promptly furnishes the symptoms which will correctly guide her. Before considering the significance of these symptoms let us appreciate certain facts common to all babies, and we will more easily interpret the meaning of the special symptoms the baby will furnish.

First of all the baby never vomits. The ejection of food, therefore, is dependent upon a condition, not a disease. If milk runs out of its mouth immediately, or within a few moments, after a feeding, the explanation is that it was fed too much; it does not vomit, the stomach simply overflows. It is exactly like trying to put more milk into a cup after it is full,—it will not hold more, it overflows.

The significance of this symptom, therefore, is that the quantity of the feeding is wrong (it is not the baby's stomach that is at fault,—it is the mother's judgment). Reduce the quantity of each feeding and you will quickly cure it. If the milk does not overflow soon after a feeding, the baby will appear satisfied and will go to sleep, and will sleep until it is time for the next feeding. It may not do this, however. In half an hour, or a little longer, after the feeding, it wakes, it begins to fret and cry, and very soon it suddenly belches gas and ejects a mouthful of milk, after which it will rest quietly for a few moments, when it will begin fretting all over again. It may keep up this performance for an hour, or until the next feeding, and if so it is exhausted and unfit to carry on the digestive process. It is in these cases where most mothers make serious mistakes. This is the beginning of real trouble, and the family physician is the only one qualified to give advice under such circumstances. Remember the warning given regarding heeding the advice of every busybody just at this time. Your baby's health is at stake; maybe its life depends upon what you choose to do.

What is the Significance of "Vomiting" After Feedings in Babies?—Let us examine the difference between the milk which overflowed immediately after the feeding and the milk which the baby ejects one-half hour or so later, and which is now being considered.

The first milk looks like ordinary milk (breast milk), or if the baby is being fed from the bottle, it looks just like the mixture in the bottle. It not only looks like what it took, but it smells just like it. Now examine the other; we find it looks like curdled milk, it is lumpy, and we immediately can tell that it is sour, because it smells sour and looks sour.

The explanation of the first overflow (immediately after the feeding) was the too great quantity; the explanation of the second overflow (one-half hour or so after the feeding), is the wrong quality of milk. The quantity was right because none overflowed right after the feeding, but the quality was wrong. Again, it is not the baby's stomach that is at fault,—it is the quality of the milk.

How do we know this? Because of what takes place in the baby's stomach during the one-half hour between the feeding and the time of the overflow of the sour milk. The quantity being right, why should the baby have any trouble if the quality is correct? It should not. Therefore by changing the quality (not the quantity as in the former case) we cure the trouble, thus proving the quality of the milk to be at fault.

What took place in the baby's stomach in the intervening half hour? The quality being wrong, the little stomach could not digest the mixture quick enough. Fermentation set in, gas was evolved, and as the stomach was full before the gas was manufactured (and as more and more gas is manufactured when food ferments), the stomach overflowed and out of the baby's mouth comes gas, and sour, fermenting, curdled milk. This process goes on until fermentation stops, or until the little stomach has just enough left to fill it and no more. But think what this is,—a sour mass of rotting, indigestible, curdled milk,—and that is what this baby is expected to live and thrive on.

Some babies seem to have trouble from the very first day of life. Either they will not retain the food, or the food fails to agree with them. If the baby is put upon artificial food at once, these troubles are, of course, not unexpected (because the right artificial food may not be first chosen for the particular baby), but it is not always the artificially fed baby that gives us trouble, and it is sometimes difficult to find the cause for such trouble in a baby who has had nothing but its mother's milk since it was born.

The cause of stomach trouble in a baby a few days old, fed exclusively on mother's milk, is invariably to be found in the quality of the milk.

The quality of the mother's milk may be affected in a number of ways which will render it unfit for the baby. For example, if the mother for any reason becomes sick, and has a high fever shortly after confinement, it will affect her milk and render it unfit temporarily.

If the mother worries or becomes highly nervous during the first few days of her baby's life, she will so affect her milk as to render it unfit for baby. If a baby is fed for a number of days after its birth by its mother, and it should prove afterward that she has not enough milk to continue feeding it, and has finally to put it on artificial food, the baby will most likely have acquired slight stomach ailments that may be troublesome for some time, because in this case both the quality and the quantity were no doubt wrong. Constipation in the mother will also cause trouble. The child will develop colic and extreme irritability until the mother's condition is relieved.

Each of these conditions affecting the milk of the nursing mother usually demands a change of food for the baby, and the substitution of the proper artificial food will invariably immediately correct the trouble. In some cases, however, the quality of the mother's milk is not dependent upon a temporary temperamental condition, but is caused by errors in diet, or conduct, or both. The milk of a physically tired, worn-out mother, is not good, no matter whether the exhaustion is caused by actual physical labor or by the exactions of a strenuous social programme. The milk of a mother who persists in eating irregularly, or who willfully caters to an appetite which craves the rich, highly seasoned articles of diet, or who attempts to satisfy a legitimate hunger by drinking large quantities of stale tea or coffee and eating bread, is unfit for her baby.

These cases are amenable to the proper treatment, which of course means, that the mother must change her conduct if at fault, and live strictly upon the diet prescribed elsewhere for nursing mothers.

If these troubles occur in babies who have been fed exclusively upon artificial food, an entire change of food is frequently necessary.

FRESH AIR FOR BABY

Baby's first journey out of doors depends upon so many contingencies that no specific age can be given when it would be perfectly safe to take it.

First, the weather and season of the year should be considered. The baby should not be taken out at all when it is wet, or foggy, or very humid; nor when it is extremely cold.

Second, the vigor or vitality of the individual child must be considered. Some children can safely be taken out if the weather is propitious when two weeks old, others cannot be taken out without risk until they are two months old, regardless of the weather conditions. If a child is robust at birth, and nurses well, and increases in weight from the beginning, he can be taken out when he is two weeks old while the sun shines during the middle of the day. If a child is small and puny when born, and begins to have nursing troubles from the beginning, does not increase in weight, is fretting, and crying, and sleeps spasmodically, it would be unsafe to take it out before the sixth week unless it is at a season of the year which would justify exposure to the sunshine.

The question of suitable clothing will be important, and will decide the advisability as to when the baby should go out. Every baby should be dressed in wool weather is not too distinctly bad. Remember always to [Transcriber's note: words missing in text] from neck to ankles. Its head should be warmly clad. Dressed thus and well wrapped in blankets, a healthy child is ready for an out-door trip at any time, if the [Transcriber's note: words missing in text] have plenty of blankets below the child as well as above it, if it is in a baby carriage. In very cold weather the child should be buried in blankets, and a hot water bottle can be wrapped in near his feet. Great care must be taken that the water in the bottle is not too hot, and that it does not actually touch the skin. No matter how many or how few blankets are used, the face should be exposed directly to the fresh air. When the air is very gusty, or high, a light veil can be laid over the face, but never at any other time.

Air Baths for Babies.—Babies necessarily require plenty of exercise and plenty of fresh air, as has been pointed out. It is a splendid custom to allow the baby to lie naked after his bath for half an hour. If the room is comfortably warm, select a spot that is free from draughts, and lay the baby on a pillow or two and let him kick and coo. In the sun by the window, his head and especially the eyes shaded from the direct rays of the sun, is an excellent place in the summer time. The influence of the direct sun rays on the little naked body is conducive to good sturdy health, good nerves, and sound sleep.