NUTRITION AND METABOLISM OF THE BREAST-FED INFANT DURING THE FIRST WEEK OF LIFE The newborn infant, exhausted by the hardships undergone at its birth, the cleansing, bathing, etc., requires rest more than anything else, and it soon goes to sleep, waking up only rarely and for short times during the first twelve to twenty-four hours. During this time no food is required. Should it begin to or become very restless after the bath and rearrangement of its couch and clothing, it may he placed at the breast ten to twelve hours after birth. Whether the infant obtains any food at all, depends on its aptitude for suckling and on the contents of the breast. As a rule only very small quantities are obtained even with strong suckling and when the breasts contain a sufficient supply. The amounts of milk taken are determined by weighing the baby before and after feeding. On an average 10 to 20 Gm. milk are taken in one or two meals during the first twenty-four hours. In the second t wenty-four hours about 90 Gm. milk are taken in four to six meals. From this time on the following average values were obtained: Deviations from these average values in either direction are observed, corresponding to the differences in the milk supply, strength of the baby, etc. but while little harm is ever produced by taking an insufficient amount. of milk during this period, overfeeding may lead to digestive disturbances which may last through a long period of time, and are sometimes corrected only with difficulty.
It is undesirable to give the breast more than eight times during twenty-four hours. Every two hours is a custom still frequently in vogue, even if the secretion of milk is insufficient and the baby is weak. It would be necessary on a two hours' interval to interrupt the sleep too frequently. The best method is to put the baby to the breast six or seven times in twenty-four hours.
In the first days post partum, particularly with primipane, no milk (or rather colostrum) or very little, is available. Anxious mothers or nurses are very easily inclined to give additional feeding under these circumstances, even when the infant is perfectly quiet. When the baby I ecomes gradually more and more restless, and when hardly any milk is produced on the second or even the third day, in spite of frequently repented efforts at stickling, many physicians doubt the possibility of feeding at the breast and deem the transition to artificial feeding neces sary. Later investigations have proved that in many cases the lacta
tion is not established before the second half of the first week, and may in some instances occur even later. The lactation in such cases takes a perfectly normal course. The absolutely necessary condition is that it shall be excited by a rational stimulus, which is to be found only in putting the baby frequently to the breast, and in taking care that the breast is emptied as completely as possible. To leave off too soon trying to nurse means nothing less than to deprive the infant of the irreplace able mother's milk. The proposal of Czerny and Keller during the first three or four days not to offer any other nourishment to the infant but the breast, can hardly be accomplished in practice, particularly NVhell the infarct is restless, :Ls the authors themselves recognize. They Justly state that as a rule the newborn infant will not suffer any serious injury, even if it does not receive any food during the first I wo or three days, yet, it, does not appear necessary Or desirable not to give anything. While it may not be absolutely necessary to give any food, it will be rational to provide a certain quantity or water, because, if none is given, an excessive concentration of the urine may cause a lesion of the kid neys, and the contents of the largo intestine may become inspissated, with evil result. It seems advisable, therefore, to give small quantities of water from time to time from the second day mi. or, if the infants are very restless, even on the first day. Built I water or thin tea sweetened with a trace of saccharin is preferable. Feller justly advises against the use of sugar water. On the second and third days 13 to 30 c.c. (!, to 1 ounce) saccharin are given four to six times, and later corre spondingly inure, in which way the administration of artificial food can be delayed without any uneasiness until the fifth sixth day. Should the secretion of milk be delayed beyond this time in spite of good sucklino., as a rule artificial feedilo—must be started. The writer observed a case, where in spite of an entirely insufficient milk supply, a strong infant did not receive any additi(mal feeding with exception of water until the 14th day, when the lactation became established and continued for four months.