The quantity taken at a single meal is subject to very wide varia tions. It is dependent on the milk supply, the state of the nipple, the strength and food requirement of the infant, and the number and dura tion of the meals. As a rule, the largest meal is taken in the morning, after the long night interval.
Healthy infants nurse until they stop of their own accord. An infant properly placed at the breast takes its meal in five to ten min utes as early as the second half of the first week, if the milk is good. The majority of infants, however, take fifteen to twenty minutes for even a small meal. It is of no use to leave an infant at the breast much longer, because the quantity of milk taken in a unit of time becomes less and less the longer the duration of nursing. For instance, a somewhat older baby observed by Feer drank during the first 5 minutes 112 Gm. milk, during the second 3 minutes (4 Gin., and during the third 3 minutes 10 Gm. Very weak infants, who are easily fatigued by the work of suck ling and have to rest during the meal, may be left at the breast for 30 minutes. Hut the scales ought to be employed in order to find out whether the lengthening of the meals actually increases correspondingly the quantity of food received. Such infants, and infants too lazy to drink, may occasionally be induced to continue musing by slight motions. The amount of milk taken may be roughly estimated by observing the frequency of the act of swallowing.
Although it is not advisable to arouse an infant from its sleep in order to feed it yet it is very desirable to adhere to regular hours for feeding, and it is remarkable how much can be accomplished by educa tion. The infant should be trained to take its meals in the first week about every three hours in day-time, while at night an interval of from five to eight hours should be interposed. If the infant is very weak and drinks little at a time, the intervals in day-time may he shortened to two and a half hours, but they should never be decreased any further.
Primiparze have certain difficulties in putting the baby to the breast. for the first time, even when the nipple.s are well developed and the is not awkward. These difficulties are mostly caused by an improper position of the child (retroflexion of the head, occlusion of the nose), or by an insufficient introduction of the nipple into the mouth. But
the young mother soon acquires the necessary experience and skill. Should the nipple be poorly developed, it is more difficult to make cor rections. In light cases it is only necessary to draw out the nipple as much as possible with a breast-pump before the baby is put to the breast : or the baby receives, beside the nipple, a. part of the areola; or a. nipple shield may be employed. If the procedures are carried out skilfully we are likely to be successful more frequently than we are inclined to be lieve. In cases of inverted nipples, the possibilities of nursing at the breast are very small and the nipple shield will only rarely be of any help. The milk may be drawn with the breast-pump and the baby will receive the benefits of the mother's milk in this manner.
The normal baby nearly always becomes very skilful the second or third time it is put to the breast and very soon may show a certain indi viduality in nursing. One drinks more rapidly, the other more slowly; one prefers a more reclining, the other a more sitting position. Pfaund ler justly emphasizes the fact that a careful observation of such peculi arities may prove of considerable importance in the growth of the baby. The introduction of the nipple into the mouth of the eagerly "search ing" baby immediately calls forth motions of suckling. The lip and the tongue enclose the nipple hermetically, and while the mouth cavity is closed behind, the sinking of the lower jaw, the floor of the mouth, and the tongue creates a diminished pressure in the cavity of the mouth. Pfaundler has shown that this does not cause the milk to enter the mouth. Only the filling of the sinus lactei is accomplished and the nip ple is held firmly. The suction itself does not remove the milk from the breast at all, and the infant receives the milk through compression of the nipple in closing the jaws. If the secretion of the milk is abundant, the suckling is immediately followed by a motion of swallowing. But if only a little milk enters the, mouth by one act, the swallowing, occurs only after repeated suckling.