WEANING The appearance of the first incisors, generally at about the seventh month, indicates that the time has arrived when the infant may pass gradually from the exclusively fluid diet to food somewhat more solid. Occasionally the teeth furnish the immediate cause for weaning. if the infant bites the nipples while suckling and makes them sore. If the production of milk remains sufficient some mothers continue to nurse their babies up to one year or even longer. Observation has demon strated that such infants do not thrive particularly well, but look pale and puffed up. This may be perhaps due to the poverty of the mother's milk in iron, and such a prolonged nursing is not of benefit to the mother. An infant should therefore not he exclusively breast-fed longer than nine or at the most ten months. Very frequently, however, the nursing has to be interrupted prematurely for sonic reason. as premature cessa tion of the secretion. disease of mother or child, advanced pregnancy, or external circumstances. The earlier this happens the more dangerous it may he for the baby. If possible. the transition should be accomplished only gradually and at first the bottle should be given alternately with the breast. In giving artificial nourishment, which must be regulated accord ing to the age, weight, and state of health of the infant. it must be remembered, that the infants obtain their food without effort and do not become fatigued, and that they are thus readily exposed to the dangers of overfeeding. Care must therefore be exercised in the beginning, that the food is not too abundant in quantity and quality. As soon as the infant has adapted itself to the new food a possible temporary standstill of weight can easily be made good.
If possible, the infant should not be weaned during the hot season or when the dentition is very active. The weaning must be done very
carefully and slowly. It is advantageous in the course of three weeks to replace one breast-feeding after the other by the bottle, giving the bottles between breast-feedings as far as possible. It is then possible to return to the breast if the artificial food does not agree with the baby. In most eases the weaning succeeds in this way without much difficulty. But babies always respond by severe intestinal disturbances to the inges tion of artificial food. Here much patience and many trials are required to reach the goal. In cases which have to be weaned at the proper time, diluted cow's milk is generally given at first (best beginning with two parts milk and one part water), increasing to greater concentration after a few days. until soon whole milk is given. According to the infant's taste and the state of digestion, something may be added to the milk; in most eases cane sugar or milk-sugar, or (a mixture of maltose and dextrin, introduced by Soxhlet) will suffice. In difficult cases, suitable higher dilutions are given, in very small amounts, and the increase is very gradual. Some infants refuse to drink from the bottle, and the author observed a case where the milk could not be given except with a spoon.
Infants weaned at the right time should soon receive additional food beside cows milk. Thin beef broths with rice, barley, or tapioca are particularly to be recommended, and gradually yolk of egg is added. Later the fare may be enriched by cocoa, zwieback, gruels, prepared from the known flours for children, with milk or bouillon, and toward the end of the first year tender vegetables, finely chopped meat, and stewed fruit are given. The amount of milk per day should not much exceed 1 litre (1 quart) at this period.