A scant secretion of milk is not a good reason for not nursing the infant. A proper diet (plenty of milk, eggs, sugar. and pastry), and massage of the abdomen to stimulate the circulation from the abdomen to the breasts, excite a greater secretion of milk.
In the first few days following childbirth the milk is thick, yellow, and rich in salts, which act as mild purges on the child. This purgative action is desirable in order to throw off quantities of meconium which are present in the intestine. The child should be put to the breast as soon as the mother has recovered from the exertions of childbirth ; either on the day of birth or about twelve hours later. By this time the child will be thirsty and will scream. If the milk has not yet appeared, the child's sucking will aid its coming. If the child be not satisfied, it may be quieted with a small quantity of sweetened water. While nursing, the mother experiences decided after pains, a sign of the contraction of the womb. During the first few days the child drinks at intervals of from two to four hours, a little later it drinks every three hours, and later still every two and a half hours. At night a long interval should elapse, namely from II p.m. to 6 a.m. In the beginning the infant tires readily ; its one-sided position in the mother's arm is uncomfortable, sucking is painful, and neither mother nor child is at ease. All this makes nervous women very impatient. When nursing a child the protruding breast must be kept from the child's nose, held away with two fingers, and the nipple brought in contact with its mouth. If one breast has been emptied, and the child is still thirsty, it may be put to the other breast.
Cleanliness in nursing is an essential for both mother and child. In the child it prevents infections of the mouth and intestinal catarrh ; in the mother it prevents inflammation of the breasts. The nipple must be freed from all crusts, and after each nursing it must be cleaned with absorbent cotton and a boracic-acid solution. During the intervals between nursing it must be kept covered with clean cloths or wads of cotton. A nursing corset may be useful. These rules for cleanliness should be observed also during pregnancy, and, besides, the nipples should be hardened so as to ward off possible inflammation of the breasts. It is wise to draw the nipples forward carefully with the hand, and apply cold water to them. After nursing, the child's mouth should be carefully washed with absorbent cotton dipped into a solution of boracic acid.
In spite of every precaution the nipples may become inflamed by being bitten by the child, especially if they he flat. In such cases it is well to use a nipple-shield as a protection ; this will also make nursing easier for the child. This nipple-shield must be boiled every clay, and should be kept in a boracic-acid solution when not in use. The glass opening must be suffi ciently large to allow the nipple to recede. As a rule, infants do not at first like a rubber nipple, but they soon become accustomed to it. In cases of receding nipple, a rubber nipple is absolutely necessary. If the child's mouth, as well as the nipple, he clean, inflammation is not likely to occur, even when fissures exist. Such fissures are very sensitive, and may be extremely painful. The nursing mother should invariably call the atten tion of her physician to this. The infant should be nursed for from nine to fifteen months if possible, and efforts should be made always to nurse it in summer, as artificial foods spoil rapidly in hot weather. Nursing for too long a time, however, weakens both mother and child. Weaning should not be done suddenly, hut should take place gradually during several weeks, by giving the breast less often to the child. The milk should be dried up gradually ; to drive it off abruptly is not necessary. There is no such thing as " milk going to the head." Disturbances which are ascribed to this fact are really caused by some sickness.
Good reasons for early and sudden weaning may arise by reason of the mother's health (increasing anxmia, consumption, syphilis, diabetes, mental derangement, epilepsy). Severe forms of liver, heart, or kidney trouble are only secondary reasons. Other reasons for discontinuance of nursing arc : tender, fat, inflamed, or fissured breasts ; insufficient or unfit milk (salty ; lacking sugar) ; continuous " milk flow " ; certain changes in the sexual organs ; continuous bloody lochia ; puerperal fever ; and pregnancy. As far as the infant is concerned it should not be nursed if there arc swellings, deformities, or other diseases of the mucous membranes of the mouth and nose (harelip ; cleft palate), or excessive weakness on account of premature birth. Such infants must be fed with mother's milk by a spoon. An infant's seeming inability to take the breast may really arise from disinclination, especially if it was fed from a spoon during the first few days. Such a possibility should be borne in mind.