General Considerations

Infants may be fed naturally, artificially or by a combination of both methods. When the child is at the breast of its own mother or another nursing woman, there is no indication for artificial feeding as long as breast milk is plentiful and of good quality. If the infant no longer thrives on mother's milk or the mother is unable to nurse it, and there is no other breast milk available, bottle feeding is then indicated. It goes without saying that many infants, chiefly foundlings, have to be bottle fed from the start, but every effort should be made to secure to the child its birthright of mother's milk.

The subject of breast feeding and choice of a wet nurse are discussed thoroughly in special works which the nurse is obliged to study, and hardly belong to the general subject of dietetics. This is also true to a large extent of artificial feeding, because the physician's orders are so explicit that they may be carried out by the mother or any intelligent woman. However, cases may occur, as they frequently do in hospitals, where the nurse is largely responsible for the thriving of the child, and is given only general instructions, if any, from the practitioner. For this reason a brief resume of the whole subject seems desirable.

Breast Feeding

The baby is first allowed to nurse after the mother has had some hours of sleep following delivery. This, however, is not actual feeding for the milk is not secreted as such until the second twenty-four hour period after birth. The first flow, called colostrum, differs from true milk in its composition, providing a small amount of nourishment ready for absorption without digestion. The first attempt at nursing aids the mother by assisting the empty uterus to contract; while the colostrum aids the infant by stimulating the digestive tract and arousing peristalsis. In addition to the colostrum the infant should receive only warm water for the first twenty-four hours. Should there be much delay in the secretion of mature milk it may be necessary to give the infant a little modified cow's milk having a very low protein content ¼ percent. to ½ per cent.).

Under ordinary conditions the mother begins to secrete mature milk by the second twenty-four hour period. Up to the third or fourth day, this milk is mixed with colostrum in increasingly small amounts, but this may be disregarded in practice. The child must be taught to nurse at stated intervals, for fifteen or twenty minutes at a time, alternating the use of the breasts.1

The Wet Nurse

When the mother is unable for any reason to nurse her child or to supply it with enough nutriment, the ideal substitute is the milk of another nursing mother, who should be in perfect health and have a child of about the same age as the infant to be nursed. When the wet nurse is a hireling the moral risk is very great, for the nurse's own child if still living is largely sacrificed for the good of the other. It is also difficult to find a wet nurse of good character or education. It is particularly necessary to supervise her diet for she may be intemperate. Her own child may be illegitimate; she herself may suffer from some venereal or parasitic disease.