INFANT FEEDING

Breast Versus Bottle ‘Shall I nurse my baby?’ This is a very frequent question.

I am in favor of it. I think it is better for both mother and child.

Nursing makes the uterus shrink down more rapidly and more completely. In the second place, most mothers find it more convenient; and in the third place, it establishes a physical intimacy between mother and baby which bottle feeding cannot do, an intimacy that is psychologically good for both. It arouses in the mother a pride, a sense of fulfillment that she is sustaining her infant with milk from her own body. The warmth, the softness, the odor of the breast give the infant a sense of security, of being wanted—a sense subtly different from the feeling the bottle imparts. Then, too, breast milk is superior to formula as nutriment for the baby.

However, all these advantages when added together are not sufficient to justify the persuasion of a mother to nurse against her will. Then, too, reluctant breast feeders are rarely successful breast feeders.

Breast Feeding

Babies are offered nothing by mouth the first twelve hours. During the remaining twelve hours of the first day they nurse each breast for two or three minutes every four hours. If the mother takes a daily shower or bath and washes the nipple area with soap and water, no anticipatory cleansing of the nipple before nursing need be done. In most instances the child requires no preliminary training or encouragement to take the nipple but begins to suck promptly. Since it gets nothing but a scanty amount of colostrum, it may soon stop and go to sleep. Treat the baby rough; wake it up, fleck the feet by snapping your fingers at its soles. On the second and third days the child suckles for three to five minutes on each breast, and ten minutes on each breast thereafter. The four-hour schedule is continued, the baby being put to both breasts, but alternating the starting breast. As long as the baby gets little milk it may be offered two ounces of five per cent glucose water after each nursing, especially in hot weather.

Stools of Breast-Fed Babies

Meconium, the initial tarry green, sticky intestinal contents of the baby, disappears around the third or fourth day with the establishment of lactation, its place being taken by feces which are bright yellow with a homogeneous consistency. For the first few days the stools, which have a characteristic sour-dough odor, are unformed, but soon take on a cylindrical shape. The bowels of the breast-fed infant move several times daily, not uncommonly toward the end of or after each nursing.

Mixed Feedings

If after several days the child does not get enough breast milk to satisfy its needs, discovered by weighing it before and after several nursings, the mother’s breast milk is supplemented by offering the baby three ounces of formula. If after forty-eight hours of mixed feedings the mother’s milk does not increase sufficiently to meet two-thirds of the baby’s needs, it is wise to discontinue breast feeding and put the baby on full bottle feedings. Failure to gain weight and excessive wakefulness and crying may cause suspicion that the baby is not getting enough to eat.

Bottle Feeding

It is quite likely you will be told how to prepare a formula at the hospital before discharge by the nursery personnel or your own pediatrician, but in case you are not, I am including the following.

Utensils for Making Formula 1 can opener or ice pick 7 nursing bottles (8-oz. size), narrow or wide mouth, preferably heat-resistant glass 7 nipples for nursing bottles 7 nipple caps—glass, bake- lite, aluminum, or paper 1 one-quart measuring pitcher 1 measuring tablespoon 1 table knife 1 long-handled spoon for stirring 1 funnel 1 sterilizer—with rack 1 bottle brush

Steps in Preparation 1. Wash all utensils to be used. Use the bottle brush to scrub the bottles, nipples, and nipple covers in hot, soapy water. Soap or a good detergent may be used. Rinse well in hot, clear water, and let drain—do not wipe. Squeeze water through nipple holes during washing and rinsing. 2. Measure the required amount of warm water from the tap (water does not need to be boiled). 3. Pour into a pitcher or quart jar. 4. Measure the required amount of syrup or sugar in the measuring tablespoon. If syrup is used, pour it from the bottle or can into the spoon. If dry sugar is used, level off measuring tablespoon with back of table knife. Add syrup or sugar to water in pitcher. Stir until dissolved. 5. Scrub the top of the can of milk powder or milk with soapsuds and rinse in hot water from the tap. Open can by punching two holes in top if you are using evaporated milk. 6. Measure the required amount of milk in measuring cup, if evaporated, or by spoon if powdered. 7. Pour milk into water-sugar mixture and stir with long-handled spoon. 8. Use the funnel and pour the formula into the bottles. (Drinking water for the baby may be sterilized in a bottle at the same time you are sterilizing the formula.) 9. Put the nipples on the bottles. 10. Place the nipple covers over the nipples. Three types are available: a glass bell-jar type for narrow-necked bottles; a hard bakelite screw-on cover for wide-necked botdes; and a brown-paper cap fastened with string or rubber band. Be sure covers are not pressed or screwed on so firmly as to form a tight seal. They should be loose enough to allow steam to circulate. 11. There are two different kinds of sterilizers. Either of them or a deep cooking utensil with lid may be used. The kinds are: a tall sterilizer (9 inches high, including lid) with rack for bottles; a standard-height sterilizer (7 or 8 inches high) for screw-cap-type bottles with nipples inverted. Can be used only with this type of botde. 12. Place rack in bottom of sterilizer. Stand the bottles of formula on it, and then pour in 2 inches of water. 13. Cover the sterilizer with lid and place on stove. Turn on heat. 14. When water starts to boil, write down the time, or set your Minute Minder. Boil 25 minutes by the clock. After water has boiled 25 minutes, take sterilizer off the burner. 15. Caution—do not remove lid from sterilizer. Do not even lift the lid until sterilizer has cooled enough to allow you to hold your hands against the sides. Then remove bottles and press or screw the nipple covers down firmly over nipples. 16. Place covered bottles in refrigerator until needed. 17. When it is time to feed the baby, warm the bottle in a pan of hot water (not boiling). 18. If screw-cap bottles are used, lift nipple and disk from bottle. Use disk to push shoulder of nipple through cap. 19. Remove disk and screw the cap on bottle. 20. Before giving the formula to the baby, test the temperature by shaking a few drops on the inside of your wrist. It should feel warm but not hot.

We are very much in favor of having the mother give her baby each bottle herself while in the hospital, except the 2 A.M. bottle. She has more time than the average hospital nurse, and it is psychologically wise to encourage her to cuddle the infant against the warmth of her body while feeding it.

Stools of Bottle-Fed Babies

The stools of infants fed on most formulas are a whitish-yellow, firm, well formed, and less frequent than those of breast-fed babies; two a day is the usual number. However, if Lactum is used, the stools are orange-yellow in color, and up to seven a day are normal.

Urine

The child usually voids a few minutes after birth and voids irregularly thereafter. The daily amount excreted depends upon the size of the baby, whether it is bottle fed or breast fed, its state of health, the temperature of the room, etc. The average breast-fed child excretes one ounce of urine on the second day of life, three on the fourth, five on the sixth, and seven on the eighth. The bottle-fed infant voids almost twice as much.

Weight Loss

Because of the excretion of meconium and urine and the evaporation of body water from the lungs and skin, the newborn loses about a half-pound, 7 to 8 per cent of its birth-weight, in the first three or four days of life. Premature infants lose proportionately more than babies of normal size (10 to 12 per cent). In mature infants the weight loss is ordinarily regained by the tenth day, and from then on for several months the child gains an average of 6 to 7 ounces per week.