Why Cannot Babies Digest Mother's Milk ?

Kai Tiaki : the journal of the nurses of New Zealand, Volume II, Issue 2, 1 April 1909, Page 73

Why Cannot Babies Digest Mother's Milk ?

ADA E. CHAPPELL

(BY

In my work as the Plunket Nurse at Auckland, it has distressed me to see how many babies do not seem to thrive on their mothers' milk. In a number of cases the nurses and mother have battled bravely through the difficulties of undeveloped, inverted, or sore nipples. In other cases there is sufficient milk for the baby, but it does not agree. The motions are curdy, and then followed by green, and very frequent. The baby is fretful, unsatisfied, and sleeps little night or day, and always seems ravenously hungry no matter how much or how often it is fed. The babies are just unhappy, suffering little atoms of humanity, and as unlike the babies our grandmothers used to tell us about (who used to sleep most of their time) as it is possible to be. As there is a cause for every effect, I have tried to discover the cause. I tried to think what I would do if these babies were on humanised milk. For indigestion, then, I would reduce the strength. One might even peptonise the humanised milk if the stomach was too weak to digest milk of a required strength unpeptonised. We cannot, however, do this wdth mother's milk. It is usually supposed when a baby cannot digest mother's milk that there is too much proteid in the milk. To overcome this difficulty (unless able to regulate the mother's exercise, etc.), we could give the baby boiled water previous to a feed from the mother. This would dilute the milk in the baby's stomach by mixing with the water ; but there are disadvantages even with this. Supposing the baby is new born and you give a bottle with water in prior to giving it a drink from the breast, baby r will not readily take the breast milk, especially if the nipple is small. If you spoonfeed with the water the baby becomes so impatient that by the time you get it to the breast it will scream instead of sucking. Then I thought : " Is there no way ? Eventually I decided to reduce the length of time a baby feeds from the mother. I was called to one baby a few weeks old, looking old and careworn, in a home where every need could be supplied. The nurse said the milk did not agree, and the motions were curdy and green. They had sent for me to

show them how to make humanised milk for the baby. I inquired why the mother was not nursing the baby entirely. I was told she had not sufficient milk. I found upon inquiry that the baby was allowed to drink until she stopped of her own accord. I asked for the drinks to be limited to fifteen minutes, and the breast last nursed from to be massaged gently (not the full one, as that would waste the milk). I then gave baby three feeds per day of graded humanised milk. I got the mother to take milk-forming food. The milk supply improved, and as the baby was unable to digest a feed of fifteen minutes, I reduced that to ten minutes. Then the mother found she had sufficient milk to nurse the baby entirely. The mother still made the humanised in case her milk should fail, and drank it herself to transform to human the humanised milk. In the meantime the baby's motions had become nearly normal — it was sleeping better and gaining in flesh. " Now," I thought, " I can advance," and I gave permission for the feed to be extended to twelve and a half minutes. This brought a return of indigestion, shown by the curdy motion, followed by the green, colicy pains, sleeplessness and crying. We reduced the time to ten minutes again, and the indigestion disappeared. We let the baby remain at that for some days ; then thought we might again increase, but more carefully, so only increased one mmute. Again a return of indigestion, but not so bad as before, as shown by the smallness of the curd, which was not followed by green colour this time. Back we had to go to ten minutes, and once more there was a contented baby, sleeping a normal amount. I know this is only one case ; but in every case where I have tried it, the effect has been the same. H Another case : A lady came to my office to see me. She wanted me to supply her with humanised milk as she had not enough, and the baby was always crying. " It used to be such a good baby," she said. I found the motions were curdy and green. The mother said, " I feel the draught of milk come and when it stops the baby cries and I have to put it to the other breast." I found.it was two hours since the baby was fed, so I got her to feed the baby then. " I can feel

the draught coming," she said. Then the baby cried, and the mother said it had stopped. " That is not a long enough feed, is it ?" she asked " Are you sure there is no more?" I asked. " Yes, quite sure." " Let me see," I said. In pressure a good supply of milk flowed from that breast, showing that the mother's feelings and impressions about there not being any more milk are often misleading. It was amusing to see her look of astonishment. " Now," I said, " you came for my advice, will you do as I ask you ?" Go home and nurse the baby for fifteen minutes, every two and a half hours during the day, and once between 10 p.m. and 6 a.m., and come and see me in three days' time, and if I find you have not enough milk when you have not given the baby more than baby could digest, then I will order humanised milk for you." This she promised to do. At the end of the three days she returned with a smiling face. " Well, how is baby," I said. " Oh ! baby is splendid. I did as you said and I have plenty of milk, and baby's motions are all right, and she sleeps, and coos, and we have got our good little baby back again. Someone told me I can be a member of the Society for 5s, so here is my subscription." I could go on citing cases, but this, I think, is sufficient to show that reducing the quantity enables babies to digest their mother's milk. I have not yet found a baby unable to digest its mother's milk when the quantity has been reduced to its digestive capabilities. ',''- j? M I do not mean to imply that all mothers' milk will sufficiently nourish a baby. There may be some of the necessary constituents missing, or be not in proper proportion. There are cases where babies suffer from malnutrition and marasmus, though fed on mothers' milk, but they are the exception, and the cases I have named are the rule so far as my experience has gone. This seems to point to the fact that it is the overfeeding in breast-fed infants which has done the mischief. Also, I think we have let the idea get too great a hold upon us that anxieties and work upset the milk for the babies. We think if women lived as native women used to do, that mothers could still nurse their babies as they did. Yet when we think of the wars between the different tribes, and how the men they loved and the fathers of their babies had to go and fight, and might never return alive, we cannot say

those women were free from anxieties, seeing womens' hearts in all ages have ever been the same ; yet they were able to nurse their babies successfully. It seems to me that this great question as to mothers nursing their babies or not, depends mostly upon us nurses. The doctor only sees the baby a few minutes a day, or every other day. If the nurse says the milk does not agree, or is not sufficient, the doctor must either take the nurses' word for it, or practically act as if the nurse does not know her work. With the fact before us, as stated by those in a position to know, that malnutrition in infants tends to the imperfect development of the brain, which in later life may develop insanity, and with the important fact also before us that the brain grows more in the first twelve months of life than in the whole of the after life, surely we can realise the importance of babies being nursed by their mothers, w r hen we remember that in mothers' milk there is special provision made to supply the materials for the growth and development of the brain. Dr. Gow says : " An infant's brain grows faster than a calf's, and science has not yet been able to extract from the cow's milk the brain feed that is necessary for the growth of an infant's intellect." If science has not yet been able to extract from cow's milk the brain food necessary for the growth of an infant's brain, how infinitely less likely is it to be extracted from patent food* There never were so many artificially-fed babies in the world's histcry, and we know insanity is on the increase. Have these two things any connection with the other ? One hears a great deal about the unnatural mothers who could, and yet will not, for selfish reasons, nurse their babies. I am pleased to say I have not met them yet ; but I have met many who ceased to nurse their babies because of the curdy green motions, which made them think their milk did not agree, whereas I have proved to my own satisfaction that it was the over-feeding that did not agree. Personally, I think the indigestion is started by the very first feed. I think if the baby was allowed to drink for five minutes only the first feed, and within six hours of its birth (if the mother was in a fit condition-) it would be better, the length of time being increased according to the digestion of the baby. Sometimes the baby is not put to the breast until the third day, because "the milk has not come in." Yet nature has provided" a weaker milk those

first three days to help prepare the little stomach for the harder work which it will have on the third day. How sad one feels for the little thing when one hears the old saying : " Oh, he will stop when he has had enough." So the wee stomach is loaded with a feed, often lasting half an hour, or threequarters. We expect a new-born infant to know what is good for him better than some adults, who do not know when to stop. Perhaps we think the babies are so near to Heaven that they have brought this wisdom with them. It seems to me we nurses have a great work before us m pointing out all the advantages of natural feeding, and all the dangers and disadvantages of artificial feeding, not forgetting the danger of rickets through lack of fresh milk direct from the mother. We should keep before us the fact that it is only the amount of food digested (whether mothers' milk or humanised) that nourishes the baby. If it were otherwise, why are the over-fed children the most like skeletons ? What an immense gain we have given to each infant when we have secured the natural food for its use, and have taught the mother the A B C of feeding according to the digestion of the individual infant. While m one case I mentioned ten minutes is all the baby could digest at present, yet m other cases fifteen minutes and half an hour may be needed. When once the amount that the individual baby can digest has been discovered — by reducing the time until there m no curd m the motion, etc. — give the baby a few days at that amount, and then advance .

: by a minute or minutes until you see signs of [ indigestion, then shorten the time just enough to allow the digestive organs to do their work, and continue at that amount. The saving to the nursing mother is great, seeing nature tries to meet the demand. Nature in the mother has been trying to make enough milk to feed a baby for thirty minutes when that baby is only able to digest a feed of ten minutes, in some cases, and the other twenty minutes feed has not only been utter waste, but injurious often to both mother and baby — particularly to the baby # Is not this one great cause why mothers do not nurse their babies ? They think they have not sufficient milk unless they have enough to feeel the baby for half or threequarters of an hour. In conclusion let me say that the result of my experiment has cheered me much ; because I no longer feel the God-given food for infants has all gone wrong (as in the great majority of cases it appeared), but it shows that the fault is that somehow we have lost sight of the need of being guided in natural feeding by what a baby can digest. This amount is not a matter to be estimated by rule of thumb ; but in cases outside the average depends on the digestive capacity of each child. Thus each child must be a special subject of stuely to the nurse, especially in cases where nature's nurse — the mother — calls in the aid of those whose duty it is to benefit by the experience gained by observation.