The Young Mother: Management of Children in Regard to Health

In speaking of the importance of keeping the bottle, from which a child takes his food, perfectly clean and sweet, I ought to have extended the injunction much farther. There is a degree of slovenliness sometimes observable in those who manage children, both when they are sick and when they are in health, which even common sense cannot and ought not to tolerate. Every vessel which is used in preparing or administering anything for children, ought, after we have used it, to be immediately and effectually cleansed. How shocking is it to see dirty vessels standing in the nursery from hour to hour, becoming sour or impure! How much more so still, to see food in copper vessels, or in the red earthen ones, glazed with a poisonous oxyd! I speak now more particularly of vessels in which food is given; for with the administration of medicine, and nursing the sick, I do not intend in this volume to interfere.

EXCEPTION 3.—We come now to the consideration of those cases—for such it will not be doubted there are—where a hired nurse is to be preferred to feeding by the hand.

Before proceeding farther, however, it is important to say, that if a nurse could always be procured whose health, and temper, and habits were good, who had no infant of her own, and who would do as well for the infant, in every respect, as his own mother, it would be preferable to have no feeding by the hand at all.

But such nurses are very scarce. Their temper, or habits, or general health, will often be such as no genuine parent would desire, and such as they ought to be sorry to see engrafted, in any degree, on the child. For even admitting what is claimed by some, that the temper of the nurse does not affect the properties of the milk, and thus injure the child both physically and morally, still much injury may and inevitably will result from the influence of her constant presence and example.

Others have infants of their own, in which case either their own child or the adopted one will suffer; and in a majority of cases, it can scarcely be doubted which it will be. And I doubt the morality of requiring a nurse, in these cases, to give up her own child wholly. If one must be fed, why not our own, as well as that of another?

The only cases, then, which seem to me to justify the employment of a nurse, are where she possesses at least the qualifications above mentioned; and as these are rare, not many nurses, of course, would on this principle be employed. But when employed, it is highly desirable that the following rules should be observed:

1: The nurse should suckle the child at both breasts; otherwise he is liable to acquire a degree of crookedness in his form. There is another evil which sometimes results from the too common neglect of this rule, which is, that it endangers the deterioration of the quality of the milk.

2. The milk which is thus substituted for that of the mother, should be as nearly as possible of the same age as the child who is to receive it. It should be remembered, however, that the milk is not so good after the twelfth or thirteenth month, nor quite so good under the third.

3. When the parent or some trusty and confidential friend can, without the aid of interested spies and emissaries, have an eye to the general treatment, and especially to the moral management, it should be done; for even the best nurses may so differ in their principles, manners and habits from the parent, that the latter would deem it preferable to withdraw the child, and resort at once to feeding.

This period will, of course, be longer or shorter according as the teeth begin to appear earlier or later, and according to the time when it is thought proper to wean.

On few points, perhaps, has there existed a greater diversity of opinion than in regard to the age most proper for weaning. The limits of this work do not permit a thorough discussion of the question; and I shall therefore be very brief in my remarks on the subject.

Dr. Cullen, whose opinion on topics of this kind is certainly entitled to much respect, thought that less than seven, or more than eleven months of nursing was injurious. Yet in some countries, and even in some parts of our own, the period is extended by the mother, from choice, to two years. And although the milk is not so good after the thirteenth or fourteenth month, I have never either known or heard that any evil consequences followed from the practice.

Dr. Loudon, a recent writer, observes, that the period of nursing has a great influence over the numbers of mankind in various countries, as is evinced by numerous facts. He adduces proofs of this, position. Thus, he says, in China, where the population is excessive, and the inhuman practice of infanticide is common, they wean a child as soon as it can put its hand to its mouth. On the other hand, the Indians of North America do not wean their children until they are old and strong enough to run about: generally they are suckled for a period of more than two years.

He then enters into a physiological inquiry why it is that British mothers do not usually suckle their children longer than ten months. He seems—though he does not give us his precise opinion—to think that, in all ordinary cases, the period of nursing ought to be protracted to two or three years, and that perhaps it would be better still to extend it to four or five. His remarks are so excellent, and withal so curious, and their tendency so humane, that we venture to insert one or two of his paragraphs entire.

"Certain it is, that the milk does not diminish particularly at that time, (ten months,) so far as regards quantity; and from the health of children reared without spoon-meat beyond this time, it as certainly undergoes no change in its quality. Children are sometimes so old before weaning, as to be able to ask for the breast; and it has not been remarked that the health of mothers, thus suckling, was in any way worse than that of their neighbors. Altogether, then, it may be asserted, that a mother is likely to enjoy better health, and to be less liable to sickness and death during lactation, than during pregnancy.

"Many women believe, or affect to believe, that the weakness they labor under arises from some latent moral or physical cause; but this weakness is not attributed to lactation in the earlier months of suckling, because the mother then considers herself fulfilling a necessary duty, which her constitution, for so long, is well able to bear. So soon, however, as the period of lactation has passed over, as it is established by custom or fashion, she imagines she is exceeding the intentions of nature, and she forthwith concludes that the continuance of suckling is the cause of her uncomfortable sensations. This whim being entertained, the child is weaned, and too often becomes the victim of a most reprehensible delusion.

"Since nature has furnished the mother with milk for a longer period than custom demands, it is evident that some good purpose for the mother and child was intended in this arrangement. Had it been otherwise, the secretion of milk would stop at a definite time, in like manner as the period of gestation is definite. That a child, in comparison with the young of the lower animals, is so long unable to provide for itself, strongly tends to corroborate the proofs already advanced—that nature originally had in view a more protracted period for lactation than is now allowed.

"Some writers, following the laws of nature, as they interpreted them, fixed the period of weaning at fifteen months, when the infant has got its eight incisors and four canine teeth. There are well-authenticated instances of mothers having suckled their children for three, four, five, and even seven consecutive years; we ourselves have known cases of lactation being prolonged far three and for four years, with the happiest results."

It appears to me better, therefore, that the child should be nursed, in all ordinary cases, from twelve to fifteen months; and when there are no special objections, about two years. As the change, whenever it is made, and however gradual it may be, is an important one, in its effects on the stomach and bowels, it is better to wean a little earlier or a little later, than to do so just at the close of summer or beginning of autumn, at which season bowel complaints are most common, most severe, and most dangerous. It is sufficiently unfortunate that teething should commence just at this period; but when we add another cause of irregular action, which we can control, to one which we cannot, we act very unwisely.

I have already observed that we may begin to feed children when the teeth begin to appear. By this is not meant that we should do so while the system is under the irritation to which teething usually, or at least often, subjects it. But when this is over, and a few teeth have appeared, it is usually a proper time to commence our operations.

The first food given should be precisely of the kind which has been recommended for those children who are fed by the hand. The rules and restrictions by which we are to be guided, are the same, except in one point, which is, that in the case we are now considering, the child should be fed between nursing.

Let not parents be anxious about their healthy children under two years, who have a supply of good milk, either from the mother or from the cow. For those that are feeble, a physician may and ought to prescribe—not medicine, but appropriate food, drink, &c.

When the grinding teeth have cut through, if we have any doubts in regard to the nutritive qualities of the food we are giving, we may improve it by adding, instead of the one third of pure water, a similar quantity of gum arabic water, barley water, or rice water. Some use a little weak animal broth; but this is unnecessary, and I think, on the whole, injurious, except for purposes strictly medicinal.

This course is so simple, and so far removed from that which is generally adopted, that few mothers will probably be willing to pursue it with perseverance, especially when the teeth appear very late. Those who are, however, will be richly rewarded, in the end, in the advantages; which will accrue to the child's health, and the vigor it will ensure to his constitution.

It has already been shown that, in weaning, some regard should be had to the season of the year; and that the end of summer and beginning of fall are of all periods the most unfavorable. The best time, on every account, is in the spring—in March, April, May, or June; and the next best is during the months of October and November. But December, January and February are better than July, August and September.

Weaning should never be sudden. We may safely and properly call upon those who are addicted to snuff or opium taking, tobacco chewing, rum drinking, and other habits which are purely artificial, to break off—to wean themselves—suddenly; since they can do so with considerable safety, and will seldom have the courage or the perseverance to do it otherwise. But with the child, in regard to his food, such a course will not be advisable. If we regard his future health or happiness, he must be weaned gradually.

The first proper step will be to give the child a little larger quantity of the cow's milk and gum arabic mixture, between nursings, at the same time increasing very gradually the intervals of nursing. When the intervals become six hours distant from each other, it will be best to add a little good bread to the milk with which it is fed, about two or three times a day. Arrowroot jelly, if he can be made to relish it, will be highly useful; but if not, some boiled rice, into which a little arrowroot has been sprinkled while boiling, may be added to his milk.

It may be worth the attempt to excite an aversion in the child to nursing his mother, so that be will refuse to nurse, if possible, of his own accord. This aversion may be excited by such an application of aloes, or some other offensive substance, as will cause him to withdraw himself from the breast as soon as he tastes it.

A serious mistake is often made, in connection with weaning, in giving the child not only too much food, but that which is too solid, or too rich. This mistake has undoubtedly grown out of the belief that his feeble condition requires it; whereas the truth is, that he neither needs food at this period, nor is capable of digesting it. For let us be as judicious in the process of weaning as we may, the tone of the child's stomach will be somewhat reduced, or in other words, its powers of digestion will be weakened by it; and to give it strong food, or overload it with that which is weaker, is not only unreasonable and unphilosophical, but cruel. And if there should be a tendency in the child's constitution to rickets, scrofula, consumption, and other wasting diseases, such a course would be likely to bring them on, and destroy life.

"When milk will agree," says Dr. Dewees, "there is no food so proper. It may be employed in any of its combinations, with good wheaten bread, rice, sago, &c., only remembering that when either of these articles is found to agree, it should be continued perseveringly, until it may become offensive. In this case, some new combination may be required." I do not see the necessity of continuing one kind of food till it offends. Besides, I do not believe that these simple articles of food are apt to become offensive to stomachs that have not already been spoiled. But whether a single dish should or should not come to be offensive, I greatly prefer an occasional change.

Buchan, in his Advice to Mothers, has recommended it to them to boil bread for their infants, in water. It should not, for this purpose—nor indeed for any other—be new; it is best at one or two days, old. It may be boiled in a small quantity of water, or what is still better, of milk; or it may be steamed till it becomes soft and light, almost like new bread, but without any of the objectionable properties of that which is wholly new. To bread, thus prepared, is to be added a suitable quantity of milk, fresh from the cow, and a little diluted with water, but not boiled.

But as there may be, here and there, at any age, a stomach with which milk, with bread, or rice, or sago, will not agree—though I think they must be very rare cases—we may be allowed to substitute for it a solution of "gum arabic, in the proportion of an ounce to a pint of water," to which may be added a little sugar; and if the child is old enough to observe the color, just milk enough to change the appearance. Another preparation for the same purpose consists of rennet whey, a little sweetened, and "disguised, if necessary, as just stated."

The health of the mother, too, during the period of weaning, often needs great attention. Let her avoid medicine, however, if possible. A due regard to food, drink, exercise, and rest of body and mind, &c., will usually be found more effective, as well as more permanently efficacious.

You will allow me to introduce in this place, some of the sentiments of Dr. Cadogan, an English physician, from a little work on the management of children.9 I do it with the more pleasure because, though he wrote almost a century ago, he urges the same general principles on which I have all along been insisting: hence it will be seen that mine are no new-fangled notions. His remarks refer to the young of every age, but chiefly to early infancy and childhood. It will be found necessary, in some instances, to abridge, but I shall endeavor not to misrepresent the Doctor's views.

"Look over the bills of mortality. Almost half of those who fill up that black list, die under five years of age; so that half the people that come into the world go out of it again, before they become of the least use to it or to themselves. To me, this seems to deserve serious consideration.

"It is ridiculous to charge it upon nature, and to suppose that infants are more subject to disease and death than grown persons; on the contrary, they bear pain and disease much better—fevers especially; and for the same reason that a twig is less hurt by a storm than an oak.

"In all the other productions of nature, we see the greatest vigor and luxuriancy of health, the nearer they are to the egg or bud. When was there a lamb, a bird, or a tree, that died because it was young? These are under the immediate nursing of unerring nature; and they thrive accordingly.

"Ought it not, therefore, to be the care of every nurse and every parent, not only to protect their nurslings from injury, but to be well assured that their own officious services be not the greatest evils the helpless creatures can suffer?

"In the lower class of mankind, especially in the country, disease and mortality are not so frequent, either among adults or their children. Health and posterity are the portion of the poor—I mean the laborious. The want of superfluity confines them more within the limits of nature; hence they enjoy the blessings they feel not, and are ignorant of their cause.

"In the course of my practice, I have had frequent occasion to be fully satisfied of this; and have often heard a mother anxiously say, 'the child has not been well ever since it has done puking and crying.'

"These complaints, though not attended to, point very plainly to the cause. Is it not very evident that when a child rids its stomach of its contents several times a day, it has been overloaded? While the natural strength lasts, (for every child is born with more health and strength than is generally imagined,) it cries at or rejects the superfluous load, and thrives apace; that is, grows very fat, bloated, and distended beyond measure, like a house lamb.

"But in time, the same oppressive cause continuing, the natural powers are overcome, being no longer able to throw off the unequal weight. The child, now unable to cry any more, languishes and is quiet.

"The misfortune is, that these complaints are not understood. The child is swaddled and crammed on, till, after gripes, purging, &c., it sinks under both burdens into a convulsion fit, and escapes farther torture. This would be the case with the lamb, were it not killed, when full fat.

"That the present mode of nursing is wrong, one would think needed no other proof than the frequent miscarriages attending it, the death of many, and the ill health of those that survive. But what I am going to complain of is, that children, in general, are over-clothed and over-fed, and fed and clothed improperly. To these causes I attribute almost all their diseases.

"But the feeding of children is much more important to them than their clothing. Let us consider what nature directs in the case. If we follow nature, instead of leading or driving her, we cannot err. In the business of nursing, as well as physic, art, if it do not exactly copy this original, is ever destructive.

"If I could prevail, no child should ever be crammed with any unnatural mixture, till the provision of nature was ready for it; nor afterwards fed with any ungenial diet whatever, at least for the first three months; for it is not well able to digest and assimilate other elements sooner.

"I have seen very healthy children that never ate or drank anything whatever but their mother's milk, for the first ten or twelve months. Nature seems to direct to this, by giving them no teeth till about that time. The call of nature should be waited for to feed them with anything more substantial; and the appetite ought ever to precede the food—not only with regard to the daily meals, but those changes of diet which opening, increasing life requires. But this is never done, in either case; which is one of the greatest mistakes of all nurses.

"When the child requires more solid sustenance, we are to inquire what and how much is most proper to give it. We may be well assured there is a great mistake either in the quantity or quality of children's food, or both, as it is usually given them, because they are made sick by it; for to this mistake I cannot help imputing nine in ten of all their diseases.

"As to quantity, there is a most ridiculous error in the common practice; for it is generally supposed that whenever a child cries, it wants victuals: it is accordingly fed ten or twelve or more times in a day and night. This is so obvious a misapprehension, that I am surprised it should ever prevail.

"If a child's wants and motions be diligently and judiciously attended to, it will be found that it never cries, but from pain. Now the first sensations of hunger are not attended with pain; accordingly, a very young child that is hungry will make a hundred other signs of its want, before it will cry for food. If it be healthy, and quite easy in its dress, it will hardly ever cry at all. Indeed, these signs and motions I speak of are but rarely observed, because it seldom happens that children are ever suffered to be hungry.10

"In a few, very few, whom I have had the pleasure to see reasonably nursed, that were not fed above two or three times in twenty-four hours, and yet were perfectly healthy, active, and happy, I have seen these signals, which were as intelligible as if they had spoken.

"There are many faults in the quality of children's food.

"1. It is not simple enough. Their paps, panadas, gruels, &c. are generally enriched with sugar, spices, and other nice things, and sometimes a drop of wine—none of which they ought ever to take. Our bodies never want them; they are what luxury only has introduced, to the destruction of the health of mankind.

"2. It is not enough that their food should be simple; it should also be light. Many people, I find, are mistaken in their notions of what is light, and fancy that most kinds of pastry, puddings, custards, &c. are light; that is, light of digestion. But there is nothing heavier, in this sense, than unfermented flour and eggs, boiled hard, which are the chief ingredients in some of these preparations.

"What I mean by light food—to give the best idea I can of it—is, any substance that is easily separated, and soluble in warm water. Good bread is the lightest thing I know, and the fittest food for young children. Cows' milk is also simple and light, and very good for them; but it is often injudiciously prepared. It should never be boiled; for boiling alters the taste and properties of it, destroys its sweetness, and makes it thicker, heavier, and less fit to mix and assimilate with the blood."

It is hardly necessary for me to repeat, that in these general views of Dr. C., with a few exceptions, I entirely concur; indeed some of them have already been presented. But I have expressed my doubts of the soundness of his conclusion in regard to sugar. Used with food, in very small quantity, by persons whose stomachs are already in a good condition, both sugar and molasses, especially the former, appear to me not only harmless, but wholesome and useful.

On the subject of simplicity in children's food, I should be glad to enlarge. There is nothing more important in diet than simplicity, and yet I think there is nothing more rare. To suit the fashion, everything must be mixed and varied. I have no objection to variety at different meals, both for children and adults; indeed I am disposed to recommend it, as will be seen hereafter. But I am utterly opposed to any considerable variety at the same meal; and above all, in a single dish. The simpler a dish can be, the better.

But let us look, for a moment, at the dishes of food which are often presented, even at what are called plain tables.

Meats cannot be eaten—so many persons think—without being covered with mustard, or pepper, or gravy—or soaked in vinegar; and not a few regard them as insipid, unless several of these are combined. Few people think a piece of plain boiled or broiled muscle (lean flesh) with nothing on it but a little salt, is fit to be eaten. Everything, it is thought, must be rendered more stimulating, or acrid; or must be swimming in gravy, or melted fat or butter.

Bread, though proverbially the staff of life, can scarcely be eaten in its simple state. It must be buttered, or honied, or toasted, or soaked in milk, or dipped in gravy. Puddings must have cherries or fruits of some sort, or spices in them, and must be sweetened largely. Or perhaps—more ridiculous still—they must have suet in them. And after all this is done, who can eat them without the addition of sauce, or butter, or molasses, or cream? Potatoes, boiled, steamed or roasted, delightful as they are to an unperverted appetite, are yet thought by many people hardly palatable till they are mashed, and buttered or gravied; or perhaps soaked in vinegar. In short, the plainest and simplest article for the table is deemed nearly unfit for the stomach, till it has been buttered, and peppered, and spiced, and perhaps pearlashed. Even bread and milk must be filled with berries or fruits. Where can you find many adults who would relish a meal which should consist entirely of plain bread, without any addition; of plain potatoes, without anything on them except a little salt; of a plain rice pudding, and nothing with it; or of plain baked or boiled apples or pears? And could such persons be found, how many of them would bring up their children to live on such plain dishes?