When shall we feed the new-born babe?
JEROME EARL HOLMAN, M.D., INDIANAPOLIS, IND.
Much has been written on infant feeding and the kinds of foods, and various formulas are so numerous that pediatricians are inclined to accept the simpler types of foods; however, a search of the literature reveals very little on when to feed the infant. At first it would seem unimportant, but a further study shows the significance of when to feed the new-born babe rather than what to feed.
It is not uncommon to find infants during the first five or ten days of life who are failing to thrive normally because of insufficient food from the mother's breast. This may be due, at the onset, to the late filling up of the breast, and later to illness of the mother, to defects of the nipple or to poor secretory function. Some newly-born infants are drowsy and sleep at the expense of eating; others express their hunger by crying immoderately. In such cases, if the weight be carefully taken each day, it will be found to keep on declining longer than usual and become a pathological condition.
It is impossible to prevent a certain amount of loss in weight in the newly-born infant, but we believe that after the third day of life no further drop in weight need occur if some simple artificial food is used while awaiting the breast milk. Multiparae who have previously nursed their infants successfully may be expected to repeat, and healthy young primiparae with normal nipples will likewise be successful. Additional feedings will probably be necessary in older primiparae and in mothers who were never successful nurses.
In suggesting that in the early days of life the infant be given additional food after each nursing, the writer wishes to emphasize that such a method must not be used to the extent of drying up the breast or interfering in any way with later complete maternal feeding. Furthermore, one must guard against overfeeding by this combined method. In most cases all the extra food needed in the first ten days is an ounce or two of the formula after taking the baby away from the breast. In most instances the artificial food can soon be discontinued entirely.
The observations recorded in this paper were made while attempting to determine whether food in addition to the breast milk is needed and of benefit during the early ten days. Although sweet milk is tolerated by many normal newly-born infants, the physician often fears that his formula, by being too concentrated, may upset the digestion. As a result, milk mixtures are often too dilute and are insufficient for producing regular gains. Pediatricians have known for several years that buttermilk is well tolerated during infancy, and have used the naturally soured milk and the Bulgarian milk. The explanation of its greater digestibility has not been offered until the last few years. Cow's milk contains a much higher percentage of mineral salts than is found in breast milk, and it is due to this fact that cow's milk is apt to be indigestible. Gastric digestion must provide sufficient acid for the milk so that the enzymes, such as pepsin, rennet and lipase, can act to the best advantage. When the food contains too much of the buffer salts, the gastric contents are slow in becoming acidified and make demands for hydrochloric acid secretion which is in excess of the infant's capacity to provide. An already soured milk facilitates the digestive process.
As yet we have seen no detailed report on the use of lactic acid milk in the feeding of newly-born infants, although this method has been used by several pediatricians in the last two years. Marriott has found that these infants tolerate acidified milk. Faber believes that acid milk is well handled, but suggests that the amount of acid which is added to sour the milk be gradually reduced until the infant is being fed sweet milk entirely. In the earlier experience of the writer the suggestion first made by Marriott was followed. At that time we used one drachm of U. S. P. lactic acid to each pint of milk, but we found that sooner or later this seemed to cause some distress. For the past year we have only partially de-bufferized the milk, using a less amount of the acid, namely, one-half drachm per pint of milk, and have found this to be entirely satisfactory.
When the infant received no breast milk, due to inability of the mother to nurse, the complete bottle feeding was equally well handled. Reports from hospitals nurseries where the baby is given simply water until the breasts fill up do not show as much or as early a gain as when complemental feeding is used. Only those infants getting large amounts of breast milk regain their birth weight by the tenth day.
The value in this method lies not in the nature of the acid in the milk. but in the fact that the milk is rendered more digestible by being sour, and more food can be handled. Milk soured in other ways is probably just as good; in fact, for many years the writer has not infrequently used buttermilk when additional food is needed for the newly born. This simple method is offered as one of value to the practitioner who may be in doubt as to the food he wishes to give the young infant deprived of sufficient breast milk. It should be emphasized that breast nursing be not discontinued even if there is only a little secreted. Whether sour milk should be fed indefinitely as the infant gets older will have to be determined by further experience. It would seem wise to begin reducing the amount of acid in the formula at the age of one or two months, so that the infant will gradually become tolerant of the sweet milk formula. After the age of ten days the amount of formula fed to the child will have to be increased if the mother's milk is inconsiderable, or if it tends to decrease from week to week. It is well to follow the accepted rule of providing at least one and one-half ounces of milk for each pound of the infants weight.
Other writers believe it unnecessary to feed acidified milk routinely to artificially fed infants. They claim the majority of normal infants do well on simple dilution of boiled milk and water, with carbohydrate added. Bearing in mind that the latter is simpler to prepare, it would seem that whole milk, water and some form of sugar could best be used.
In conclusion, let me say that after the third day a further loss of weight in the new-born babe, along with other symptoms of crying, deficient mother's milk, etc., I would suggest the addition of artificial feeding by the fifth or sixth day, and not when the baby is a month old and half-starved. It is my belief that the proper and early feeding develops a properly nourished baby, which resists disease and develops a body more normal in type.
Kerley, Charles G.: General Principles Governing My Infant Feeding Problem. Archives of Pediatrics. July, 1926.
Walker, Alfred A.: Common Sense and Infant Feeding. Southern Medical Journal, December, 1926.
McKee, James H.: Little Things in Successful Infant Feeding. The Therapeutic Gazette, December, 1926.
Murison, C. C.: Non-Diluted Milk for Infants. The Indian Medical Gazette, September, 1926.
Neff, Frank C.. and Dillon, T. C.: Lactic Acid Milk as an Additional Food for Young Infants. Journal Kansas City Medical Society, May, 1926.
Jones, Thomas D.: Feeding the Normal Infant the First Year. April, 1926.
DR. C. W. BEAMAN (Cincinnati, O.): I wish to commend Dr. Holman for his paper. It is very timely, and it is too bad that we do not have more time at our disposal for a long discussion of the subject. It occurs to me regarding his suggestion and in regard to acid milks that we have at our disposal the lactic acid milk and the protein milk, which are excellent if we understand how to use them.