711 
at night permits her to continue lactation long after the time she 
would otherwise have to abandon it. 
Mode of giving the child the breast. — It is surprising to note the 
ignorance of some mothers even in such essential details as this. It 
is, therefore, necessary to see that the breast is properly presented to 
the child. The child should be held in such a position that it can 
seize squarely upon the nipple, which should not be presented ob- 
liquely to it. It is important to avoid pressing the child’s nose into 
the breast, in order to allow it free respiration. 
Signs of successful breast feeding. — The child who is receiving 
adequate nourishment from the breast performs all its functions with 
the optimum of regularity. Its sleep is peaceful, its appetite is keen, 
and it presents a general appearance of contentment and bien etre. 
The bowel movements are free, and consist of two or three golden, 
smooth, salve-like discharges a day. The urine is odorless, limpid 
and adequate in amount. The body tissues are firm and elastic, and 
their outlines plump and rounded. Most important of all, the child 
gains steadily and constantly in weight. If an infant cease to gain 
in weight something is always wrong. On the other hand, sudden 
and abnormal gains in weight point to excessive overfeeding, and re- 
quire a reduction of the nourishment in amount. 
After the initial loss following birth has been regained, the average 
healthy child increases in weight during the first three months from 
120 to 150 grams (.4 to 5 ounces) every week and from the third to the 
sixth month from 100 to 120 grams (3J to 4 ounces). The effect of 
these increases is to double the initial weight at six months, and to 
treble it at the close of the first year. Large children gain absolutely 
but not relatively greater weekly amounts than the small. This rate 
of gain may be considerably increased within physiological limits, 
the main indication of abnormality being a wide departure from a 
rate of gain previously observed. To this end infants should be 
regularly weighed on sets of scales sensitive to 15 grams (-J ounce). 
A careful record of the weight should be kept. 
Signs of inadequate nursing. — The early detection and diagnosis 
of abnormalities in the quality and quantity of the milk furnished 
by the mother is imperative; for, unless corrected, they are fraught 
with danger to the child. While nothing can take the place of good 
natural nursing, and while poor artificial feeding is the very worst 
method of infant nutrition we have, poor maternal nursing is an 
inferior alternative to good artificial feeding. We should, there- 
fore, endeavor to discover the difficulty as soon as possible in order 
that hasty weaning of the child should not take place when the 
symptoms are unconnected with the food, or the indigestion from 
which it is suffering is due to causes temporary or remediable. On 
the other hand it is obvious that, if from every symptom maternal 
