THE NUTRITION OF MOTHER AND BABY
Perhaps you are wondering, just a little, why I devote even a short
chapter to the subject of nutrition when I have already given you
suggestions about dietaries for yourself and your baby. I am doing so
because this question of nutrition is one of such enormous importance in
relation to the baby’s future well-being that I want to give it special
emphasis.
It is probably safe to say that the two most influential factors in
creating and maintaining a satisfactory state of health are suitable
nutrition and the prevention of infection. Although we shall concern
ourselves solely with nutrition, in this chapter, it may be stated in
passing that a state of good nutrition goes far toward protecting one
from infection.
It will help to make the entire matter clearer to explain in the
beginning that a state of good nutrition is not necessarily evidenced by
one’s being tall nor by being fat. But it is evidenced by normal size
and development; sound teeth and bones; hair and skin of normal color
and texture; blood of the normal composition; stable nerves; vigor both
mental and physical; normally functioning organs; resistance to disease,
and above all that indescribable condition which is summed up as a state
of general well-being.
That this degree of nutritional stability is not as prevalent in this
country as might be desired is disclosed by reports upon findings of the
examining boards for army service, over a period of three years, and
physical examinations of various groups of school children throughout
the country. It was found in the first case, that about sixteen per
cent. of the apparently normal young men who were inspected for military
service, were undernourished in some degree, and according to Dr. Thomas
W. Wood, Professor of Physical Education, Columbia University, “Five
million children in the United States are suffering from malnutrition.”
This army of undernourished children, which represents about one third
of the children of the country, is on the broad highway to ill health,
invalidism of various kinds and degrees, instability and inefficiency.
They are certainly not developing into the clear-eyed, alert, buoyant
individuals that go to make up good citizenry.
The tragic aspect of this state of undernourishment is that though a
great deal can be done to nourish and build up the malnourished child or
adult, a certain amount of damage that results from inadequate
nourishment during the early, formative weeks and months cannot be
entirely repaired later on in life.
As the baby grows and develops, certain substances are needed at the
various stages of his progress, and if these are not supplied at these
stages, there will always be some degree of inadequacy in the adult make
up. It is much like the futility, when building a house, of using bricks
without straw for the foundation instead of firm, durable rock, and then
trying to make the structure substantial and secure later on by using
good materials when building the upper stories.
The solid foundation and substantial beams and girders for men and women
are put in during infancy and early childhood in the shape of good
material that forms good nerves, muscles, bones, teeth and general
physical stability. It is practically impossible to make up to the older
child or adult for damage caused by failure to supply sufficient
nourishment to the growing, developing, infant body.
“The moving finger writes; and, having writ,
Moves on; nor all thy piety nor wit
Shall lure it back to cancel half a line,
Nor all thy tears wash out a word of it.”
We see all about us, the results of this form of neglect of babies, in
the bow-legged, knock-kneed, undersized, misshapen, chicken-breasted
adults and in those who are nervous and below par in endurance; are
susceptible to colds and other infections and may be summed up as being
“not strong.”
The reasons for much of the undernourishment among people in this
country to-day are to be found in certain widespread misconceptions of
long standing as to what constitutes a state of good nutrition or
malnutrition and the value and purposes of different foodstuffs. For
malnutrition does not necessarily describe a simple condition due to an
insufficient amount of food, but to any one of several complex
conditions due to a lack in the food of one or more essential
substances.
One may eat a large amount of food and even have a well-padded body and
yet be seriously in need of certain food factors—in other words, be
incompletely nourished in some particular.
That was possibly the first misconception—the belief that one simply
needed enough food, and accordingly was well nourished if three large
meals were eaten daily, irrespective of the composition of those meals.
A step forward was taken when housewives and people generally accepted
the fact that quantity alone was not enough to consider in providing
food, but that the dietary should consist of balanced amounts of the
five food materials: fats, carbohydrates, proteins, minerals and water,
in order to build and maintain the body in a state of health.
But this, too, was found to be an error, in so far as it was only a part
of the truth, for it was next ascertained that even provision for a
suitable balance of the five food groups was not enough to nourish us,
but that we must consider the heat-and-energy-producing properties of
these component parts, as measured by the caloric unit, and that we must
daily take in the requisite number of calories if we would keep our
engines going.
It is now known that even this is not enough, for we may eat food in
ample quantities, consisting of the properly balanced fats, proteins,
carbohydrates, minerals and water, and it may daily yield the required
number of calories, and still we may suffer from seriously faulty
nutrition.
We find an explanation for this fact in the comparatively recent
recognition of three substances, as yet not clearly understood, which
are contained in a certain few articles of food, each one of which is
essential to growth and normal health and well-being, though not
necessarily concerned in the production of heat or energy. Various terms
have been applied to these mysterious, but necessary substances, such as
_vitamines_, _accessory food substances_, as applied to all, or
fat-soluble A, water-soluble B and water-soluble C to designate them
separately.
A surprisingly small amount of each of these substances is sufficient to
meet the needs of an individual, but no one of these, even in this small
amount, can be safely dispensed with, for if the diet is deficient, or
lacking in one or more of them some form of nutritional disturbance will
result. It may be severe enough to be diagnosed as a disease, or it may
be only enough to keep the individual below a normal state of health.
When the disturbance is profound enough to produce a definite,
recognizable condition, it is designated as a deficiency disease, of
which there are three: scurvy, beri-beri and xerophthalmia. With these
are sometimes included rickets and pellagra. The exact cause of the two
latter disorders is not definitely known but both are associated with
faulty nutrition. Poor hygienic conditions may enter into the causation
of rickets, and infection may be a factor in the occurrence of pellagra,
but neither disease appears in people who are suitably fed while both
diseases may be produced by faulty diet and both may be cured with
suitable food.
But probably of graver importance to the public welfare than the well
defined nutritional disturbances, themselves, is the fact that between a
state of good health and the level upon which a disease is recognizable
is a long scale, along which is ranged an uncounted army of under-par,
half-sick people. These are the ones who are tired, nervous, susceptible
to infections, with feeble recuperative powers, and in general are more
or less ineffective in the business of life.
It is this borderline state, or as Dr. Goldberger terms it, “the
twilight zone,” which cannot quite be called disease but is not health,
that is serious to the masses, for diagnosed disease is given treatment,
but nervousness, lack of energy and endurance, weakness and inefficiency
are not treated; as a rule they are merely tolerated. The sufferers fail
to reach their highest possible development and they fail to be of
highest value to society.
This is the condition which can be so largely prevented by giving the
baby a good nutritional foundation. This must be started during his
prenatal existence, carried through the nursing period and then
continued throughout the rest of his life.
It will mean much to the coming generation if the expectant and nursing
mothers at large are able so to compose their diets that they will
provide not only the requisite fats, proteins, carbohydrates, minerals
and water and yield the necessary calories, but will contain, also, all
three protective substances: fat-soluble A, water-soluble B and
water-soluble C. It can be demonstrated that when these food factors are
not present in the mother’s diet, they will not appear in her milk, and
accordingly will not be supplied to her baby.
That is the crux of the whole question. If your diet is faulty, your
milk will be faulty in the same respect and your baby, being
incompletely nourished, will start life with tissues that are lacking in
those substances that are needed to make them sound and to promote
health. That is what we have in mind when we say that the mother’s milk
must be satisfactory not alone in quantity but in quality as well, if
the baby is to be well nourished.
In order to make quite clear how damaging are the results of diets which
are deficient or lacking in protective substances we shall have a word
about rickets and scurvy, the two diseases due to faulty diet, that are
so serious for babies.
=Rickets= is a nutritional disturbance, common among babies who are fed
solely or continuously on heated milk, either boiled or canned, and on
proprietary food and sweetened condensed milk. Rickets may develop,
also, among nursing babies whose mothers are on faulty diets.
The chief characteristics of the disease are arrested growth and
softening of the bones, with dwarfism and deformities as a result. It is
essentially a disease of infancy, occurring as a rule, between the
fourth and eighteenth months but some of its unfavorable effects, such
as bone deformities and poor resistance to disease, may persist
throughout life. Although babies rarely die of rickets alone, it is one
of the most serious of all health problems since it predisposes to such
diseases as bronchitis, pneumonia, tuberculosis, measles and whooping
cough and in general greatly weakens the powers of resistance and
recuperation.
The common, early symptoms of rickets are irritability; restlessness,
particularly at night; a tendency to have convulsions from very slight
causes; digestive disturbances and profuse perspiration about the head.
The baby may be fat, but is likely to be flabby and have a
characteristically white, “pasty” color. The fontanelles are large and
late in closing; the abdomen is large and the chest narrow; teething is
usually delayed and the teeth may be soft, when they do come in, and
decay early. But the most conspicuous effect of rickets is upon the
bones which are soft, easily bent and broken and often misshapen. Their
growth is likely to be retarded and the ends of the long bones may be
enlarged, causing swollen wrists and ankles and the little lumps on the
chest, so commonly called a “rickety rosary.” The bones in the arms and
legs may become curved as the baby lies or sits in his crib, making him
either bow-legged or knock-kneed. Since the soft bones are easily bent
their deformity is increased by the baby’s walking or by the bunch which
may be formed between the thighs by a large, improperly applied diaper.
The spinal column may be curved, or too weak to permit the baby to sit
straight or stand alone. The entire chest wall is often deformed,
producing the familiar “chicken-breast” and so decreasing the size of
the chest that the baby’s breathing space is cut down. This is one
reason why pneumonia is so serious with a baby who has, or has had
rickets. The forehead is prominent and the whole head looks square and
larger than normal, while the pelvic deformities in girl babies often
give rise to very serious obstetrical complications later in life.
All of this, with the misery which it entails, is due to faulty
nutrition.
The sovereign remedies in rickets are cod-liver oil and sunshine, in
addition to general good care. But the treatment is a long, slow
process, taking from three to fifteen months, and it is doubtful if the
damage which the disease works can ever be repaired.
Rickets is more common during the cold months of the year, winter and
spring, than during the milder summer and autumn seasons. A possible
explanation for this lies in the higher value of the cows’ food during
the warm months when green things form the diets of animals. Since it is
now recognized that milk is not a constant product, but that its
properties vary with the food of the animals that produce it, cows’ milk
would be favorably influenced by their being put to pasture.
Similar evidence of such an influence is seen in the fact that although
rickets is not seen among breast-fed babies whose mothers are on
satisfactory diets, it may and does occur in breast-fed babies who are
nourished by mothers who are, themselves, on dietaries which are poor in
milk and fresh fruit and vegetables.
It is quite plain that a baby who is fed and cared for in accordance
with the suggestions offered in the preceding chapters is not likely to
develop rickets.
=Infantile scurvy= is seen among babies who are fed solely on milk that
has been heated, boiled, pasteurized or canned, since the vitamine, in
milk, that prevents scurvy is practically destroyed by heating or aging.
That is one reason why it is dangerous to give stale milk to babies and
why you should not use canned milk on your own responsibility. If the
doctor orders it for your baby, he will know what to give in addition to
the milk to keep the baby from having scurvy.
The disease develops slowly, the first symptoms appearing between the
seventh and tenth months. Tenderness or pain in the legs is perhaps the
most common symptom and may be detected first by the baby’s crying when
his diaper is changed or his stockings put on. And a baby who has been
cheerful, playful and active will prefer to lie quietly and will cry
whenever he is touched. He grows pale, listless and weak and fails to
gain in weight or length. His large joints are likely to be swollen and
tender; his swollen gums may bleed; his urine be diminished in amount
and contain blood. But it is entirely possible for a baby to be in
serious need of the vitamine that prevents scurvy and still not present
these well defined symptoms of the disease. In such a case there may be
stationary weight, fretfulness, a muddy complexion and perhaps
tenderness of the bones.
Scurvy, of itself, does not often cause death among babies, but it is
serious, nevertheless, for it makes the babies very susceptible to
infection, particularly nasal diphtheria and “grip.”
The disease may be either prevented or cured by giving orange juice,
potato water, spinach or tomato juice to a baby whose diet consists of
milk that has been heated and is therefore lacking in the vitamine that
prevents scurvy.
Although scurvy is seldom seen in breast-fed babies it is believed that
an infant who is nursing at the breast of a woman whose diet is lacking
or deficient in fresh milk, oranges and leafy vegetables will suffer a
certain degree of starvation and thus be sickly and susceptible to
infection without actually having scurvy.
The significance to you, of this complicated and enormously important
question of nutrition may be summed up as follows:
1. There are five recognized diseases resulting from faulty nutrition,
which may be either prevented or cured by a diet which contains
the protective substances, called vitamines, which are now
regarded as essential to normal growth, development and
well-being.
2. These essential substances are not necessarily provided in adequate
amounts by a diet that is satisfactory in bulk or in its balance
of fats, carbohydrates, proteins, salts and water or that yields
the requisite number of calories. The familiar diet of meat,
potatoes, peas, beans, bread, pie and coffee is so far from
providing complete nourishment that those who are limited to it
are in a state of partial starvation.
3. Although the breast tissues are capable of converting into milk
certain substances which they extract from the blood, they cannot
create the protective substances which we have been considering.
They can merely excrete these substances if they are contained in
the mother’s diet. The absence, or shortage of these food
essentials in the mother’s diet, and therefore in her milk, may
result in rickets or other malnourished conditions in the baby,
or in a degree of faulty nutrition which is not marked enough to
be diagnosed, but enough to keep him frail; enough to give him
the poor start that is so likely to put him, ultimately, in the
class of those adults who are more or less unfit, though not
actually ill.
4. The great protective foods are milk and leafy vegetables and any
diet which is poor in these is incapable of nourishing
satisfactorily.
By =milk= we mean fresh milk, first and foremost and also cream, butter,
buttermilk, cream soups and sauces, custards, ice-cream and all dishes
and beverages made of milk.
By =leafy vegetables= we mean lettuce, romaine, endive, cress, celery,
cabbage, spinach, onions, string beans, asparagus, cauliflower, Brussels
sprouts, artichokes, beet greens, dandelions, turnip tops and the like.
Other foods which are rich in protective substances are fresh fruit,
egg-yolks and glandular organs, as liver and sweetbreads.
Nearly all of the common foods are deficient in some respect, but
as the shortcomings of the various groups are different, we can
arrange entirely satisfactory diets by combining foods which
supplement each other’s deficiencies. This explains to us why the
meat-potato-peas-beans-bread-and-pie type of meals fail to supply
adequate nourishment. These foods belong in the same general group
and are deficient in about the same kind of food factors, thus
tending to duplicate, rather than supplement each other.
If such a fare is enriched by the addition of the protective foods, milk
and leafy vegetables, we have a well rounded diet in which the
deficiencies of one group of foods are supplied by the properties of the
other groups. In fact, it is only by such a supplementing combination
that an entirely satisfactory diet can be secured.
It is generally agreed that the two big problems of babyhood are proper
nutrition and the prevention of infection, but nutrition is perhaps the
greater problem, since any form or degree of malnutrition lessens the
baby’s powers to resist and to recover from infection. Whether
breast-fed or bottle-fed, therefore, it is imperative that the baby be
nourished in the complete sense of being given all of the food materials
which are essential to normal growth, development and protection against
disease.
If your baby is artificially fed on milk that has been heated you will
understand why the doctor adds such protectives as cod-liver oil and
orange juice, since the protective properties of milk are impaired by
heating. If he is breast-fed, you will be able to supply to your baby
the requisite nourishment and protective substances only if you yourself
are adequately nourished and in good condition.
That is the point of this discussion; the fact that you must be on a
satisfactory diet or you cannot satisfactorily nurse your baby.
Satisfactory nursing means to give to your baby, from the beginning,
through your milk, the materials necessary to build well and securely
that temple, in the form of his body, which he will occupy throughout
life; a structure so substantially built, from the foundation up through
each successive stage, that it will be able to withstand the attacks of
disease and weather the inevitable storm and stress of life, for perhaps
even more than the allotted three score years and ten.
“The race marches forward on the feet of little children.”
------------------------------------------------------------------------
TRANSCRIBER’S NOTES
1. Silently corrected obvious typographical errors and variations in
spelling.
2. Retained archaic, non-standard, and uncertain spellings as printed.
3. Re-indexed footnotes using numbers.
4. Enclosed italics font in _underscores_.