TEETHING AND WEANING
TEETHING A NATURAL PROCESS—PUTTING THE BABY IN SHAPE TO TEETHE
EASILY—DENTITION TABLE—CARE OF THE FIRST TEETH—GRADUAL WEANING IS
SIMPLE PROCESS—ALTERNATE BREAST AND BOTTLE FEEDING—EVILS OF DELAYED
WEANING—DIET TABLES FOR CHILDREN FROM NINE MONTHS TO THIRTY-SIX MONTHS
One of those dear women who never master the art of taking comfort out
of life as they go along remarked to me recently:
“Well, I suppose there are some mothers who find pleasure in raising
children, but I’ve never had a care-free moment with mine. Just as soon
as I could draw a long breath because they had survived the first month
or so, I began to think about teething. When a couple of teeth were
safely through, along came weaning. And then measles——”
Yet this mother has raised four splendidly strong boys and girls, and
has never lost a child. Her husband would tell you that the family
doctor’s bills have been extremely small. Perhaps you think the
babies escaped illness because she worried over them and guarded their
health. Not at all! They were healthy, normal babies. If they had been
otherwise, the family doctor would literally have camped in her nursery.
The real trouble with their mother was that she did not recognize a
normal baby when she had one, and she did not consider teething and
weaning natural events or processes in a baby’s life. She could not
believe that it was possible to raise babies without fighting illness
in some form or another. She did not understand that her simple methods
of preventive medicine, the intelligent care of her children from
the day of their birth, insured normal digestion. With this health
insurance she had no need to fear “symptoms” or bad results from
teething and weaning.
The testimony of physicians who have specialized in the care and
feeding of children, and of mothers who have raised normal babies,
proves that both teething and weaning are normal and gradual operations
which do not seriously disturb the child’s health, if the digestion is
in good condition.
Teething in particular is often made the excuse or the cloak for
chronic disturbances of the digestion, which should have been corrected
long before the time for dentition arrived. The average child does
not cut its first teeth until the sixth month, yet it is not unusual
to hear a mother claim that an attack of indigestion, vomiting, or
diarrhea in a three months’ old child is due to the fact that teeth are
beginning to make trouble.
If the child is kept in all-round good condition, teething is merely a
part of its all-round development, no more troublesome than the growth
of the hair on the head, or the nails on the fingers. To the healthy
child, the cutting of each successive tooth may bring a trifling
irritability, restlessness or wakefulness for a few nights, and
drooling. The baby may even suffer from loss of appetite, a very slight
fever, light vomiting, or streaks of undigested food in the stools; but
these symptoms will last only a few days and the baby will recuperate
rapidly.
When the child is not in a healthy condition, and especially if it
is fed irregularly and improperly, these slight disturbances take on
a more serious form. The fever will run up to 101° or 102° F. The
child will be unable to retain food, and the vomiting will be severe.
Diarrhea next sets in, and the child is in a fair way to develop a
case of cholera infantum, the dread disease responsible for the high
death rate among children under one year of age. Summer complaint, as
it is commonly called, is not due to teething, however, but to the bad
condition of the digestive organs, which teething aggravates.
While it is important to guard the baby’s digestion always, it is even
more important to prepare his entire system for the process of teething
by setting the digestive organs in good order before—not after—the
process starts. Here, indeed, the proverbial ounce of prevention is
worth many pounds of cure. It is far easier to put stomach and bowels
into good shape before the first tooth appears than it is to check the
diarrhea which comes when the child’s digestion is too weak to meet the
slight added strain of dentition.
The first teeth appear some time between the fifth and ninth months.
These are the two central lower teeth. The average time of dentition in
a healthy child is six months. Generally these two teeth appear very
close together. Next, between the eighth and twelfth month come the
four upper central teeth. Between the twelfth and eighteenth month the
baby cuts two more lower central teeth, and four double teeth. Next in
order are the four canine teeth, the upper teeth in this set are known
as “eye teeth” and the two lower as “stomach teeth.” These should make
their appearance by the twenty-fourth month. Between this date and the
thirtieth month come the four back double teeth, which, according to
tradition, are the most difficult to cut. In reality, they give little
more trouble than any others, provided, of course, that the child is in
good condition.
The following is an average table of dentition:
At 12 months, six teeth.
At 18 months, twelve teeth.
At 24 months, sixteen teeth.
At 30 months, twenty teeth, or the complete set of first, or milk,
teeth, as they are sometimes called.
Various causes are assigned to delayed dentition or slowness in
teething. A prolonged and serious illness, or a case of rickets,
will delay the teething; and it is also said to be a matter of
family traits. In some families the children, whether bottle-fed or
breast-fed, teethe later than in others. As a rule, too, the breast-fed
baby teethes earlier and more easily than the bottle-fed baby, because
the breast milk keeps the digestion in a uniformly normal condition.
The mother who studies this table of dentition and the diet tables
on pages 109-111 will see that the cutting of the larger teeth, and
the change in diet from milk to foods that require chewing, come at
the same time, at eighteen months. If she will follow the directions
of the diet table, the baby will not suffer from the consequences of
overfeeding or of food that is too rich.
There is no way of hastening the process of dentition until the gums
become swollen and the child is irritated by the discomfort entailed.
Then the gums may be rubbed very gently several times daily with a
_clean_ piece of Turkish toweling twisted around the index finger.
The old habit of rubbing the baby’s gums with the bare finger, which
may or may not have been washed, is not sanitary, nor for that matter
does it assist the cutting of the tooth. But the moderate roughness
of Turkish toweling is helpful. Small squares of the toweling may be
kept in the baby’s basket for ready use. If the baby is feverish and
the gums are hot as well as swollen, they can be washed gently several
times daily with a soft bit of gauze dipped in water that has been
first boiled, then cooled in a sanitary vessel.
If the baby seems to find relief in biting on something hard, provide
an ivory ring or toy that can be washed. Never allow the child to put
the ring in his mouth after it has been dropped on the floor, or in
dust of any sort, until you have cleansed it again.
If the gums remain swollen and hard, and if such symptoms as fever,
vomiting, and diarrhea persist, have your physician examine the baby’s
mouth. If the gums need lancing, this may be done; but do not urge it
against the doctor’s better judgment. If the tooth is not close to the
surface, the gum will heal over after lancing and form a tough scar
more difficult to penetrate than the uncut flesh.
If your baby has a convulsion while teething, do not lay this acute
attack to the teeth. It probably springs from other causes and should
have the attention of the family doctor. Convulsions are not symptoms
of teething and they are serious enough to require immediate treatment.
As the health of the teeth is dependent upon cleanliness, they should
be kept clean from the day the first pearly point forces itself through
the gums. Up to this time the gums have been washed daily. Now a small,
very soft toothbrush, “baby size,” should be bought, and the teeth and
gums should be rubbed gently twice a day. By the time the child is
able to seize and guide the brush, he will find both satisfaction and
diversion in brushing his own teeth. The average child seems to be born
with a desire for self-expression, and the sooner he can be entrusted
with the proper care of his own body the better. The child who is
washed and has his teeth cleaned by another person, often against his
will, is seldom as clean a child as the one who is given to understand
that keeping himself clean is a privilege.
In brushing these first teeth, it is not necessary to use any powder
or paste on the brush; but a mild antiseptic solution, like listerine
or glycothymoline, may be added to the water. As the little jaws fill
up with teeth, their general condition must be watched closely for two
reasons: first, because the condition of the teeth may be a symptom of
constitutional disorder; second, because the health of the second or
permanent teeth is largely dependent upon the condition and care of the
first teeth.
The teeth should be brushed up and down as well as from side to side.
The gums should be thoroughly cleaned, and the child should be taught
to rinse the mouth well.
Watch for signs of decay. It is astonishing how soon these appear,
especially if the diet is not what the child needs. Decay springs from
three causes: uncleanliness, a diet which lacks bone-making properties,
and disuse. The tiny brush will keep the teeth clean. If the diet
tables given in this book are followed, the bones and the teeth will be
properly nourished. The average mother makes the mistake of not giving
the teeth enough work to do.
Dogs and all animals which chew on bones have hard, strong teeth. Human
beings who eat food that requires slow, persistent mastication, such as
hard tack, tough meats, etc., develop strong and generally sound teeth;
while the more civilized races and the privileged few who eat prepared
foods or the most delicate and tender of meats, sauces, etc., are the
dentist’s best-paying patients. If the mother puts this theory into
practice and gives her child’s teeth work to do, she will help harden
the teeth and prevent their decay.
Especially after the fourteenth month, the diet must include broths
made from meat, eggs, vegetables and fruits, plenty of starch and
fats, with little sweets. Candy is especially bad for the teeth. Bread
toasted in the oven, zwieback, and hard crackers should partially
supplant cereals and mush. When the child is old enough to be fed meat,
either chicken, lamb chop, or beefsteak broiled, may be scraped or
minced away from the bone, and then the bone itself be given to the
child to “pick.” The little teeth will thus have fine exercise.
The habit of swallowing solid food whole, gulping it down with water or
milk, is dangerous to the teeth as well as to the stomach. If the child
shows a tendency to do this, do not serve liquid food and solid food at
the same time. Teach the baby by example to eat slowly and masticate
each bite thoroughly.
If the first teeth are discolored and irregular, or if they decay
early, have a dentist look them over. It may be necessary to treat them
and have them filled long before time for the second set to appear.
If decayed first teeth are permitted to remain in the jaw, or if they
are drawn too soon, the second teeth will be unhealthy or irregular in
shape and position.
Weaning is a process which frequently accompanies the first period
of dentition—by which I mean the last three months of baby’s
first year, during which time he will probably cut six teeth. The
combination of teething and weaning, however, is not so fearsome as it
sounds—provided, of course, that the baby has been properly nourished
and is developing along normal lines.
Most of us can look back to the day when weaning the family baby
was almost a domestic tragedy. The mother, more through fear than
sentiment, wept and declared that, once her child did not nurse from
the breast, life would never be quite the same! The baby would grow
away from her! The entire family watched the process in awe, wondering
whether baby would survive the sudden change of diet.
And in that word “sudden” lay all the dread possibilities for both
mother and child. Fortunately, we have outgrown sudden weaning, along
with many other dangerous superstitions and traditions of motherhood.
In those days, when grandmothers and aunts came flocking round to
assist in weaning the family treasure, babies were fed on breast
milk from birth to practically the day when weaning became a stern
necessity. Consequently, the enforced weaning represented for the baby
an abrupt change in diet, which was most disturbing to his stomach;
and for the mother all the horrors of breast-trouble when the baby
no longer nursed. Artificial pumping, caked breasts, abscesses, were
common features of the old-fashioned system of weaning, which the
modern mother does not undergo.
To-day the wise physician and mother agree that, from the third
month on, the baby shall vary breast feedings with properly modified
cow’s milk from the bottle. As the months pass, the bottle feedings
are increased. Then, no matter what emergency may arise—illness or
pregnancy in the mother, the necessity for a prolonged separation
between mother and child—the baby is so accustomed to the bottle
that, deprived of natural nourishment, he will not resent bottle food
exclusively, and his entire digestive system is at least partially
prepared for the change.
When weaning is not due to emergency, but is gradual and part of the
natural development of the child, it is a very simple process. From
the third to the tenth month, we will say that the child has had both
breast milk and the occasional bottle feeding. Gradually, from the
sixth month on, the bottle feedings have been increased in both number
and strength. Now, at the tenth month, he may drink milk, orange juice,
and clear broth out of a cup. His cereal and thick broth may be fed to
him with a spoon. All this time he draws less and less on the mother
for nourishment. By the twelfth month, or the end of his first year, if
his health is good, the baby is weaned automatically without any abrupt
and dangerous change in diet.
During the latter part of this gradual weaning process, as he has drawn
less on the breast, the amount of milk has decreased with the lack of
demand, and so the weaning involves less danger and pain for the mother.
Very few mothers have the strength to nourish their babies after the
twelfth month. In fact, pediatrists and nurses who have done dispensary
work among children state that many cases of anemia and rickets can be
traced to poor nourishment, due to the overworked mother’s well-meaning
but mistaken effort to nurse the baby, without any bottle feedings,
through teething, and beyond the first year.
The bottle-fed baby must be weaned from the bottle in the same
gradual way. At nine months, if he is in good condition, and the
artificial food is properly digested, he may be fed partly from cup
or spoon at each feeding. The modified milk fed in the bottle should
be divided—half should be served first from the spoon or cup, while
the baby is hungry enough to accept food in any form, by any means.
Then the second half of his feeding may be given from the bottle. If
he is given the bottle first and his hunger is partly satisfied, he
will resent the new form of feeding, which is slower and therefore
less pleasing to his small majesty. At a year, he is given one entire
feeding with cup or spoon, preferably the midday meal. This replaces
one bottle feeding. The spoon and cup feedings are then increased
gradually and the bottle feedings are decreased. At fourteen months,
he gets two meals of spoon food and three bottle feedings; at sixteen
months, three spoon and cup meals a day, and a bottle at 9 or 10 at
night; at eighteen or twenty months, the night bottle is stopped. The
baby is safely weaned.
The triumph of modern weaning is due entirely to the fact that it is a
natural, gradual process, in contrast to the more abrupt and drastic
changes under the old-fashioned methods.
The following diet list, which will serve to guide the mother in
carrying her child safely through the joint process of teething and
weaning, is used in private practice by Roger H. Dennett, M.D.,
Professor of Pediatrics in the Post Graduate Hospital of New York:
DIET FOR CHILD
FROM NINE OR TEN MONTHS TO THIRTEEN OR FOURTEEN MONTHS:
6 A.M. Bottle feeding of undiluted, unsweetened cow’s milk, or
Breast feeding when there is an ample supply of milk, or
Drink of milk from the cup.
9 A.M. Cereal and drink of milk from the cup; varying
the cereals with Farina, Cream of
Wheat, Wheatina, Oatmeal, Ralston’s Food,
Hominy, Rice, Cornmeal-mush, and Cornstarch.
12 Noon. Same as 6 A.M.
3 P.M. Toast, stale bread, or zwieback, and drink of milk
from cup.
6 P.M. Same as 6 A.M.
9 or 10 P.M. Same as 6 A.M.
Orange juice or scraped raw apple may be
given between the feedings.
FOURTEEN MONTHS TO EIGHTEEN MONTHS
7 or 8 A.M. BREAKFAST: Cereal, bread or toast; cup of
milk. The cereal may be varied as above.
10 A.M. Scraped raw apple, pear or peach, or orange
juice. Avoid skins and seeds.
12 or 1 P.M. DINNER: An egg; potato; one other vegetable;
bread; fruit juices or scraped fruit. The
egg may be coddled, boiled, shirred, or
poached. Potatoes may be baked, boiled,
or mashed; preferably baked. Spinach, carrots,
peas, string beans, asparagus tips, all
cooked soft and mashed fine, may be used.
Once or twice a week soups may be substituted
for the egg, thickened with peas,
beans, farina, sago, rice, or vegetables.
For dessert, apple sauce, baked apple, prune
pulp, or cooked fruit.
5 or 6 P.M. SUPPER: Eight ounces of undiluted milk from
the cup, bread, toast or zwieback, Graham
or arrowroot crackers.
10 P.M. (If desired) Eight ounces of undiluted milk.
EIGHTEEN MONTHS TO THREE YEARS
7 or 8 A.M. BREAKFAST: Cereal; egg; stale bread or toast;
dry bacon.
12 to 1 P.M. DINNER: Meat; potatoes; one vegetable; dessert.
A small quantity of meat, such as
scraped beef, lamb chop, roast beef, roast
lamb, Hamburger steak, all cooked rare and
cut fine. The roast may be hot or cold.
Chicken, boiled, fricasseed, or roasted, may
be given. Occasionally soups as described
above may be given instead of meat, but
they do not take the place of meat. Vegetables,
such as carrots, spinach, green peas,
string beans, squash, and macaroni. The
dessert may be of apple sauce, baked apple,
prune pulp, stale lady fingers, Graham or
arrowroot crackers, rice, bread, tapioca or
blanc-mange pudding, baked custard, junket,
or rice with hot milk.
5 to 6 P.M. SUPPER: Stale bread or toast, unsweetened
crackers; milk; fruit, raw or cooked. Clear
broth or cereal may be given occasionally
instead of the milk.
This diet list will meet the needs of normal, healthy babies only. It
is not intended as a guide to the mother of the extremely delicate
baby, nor will it serve when the child has shown from birth a tendency
to anemia, malnutrition, or chronic digestive disturbances, like
constipation or diarrhea. Such cases are individual or abnormal, and
require medical attention. No general diet will serve for such babies,
who should be under the care of a child-specialist.