CHAPTER VIITEETHING 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
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
Oneof 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’sbills 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 thesixth 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 digestionalways, 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.
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 acleanpiece of Turkish toweling twisted around the index finger. The old habit ofrubbing 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. Convulsionsare 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, andhard 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 bottlefeedings 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 nourishtheir 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 atnight; 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
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.