infant feeding

infant feeding Mammals have existed on earth for around 200 million years. The first hominid mammals appeared about 5 million years ago, while the genus Homo is known to have existed for at least 2 million years. Our own species Homo sapiens sapiens appeared only in the last 150 000 or so, and some populations probably began the transition from hunter gatherer, hunter fisher to farmer during the last 12 000 years.

With animal husbandry came increased opportunities for feeding human infants on the milk of other mammals. Although it is likely that other lactating females in the tribe would provide for the needs of most orphaned infants, high maternal mortality would encourage the finding of alternative sources of milk. With the industrial revolution came increasing social pressures for women to work outside of the home and to use at first home made and subsequently commercially prepared substitute formulas for feeding their infants.

Earliest records of infant feeding practices date from about 3000 bc. The civilizations of Mesopotamia and Egypt were largely matriarchal and from the Old Testament Hebrew text we learn that the ability to suckle children was regarded as a gift from God. In the pre-Semetic Sumerian peoples of Mesopotamia the goddess Inanna was believed to protect the child throughout early life, and in ancient Egypt the goddess Isis is usually depicted nursing the infant king Horus. Much of our information about these early civilizations comes from the papyri of Ebers and Lesser Berlin (sixteenth century bc). Remedies recommended in these documents include rubbing the breasts with poppy plant whilst eating fragrant bread of soured Dourra to improve milk supply. To relieve breast pain it was recommended that a mixture of calamine, oxgall, fly dirt, and yellow ochre should be rubbed into the breast daily for four days.

Wet nursing

A Sumerian lullaby of the third millenium bc refers to the wife's nursemaid suckling the son of Shulgi, ruler of Ur. The Code of Laws of Hammurabi, Amorite king of Babylon, indicates that there were laws safeguarding arrangements between parents and employed wet nurses — probably one of the earliest examples of employment legislation.

From the Old Testament we learn that there was a search amongst Egyptian and Hebrew women for a wet nurse to feed the infant Moses rescued from his basket trapped in the bullrushes. We also learn that Deborah was the wet nurse to Rebecca and that Ruth gave her son to her mother-in-law Naomi to nurse.

Around the time of the birth of Christ it was clear from the contracts of wet nurses that they were usually, but not always, slave women. Some contracts specified for how long the child should be breast-fed by the nurse and from this information it was clear that up to 3 years was not uncommon but 16 months would be about the average length of contract. Hannah breast-fed her own son, Samuel, for three years and Isaac, son of Abraham, was weaned from the breast at 2 years. In Greek mythology Zeus was reported to have been suckled by the goat Amalthea, and Romulus and Remus, the founders of Rome in the eighth century bc, were thought to have been suckled by a she-wolf. Direct suckling from animals is well documented throughout recorded history and persisted in Europe into the twentieth century.

There is very little recorded about the views of Hippocrates, the father of modern medicine, on matters related to early infant feeding and it seems likely that records of his views on this topic have been lost or not recorded. Aristotle (384–22 bc), who was the son of a court physician but was not himself a physician, made several references to children and clearly indicated that breast-feeding should ideally commence on the first day, contrary to many earlier European and Asian reports which delayed suckling at the breast for 3–4 days. He also made the link between the duration of breastfeeding and menstruation; the longer the duration of suckling the greater the delay in the recommencement of menstruation (and therefore child-bearing). He also repeated the myth that breast milk (which was believed to be formed from menstrual blood diverted to the breast) produced after menstruation had recommenced was unfit for infant feeding. Soranus of Ephesus (ad 98–117) recommended that the newborn infant should be given boiled honey or honey and goat's milk during the first few days to help expel meconium from the infant bowel before giving the child to a wet nurse for feeding. He held the view that maternal milk was unwholesome for the first 21 days after birth. Galen (ad 130–200) recommended boiled honey for three days before allowing the mother to feed her infant, but only after she had expressed or allowed an older child to suckle her ‘first milk’. Thus the meddlesome interference by men in the natural feeding processes of mother and infant has a long and sorry history.

Emperor Tiberius was a drunkard and Caligula a cruel thug. History relates their behaviour to the fact that Tiberius had an alcoholic wet nurse and that Caligula's was spiteful, bloodthirsty, and smeared her nipples with blood. These views on the transference of character through the breast milk persisted throughout medieval times. During the sixteenth to eighteenth centuries in Europe understanding about the transmission of what we now know as venereal diseases and tuberculosis gradually improved, although it was not until the nineteenth century that Koch and Pasteur began to clarify the nature and basis of infections.

Artificial feeding

Feeding vessels such as terracotta feeding horns and horns of sheep and goats have been identified in infant graves from about 4000 bc and shown to contain residues of milk. Since then most societies have used horns of animals with the tips cut off and covered with parchment, leather, sponges, and cloths for infants to suckle. A variety of shaped containers and feeding spoons and cups were manufactured for feeding artificial milks and weaning foods. Many of these vessels undoubtedly transmitted infections to the infants resulting in disease and death. Even with modern plastic bottles and synthetic teats failure of hygienic cleaning and contaminated water supplies can prove lethal.

The unsatisfactory nature of animal milks for the human infant led to many experimentations in attempts to ‘improve’ or modify animal milks.

In an MD dissertation submitted in 1761 Thomas Young, later to become a Professor of Medicine in Edinburgh, reported on the admixture of alkali, gastric juices, and other chemicals to milk and the differences between fore-milk and after-milk. Pierre Budin in Paris in about 1860 used calf pancreatic extracts to ‘digest’ cow milk for feeding to the infants in his maternity hospital, as he was unable to obtain adequate supplies from wet nurses and the mortality from feeding untreated cow milk was horrendous. Infant morbidity and mortality in Europe during the late nineteenth century due to artificial infant feeding was similar to that found in developing countries today. Current commercially-produced infant formulas are subject to strict controls in terms of microbiological safety and chemical composition, but remain nutritionally inferior to the natural mother's milk in many respects. There are a number of identifiable health benefits to infants fed solely breast milk during the first months of life.

Weaning

A report on health and social subjects entitled ‘Weaning and the Weaning Diet’ published by a Working Group of the Committee on Medical Aspects of Food Policy of the Department of Health in England and Wales, defined weaning as the process of expanding the diet to include foods and drinks other than breast milk or infant formula. Weaning allows the infant to meet changing nutritional needs and to become less nutritionally dependent upon milk. In Egypt during Roman times weaning was usually commenced once the child was erupting teeth (6–8 months). Other foods, particularly animal milk and eggs, were introduced and the milk of camels, goats, sheep, and cows, together with fruit and vegetables, were the usual weaning foods. Corn and pulses are also mentioned in the Old Testament. Even in today's societies there are many different weaning practices dependent upon history, religious taboos, and the availability of nourishing foods suitable for infants. Continuation of breastfeeding during the weaning process contributes a degree of protection to the infant gastrointestinal tract whilst new foods and potentially infectious materials are introduced during the weaning processes. The modern view is that human milk is entirely nutritionally adequate for the first four to six months of life but thereafter other nutrients need to be introduced to the diet. The duration of breast-feeding is largely determined by the mother's and family's attitudes to child rearing and the financial, social, and educational status of the mother and society. The Department of Health report on Weaning and the Weaning Diet gives a view of the current weaning practices in the United Kingdom.

Forrester Cockburn

Bibliography

Fildes, V. A. (1986). Breasts, bottles and babies. Edinburgh University Press.
Still, G. F. (1996). The history of paediatrics. College of Paediatrics and Child Health, London
HMSO (1994). Weaning and the Weaning Diet. Report on Health and Social Subjects, Vol. 45. London.

See also breast; infancy; wet nurse.