170
Letters to the Editor
and bottle-fed infants wake during the night at some point in their development, it would appear that night waking in human infants is as natural as it is in other mammals. The rat feeds only once a day and the kangaroo joey never lets go of the teat, but most mammals are somewhere in between, on and off the mammary gland throughout the 24-hour period. There is implicit in the discussion of night waking, the idea that something sacred and healthful will occur if the mother (and the infant) sleep eight straight-through hours. If one asks nonWestern women how they feel about night waking they often find the question puzzling. If asked what they do when wide awake after nursing, they simply remark, "Go back to sleep." I would suggest that the problem is in the expectations and anxieties of our culture about sleep. We all know that after a while infants stop waking and that the milk supply eventually responds only when the breast is sucked by the infant. So it all works out in the end. I reckon the problem to be centered right in the middle of an alarm clock. It certainly reflects a social system so arranged that women have to be up to serve breakfast, run all the household errands, clean, wash, cook, baby tend, etc.-without the support of others. These are the culprit facts which make night feeding a problem. The infant and mother have very little to do with it. Dana Raphael, Ph.D. Director The Human Lactation Center Ltd. 666 Sturges Highway Westport, Conn. 06880 REFERENCE
1. Carey WB: Breast feeding and night waking, J PEDIATR 87:327, 1975.
Repty To the Editor: The comments of Dr. Raphael are of limited value because he (or she) has misread the content and intent of nay letter ' and is evidently unfamiliar with the original paper ~ to which it was an addendum. The interested reader can verify for himself that I said nothing about the mother-infant interaction in respect to night waking spoiling the child or negatively affecting his personality and nothing about nutritional inadequacy of breast milk. What I did say was that night waking involves about a quarter of infants between six and 12 months and is significantly correlated with a low sensory threshold and with breast feeding. I should now add that, although some mothers report that they enjoy getting up at night to feed their babies and others tolerate night waking without complaint to the doctor, most mothers have told me that they do not like it. They wish it would stop and ask for help. They know that most infants are sleeping through by then and do not really need night feedings. Furthermore, some of these babies wake up and cry not just once but as much as every hour or two all night for several weeks. When night waking
The Journal of Pediatrics January 1976
makes parents overtired or concerned, there is a problem for the family and the pediatrician. William B. Care v, M.D. 319 W. Front St. Media, Pa. 19063 REFERENCES
1. Carey WB: Breast feeding and night waking, J PEDIATR 87:327, 1975. Carey WB: Night waking and temperament in infancy, J PEDIATR 84:756, 1974.
Insect sting emergency first-aid kits To the Editor: Recently I have been engaged in a seemingly one-man crusade against inadequate knowledge of the use of the emergency insect sting first-aid kit, and also against its being unavailable to those who should have it on hand in case of a severe insect sting reaction. For example, the following groups of persons usually do not have the kit nor the knowledge of its use, and yet they are more likely to be faced with this situation: school nurses o r principals, forest rangers, scout masters, golf pros, swimming instructors, and tennis pros. I feel that some deaths could have been prevented by making this kit available to these people, with instructions for its use. I have been given to understand that it is against the law for these persons to give injections and yet we physicians give insect sting kits to our insect allergy patients and train them in their use. I think that the law should be changed. These people should be trained in the use of the emergency insect sting kit and allowed to give the medication in cases of a life-or-death situation. I hope others feel the same as I do and will help to get the laws changed so that this can be done. I know of two instances where the use o f this kit could have prevented death in the individual who suffered the severe reaction. I would appreciate hearing from others who know of similar cases in which the use of an insect sting kit would have prevented the death of a person. Claude A. Frazier, M.D. Doctors Park, Bldg. 4 Asheville, N. C. 28801
Repty Dr. Paul Lietman was asked if he would care to comment on the above letter. His response is below.
To the Editor: The idea presented by Dr. Frazier is an interesting and provocative one, deserving of our consideration. The solution to the
Letters to the Editor
and bottle-fed infants wake during the night at some point in their development, it would appear that night waking in human infants is as natural as it is in other mammals. The rat feeds only once a day and the kangaroo joey never lets go of the teat, but most mammals are somewhere in between, on and off the mammary gland throughout the 24-hour period. There is implicit in the discussion of night waking, the idea that something sacred and healthful will occur if the mother (and the infant) sleep eight straight-through hours. If one asks nonWestern women how they feel about night waking they often find the question puzzling. If asked what they do when wide awake after nursing, they simply remark, "Go back to sleep." I would suggest that the problem is in the expectations and anxieties of our culture about sleep. We all know that after a while infants stop waking and that the milk supply eventually responds only when the breast is sucked by the infant. So it all works out in the end. I reckon the problem to be centered right in the middle of an alarm clock. It certainly reflects a social system so arranged that women have to be up to serve breakfast, run all the household errands, clean, wash, cook, baby tend, etc.-without the support of others. These are the culprit facts which make night feeding a problem. The infant and mother have very little to do with it. Dana Raphael, Ph.D. Director The Human Lactation Center Ltd. 666 Sturges Highway Westport, Conn. 06880 REFERENCE
1. Carey WB: Breast feeding and night waking, J PEDIATR 87:327, 1975.
Repty To the Editor: The comments of Dr. Raphael are of limited value because he (or she) has misread the content and intent of nay letter ' and is evidently unfamiliar with the original paper ~ to which it was an addendum. The interested reader can verify for himself that I said nothing about the mother-infant interaction in respect to night waking spoiling the child or negatively affecting his personality and nothing about nutritional inadequacy of breast milk. What I did say was that night waking involves about a quarter of infants between six and 12 months and is significantly correlated with a low sensory threshold and with breast feeding. I should now add that, although some mothers report that they enjoy getting up at night to feed their babies and others tolerate night waking without complaint to the doctor, most mothers have told me that they do not like it. They wish it would stop and ask for help. They know that most infants are sleeping through by then and do not really need night feedings. Furthermore, some of these babies wake up and cry not just once but as much as every hour or two all night for several weeks. When night waking
The Journal of Pediatrics January 1976
makes parents overtired or concerned, there is a problem for the family and the pediatrician. William B. Care v, M.D. 319 W. Front St. Media, Pa. 19063 REFERENCES
1. Carey WB: Breast feeding and night waking, J PEDIATR 87:327, 1975. Carey WB: Night waking and temperament in infancy, J PEDIATR 84:756, 1974.
Insect sting emergency first-aid kits To the Editor: Recently I have been engaged in a seemingly one-man crusade against inadequate knowledge of the use of the emergency insect sting first-aid kit, and also against its being unavailable to those who should have it on hand in case of a severe insect sting reaction. For example, the following groups of persons usually do not have the kit nor the knowledge of its use, and yet they are more likely to be faced with this situation: school nurses o r principals, forest rangers, scout masters, golf pros, swimming instructors, and tennis pros. I feel that some deaths could have been prevented by making this kit available to these people, with instructions for its use. I have been given to understand that it is against the law for these persons to give injections and yet we physicians give insect sting kits to our insect allergy patients and train them in their use. I think that the law should be changed. These people should be trained in the use of the emergency insect sting kit and allowed to give the medication in cases of a life-or-death situation. I hope others feel the same as I do and will help to get the laws changed so that this can be done. I know of two instances where the use o f this kit could have prevented death in the individual who suffered the severe reaction. I would appreciate hearing from others who know of similar cases in which the use of an insect sting kit would have prevented the death of a person. Claude A. Frazier, M.D. Doctors Park, Bldg. 4 Asheville, N. C. 28801
Repty Dr. Paul Lietman was asked if he would care to comment on the above letter. His response is below.
To the Editor: The idea presented by Dr. Frazier is an interesting and provocative one, deserving of our consideration. The solution to the
![Insect sting allergy kits [letter].](/assets/img/hold.png)
