The Care and Feeding of Children - L. Emmett Holt (chrysanthemum read aloud .TXT) 📗

Why is it that an infant so often vomits some of its food within a few moments after finishing its bottle?

Usually because the quantity is too large. Sometimes it is due to the fact that the food is taken too rapidly, from too large a hole in the nipple. It may be due to too tight clothing, or to moving the child about in such a way as to press upon the stomach.

What are the principal causes of, and the changes in the food required by habitual vomiting, regurgitation, or spitting up of small quantities of food between feedings, often repeated many times a day?

This is always a symptom of gastric indigestion, and a most troublesome one. In such conditions the fat and often the sugar also should be reduced and the lime-water increased.

Formulas made from rich top-milk or milk and cream are to be avoided. Those made from 7-per-cent milk are less likely to be the cause of trouble than those from 10-per-cent milk; but if the symptoms are at all severe it is better to use instead of these the formulas of the Fourth Series derived from plain milk.

Reduction in the sugar may be made by adding only one half ounce of milk sugar to each twenty ounces of the food; in severe cases the sugar may be omitted altogether.

It is often advisable to double the amount of lime-water—i.e., use two ounces to each twenty ounces of food.

The malted foods and all other foods containing much sugar usually aggravate the symptoms.

The intervals between meals should generally be half an hour longer, and sometimes an hour longer, than when digestion is normal.

The quantity given at a feeding should generally be less than with a normal digestion. Usually a smaller quantity of a strong food succeeds better than a larger quantity of a weak food.

What are the causes of, and food changes required by a constant and excessive formation of gas in the stomach, leading to distention and pain, or eructations (belching) of gas and often of a sour, watery fluid?

This is often associated with habitual vomiting, and is due to similar causes, but particularly to the sugar, which should be greatly reduced or omitted entirely.

What changes should be made when there is habitual colic?

This is generally due to an accumulation of gas in the intestines which forms there because the proteids (curd) of the milk are not digested. They should be reduced by using in the early months a weaker formula—i.e., instead of Formula V of the First or Second Series, IV might be used, or, for a short time, even III. The proteids may be reduced in the middle period by using weaker formulas If we desire to reduce the proteids without reducing the fat, we may change from the Second to the First Series.

Another means of relieving habitual colic is the use of partially peptonized milk (page 115); still another the dilution with barley-water instead of plain water.

What change should be made if curds appear in the stools regularly or frequently?

This is usually associated with habitual colic, and has to be managed exactly like that condition, by the means just described.

How should the milk be modified for chronic constipation?

The constipation of the first weeks of life has been already referred to (page 82); it usually disappears as the food is gradually strengthened in all its proportions.

Habitual constipation at a later period is difficult to overcome by diet alone. It sometimes depends upon the fact that the proteids are too high, and sometimes that the fat is too low. Hence it is more frequent when infants are fed upon plain milk variously diluted (page 90), then when 7-per-cent or 10-per-cent milk is used, and diluted to a greater degree. But it is not desirable to use a top-milk containing more than ten per cent fat for this purpose, nor is it wise to carry the fat in the food above 4 per cent (i.e., 8 ounces of 10-per-cent milk, or 12 ounces of 7-per-cent milk, in a 20-ounce mixture) or other disturbances of digestion may be produced.

In some cases the use, in place of milk sugar, of ordinary brown sugar, in half the quantity, is of assistance; or of some of the malted foods (Mellin's food, malted milk, cereal milk) also in the place of milk sugar.

The substitution of the milk of magnesia for the lime-water as recommended on page 60 will often be found useful.

To infants over nine months old, orange juice may be given.

What special modifications are required during very hot weather?

During the warm season it is well to make the proportion of fat less than during cold weather. During short periods of excessive heat it should be much less. The fat is reduced by using 7-per-cent milk in place of 10-per-cent (i.e., the Second instead of the First Series of formulas, page 71), or plain milk in place of the 7-per-cent milk in the Second and Third Series (page 90). At such times also the usual food should be diluted, and water should be given freely between the feedings.

What changes should be made in the food of a child who, with all the signs of good digestion, gains very little or not at all in weight?

If the child seems hungry the quantity of food may be increased; but if the child will not readily take any more in quantity the strength may be increased by the use of the next higher formula. One should, however, be extremely careful under these circumstances not to coax or force a child; for this plan is almost certain to cause disturbance of digestion and actual loss in weight. A better policy is that of looking after the other factors in the child's life,—the care, sleep, fresh air, etc., for with these rather than with the food the trouble often lies.

What should be done with infants who in spite of all variations in the milk continue to have symptoms of indigestion and do not thrive?

Except inmates of institutions who form a class by themselves, most infants who receive proper care thrive upon milk if the proportions suited to the digestion are given. Still there are some who do not. The nutrition of such is always a matter of difficulty.

If a wet-nurse is available the employment of one is the thing most likely to succeed, particularly if the infant is under four or five months old.

If the infant is older, or if a wet-nurse cannot be obtained, some of the substitutes for fresh cow's milk may be tried. One of the best is condensed milk, Borden's Eagle brand, canned, being preferred. This is more likely to agree if the symptoms are chiefly intestinal (colic, flatulence, curds in the stools, constipation or diarrhoea) than if they are chiefly gastric (vomiting, regurgitation, etc.).

How should condensed milk be used?

For an infant three or four months old with symptoms of indigestion, it should at first be diluted with 16 parts of boiled water, or, sometimes preferably, with barley-water. With improvement in the symptoms the dilution may be made 1 to 14, 1 to 12, 1 to 10, and 1 to 8, these changes being gradually made. The intervals between feedings and the quantities for one feeding are given on page 108.

How long should condensed milk be continued?

In most cases it should be used as the sole food for a few weeks only. Afterward, one feeding a day of a weak formula of modified milk (e.g., No. III or IV of the Second Series, page 71) may be given; later two feedings, and thus gradually the number of milk feedings is increased until the child is taking only modified milk.

Condensed milk is not to be recommended as a permanent food where good fresh cow's milk can be obtained.

What are the objections to its use?

It is very low in fat and proteids, and high in sugar. This accounts for its easy digestibility, and also explains why children reared upon it often gain very rapidly in weight, yet have as a rule but little resistance. They are very prone to develop rickets and sometimes scurvy.

Are the proprietary infant foods open to the same objections as condensed milk?

They are. What has been said of condensed milk applies equally well to most of those that are sold in the market as substitutes for milk.

What changes in the food are required by slight indisposition?

For slight general disturbances such as dentition, colds, sore throats, etc., it is usually sufficient simply to dilute the food. If this is but for two or three feedings, it is most easily done by replacing with boiled water an ounce or two of the food removed from the bottle just before it is given; if for several days, a weaker formula should be used.

What changes should be made for a serious acute illness?

For such attacks as those of pneumonia, bronchitis measles, etc., attended with fever, the food should be diluted and the fat reduced as described on page 95. It should be given at regular intervals, rather less frequently than in health. Water should be given freely between the feedings. Food should not be forced in the early days of an acute illness, since the loss of appetite usually means an inability to digest much food.

What immediate changes should be made in the food when the child is taken with an acute attack of gastric indigestion with repeated vomiting, fever, pain, etc.?

All milk should be stopped at once, and only boiled water given for ten or twelve hours; afterward barley-water or whey may be tried, but no milk for at least twenty-four hours after the vomiting has ceased. When beginning with modified milk the quantity should be small and the fat low, which may be secured by the use of the Fourth Series of formulas in the place of the First or Second Series. The proportion of lime-water may be doubled.

What changes should be made for an attack of intestinal indigestion attended by looseness of the bowels?

If this is not severe (only two or three passages daily) the fat should be lowered in the manner stated just above, and the milk should be boiled for five minutes. If curds are present in the stools, it may be still further diluted.

If the diarrhoeal attack is