GUARDING THE BABY’S DIGESTION
SOUND DIGESTION MEANS A STRONG BABY—BOWEL CONDITIONS TELL THE
STORY—THE UNDERFED AND THE OVERFED BABY—SYMPTOMS OF DISORDER IN THE
DIGESTIVE SYSTEM—VOMITING—COLIC AND CONSTIPATION—DIARRHEA AND ITS
TREATMENT
Sound digestion in the family baby stands for many good things. It
spells peace and comfort for the entire household; for good digestion
means good health and good humor, therefore a baby whose presence does
not disturb the family. It spells small doctor’s bills, because a
sound digestion gives the baby power of resistance to throw off germs
of disease and even to pass safely through exposure to contagion. It
spells efficiency and intelligent care on the part of the mother, for,
common belief to the contrary notwithstanding, the healthy baby is not
a matter of accident but of care. The knowledge of how to give that
care may be innate, inherited from a line of sensible, motherly women,
or it may be acquired by education in the feeding and care of infants;
but it is there.
That fact is proved by experiment among untrained mothers. A
Philadelphia branch of the Congress of Mothers started an infant-saving
campaign in a certain ward of that city. For a given time, they had
meetings of mothers, with talks on the care and feeding of babies, week
in and week out. Babies were weighed and measured, and, as they gained,
the mothers were praised for the improvement in their children. In this
one ward, where education for motherhood was taught persistently and
intelligently, the death rate was reduced 44 per cent. on the year. No
record was kept of the improved condition in mothers and homes. These
are blessings which cannot be reduced to figures.
When the American woman knows as much about feeding babies and children
under three years of age as she knows about mixing bread, polishing
furniture, and embroidering doilies, our home economics and domestic
relations will undergo a change for the better. Thousands of marriages
have been wrecked by the ignorance of the mother in rearing her
children, and the subsequent confusion and quarreling. A sickly baby
loads the husband and father with harassing expenses. It brings the
family bread-winner home to a disordered house and a tired, fretful
wife. It keeps both husband and wife awake when they should be securing
a good night’s rest to meet the next day’s duties. Result: in poor
circles, the husband turns coward and deserts wife and child; higher
up in the economic scale, the husband secures work in a distant city
and the wife goes home to “her people.” In either case, the man often
seeks, in more pleasant companionship, relief from the unsatisfactory
conditions existing in his own home.
The wife considers the husband unreasonable and dishonorable. She
declares that she has the heavier burden to bear, a sickly baby to
tend day and night. What she does not realize is that the baby would
not be sickly if the mother knew her job of motherhood as well as the
father knows his trade of bread-winning. The law does not recognize
indigestion in the family baby as a divorce cause, but any judge who
has ever presided over what is known as a court of domestic relations
will tell you that desertion, non-support, cruelty, and infidelity on
the part of the husband can often be traced directly to the wailing of
a baby or several babies, who would not wail if their mothers knew how
to guard their digestion.
Mothers are not altogether to blame for their inability to prevent
digestive ailments in their babies. Generally, their own mothers did
not understand this wonderful science of infant feeding, nor warn them
of the pitfalls which yawn before the young mother who has not studied
it.
Even general practitioners have not placed great importance on the
study of babies. They have had their hands full by doctoring grown-ups,
who might have been healthy adults if properly started in life.
After ushering the child into the world and pronouncing it sound, the
average family physician has turned the baby over to the parents; and
under their care it has remained until it developed some acute malady,
when the doctor has reappeared on the scene. The cure of the malady,
not its prevention, has long been the office of the family physician.
They do it better in China, where physicians are paid only so long as
the health of the family is good.
The world has long proceeded on the theory that with the birth of
the baby was born in the mother some heaven-sent knowledge of how to
raise the baby. To be sure, she was taught to read and write and cook
and sew, but there was no need to teach her how to feed her baby. By
some mysterious process, God supplied that knowledge. That He did not
is shown by the fact that twenty-five per cent. of the deaths in our
country are of children under one year of age.
Another mistaken belief about babies has been that they are born
“delicate” or “strong”; and, as they are born, so must they live—that
is, if they live at all! The delicate baby has been regarded as a
cross, to be carried with patience and resignation. Mother trotted
and dosed it by day; Father walked the floor with it by night; and the
neighbors pitied them both. The idea that the poor little tot was born
with the right to acquire strength and health was not preached: the
thought of calling in science to transform the delicate baby into a
strong one is comparatively new.
Fortunately for the race, a few brave spirits in the medical profession
decided to defy tradition and study babies as controllable human
machines rather than as dispensations of a more or less kindly
Providence. They found that babies born healthy and normal could
be kept that way; that babies born puny and delicate could be made
sturdy and strong; that even babies born with inherited defects,
physical and mental, could be so treated that they would develop into
useful, self-supporting citizens, where once they were consigned to
that hideous human scrap-heap, the institutions for defective and
feeble-minded children.
Only those of us who have followed the work of specialists in
children’s diseases—pediatrists, as they are known in the medical
profession—can appreciate what marvels have been worked in children
born without the birthright of good health. Now these men are going
farther. They stand behind the twentieth-century campaign for public
education among women in the care and feeding of children. They have
rent the veil of mystery which so long has surrounded medical learning;
they have written books for mothers, couched not in dictionary-defying
terms, but in simple English which the average mother can understand;
they have given public talks to mothers on infant feeding; and now
they are leading the movement for health conferences between parents,
physicians, and health officers—city, county, and state—and for what
are known as Better Babies Contests, where babies are brought by their
parents for examination in physical and mental development.
All these signs indicate a new and popular appreciation of what is
known as preventive medicine. The broad-minded physician practises
preventive medicine. The progressive mother works with the progressive
physician, and the baby profits by the combination. To-day there is
little excuse for a colicky, crying, sickly baby in the family circle.
Except in rare cases, when the baby’s poor condition does not improve
under intelligent mother-care, modern medical science can effect a
cure. What generally stands between the sick baby and its cure to-day
is ignorance or tradition on the part of the parent, who clings to the
belief that strong babies are born to live, that weak babies are born
to die, and that the Creator has decreed it!
In reality the Creator should not be held responsible for the physical
future of the child. Its normal development is practically in the
hands of the mother. In the midst of this magnificent campaign for the
intelligent care and feeding of infants, she has no right to remain
ignorant. Lectures, conferences, and books are at her command; and what
this simple preventive medicine teaches her to do for her child she is
morally bound to perform.
And this brings us back to the original statement at the head of this
chapter: Sound digestion in the family baby stands for many good
things—more especially for the safety and comfort of the baby. So it is
most important that the mother ask herself:
“What is the condition of my baby’s digestion?”
The baby whose digestion is in good order gains steadily in weight,
has firm flesh, a clear skin, and good color. During the first few
months of its life it sleeps two or three hours after nursing; and
during the brief periods of wakefulness it is quiet, good-natured, and
quite content to lie staring at nothing. It does not demand attention,
rocking or walking. It has an excellent appetite, nursing with relish,
often greedily. This does not mean whimpering or fretting for food. The
baby that tugs nervously at the breast is not properly nourished.
The healthy baby may have what is known as regurgitation, which is
best described as the overflow when the baby has taken more milk than
its little stomach will hold. The milk, uncurdled, practically exactly
as it was swallowed, rolls out of the baby’s mouth without any gagging
or muscular contraction. This is especially apt to happen when there is
an unusually strong flow of mother’s milk; or when the nipple hole is
too large for the bottle-fed baby.
The healthy baby does not have colic or gas on the stomach.
A healthy baby may cry, especially just before it is fed, because
crying is its only method of announcing that it is hungry. It may also
cry while being bathed or dressed, because it resents being disturbed.
Such crying in moderation is healthful, for it is about the only
exercise the baby gets.
Perhaps the best indication that a baby’s digestion is in good
condition is the state of the bowels. The mother should watch this
closely. For the first three or four days the movements are black and
sticky. There should be not less than two and not more than four in
number. From black they are very apt to turn green, and remain so for a
week or more, because the flow of mother’s milk is not yet established.
As a rule, however, during the second week, the breast milk gains in
quality, and the stools turn a light yellow and become more solid,
about the consistency of mush. If the mother’s digestion and general
health are good, the child will have from two to four movements a day.
Neglect to regulate the bowels is one of the most common causes of
death among bottle-fed babies. The entire system is poisoned, for the
waste matter is not carried off through the bowels. The inexperienced
mother will be wise to have her physician watch the stools until the
child’s health seems fairly well established. Hundreds of bottle-fed
babies, who do not outlive the first month, might be saved if this rule
were observed. When a physician is not at hand, the mother must watch
the stools with a critical eye.
The bowels of the bottle-fed baby rarely move as often as those of the
breast-fed infant; but the stool is larger, and of a lighter yellow,
smooth, and of the consistency of a firm ointment or cold cream. If the
child does not have at least one movement a day, the proportions used
in the modified milk must be changed.
The digestion of the nursing baby may be disturbed by milk that is
scanty and poor in quality, or by milk that is too rich and flows too
fast. When the former condition exists the child does not gain, and
it may even lose in weight; the flesh is soft and flabby, the skin
pale; the child sleeps poorly and often brokenly or with sobs. When
awake the baby looks dull and listless, or is fretful or irritable. It
may also belch gas or, if the gas is retained, there will be colic
and a distended abdomen. Sometimes the bowels are constipated, but
more generally the movements are loose and the stools green in color
and streaked with mucus. Also the movement is accompanied by pain
sufficient to make the child cry.
When the supply of milk is scant, the baby will seem hungry and
restless; again, three-quarters of an hour after nursing, the baby will
seize the nipple greedily but, after a moment, drop it in apparent
disgust and begin to cry.
Sometimes both the quality and the quantity of the milk can be built up
by attention to the health and diet of the mother; but, as this process
is necessarily slow, the baby in the meantime must be given occasional
feedings of modified milk, as described in Chapter V. Then, if the flow
of milk is not established or the child still turns from the breast, a
complete weaning must follow.
If the indigestion is due to overfeeding, the child shows an abnormal
gain in weight, is restless after nursing, vomits, suffers from wind
and colic, is dull and sleeps a great deal but restlessly, not quietly,
perspires heavily on head and neck, and passes so much urine that,
despite frequent changing, the diapers are always wet.
For these conditions there may be either or both of two causes: milk
that flows too quickly, and milk that is too rich. The first trouble
is easily corrected by the mother compressing the base of the nipple
between her first and second fingers while the child is nursing, thus
checking the rapid flow of the milk. The second trouble is not so
easily corrected, for it is caused by one of three things: (1) the
mother is eating food that is too rich; (2) she is taking too little
exercise; (3) she is giving way to mental excitement, hysterics, grief,
or temper. If the condition is not mental, and the mother is taking
sufficient exercise, then it is a question of modifying the mother’s
milk.
This can be done, first, through the mother’s diet—simpler food, less
meat, no alcohol; second, just before nursing, the baby may be given an
ounce of boiled water in which one-fourth teaspoonful of malt sugar has
been dissolved, using an ordinary nursing bottle with a plain nipple.
The child will then nurse a shorter time and the water taken from the
bottle will dilute the milk drawn from the breast. The first few ounces
drawn from the breast are less rich than the last ones; so if the child
does not drain the breast, he does not get the richest part of the
milk. This experiment should not be tried, however, without consulting
the family physician, who will have a sample of the mother’s milk drawn
with a breast-pump and analyzed before prescribing the sweetened water.
The mother must bear in mind, however, that there is a distinct
difference between chronic and acute illness from indigestion. When
a baby, that has nursed contentedly and gained regularly in weight,
suddenly refuses the breast, this is generally a sign of acute
illness, requiring the immediate attention of a physician and prompt
treatment. When the symptoms of indigestion are slight, but persistent
and regular, and the baby shows general distaste for either breast or
bottle, then it is merely some disturbance of digestion, malnutrition
or mal-assimilation of food, which can be corrected by modifying the
diet.
Neglect of acute indigestion may mean convulsions, intestinal
inflammation or other ailment which will quickly prove fatal. Slight
but chronic indigestion should be corrected because it disturbs and
weakens the entire system, fills it with poison and makes the child
liable to disease. The child who “takes cold easily” or “teethes hard”
is generally the child whose digestion is out of order.
General disorder of the digestive system is indicated by one or more of
these symptoms: Constipation, diarrhea, colic, and vomiting. Gastric
or stomach trouble is indicated by vomiting or the belching of gas;
intestinal trouble by colic, flatulence, diarrhea, and constipation.
The wise mother will learn to distinguish between the various forms of
vomiting. Regurgitation, already described, is not a danger signal;
if the milk, unchanged in consistency and color, runs easily from the
baby’s mouth almost immediately after the child is taken from the
breast or bottle, and then, as if relieved, the infant rolls over in
comfortable slumber, there is no cause for anxiety. If, however, the
vomiting happens just before the next nursing period, or even an hour
after nursing, the diet should receive attention; especially if the
milk is curdled or colored with bile.
Before changing the diet, however, other factors in the care of the
baby should be considered:
Is it fed at regular intervals, as outlined in Chapter IV?
At the Better Babies Contests I have often been shocked at the replies
given by mothers when the doctors inquired, “How often is your child
fed?”
Here are some of the answers: “I don’t know.” “When he wakes up.”
“Whenever he cries.” “When I have time to sit down.”
The child that is fed irregularly is very apt to vomit.
So is the child that is jostled, jogged, or rocked after nursing.
Directly a baby is fed it should be laid down in its crib and the food
given a chance to digest.
Tight clothing over the stomach and abdomen will cause vomiting; and,
for that reason, belly-bands must not be pinned tightly.
If none of the above reasons is present, and the baby vomits
habitually, the diet must be changed.
The third form of vomiting is acute and sudden. It may generally be
regarded as a symptom of an acute illness, such as measles, pneumonia,
scarlet fever. It is safest to send for a physician under such
circumstances. He can decide whether the acute vomiting is due to
something the mother or child has eaten, or whether other symptoms of
a serious ailment are present. Under ordinary circumstances the mother
should merely withhold food until the arrival of the doctor. If the
doctor cannot be secured for some time, she may safely give the child
calomel, one-tenth of one grain every half-hour until one-half of a
grain has been taken. The calomel should be carried off by an enema of
warm water and sweet-oil. This may prevent serious consequences until
the doctor arrives.
Gas on the stomach, with distention and pain, is indicated by belching,
sometimes accompanied by a sour, watery fluid. Relief can be given by
adding half a grain of benzoate of soda to each ounce of food for the
bottle baby; but it is far better for both nursing and bottle baby if
the mother will either change her own diet or reduce the quality of the
bottle milk. Dr. Holt recommends, for gastric indigestion, two ounces
of lime water to each twenty ounces of food.
Colic and flatulence come from the distention of the bowel by gas,
and are generally accompanied by constipation. As a rule, if the
constipation is relieved, the colic will disappear.
The presence of gas in the intestines generally indicates that either
the sugar or the starch in the food is not being properly digested.
The mother must reduce the quantity of starch and sweets which she is
eating, in order to modify the breast milk. For the bottle-fed baby
starch may be omitted from the food, and malto should be used instead
of cane sugar.
For constipation in bottle-fed babies, milk of magnesia, which can be
purchased at any first-class drugstore, may be added to the modified
milk, in the proportion of one-half to one teaspoonful to each twenty
ounces of food. The proportion must be according to the age of the
child and the stubbornness of the constipation.
Constipation may also come from weak milk; in this case top milk
instead of plain milk should be used in preparing the food for the
bottle-fed baby.
No baby should be given cathartics nor enemas, except in emergencies.
Even castor-oil is not safe, because if constipation springs from the
fact that the milk is already too rich in fat, the oil increases the
trouble. Enemas given every day weaken the muscles of the lower bowel.
Up to the time the baby is six months old the mother should give no
cathartic except milk of magnesia. The bottle-fed baby is given some
of this at each feeding. It may be given to the breast-fed baby in
a little boiled and warmed water, just before nursing. If milk of
magnesia and attention to the diet do not correct the trouble, then a
physician should be called in.
After six months a child may have orange juice, or orange and pineapple
juice, strained; also apples scraped very fine.
Massage or kneading the abdomen lightly sometimes brings relief; but
this should never be done immediately after the baby is fed. An hour
should be permitted to elapse; and it is still better to massage the
abdomen just before feeding. However, massage without correcting the
diet is not sufficient.
Constipation must be corrected during infancy, for there is no other
evil of the human system that can bring upon men and women a greater
number of ailments which make life one long story of aches and pains.
Diarrhea is a symptom of acute illness, and frequently ends in death.
It is the most dangerous of all symptoms that babies develop. With
all the agencies at work for infant welfare in large cities, during
hot weather, more babies die of diarrhea than of all the contagious
diseases, like measles, whooping-cough, diphtheria, scarlet and typhoid
fever, put together. Even in the country, with its pure air and its
better facilities for securing clean milk, babies die of diarrhea in
shocking numbers.
This dreaded disease of infancy can generally be traced to two causes:
improper food, and unclean milk.
One reason why it is more prevalent in summer than in winter is the
fact that heat affects milk quickly and unfits it for the baby’s
digestion. When the breast-fed baby has diarrhea, the mother must
immediately look to her own diet. The mother of the bottle-fed baby
must look to the source and care given to the cow’s milk fed to the
baby.
In this respect the small-town mother and the farmer’s wife have the
advantage over the city mother. They can secure milk from healthy cows,
directly the milking is over, twice a day. They can strain it through
cheese-cloth, cool it rapidly on ice, and allow no contaminating hand
or utensil to touch it. The city mother must pin her faith to certified
milk.
So much for the prevention of diarrhea. If, in spite of every
precaution, it appears, food of any kind must be withdrawn. Even the
breast-fed baby should fast for twelve hours. Cleanse the bowels with
either castor-oil or calomel. Try castor-oil first: one teaspoonful
for the baby three months old or less. From three months to a year
old, the dose may be graduated from a teaspoonful to a tablespoonful.
If the baby cannot retain the castor-oil, try calomel as prescribed
for vomiting—one-tenth of one grain every half-hour until one-half
grain has been taken—for the baby up to four months. After that, and
up to one year, the quantity may be increased, one-tenth of one grain
every half-hour until two grains have been taken. Boiled water may be
given at intervals, but not in any quantity, especially if the diarrhea
is accompanied by vomiting. If the diarrhea does not yield to this
treatment within twenty-four hours, a physician should be called in.