DIGESTIVE DISORDERS
In this chapter we will consider the diseases which commonly occur
during infancy and early childhood relative to digestion and the
alimentary tract. Irregularity of feeding, feeding between meals,
feeding too much at any given time, as well as feeding the wrong kind
of food may cause stomach disturbances and intestinal troubles.
VOMITING
In a previous chapter, "The Feeding Problem," a common stomach
disturbance, vomiting, was gone into quite thoroughly, and in passing
to other disorders, we wish to remind the mother that vomiting should
always be taken seriously. The interval between meals should usually
be lengthened, the time spent in feeding shortened, and it is often
necessary to withhold all milk and food of any kind for twelve or
eighteen hours, giving only boiled, unsweetened water. Vomiting
frequently ushers in some acute disease, and in remote cases, when it
is very persistent, it may indicate inflammation of the brain.
Complete rest is essential, trotting on the knee, suddenly changing
the baby's position, or other quick movements must all be avoided. A
physician should see the sick one and determine the cause of the
trouble.
COLIC
Cases of ordinary colic are usually relieved by heat to the abdomen
and feet, drinking hot water in which there has been dissolved a pinch
of ordinary baking soda, or a portion of a soda mint tablet, or by the
use of the photophore, as previously described. The treatment of such
ordinary colic need not be given further consideration here because
it has been described at length in a former chapter; but we do call
the attention of the mother to a more serious form of recurring colic
which so often accompanies chronic intestinal indigestion, marasmus,
and malnutrition.
In most instances the food is radically at fault and should be reduced
to a mixture which can more readily be digested and assimilated by the
child. Often whey mixtures, peptonized foods, or buttermilk may be
indicated. The weight of the baby, the age of the baby, and the color
of the stools, must all be taken into account in the preparation of
this easily digested food. Weak mixtures should be given at first and
then gradually and carefully the quality may be strengthened until the
normal formula is again used for the baby.
Injections into the bowel of water, to which has been added one level
teaspoon of soda to the pint, will often give relief in this form of
colic.
CHRONIC INDIGESTION
While this condition may occur at any time during babyhood days, it
often makes its appearance during the last half of the first year and
up to the fifth year. It is accompanied by mucus in the stools,
chronic flatulence, constipation or diarrhea, or the alternating of
the two, restlessness at night, distention of the abdomen ("pot
bellied") accompanied by pain, a coated tongue with a fetid breath,
and loss of appetite. It is a pitiable picture--the weight is usually
reduced and the child gives the appearance of being decidedly
undernourished. This condition is usually occasioned by errors in
diet, whether it be over-feeding or feeding of the wrong element of
food, and, since the diet is usually responsible for the condition, in
the line of treatment diet is a prime factor.
All fats must be taken from the food, sugars should be avoided, and
the amount of starchy foods, such as flour, potatoes and bread, should
be greatly reduced. Buttermilk, skimmed milk, eggs, green vegetables,
and fruit juices should be given. In the older child, if grains are
used, they should be well toasted or baked.
JAUNDICE
It is altogether common and physiological for the newborn baby to pass
through a few days of yellow skin which usually clears up in the
second or third week, but it should not recur. Occasionally this
yellow tint deepens, the whites of the eyes are yellow, the urine
passed leaves a yellow stain on the diaper, while passages from the
bowels are white or clay colored. If the child shows symptoms of ill
health other than the yellow tint, it should receive medical
attention. Older children troubled with jaundice should receive the
following treatment: The photophore as described elsewhere should be
applied to the liver and abdomen (the liver is on the right side), and
this should be followed by the application of what is known as a
heating compress, consisting of three layers--a cloth wrung from cold
water, a mackintosh, and then two thicknesses of blanket
flannel--which are all applied when the skin has been made red by the
application of heat. (If the photophore is unavailable, a hot-water
bottle may be applied.) The flannel is pinned snugly on the outside as
the wet cloth goes next to the skin with the mackintosh between. This
should remain on the abdomen for three or four hours, after which the
hot application is again made to the liver and abdomen. The
administration of broken doses of calomel is sometimes indicated in
obstinate cases in connection with these applications of heat to the
liver. Hot milk or mineral water may be taken with dry toast. In a day
or two the color should clear up, the stools should be normal again,
and the treatment may be discontinued.
WORMS
Irritation about the rectum which cannot be otherwise explained is
usually suggestive of pinworms. These seatworms or pinworms are very
much like little pieces of cotton thread--one-fourth of an inch in
length. They grow and thrive in the lower part of the large bowel.
Simple and effective treatment is as follows:
It is well to bathe the parts about the rectum after each bowel
movement and often two or three times a day with a weak antiseptic
solution. Itching may be controlled by the application of a
disinfectant ointment, or the local applications of ice may serve the
same purpose. After a thorough cleansing of the colon by an injection
of lukewarm water containing a teaspoon of borax to the pint in order
to remove the mucus, Doctor Holt suggests that after the discharge of
this borated enema, infusions of quassia are very helpful (See
Appendix).
Children suffering from roundworms experience a loss of appetite,
varying temperature from above normal to subnormal, with colicky pains
in the abdomen on coming to the table and beginning to eat. They are
pale and listless, or nervous and irritable.
Roundworms very much resemble earthworms in shape and color. While
their home is in the small intestines they often travel to other parts
of the body. They have sometimes crawled into the stomach and have
been vomited. The only definite symptom of worms is to find the eggs
or the worms themselves in the stool. No worm medicine should ever be
given by the mouth without being prescribed by a physician. Cases are
on record where well-meaning mothers have killed their children by
giving an over dose of worm medicine.
Tapeworms sometimes trouble children; their segments are found in the
stool, and look like small pieces of tape line. The segments are flat
and thin, one-fourth inch to one-half inch in width and three-fourths
to one inch in length. They are joined together and often their number
is so great the worm is many feet in length. The segments grow smaller
and smaller as they approach the neck, the head of the worm being a
mere point. As the worm is passing from the child it should never be
pulled, as the head is easily broken off, and, on remaining in the
bowel, it will grow to a full-sized worm.
Worms come from the eating of half-cooked meats; they enter the
stomach as eggs or tiny worms, and pass out into the small intestines,
where they begin to grow. They are a common parasite in the human
family and should be suspected in all instances where digestive
symptoms are masked or do not yield to treatment.
HOOKWORM DISEASE
This disease, once seen only in the southern part of the United
States, is leaving its former domains as the migrating population is
distributing it more or less widely everywhere. Sandy soil and country
districts are infected by a tiny worm which thrives in polluted soil
and enters the body through the skin of the feet. It also gets into
the body through the drinking water or from the eating of uncooked
vegetables, such as are used in salads.
The disease is manifested by "sallow skin, paleness, headache, swollen
abdomen and sores on the legs." Little swollen places where the worm
enters the skin may be seen on the flesh. The condition yields readily
to treatment. If a child is discovered scratching his feet (especially
in the southern part of this country), he should be taken at once to a
physician.
DISORDERED STOMACH
At the first symptom of a disordered stomach take all food from the
baby and give him rice water prepared by throwing a cupful of
well-washed rice into a kettle of boiling water and allowing it to
continue to boil for a couple of hours. The water which is strained
off is rice water, ready for use after it is cooled. This may be given
to the child at the meal hour in the place of his regular food. It
should be kept in a glass-covered jar in the ice box. A dose of castor
oil, according to the age, should be administered before the feed. The
bowels should be washed out and boiled water given freely between the
meals of rice water. For a day or two (twenty-four to forty-eight
hours), the child should be fed only this rice water, or until the
temperature returns to normal and he appears very hungry, at which
time milk, which has been boiled for five minutes, may be added to the
rice water, first in one-half ounce quantities and gradually
increased. Each day a little more milk is added until baby is taking
his regular food again.
Many a death and many acute attacks of summer complaint are avoided by
the quick use of castor oil, and by withholding food and stopping the
use of milk as soon as the child becomes ill.
STOMATITIS OR THRUSH
Thrush is evidenced by fretfulness or crying on attempting to nurse.
On examination of the mouth it is found to be hot and very tender and
covered with little white specks which, if looked at under the
microscope, appear to be a fungus growth. If scratched off, the mucous
membrane bleeds easily. Thrush often occurs during a fever or in
connection with other diseases, and is often due to neglect and lack
of cleanliness about the bottles, nipples, etc. Taken in time it is
quickly cured. An immediate dose of castor oil or milk of magnesia is
indicated, and the use of a mouth wash which will be prescribed by the
physician. If neglected, it may become ulcerous or gangrenous, which
is a very serious condition. Everything pertaining to the feeding, as
well as the child's toys, hands, etc., must be kept scrupulously
clean.
CONSTIPATION
In the chapter, "The Feeding Problem," constipation in bottle-fed
babies was discussed. The bowels should move at least once in
twenty-four hours. The passages are frequently very hard and leave the
body only after a very great effort of straining. This constipation,
often continuing until late childhood, should be corrected in the
following manner:
In early infancy--as early as the fourth month--prune juice may be
given as directed elsewhere, while in later months prune pulp or fig
pulp, which has been carefully rubbed through a fine-mesh colander,
may be given at meal time. By the time the baby is eleven or twelve
months old, strained apple sauce may be given.
We deplore the use of the water enema as a regular daily procedure; in
its place we suggest the use of the enema of oil or the introduction
into the rectum of a gluten suppository or in obstinate cases a
glycerine suppository. Abdominal massage should be daily administered.
With a well-oiled hand, begin on the right abdomen and proceed upward
to the lower border of the right ribs and across to the left side and
down. This should be repeated many times at a regular hour each day.
The mother should select an hour for the bowels to move, preferably
after the forenoon feeding, and if the child is too small to sit upon
the toilet chair, a gluten suppository may be placed into the rectum
before the forenoon feed and some time during the middle of the day
the bowel movement will be found in the napkin.
For the older child, before a certain meal each day, a well-vaselined
piece of cotton may be inserted in the rectum; this often produces a
bowel movement immediately after the meal. Laxative foods, such as
bran, stewed figs, stewed prunes, or a raw apple, should be used
faithfully--as repeated medication never corrects the difficulty, but
usually prolongs it.
To immediately flush out the bowel, a soapsuds enema or a plain water
enema may be allowed to flow into the lower colon, or a glycerine
suppository inserted into the rectum will quickly bring a bowel
movement. These methods are only of temporary value; a regular habit
should be formed, if possible, to bring about a natural, normal bowel
movement. When necessary to resort to drugs--such remedies as cascara
sagrada, milk of magnesia, or syrup of rhubarb, are satisfactory, as
well as our old stand-by--castor oil. Regular habits must be insisted
upon, and if the mother pays attention to regularity at stool in early
childhood very little trouble will be met later on in adolescence and
adult life.
Chronic constipation often produces abnormal conditions about the
rectum such as fissures, hemorrhoids, or prolapse, which may be of
serious import.
DIARRHEA
Diarrhea is a symptom of an acute illness, or it may be associated
with a chronic condition such as chronic intestinal indigestion,
tuberculosis of the bowel, or may occur alternately with constipation
in colitis. It is the most dangerous of all symptoms that babies
develop, and in spite of all the instruction given to mothers at the
present time, in spite of all the welfare stations in large cities,
and in spite of all the efforts put forth by the commissioner of
health, with his corps of visiting nurses--even yet, more babies die
of diarrhea each summer than from any other single cause.
There are usually just two reasons for diarrhea--uncleanliness and bad
milk. During the hot summer days flies multiply greatly and all manner
of bacteria and germs grow in warm, moist, shadowy places, so that
usually before the milk leaves the dairy farm it is seriously
contaminated with disease-producing germs. If the milk is not kept at
a temperature of 35 or 40 F. (which is just above the freezing point),
these bacteria, particularly the manure germ, grow at such a rate that
by the time the milk gets to the infant it is teeming with bacteria,
and diarrhea is the sure result.
Another form of diarrhea is cholera infantum, where the stools soon
become watery and colorless. The vomiting is almost incessant and
there is high fever. Fortunately it is a rare disease, but when once
seen it is never forgotten. One beautiful baby weighing nearly thirty
pounds was reduced to sixteen within forty-eight hours, and when death
came he could hardly be recognized because of the wasting from this
most dreaded of infant diseases.
Another form of diarrhea is seen in an acute inflammatory condition of
the intestine itself. The stools contain more or less mucus and blood.
The bowel movements, which are very frequent, are accompanied by a
great deal of pain and straining. This form is often seen in the more
severe types of summer dysentery. We wish to impress upon the reader's
mind that these diarrheas may all be avoided if the baby's food is
clean and free from germs, if the apple or pear is not only washed,
but thoroughly scrubbed before paring during the summer months. If all
the bottles, nipples, water, toys, etc., are adequately clean, no
summer diarrhea, no dysentery, no other infection due to dirt, will
attack the baby. Of paramount importance is the pasteurization of milk
during the summer months, as mentioned elsewhere.
TREATMENT OF DIARRHEA
Simple diarrhea in the older child of two or three years is treated as
follows: Take away all solid foods. Give a big dose of castor oil,
thoroughly wash out the bowel by warm water containing a level
teaspoon of salt and a level teaspoon of baking soda to the pint, and
put the child to bed in a quiet room. Boil all milk for ten minutes
and thicken it with flour that has been browned in the oven; feed this
to the child at five-hour intervals. After each bowel movement, no
matter how often they come, the colon should be washed out with the
salt and soda enema as before mentioned.
Bear in mind that the child is losing liquids, and so, after the
bowels have moved, boiled water should be given by mouth, or a cupful
of water can often be retained if it is introduced into the rectum
slowly under very low pressure. Twenty-four or forty hours should
clear up a case of simple diarrhea, and on returning to food it should
be dry toast and boiled milk. For the younger baby, withhold all milk
and give barley water or rice water for the first twenty-four hours,
returning to milk very gradually and slowly.
For the more severe types, such as the dysentery containing mucus and
blood, everything that has been done for the simple diarrhea should be
done; the baby should be kept very quiet, while castor oil should be
promptly administered. Food is withheld and the bowels are carefully
irrigated after each movement with the salt and soda solutions. After
the bowels have moved from the castor oil, then bismuth subnitrate,
which has been dissolved in two ounces of water, should be given--one
or two teaspoons every three hours. This will naturally turn the bowel
movements dark.
Under no circumstances should any other medicines be given without the
physician's knowledge, as it is at such times as this that many
"would-be friends" advise laudanum, paregoric, and other opiates. The
skin must be kept warm, and fluids must replace those that have been
carried off in the many stools. Water may be given by an enema, by
water drinking, and in such rare cases as cholera infantum, when water
cannot be retained on the stomach, it often becomes necessary to
inject it under the skin (hypodermoclysis) so that it may go at once
to the wasted tissues and perhaps save the baby's life.
Give the baby ten days or two weeks to return to normal condition, and
under no circumstances hurry the feeding of milk, as a second attack
may occur much more readily than the first; may more profoundly
overcome the baby and result in death.
RUPTURE
A protrusion of a loop or portion of intestine through a weakened
abdominal muscle--which grows larger when baby cries and smaller when
he is lying down in a relaxed condition--is known as rupture or
hernia, and is of common occurrence in infancy. It is often seen at
the navel and sometimes in the groin as early as the second week.
Hernia is always dangerous and should never be neglected. The
physician will protect the navel by a special support with adhesive
plaster which is carefully renewed twice a week, and if worn for
several months usually entirely corrects the condition. A comfortable
truss made from skeins of white yarn will amply protect a groin
hernia. The condition should always be taken seriously and receive
immediate treatment.
PROLAPSE OF THE BOWEL
Occasionally, as the result of severe straining in constipation, the
rectum protrudes sometimes one-half inch, and in rare instances two or
three inches. The placing of a young child upon a toilet chair and
insisting upon severe straining sometimes results in such a protrusion
of the rectum. This may be avoided by the application of vaseline to
the rectum or by the use of the gluten or glycerine suppositories
which cause the hardened masses to make their way out easily. Someone
has suggested that if the buttocks are supported by a board placed
over the toilet seat with a two-inch opening so that severe straining
of the rectal muscles is impossible, the prolapse of the rectum will
not recur.
The moment the mother observes the slightest protrusion of the rectum
she should quickly put it back and have the child lie down and move
the bowel in the diaper. Very severe cases require a physician's
attention, but if prompt and quick measures are taken on the first
appearance it may be quickly corrected and serious consequences be
avoided.
In this connection we might mention a condition which sometimes babies
are born with--the absence of the rectal opening. If the baby's bowels
do not move for the first two days, surgical interference is more than
likely necessary. Often the external opening alone is missing.
Sometimes there is a complete closure or atresia of the lower part of
the colon.
BLEEDING FROM THE NAVEL
There should be no hemorrhage from the umbilical stump after it has
been properly tied, but occasionally a bit of blood is found upon the
dressing and a second tying of the cord stump is necessary. The cord
drops off in eight or ten days, and the umbilicus that is left may be
moist or it may bleed slightly; if such is the case, great care should
be exercised in bathing this ulcer that has been left behind. It
simply should be touched with alcohol, a bit of boric acid powder
applied, and a small piece of sterile gauze be placed over it. In the
course of two or three days it will entirely heal. Care should always
be exercised in washing the umbilicus. Extensive hemorrhage from this
portion of the body is rare, but it does happen occasionally and is a
severe condition which demands surgical attention.
If the umbilicus remains moist and foul smelling, general blood
poisoning of the infant may easily follow. Thorough dusting with boric
acid powder, with possibly a little oxide of zinc, will usually effect
a cure promptly, but should the condition continue, which it does only
in rare instances, the doctor may have to cauterize it.