CONSTIPATION IN INFANTS AND CHILDREN
"It is a greater disgrace to be sick than to be in the
penitentiary. When you are arrested it is because you have
broken a man-made statute, but when you are ill, it is because
you have disobeyed one of God's laws."
Constipation--Regularity of Bowel Function--The Function of the
Stomach--Fermentation--Incomplete Constipation--Importance of a
Clean Bowel--A Daily Movement of the Bowel
Necessary--Constipation in Breast-Fed Infants--Treatment of
Constipation in Breast-Fed Infants--Constipation in Bottle-Fed
Infants--Treatment of Constipation in Bottle-Fed
Infants--Constipation in Children Over Two Years of Age--Diet
List for Constipation in Children--Bran Muffins in
Constipation--Treatment of Obstinate Constipation--Oil
Injections in Constipation.
CONSTIPATION. REGULARITY OF BOWEL FUNCTION
The most frequent cause of ill health and inefficiency in the human race
is inattention to regulation of the bowel function. Good health depends
upon many causes of which good blood is an absolutely necessary
requisite. Good blood depends upon what feeds and sustains it. There are
other contributing factors, such as the proper kind of exercise, the
proper amount and quality of fresh air, the method of living, etc., but
these are all food in a sense. The food we take in is acted upon by the
various digestive juices until everything is extracted from it that
contributes to the building up of the body. Whatever is left, whatever
the body does not want, is immediately, or within a reasonable time,
passed out in the form of a movement of the bowels.
If any part of the digestive function is deficient, impaired health, or
mental and physical inefficiency expressed in the form of indigestion,
is the result. If the bowel is at fault, constipation is the usual
consequence. A perfectly healthy living machine must maintain a perfect
digestion and regular bowel movements.
THE FUNCTION OF THE STOMACH is to mix and churn the food, and to add
certain ingredients to the mixture so that before it is carried into the
intestines it is (as far as it is the stomach's duty to render it) ready
to be absorbed into the system. Before it reaches that part of the
intestine which absorbs, it is acted upon again and certain other
ingredients are added to it by certain other digestive organs. In time
it is in shape to be used and it is sent along on its way. As it passes
onward the little sucking glands in the wall of the bowel suck up all
the liquid element in the mass of food. The liquid element in the mass
is the food itself, rendered liquid by the stomach and other digestive
organs and juices. The remaining solid mass is that part of the food
which the body cannot use and does not want. By the time the liquid
element is absorbed, the solid mass (always kept moving by the bowel
wall) has reached the rectum, ready to be passed out at once, or very
soon, provided--and upon this provision depends the success of the
entire process,--it has all been done within a certain time. If the
stomach takes too long to do its work we have indigestion. If the bowel
takes too long to do its work we have constipation.
FERMENTATION.--Now let us consider the matter from another standpoint.
If food stays too long in the stomach it begins to ferment. When
anything ferments it makes and evolves gas. You, no doubt, have noticed
many times how the cork pops out of a bottle if its contents are
"working," or fermenting. If you watch that bottle you will notice that
it is quietly or actively evolving air bubbles. That is gas,--gas
manufactured by the process of fermentation. This is exactly the process
that goes on in the stomach or bowel of a dyspeptic, and it is this
collection of foul, poisonous gas that causes the distress and bloated
feeling which every dyspeptic suffers from after eating,--if it is this
"flatulent" type of indigestion which is present.
THE SIGNIFICANCE OF CONSTIPATION.--If the food takes too long to pass
through the bowel it causes, as we have stated, constipation. What is
the real significance of constipation? It means that in passing through
the bowel the food has given up all its liquid element (which is all its
nourishing element), but the bowel has been too slow in passing it
along. Consequently it is not ready to be expelled while it is yet a
harmless semi-solid mass. It stays in the bowel too long--it begins to
putrefy, bacteria attack it, and it is soon a semi-liquid, foul, rotting
mass. The sucking glands in the intestinal wall continue to suck--that
is their duty. They cannot discriminate between what is good and what is
bad--they simply go on absorbing whatever is there to absorb. So there
are absorbed into the system liquid and gaseous products which are
poison.
This process has been called by a number of names; "self-poisoning"
explains the condition thoroughly. The other names are, auto-infection,
auto-intoxication, enteric-infection, enteric-toxemia, intestinal
indigestion.
The condition is a serious one, because it is absolutely impossible to
feel well, or to enjoy good health, while it lasts. The feeling of being
constantly sick, yet not sick enough to stop working or to demand a
radical cure, affects a woman's efficiency, interferes with her capacity
to work, her ability to render the home an abode of contentment, to be
an agreeable companion, or to adequately take care of her children.
The constant absorption of intestinal poisons affects the system
itself,--the symptoms are headache, neuralgia, loss of appetite,
nervousness, insomnia, vertigo, inability to concentrate, lassitude,
indigestion. The condition which we name constipation is therefore one
of supreme importance. From a medical standpoint, it is the biggest
problem in the whole realm of disease. It is the most significant
hygienic function of life, and it is becoming more and more important,
and more and more a problem. Every modern factor upon which physical
efficiency seems to depend is an enemy to the systematic regulation of
this function. Our method of hurried and indiscriminate eating, our
system of strenuous living, our unsanitary environment, our business
activity, our method of pursuing pleasure, take no account of, and
resent the time devoted to cultivating, as a hygienic necessity, this
toilet requirement. This imperative call of nature is pushed aside by
the child at play, by the housewife for a duty which could wait, by the
merchant for an engagement. It is particularly an American disease, and
it is uniquely an American woman's affliction. It is a curious
commentary on the intelligence of the American people, who are
ordinarily alert and analytical, to realize how few of them really know
how serious a matter constipation is. They don't know because they have
given the matter absolutely no thought. They have accepted it as a mere
matter of fact, almost of fate.
INCOMPLETE CONSTIPATION.--There is a type of constipation that is not
known to the average person and not well understood by those few who
know of its existence. In this form of constipation there is a daily
bowel movement but the movement is not complete. The bowel does not
thoroughly empty itself; it has established this habit because of
conditions under which it has had to do its work. If a woman
neglects herself, becomes muscularly inactive, does not take
proper out-door exercise, grows fat and lazy, eats irregularly and
indiscriminately,--the bowel suffers with the rest of the system. The
woman may have a healthy appetite, may eat the wrong things at the wrong
time, yet the bowel is supposed to go on acting rightly, but it does
not. It, too, becomes lazy and acquires bad habits, and this form of
incomplete constipation is the result. These patients look healthy and
get little sympathy for any pains they may have. They may even gain in
weight; they get headaches once in a while, and if they go shopping or
visiting they don't feel quite well afterward. They are suffering from
the effects of chronic constipation, though their bowels are apparently
regular. They are marching onward toward apoplexy or Bright's disease of
the kidney.
IMPORTANCE OF A CLEAN BOWEL.--Every mother, sooner or later, observes
that a physician always thoroughly cleans out the bowel of a sick child
at once, no matter what the character of the sickness is. He does this
for two reasons,--first, because he knows that the great majority of
children's ailments are of gastro-intestinal origin; second, if the
origin of the disease is not in the stomach or bowels, experience has
taught him that if the bowels are clean at the beginning of a disease,
that disease will run a milder and shorter course than if complicated
with a condition of self-poisoning. If a child develops fever the
digestive function stops; whatever food is in the stomach or bowel will
promptly ferment and putrefy because of the abnormal heat caused by the
fever and the arrested digestion. If this is not cleaned out at once the
self-poisoning process begins.
The above is a suggestive admission for a physician to make. It simply
means that the vast majority of the calls made by a physician on ailing
children are caused by errors in diet and can be completely cured by a
dose of castor oil or calomel, or, better still, need never occur.
A mother who neglects, who is guilty of inattention to the conditions of
her child's bowel, fails in one of the most important duties of
motherhood. I know as a father and a physician that if a child's bowel
acts regularly and thoroughly, that child is fortified to the highest
efficient degree against the multitude of little ailments common to all
children. A clean bowel means good blood, good digestion, ability to
exercise properly, to sleep soundly and to think clearly. Such a child
will resist infection and throw off the minor troubles that pave the way
for serious sickness. It is a secret worth knowing.
A DAILY MOVEMENT OF THE BOWEL NECESSARY.--In order to preserve good
health one thorough movement of the bowel is necessary daily. A baby may
have two or three and enjoy robust health. A larger daily number
suggests an abnormal condition of the bowel and an investigation should
be made. If a nursing baby's bowels do not move before bedtime it should
be given an injection of equal parts of glycerine and hot water,
one-half cupful; or an enema of soap and water, or a glycerine
suppository. When a child is six months old, in some sooner, it should
be put on the stool at a certain time every morning. This will aid in
the establishment of the habit, as a child soon understands why it is
made to assume this position and acts accordingly.
The condition referred to above and which we termed incomplete
constipation may affect the nursing infant. A child's bowels may move
daily and yet the child will suffer from constipation. If the movements
are watched it will be observed that certain children strain when at
stool, and after a time succeed in passing hard, dry lumps or balls of
fecal matter. Such a movement is a certain indication that the bowel is
not emptying itself satisfactorily and that a constant toxemia or
poisoning is going on. Very faithful efforts should be made to remedy
this condition by the use of articles of diet that are known to be
laxative, otherwise the condition is one that will "grow" with the child
and establish an obstinate chronic constipation with all its miseries
and dangers.
CONSTIPATION IN BREAST-FED INFANTS.--Many nursing infants thrive and
gain in weight, yet they are constipated. Before you drug your baby be
sure the fault is not your own. Many mothers are responsible for the
constipation with which baby suffers. If the mother is constipated, so
will the child be. Cure the constipation of the mother and the baby's
bowels will regulate themselves. Nursing mothers who are large
tea-drinkers have irregular bowels as a rule. A baby whose mother is
lazy or indolent, who does not take a reasonable amount of exercise,
whose diet is faulty and whose hours are bad, is a sufferer from
constipation. The mother's life must be regulated, her diet and habits
corrected, and the instructions carried out as already recommended. The
breast milk should be examined and if any cause for constipation exists
in it, it should be rectified as suggested elsewhere.
If it is thought advisable to resort to drugs for the immediate relief
of the constipation of infants, the best ones are the aromatic fluid
extract of cascara sagrada; milk of magnesia with equal parts of the
aromatic syrup of rhubarb given in doses of one to three teaspoonfuls
daily.
Irrigations, enemas, and suppositories should not be used continuously.
The habit is a bad one. The parts become accustomed to their use and
fail to act. If the child is passing dry and hard stools it is of
advantage to inject two ounces of warm sweet oil at night, allowing it
to remain in the bowel until the following morning. See page 312.
CONSTIPATION IN BOTTLE-FED INFANTS.--It is much easier to treat the
constipation of bottle-fed babies than of those breast-fed, because the
food can be changed to ensure regular bowel movements. The first change
to be made in a bottle-fed baby who is habitually constipated is to add
more cream to the food. The way to do this is to take out of the bottle
of each feeding one tablespoonful of the food and put in its place one
tablespoonful pure cream. If this change partly rectifies the bowel
ailment, add more cream until the bowels are of the proper consistency.
Milk given constipated babies should be raw, never boiled, as boiled
milk will always aggravate the trouble.
The use of oatmeal water instead of plain water in making the baby's
food may cure the bowel trouble. Taking the sugar of milk out of the
baby's food and putting in its place the same quantity of Mellin's food
will sometimes cure the constipation.
One or two teaspoonfuls of milk of magnesia put into one feeding daily,
or fifteen drops to one tablespoonful of the aromatic fluid extract of
cascara sagrada will move the bowels. Orange juice, strained, two
teaspoonfuls twice daily, is an excellent remedy and should be tried in
every case. Sweet oil and pure cod liver oil, in doses of thirty drops
to two teaspoonfuls three times daily after feedings, if the little
patient is poorly nourished. If the stools remain hard and dry, an
injection of two ounces of warm sweet oil at bedtime is an excellent
method of aiding the bowel. The oil should remain in the bowel all
night. This lubricates the parts, softens the fecal mass and stimulates
the gut to perform its own work. See page 312.
CONSTIPATION IN CHILDREN OVER TWO YEARS OF AGE.--Most children when put
upon a varied diet after the nursing days are over are relieved of any
constipation which may have existed up to that time. There are a few,
however, whose condition does not seem to improve. These children need
attention. We should first insist on regular habits. A child should be
told that its bowels must move every morning after breakfast. If this
is absolutely insisted upon the child will soon recognize the
uselessness of fighting the proposition and submit. If at any time a
conscientious effort is made to move the bowel without result after
fifteen minutes it is wise to use a glycerine suppository so that the
bowel will empty itself.
It has been stated in another part of this book that there are children
with whom milk does not agree. Experience has taught us that milk,
especially milk that has been boiled, causes more cases of constipation
in growing children than all other causes combined. Find out if it is
milk that is the cause in any individual case. While these children
cannot take whole milk just as it comes from the dairy without suffering
in a great many ways, they can take milk and water, or milk and oatmeal
water, prepared in the following way, without becoming constipated. A
bottle of fresh milk is allowed to stand in a cool place for five hours,
when the top ten ounces are skimmed off with a Chapin dipper and mixed
with twelve ounces of oatmeal gruel or plain water. This can be used as
a drink.
Parents can select from the following list of articles such combinations
as may be suitable to constitute the regular meals of a constipated
child:
Lamb chops.
Rare steak.
Rare roast beef.
Hashed chicken.
Soft boiled eggs.
Cracked wheat.
Hominy.
Cornmeal.
Oatmeal, Scotch.
Bran biscuits.
Oatmeal crackers.
Graham wafers.
Stewed or baked apple.
Apple sauce.
Plain vanilla ice cream.
Animal broths, purees of peas.
Beans, and lentils.
Peas.
String beans.
Spinach.
Cauliflower.
Asparagus.
Stewed tomatoes, strained.
Whole wheat bread.
Zwieback.
Custard.
Stewed prunes.
Junket.
Cornstarch.
Malted milk is agreeable and advisable as a drink.
Orange juice or a scraped raw apple is allowable at this time.
Constipated children should eat plenty of good butter. Olive oil, two
or three teaspoonfuls after each meal, is excellent. It can be kept up
for months to advantage. Older children may eat raw and cooked fruits,
figs, dates, baked potatoes, poultry, and fish. One or two raw apples or
a peach or orange may be given daily. A strict observance of the above
rules and diet will result in normal movements of the bowel if persisted
in for a reasonable time. It may be necessary occasionally to use a
suppository or an enema now and again until the habit is established.
In children from five to fifteen years of age the use of bran muffins,
with fruit, etc., as described above, will effect a cure of constipation
without having to resort to drugs. I have cured many cases of
constipation in growing children with these muffins without making any
other change in their diet or habits.
RECIPE FOR BRAN MUFFINS
Take one pint of best flour, one quart unsifted bran, one
teaspoonful bicarbonate of soda (baking soda), a pinch of salt.
Mix these thoroughly together, then add: six to eight
tablespoonfuls good, New Orleans molasses, one pint of milk.
Mix together very thoroughly. Put in muffin rings and bake in
oven. About one ounce should be put in each ring as they raise
easily. Eat with plenty of good butter. They should be given to
children before each meal, when they are hungry, not after
their stomachs are full. Put bran in dish first. Sift in flour,
soda and salt. Mix these thoroughly together, then add one pint
of milk (two cupfuls) and six to eight tablespoonfuls of New
Orleans molasses. The quantity of molasses depends upon the
individual taste. They are good for any child or adult whether
constipation exists or not.
Drugs may be of temporary service in some cases. A pill of cascara
sagrada is the best for this purpose. It should not be continued for
more than two weeks. Castor oil, calomel, and other frequently-used
cathartics should never be used in simple constipation.
TREATMENT OF OBSTINATE CONSTIPATION
There are cases that resist treatment of the kind described above. Diet
and drugs do not succeed in establishing the habit of daily bowel
movements. In these cases radical treatment is imperative. The diet
should be the same as that described above, but it will be found
advisable to cut out milk altogether. Cereals can be taken with sugar
and butter instead of milk. The oil injection plan of Professor Kerley
has given me excellent results. I quote his comments upon and method of
giving it:--
"OIL INJECTIONS."--"For this purpose a soft-bulb syringe of four ounces'
capacity is ordered. Over the hard rubber tip is place a small sized
adult rectal tube or a No. 18 American catheter. The catheter or tube is
cut so that but nine inches remain for use. The cut end is forced over
the small, hard rubber tip of the syringe. A fountain syringe is
impracticable for this purpose, as it is soon destroyed by the oil and
rendered unfit for use. Besides, sufficient pressure is not produced to
force the oil into the gut even with a high elevation of the bag. The
child is placed on his back or on his left side. The syringe is filled
with oil, the tube is lubricated, and passed through the rectum as far
as it can go. When it has been passed to the full nine inches, as may
readily be done with a little practice, the syringe is emptied and the
tube withdrawn. The injection should be given after the child has been
placed in bed for the night. It is our object to have the oil retained
during the night. If a passage of the bowels is produced at the time, or
if the oil leaks out during the night, a small quantity should be used.
In some of my patients I have been able to use but one ounce. In very
few, indeed, does it cause an evacuation at the time. If there is a
tendency to leakage a napkin should be worn to avoid soiling the
bed-linen. The following morning after breakfast, the child is placed on
the vessel and kept there until a bowel movement results or until
fifteen minutes have elapsed. In a great many cases if the constipation
has been obstinate for months, the bowel will be at once evacuated. When
this does not occur in fifteen minutes, a glycerine suppository is
inserted, which invariably produces an evacuation. This use of the
suppository, according to my observation, can usually be dispensed with
in a very few days; the use of the oil, however, may have to be
continued for several weeks. When the child has had the oil nightly and
an evacuation the next morning without assistance for two weeks, I
direct that the oil be omitted for a night and the effect noted. If the
usual passage occurs after breakfast, the oil is given for five nights
and then omitted. If the case progresses satisfactorily the use of the
oil is gradually omitted, being given at first every second night, then
every third, fourth, or fifth night, etc. A considerable number of cases
have been completely relieved in two months. In the event of no passage
following the omission of the oil, its use is continued for two weeks
longer, when it is again omitted for a night." To illustrate this point
the following case is cited.
"ILLUSTRATIVE CASE.--A boy three years of age had never had a bowel
evacuation without drugs, soap enemas, or suppositories since birth, and
finally these were no longer effective. The mother, thoroughly
frightened, brought the child to me. Eight months of diet and the use of
the oil were required before he was entirely well. It is now three
months since the local treatment was discontinued and the bowel function
remains normal.
"The diet with the absence of milk must be continued for months after
the patient is apparently well, and he must not be allowed to pass a
single morning without an evacuation at the usual time. In assuming the
management of one of these cases I explain to the mother or nurse that
the treatment is not pleasant for the child or the attendant, and that
it may have to be persisted in for weeks, and unless she is willing to
carry it out to the end, it would better not be undertaken. I assure
her, however, that with her cooeperation, which is usually readily given,
the child will make a complete recovery. Cases that are slow in
responding to treatment, I usually give the additional advantage of
abdominal massage from twenty minutes to one-half hour, before the child
is placed at stool. The massage should practiced by one skilled in the
work.
"The above local measures apply particularly to children after the
eighteenth month. They may be used earlier, however, following out the
diet along the lines laid down for bottle-fed children who suffer from
constipation. In very young children a smaller amount of oil should be
used, never more than two ounces, usually one ounce is all that is
required. When the oil treatment is under way, whatever the age of the
patient, laxative drugs should not be given."