SYMPTOMS OF DISSATISFACTION

Some of the pointed questions which are put to a young mother who brings her child into the office of the baby specialist, are the following:

Does the baby seem satisfied after his feeding?

Does he suck his fist?

How much does he gain each week in weight?

Does he sleep well?

Does the baby vomit?

What do his bowel movements look like?

Will you please send a stool to the office?

With the intelligent answers to these questions--after knowing the birth weight and the age of the child and its general nervous disposition--the physician can formulate some conclusion as to the babe's general condition and can usually find a feeding formula that will make him grow.

Vomiting, restlessness, sleeplessness and the condition of the bowels, are the telltales which indicate whether or not the food is being a.s.similated; and the stools may vary all the way from hard bullet-like lumps to a green diarrhea.

Babies do not thrive well in large inst.i.tutions where the food is so often made up in a wholesale manner, for the simple reason that the food elements are not suited to the need of each individual baby. Some infants are unable to digest raw milk, and for them sterilized or boiled milk should be tried; others require a fat-free mixture such as skimmed milk, while still others may need b.u.t.termilk for a short time.

Babies require individual care, particularly in their food, and the good or bad results are plainly shown in the stools, weight, sleep, etc.

FLATULENCE

Flatulence is an excessive formation of gas in the stomach and bowels leading to distension of the abdomen and the belching of gas, and often the bringing up of a sour, pungent, watery fluid.

Flatulence is seen in infants suffering from intestinal indigestion and the food is nearly always at fault. This condition is the result of the faulty digestion of the sugar and starches--particularly the starch--which should be immediately reduced. In such conditions the addition of a slight amount of some alkaline (such as soda, magnesia or lime water) to the food often produces good results. Great patience must be exercised with a child that suffers from flatulence, for immediate improvement can hardly be expected; time is required for the restoration of good digestion.

VOMITING

Vomiting is perhaps more often the result of over feeding or too frequent feeding than anything else. A healthy, breast-fed baby may now and then regurgitate a bit, but it simply spills over because it is too full. We do not refer to this as vomiting, we refer to the belching up or vomiting of very sour or acrid milk which leaves a sour odor on the clothing. This can all usually be rectified by lengthening the intervals from two to three hours and preventing bolting of food by getting a nipple whose hole is not so large. Too much cream in the food will also sometimes cause vomiting.

Too frequent feeding at night is another cause of vomiting. When the stomach is full, the failure to lay the baby down quietly, as is so often seen in those homes where bouncing and jolting are practiced, may also result in vomiting.

Vomiting may be the first sign of many acute illnesses such as scarlet fever, measles, pneumonia, whooping cough, etc.

The treatment for acute vomiting is simple. All foods should be withheld--nothing but plain, sweetened water should be administered, while it is often advisable to give a dose of castor oil. A physician should be called at once if the vomiting continues, and not until the vomiting has entirely ceased for a number of hours and water is easily retained, should food be given, and even then it should be begun on very weak mixtures.

OVER-FEEDING

The size of the child's stomach should be the guide to the quant.i.ty of food given, and attention is called to the table given in a previous chapter. All food taken in excess of his needs lies in his stomach and intestines only to ferment and cause wind and colic. The symptoms of over-feeding are restlessness, sleeplessness, stationary weight (or loss in weight), and oftentimes these very symptoms are interpreted by the mother as sufficient evidence that the baby needs more food; and so the reader can see the terrible havoc which is soon wrought where such ignorance reigns.

WEIGHT

The weighing time should immediately follow a bowel movement and just before a feeding time; then, and only then, we have the real weight of baby, as a retained bowel movement may often add from four to five ounces to the child's weight. There should be a careful record of each weighing, for there may develop a great difference if different members of the family endeavor to keep the weight in their minds. The normal baby should gain four to eight ounces a week up to six months, and from then on the weekly gain is from two to four ounces; in other words, by six months the baby should double his birth weight and at the end of a year his weight should be three times the birth weight. A stationary or diminishing weight demands careful attention; a good doctor should be called at once. Likewise, a very rapid increase in weight is not to be desired, as we do not want a fat baby, but we do desire a well-proportioned and alert baby, and, as someone has said, it is better to have little or no gain during the excessive heat than to upset the digestion by over-feeding, designed to keep the baby gaining.

In weighing, usually the outside garments are removed, leaving on a shirt, band, diaper, and stockings with the necessary pins; the little fellow thus protected is placed into the weighing basket and at each successive weighing, these same clothes or others just like them are always included in the weight, and it should be so reported to the physician.

THE STOOLS

In the chapter "Baby's Early Care," the first stools were described in detail, and there we learned that the dark, tarry, meconium stools are quickly changed within a week to the normal canary-yellow stool, having the odor of sour milk.

The bottle-fed babies' stools differ somewhat in appearance; they are thicker and a lighter color, but should always be h.o.m.ogeneous if the food is well digested. They do not have nearly the number of bowel movements each day that the breast-fed baby does. If a bottle-fed baby's bowels move once a day and he seems perfectly well otherwise, we are satisfied. And curds (white lumps), or mucus (sedimentary, slimy phlegm), indicate that the food is not well digested.

BOTTLE FEEDING AND CONSTIPATION

A bottle baby may be constipated because the proteins are too high, the fat too high, the food of an insufficient quant.i.ty or quality, or the milk have been boiled, while weak babies really may lack the muscular power to produce a bowel movement. With the help of your physician endeavor to arrive at the cause of the constipation, and, if the baby is two or three months old, from one to two teaspoons of unsweetened prune juice may be administered. Milk of magnesia may be added to the food (leaving out the lime water), or a gluten suppository may be used.

The change from milk sugar to malt sugar has helped many infants; while the giving of orange juice (after six months) is very beneficial in many cases. A small amount of sweet oil may be injected into the r.e.c.t.u.m which will lubricate the hard lumps and thus favor comfortable evacuation. The periodicity of the bowel movement (at definite times each day) is a matter of great importance. Immediately after a meal, if the child is old enough, he should be placed on the toilet chair. A bit of cotton, well anointed with vaseline and inserted into the r.e.c.t.u.m just before meals, will often aid in producing a bowel movement shortly after the meal has been taken.

Abdominal ma.s.sage should be administered in all instances of constipation, beginning with light movements and gradually increasing, with well-oiled hands.

DIARRHOEA

Diarrhoea usually accompanies acute intestinal indigestion and is so often a.s.sociated with the common disorders of infancy that we refer the reader to the chapter "Common Disorders of Infancy." Dark stools should always be saved for the physician to observe, as they frequently contain blood. Stools full of air bubbles with pungent sour odor show fermentation; in which cases the starches should be reduced, if not entirely taken away from the food mixtures. Green stools mean putrefaction from filth-germs; a thorough cleansing of the bowel should be immediately followed by a reduction in the strength of the food and the boiling of the milk.

REGULATION OF THE STOOLS

At a certain time each day the napkin should be removed and the child should be held out over a small jar. It is surprising to note how quickly and readily the little fellow cooperates. Diaper experiences may be limited to much less than a year if the mother has patience enough and the baby has the normal intelligence to enter into this regulation regime. We recall one caretaker who complained bitterly because the child under her care constantly wet his diaper; so the caretaker was instructed to keep a daily schedule of the baby's actions for five days; and, to her surprise, she discovered that the baby urinated about the same time each day. A regularity was also noted concerning the bowel movements.

The variations in the time of the urinations were only fifteen or twenty minutes, so nearly did the kidneys act at the same time each day. The caretaker was instructed to remove the diaper and hold the baby out at the earliest occurrence on the daily schedule, and, to the astonishment of the entire family, no further accidents occurred, and the child soon acquired the habit of letting them understand when he was about to wet his diaper. Bowel movements may be regulated more easily than the urination. After the child is about a year old, very few accidents should occur.

MIXED FEEDING

In many instances, and particularly if the infant is under six months of age, and where he has had to have additional feeding from the bottle--under such circ.u.mstances the breast milk may be continued as "partial feeding," at least until the baby has reached his ninth or tenth month, at which time it may be wholly discontinued.

At each nursing time the baby empties both b.r.e.a.s.t.s, and the amount he draws may readily be estimated by carefully weighing him before and after each nursing. By referring to the directions in a previous chapter, the quant.i.ty of food needed for his size and age may be determined; while the deficit is made up from a bottle of milk containing properly modified cow's milk.

If the mother's health admits, or if the b.r.e.a.s.t.s continue to secrete a partial meal for the babe, mixed feeding should be continued until after the ninth or tenth month, when it can gradually be reduced from four or five times each day to once or twice a day, until it is finally omitted altogether. In the meantime, the baby is gradually getting stronger food and at eleven or twelve months the little fellow is able to subsist and thrive upon whole milk.

INFANT FEEDING PUZZLES

It is very difficult to explain how some babies thrive on some certain food while others grow thin and speedily go into a decline on the same regime. The hereditary tendencies and predispositions undoubtedly have a great deal to do with such puzzling cases.

Again, sometimes a slight variation in technic or some other trifling error in connection with the preparation of the baby's food, may be more or less responsible for the variation in the results obtained. No two mothers will prepare food exactly alike even when both are following the same printed directions and these slight discrepancies are enough to upset some delicately balanced baby.

On the other hand, some babies are born with such strong digestive powers and such a powerful const.i.tution that they are easily able to survive almost any and all blunders as regards artificial feeding, while at the same time they also manifest the ability to surmount a score of other obstacles which the combined ignorance and carelessness of their parents or caretakers unknowingly place in the pathway of early life which these little folks must tread.

The fact that so many babies do so well on such unscientific feeding only serves to demonstrate the old law of "the survival of the fittest"--they are born in the world with an enormous endowment of "survival qualities"--and in many cases the little fellows thrive and grow no matter how atrociously they are fed.

There may be other factors in the explanation of why some babies do so well on such poor care, but heredity is the chief explanation, while adaptation is the other. If the little fellows can survive for a few weeks or a few months, the human machine possesses marvelous powers of adaptation, and we find here the explanation why many a neglected baby pulls through.