The Maternal Management Of Children, In Health And Disease Part 16

UNHEALTHY MILK.--The infant's stomach and bowels may become deranged from the breast-milk becoming unwholesome.

This may arise from the parent getting out of health, a circ.u.mstance which will be so manifest to herself, and to those more immediately interested in her welfare, that it is only necessary just to allude to it here. Suffice it to say, that there are many causes of a general kind to which it may owe its origin; but that the most frequent is undue lactation, a subject to which reference has already been made, and the effects both upon mother and child fully dwelt upon.[FN#31] To cure derangement of the bowels from this cause, a wet-nurse is the only remedy.

[FN#31] See page 15.

Anxiety of mind in the mother will cause her milk to be unhealthy in its character, and deficient in quant.i.ty, giving rise to flatulence, griping, and sometimes even convulsions in the infant.[FN#32] A fit of pa.s.sion in the nurse will frequently be followed by a fit of bowel complain in the child.[FN#33] These causes of course are temporary, and when removed the milk becomes a healthy and sufficient for the child as before.

[FN#32] See page 25.

[FN#33] See page 33.

Sudden and great mental disturbance, however, will occasionally drive away the milk altogether, and in a few hours. A Mrs. S., aet. 21, a fine healthy woman, of a blonde complexion, was confined of a boy in October, 1836. She had a good time, and a plentiful supply of milk for the child, which she continued to suckle till the following January, a period of three months, when her milk suddenly disappeared. This circ.u.mstance puzzled the medical attendant, for he could not trace it to any physical ailment; but the milk never returned, and a wet-nurse became necessary. In the following spring the husband of this lady failed, an adversity which had been impending since the date when the breast-milk disappeared, upon which day the deranged state of the husband's affairs was made known to the wife,--a fact which at once explained the mysterious disappearance of the milk.

Unwholesome articles of diet will affect the mother's milk, and derange the infant's bowels. On the 25th May, 1836, I was called to see an infant at the breast with diarrhoea. The remedial measures had but little effect so long as the infant was allowed the breast-milk; but this being discontinued, and arrow-root made with water only allowed, the complaint was quickly put a stop to. Believing that the mother's milk was impaired from some accidental cause which might now be pa.s.sed, the infant was again allowed the breast. In less than four-and-twenty hours, however, the diarrhoea returned. The mother being a very healthy woman, it was suspected that some unwholesome article in her diet might be the cause. The regimen was accordingly carefully inquired into, when it appeared that porter from a neighbouring publican's had been subst.i.tuted for their own for some little time past. This proved to be bad, throwing down, when left to stand a few hours, a considerable sediment; it was discontinued; good sound ale taken instead; the infant again put to the breast, upon the milk of which it flourished, and never had another attack.

In the same way aperient medicine, taken by the mother, will act on the child's bowels, through the effect which it produces upon her milk.

This, however, is not the case with all kinds of purgative medicine, nor does the same purgative produce a like effect upon all children. It is well, therefore, for a parent to notice what aperient acts thus through her system upon that of her child, and what does not, and when an aperient becomes necessary for herself, unless she desire that the infant's bowels be moved, to avoid the latter; if otherwise, she may take the former with good effect.

Again; the return of the monthly periods whilst the mother is a nurse always affects the properties of the milk, more or less, deranging the stomach and bowels of the infant. It will thus frequently happen, that a few days before the mother is going to be unwell, the infant will become fretful and uneasy; its stomach will throw up the milk, and its motions will be frequent, watery, and greenish. And then, when the period is fully over, the milk will cease to purge. It is princ.i.p.ally in the early months, however, that the infant seems to be affected by this circ.u.mstance; for it will be generally found that although the milk is certainly impaired by it, being less abundant and nutritious, still, after the third or fourth month it ceases to affect the infant.

Is then a mother, because her monthly periods return after her delivery, to give up nursing? Certainly not, unless the infant's health is seriously affected by it; for she will generally find that, as the periods come round, by keeping the infant pretty much from the breast, during its continuance, and feeding him upon artificial food, she will prevent disorder of the child's health, and be able in the intervals to nurse her infant with advantage. It must be added, however, that a wet- nurse is to be resorted to rather than any risk incurred of injuring the child's health; and that, in every case, partial feeding will be necessary at a much earlier period than when a mother is not thus affected.

The milk may also be rendered less nutritive, and diminished in quant.i.ty, by the mother again becoming pregnant. In this case, however, the parent's health will chiefly suffer, if she persevere in nursing; this, however, will again act prejudicially to the child. It will be wise, therefore, if pregnancy should occur, and the milk disagree with the infant, to resign the duties of a nurse, and to put the child upon a suitable artificial diet;--if, however, pregnancy should take place before the infant is six month's old, a wet-nurse ought to be procured.

FROM IRREGULAR NURSING.--This is one of the most frequent sources of derangement of the stomach and bowels of the child. The infant that is constantly at the breast will always be suffering, more or less, from flatulence, griping, looseness of the bowels, and vomiting. This is caused by a sufficient interval not being allowed between the meals for digestion. The milk, therefore, pa.s.ses on from the stomach into the bowels undigested, and the effects just alluded to follow. Time must not only be given for the proper digestion of the milk, but the stomach itself must be allowed a season of repose. This evil, then, must be avoided most carefully by the mother strictly adhering to those rules for nursing which have been already laid down.[FN#34]

[FN#34] See page 5.

FROM TEETHING.--The bowels of the infant at the breast, as well as after it is weaned, are generally affected by teething. And it is fortunate that this is the case, for it prevents more serious affections. Indeed, the diarrhoea that occurs during dent.i.tion, except it be violent, must not be subdued; if, however, this is the case, attention must be paid to it. It will generally be found to be accompanied by a swollen gum; the freely lancing of which will sometimes alone put a stop to the looseness: further medical aid may, however, be necessary.

FROM COLD AND DAMP, ETC.--Of course there are other causes besides these already alluded to, giving rise to bowel complaints, during this epoch,--causes not cognisable by the mother, however, and not mentioned therefore here. It is right, however, that she should be aware that these affections are sometimes the result simply of impressions of cold or damp, particularly at certain seasons of the year; in the autumn, for instance, when, as is well known, bowel complaints are very frequent. When thus produced, it is important early to seek medical aid, as inflammation is generally the result.

2. AT THE PERIOD OF WEANING.

There is great susceptibility to derangements of the stomach and bowels of the child at the period when weaning ordinarily takes place, so that great care and judgment must be exercised in effecting this object. Usually, however, the bowels are deranged during this process from one of these causes; from weaning too early, from effecting it too suddenly and abruptly, or from over-feeding and the use of improper and unsuitable food. There is another cause which also may give rise to diarrhoea at this time, independently of weaning, viz. the irritation of difficult teething.

WEANING TOO EARLY.--The subst.i.tution of artificial food for the breast- milk of the mother, at a period when the digestive organs of the infant are too delicate for this change, is a frequent source of the affections now under consideration.

The attempt to wean a delicate child, for instance, when only six months old, will inevitably be followed by disorder of the stomach and bowels. Unless, therefore, a mother is obliged to resort to this measure, from becoming pregnant, or any other unavoidable cause, if she consult the welfare of her child, she will not give up nursing at this early period. But if she should be no longer competent to suckle, and her infant be delicate, a wet-nurse must be obtained; for, the infant's bowels becoming disordered, medicine or remedies will avail little without healthy breast milk.

The age at which weaning ought to take place must ever depend upon circ.u.mstances; the ninth month would not be too early for some, the twelfth would be for others.[FN#35]

[FN#35] See page 51.

FOR SUDDEN AND ABRUPT ALTERATION OF DIET.--Depriving the child at once of the breast, and subst.i.tuting artificial food, however proper under due regulations such food may be, will invariably cause bowel complaints. Certain rules and regulations must be adopted to effect weaning safely, the details of which are given elsewhere.[FN#36]

[FN#36] See page 52.

OVERFEEDING, AND THE USE OF IMPROPER AND UNWHOLESOME FOOD.--These causes are more productive of disorder of the stomach and bowels at the time of weaning than any yet referred to.

If too large a quant.i.ty of food is given at each meal, or the meals are too frequently repeated, in both instances the stomach will become oppressed, wearied, and deranged; part of the food, perhaps, thrown up by vomiting, whilst the remainder, not having undergone the digestive process, will pa.s.s on into the bowels, irritate its delicate lining membrane, and produce flatulence, with griping, purging, and perhaps convulsions.

Then, again, improper and unsuitable food will be followed by precisely the same effects; and unless a judicious alteration be quickly made, remedies will not only have no influence over the disease, but the cause being continued, the disease will become most seriously aggravated.

It is, therefore, of the first importance to the well-doing of the child, that at this period, when the mother is about to subst.i.tute an artificial food for that of her own breast, she should first ascertain what kind of food suits the child best, and then the precise quant.i.ty which nature demands. Many cases might be cited, where children have never had a prescription written for them, simply because, these points having been attended to, their diet has been managed with judgment and care; whilst, on the other hand, others might be referred to, whose life has been hazarded, and all but lost, simply from injudicious dietetic management. Over-feeding, and improper articles of food, are more frequently productive, in their result, of anxious hours and distressing scenes to the parent, and of danger and loss of life to the child, than almost any other causes.

TEETHING.--The irritation caused by difficult teething may give rise to diarrhoea at the period when the infant is weaned, independently of the weaning itself. Such disorder of the bowels, if it manifestly occur from this cause, is a favourable circ.u.mstance, and should not be interfered with, unless indeed the attack be severe and aggravated, when medical aid becomes necessary. Slight diarrhoea then, during weaning, when it is fairly traceable to the cutting of a tooth (the heated and inflamed state of the gum will at once point to this as the source of the derangement), is of no consequence, but it must not be mistaken for disorder arising from other causes. Lancing the gum will at once, then, remove the cause, and generally cure the bowel complaint.

3. TO THE CHILD BROUGHT UP BY HAND.

Children brought up on an artificial diet are very liable to indigestion and bowel complaints; indeed none more so: and it is from these affections that so many of these infants perish. When, then, it is absolutely necessary from untoward circ.u.mstances to have recourse to this mode of nourishing the child, the rules and regulations laid down in the section on "Artificial Feeding" must be most strictly followed out, if the parent would hope to avoid disease and rear her child.[FN#37] And if these affections should at any time unfortunately manifest themselves, the mother ought carefully and diligently to examine whether the plan of feeding pursued is in every particular correct, particularly bearing in mind that the two causes most frequently productive of disorder in the child are overfeeding and the exhibition of unsuitable food--the two grand errors of the nursery.

These results, however, have already been sufficiently dwelt upon as likely to take place at weaning, and they may of course occur to a child who is brought up on an artificial diet at any period.

[FN#37] See page 34.