The Maternal Management Of Children, In Health And Disease Part 4

It is a very desirable thing, then, to correct the disordered conditions of the digestive organs of an infant, if possible, without medicine; and much may be done by changing the nature, and sometimes by simply diminishing the quant.i.ty, of food.

A diarrhoea, or looseness of the bowels, may frequently be checked by giving, as the diet, sago thoroughly boiled in very weak beef-tea, with the addition of a little milk. The same purpose is frequently to be answered by two thirds of arrow-root with one third of milk, or simply thin arrow-root made with water only; or, if these fail, baked flour, mixed with boiled milk.

Costiveness of the bowels may frequently be removed by changing the food to tops and bottoms steeped in hot water, and a small quant.i.ty of milk added, or prepared barley,--mixed in warm water and unboiled milk.

Flatulence and griping generally arise from an undue quant.i.ty of food, which pa.s.sing undigested into the bowels, they are thus irritated and disturbed. This may be cured by abstinence alone. The same state of things may be caused by the food not being prepared fresh at every meal, or even from the nursing-bottle or vessel in which the food is given not having been perfectly clean. In this case weak chicken-broth, or beef-tea freed from fat, and thickened with soft boiled rice or arrow-root, may be given.

Sect. II. WEANING.

THE TIME WHEN TO TAKE PLACE.--The time when weaning is to take place must ever depend upon a variety of circ.u.mstances, which will regulate this matter, independently of any general rule that might be laid down.

The mother's health may, in one case, oblige her to resort to weaning before the sixth month, and, in another instance, the delicacy of the infant's health, to delay it beyond the twelfth. Nevertheless, as a general rule, both child and parent being in good health, weaning ought never to take place earlier than the ninth (the most usual date), and never delayed beyond the twelfth month.

I should say further, that if child and parent are both in vigorous health, if the infant has cut several of its teeth, and been already accustomed to be partially fed, weaning ought to be gradually accomplished at the ninth month. On the other hand, that if the child is feeble in const.i.tution, the teeth late in appearing, and the mother is healthy, and has a sufficient supply of good milk, especially if it be the autumnal season, it will be far better to prolong the nursing for a few months. In such a case, the fact of the on-appearance of the teeth indicates an unfitness of the system for any other than the natural food from the maternal breast.

And again, if the infant is born of a consumptive parent, and a healthy and vigorous wet-nurse has been provided, weaning should most certainly be deferred beyond the usual time, carefully watching, however, that neither nurse nor child suffer from its continuance.

THE MODE.--It should be effected gradually. From the sixth month most children are fed twice or oftener in the four-and-twenty hours; the infant is in fact, therefore, from this time in the progress of weaning; that is to say, its natural diet is partly changed for an artificial one, so that when the time for complete weaning arrives, it will be easily accomplished, without suffering to the mother, or much denial to the child.

It is, however, of the greatest importance to regulate the quant.i.ty and quality of the food at this time. If too much food is given (and this is the great danger) the stomach will be overloaded, the digestive powers destroyed, and if the child is not carried off suddenly by convulsions, its bowels will become obstinately disordered; it will fall away from not being nourished, and perhaps eventually become a sacrifice to the overanxious desire of the parent and its friends to promote its welfare.

The kind of food proper for this period, and the mode of administering it, is detailed in the previous section, on "Artificial Feeding."[FN#12]

[FN#12] The kind of food after the sixth month to the completion of first dent.i.tion, p. 44.

Much exercise in the open air (whenever there is no dampness of atmosphere) is highly necessary and beneficial at this time; it tends to invigorate the system, and strengthens the digestive organs, and thus enables the latter to bear without injury the alteration in diet.

THE DRYING UP OF THE MOTHER'S MILK.--This will generally be attended with no difficulty. When the weaning is effected gradually, the milk will usually go away of itself without any measures being resorted to.

If, however, the b.r.e.a.s.t.s should continue loaded, or indeed painfully distended, a gentle aperient should be taken every morning, so that the bowels are kept slightly relaxed; the diet must be diminished in quant.i.ty, and solid nourishment only taken. The breast, if painfully distended, must be occasionally drawn, but only just sufficiently to relieve the distention. In either case they must be rubbed for five or ten minutes, every four or five hours, with the following liniment, previously warmed:--

Compound soap liniment, one ounce and a half; Laudanum, three drachms.

Sect. III. DIETETICS OF CHILDHOOD.

Childhood, as has been before intimated, extends from about the second to the seventh or eighth year, when the second dent.i.tion is commenced.

No precise rules of diet can be laid down for this period, as this requires to be adapted in every case to the particular const.i.tution concerned. There are, however, certain general principles which must be acted upon, and which can be easily modified by a judicious and observant parent, as circ.u.mstances and const.i.tution may require.

GENERAL DIRECTIONS, AND OF ANIMAL FOOD.--The diet of the latter months of infancy is still to be continued, but with the important addition of animal food, which the child has now got teeth to masticate. This must be given in small quant.i.ty; it should be of the lightest quality, only allowed on alternate days, and even then its effects must be carefully watched, as all changes in the regimen of children should be gradual.

A child at this age, then, should have its meals at intervals of about four hours:--thus its breakfast between seven and eight o'clock, to consist of tops and bottoms, steeped in hot water, a little milk added, and the whole sweetened with sugar; or bread may be softened in hot water, the latter drained off, and fresh milk and sugar added to the bread. Its dinner about twelve o'clock, to consist, every other day, of a small quant.i.ty of animal food (chicken, fresh mutton, or beef, being the only meats allowed) with a little bread and water; on the alternate days, well boiled rice and milk, a plain bread, sago, tapioca, or arrow- root pudding, containing one egg; or farinaceous food, with beef-tea.

Its afternoon mealy about four o'clock, the same diet as formed the breakfast. At seven, a little arrow-root, made with a very small proportion of milk, or a biscuit, or crust of bread, after which the child should be put to bed.

The child must be taught to take its food slowly, retain it in it's mouth long, and swallow it tardily. Nothing must be given in the intervals of the meals. The stomach requires a period of repose after the labour of digestion; and if the child is entertained by its nurse, and its mind occupied, there will be no difficulty in following out this important direction.

As the child grows older, the quant.i.ty at each meal should be increased; the tops and bottoms changed for bread and pure milk, boiled or not; meat may be taken daily, except circ.u.mstances forbid it; and a small quant.i.ty of vegetable also.

If a child, then, be of a sound const.i.tution, with healthy bowels, a cool skin, and clean tongue, the diet may be liberal, and provided it is sufficiently advanced in age, animal food may be taken daily. Too low a diet would stint the growth of such a child, and induce a state of body deficient in vigour, and unfit for maintaining full health: scrofula and other diseases would be induced. At the same time let the mother guard against pampering, for this would lead to evils no less formidable, though of a different character. And as long as the general health of this child is unimpaired, the body and mind active, and no evidence present to mark excess of nutriment, this diet may be continued. But if languor at any time ensue, fever become manifested, the skin hotter than natural, the tongue white and furred, and the bowels irregular, then, though these symptoms should bebonly in slight degree, and unattended with any specific derangement amounting to what is considered disease, not only should the parent lower the diet, and for a time withdraw the animal part, but the medical adviser should be consulted, that measures may be taken to correct the state of repletion which has been suffered to arise. For some time after its removal, care should also be taken to keep the diet under that, which occasioned the const.i.tutional disturbance.

But if the child be of a delicate and weakly const.i.tution (and this is unfortunately the more common case), it will not bear so generous a diet as the foregoing. During the three or four earliest years, it should be restricted chiefly to a mild farinaceous diet, with a small allowance only of meat on alternate days. The constant endeavour of the parent now should be, to seek to increase the digestive power and bodily vigour of her child by frequent exercise in the open air, and by attention to those general points of management detailed in the after- part of this chapter. This accomplished, a greater proportion of animal food may be given, and, in fact, will become necessary for the growth of the system, while at the same time there will be a corresponding power for its a.s.similation and digestion.

A great error in the dietetic management of such children is but too frequently committed by parents. They suppose that because their child is weakly and delicate, that the more animal food it takes the more it will be strengthened, and they therefore give animal food too early, and in too great quant.i.ty. It only adds to its debility. The system, as a consequence, becomes excited, nutrition is impeded, and disease produced, ultimately manifesting itself in scrofula, disease in the abdomen, head, or chest. The first seeds of consumption are but too frequently originated in this way. A child so indulged will eat heartily enough, but he remains thin notwithstanding. After a time he will have frequent fever, will appear heated and flushed towards evening, when he will drink greedily, and more than is usual in children of the same age; there will be deranged condition of the bowels, and headach,--the child will soon become peevish, irritable, and impatient; it will entirely lose the good humour so natural to childhood, and that there is something wrong will be evident enough, the parent, however, little suspecting the real cause and occasion of all the evil. In such a child, too, it will be found that the ordinary diseases of infancy, scarlet fever, measles, small pox, etc., will be attended with an unusual degree of const.i.tutional disturbance; that it will not bear such active treatment as other children, or so quickly rally from the illness.

"Strength is to be obtained not from the kind of food which contains most nourishment in itself, but from that which is best adapted to the condition of the digestive organs at the time when it is taken."

SUGAR.--This is a necessary condiment for the food of children, and it is nutritious, and does not injure the teeth, as is generally imagined.

"During the sugar season," observes Dr. Dunglison, "the negroes of the West India islands drink copiously of the juice of the cane, yet their teeth are not injured; on the contrary, they have been praised by writers for their beauty and soundness; and the rounded form of the body, whilst they can indulge in the juice, sufficiently testifies to the nutrient qualities of the saccharine beverage."[FN#13] Sweetmeats, on the other hand, are most indigestible, and seriously injurious.

[FN#13] Elements of Hygiem. Philadephia, 1835.

SALT.--This is necessary for the health of a child; it acts as a stimulant to the digestive organs, and if not allowed in sufficient quant.i.ty with the food, worms will result.[FN#14] It may, therefore, be added in small quant.i.ty, and with advantage, even to the farinaceous food of infants. Salted meats, however, should never be permitted to the child; for by the process of salting the fibre of the meat is so changed, that it is less nutritive, as well as less digestible.

[FN#14] Lord Sommerville, in his Address to the Board of Agriculture, gave an interesting account of the effects of a punishment which formerly existed in Holland. "The ancient laws of the country ordained men to be kept on bread alone, un-mixed with salt, as the severest punishment that could be inflicted upon them in their moist climate.

The effect was horrible: these wretched criminals are said to have been devoured by worms engendered in their own stomachs."

"The wholesomeness and digestibility of our bread are undoubtedly much promoted by the addition of the salt which it so universally receives. A pound of salt is generally added to each bushel of flour.

Hence it may be presumed, that every adult consumes two ounces of salt per week, or six pounds and a half per annum, in bread alone."

Dr. Paris on Diet.

FRUITS.--These, and of all kinds whether fresh or dried, a delicate child is better without; except the orange, which when perfectly ripe may be allowed to any child, but the white or inner skin should be scrupulously rejected, as it is most indigestible.

A healthy child may be permitted to partake of most fresh fruits. Of the stone-fruits, the ripe peach, the apricot, and nectarine, are the most wholesome; but cherries, from the stones being but too frequently swallowed, had better not be allowed. Apples and pears, when ripe and well masticated, are not unwholesome; and the apple when baked affords a pleasant repast, and where there is a costive habit, it is useful as a laxative. The small-seeded fruits, however, are by far the most wholesome. Of these, the ripe strawberry and raspberry deserve the first rank. The grape is also cooling and antiseptic, but the husks and seeds should be rejected. The gooseberry is less wholesome on account of the indigestibility of the skin, which is too frequently swallowed.

Dried fruits a child should never be permitted to eat.