Vomiting may or may not be serious. The child may nurse too rapidly or too much, and the over-distended stomach simply empties itself. Many infants “spit up” their excess of milk, and thus relieve themselves. This is a simple regurgitation, usually of unchanged milk, though it may be acid from admixture with the gastric juice.
Vomiting, in a breast-fed child, may come during an attack of colic when the eructations of gas appear. It may be a symptom of gastrointestinal intoxication, of too much fat in the food, too short intervals between feedings, or too much sugar in the food.
Projectional vomiting awakens suspicion of a pyloric stenosis or meningitis, and must be reported to the physician at once.
Vomiting which occurs within twenty minutes after feedings is not serious ordinarily, even though gas and large curds are expelled, but all vomiting later than this, is significant of a pathology.
Treatment.—Regulation of the hours of feeding is most important, and next, the character of the food. If the child vomits an hour or so after nursing, it may be that the milk is too rich (fat). Try a longer interval, or give an ounce or so of cereal water before putting the child to the breast.
Prematurity exposes the child to three distinct dangers, which arise, respectively, from atmosphere, food, and infection. Very few children born before the seventh month survive. A child born at the eighth month, or with a weight of three pounds, or more, can be saved almost always. The premature child up to the time of birth, has been protected very carefully against temperature variations by the liquor amnii, and when suddenly precipitated into a new environment, which its vitality barely tolerates, the consequences are serious.
These infants have a poor heat production, and the natural warmth of the body must be preserved. This is best done by incubators, which supply air and moisture in stable and appropriate amounts. Chilling of the child for even a few moments may be fatal. A room may be fitted up to produce the necessary conditions of light, air, heat and moisture. The child, wrapped in sheets of cotton, except the face, is then covered with a blanket, and surrounded by a temperature varying from 88° to 95° F., which is gradually lowered to 80° F. as the child gains strength. An occasional whiff of oxygen, as prescribed for an atelectatic child, is sometimes advantageous.
Bathing.—Premature infants must not be bathed, but the skin should be cleansed with cotton and warm sweet oil or albolene. All unnecessary handling is to be avoided.
Food.—Breast milk is the secret of success with these cases. Since most of the infants are too weak to take the nipple, the breasts must be pumped, and the child fed with spoon or pipette.
The interval between the feedings depends a little on the amount taken, but it should not be less than one and one-half hours, nor more than two hours. As the child gains, the interval may be lengthened to three hours. Lack of sufficient nourishment is shown by cyanosis and loss of weight, and overfeeding, by vomiting and diarrhœa.