The child must be fed by hand until strong enough to nurse the breast. In certain cases of prematurity, as well as in diseases like pneumonia, scarlet fever, and diphtheria, the child must be fed by gavage. Nutritive inunctions of benzoated lard or cod-liver oil are also valuable, not only for the passive exercise supplied, but for the absorption of a certain amount of the unguent.
Marasmus means wasting, but the term is applied to infants that steadily lose weight. The bodies of infants are so largely composed of fluid, that loss of weight occurs quite easily and rapidly. Loss of weight may be sudden or gradual. It comes on rapidly after acute diarrhœa, either with or without vomiting, or it may follow persistent vomiting without diarrhœa.
Malnutrition from defective feeding is the most common cause of wasting in infants. This may be from lack of sufficient food or lack of proper ingredients, as well as irregularity of intervals, and disease. Rickets, congenital stenosis of the pylorus, congenital syphilis, and tuberculosis are all possible factors in the etiology.
In any case, no treatment can be instituted until these conditions have been confirmed or excluded.
Pyloric stenosis (the account follows Grulee) may be a thickening of the muscular coat of the outlet of the stomach (pylorus) or a spasmodic contraction. The condition is most frequent in males and in the first born.
Symptoms usually begin before the second week. There is constipation with small ribbon-like stools, and the urine is scanty. The most marked sign, however, when it is present, is the excessive, uncontrollable vomiting, which ordinarily occurs fifteen to thirty minutes after eating, but may be delayed for several hours. The vomiting may be of the common type, but more frequently it is projectile in character, like that seen in meningitis. The contents of the stomach are violently expelled, sometimes several feet. Physical examination may reveal the stomach bulging under the arch of the ribs and peristaltic waves moving back and forth across its surface. The pylorus itself may sometimes be felt as a lump or tumor.
Prognosis.—About fifty per cent die.
Treatment.—Dietetic and surgical. Grulee recommends small amounts of food, poor in fat, be given at short intervals. If this fails, operation is required.
Pneumonia in the newborn most frequently results from the aspiration of mucus out of the maternal passages as the child is born. This may happen when the cord is compressed, or at any time when a partial asphyxiation impels the child to try to breathe.
It may also come on when a feeble child has been chilled by a prolonged first bath.