Never decrease the interval of feeding of a baby who is bringing up parts of its meal between feedings; it is frequently advisable to increase the interval. If a child is colicky and is bringing up lots of gas in addition to some food, one-half grain of benzoate of soda may be added to each ounce of food given and continued for a number of weeks if necessary. When the gas is located in the intestines and is not brought up, it must be made to pass downward. Attention to the bowels is of great importance in these cases and it may be necessary to peptonize the milk for some time. A reduction of the sugar and starch in the feeding frequently cures this condition. (See "Colic.")
There are children who continue to have symptoms of indigestion and who do not thrive despite various changes in the quantity and quality of the feedings. It may be necessary to obtain a wet nurse for them, as it is with "the delicate child." If a wet nurse cannot be obtained, or if the age will permit, a substitute may be tried. Borden's Eagle brand of condensed milk, canned, is probably the best substitute under these circumstances. Condensed milk should never be used as a continuous food; as a substitute, however, for a few weeks it is often invaluable. With an infant of three or four months it should be used at the beginning in the proportion of one ounce of the milk to sixteen ounces of plain boiled water or barley water. The proper quantity, whatever the child is taking (four or six ounces according to the age) at the time, can be taken from the sixteen ounces and fed to the child. As the symptoms improve the milk should be diluted less and less, 1 to 14, 1 to 10, and so on until the proper strength is reached. After the child has been on the condensed milk for a month it should be changed back to cow's milk, using of course a diluted formula until the child becomes accustomed to the change. Condensed milk, if used as a permanent food, will fatten babies, but their vitality is very deficient, the muscles flabby, and the resistance to disease exceedingly poor. They are apt to develop rickets and sometimes scurvy.
Regularity of Feeding.—One of the very first, and one of the most important factors in contributing to the good health and the comfort of a baby is absolute regularity in feeding. A regular interval of feeding is particularly essential during the first month of a baby's life.
Despite the explicit way in which young mothers are instructed in this respect, it is one of the disappointing incidents of the practice of medicine to observe how many of these mothers fail to heed the advice. We have personally tried to find an explanation for this astonishing carelessness, and have come to the conclusion that it is not due to intentional forgetfulness, but rather to an inexplicable failure to appreciate that the physician means exactly what he says.
If, for example, specific instructions are given to feed, or nurse, the child every two hours (and by "specific instructions" it is meant, that the physician takes time to explain in detail the instructions he gives—that the instructions are not incidental to the call, but part of the call;—that the advice is given not as a choice of what is desirable, but as an absolute rule to follow; and carefully explains why it is imperative to do as he says; and is satisfied the mother understands what he means) it would seem that there could be no possible reason why the directions should not be faithfully carried out. Yet such is not the case in many instances, and the excuses given by mothers for failure are so trivial and annoying that they show a failure to appreciate that they are dealing with a serious problem—a problem affecting human life. They fail to understand that fatal consequences may follow their negligence. They treat the baby problem exactly as they would a household incident, and as they do not consider it important whether the breakfast dishes are washed at 9 a. m. or at twelve noon, neither do they consider it important whether the baby is fed at 9 a. m. or an hour later. When mothers learn that the attention they must give their babies is essentially different from the attention they give ordinary household duties, the problem of raising children with success and comfort will be greatly simplified.
If the instructions are to feed the baby at certain intervals, do so at all hazards. To offer the foolish excuse that the baby was asleep when feeding time came, is no excuse at all; as a matter of fact the baby should be asleep at each feeding time, if it is healthy. Wake it and feed it, for, as will be shown later, it is the constant regularity that counts. It will be more difficult to institute regular feeding intervals during the first month, because a healthy baby is very difficult to wake up, even to be fed, during the first few weeks of life. It is absolutely essential, however, that it should be wakened: otherwise the tendency to overfill the stomach at the next feeding will lead to indigestion and colic.
Why is Regularity of Feeding Important?—Because a baby's stomach holds a very small quantity, and experience has taught us that a baby will thrive better on small quantities given frequently, rather than large quantities at longer intervals. The smaller the baby, the smaller the quantity to begin with. Some babies weigh from five to seven pounds at birth, while others weigh from nine to twelve pounds. It would be unreasonable to expect a very small baby to be able to hold and digest as much as a very large baby. Considerable common sense and the exercise of some judgment is therefore necessary on the part of the uninstructed mother, as to just the right quantity to give. Fortunately, a little experience will enable the observant mother quickly to solve this important problem. Nature promptly furnishes the symptoms which will correctly guide her. Before considering the significance of these symptoms let us appreciate certain facts common to all babies, and we will more easily interpret the meaning of the special symptoms the baby will furnish.
First of all the baby never vomits. The ejection of food, therefore, is dependent upon a condition, not a disease. If milk runs out of its mouth immediately, or within a few moments, after a feeding, the explanation is that it was fed too much; it does not vomit, the stomach simply overflows. It is exactly like trying to put more milk into a cup after it is full,—it will not hold more, it overflows.
The significance of this symptom, therefore, is that the quantity of the feeding is wrong (it is not the baby's stomach that is at fault,—it is the mother's judgment). Reduce the quantity of each feeding and you will quickly cure it. If the milk does not overflow soon after a feeding, the baby will appear satisfied and will go to sleep, and will sleep until it is time for the next feeding. It may not do this, however. In half an hour, or a little longer, after the feeding, it wakes, it begins to fret and cry, and very soon it suddenly belches gas and ejects a mouthful of milk, after which it will rest quietly for a few moments, when it will begin fretting all over again. It may keep up this performance for an hour, or until the next feeding, and if so it is exhausted and unfit to carry on the digestive process. It is in these cases where most mothers make serious mistakes. This is the beginning of real trouble, and the family physician is the only one qualified to give advice under such circumstances. Remember the warning given regarding heeding the advice of every busybody just at this time. Your baby's health is at stake; maybe its life depends upon what you choose to do.
What is the Significance of "Vomiting" After Feedings in Babies?—Let us examine the difference between the milk which overflowed immediately after the feeding and the milk which the baby ejects one-half hour or so later, and which is now being considered.