The Maternal Management of Children, in Health and Disease. - Thomas Bull, M.D.
THE QUANTITY OF FOOD TO BE GIVEN AT EACH MEAL.--This must be regulated
by the age of the child, and its digestive power. A little experience
will soon enable a careful and observing mother to determine this
point.--As the child grows older the quantity of course must be
increased.
The chief error in rearing the young is overfeeding; and a most
serious one it is; but which may be easily avoided by the parent
pursuing a systematic plan with regard to the hours of feeding, and
then only yielding to the indications of appetite, and administering
the food slowly, in small quantities at a time. This is the only way
effectually to prevent indigestion, and bowel complaints, and the
irritable condition of the nervous system, so common in infancy, and
secure to the infant healthy nutrition, and consequent strength of
constitution. As has been well observed, "Nature never intended the
infant's stomach to be converted into a receptacle for laxatives,
carminatives, antacids, stimulants, and astringents; and when these
become necessary, we may rest assured that there is something faulty in
our management, however perfect it may seem to ourselves."
THE FREQUENCY OF GIVING FOOD.--This must be determined, as a general
rule, by allowing such an interval between each meal as will insure the
digestion of the previous quantity; and this may be fixed at about
every three or four hours. If this rule be departed from, and the child
receives a fresh supply of food every hour or so, time will not be
given for the digestion of the previous quantity, and as a consequence
of this process being interrupted, the food passing on into the bowel
undigested, will there ferment and become sour, will inevitably produce
cholic and purging, and in no way contribute to the nourishment of the
child.
THE POSTURE OF THE CHILD WHEN FED.--It is important to attend to this.
It must not receive its meals lying; the head should be raised on the
nurse's arm, the most natural position, and one in which there will be
no danger of the food going the wrong way, as it is called. After each
meal the little one should be put into its cot, or repose on its
mother's knee, for at least half an hour. This is essential for the
process of digestion, as exercise is important at other times for the
promotion of health.
THE KIND OF ARTIFICIAL FOOD AFTER THE SIXTH MONTH, TO THE COMPLETION
OF FIRST DENTITION.
As soon as the child has got any teeth,--and about this period one or
two will make their appearance,--solid farinaceous matter boiled in
water, beaten through a sieve, and mixed with a small quantity of milk,
may be employed. Or tops and bottoms, steeped in hot water, with the
addition of fresh milk and loaf sugar to sweeten. And the child may
now, for the first time, be fed with a spoon.
When one or two of the large grinding teeth have appeared, the same
food may be continued, but need not be passed through a sieve. Beef tea
and chicken broth may occasionally be added; and, as an introduction to
the use of a more completely animal diet, a portion, now and then, of a
soft boiled egg; by and by a small bread pudding, made with one egg in
it, may be taken as the dinner meal.
Nothing is more common than for parents during this period to give
their children animal food. This is a great error. "To feed an infant
with animal food before it has teeth proper for masticating it, shows a
total disregard to the plain indications of nature, in withholding such
teeth till the system requires their assistance to masticate solid
food. And the method of grating and pounding meat, as a substitute for
chewing, may be well suited to the toothless octogenarian, whose
stomach is capable of digesting it; but the stomach of a young child is
not adapted to the digestion of such food, and will be disordered by
it."[FN#10]
[FN#10] Sir James Clarke on Consumption.
"If the principles already laid down be true, it cannot reasonably be
maintained that a child's mouth without teeth, and that of an adult,
furnished with the teeth of carnivorous and graminivorous animals, are
designed by the Creator for the same sort of food. If the mastication
of solid food, whether animal or vegetable, and a due admixture of
saliva, be necessary for digestion, then solid food cannot be proper,
when there is no power of mastication. If it is swallowed in large
masses it cannot be masticated at all, and will have but a small chance
of being digested; and in an undigested state it will prove injurious
to the stomach and to the other organs concerned in digestion, by
forming unnatural compounds. The practice of giving solid food to a
toothless child, is not less absurd, than to expect corn to be ground
where there is no apparatus for grinding it. That which would be
considered as an evidence of idiotism or insanity in the last instance,
is defended and practised in the former. If, on the other hand, to
obviate this evil, the solid matter, whether animal or vegetable, be
previously broken into small masses, the infant will instantly swallow
it, but it will be unmixed with saliva. Yet in every day's observation
it will be seen, that children are so fed in their most tender age; and
it is not wonderful that present evils are by this means produced, and
the foundation laid for future disease."[FN#11]
[FN#11] Dr. John Clarke's Commentaries.
The diet pointed out, then, is to be continued until the second year.
Great care, however, is necessary in its management; for this period of
infancy is ushered in by the process of teething, which is commonly
connected with more or less of disorder of the system. Any error,
therefore, in diet or regimen is now to be most carefully avoided. 'Tis
true that the infant, who is of a sound and healthy constitution, in
whom, therefore, the powers of life are energetic, and who up to this
time has been nursed upon the breast of its parent, and now commences
an artificial diet for the first time, disorder is scarcely
perceptible, unless from the operation of very efficient causes. Not
so, however, with the child who from the first hour of its birth has
been nourished upon artificial food. Teething under such circumstances
is always attended with more or less of disturbance of the frame, and
disease of the most dangerous character but too frequently ensues. It
is at this age, too, that all infectious and eruptive fevers are most
prevalent; worms often begin to form, and diarrhoea, thrush, rickets,
cutaneous eruptions, etc. manifest themselves, and the foundation of
strumous disease is originated or developed. A judicious management of
diet will prevent some of these complaints, and mitigate the violence
of others when they occur.
THE KIND OF ARTIFICIAL DIET MOST SUITABLE UNDER THE DIFFERENT
COMPLAINTS TO WHICH INFANTS ARE LIABLE.
Artificial food, from mismanagement and other causes, will now and
then disagree with the infant. The stomach and bowels are thus
deranged, and medicine is resorted to, and again and again the same
thing occurs.
This is wrong, and but too frequently productive of serious and
lasting mischief. Alteration of diet, rather than the exhibition of
medicine, should, under these circumstances, be relied on for remedying
the evil. Calomel, and such like remedies, "the little powders of the
nursery," ought not to be given on every trivial occasion. More
mischief has been effected, and more positive disease produced, by the
indiscriminate use of the above powerful drug, either alone or in
combination with other drastic purgatives, than would be credited.
Purgative medicines ought at all times to be exhibited with caution to
an infant, for so delicate and susceptible is the structure of its
alimentary canal, that disease is but too frequently caused by that
which was resorted to in the first instance as a remedy. The bowels
should always be kept free; but then it must be by the mildest and
least irritating means.
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 quantity, 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 quantity of
milk added, or prepared barley,--mixed in warm water and unboiled milk.
Flatulence and griping generally arise from an undue quantity of food,
which passing 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 circumstances, 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 constitution, 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 quantity
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 dentition, 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 breasts 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
quantity, 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 dentition 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 constitution
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 circumstances and constitution 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 quantity; 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 quantity 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 quantity 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 circumstances forbid it; and a
small quantity of vegetable also.
If a child, then, be of a sound constitution, 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
constitutional disturbance.
But if the child be of a delicate and weakly constitution (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 assimilation 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 quantity. 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 constitutional 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
quantity with the food, worms will result.[FN#14] It may, therefore, be
added in small quantity, 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.
WATER.--This should be the only beverage throughout childhood. Toast-
and-water, if the child prefer it, which is rendered slightly more
nutritive than the more simple fluid. The water employed in its
preparation, however, must be at a boiling temperature, and it ought to
be drunk as soon as it has sufficiently cooled; for by being kept, it
acquires a mawkish and unpleasant flavour.
WINE, BEER, etc.--The practice of giving wine, or, indeed, any
stimulant, to a healthy child, is highly reprehensible; it ought never
to be given but medicinally.
The circulation in infancy and childhood is not only more rapid than
in the adult, but easily excited to greater vehemence of action; the
nervous system, too, is so susceptible, that the slightest causes of
irritation produce strong and powerful impressions: the result in
either case is diseased action in the frame, productive of fever,
convulsions, etc.; wine, accordingly, is detrimental to children.
An experiment made by Dr. Hunter upon two of his children illustrates,
in a striking manner, the pernicious effects of even a small portion of
intoxicating liquors in persons of this tender age. To one of the
children he gave, every day after dinner, a full glass of sherry: the
child was five years of age, and unaccustomed to the use of wine. To
the other child, of nearly the same age, and equally unused to wine, he
gave an orange. In the course of a week, a very marked difference was
perceptible in the pulse, urine, and evacuations from the bowels of the
two children. The pulse of the first was raised, the urine high
coloured, and the evacuations destitute of their usual quantity of
bile. In the other child, no change whatever was produced. He then
reversed the experiment, giving to the first the orange, and to the
second the wine, and the results corresponded: the child who had the
orange continued well, and the system of the other got straightway
into disorder, as in the first experiment.[FN#15]
[FN#15] Marcellin relates an instance of seven children in a family
whose bowels became infested with worms, from the use of stimulants.
They were cured by substituting water for the pernicious beverage.
In this town, spirits, particularly gin, are given to infants and
children to a frightful extent. I have seen an old Irish woman give
diluted spirits to the infant just born. A short time since one of
those dram-drinking children, about eight years of age, was brought
into one of our hospitals. The attendants, from its emaciated
appearance, considered the child was dying from mere starvation; which
was true enough in a certain sense. Food was accordingly offered and
pressed upon it, but the boy would not even put it to his lips. The
next day it was discovered that the mother brought the child very
nearly a pint of gin, every drop of which before night he had consumed.