The Dietetic Treatment In Cases Of Minor Ailment

Of minor ailments occurring in infancy, constipation is one of the commonest, and in its treatment diet is all-important.

Constipation frequently occurs in infants who are apparently suitably fed, and in all cases it is necessary to exclude any local affection of the rectum or anus. Habit is important in the prophylaxis of constipation, and careful training is always valuable in its cure. The addition of a dilute cereal gruel, such as barley-water, to the food, an increase in the amount of cream, a change from milk sugar to cane sugar, a tablespoonful of a fresh fruit juice thrice daily - all are important dietetic methods of counteracting this condition in the case of bottle-fed infants. The employment of citrated milk is frequently associated with the condition of constipation, and the addition of sodium citrate to milk-mixtures must always be only a temporary expedient.

In other cases variation of the food is frequently useful, and a tcaspoonful of a proprietary food, such as Benger or Mellin, added to one or two of the bottles in the day, may prove very satisfactory.

The condition is not uncommon among breast-fed infants, and in such cases the digestion and the diet of the mother must in the first place be carefully attended to. Constipation occurs when the baby is not getting enough food, and when its food is not strong enough; in both cases the remedy is simple, when the cause of the condition is recognised.

Encmata should not be continued in routine use. There is a great tendency, when the practice is once started, to continue, daily, syringing out the infant's rectum. This is distinctly inadvisable, and when the condition is not amenable to treatment by dietetic measures, olive oil (1 dram) or cascara (5 m.) thrice daily, are more satisfactory.

Vomiting may occur through over-filling of the stomach in cases where the amount of food is too large, or it may be due to the infant drinking too quickly; both conditions, when recognised, are obviously readily remedied. All infants occasionally regurgitate a small quantity of fluid soon after drinking. This condition must not be allowed to continue, as a habit of vomiting is readily developed in certain infants and is often very difficult to treat. If the amount of fluid given at each feeding-time is not too large, and if the infant does not drink too quickly, it is usually sufficient, to stop the habit of regurgitation in early cases, to prop the upper part of the baby's body up in the cot after feeding, and to avoid rocking, nursing, or moving him about. The chief cause of serious vomiting is irritability of the stomach, due to the presence in it of undigested or unsuitable food, and such cases are dealt with on pages 256 to 258.

Colic and diarrhoea due, it may be, to a chill, or to some temporary indiscretion in the diet, require, in the first place, satisfactory cleansing of the contents of the alimentary tract, and this is most satisfactorily brought about by a dose of castor oil. Thereafter, for twenty-four or thirty-six hours, the infant is given a food considerably weaker than it was accustomed to; then gradually a full diet is regained. The addition of sodium citrate to the milk-mixture is frequently a valuable dietetic means of treatment (p. 239). It is of use in a variety of conditions. An infant may have to be weaned suddenly, while still in the early months of infancy, owing to the illness of the mother, and this infant may at first bear badly a diet consisting of a cow's milk-mixture. By adding sodium citrate, a milk-mixture of adequate strength can, however, be more readily tolerated, and the infant's nutrition satisfactorily maintained. Again, when breast-nursing has been irregular, when, perhaps, in addition, a proprietary food has been given occasionally, and when, in all probability, the digestive powers of the infant have been somewhat irregularly developed, it is, as a rule, wise to commence milk-feeding with a citrated milk. Or, when a strong infant is recovering from an attack of acute gastro-enteric catarrh, citration of a milk-mixture may permit of stronger and more satisfactory food being given early; while to any infant recovering from such an attack, citrated milk is one of the steps which may be taken on the way to regain a natural diet (p. 255).

The indications for the prcdigestion or peptonisation of a milk-mixture are acute illness, high fever, and in many cases those already mentioned in which sodium citrate is of use.

In chronic conditions peptonised milk is, however, of less value practically than theoretically it ought to be, and not infrequently citration of the milk proves more satisfactory (P. 239).

Buttermilk, prepared naturally or by artificial means, is a valuable form of diet in certain cases. It is, however, not yet possible to lay down any very definite rules as to the cases in which it should be given. When given raw, its outstanding characteristics are its poverty in fat, and the presence in it of living lactic acid bacilli, and, theoretically, it .should accordingly be given in those cases in which there is difficulty in fat digestion, and in which we wish to extend the area of the lactic acid flora. The ordinary putrefactive changes in milk occurring in the digestive tract take place through the agency of organisms acting in an alkaline medium, and the presence of large numbers of lactic acid bacilli in the milk prevent the action of these organisms.

I have found buttermilk - raw commercial buttermilk - of marked value in cases of summer infective diarrhoea. Being a food of low nutritive value, it is well to add to it as the symptoms improve a small amount of barley or oatmeal flour, and as there is a tendency for the infant to become so accustomed to this form of nourishment as to render it unwilling to return to a more suitable diet, the administration of the buttermilk should be of as temporary a nature as possible (p. 239).