See POSTNATAL DEPRESSION
See INFANTILE COLIC
A baby will normally be introduced to solids at about four months. These will consist of strained vegetables and fruits. At the beginning they are not a substitute for milk but are simply to get the baby used to them. Gradually solids become an integral part of the diet, and by six months the amount of milk can usually be reduced in proportion to solids in each meal.
Breast milk is the best possible food for a baby from birth, and no other milk is needed until one year of age, when cow's milk may be introduced. If the baby is not breast fed, infant formula is recommended for most of the first year, although many babies cope with ordinary cow’s milk from six months. From the age of about six months it is safe to stop sterilising the bottles. Many babies are able to master the art of drinking out of a cup at about nine months. By the time a baby is a toddler, they should be eating much the same meals as the rest of the family, assuming these are nutritious and well balanced. It is important that food is attractively prepared and presented so that it looks appetising.
Some parents become excessively anxious because their child seems to be a fussy eater, and they worry that the child will not receive adequate nutrition. This is usually because meals have become a battleground with a parent insisting on every last scrap being consumed. Once mealtimes become unpleasant, the child not unnaturally tries to avoid them. Children are like adults. Sometimes they are hungrier than other times, and they like some foods and dislike others. If you allow your child some individual choice in what and how much they eat, it is unlikely that problems will arise.
If a child goes off a particular food for a period, respect their wish - it will usually be short-lived. It is unknown for a child voluntarily to starve itself to death.
There is growing evidence that children should not be overfed. A chubby child has long been regarded as desirably healthy and a tribute to its mother. No-one would suggest that children ought to be thin and that a little extra fat does not provide the necessary fuel for a growing and energetic youngster, but increasingly it is being realised that fat children grow into overweight adults.
See also BOTTLE FEEDING; BREASTFEEDING; CHILDHOOD
A generalised lack of muscle tone in a newborn infant is an uncommon problem, but may be a sign of serious illness.
If the baby is floppy, and not moving arms and legs spontaneously a serious viral or bacterial infection caught before birth from the mother, or in the first few days of life, may be responsible.
Malnutrition in the mother causing poor nutrition of the baby, or poor nutrition of the baby after birth (often due to failure of breastfeeding), is another cause.
Other less common causes of a floppy baby include cerebral palsy (spasticity), Down syndrome (mongolism), Ehlers-Danlos syndrome, Prader-Willi syndrome, myasthenia syndromes, muscular dystrophy (failure of muscle development), Werdnig-Hoffmann disease (inherited progressive muscle wasting), Duchenne muscular dystrophy and other disorders that affect the nerve control of muscles.
Babies fed honey contaminated with dust containing Clostridium botulinum are affected by the toxin produced by these bacteria, which results in muscle weakness.
Abnormalities of body chemical control may also cause weak muscles or poor muscle tone. Examples include rickets (lack of vitamin D), glycogen storage disease (inability to use sugar effectively for energy) and aminoaciduria (protein chemistry disorder).
See also FAILURE TO THRIVE; FLOPPY BABY SYNDROME
See LANUGO
See ROSEOLA INFANTUM
See BOTTLE FEEDING; BREASTFEEDING; WITCH’S MILK
More than half of all parents experience problems with their baby’s sleep pattern between six and twelve months of age. These problems may include difficulty in getting to sleep, frequent night waking, and failing to return to sleep after waking. They are often the result of a behaviour the child has learned, and rarely due to any underlying medical problem.
Strategies to change the behaviour of these babies is successful in the vast majority if correctly applied, but this may take up to three weeks of persistence in applying a consistent form of behaviour. Sedative medications should very rarely be used under twelve months of age, and even in older children, should be used with great caution.
Different babies need different amounts of sleep, and what is appropriate in one child, is not necessarily what is appropriate in another. Nine out of ten babies under twelve months will need a daytime nap, and some need two. These naps may vary from 15 minutes to two hours in length between six and twelve months of age.
A child may be put down to sleep at any convenient time between 6 PM and 10 PM or even later, but this time will become a long-term habit. Babies may take up to half an hour to fall asleep, and most then sleep for more than ten hours, but most also wake at least once during the night.
Waking during the night is very common, but is only a problem when the baby is unable to fall asleep again without a parent’s assistance. This problem can be worsened by the way in which the baby is put to sleep initially, as this is the way the child expects to return to sleep after waking, so that if a baby normally falls asleep in a parent’s arms, or while being rocked, that is the way in which they will expect to return to sleep after waking.
A baby who becomes used to falling asleep with a dummy in its mouth, may be unable to return to sleep if the dummy falls out during the night. Tie the dummy to a short ribbon and attach this to the clothing collar. When the baby wakes and starts to cry for the dummy, run the infant’s hand from the collar down the ribbon to the dummy and let them reinsert it themselves. Most children learn this trick by eight months of age.
It may become necessary to teach the child to fall asleep on its own. When starting a new scheme to teach a baby to sleep, start by changing the sleep environment by altering the position of the cot in the room, and installing (or removing) a night-light. The baby should be put in the cot while awake, and then allowed to fall asleep. If the baby cries, this can be dealt with in three ways -
- leaving the child alone to cry itself to sleep. Very tiring on the nerves and may lead to an insecure child.
- controlled crying. This means comforting the child when it starts crying, but during the night, extending the time between each comfort session. As soon as the child settles, it should be left alone immediately and allowed to fall asleep by itself. If crying starts again, return after an increased time to comfort it again. On subsequent nights the times between each comfort are slowly extended further.
- allowing the child, in its cot, to fall asleep while a parent lies beside the cot. Initially the parent may be actually touching the child gently with a hand, but gradually, night by night, the parent moves further and further away, and eventually out of the room.
Spending a week or three changing a child’s sleep habits will be very tiring for the parents, and possibly stressful in the short term for the child, but in the long term, all will benefit.
After one year of age sleep problems steadily decrease, but even at three years of age, one in twenty children wake during the night.
See also BEHAVIOUR THERAPY; CHILDHOOD; NIGHT TERRORS
See CHILD SMALL; FAILURE TO THRIVE; GROWTH REDUCED
Baby teeth (also known as primary or deciduous teeth) are twenty in number. They are gradually replaced during childhood and the teenage years by 32 permanent adult teeth.
Both baby and adult teeth are located and shaped according to the role they play in the mouth. The front teeth are incisors, and are responsible for cutting food. The eye teeth (or canines) are shaped to tear food, while the back teeth (molars) are responsible for grinding.
Each baby tooth also has a very important part to play in minding the appropriate space in the jaw for the permanent tooth that is to follow. Premature loss of a baby tooth can compromise this space relationship, and lead to crowding later in life.
Teeth are also involved in the process of speech, and are of obvious cosmetic significance. It follows that if the baby teeth are abnormal or damaged, it can have an adverse effect upon a child's development and personality.
It is therefore necessary to have a child's teeth regularly assessed by a dentist to ensure that no problems arise during these vital years of growth.
Dental caries, or the process of holes forming in teeth, is an insidious process. Although invisible to the untrained eye, a tooth can become seriously damaged by the rapid decay of its surface enamel. Baby teeth may also break, become infected and even damage the following adult tooth if not properly attended to by a dentist.
A routine dental examination can also take into account the adverse effects of thumb sucking and tooth grinding, the space available for the following adult teeth, and congenital or hereditary anomalies. It is also important to check for disease in the tissues that support the teeth - the gums.
The overuse of a bottle containing milk or cordials can lead to bottle caries, ringbarking of the teeth, and destruction of an infant's smile.
As soon as teeth appear in the mouth, they need to be carefully maintained. Tooth brushing should be more than a pre-bedtime ritual, it should be a supervised procedure, performed at least twice a day. Irreversible damage can be done by the incorrect use of a toothbrush, and parents have a responsibility to teach their children the correct brushing technique from an early age.
See also BOTTLE CARIES; TEETH
Tonsillitis, pneumonia, cystitis, school sores and conjunctivitis all have one thing in common - they are all caused by bacteria. Bacteria are not all bad. They are essential for the production of many foods, from wine and beer to mature cheese and yoghurt.
Bacteria are microscopic single celled organisms that are between 0.3 and 10 microns in length. A thousand microns make one millimetre, or a micron is 0.0000001 of a metre. Bacteria are everywhere in the environment in extraordinarily vast numbers. Every gram of soil contains between 1,000,000,000 and 20,000,000,000 bacteria, as well as 10,000,000 to 50,000,000 fungi, about 20,000 algae and 100 to 1000 protozoa and other single celled organisms. Amazingly, eight out of every ten cells in our bodies is actually a bacterium, and there are between 500 and 1000 different types of bacteria in a person’s body at any time. That means that we are more a bacteria than a human. The ratios of these bacteria vary from one person to another, and can be as identifying as a fingerprint. It is obvious that humans evolved with these bacteria and could not survive without them.
Human life would be impossible without bacteria as they are essential for our digestive systems, the manufacture of some essential vitamins, and the good symbiotic bacteria even fight of the pathogenic ones. Sometimes the beneficial bacteria multiply excessively or move to different areas of the body where they become pathogenic (harmful). For example, the Escherichia coli bacterium is very common, and usually harmless in the gut, but in the bladder it can cause a urinary infection. Other bacteria (eg. Mycobacterium tuberculosis that cause tuberculosis) are always pathogenic.
Pathogenic bacteria can penetrate into healthy tissues, and start multiplying into vast numbers. When they do this they damage the tissue that they are infecting, causing it to break down into pus. Because of the damage they cause, the involved area becomes red, swollen, hot and painful. The waste products of the damaged tissue, along with the bacteria, spread into the blood stream, and this stimulates the brain to raise the body temperature in order to fight off the infection. Thus a fever develops.
The body is invaded by millions of pathogenic bacteria every day, but very few ever cause problems because the body’s defence mechanisms destroy the majority of the invading organisms. The white blood cells are the main line of defence against infection. They rapidly recognise an unwanted bacteria, and large numbers move to the area involved to engulf the bacteria and destroy them. It is only when these defences are overwhelmed that a noticeable infection develops.
Hundreds of bacteria are known to microbiologists (the doctors and scientists who study them), but only a few dozen cause significant infections in mankind. All these bacteria have specific names and can be identified under a microscope by experts who can tell them apart as easily as most of us can identify different breeds of dogs.
Every species of bacteria (and fungi, but not viruses) has two names - a family name (eg: Staphylococcus) which uses a capital initial letter and comes first, and a specific species name (eg: aureus) that uses a lower case initial letter and comes second. The golden staph bacteria which causes many serious throat infections is thus called Staphylococcus aureus but may be abbreviated to S.aureus.
When an infection occurs, the patient usually consults a doctor because of the symptoms. If the infection is bacterial, the appropriate antibiotics can be given to destroy the invading bacteria. Because different types of bacteria favour different parts of the body and lead to different symptoms, a doctor can make an educated guess about the antibiotic to use. When there is any doubt, a sample or swab is sent to a laboratory for expert analysis so that the precise organism can be identified, together with the appropriate antibiotic to kill it.
Many bacteria, particularly those in the gut, are beneficial to the normal functioning of the body. They can aid digestion, and prevent infections caused by fungi (eg. thrush) and sometimes viruses. Unfortunately, antibiotics can kill off these good bacteria too, and so common side effects of the use of antibiotics are diarrhoea, and fungal infections of the mouth and vagina.
The most common bacteria that attack humans, and the diseases they cause, or organs they attack, are listed below.
|
BACTERIA |
DISEASE OR PLACE OF INFECTION |
|
Bacillus Bacteroides Bordetella pertussis Brucella abortus Chlamydia tracholatis Clostridium perfringens Clostridium tetani Corynebacterium diphtheriae Escherichia coli Haemophilus influenzae Helicobacter pylori Klebsiella pneumoniae Kingella kingae Legionella pneumophilia Moraxella Mycobacterium leprae Mycobacterium tuberculosis Mycoplasma pneumoniae Neisseria gonorrhoea Neisseria meningitidis Proteus Pseudomonas aeruginosa Salmonella typhi Shigella dysenteriae Staphylococcus aureus Streptococcus pneumoniae Streptococcus pyogenes Streptococcus viridans Treponema pallidum Vibrio cholerae Yersinia pestis |
Anthrax, tuberculosis. Pelvic organs. Whooping cough. Brucellosis. Venereal disease, pelvic organs, eye. Gas gangrene, pseudomembranous colitis. Tetanus. Diphtheria. Urine, gut, Fallopian tubes, peritonitis. Ear, meningitis, sinusitis, epiglottitis. Peptic ulcers. Lungs, urine. Mouth, throat, joints, bone Lungs. Nose, ears, eye, lungs. Leprosy. Tuberculosis. Lungs. Gonorrhoea, pelvic organs. Meningitis. Urine, ear. Urine, ear, lungs, heart. Typhoid fever. Gut infections. Lungs, throat, sinusitis, ear, skin, eye, gut, meningitis, heart, bone, joints. Throat, ear, sinusitis, lungs, eye, joints. Sinuses, ear, throat, skin. Heart. Syphilis. Cholera. Plague. |
As a side curiosity, sharks never catch bacterial infections, and medical scientists are still trying to work out why.
See also FEVER; FUNGI; VIRUS
See CONJUNCTIVITIS
Bed wetting (enuresis) is a medical problem that makes businessmen dread overnight trips to a conference, causes marriages to break up, stops teenagers from spending the night at a friend’s, and drives the mothers of some children to desperation.
Normally, urine is retained in the bladder by the contraction of a ring shaped bundle of muscle that surrounds the bladder opening. When one wishes to pass urine, this ring of muscle relaxes, and the muscles in the wall of the bladder and around the abdominal cavity, contract to squirt the urine out in a steady stream.
Those who are bed wetters, tend to sleep very deeply, and during the deepest phases of this sleep, when all the main muscles of the body are totally relaxed, the sphincter ring muscle that retains the urine in the bladder, also relaxes. Because there is no associated contraction of the muscles in the bladder wall or elsewhere, the urine just dribbles out slowly in the night, not in a hard stream.
Many children may be three or four years old before bladder control is obtained.
The first step is to investigate the patient to exclude any cause for bed wetting. Chronic urine infections, structural abnormalities of the bladder, and other rarer conditions may cause a weakness or excessive irritability of the bladder. These problems must be excluded by urine tests and x-rays.
In children lifestyle stresses (eg: family break up, moving home, hospital admission), social pressures (eg: poverty, overcrowding, lack of privacy) and excessively strict toilet training may cause psychological barriers to bladder control. Mental subnormality may make it impossible for a child to learn the reasons for bladder control.
Other uncommon possible causes include diabetes mellitus (lack of insulin production in the pancreas), diabetes insipidus, epilepsy, paraplegia, Bartter syndrome, spina bifida or a fracture of the pelvis.
A number of very rare brain disorders may also cause enuresis.
There are several steps in any treatment regime for this condition, but do not start before five years of age. They include:- restrict fluids for three hours before bedtime, take child to the toilet during the night, and establish a reward system for dry nights.
- a bed-wetting alarm that consists of a moisture-sensitive pad that is placed under the patient, a battery and an alarm. When it becomes wet from the first small dribble of urine, it sounds the alarm, the patient is woken, and can empty the bladder before returning to sleep. After a few weeks use, most people learn to waken before the alarm.
- amitriptyline (Tryptanol) is taken every night to alter the type of sleep. Over a few weeks, the dosage is slowly lowered and hopefully, the bad sleep habits and bed-wetting do not return.
- desmopressin nasal spray or tablets at bed time acts on the pituitary gland in the brain, and this instructs the kidney to reduce the amount of urine produced during the night.
- psychotherapy in the most resistant cases.
Please remember that premature treatment can cause permanent sleep disturbances in a child, but there are no serious long-term medical consequences from bed wetting.
See also TOILET TRAINING
Behaviour (behavioural) therapy is used by psychologists and psychiatrists to modify a patient's behaviour. In its basic principle, a patient is taught by rewards that acceptable behaviour is better than unacceptable behaviour, which may be punished by withholding a pleasure, or giving “time out” to the patient. It is a modification of the “carrot and stick” technique traditionally used with donkeys. One of the most successful models is that promoted by Triple P.
The technique can be applied in ways that vary in their sophistication to children, intelligent adults, subnormal people, or to the confused elderly. It is vital that any reward be far more significant than the punishment.
See also TRIPLE P
The weight of a baby at birth varies with many factors including number of weeks of pregnancy (ie. is the baby premature), the size of the parents, the racial background of the parents, smoking by the mother and illness in the mother. The range of weights for the average Caucasian baby in developed nations is shown on the following graph.
Effective bonding between a mother and her baby is critical form the wellbeing of both.
If an infant is deprived of maternal care, although fed and kept comfortable, it will develop slowly in all areas including physical, intellectual and emotional. Such infants are small for their age, poorly nourished, apathetic, respond inappropriately to stimuli, do not develop language skills and become inactive.
Bonding begins before birth as the mother feels foetal movements within her. After birth, the mother and baby become extraordinarily emotionally involved with each other, with the attachment beginning within minutes, and intensifying hour by hour. It is important not to separate the mother and baby during the first few hours after birth except for essential bathing, testing and cleaning procedures. The baby responds to the mother’s actions and sounds in order to ensure the bonding develops and continues.
There is even a hormonal component to early bonding, as the baby sucks on the breast to stimulate milk production. The baby is even colonised by the same bacteria, viruses and fungi that inhabit the mother’s skin, mouth and gut. Immunologically they are almost identical for the first few weeks until other people begin to interact.
The bonding can also involve the father, who will become very close to his child, and participate fully in its life and upbringing, but fathers can never know the complete intimacy that exists between a mother and her very own baby.
See also BABY FEEDING; IMPRINTING
Nursing bottle dental decay or bottle caries is a type of decay associated with prolonged feeding of sugary fluids from a nursing bottle. Affected children are often put to bed with a bottle full of sweetened milk, juice or cordial, which remains in their mouth even when asleep. A dummy dipped in honey is another possible cause.
Sugar in the bottle liquid mixes with bacteria in the dental plaque to form acids that attack tooth enamel. Each time a sweet liquid is taken, acids attack the teeth for at least 20 minutes. When children are awake, the saliva is able to remove some of the liquid, however, during sleep, the saliva flow decreases and the sweet liquids collect around the teeth for prolonged periods, bathing the teeth in acids.
The earliest appearance of decay is the enamel turning a chalky white colour, usually around the gum line. Then as more calcium is lost from the tooth, a hole finally appears. In severe cases of bottle caries, the cavities can ring bark the teeth and cause them to break off. At the early stages, the cavities do not cause pain, but as they enlarge, increasing discomfort may be experienced and a dental abscesses may result.
Bottle caries may be treated by fillings or extractions, but because most children are not co-operative at such a young age, they usually need to be sedated. Very often, general anaesthetics have to be given. When the milk teeth are lost early, the appearance and speech may be affected and space for the second teeth may be lost. Dentists often refer such cases to a periodontist (children's dentist) for special management.
The best form of treatment for nursing bottle decay is prevention. Children should not be allowed to sleep with a bottle of sweet liquid; if a child needs a bottle for comfort before falling asleep, fill the bottle with plain water, milk or formula, and remove the bottle as soon as the child is asleep. Dummies should never be dipped in honey.
Fluoride supplements should be given if the local water supply is not fluoridated.
See also BABY TEETH; TEETH
Although cow's milk is part of the normal diet of most Western nations, it is not suitable for young babies. The naturally intended food for babies is breast milk, and a baby who is not being breastfed must be fed with special formulas developed to approximate breast milk, which has more sugar and less protein than cow's milk.
Provided the manufacturer's instructions are followed exactly, most babies will thrive on formula. It is quite wrong to think that a slightly stronger formula might give the baby more nourishment. If the mixture is made stronger than the manufacturer recommends, the baby will get too much fat, protein, minerals and salt, and not enough water.
Milk, especially when at room temperature, is an ideal breeding ground for bacteria, and it is therefore essential that formula is prepared in a sterile environment. Bottles, utensils, measuring implements, teats and anything used in the preparation of a baby's food must be boiled and stored in one of the commercially available sterilising solutions. Carers should also wash their hands before embarking on preparation. Made-up formula must be stored in the refrigerator. If these precautions are not followed, the baby may develop gastroenteritis and require hospitalisation.
The baby should be allowed some say in how much food s/he needs. Carers will generally be advised by the hospital or baby health clinic how much to offer the baby (calculated according to weight), but just as breastfed babies have different needs that can vary from feed to feed, so too do bottle-fed babies. Mothers often feel that the baby should finish the last drop in the bottle. But within reason, babies can generally be relied upon to assess their own needs quite satisfactorily.
Just as with breastfed babies, it is generally considered best to feed a baby as and when they are hungry. In the first few weeks this may be at irregular and frequent intervals. It takes about three or four hours for a feed to be digested, and as the baby's digestive system matures, signs of hunger will normally settle down into a regular pattern.
The rate at which babies feed also varies. Some like to gulp down their formula, while others like to take things easy. The rate of feed can upset a baby if it is too fast or slow for its liking. Teats with different hole sizes can be purchased, and a small hole can be enlarged with a hot needle. Frequent breaks from the bottle during a feed in order to let a burp come up and the milk go down can also smooth the progress of the feed and avoid stomach discomfort afterwards.
See also BABY FEEDING; BREASTFEEDING
Breastfeeding is technically known as lactation.
After birth, a woman’s breasts automatically start to produce milk to feed the baby. The admonition “breast is best” features prominently on cans of infant formula and on advertising for breast milk substitutes in many third- world countries, and there is little doubt that it is true. Because of poverty, poor hygiene and poorly prepared formula, bottle-feeding should be actively discouraged in disadvantaged areas.
Unfortunately, for a variety of reasons, not all mothers are capable of breastfeeding. Those who can't should not feel guilty, but should accept that this is a problem that can occur through no fault of theirs, and be grateful that there are excellent feeding formulas available for their child.
Breastfeeding protects the baby from some childhood infections and the stimulation it also helps the mother by stimulating the uterus to contract to its pre-pregnant size more rapidly.
Babies don't consume much food for the first three or four days of life. Nevertheless, they are usually put to the breast shortly after birth. For the first few days the breasts produce colostrum, a very watery, sweet milk, which is specifically designed to nourish the newborn. It contains antibodies from the mother, which help prevent infections.
Breastfeeding may be started immediately after birth in the labour ward. All babies are born with a sucking reflex, and will turn towards the side on which their cheek is stroked. Moving the baby's cheek gently against the nipple will cause most babies to turn towards the nipple and start sucking. Suckling at this early stage gives comfort to both mother and child. In the next few days, relatively frequent feeds should be the rule to give stimulation to the breast and build up the milk supply. The breast milk slowly becomes thicker and heavier over the next week, naturally compensating for the infant's increasing demands.
After the first week, the frequency of feeding should be determined by the mother and child's needs, not laid down by any arbitrary authority. Each will work out what is best for them, with the number of feeds varying between five and ten a day.
Like other beings, babies feed better if they are in a relaxed comfortable environment, with a relaxed comfortable mother. A baby who is upset will not be able to concentrate on feeding, and if the mother is tense and anxious, the baby will sense this and react, and she will not be able to produce the “let-down reflex” which allows the milk to flow. The milk supply is a natural supply and demand system. If the baby drinks a lot, the breasts will manufacture more milk in response to the vigorous stimulation. Mothers of twins can produce enough milk to feed both babies because of this mechanism.
While milk is being produced, a woman's reproductive hormones are suppressed and she may not have any periods. This varies greatly from woman to woman, and some have regular periods while feeding, some have irregular bleeds, and most have none. Breastfeeding is sometimes relied upon as a form of contraception, but this is not safe. The chances of pregnancy are only reduced, not eliminated. The mini contraceptive pill, condoms, and the intrauterine device can all be used during breastfeeding to prevent pregnancy.
It is important for the mother to have a nourishing diet throughout pregnancy and lactation. The mother's daily protein intake should be increased, and extra fresh fruit and vegetables should be eaten. Extra iron can be obtained from egg yolk, dark green vegetables (eg. spinach), as well as from red meat and liver. Extra fluid is also needed.
See also BOTTLE FEEDING; WEANING
See WEANING
Most women hope to feed their newborn child for the first few months of life, but unfortunately not all women succeed. The most common reason for failure is emotional or physical stress. The harder the woman tries to succeed, the more she fails. Being relaxed with the baby, the concept of breastfeeding, and the physical and emotional surroundings is vital.
To increase the breast milk supply the nipples should be stimulated as much as possible by the baby suckling. The medications domperidone or metoclopramide can also be used to increase breast milk production as they stimulate the release of prolactin from the pituitary gland in the brain.
There are medical reasons for being unable to breast feed. A mother who has a significant illness, be it an infection, dietary problems, cancer or any other form of debilitation, is not going to be as successful at breastfeeding as a woman who is in perfect health. In primitive areas of the world, malnutrition may be a factor, but even in developed countries, a fad diet may lack vital nutrients and have an adverse effect. Rarely, damage to the pituitary gland under the brain may be responsible.
See also BREASTFEEDING; WEANING
Breast milk is the perfect food for babies, and can be used alone up to three months of age. It is cheap, easily digested, results in minimal faeces production, protects against numerous infections (eg. gastroenteritis, bronchiolitis) and is conveniently packaged for immediate use without any messy preparation.
Colostrum is the type of milk produced from one to five days after the birth of a baby, transition milk from five to ten days after birth and mature milk after that.
Breast milk can be scientifically analysed to detect the reason for infant feeding problems, a failure of the infant to thrive and inadequate or inappropriate milk production. The normal results are summarised below:-
|
UNIT |
COLOSTRUM |
TRANSITION MILK |
MATURE MILK |
|
|
Energy |
kJ/100 mL |
239 |
264 |
272 |
|
calories/100 mLs |
57 |
63 |
65 |
|
|
Total protein |
mg/100 mL |
1460 to 6800. |
1270 to 1890 |
730 to 2000 |
|
Lactose (milk sugar) |
mg/100 mL. |
1100 to 7900 |
6100 to 6700 |
4900 to 9500 |
|
Amino acids |
mg/100 mL. |
700 to 4000 |
600 to 1000 |
900 to 1600 |
|
Total fats |
mg/100 mL |
2740 to 3180. |
2730 to 5180 |
1340 to 8290 |
|
Specific gravity |
SG |
1.034 to 1.036 |
1.026 to 1.037 |
|
|
Total solids |
g/100 mL. |
10 to 16 |
10.5 to 15.5 |
10.3 to 17.5 |
|
Sodium |
mEq/L. |
26 to 135 |
19 to 53 |
6 to 43 |
|
Iron |
mg/100 mL. |
0.02 to 0.05 |
0.04 to 0.07 |
0.02 to 0.09 |
See also BABY FEEDING; BREASTFEEDING; BREAST MILK INADEQUATE; WITCH’S MILK
If the milk supply appears to be inadequate, increasing the frequency of feeds will increase the breast stimulation, and the reflex between the breast and the pituitary gland under the brain is also stimulated. This gland then increases the supply of hormones that cause the production of milk. Sometimes, medications (eg. domperidone, metoclopramide) that stimulate the pituitary gland can be used to increase milk production, or even induce milk production in mothers who adopt a baby.
A mother who is tense and anxious about her new baby may have trouble breastfeeding. The mother should be allowed plenty of time for feeding and relaxation so that she becomes more relaxed and never feels rushed. A lack of privacy can sometimes be a hindrance to successful breastfeeding. Lots of reassurance, support from family, and advice from doctors, health centre nurses or associations that support nursing mothers can help her through this difficult time.
The best way to determine if the baby is receiving adequate milk is regular weighing at a child welfare clinic or doctor's surgery. Provided the weight is steadily increasing, there is no need for concern. If the weight gain is very slight, or static, and increasing the frequency of feeds fails to improve the breast milk supply, then as a last resort supplementation of the breast feeds may be required. It is best to offer the breast first, and once they appear to be empty of milk, a bottle of suitable formula can be given to finish the feed.
See also BOTTLE FEEDING; BREASTFEEDING; BREASTFEEDING FAILURE
One of the most common breast problems is engorgement, which is not only uncomfortable but may lead to difficulty in feeding and to infection. If the breasts are swollen and overfilled with milk, expressing the excess milk usually relieves the discomfort. This can be done by hand under a shower or into a container, or with the assistance of a breast pump. At other times, expressed milk may be kept and given to the baby by a carer while the mother is out or at work. Breastfeeding need not tie the mother to the home.
The infant may find it difficult to suckle on an overfilled breast, so expressing a little milk before the feed may be helpful. A well-fitted, supportive bra is essential for the mother's comfort. Mild analgesics such as aspirin may be necessary, particularly before feeds, so that the feeding itself is less painful. Heat, in the form of a warm cloth or hot shower, will help with the expression of milk and with releasing milk from blocked areas of the breast.
Engorgement usually settles down after a few days or a week, but if the problem persists, fluid tablets can be used to reduce the amount of total fluid in the body and make it more difficult for the body to produce milk. In severe cases, partial suppression of the milk supply may be necessary.
See also BREASTFEEDING
The respiratory syncitial virus (RSV) is responsible for bronchiolitis, a lung infection of children under two years of age. The infant develops a cough and wheeze, shortness of breath and a runny nose. In severe cases, the child may be very weak, blue around the mouth and dehydrated.
Antibiotics cannot cure this viral condition but are sometimes given to prevent pneumonia. Bronchodilator medications may be used but often are of little help. Placing the child in a warm room with a humidifier, or in a steam tent may give relief. More severe cases will require hospitalisation, where steroids are given and oxygen may be administered into a steam tent to assist with breathing. Tribavirin is an antiviral medication that was introduced 1999 to treat severe bronchiolitis
The vast majority of cases settle without complications in a few days to a week.
See also BRONCHITIS; RESPIRATORY SYNCITIAL VIRUS
Bronchitis is a very common infection of the major tubes (bronchi) that carry air within the lungs, but it occurs in two very different forms, acute and chronic.
The acute form is commonly caused by viruses, occasionally by bacteria, and rarely by fungi. It spreads easily from one person to another on the breath. The symptoms include a fever, chest aches and pains, headache, tiredness, and a productive cough with dark yellow or green mucus.
The diagnosis is confirmed by listening to the chest through a stethoscope. In early stages, X-rays may be normal, but later show characteristic changes. Sputum may be cultured to identify any bacteria present, and the correct antibiotic to treat it.
Viral infections settle with time, rest, inhalations, bronchodilators (open up the bronchi) and physiotherapy. If bacteria are responsible, antibiotics can be prescribed. Bacterial infections settle rapidly with antibiotics, but viral bronchitis takes about ten days to fade in most patients, but may persist for several weeks in the elderly or debilitated.
See also BRONCHIOLITIS; PNEUMONIA