MILK IN ITS RELATION TO INFANT FEEDING 593 



immediately afterward should be given a mixture of cow's milk to 

 make up the required amount of feeding. 



If underfeeding occurs in the case of an artificially fed child 

 both the quantity and the quality of the milk the child has been 

 getting should be scrutinized and means taken to improve both. 

 Increases in the amount of the food should be made very grad- 

 ually, however. When a child has reached the stage where it 

 shows marked effects of underfeeding it is best to procure some 

 breast milk for it. If that is not possible, the child should be 

 started on small doses of cow's milk given at short intervals, the 

 quantity to be increased by degrees until the child is able to take 

 the amount required for its age and weight. 



Disturbance of Balance. — The second group of alimentary dis- 

 turbances has to do with qualitative errors in the food given, one 

 or more of the food elements being at fault. 



The disturbance in weight balance constitutes the lightest 

 form of quahtative alimentary disturbance. It manifests itself 

 principally in a stationary weight curve, or in a fluctuation of the 

 weight curve in contrast to the continuously ascending weight 

 curve of the normal infant. If the weight curve continues to be 

 stationary for any length of time the child becomes restless and 

 less resistant to infection than a healthy infant. The stool may 

 be normal or it may be lighter and drier than usual. Occasionally 

 also the stool may present the type known as fat-soap stool, so- 

 called because it contains more earth-alkali soaps and less free 

 fatty acids. 



Disturbances in weight balance may be due either to an ex- 

 cess of fat or to an insufficiency or even a complete lack of carbo- 

 hydrates in the food. The element of food directly responsible 

 for this nutritional disturbance both Czerny and Finkelstein 

 beheve to be the fat. The trouble lies in the superabundance of 

 fat and the deficiency of carbohydrates. The treatment consists 

 in the reduction of the amount of milk and in the addition of 

 carbohydrates to the food. The latter may be given in the 

 form of dextrimaltose, flour, or malt soup. The additions 

 should be made very gradually, however, to avoid upsetting 

 the child's digestive power, thereby producing a severe ahmen- 

 tary disturbance. 



Dyspepsia is a more advanced form of ahmentary derange- 

 ment than disturbance of balance. It is characterized by loss of 

 appetite, distention of the abdomen, vomiting, and numerous 

 stools. The stools of a child suffering from dyspepsia are usually 

 of thin consistency, mucous in content, and greenish in color. 

 The weight curve varies in different cases; it may go down, it 

 may remain normal, or it may even go up for a few days, only to 



