This occurs especially during the first few months before the baby and the breast have become adapted to one another. The baby gets either too much milk at proper intervals, or, more commonly, too much at too frequent intervals, or else its tolerance for fat is lower than normal. Regurgitation and vomiting are commonly the first symptoms. Occurring immediately after feeding, it may be considered a physiological process of getting rid of an excess of food. Sooner or later it comes on some time after nursing, and is then part of a dyspeptic condition that manifests itself further, if unchecked, in undigested, curdy, greenish, slimy, sour, and irritating bowel movements that are greatly increased in frequency. With this there are discomfort and restlessness, shown even in the short intervals of sleep by the drawn, anxious, twitching face. The child seems hungry, sucks its fingers, and eagerly looks for the breast, that is only too often given still more frequently. Periods of colic that are exceedingly painful and cause the child to draw up its legs and scream pitifully, occur as a result of increased gas production and distention of the intestines, making it difficult and painful for the gas to pass on. The buttocks are excoriated, often ulcerated. Thrush is apt to appear in the mouth. Eczema of the cheeks, scalp, and body is common. The child becomes pale and flabby and loses in weight. Fever and intoxication naturally follow in severe cases, unless the condition is relieved. The fat is, doubtless, the chief disturbing element.

Treatment

In mild cases simple lengthening of the feeding intervals to four hours is all that is necessary. In more severe cases it is also necessary to reduce the amount of food taken at each feeding by limiting the time of each nursing, or by allowing the child to take a limited amount from both breasts at each feeding so as to get only the first weaker milk. Five, or even three, minutes may be long enough for a time until the child and the breasts become adapted to one another. This is commonly not a great hardship, as the baby normally gets the greater part of a twenty-minute feeding in the first few minutes. The scales will be of great service, both to determine the baby's condition and to find out how much it is getting. In the still severer cases that are accompanied by intoxication, the child is best taken from the breast for twenty-four, or even forty-eight hours, and then returned to it with short feedings and long intervals. During this time the baby must be given water freely, or barley water, or albumin water, without sugar, and the breasts must be emptied at regular intervals with a breast pump or by hand pressure. Colic is best relieved at the time by laxative enemas. The mother should lead an active, healthy life with outdoor exercise, should not eat excessively of rich fatty foods and meat, and should drink water freely. Examination of her milk is unfortunately rarely of much practical value. If the above measures fail, it is then best to substitute daily for a time one or more breast feedings by artificial food, containing little or no fat, such as modified skimmed milk, malt soup, or malted milk. As the child and breast become better adapted to one another, these can often be discontinued again.