Infant Feeding and Dental Disorders

By L. G. BARRETT, D. M. D.Lebanon, N. H.

The belief that additional factual knowledge regarding this relationship might facilitate our understanding of certain office problems and dental disorders has given rise to this presentation of a few observations made by men in this field.

Some of the factors entering into the feeding problems of early childhood and consequently the functional dental disorders of later years are of direct concern for the dentist. The mother may be unhappy, oversolicitious or ambivalent in her attitude toward her child; she may prolong the nursing periods because of the pleasure she receives from nursing her child. Her supply of milk may be inadequate or excessive.

Although she may have plenty of milk the mother may feed her baby for an inadequate length of time because her nipples are depressed. Early weaning may be necessary because of mastitis, cardiac decompensation, or pulmonary tuberculosis. The mother may wean her baby early because nursing interferes with her social activities. Emotional stress, as pique over the nuisance and discomfort of menstruation, grief, anger or anxiety associated with marital disharmony or the hatred on an unwanted child may cause the cessation of lactation.

Whatever the interference with normal lactation may be the baby may react with inadequate nursing effort of by refusing to nurse. Even though artificial feeding is accepted it appears that the child often senses deprivation and may react later in life with antagonism or an ambivalent attitude toward the mother. Not only does maternal breast-feeding appear to be advantageous but the mortality of artificially-fed children is considerably higher than that of breast-fed children.

The student from whom I quote observed emotional instability shown by fears, excessive crying and by tantrums. The children played excessively with food, ingested foreign substances such as sand or nasal secretions, refused all or certain kinds of food, or they regurgitated it. Finger sucking or nail-biting was common as was also diarrhea or constipation or incontinence.

In this study, about which I am writing, a group 172 cases, selected because of adequate available feeding data, from 336 routine admissions at a clinic in the New York Hospital disclosed that breast-feeding was adequate in 72 cases, excessive in 16 and inadequate in 84. In 33 of the latter there was no breastfeeding at all. A period of 5 to 12

months of breast-feeding was accepted as adequate although the generally accepted period of 6 to 9 months appears to be ideal. The child is then able to appreciate other manifestations of the mother’s affection and the child’s teeth make nursing painful to the mother.

Among the cases of inadequate breast-feeding the following seems sufficient.

Boy, 2 yr. 9 mon. Diagnosis: neurotic vomiting. The parents had planned for two children, but after the arrival of the patient they did not wish the second. His mother often listened to his breathing at night to determine if he was still living. She was nauseated each time he vomited. She was nauseated also by her husband’s amorous advances, and when she refused them he was so angry.

He was a full term, seven pound baby. To keep him from going to sleep while nursing, he was tickled, pinched and slapped. At three weeks a bottle was added to the breast feeding, and that he vomited more frequently following the breast than the bottle-feeding. At two and one-half months, nursing was stopped and semi-solid foods were gradually added to his bottle feeding, He began to suck his fingers and tickle his nose with a blanket at five months. At nine months he talked enough to indicate that he was through with his food. When one year old, “he would lie rigid at night and scream his head off.” X-rays of the gastro-intestinal tract at that age revealed no organic pathology. Constipation, that had been present from birth, was treated four times a week and at night when he restlessly “pawed the air”. At two years the bottle was discarded. Vomiting occurred at any time from immediately after eating to four hours later. It was worse following sneezing, coughing, or excitement. Most of the furniture in the home was soiled with his vomitus. When he vomited at night, his mother washed the sheets at once, even if it was at three in the morning.

When he entered the clinic, he was seven pounds under weight. He did not mingle with the other children and cried for his mother. On being fed he said, “Too much. I have to wait. You eat it. I have to vomit. Too much. All through, all finished. Take it away.” He played with his food and ate very little unless urged. Then he had spells of angry crying. He often interrupted his eating to urinate. He required 40 minutes to finish sipping a glass of orange juice. He poured his glass of milk in the wastebasket while the nurse was not looking. He coughed and gagged until he announced. “I have to vomit.” He vomited anywhere except in a basin that was kept beside him. He often wet himself, both day and night. He called his feces his “duty” and took much pride in saying, “it’s a big one.” When he defecated on the floor he affectionately patted the soiled spot. He screamed angrily when given an oil injection because of osbtinate constipation. Intellectual tests indicated

he was of normal mental age. During his two months residence in the clinic, he stopped vomiting but sometimes refused to eat, and his weight remained unchanged.

Summary: Mother tense, dissatisfied with her husband, and oversolicitous with the patient. Breast-feeding stopped at two and one-half months. Refusal to eat, vomiting, constipation and angry crying spells developed gradually, the first symptoms appearing during early infancy.

Among the cases of excessive breast-feeding I consider the following representative. These patients exhibited beside complex nervous symptoms as in the inadequate breast-feeding cases, ideas about good and bad food, food rituals, and a crankiness about quality of food.

Example: an eight-year-old boy. He entered the clinic because he presented a feeding problem and suffering from fears, compulsions and tantrums.

He was breast-fed 14 months. The nursing was prolonged because his mother enjoyed it and she thought a subsequent pregnancy that she did not desire was impossible during lactation. His later feeding was a problem. He did not give the bottle until six years of age, when his younger sibling arrived. He required spoon-fooding by his mother until admission to the clinic. Soiling stopped at four years. He was often constipated and resisted the enemas that his father gave him. At two years of age his parents found him touching his genitals. They rebuked him and gave him a crayon suggesting that he draw pictures. Thereafter he showed little interest in his genitals, and had spells of attempting to touch the eyes of others and of drawing peculiar animals.

On admission to the clinic his mental age, according to the Binet-Simon test was six months below his physiological age. He weighed nine pounds more than his proper weight. He refused to eat various foods, including eggs, bananas, and asparagus. He attempted to eat paper, sand, and his nasal secretion. He played games with dolls. One of the games was to feed milk to the babies. To each of them he offered milk, commenting on its quality. “What’s in here? It’s too sour. And this one is too sweet. This one is no good. And this has poison. And this one has very naughty poison. And this” –he smiled happily and drank the milk –“is good”. In discussing his feelings towards a six-year-younger brother, Jackie, from whom he hated to be separated because of a fearless Jackie be eaten by wild animals, he said, “Babies are a nuisance. They don’t know anything. When Jackie sucked on mother’s titty (here patient eagerly licked his lips) he cried. Jackie cried when mother gave him titty. He wanted to go to sleep. No, he didn’t want no titty.” (Why?) “When I was little I liked titty. I asked my mama if it tasted sour. She asked me if I wanted titty. I said, ‘No. It tastes sour!’” (What does it taste like?) “Poison.” In a game with dolls he fed them with milk. When they refused the milk, he said they were bad and must go to bed without supper. To the good dolls who drank their milk, he fed eggs, sausages, and bread, “and the ate everything.”

At times he felt compelled to draw. “Now I must draw. I have to draw.” While drawing pictures of mutilated animals and of animals eating each other, he appeared excited, panted, and bit his fingers. He frequently tried to touch the eyes of others, saying, “I will take your eyes out. I will make them bleed. I will bake them. I will east them.” When the nurse did not allow him to touch her eyes, he appeared angry, bit his fingers, pressed his nose against the table, licked it, and ran to the wall, pounding his head against it.

Summary: Excessive breast-feed-ing and unduly prolonged bottle-feeding. Difficulty of finding acceptable foods, and an interest in foods that are not usually acceptable. Possibly the prolonged bottle-feed-ing and the over discriminating attitude toward solid food may have been associated with difficulty in giving up the more satisfying breast-feeding. The fantasies about the good, bad, sweet, sour, and poisoned foods were apparently related to varying emotional attitudes toward breast-feeding and were stimulated by jealousy at observing the breast-feeding of the younger sibling.

I select from the report the following where breast-feeding was adequate but an undue familial interest in the upper gastro-intestinal tract was marked and the mother unduly interested in the child.

Example: a 20-year-old female college student. Diagnosis: manic-depressive psychosis, circular type, manic phase. She came to the clinic because she was elated, overactive and rebellious against her usual social regulations.

She has suffered from depressions and elations of spirits for one and one-half years. The elated phase of illness in which she entered the clinic appeared when she planned to leave home and attend her first year of college. She bought unnecessary clothes, made too many social engagements with boys, talked more than usual and appeared very cheerful or irritable. She at times spoke kindly of her mother and again was rebellious of her solicitous attitude. “It was said I was in a drug store acting as if I was drunk, with four or five boys, raising merry Ned. I drank some hot coffee, pouring it into my glass to cool it. It made me mad that they should think I was drinking. I had no liquor. Then I started going out with boys who drank. I always act crazy and talk a lot, and then they would think I was drinking. Mother was worrying about who I was with and if I was drinking too.”

Her paternal grandfather and father took frequent doses of medicine for minor ailments. Her father, a periodic drinker, often complained of indigestion. There was no open friction between the parents, although the mother admitted disliking the father’s peculiarity of nervously tapping his hand and foot against nearby objects. The mother, an obese woman, thought her children better than others. She was over solicitous of their welfare and encouraged a closely-knit family group. She was proud of serving the beast quality of food and drink in her home. The family enjoyed automobile trips during which they amused themselves by singing and by eating good foods. Although she was devoted to her three-year-older brother, she was jealous of the greater freedom that her parents allowed him because he was a boy.

She was breast-fed nine months. During the first month of this feeding, she had frequent spells of “colic” that were relieved by the ingestion of peppermint water. She walked at three years and she sucked her thumb until the age of four in spite of attempted corrective measures of tying the thumb with cloth and covering it with alum and black paint. She was a stubborn child and had tantrums when her mother spanked her. As she grew older she was very fond of the good food that was abundantly supplied in her home. She was obese since the age of 15. In spite of internal glandular therapy, she ate excessively and continued to gain weight.

On admission to the clinic she was 20 pounds overweight. She made frequent trips to the smoking room, where she requested cigarettes. She complained that the coffee was not strong enough. She requested that she be allowed to have more than the usual number of eggs for breakfast. She was irritated and refused supper when not allowed to wear pajamas in the dining room. She often complained of vague head discomfort, and requested aspirin. She wished to reduce her weight to compete with other girls for the attention of boys. In spite of receiving an anti-obesity diet, she gained seven pounds during her residence in the clinic. She secretly ate candy that had been sent to other patients and traded with another patient her evening nourishment of an apple for the usual cup of cocoa. Her family sent fruit to her, and during periods of irritability she gorged upon it, eating as many as nine apples in one day, throwing the cores on the floor. Following these periods of overeating, she complained of nausea. On visits outside the clinic with her family she stuffed herself with food. When she attempted to adhere to her anti-obesity diet, she complained. “I feel kind of weak and sick to my stomach. I haven’t eaten anything much today, as I am trying to lose weight. I’m all worn out from not eating anything.”

Summary: Here the familial over interest in the upper alimentary tract was present on both the paternal and maternal sides. The mother was not well adjusted to her husband’s peculiarities. She was tensely oversolicitous about the patient’s welfare, catering to her appetite and accustoming her to large quantities of the best foods. The father encouraged her to take medicine for her minor ailments. These factors may have influenced the excessive upper alimentary tract interest that was associated with her mood disorder.

Example: a tall, muscular, 25-year-old business executive. Diagnosis: without psychosis, alcoholism. He came to the clinic because of alcoholic sprees in which he worked inefficiently, misappropriated money, and thought of killing himself.

He began to drink alcoholic beverages socially at 18 and by the age of 23 was drinking whiskey in the morning to relieve the headache, nausea and tremors that resulted from the drinking of the previous night. He held minor positions many of which were secured by family influence. After marrying at 23, his drinking increased. He then went on sprees of several months’ duration. Between sprees he was penitent and begged his wife to accompany him from work to avoid the temptation of drinking at public bars. When intoxicated he preferred to associate with inferior men, and after his funds were exhausted he borrowed money from the cash box of his employer, forgetting or being unable to replace the money next day. His mother paid these expenditures. During the latter part of his sprees, he feared lest he kill himself or desert his wife. Following the birth of a son, he drank still more. His mother then persuaded him to come to the clinic.

His father, a capable political executive, was well known for his biting, sarcastic, humorous manner of talking. He realized the mother’s lenient attitude toward the patient and, therefore, handled him more firmly than the other children. On the maternal side the great grandfather was alcoholic and the grandfather was a gifted public speaker. The mother, who loved and respected her husband, considered the patient her favorite child. He was more found of her than of his father. Because he was the youngest of four siblings born in quick succession, he received more prolonged attention from his mother than did the other children.

His mother was well and happy during the pregnancy. He was breast-fed nine months. His mother said she received great mental contentment and most delightful physical sensations in her breasts during the act of nursing. He was the easiest of her children to rear. As a baby he was plump and slept quietly between feedings. He did not suffer from gastro-intestinal disorders. He gracefully accepted the transition from liquid to solid foods. However, one of the earliest memories elicited from him was that at the age of five, when he voluntarily wet the bed at night. Following this incident his mother allowed him to sleep with her until she discovered that he attempted to suck at her breasts. His feeling of frustration and not understanding why his attentions were repelled, was recalled quite vividly. Other early memories were of observing a mother goat suckling her young and of the time when his family kept a cow and he had all the milk he wished to drink. The family were not poor people, but his demands for milk were decidedly in excess of what the usual family budget allowed. At school he sang in the glee club. At 17 he became interested in girls, preferring those with large breasts. An important part of his love making consisted of sucking and nibbling on the breasts, “because it stimulates the woman.” He was reasonable fond of food and ate uncomplainingly what was put before him. He was particularly fond of milk and found that interest associated with his alcolohism. “After drinking for a long time, I suddenly feel a tremendous urge to drink milk. When I have a great thirst, I drink milk and it makes me feel as if I had eaten a meal. It is the beginning of the end of liquor when I drink milk. I finally drink milk the first thing in the morning and between my meals as well as on the last thing at night. I get away with three to four quarts a day.”

On admission to the clinic, his weight was normal. He was more cheerful and agreeable than the usual alcoholic. He ate and slept well and was free of physical discomforts. When interviewed the day after admission he said, “I can’t think of anything to report. As I went to sleep, I had a thought of not going to work today. I slept all right.” Only occasionally did he grumble. “My old lady pulled a fast one on me, getting me to come into this place, but I will not be a sucker all my life.”

Summary: On both the paternal and the maternal sides there was a strong upper alimentary drive. The mother’s unusually positive interest in the act of nursing and the excessive amount of attention that she gave him, the youngest of her children, was associated with hi prolonged interest in her breasts and those of other women. When grown his love making interesting was directed toward giving pleasure to women by his oral stimulation of their breasts. The unusually great love for milk in childhood, the adult alcoholism and the substitution of milk for alcohol toward the end of a drinking spree suggest his close psychological association between the two fluids, milk and alcohol. This association was expressed by another spree drinker who jokingly said, “Scotch whiskey is almost as good as mother’s milk.”

While these observations were made from a psychiatric standpoint, I believe,

  1. It becomes obvious that a great many of our patients have had feeding difficulties during infancy.
  2. The resulting disorders of all sorts including nervous or mental, dental and general physical give us the very problems which develop a great deal of the friction between dentist and patient, make for a good deal of the “emery in the chinery” of our office.
  3. The variations of “natural” selection of foods does indeed determine considerable degree the amount of caries found in deciduous molars for example but those variations are due to factors too strong for a mix of cement to repair or a bit of advice about orange juice or a vitamin. Appeal to the patient’s interest in food and consequently teeth with which to enjoy it might do more.
  4. Foods are indeed a powerful factor in dental disorder but let us start at the right end and proceed in the order of development – from birth to the dental chair.

Conclusions:

  1. Inadequate or excessive breast-feeding is undesirable.
  2. Both of these extremes in infant feeding are common. Inadequate in 49% -excessive in 9%.
  3. A strong familial interest in upper alimentary tract and a faulty maternal emotional reaction to the child are important factors in functional gastro-intestinal, emotional and dental disorders.
  4. Recognition of these factors in our patients permits suggestions for prospective mothers, possibly general anesthetics or suitable measures for the “spoiled” child, premedication and local anesthetics for the adult whose concern with oral attentions is not limited to reconstruction procedures. Thus the dentist who understands these as factors in his problems saves much of his “time” and “energy” by an appropriate attitude and behavior and consequently delivers a more efficient and satisfactory service, tending toward more generous compensation in all ways.

 

October 8, 2017 · jagdish1 · Comments Closed