“He is happy to starve”

A Nineteen Day Old Infant Presents with a Case of Thrush:
Melanie P. brings in her two week old baby who has thrush, a candidal infection in the mouth. He has a whitish coating in his mouth and his mother thinks that this might be causing his feeding problems. Melanie is 24 years old, thin and weary looking, and this is her first child. She appears to have a calm, matter-of-fact demeanor. The baby, Leo, is small, angular with a marked absence of subcutaneous fat a factor that contributes to him looking like an old wrinkled man. He has a ruddy reddish complexion.

On questioning Melanie states that the pregnancy was unremarkable but she describes the birth as “tough.” Leo was fine but he weighed 9 pounds. During the labor her vagina and her cervix were torn. Stitching the cervical laceration was difficult and it required that she have a general anesthetic. The baby was held by his father in the interim which was about four hours.

Leo is an easy-going baby but he has had difficulty with breastfeeding. At first he would not latch on well and this, coupled with the fact that he was a very sleepy infant, resulted in the milk coming in late, at five days after the birth. Melanie was quite uncomfortable the first week because her cervix was swollen and painful. Since the birth Melanie has lost 30 pounds. Aware that Leo was having a hard time learning to nurse–the baby was not nursing vigorously and he was spitting up large quantities of each feed–she had called the hospital to ask for assistance. The hospital sent a nurse to evaluate the situation and give her pointers on nursing. Melanie then phoned the Nursing Women’s Council an organization that sent out a trained lactation consultant. Apparently these efforts were not effective in identifying or alleviating the problem and these professionals did not sense that the situation was becoming critical.

Then Melanie had an insight. She reasoned that because her husband had been milk intolerant as a child, perhaps Leo was also affected by dairy products. She stopped eating all milk products and this helped marginally with the regurgitation. But by this time Leo was in the habit of sleeping through the night without feeding. He was becoming more lethargic and Melanie’s milk supply was dwindling due to lack of nipple stimulation. She did not realize that her infant was losing weight and, in essence, slipping away. Although the chief presenting complaint was thrush this was clearly a case of failure to thrive.

At seven days she brought him to the doctor for a well-baby examination. The doctor became alarmed when he found that Leo had lost over a pound since his birth and suggested supplementation with formula. The first soy-based supplement was not well tolerated so Leo was switched to another formula that was more digestible. Melanie was instructed to wake him during the night to feed him, but he was quite sleepy and she had difficulty arousing him. He could only be fed by bottle during the night as he stubbornly refused to breast feed when in a sleepy state. “If it was up to him he would just starve himself,” Melanie told me. In addition, Leo had to be bundled up to prevent heat loss. The doctor explained that it would use too many calories if he had to struggle to maintain his body temperature.

At this point in the interview Melanie notices that the baby needs a diaper change. She puts him on his back and removes his diaper, then begins to clean him. As she wipes with some pressure around his genitalia, the baby just lies there in a relaxed and flaccid posture, with his head turned to the side, eyes open but not moving. I note that there is no reaction as his mother moves his legs and rubs his skin. His arms and legs do not reflexively bend. He is awake but hypotonic.

Now Melanie picks him up and the baby begins to root, turning his head to the side and stretching his mouth. I suggest that she try to nurse him. I have found that it is helpful to observe the interaction between mother and baby. When taking the case of an infant it can be important to get information about how the child feeds; if one breast is preferred, whether the baby likes a sweet tasting milk, if the child become easily sated or wants to stay on the breast for a long time, etc. Melanie is reluctant at first and I can tell that she does not want me to see how difficult the process of feeding has become. The baby opens his mouth and takes all of the nipple into it, then he licks weakly and his eyes roll back and he nods out, falling asleep. I try to stimulate him by vigorously rubbing his feet but he is fairly unresponsive. Again his mother remarks, “He is happy to starve.”

The baby has a thin white coating on the tongue from the yeast with a few small plaques. His stools are yellow-to yellow green and loose. He does not have a diaper rash. Apparently quite chilly, he does not like being undressed. He cries during the bath and shivers afterward. He doesn’t seem to mind having his hair washed. He does not sweat and he startles when naked and startles in his sleep. He snores, sleeps with his eyes half open and his mouth sometimes quivers.

As a note: I phoned the medical doctor who had referred Leo to the practice and went over the diagnosis with him. I said that the mother told me the diagnosis was Candida but I noted Failure to Thrive syndrome. The physician then told me that upon referral he had told the mother, “If the homeopathy does not help we will have to insert a nasogastric tube and begin to gavage feed the baby.”

Discussion
This infant was close to being seriously dehydrated and emaciated. In addition to the correct prescription, I felt it was very important to address the unspoken fear and tension that accompanied this case. The mother had experienced a difficult labor and post-partum period. She did not have adequate support. Although she had tried to get the appropriate help, she had been dealing with this problem by herself and then had the additional shock of going to her doctor and finding that her baby was indeed starving. Although she has reported all the facts in a flat monotone without a hint of emotion, I knew that she had been traumatized by these events and suspected that she probably harbored feelings of guilt, having unknowingly allowed her baby to become dangerously undernourished.

I address this directly by saying that she must have had a very hard time with all this and that it must have been quite a shock to find out that the baby had lost so much weight. With this the tears begin to fill her eyes finally there is a flood of emotion and she is able to talk about her sadness and fear. I feel that this exchange is an important part of the healing process and will help to alleviate some of the unresolved feelings that could potentially stand in the way of her bonding deeply with her child.

Although there are many remedies that come to mind in babies who fail to thrive including Calcarea carbonica, Abrotanum, Arsenicum and Silica, I sought a remedy that matched the total state of this baby. What seemed most prominent to me in this case was the baby’s unresponsiveness and indifference. Despite having daily periods of wakefulness, he remained passive, uncomplaining, and fairly motionless. The peculiar phrase “He would rather starve himself” appeared at least two times during the interview. This child was in a dreamlike, dissociated state. I focused the case using the following rubrics:

Generalities Emaciation, children in (2)
Mind, Indifference (3)
Mind, Indifferent to pleasure (3)
Mind, Asks for nothing (2)
Mind, Dream as if in (3)
Mind, Stupefaction (3)
Mind, Tranquillity
Sleep, Deep (3)
Sleepiness, overpowering (3)
Extremities, relaxation (3)

And the supporting data:
Mind Starting during sleep (2)
Respiration, snoring (3)
Face, Expression, old looking (3)
Face Discoloration, red, or earthy (3)
Face, twitching, mouth around (3)
Eye, Movement, rolling

The remedy is Papaver sominiferum derived from the poppy from which opium is also obtained.

J. H. Clarke says of Papaver sominiferum, “An agreeable languor, followed by sleep…” and “No doubt abnormal painlessness is a grand keynote for opium.” He goes on to explain, “Diminished irritability and inactivity of the voluntary and morbidity exalted excitability of the involuntary…” In this case the baby had flaccid extremities and was unreactive, but startled when undressed and during his sleep.

Ananda Zaren, a prominent modern homeopath has said, “think of this remedy as a drug that reduces your defenses. You melt and become floppy, the tension in the body goes. There is no resistance.” In this case the mother’s exclamation, “He is happy to starve” illustrates this lack of resistance. Ananda describes some other babies that required this remedy as being still and quiet with a quality of dreaminess. The movements are often slow and the babies are unreactive and do not seek contact. Ananda also suggests that the physical symptoms exhibited by individuals who respond to Papaver sominiferum indicate a sense of fright. Thus there is shaking, quivering, diarrhea and startling. But this is a particular kind of fright. A state of flight or dissociation resulting in staring, stupefaction, lack of response or unconsciousness. The muscles are not held in rigid tension but are floppy or flaccid. Like the state of the opium smoker, tension melts, the world fades away and all cares are erased. Painful things can be painless, yet the organism can be exquisitely sensitive to noise.

The etiology of the Papaver state can be a shock or a fright. Perhaps this infant was frightened during the difficult labor or in his period of separation from his mothers. His physical body is indicating the state of fright by shaking, starting and quivering. Thus we can also use the rubrics;

Mind, Fright, ailments from (3)
Chill, Shaking, shivering (3)
Generalities, Trembling, externally (3)

Papaver is a well-known remedy in cases of hypoxia occurring during birth. These infants can be blue or have a reddish discoloration of the face. Respirations can be stertorous or uneven. As time goes on the other indications for Opium will occur including indifference, floppiness, and dreamlike state of consciousness.

Follow-up one week later:
Leo is doing quite well and has quickly regained his lost weight and now exceeds his weight at birth. Although he is still being supplemented with formula, he now wants to breast feed every two hours. At night he wakes every three or four hours to feed. He is far more alert and he is also more demanding. When he nurses he latches firmly and easily on to the nipple. He no longer falls asleep during his feeds. With the weight gain he is better able to maintain his body temperature. The thrush in his mouth is 80% better.

Melanie appears to be more relaxed. Her milk supply is increasing. Her physician was surprised that she has been able to breast feed through this crisis as he expected the baby to go completely to the bottle. He has encouraged her and says that if the baby continues to gain weight she can stop supplementing him within two weeks.

Melanie now says that she is beginning to see the emergence of a personality in Leo. He lets her know what he likes and does not like. She is able to understand him and is enjoying their interaction. He has come out of his dream-like state and is responding to the loving touch of his mother.

Follow-up three months later:
Leo wakes at about 5 AM and eats well. He nurses very regularly at 2-3 hour intervals in the day and sleeps 8 hours at night. He is awake most of the day taking two naps in the morning and afternoon. He appears to be content and only cries on occasion. He can still drift off during a feed. After the remedy he was more fussy for a time and now he is happier and does not whine. He has no diaper rash and no sign of thrush.

Melanie has gone back to work but her husband is at home with the baby. Leo is comfortable with both his mother and father. When he was left with a baby sitter he did not like it and screamed for over an hour. I see this as a positive sign that the child is not indifferent and has the vitality to mount a sustained protest. He prefers to be held by his parents and although he sees one of their neighbors almost daily, he doesn’t want to be held by her.

When strangers approach, Leo studies them carefully. He will stare at a stranger and sometimes his eyes will open wide. This is possibly and indication of anxiety. Melanie admits that it is depressing to her to have to leave her baby to go to work. Over all, this mother tends to “keep a stiff upper lip” and contain her emotions. I suggest homeopathic therapy might help her deal with this transition and she agrees to make an appointment in the future.

Leo likes to lie on his back and be stimulated with toys. He will attempt to bat at them. He is active and kicks and smiles at his parents. He likes to be held standing upright and hates to be left on his stomach. He gets very warm when he sleeps and continues to startle in his sleep.

Leo likes to be at home. The family cat mesmerizes him. He is cautious around strangers and cautious in new situations. He doesn’t mind a diaper change and likes the sound of the vacuum cleaner. He no longer spaces out, but he has a timid personality.
There are no nursing problems and he continues to gain weight without problems in feeding. He has begun to suck his fingers.

Plan
A new remedy picture might be emerging but the child is doing well and still exhibits signs of the first remedy including startling, nodding into sleep, staring, fear of others approaching him, desire to be at home, etc. At this time I will wait. It will be important to support this new family during the difficult adjustments that are being made during the first years of life.

Homeopathy is a powerful tool in the development of family bonding and helps to potentate emotional growth for all members of the family. The homeopathic interview involves a process that includes non-judgmental observation and recognition of the family system, provides a safe environment for expression of fear sadness and isolation that are the unfortunate by-products of our busy culture. Our remedies can work miracles and because of the simple process of sitting with people and listening with an open mind and heart we homeopaths are privileged to witness and support the individuals and families who come to us for care.