  To the mother who has passed through the experience of bringing the child into the world is usually given that intuitiveness which helps her in caring for that child when it is well and in recognizing certain symptoms when it is sick. The newborn baby brings with him a large responsibility, but as the weeks pass by his care becomes less and less of a nervous strain, as the routine duties, so nearly alike each day of his little life, have made the task comparatively easy; but when the baby gets sick, particularly if he is under one year of age, and it is impossible for him clearly to make known his wants, and being unable to tell where it hurts or how badly it hurts, the average mother is likely to become somewhat panicky; and this confusion of mind often renders her quite unfit successfully to nurse the sick baby. THE NURSEIt is often wise to secure the services of a trained nurse, and if the family purse will allow such services, a good, sincere, capable, practical nurse should be engaged, for her firm kindness will often accomplish much more than the unintentional irritability and anxious solicitude of an overworked and nervous mother. Usually the mother not only attempts the care of the sick baby with the long night vigil—often not having the opportunity to take a bath or change her raiment day in and day out—but she often attempts to manage the entire household No matter how low the financial conditions of the family may be, outside help is always essential in cases of severe or long-continued illness of the children. Should the mother insist upon caring for the baby herself, then all household duties should be given over to outside help, and as she takes the rÔle of the nurse, the same daily outing and sleep that an outside nurse would receive should be hers to enjoy. Dr. Griffith has so ably detailed the "features of disease" that we can do no better than to quote the following: POSITIONThe position assumed in sickness is a matter of importance. A child feverish or in pain is usually very restless even when asleep. When awake it desires constantly to be taken up, put down again, or carried about. Sometimes, however, at the beginning of an acute disease it lies heavy and stupid for a long time. In prolonged illnesses and in severe acute disorders the great exhaustion is shown by the child lying upon its back, with its face turned toward the ceiling, in a condition of complete apathy. It may remain like a log, scarcely breathing for days before death takes place. Perfect immobility may also be seen in children who are entirely unconscious although not exhausted. A constant tossing off of the covers at night occurs early in rickets, but, of course, is seen in many healthy infants, especially if they are too warmly covered. A baby shows a desire to be propped up with pillows or to sit erect or to be carried in the mother's arms with its head over her shoulder whenever breathing is much interfered with, as in diphtheria of the larynx and in affections of the heart and lungs. The constant assumption of one position or the keeping of one part of the body still, may indicate paralysis. When, however, a cry attends a forcible change of position, it shows that the child was still because movement caused pain. Sleeping with the mouth open and the head thrown back often attends chronic enlargement of the tonsils and the presence of GESTURESThe gestures are often indicative of disease. Babies frequently place the hands near the seat of pain; thus in slight inflammation of the mouth they tend to put the hand in the mouth; in earache to move it to the ear; and in headache to raise it to the head. In headache or in affections of the brain they sometimes pluck at the hair or the ears, although they may often do this when there is no such trouble. Picking at the nose or at the opening of the bowel is seen in irritation of the intestine from worms or oftener from other cause. A child with a painful disease of its chest may sometimes place its hand on its abdomen, or a hungry child try to put its fists into its mouth. In approaching convulsions the thumbs are often drawn tightly into the palms of the hands and the toes are stiffly bent or straightened. Very young babies, however, tend to do this, although healthy. The alternate doubling up and straightening of the body, with squirming movements, making of fists, kicking, and crying, are indications of colic. This is especially true if the symptoms come on suddenly and disappear as suddenly, perhaps attended by the expulsion of gas from the bowel. SKIN COLORThe color of the skin is often altered in disease. It is yellow in jaundice, and is bluish, especially over the face, in congenital heart disease. There is a purplish tint around the eyes and mouth, with a prominence of the veins of the face, in weakly children or in those with disordered digestion. A pale circle around the mouth accompanies nausea. The skin frequently acquires an earthy hue in chronic diarrhea, and is pale in any condition in which the blood is impoverished, as in Bright's disease, rickets, consumption, or any exhausted state. Flushing of the face accompanies fever, but besides this there is often seen a flushing without fever in older children the subjects of chronic disorders of digestion. Sudden flushing or paling is sometimes seen in disease of the brain. FACIAL EXPRESSIONThe expression of the face varies with the disease. In whooping cough and measles the face is swollen and somewhat flushed, giving the child a heavy, stupid expression. There is also swelling of the face, especially about the eyes, in Bright's disease. Repeated momentary crossing of the eyes often indicates approaching convulsions. In very severe acute diarrhea it is astonishing with what rapidity the face will become sunken and shriveled, and so covered with deep lines that the baby is almost unrecognizable. The same thing occurs more slowly in the condition commonly known as marasmus. Often the face has an expression of distress in the beginning of any serious disease. If the edges of the nostrils move in and out with breathing, we may suspect some difficulty of respiration, such as attends pneumonia. The baby sleeps with its eyes half open in exhausted conditions or when suffering pain. THE HEADThe head exhibits certain noteworthy features. Excessive perspiration when sleeping is an early symptom of rickets. It must be remembered, however, that any debilitated child may perspire more or less when asleep. Both in rickets and in hydrocephalus (water on the brain) the face seems small and the head large, but in the former the head is square and flat on top, while in the latter it is of a somewhat globular shape. The fontanelle is prominent and throbs forcibly in inflammation of the brain, is too large in rickets and hydrocephalus, bulges in the latter affection, and sometimes sinks in conditions with only slight debility. THE CHESTThe chest exhibits a heaving movement with a drawing in of the spaces between the ribs in any disease in which breathing is difficult. A chicken-breasted chest is seen in Pott's disease of the spine, and to some extent in bad cases of enlargement of the tonsillar tissue; a "violin-shaped" chest in rickets; a bulging of one side in pleurisy with fluid; and a long, narrow chest, with a general flattening of the upper part, in older children predisposed to consumption. THE ABDOMENThe abdomen is swollen and hard in colic. It is also much distended with gas in rickets, and is constantly so in chronic indiges THE CRYThe study of the cry furnishes one of the most valuable means of learning what ails a baby. A persistent cry may be produced by the intense, constant itching of eczema. The paroxysmal cry, very severe for a time and then ceasing absolutely, is probably due to colic, particularly if accompanied by the distention of the abdomen and the movements of the body already referred to. A frequent, peevish, whining cry is heard in children with general poor health or discomfort. A single shrill scream uttered now and then is often heard in inflammation of the brain. In any disease in which there is difficulty in getting enough air into the lungs, as in pneumonia, the cry is usually very short and the child cries but little, because it cannot hold its breath long enough for it. A nasal cry occurs with cold in the head. A short cry immediately after coughing indicates that the cough hurts the chest. Crying when the bowels are moved shows that there is pain at that time. A child of from two to six years, waking at night with violent screaming, is probably suffering from night terrors. In conditions of very great weakness and exhaustion the baby moans feebly, or it may twist its face into the position for crying, but emit no sound at all. This latter is also true in some cases of inflammation of the larynx, while in other cases the cry is hoarse or croupy. Crying when anything goes into the mouth makes one suspect some trouble there. If it occurs with swallowing, it is probable that the throat is inflamed. With the act of crying there ought always to be tears in children over three or four months of age. If there are none, serious disease is indicated, and their reappearance is then a good sign. COUGHINGThe character of the cough is also instructive. A frequent, loud, nearly painless cough, at first tight and later loose, is heard in bronchitis. A short, tight, suppressed cough, which is followed by a grimace, and, perhaps, by a cry, indicates some inflammation about the chest, often pneumonia. There is a brazen, barking, "croupy" cough in spasmodic croup. In inflammation of the larynx, including true croup, the cough may be hoarse, croupy, or sometimes almost noiseless. The cough of whooping cough is so peculiar that it must be described separately when considering this disease. Then there are certain coughs which are purely nervous or dependent upon remote affections. Thus the so-called "stomach cough" is caused by some irritation of the stomach or bowels. It is not nearly so frequent as mothers suppose. Irritation about the nose or the canal of the ears sometimes induces a cough in a similar way. Enlarged tonsils or elongated palate or throat irritation may also produce a cough. THE BREATHINGThe breathing of a young child, particularly if under one year of age and awake, is always slightly irregular. If it becomes very decidedly so, we suspect disease, particularly of the brain. A combination of long pauses, lasting half a minute or a minute, with breathing which is at first very faint, gradually becomes more and more deep, and then slowly dies away entirely, goes by the name of "Cheyne-Stokes respiration," and is found in affections of the brain. It is one of the worst of symptoms except in infancy, and even then it is very serious. The rate of respiration is increased in fever in proportion to the height of the temperature. It is increased also by pain in rickets, and especially in some affections of the lungs. Sixty respirations a minute are not at all excessive for a child of two years with pneumonia, and the speed is frequently decidedly greater than this. Breathing is often very slow in disease of the brain, particularly tubercular meningitis. Poisoning by opiates produces the same effect. Frequent deep sighing or yawning occurs in affections of the brain, in faintness, or in great exhaustion, and may be a very unfavorable symptom. Breathing entirely through the mouth shows that the nose is completely blocked, while snuffling breathing is the result of a partial catarrhal obstruction. A gurgling in the throat not accompanied by cough may indicate that there is mucus in the back part of it, the result of an inflammation, sometimes slight, sometimes serious. "Labored" breathing, in which the chest is pulled up with each breath while the muscles of the neck become tense, the pit of the stomach and the spaces between the ribs sink in, and the edges of the nostrils move in and out, is seen in conditions where the natural ease of respiration is greatly interfered with, as in pneumonia, diphtheria of the larynx, asthma, and the like. Long-drawn, noisy inspirations and expirations are heard in obstruction of the larynx, as from laryngeal diphtheria or spasmodic croup. THE PULSEThe rate of the pulse is subject to such variations in infants that its examination is of less value than it would otherwise be. In early childhood its observation is of more service, although even then deceptive. Slight irregularity is not uncommon. Unusual irregularity is an important symptom in affections of the brain or heart. Fever produces an increase in the pulse rate, the degree of which depends, as a rule, upon the height of the temperature. Slowing of the pulse is a very significant symptom, seen particularly in affections of the brain, and sometimes in Bright's disease and jaundice. THE TEMPERATUREThe temperature is of all things important to remember in infancy and childhood because fever is easily produced and runs high from slight causes. Even slight cold or the presence of constipation or slight disturbances of digestion may in babies sometimes produce a temperature of 103 F. or more. We do not speak of fever unless the elevation reaches 100 F. A temperature of 102 or 103 F. constitutes moderate fever, while that of 104 or 105 F. is high fever, and above 105 F. very high. A temperature of 107 F. is very dangerous, and is usually not recovered from. The danger from fever depends not only upon its height, but upon its duration also. An elevation of 105 F. may be easily borne for a short time, but it becomes alarming if much prolonged. THE MOUTHThe tongue of newborn infants is generally whitish and continues to be so until the saliva becomes plentiful. After this we usually find it coated in disturbances of the stomach and bowels and in nearly any disorder accompanied by fever. In scarlet fever the tongue becomes bright red after a few days, and in measles and whooping cough it is often faintly bluish. In the latter affection an ulcer may sometimes be found directly under the tongue, where the thin membrane binds it to the floor of the mouth. In thrush the tongue is covered with white patches like curdled milk. A pale, flabby tongue, marked by the teeth at its edges, indicates debility or impaired digestion. In prolonged or very high fever the tongue grows dry, and in some diseases of the stomach or bowels it may look like raw beef. Grinding of the teeth is a frequent symptom in infants in whom dentition has commenced. It generally indicates an irritated nervous system. Most often this depends upon some disturbance of digestion; less often upon the presence of worms. The symptom is present during or preceding a convulsion, and may occur, too, in disease of the brain. In some babies it appears to be only a nervous habit. NURSINGThe manner of nursing or swallowing frequently affords important information. A baby whose nose is much obstructed or who has pneumonia can nurse but for a moment, and then has to let the nipple go in order to breathe more satisfactorily. If it gives a few sucks and then drops the nipple with a cry, we must suspect that the mouth is sore and that nursing is painful. If it swallows with a gurgling noise, often stops to cough, and does as little nursing as possible, we suspect that the throat may be sore. The ceasing to nurse at all, in the case of a very sick baby, is an evidence of great weakness or increasing stupor, and is a most unfavorable symptom. THE URINEUrine that is high-colored and stains the diaper, or that shows a thick, reddish cloud after standing, may accompany fever or indigestion. Sometimes the urine under these conditions is milky when first passed. In some babies a diet containing beef juice or other highly nitrogenous food will produce the reddish cloud, or even actual, red, sandlike particles. A decidedly yellow stain on the diaper occurs when there is jaundice. A faint reddish stain seldom indicates blood. The amount of urine passed is scanty in fever, in diarrhea, and especially in acute Bright's disease. In the latter disease the urine is often of a smoky or even a muddy appearance. The possibility of the occurrence of this symptom after scarlet fever must always be kept in mind, in order that a physician may be summoned very quickly, since it is a serious matter. THE STOOLSWe find that the passages are often putty-colored in disorders of the liver, frequently bloody or tarry in appearance in bleeding within the bowel, and liable to be black after taking bismuth, charcoal, or iron, and red after krameria, kino, or haematoxylon. Infants who are receiving more milk than they can digest constantly have whitish lumps in their stools, or even entirely formed but almost white WHEN BABY GETS SICKWhen baby shows that he is sick, take his temperature as directed elsewhere, cut down the feeding to at least one half, or, if his temperature is around 102 F. give him nothing but rice water or barley water. If he is constipated give him a cleansing enema, and if hot and feverish a sponge bath may be administered. He should then be put into a bed with light covers and wait further orders which the doctor will give on his arrival. Give the baby no medicine unless ordered to do so by the physician. Known to every physician who undertakes the care of children, is the failure of many well-meaning mothers to call him early. The mother attempts the care of the baby herself, and not until the condition gets beyond her knowledge and wisdom does she seek medical advice. In the early hours of an approaching cold, the beginning of intestinal indigestion, or at the beginning of bronchitis, if the physician can see the child early, prolonged illness may be avoided as well as unnecessary expense and many heart-breaking experiences. FEEDING THE SICK BABYFeeding the sick baby differs somewhat with the character of the individual disease, but in the outset of any and all diseases the intestinal tract should not be overburdened with food. At the approach of any illness, the food should at least be cut down one half; for instance, in the case of a serious acute illness accompanied by fever, not only should the strength of the food be reduced one half, but water should be given plentifully between feedings. It is better never to urge the baby to eat at such times—for the ability to digest food is very much reduced. In cases of acute attacks with much vomiting and fever, all milk should be immediately stopped and rice water or bar EXAMINING SICK CHILDRENAnd now, above all times, the early seed sowing of teaching the child self-control, teaching him to gargle if he is sufficiently old enough, to open his mouth and allow observation without resistance, brings sure results. The great harm of making the doctor and his medicine a threat to obtain obedience also brings its harvest at this time; for the doctor, of all people, ought to be regarded as the child's best friend. When baby is sick, the doctor is needed, his daily visits must not be resisted, his medicines must not be feared—these and such other matters should be made a part of every child's early education. Under no circumstances or conditions should we directly falsify to a child. Nothing is accomplished by telling a child it will not hurt when you know that it will hurt, or that the medicine tastes good when you know it is bad-tasting. Every physician can recall unnecessary disturbances in the office because a mother has allowed a child to acquire a wrong mental attitude toward the family physician. One mother told her little girl in my office when I wished to make an examination for adenoids which necessitated my putting my finger back of the child's uvula, "Now Mary, the doctor won't hurt you at all, it will feel nice." I turned to the little girl and said: "Mary, it will not feel nice, it really won't hurt you, but it will feel uncomfortable." It was a grave mistake to tell her that it would feel nice. The child resisted, and, while the examination was successfully made, the greatest of It is far better when the throat is to be examined to wrap the child in a shawl or a sheet with his arms placed at his side, and for a member of the family to take him in her lap and hold him securely while the physician quickly makes the observation. And while we appreciate that sickness is not the time to introduce new methods of training, in instances where children have been spoiled, it is far better quietly and firmly to go about the task in a manner that you know can be carried through to a successful finish. TREATMENT OF SICK CHILDRENA sick child should be encouraged to lie in his bed much of the time, and the bed should be kept clean and cool. He should never be set up suddenly or laid back quickly. In the case of a broken leg, all rapid movements should be avoided. A simple story or a soothing lullaby, or the giving of a toy, will often divert attention when some painful movement must be made or some disagreeable task performed. Both cleanliness of the body and cleanliness of the mouth are exceedingly necessary in sickness. In all instances of disease or indisposition, the mouth must receive daily care, for stomatitis or gangrene of the mouth often follows neglect. A listerine wash in proportion of one to four, or a magnesia wash, or the addition of a few drops of essence of cinnamon to the mouth wash will do much to prevent such conditions, as well as to relieve them. Applications of medicine to the throat may be made without resistance if the tactful nurse watches her time. She should slowly introduce the tongue depressor which may be a flat stick or a spoon, when the application of medicine with a camel's-hair brush is quickly made to the rolled-out throat as the child gags, and if the nurse then quickly diverts his attention to some beautiful story or a picture or a new toy, the treatment is soon forgotten. Under no circumstances argue with or scold a sick child. Get everything ready, if possible behind his back or in another room, and then with plenty of help make the NURSING RECORDSWhether the nurse be the mother, caretaker, practical or professional nurse, a record should always be kept of the condition of the patient. The temperature should be reported at different periods designated by the physician. The pulse should be recorded, the amount of urine passed and the time it was passed, the number of bowel movements, all feedings and the general well being of the child—whether it is restless or comfortable, sleeping or awake, together with the water that he drinks. The record may be kept, if necessary, on a piece of common letter paper, and should read something like this: March 26, 1916 7 a. m. Temperature 102; pulse 132; respiration 40; morning toilet; took 4 ounces of milk; 2 ounces of barley water; 1 ounce of lime water. 9 a. m. Enema given; good bowel movement; mustard paste applied to chest, front and back, and oil-silk jacket applied; drank boiled water, 4 ounces. 11 a. m. Took the juice of one orange; temperature 103; pulse 135. 12 Noon. Very listless and nervous; temperature 104. Has coughed a great deal. Gave mustard paste to chest, front and back, and wet-sheet pack. 1:30 p. m. Temperature 101.8; 4 ounces of water to drink; looks better. 3 p. m. Has slept 1-1/2 hours; temperature 102.5; pulse 134; respiration 40; 6 ounces of food given (3 ounces of milk, 2 ounces of barley water and 1 ounce of lime water). A record like this is a great help to the physician, and such a record may be kept by anyone who can read and write. There are printed record blanks which may be procured from any medical supply house and most drug stores. BAD-TASTING MEDICINESCastor oil has neither a pleasant smell nor taste, and nothing is accomplished by telling the child that it does smell good or taste good. If the patient is old enough to drink from a cup, put in a layer of orange juice and then the castor oil and then another layer of orange juice, and in this way it often can be easily taken. Someone has suggested that a piece of ice held in the mouth just before the medicine is taken will often make a bad dose go down without so much forcing. A taste of currant jelly, or a bit of sweet chocolate, or the chewing of a stick of cinnamon is a great adjunct to the administration of bad-tasting medicines. All oily medicines must be kept in a cool place and should always be given in spoons or from medicine glasses that have first been dipped in very cold water. Very often the addition of sugar to bad-tasting medicines will in no wise interfere with their action, while it often facilitates the administration of the disagreeable dose. The majority of bad-tasting medicines are now put up in the form of chocolate-flavored candy tablets. TEMPERATURES AND PULSEThe normal temperature of a baby is 98.5 to 99 F. in the rectum. After shaking the mercury of the thermometer down below the 97 mark it is well lubricated with vaseline and then carefully, gently, pushed into the rectum for about an inch and a half or two inches, and left there for three minutes before removing. Mothers should exercise self-control in taking the temperature, for nothing is gained by allowing a panicky fear to seize you should the mercury register higher than you anticipated. Notify your physician when the temperature registers above 100 F. The respirations of a child are fairly regular and rhythmic and occur about forty times per minute during the first month of life and about thirty times per minute during the remainder of the year. From one to two years, twenty-six to twenty-eight is the average. Breathing is somewhat irregular when FEVERChildren get fever very easily—the digestive disturbance of overeating, constipation, a slight bilious attack—all produce fever which disappears quite as suddenly as it came. The first thing to do under such circumstances is to withhold food, give plenty of water to drink, produce a brisk movement of the bowel by giving a dose of castor oil, give a cleansing enema, and treat the fever as follows: After removing all of the clothes from the child, place him in a warm blanket and then prepare a sponge bath which may be equal parts of alcohol and water; expose one portion of the body at a time and apply the water and alcohol first to one arm and then to the other arm, the chest, one leg, the other leg, the back and then the buttocks. Do not dry the part but allow evaporation to take place, and this, accompanied by the cooling of the blood which is brought to the skin by the friction, readily reduces the fever. Another procedure which may be employed if the fever registers high is the wet-sheet pack which is administered as follows: Three thicknesses of wool blankets are placed on the bed and a sheet as long as the baby and just enough to wrap around him once, is wrung out of cool water and spread over these blankets. With a hot-water bottle to the feet, the child is then laid down in the wet sheet which is now brought in contact with every portion of his body, then the blankets are quickly brought around, and he is allowed to warm up the sheet—which lowers his temperature. Another valuable procedure is the cooling enema. Water the same temperature as that of the body, is allowed to enter |
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