Enuresis, or incontinence of urine, is customary in infancy. Just when urination becomes a voluntary act depends upon the development and training of the individual child. As a rule children can be taught to control this function during the day, or while awake, about the tenth month. It is not under control during sleep until a much later period, usually by the end of the second year, but lack of control should not be regarded as abnormal until the child has entered the fourth year. If the child fails to control the act of urination during the day at the end of the second year, and is addicted to habitual bed-wetting, some measures should be adopted to cure the condition.

Boys under twelve years of age seem to be affected more frequently than girls. It is wrong to a.s.sume that it is caused by negligence or laziness, as some parents do. It has generally a special cause, and the cause usually can be found if it is carefully sought for. It may be the result of bad habits: exposure to cold in the night; lying on the back; drinking too much liquid in the afternoon or at bedtime. It may be due to too much acid in the urine, and if so it will be found necessary to reduce meats and eggs the child is eating. Worms, stone in the bladder, some anatomical abnormality or deficiency, may be responsible for it.

The diet may be at fault; adenoids are supposed by some physicians to be the cause. No matter what the actual cause may be, it must be found and remedied before we can hope for a permanent cure. A very large majority of these cases are due to nervousness. These children are of a nervous temperament. They are not necessarily sickly children; they are simply of a nervous type. They are well-nourished, active, and lively.

Incontinence of urine during the day and long-continued bed-wetting does not at all affect the health of the child. If they are in poor health, it is essential to treat their general condition before trying to cure the incontinence.

It is absolutely wrong to punish or to crush the spirit of these children. Constant nagging and taunting, even if done in the hope of shaming the child into a cure, will simply make a coward of him and will not aid in improving matters, but will be distinctly detrimental.

Scrupulous cleanliness must be constantly practiced or these children, if neglected, may develop ulcers and sores of a very obstinate character. The odor is also bad for the health of the child.

Treatment.--Find and remove the cause if possible. If due to general poor health, give tonics, obtain a change of air, and build the child up. Reduce the total quant.i.ty of liquids, if in excess, and be very careful not to give any liquids near bedtime. Don't cover these children too much; they should never be "too warm"; they should sleep in a well-aired room, and they should receive a quick, cool sponge bath every morning. They should be taught to sleep on their sides, never on their backs. Their diet should be light but nourishing. When bed-wetting is established it will continue, if untreated, until the child is eight or ten years of age, and it frequently lasts much longer. When treatment is undertaken it should be distinctly understood by the mother that it will take many months to cure; and during these months she must give her constant attention to the child. If she does not undertake to do this, or if she fails to do it, the treatment should not be begun at all, as it will not succeed. Various plans should be tried to keep the child from sleeping on its back. The reason of this is because it has been found that the child wets the bed only when sleeping on its back and never when sleeping on its side. The simplest method, of tying a towel or cloth around the child with a knot over the spinal column, so that it will hurt and waken it, if it turns on its back, is a very good one and should be carefully tried for some time. The nervous system of these children should never be overtaxed at home or at school. Early hours and plenty of sleep are desirable. Certain articles of diet of a stimulating character should be entirely avoided,--for example, coffee, tea, beer, candies, sugars, and pickles. The best diet for these children is one composed exclusively of milk, vegetables, fruits, meats, and cereals.

Meats, however, should be given only once every two days. It is a good plan to teach the child to hold his water during the day, as long as he can, to accustom the bladder to being full. Adenoid growths, which contribute to the nervousness of a naturally nervous child, should be removed. It is a good plan to take the child up when the parents go in bed and let him urinate. This often cures the condition in itself.

Sometimes moral measures, such as the promise of a reward, will strengthen the will so that the child may overcome the tendency. Find out what the child most desires in the way of a toy, and promise it if he goes so long without wetting the bed. Aid and encourage him to make efforts to win the reward.

If drugs have to be resorted to, it is necessary to call the family physician, as the only drugs that are of any use are very powerful and have to be given with great care and caution. It is the experience of most physicians and specialists, however, that in a large majority of cases the treatment, along the lines as given above, will be effective, without drugs, if faithfully persisted in by the mother.

These children should be examined by a physician. The cause of the bed-wetting is frequently discovered to be produced by anatomical abnormalities which render circ.u.mcision imperative. In these cases no method of treatment will succeed until circ.u.mcision is performed.

SLEEPLESSNESS. DISTURBED SLEEP

Causes.--In babies, disturbed sleep is most frequently due to hunger or to indigestion. The latter is the result of overfeeding or improper feeding. Rocking the child to sleep, or feeding it during the night will cause sleeplessness. Teething, colic, or any pain will result in disturbed sleep. Nervous children are frequently poor sleepers.

In older children, some digestive disturbance is, as a rule, the cause.

Chronic intestinal indigestion, worms, adenoid growths, enlarged tonsils, lack of fresh air in the bedroom, cold feet, may, however, be the cause. Overstudy in school, poor blood, poor nourishment are always accompanied by inability to sleep soundly. Too strenuous play, exciting stories read before bedtime, may cause sleeplessness.

Treatment.--The removal of the cause is absolutely necessary. In order to discover the cause it is sometimes essential to study the child's whole routine in order to be able to tell exactly just what is causing the apparent insomnia. It may be necessary to change the method of feeding, to regulate the studies and the exercises, and to suggest changes regarding the sanitary and hygienic environment of the child's life. Mothers must be warned against using drugs in the form of soothing syrups or teething mixtures. They are dangerous and absolutely forbidden under the above conditions.

The nervous disposition of the child must be taken into consideration and treated if necessary. If bad habits exist they must be stopped. Poor blood and poor nutrition must receive the treatment suggested under these headings.

NIGHTMARE. NIGHT TERRORS

In a nightmare a child wakes suddenly in a state of fright and will inform you that it has had a bad dream. His mind seems clear and he recognizes those about him. He is not easily calmed and may cry for some time; finally he goes to sleep again. The next day he will remember the dream and most of the incidents of the night before. Such cases are quite frequent. They are to be treated in the same way as cases of disturbed sleep, as they really have the same cause. They are mostly due to digestive disturbances and errors of diet.

Night-Terrors.--Cases under this heading form a distinct group by themselves. They are not frequent, but the condition is much more serious. The cause seems to be wholly nervous and may indicate an important nervous derangement. It seems to have some indefinite relation to such conditions as migraine, hysteria, epilepsy, and even insanity.

The child wakes suddenly during the night and sits up, evidently in terror; he does not apparently regain his full consciousness. He talks of being scared, calls for his mother, trembles and shakes, cannot answer questions intelligently, and after a time goes to sleep. Next day he remembers nothing of the attack and does not seem to suffer in any way as a result of it.

I am disposed to believe that all of these attacks are not due to a nervous condition. A number of them of exactly this type have been cured by absolutely withdrawing milk from the diet.

It is a good plan to restrict the possibility of excessive play in these children. They are of the type whose play is work, and too much of it is too exhausting. Some person should sleep in the same room with these patients or in an adjoining room with the door open.

If the condition occurs frequently the child should be subjected to a thorough physical examination, because it may be one evidence of a serious ailment.

Sometimes these little patients have to be taken out of school and sent to the country, where they should remain for many months. It is far better to regard the condition as indicating an abnormality,--even though it may not have any deeper significance than that the digestive apparatus of the child is not quite right,--and make every effort to cure it, than to permit the child to go on under what really are unjust and unfavorable conditions.

HEADACHE

Headaches are not common in little children. The most frequent ones are caused by:

1. Chronic indigestion and constipation.

2. Anemia and malnutrition.

3. Nervous disorders.

4. Diseases of the eye, nose, throat.

5. Rheumatism and gout.

6. Disturbances of the genital tract.

Those arising from anemia and poor nutrition are most frequently present in girls from ten to fifteen years of age. They may result from overcrowding of school work, which results in loss of appet.i.te and poor sleep.

Nervous headaches may be hereditary or acquired through unhygienic surroundings. Hysteria, epilepsy, disease of the brain, neuralgia from carious teeth, may result in nervous headaches.

Headaches from disturbances of the genital tract may afflict girls about the time of p.u.b.erty.

Treatment.--To remove the cause is the only plan that promises any result. Each one must be investigated by itself and dealt with accordingly. For the headache itself a hot foot bath, cold to the head, and small doses of phenacetine (one grain every hour for four doses) are perhaps the most certain of all methods of treatment.

THUMB-SUCKING

The habit of sucking the thumb may be corrected by wearing a pair of white mittens, or gloves tied at the wrist. Should children attempt to suck the thumb with gloves on, as some do, it will be necessary to saturate the thumb and fingers of the gloves with tincture of aloes, or a solution of the bisulphate of quinine, one dram to two ounces of water.

BITING THE FINGER NAILS

Biting the finger nails may be stopped by the use of the same bitter remedies as are used in thumb-sucking.

HOW TO WASH OUT THE BOWELS

COLON IRRIGATION. A HIGH ENEMA

Procure a soft rubber catheter,--No. 18 American is about right. It is not advisable to get too soft rubber for the reason that it will buckle when the child strains and it will be impossible to wash out the bowel.

Fill half full an ordinary two-quart douche bag with water that is warm, but not too hot. Dissolve a heaping teaspoonful of table salt in a gla.s.s of hot water and add this to the water in the bag. Hang the bag about two feet above the level of the child, so that the water will not flow in with too strong a stream; otherwise the child will immediately try to eject it. If the water flows in gently, the child may not object to it to the extent of making strenuous efforts to force the catheter out.

Use the small sized nozzle that comes with the douche bag. Place the rubber catheter over this nozzle, lubricate the catheter, place the child on its back over a douche pan, insert the catheter about two inches, let the water run and as it runs in push the catheter up gently until it is all in the bowel except the end on the douche tip. The object of letting the water run while pushing in the catheter is because it floats up with the water as it distends the bowel; there is no risk then of pushing the end into the intestinal wall or hurting the child.

While the water is flowing into the bowel it is a good plan to compress the b.u.t.tocks together to aid in holding the water, as the child is very apt to let it run out as soon as it feels uncomfortable.

The temperature of the water for the ordinary rectal injection should be 95 F. When the child is exhausted or very weak, or when the circulation is poor, the temperature of the water may be as high as 110 F. When, on the other hand, the fever is very high, the water may be much cooler; as low as 70 F. has been given with good results on the fever. If the irrigation is given with the intention of reducing the fever, it is best to begin with water around 90 F., and reduce it to 70 F., gradually.

Indications for Irrigation of the Colon.--When it is desired to cleanse the bowel of any collection of matter a colon irrigation is indicated. This matter may be mucus, fecal substance, undigested food, or the decomposing waste products which may remain there as a result of disease or other conditions.

When it is desired to medicate by putting fluids into the bowel we adopt the colon infusion.

Every diseased condition of the bowel does not, however, indicate irrigation. If a child is having frequent loose movements every half-hour it is safe to a.s.sume that the bowel is being cleaned out sufficiently without any artificial aid. To irrigate in these cases would only irritate and would not accomplish anything. The cases which are benefited are those in which we have a fever with four or five green stools in the twenty-four hours, or where we have a high fever with no movement at all. To irrigate in these cases we not only get rid of the products of decomposition, but we prevent further decomposition and we reduce the fever, thereby contributing to the general welfare of the child.