THE BREATHING

The 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 s.p.a.ces 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 PULSE

The 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 TEMPERATURE

The 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.

const.i.tutes 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 MOUTH

The 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 dent.i.tion 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.

NURSING

The 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 URINE

Urine 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 pa.s.sed. 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 pa.s.sed 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 STOOLS

We find that the pa.s.sages are often putty-colored in disorders of the liver, frequently b.l.o.o.d.y or tarry in appearance in bleeding within the bowel, and liable to be black after taking bis.m.u.th, 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 pa.s.sages. The presence of a certain amount of greenish coloration of the pa.s.sages is not infrequent.

This is usually an evidence of indigestion, but pa.s.sages which are yellow when pa.s.sed and turn to a faint pea green some time later are not an indication of disease.

WHEN BABY GETS SICK

When 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 BABY

Feeding 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 barley water subst.i.tuted. When vomiting ceases and the fever approaches normal and food is desired, begin with boiled skim milk in small amounts, well diluted with cereal water, and do not approach the normal amount of milk for twenty-four to forty-eight hours. In this way the weak digestive organs are not overtaxed and they gradually resume their usual work of good digestion. When a baby seems to have no appet.i.te for food, lengthen the intervals from three to four or five hours, for feeding when food is not desired usually aggravates disease disturbances.

EXAMINING SICK CHILDREN

And 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 circ.u.mstances 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 att.i.tude 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 tact had to be used in securing the friendship of the child after the examination.

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 CHILDREN

A 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 stomat.i.tis 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 circ.u.mstances 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 application or the observation without words, always with gentleness and firmness.

NURSING RECORDS

Whether 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 pa.s.sed and the time it was pa.s.sed, 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.