MISCELLANEOUS
THE BOWELS
_How many movements daily should an infant have during the first few
weeks of life?_
Usually two or three a day for the first week, and then one or two
each day.
_How many after a child is a month old?_
A healthy child should have at least one movement each day; many have
two and some more than two; but it is the character of the stools
rather than their number which is to be taken as the evidence of
perfect digestion.
_What is the appearance of a healthy movement of a child who is taking
nothing but milk?_
It is soft, yellow, and smooth, containing no lumps.
_When are the stools dark brown or black?_
While taking bismuth, iron, and sometimes when taking much meat or
beef juice; also while taking many of the prepared foods. They may be
dark brown or black from blood. This last is a condition which may
indicate serious illness.
_How may a child be trained to be regular in the action of its
bowels?_
By endeavouring to have them move at exactly the same time every day.
_At what age may an infant be trained in this way?_
Usually by the second month if training is begun early.
_What is the best method of training?_
A small chamber, about the size of a pint bowl, is placed between the
nurse's knees, and upon this the infant is held, its back being
against the nurse's chest and its body firmly supported. This should
be done twice a day, after the morning and afternoon feedings, and
always at the same hour. At first there may be necessary some local
irritation, like that produced by tickling the anus or introducing
just inside the rectum a small cone of oiled paper or a piece of soap,
as a suggestion of the purpose for which the baby is placed upon the
chamber; but in a surprisingly short time the position is all that is
required. With most infants, after a few weeks the bowels will move as
soon as the infant is placed on the chamber.
_What advantage has such training?_
It forms the habit of having the bowels move regularly at the same
hour, which is a matter of great importance in infancy and makes
regularity in childhood much easier. It also saves the nurse much
trouble and labour.
SLEEP
_Should a child sleep in the same bed with its mother or nurse?_
Under no circumstances, if this can possibly be avoided. Very young
infants have often been smothered by their mothers, by overlying
during sleep. If the infant sleeps with the mother, there is always
the temptation to frequent nursing at night, which is injurious to
both mother and child. Older children also should, if possible, have
separate beds; many contagious diseases and bad habits are contracted
by children sleeping together.
_How should an infant's bed be prepared?_
The mattress should be firm but soft, the pillow very thin, and the
covering not excessive. A baby should not be allowed to sleep always
in the same position, but should be changed from side to side. Hair
pillows are useful in summer and for children who perspire very much.
_How much sleep is natural for a newly born baby?_
A baby with a good digestion and proper food will usually sleep at
this period about nine tenths of the time.
_How much should a baby sleep at six months?_
About two thirds of the time.
_Up to what age should an older child take a nap during the day?_
Always until four years old, and if possible longer.
_At what age may an infant go all night without feeding?_
At five months a child should not be fed or nursed between 10 P.M. and
6 A.M. At two years a child can easily go from 6 P.M. to 6 A.M.
without feeding.
_How should a baby be put to sleep?_
The room should be darkened and quiet, the child's hunger satisfied,
and the child made generally comfortable and laid in its crib while
awake.
_Is rocking necessary?_
By no means. It is a habit easily acquired, but hard to break, and a
very useless and sometimes injurious one. The same may be said of
sucking a rubber nipple, or "pacifier," and all other devices for
putting children to sleep.
_What are the principal causes of disturbed sleep?_
As quiet peaceful sleep is a sign of perfect health, disorders of
sleep may be produced by almost anything which is wrong with the
child.
1. Habitual disturbance of sleep in infants is most frequently
associated with the food or feeding. It may be from the discomfort of
chronic indigestion due to improper food. In bottle-fed infants it is
often the result of overfeeding; in those who are nursed it is often
due to hunger. A common cause is frequent night feeding; an infant who
is fed three or four times during the night is almost invariably a bad
sleeper.
2. Disturbed sleep or sleeplessness may be due to causes purely
nervous. Such are bad habits acquired by faulty training; as when the
nursery is lighted and the child taken from its crib whenever it wakes
or cries; or when some of the contrivances for inducing sleep have
been used. Any excitement or romping play just before bedtime, and
fears aroused by pictures or stories, are frequent causes. Children
who inherit from their parents a nervous constitution are especially
likely to suffer thus.
3. There may be physical discomfort from cold feet, insufficient or
too much clothing, or want of fresh air in the sleeping room.
4. Interference with breathing due to obstruction from large tonsils
or adenoids. These cause great restlessness and lead a child to assume
many different postures during sleep, often lying upon the face or
upon the hands and knees.
5. Chronic pains or frequently recurring night pains may be causes of
disordered sleep, when a child wakes with a sudden sharp cry. In
infants this is most often due to scurvy, sometimes to syphilis. In
older children it may be the earliest symptom of disease of the hip or
spine.
6. Sleeplessness and disturbed sleep are frequent whenever the general
condition falls much below a healthy standard; e.g., in infants who
are not thriving and in children suffering from marked anæmia.
_How are children who sleep too little, or whose sleep is constantly
disturbed, to be treated?_
Never by the use of soothing sirups or other medicines. Successful
treatment consists in the discovery and removal of the cause.
_Do children ever sleep too much?_
It is doubtful if healthy children ever do. Excessive sleep is an
important symptom of some diseases of the brain. Otherwise it seldom
if ever occurs unless soothing sirups or other drugs have been given.
EXERCISE
_Is exercise important for infants?_
It is as necessary for them as for older children.
_How is it obtained?_
A young baby gets its exercise by screaming, waving its arms, kicking,
etc. The clothing should not be so tight as to make these movements
impossible. At least twice a day the infant should be allowed for
fifteen or twenty minutes the free use of its limbs by permitting it
to lie upon a bed in a warm room, with all clothing except the shirt,
stockings, and napkin removed. Later, when in short clothes, the baby
may be put upon a thick blanket or quilt laid upon the floor, and be
allowed to tumble about at will. A nursery fence two feet high, made
to surround a mattress, is an excellent device and makes a convenient
box stall for the young animal, where it can learn to use both its
arms and legs without the danger of injury. Only by exercise such as
this do the muscles have an opportunity to develop properly.
THE CRY
_When is crying useful?_
In the newly born infant the cry expands the lungs, and it is
necessary that it should be repeated for a few minutes every day in
order to keep them well expanded.
_How much crying is normal for a very young baby?_
From fifteen to thirty minutes a day is not too much.
_What is the nature of this cry?_
It is loud and strong. Infants get red in the face with it; in fact,
it is a scream. This is necessary for health. It is the baby's
exercise.
_When is a cry abnormal?_
When it is too long or too frequent. The abnormal cry is rarely
strong, often it is a moaning or a worrying cry, sometimes only a
feeble whine.
_What are the causes of such crying?_
Pain, temper, hunger, illness, and habit.
_What is the cry of pain?_
It is usually strong and sharp, but not generally continuous. It is
accompanied by contraction of the features, drawing up of the legs,
and other symptoms of distress.
_What is the cry of hunger?_
It is usually a continuous, fretful cry, rarely strong and lusty.
_What is the cry of temper?_
It is loud and strong and accompanied by kicking or stiffening of the
body, and is usually violent.
_What is the cry of illness?_
There is usually more of fretfulness and moaning than real crying,
although crying is excited by very slight causes.
_What is the cry of indulgence or from habit?_
This is often heard even in very young infants, who cry to be rocked,
to be carried about, sometimes for a light in the room, for a bottle
to suck, or for the continuance of any other bad habit which has been
acquired.
_How can we be sure that a child is crying to be indulged?_
If it stops immediately when it gets what it wants, and cries when it
is withdrawn or withheld.
_What should be done if a baby cries at night?_
One should get up and see that the child is comfortable--the clothing
smooth under the body, the hands and feet warm, and the napkin not wet
or soiled. If all these matters are properly adjusted and the child
simply crying to be taken up, it should not be further interfered
with. If the night cry is habitual some other cause should be sought
(see page 121).
_How is an infant to be managed that cries from temper, habit, or to
be indulged?_
It should simply be allowed to "cry it out." This often requires an
hour, and in extreme cases, two or three hours. A second struggle will
seldom last more than ten or fifteen minutes, and a third will rarely
be necessary. Such discipline is not to be carried out unless one is
sure as to the cause of the habitual crying.
_Is it likely that rupture will be caused from crying?_
Not in young infants if the abdominal band is properly applied, and
not after a year under any circumstances.
LIFTING CHILDREN
_How should a young baby be lifted from its bed?_
The right hand should grasp the clothing below the feet, and the left
hand should be slipped beneath the infant's body to its head. It is
then raised upon the left arm.
_What is the advantage of this?_
The entire spine is supported, and no undue pressure is made upon the
chest or abdomen, as often happens if the baby is grasped around the
body or under the arms.
_How should a child old enough to run about be lifted?_
Always by placing the hands under the child's arms, and never by the
wrists.
_What injury may be inflicted by lifting the child by the wrists or
hands?_
Often serious injury is done to the elbow or shoulder joints.
THE TEMPERATURE
_What is the normal temperature of an infant?_
The normal temperature varies more than in adults. In the rectum it
usually fluctuates between 98° and 99.5° F.; a rectal temperature of
97.5° F. or of 100.5° F. is of no importance whatever unless it
continues.
_Where should the temperature of infants and young children be taken?_
The rectum is altogether the best place, and next to this the groin.
The rectal temperature is from half a degree to a degree higher than
that in the groin.
_How long should the thermometer be left in place to take the
temperature?_
Two minutes in the rectum, and five minutes in the groin.
_Is the temperature of a young child a good guide as to the severity
of its symptoms in illness?_
As a rule it is. A temperature of 100° to 102° F. commonly means a mild
illness, and one of 104° F. or over a serious one. The duration of the
fever is, however, even more important than the height of the
temperature. It should be remembered that in all young children slight
causes often produce a high temperature which lasts for a few hours;
one should not therefore be unduly alarmed unless the temperature
continues high, or is accompanied by other important signs of illness.
_Is not a high temperature a more serious symptom in a young child
than in an adult?_
The opposite is rather the case. Young children are extremely
sensitive to conditions which produce fever, and the thermometer often
gives an exaggerated idea of the severity of the symptoms. A cause
which in an adult might produce a temperature of 102° F. or 103° F.,
in a young child would very likely be accompanied by a temperature of
104° or 105° F.
NERVOUSNESS
_What are the principal causes of excessive nervousness in infants and
young children, and what can be done to prevent this?_
The most important cause is the delicate structure of the brain at
this time, and its rapid growth. It grows as much during the first
year as during all the rest of life. This requires quiet and peaceful
surroundings. Infants who are naturally nervous should be left much
alone, should see but few people, should be played with very little,
and should never be quieted with soothing sirups or the "pacifier."
_At what age may playing with babies be begun?_
Babies under six months old should never be played with; and the less
of it at any time the better for the infant.
_What harm is done by playing with very young babies?_
They are made nervous and irritable, sleep badly and suffer from
indigestion and in many other respects.
_When may young children be played with?_
If at all, in the morning, or after the midday nap; but never just
before bedtime.
TOYS
_What points should guide one in selecting toys and playthings for an
infant?_
The instinct in a baby to put everything into the mouth is so strong
that nothing should be given that cannot be safely treated in this
way. Hence one should choose things which are smooth, those which can
be easily washed, and those which cannot be swallowed.
One should avoid (1) toys with sharp points or corners; (2) those with
loose parts that might be detached or broken off and swallowed; (3)
small objects which might be swallowed or pushed into the nose or ear,
such as coins, marbles, and safety-pins, also beads and buttons unless
strung upon a stout cord; (4) painted toys; (5) those covered with
hair or wool. Infants have often been severely injured by swallowing
what they have pulled off from their small toy animals.
_What points are to be considered in selecting the toys and playthings
of a child over two years old?_
It should be remembered that toys are not merely a source of
amusement, but that they have an educational value as well. Those are
therefore to be preferred the use of which develops the child's
imagination, and with which he can be taught to amuse himself. For
boys nothing can surpass blocks, toy soldiers, balls, engines, and
cars; and for girls, dolls and housekeeping sets. The complicated
mechanical toys now so much in vogue give only a momentary pleasure,
and as soon as the wonder at their operation has worn off, they have
lost interest for the child except that which he gets in breaking them
to see how the thing worked.
_What important things can be taught children with their toys and how
may this be done?_
The imagination may be developed, and children may be trained to
habits of neatness, order and regularity and to concentration of mind.
To this end toys should be kept in an orderly way upon a shelf in the
nursery or in a closet, never piled in a miscellaneous heap in the
corner of the room. Children should select their toys and play with
one thing at a time, which they should be taught to put away in its
place before another is given. They should never be allowed to have a
dozen things strewn about the room at one time, with none of which
they are occupied.
KISSING
_Are there any valid objections to kissing infants?_
There are many serious objections. Tuberculosis, diphtheria, and many
other grave diseases may be communicated in this way. The kissing of
infants upon the mouth by other children, by nurses, or by people
generally, should under no circumstances be permitted. Infants should
be kissed, if at all, upon the cheek or forehead, but the less even of
this the better.
CONVULSIONS
_What should be done for a child in convulsions before a doctor
arrives?_
Keep the child perfectly quiet with ice at the head, put the feet in a
mustard bath, and roll the entire body in large towels which have been
dipped in mustard water (two heaping tablespoonfuls of mustard to one
quart of tepid water), and have plenty of hot water and a bath tub at
hand, so that the doctor can give a hot bath if he thinks it
advisable.
_When is a hot bath useful?_
If the convulsions have continued until the pulse is weak, the face
very pale, the nails and lips blue, and the feet and hands cold, the
hot bath will be useful by bringing blood to the surface and relieving
the heart, lungs, and brain.
_How should the bath be given?_
The temperature should not be over 106° F.; this should always be
tested by a thermometer if one can be obtained. Without this
precaution, in the excitement of the moment, infants have frequently
been put into baths so hot that serious and even fatal burns have been
produced. If no thermometer is available the nurse may plunge her arm
to the elbow into the water. It should feel warm, but not so hot as to
be at all uncomfortable. One half a teacupful of powdered mustard
added to the bath often adds to its efficacy.
FOREIGN BODIES
_What should be done if a foreign body has been swallowed?_
First, examine the throat with the finger to see if it has lodged
there, and if so remove it. If it has passed from the throat it has
usually gone into the stomach.
_What should be done in this case?_
Give the child plenty of dry food, like bread, potato, etc., but under
no circumstances either an emetic or cathartic. An infant may have its
usual food.
_What harm would a cathartic do?_
It is likely to hurry the foreign body too rapidly through the
intestine and in this way do harm; otherwise it becomes coated with
fecal matter and passes the intestine usually without doing injury.
_What should be done if a child gets a foreign body into the ear?_
Unless this can easily be removed with the fingers it should not be
meddled with, for it is likely to be pushed farther into the ear. The
child should be taken to a physician.
_What should be done if there is a foreign body in the nose?_
The child should blow his nose strongly while the empty nostril is
compressed. Unless this removes it a physician should be called.
Meddlesome interference is always harmful.
COLIC
_What are the symptoms of colic?_
There is a strong, hard cry, which comes suddenly and returns every
few minutes. With this there is drawing up of the feet, contraction of
the muscles of the face, and other signs of pain. The abdomen is
usually tense and hard.
_What should be done for a baby with colic?_
First, see that the feet are warm. Place them against a hot-water bag,
or hold them before an open fire; apply a hot flannel to the abdomen,
or let the child lie upon its stomach across a hot-water bag. If the
colic continues, a half teacupful of warm water containing ten drops
of turpentine may be injected into the bowels with a syringe; at the
same time the abdomen should be gently rubbed so as to start the wind.
If the gas is in the stomach, half of a soda mint tablet may be given
in a tablespoonful of very warm water.
EARACHE
_What are the symptoms of earache?_
The pain is generally severe and accompanied by a sharp scream; the
child often puts the hand to the affected ear, or cries whenever it is
touched. The pain is likely to be prolonged and continuous.
_How should a child with earache be treated?_
The ear should be irrigated with a solution of boric acid (twenty
grains to the ounce) as warm as can be borne. Dry heat may then be
applied in several ways. The ear having been first covered with
cotton, a small hot-water bag or one filled with hot salt or bran, may
be bound over it with a bandage; or a small butter plate heated in hot
water may be used in the same way. The hot-water bag may be held
against the ear or the child may lie with his head upon it. The use of
such substances as oil and laudanum in the ear is not to be
recommended.
CROUP
_What are the symptoms of croup?_
There is a hollow, dry, barking cough, with some difficulty in
breathing.
_When is this likely to come on?_
Usually at night.
_Is simple croup dangerous?_
The ordinary croup of infants is spasmodic croup, and is very rarely
dangerous, although the symptoms seem very alarming.
_What are the symptoms?_
In a mild attack there is simply noisy breathing, especially on
drawing in the breath, with a tight, barking, or croupy cough. In a
severe attack the child's breathing is more noisy and becomes
difficult.
_What is the dangerous form of croup?_
Membranous croup, which is the same thing as diphtheria of the larynx.
_How does this develop?_
Gradually; very rarely does it come on suddenly.
_What should be done for a baby who has spasmodic croup?_
The room should be very warm, hot cloths or poultices should be
applied over the throat, and either a croup kettle or an ordinary
tea-kettle kept boiling in the room. This is more efficacious if the
child is placed in a tent made by a raised umbrella with a sheet
thrown over it, and the steam introduced beneath the tent. If the
symptoms are urgent, ten drops of the sirup of ipecac should be given
every fifteen minutes until free vomiting occurs. Whenever the
symptoms reach a point where breathing becomes difficult, a doctor
should be summoned without delay.
CONTAGIOUS DISEASES
_What are the first symptoms of measles?_
Measles comes on rather gradually with cough, sneezing, watery eyes
and nose, much like an ordinary cold in the head. The eruption appears
after three or four days, first upon the face and neck as small red
spots, and spreads slowly over the body.
_Is measles a serious disease?_
In infants and during the winter season it is likely to be very
serious on account of the danger of bronchitis and pneumonia, which
frequently accompany it. In children over four years old it is
generally not severe. No child should be voluntarily exposed to this
disease, and particularly one who is delicate or prone to disease of
the lungs should be protected against it.
_When and how is measles contagious?_
Measles may readily be conveyed from the very beginning of the
catarrh, two or three days before any eruption is present. It is not
often carried by healthy persons. Its poison does not cling long to a
sick room.
_What is German measles?_
German measles, or rubella, is a distinct disease and has nothing to
do with ordinary measles. It is extremely rare for a child to be much
sick with it. There is usually a very extensive eruption which may
cover the body, but few other symptoms.
_What are the first symptoms of scarlet fever?_
Generally it comes suddenly, with vomiting, high fever, and sore
throat. The eruption usually appears within twenty-four hours as a red
blush, first upon the neck and chest, and spreads rapidly.
_When and how is scarlet fever contagious?_
Scarlet fever is only slightly contagious for the first one or two
days of the attack. It is most contagious at the height of the disease
and during desquamation. It may be carried by healthy persons and by
the clothing or bedding from the sick room.
_How does whooping-cough begin?_
For a week or ten days it cannot be distinguished from an ordinary
cold on the chest. Then the attacks of coughing gradually become more
severe and vomiting may follow. After a severe coughing fit the breath
is caught with a peculiar noise known as the "whoop."
_How does chicken-pox begin?_
It usually comes out gradually, as widely scattered pimples over the
scalp, face, and body, many of which soon become small vesicles,
resembling tiny blisters. There is itching and local discomfort but
little fever, and the child rarely seems to be very ill.
_How does diphtheria begin?_
Sometimes suddenly, but usually gradually, with sore throat and
swelling of the glands of the neck, with white patches upon the
tonsils, or a free discharge which may be bloody, from the nostrils.
_How does mumps begin?_
As a swelling upon the jaw, beneath the ear. As it increases it
extends forward upon the cheek and backward behind the ear. It affects
one or both sides.
Mumps is not very common in young children, and in them it is usually
mild. After twelve or thirteen years it is likely to be more severe.
_How long after exposure do the first symptoms appear in the different
diseases?_
In scarlet fever in from three to five days, rarely later than a week;
in measles in from nine to fourteen days, occasionally as late as
twenty days; in whooping-cough in from one to two weeks; in
chicken-pox in from fourteen to sixteen days; in German measles in
from ten to sixteen days. In diphtheria the time varies much; it may
be only one day, and it may be one or two weeks. In mumps it is
usually a little less than three weeks, the average being twenty days.
_Which of these diseases are most contagious?_
Measles and chicken-pox are very contagious, and very few children who
have not had them can come near a person suffering from either disease
without taking it. Whooping-cough is almost as contagious as measles,
and for young babies even more so. A very close exposure is not
necessary in the case of either of these diseases, and whooping-cough
can undoubtedly be contracted in the open air. Scarlet fever and
diphtheria are much less contagious; for both of these a pretty close
exposure is necessary.
_How long should a child with any of these diseases be kept away from
other children?_
With measles, for two weeks after the rash has gone; with scarlet
fever, for at least four weeks after the rash has gone, and longer if
the peeling is not over or if the ears are running; with
whooping-cough, for two months, or so long as the paroxysmal cough
continues; with chicken-pox, until all crusts have fallen off, or for
about three weeks after the eruption appears; with German measles for
one week after the eruption has faded; with diphtheria, at least ten
days after the throat is well in a very mild case, and four weeks if
the case has been severe; with mumps for one week after the swelling
has gone.
_What should be done when a child shows the first symptoms of serious
illness?_
The child should be put to bed. If it is an infant the food should be
diluted to one half the usual strength; if an older child, only fluid
food should be given. If the child seems feverish, take the
temperature If the bowels are constipated, give a teaspoonful of
castor oil; but no other medicine without the doctor's orders. Send
for the doctor at once, and until he comes carefully exclude all other
children from the room.
_By what nursery training may the examination and treatment of sick
children he made much easier?_
By teaching all children to gargle, to show the throat, to take pills,
and by constantly teaching them to regard the doctor as the child's
best friend, and his visits as a great treat. On no account should a
child be frightened into obedience by threats of what the doctor will
do.
With care and patience most children may be taught to gargle and take
pills at four or five years, and to show the throat willingly at two
or three. All these matters should be made a part of the child's
education.
SCURVY
_What is scurvy and how is it produced?_
Scurvy is a disease of general nutrition, usually caused by the
long-continued use of improper food. Most of the cases come from the
use of the prepared infant's foods sold in the stores, especially when
they are given without fresh milk; occasionally the use of condensed
milk and of sterilized milk is followed by scurvy; sometimes it is
seen when, owing to feeble digestion, it has been necessary to make
cow's milk very weak for a long time.
_What symptoms are seen in an infant with scurvy?_
At first there is only indefinite and occasional soreness in the legs
so that the child cries out when handled. As this soreness becomes
more severe the child is often thought to have rheumatism. The gums
swell and are of a deep purple colour. There may be bleeding from the
gums, nose, bowels, or black-and-blue spots may be seen upon the legs.
The ankles and knees may swell. The child grows very pale, loses
appetite and weight, and sleeps badly.
_What should be done when an infant shows signs of scurvy?_
The diet should at once be changed to fresh milk, properly modified
according to the child's digestion, but not sterilized or pasteurized.
The juice of a sweet orange should be given, best about an hour before
the feeding. At first one or two teaspoonfuls, four or five times a
day; later, more may be given if the symptoms are not improved.
Properly treated an infant with scurvy generally recovers promptly and
completely. If not recognised, or untreated, it may cause death.
CONSTIPATION
_When it is necessary to move the bowels immediately, what are some of
the easiest methods?_
An injection of one tablespoonful of sweet oil may be given, or half a
teaspoonful of glycerine in one tablespoonful of water, or a teacupful
of tepid soap and water, or a glycerine suppository. None of these
should be continued excepting under the physician's directions.
_What sort of a syringe is to be preferred for giving an injection to
an infant?_
The bulb syringe is the simplest; this consists of an oval bulb of
soft rubber and a soft rubber or a hard rubber tip. It holds one or
two ounces.
_What is the most essential thing in preventing or overcoming
constipation?_
The formation of the habit of having the bowels move every day
regularly at the same hour, and proper early training (see page 156).
_What is the best hour?_
In most cases immediately after the first meal in the morning.
_What are some simple means by which constipation may be relieved?_
The best are diet, suppositories, and massage.
The changes to be made in the milk of constipated infants have been
mentioned on page 82. The addition to the milk of some of the malted
foods, such as Mellin's food or malted milk, is sometimes useful. For
little children the fruit juices are particularly beneficial when
given half an hour or more before the first morning feeding, with half
a glass of water.
For older children the amount of white bread, toast, and potato,
should be reduced, and green vegetables oatmeal, and Graham bread
given, with plenty of fruit twice a day. Raw scraped apples are
sometimes of more value than any other fruit.
The best suppositories for continuous use are probably the gluten
suppositories of the Health Food Company. One should be given the
first thing in the morning. They act rather slowly, usually in about
two hours. In obstinate cases one may also be used at bedtime.
Glycerine suppositories act more quickly, but are too irritating for
regular use.
Massage consists in rubbing the abdomen, which may be done in one of
two ways: Beginning at the right groin, the hand is carried up to the
ribs, then across to the opposite side, then around to the left groin.
The abdomen is stroked gently at first, and afterward deeper pressure
used as the child becomes accustomed to it. The second method is by
rubbing the deeper parts with a circular movement--the fingers not
moving upon the skin--making a series of small circles, beginning at
the right groin and following the same course as described above.
Either method should be employed for six or eight minutes twice a day,
at almost any regular time, except soon after a meal.
DIARRHOEA
_In case a child is taken with diarrhoea, what should be done?_
With a moderate looseness of the bowels in an older child, solid food
should be stopped, and boiled milk given diluted with gruel; the child
should be kept perfectly quiet, as walking about always aggravates
such a disturbance. If the symptoms are more severe and attended by
fever and vomiting, all milk should be stopped at once, and only
broth, barley water, or some thin gruel given. Some cathartic, usually
castor oil, is required with a severe attack.
If the patient is an infant, the milk should be diluted and especially
should the fat be reduced (see page 76). In severe attacks with
vomiting or frequent foul stools, all food should be stopped for at
least twelve hours and all milk for a longer time, and the bowels
freely moved by a cathartic.
_Why is a cathartic necessary if the movements are already frequent?_
Such movements are nearly always due to an irritation in the bowel,
set up by the fermenting food which has not been digested. The
diarrhoea is Nature's effort to get rid of the irritant. Nothing to
stop the movements should be given until the bowels have been
thoroughly cleared by the treatment mentioned.
BAD HABITS
_What are the most common bad habits of young children?_
Sucking, nail-biting, dirt-eating, bed-wetting, and masturbation.
_What do children suck?_
Most frequently the thumbs or fingers, sometimes the clothing or
blanket; often the "pacifier" or rubber nipple.
_When is this habit most frequently seen?_
It begins in quite early infancy, and if not broken may last until
children are six or seven years old.
_Is the sucking habit a harmful one?_
When persisted in it may produce a misshapen mouth or fingers. It
constantly stimulates the flow of saliva and certainly aggravates
disturbances of digestion during which the sucking habit is likely to
be practised. It may lead to thrush or other forms of infection of the
mouth. It is not necessary as a means of quieting a child, though it
may in some degree cover up the consequences of bad feeding or bad
training. On no account should the habit of sucking the "pacifier" be
allowed as a means of putting children to sleep, or of quieting them
while restless from dentition or indigestion.
_How is the sucking habit to be controlled?_
One should be sure in the first place that the constant sucking of
fingers is not due to hunger from insufficient food. Sucking of the
hands may often be controlled by wearing mittens or fastening the
hands to the sides during sleep. In more obstinate cases it may be
necessary to confine the elbow by small pasteboard splints to prevent
the child from bending the arm so as to get the hand to the mouth.
_When are nail-biting and dirt-eating seen, and how are they to be
controlled?_
These habits belong especially to children over three years old. They
are seen particularly in those who are excessively nervous or whose
general health is below par; sometimes in those who develop serious
nervous diseases later in life. Children with such tendencies should
be closely watched, and every means used to break up these habits
early. Dirt-eating is a morbid craving which is rarely seen in a
normal child.
_At what age may a child generally be expected to go without wetting
the bed during the night?_
Usually at two and a half years, if it is taken up late in the
evening. Some children acquire control of the bladder at night when
two years old, and a few not until three years. After three years
habitual bed-wetting is abnormal.
_How should a young child addicted to bed-wetting be managed?_
At three or four years of age, punishments are sometimes useful,
especially when it seems to depend more upon the child's indifference
than anything else. They are of no value in older children, rewards
being much more efficacious. In all cases one should give a child
plenty of milk and water early in the day, but no fluids after 4 P.M.,
the supper being always of solid or semi-solid food. The child
should be taken up regularly at ten o'clock or thereabouts. It often
happens that the formation or continuance of the habit is due to the
child being in poor general condition, to some irritation in the
urine, or in the genital organs. Unless the simple means mentioned are
successful the child should be placed under the charge of a physician.
_What is masturbation?_
It is the habit of rubbing the genital organs with the hands, with the
clothing, against the bed, or rubbing the thighs together. Sometimes
the child sits upon the floor, crosses its thighs tightly and rocks
backward and forward. Many of these things are passed over lightly and
are regarded for months as simply a "queer trick" of the child. It may
be seen at any age, even in those not more than a year old, and in
both sexes.
_How should such a child be treated?_
Masturbation is the most injurious of all the bad habits, and should
be broken up just as early as possible. Children should especially be
watched at the time of going to sleep and on first waking. Punishments
and mechanical restraint are of little avail except with infants. With
older children they usually make matters worse. Rewards are much more
efficacious. It is of the utmost importance to watch the child
closely, to keep his confidence, and by all possible means to teach
self-control.
Some local cause of irritation is often present, which can be removed.
Medical advice should at once be sought.
VACCINATION
_Nowadays when small-pox occurs so seldom is it necessary to have
every child vaccinated?_
It should by all means be done. It is only by the practice of general
vaccination that small-pox is kept down. In countries or in
communities where vaccination is neglected, frightful outbreaks of
small-pox occur every now and then just as in olden times.
_What is the best time for vaccination?_
The time usually selected is from the third to the sixth month. It may
be deferred in a very delicate child who is not likely to be exposed
to small-pox, or in a child suffering from any form of skin disease.
_Which is preferable for vaccination, the arm or the leg?_
The part which can be most easily protected and kept at rest is to be
chosen. In infants who do not yet walk or creep, the leg is to be
preferred? in older children, in most circumstances, the arm. If older
children are vaccinated on the leg, they should not be allowed to walk
much while the vaccination is active.
_When should vaccination be repeated?_
An unsuccessful vaccination proves nothing and should be repeated in
two or three weeks. If success fully vaccinated in infancy, a child
should invariably be revaccinated before puberty. If exposed or likely
to be exposed to small-pox at any time vaccination should be repeated.
[Illustration: Weight chart for the first year; the curved line
indicates the average rate of gain.]
[Illustration: Weight chart, one to fourteen years. The upper line
indicates the average for boys; the lower (dotted) line that for
girls.]
End of Project Gutenberg's The Care and Feeding of Children, by L. Emmett Holt