The Mother and Her Child

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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 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 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.
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 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
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.

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 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 STOOLS

We 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 passages. The presence of a certain
amount of greenish coloration of the passages is not infrequent.
This is usually an evidence of indigestion, but passages which
are yellow when passed 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
substituted. 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 appetite
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 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 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 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
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
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 11/2 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 MEDICINES

Castor 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 PULSE

The 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 the child is awake and may be a bit slower
when asleep. Before the baby is born the fetal pulse is about 150. At
birth it ranges from 130 to 140. During the first month the pulse is
found to be from 120 to 140. By the sixth month it gets down to 120 or
130, and from that on to a year the normal pulse beat of the baby is
about 120. The pulse is influenced very much by exercise and is often
increased by crying or nursing or any other excitement.

FEVER

Children 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 the bowel and is
then quickly cooled down to 90 or 85 F.; in this manner much heat is
taken out of the body and the fever quickly reduced. (For further
treatment of fevers see Appendix.)

CHAPTER XXVI

BABY'S SICK ROOM

Visitors should never be allowed in the sick room during the height of
a disease, and during convalescence not more than one visitor should
be allowed at one time, and the visit then should be only two or three
minutes in length. The order and the quietness and the system of the
sick room should be perfect. Visitors and loitering members of the
family do no good and they may do much harm to the recuperating
nervous system of the child.

LOCATION OF THE SICK ROOM

In these days of high rents, we realize that the greater per cent of
our readers are living in apartments and homes just big enough
conveniently to care for the family during health, and while it would
be pleasant and convenient to have a spare room or an attic chamber
that could be used in case of illness, it is the exception rather than
the rule that the families to whom sickness comes have these extra
apartments. When a contagious or an infectious disease comes to the
family, it is of great importance that the sick child be isolated,
preferably on another floor, from that used by the immediate family.

Those living in homes, more than likely can fix up a room on the attic
floor for the isolation, and those living in apartments may put the
sick child in one end of the apartment, while they inhabit the other
end. One family under my observation not long ago had a child stricken
with the measles. In the same apartment there lived a puny baby not
quite two years old. Coming as it did in February, the mother of the
child was apprehensive, fearing that measles would leave a severe
bronchitis which might mean the death of the already too-delicate
baby. She was instructed to move the baby's bed to the sun parlor in
the front of the flat, while the boy with the measles was put in the
parents' room in the rear end of the flat. A sheet was suspended in
the middle of the hall leading from the living-room to the bedrooms.
Door knobs were disinfected daily, a caretaker was put in charge of
the measles patient, the mother very frequently was compelled to go
back and administer a treatment, but each time she donned a large
apron and completely covered her hair with a towel, she administered
the treatment, took off her wrappings, thoroughly washed her face and
hands--disinfected them--and returned to her baby in the front part of
the house.

At night this mother slept on the floor on springs and mattress in the
living-room, and to that home the measles came and departed, and the
baby did not get them at all, so perfect was the isolation, so
vigilant the disinfection, and so scrupulous the care to prevent
contamination. So you see from this one instance that it is altogether
possible to make isolation complete even on the same floor. But, mind
you, the dishes that the lad ate from were all kept in his room. Food
was brought to the sheet and there the caretaker held her dishes while
the cook poured or lifted the food from her clean dishes to the dishes
the caretaker brought from the sick room.

Whether the sick room is in the attic or whether it be the rear end of
an apartment, if the principles of contagion and disinfection are
understood I believe it is perfectly possible to isolate even scarlet
fever without danger to the other members of the family.

NECESSARY FURNISHINGS

For slight indispositions and trifling disorders, it is not necessary
to strip the room of its adornment, but it is well to clear off the
dresser tops, protect them well with many thicknesses of newspapers
covered over by a folded sheet so that alcohol, witch-hazel and other
necessaries will not injure the mahogany or oak-top dresser. Whenever
the children are sick, rob the room of anything that is going to be in
your way. In instances of infectious or contagious diseases, take down
all silk or wool hangings, replace them by washable curtains or
inexpensive ones that can be burned if necessary, and remove valuable
paintings and other bric-a-brac that later fumigation will harm or
that may gather the dust during the days of illness.

Just as it is necessary for the man who mines the coal to wear
suitable garments, and for the woman who does the scrubbing to dress
accordingly, and for the nurse who cares for the case to wear washable
clothes--so it is necessary to dress the sick room in garments that
are suitable, convenient, and capable of being thoroughly disinfected,
fumigated, or even burned if the occasion demands. Hence, expensive
rugs should be replaced by rag carpets or no rug at all, while
unnecessary articles and garments should be removed from closets, etc.

Remembering that the little fellow is to remain in this room for
possibly two weeks or maybe six weeks, let us put up some
bright-colored pictures that he will enjoy, bring in some books and
magazines by which he may be entertained, secure a few simple toys
that will not tax the brain, but serve as a help to pass away the long
hours. There are many paper games that may be had, such as transfer
pictures, picture puzzles, kindergarten papers, drawing pictures, as
well as toys that may be put together to fashion new articles. A whole
lot of fun can be gotten out of a bunch of burrs that can be stuck
together to make men, animals, houses, etc. Scissors and pictures are
entertaining as well as paper dolls with their wardrobes. Rubber
balloons, or a target gun for the boy of six will be a great source of
delight to him; as will a doll with a trunk full of clothes for the
little girl during her convalescent days. A tactful nurse and a
resourceful mother will think of all the rest that we have not
mentioned--which will amuse, entertain and keep happy our convalescent
children, help them to forget that they are "shut ins."

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