CHAPTER IV.
CARE OF INFANT CHILDREN.
Infants sometimes require treatment for ailments either slight or severe when the advice of a physician cannot be obtained.
The NAVAL is sometimes a little sore after the naval string comes away. It may be dressed by putting a little simple cerate or vaseline or carbolized cosmoline on lint or a linen rag, and applying it to the part affected every morning, and a bread poultice every night until it is quite healed.
A RUPTURE OF THE NAVAL is sometimes caused by much crying, and it may be occasioned by the nurse pulling on the cord to remove it before it will readily separate from the infant’s body.
The best treatment is a piece of adhesive plaster as large as the top of a tumbler, with a properly adjusted pad made of several folds of muslin fastened on the plaster, which will keep the bowels from protruding. The bandage or belly band can be put on over this.
If the infant have a GROIN RUPTURE the only proper treatment is to keep on it day and night if it cry much, a well fitting truss. In applying the truss be careful to return the rupture thoroughly, and endeavor to have it well adjusted or it will chafe and will not effectually cure.
If the child is TONGUE TIED so that it cannot apply its tongue to the nipple to suck, the frenum may be cut, but it will not be necessary to make more than a small nick or a slight cut in it.
MILK IN THE BREASTS OF NEW BORN INFANTS, or a serous fluid resembling it, is often found, and sometimes there is considerable swelling both of the breasts of male and female children. It is not the better way to apply plasters or to squeeze or press them, but the milk may be drawn out by putting an open top thimble over the nipple and drawing on it.
CHAFINGS may be caused by inattention to cleanliness. Fat babies are subject to them, and when there is disorder of the bowels or kidneys they cannot at all times be prevented. Thoroughly sponge the parts with tepid rain water, allowing the water from a well filled sponge to stream over them, then carefully dry with a soft towel, and perhaps dust over them sub-nitrate of bismuth. (F. 202.)
DIARRHŒA and DYSENTERY and also COSTIVENESS are among the ailments with which infants may be afflicted. I wish to be particular in giving directions, that these may generally be avoided, but I must again repeat that the nurse should never be influenced by my advice to do any thing contrary to the directions of the attending physician.
To avoid the subsequent necessity of giving medicine you must be very careful in their administration at first. It is indeed necessary that the meconium should be purged off at first, but nature in general provides such physic as is required, and if the child is applied to the mother’s breast, it obtains in the colostrum such medicine as it needs. Where the infant cannot obtain anything from the breast a gentle aperient may be given, and I name the following as being suitable: either molasses and water, raw sugar, a solution of manna in warm water, a teaspoonful of sweet oil, or of simple syrup of rhubarb, or in more obstinate cases, of castor oil, or one-fourth teaspoonful compound licorice powder, (F. 108.) but you must never give a drastic purgative, and you must not repeat the aperient if the discharges become yellow and natural. A young infant ought to have from three to six motions in the twenty-four hours, the color ought to be of a bright yellow or orange, and of the consistency of mustard as ordinarily prepared for the table, and there ought not to be any lumps or curds in its motions. A mother or nurse ought to be very observant of the state of the bladder and bowels—should inspect motions daily and see that they are not slimy, or curdled, or green. If they are she should be very careful, especially in regard to what the mother eats and drinks. If the bowels are costive she must avoid the frequent repetition of opening medicine, however gentle and well selected the aperients may be. They interfere with digestion, often irritate the bowels, and render them more costive. For the sake of the child as well as herself, the mother may vary her diet considerably after the first week, she may eat boiled and stewed, broiled and roast meats, mutton, lamb, and beef, fish, game, and chickens, potatoes, turnips, spinach, celery, peas, beans, figs, bananas, prunes, baked apples, &c. (F. 45 to 60.) The bowels of the child that nurses generally (not always) keep pace with those of the mother, and she must endeavor both for her own sake and that of the child, to keep her bowels loose by means of diet. If necessary she must take physic. (F. 107, 108, 109.)
If the constipated child nurses the mother and the mother constantly pays proper attention to her own health, and especially to her diet, the child will very seldom require physic. Indeed I would not give active physic when the child seemed well, if it did not have a passage oftener than once a week. If it has cow’s milk or other food besides the mother’s milk, do not boil the milk and you can add to the cow’s milk, corn starch, or the following: Make a thin mush by boiling a small quantity at a time of unbolted wheat flour in water and straining it through a sieve while hot. The child may sometimes be fed with this alone, a little sweetened. Molasses may be given freely, or molasses and soda. The child should be watched, and if there is occasional costiveness, and at the time any indisposition, make a suppository of common soap about an inch in length and a quarter of an inch thick, dip it in water and pass it into the rectum. Or give an injection of less than a gill of water with perhaps a teaspoonful of molasses and a pinch of salt. But I would avoid the practice of giving an enema daily, as tending to get up a bad habit in the system. Should the costiveness have provoked fever, induced pain, or excited convulsions, active physic may be given, either castor oil, magnesia, calomel, or F. 108. But be sure that costiveness is not brought on by giving paregoric or other opiates, and let a child drink freely of pure cold and fresh water. The water may be boiled to destroy germs, and then cooled in a refrigerator; it should always be boiled before being used when there is an epidemic of bowel complaint prevailing.
In DYSENTERY there is a specific inflammation and ulceration of the mucous membrane of the colon, especially of the lower part, and of the rectum—there is generally some fever, frequent and bloody stools, tenesmus, and griping pains. Sometimes it attacks an infant or a delicate child, there being at first for several days diarrhœa, the motions being slimy and frothy like frogspawn, afterward entirely mucous and blood. The child is dreadfully griped, strains violently, and screams, and twists about every time it has a motion, and there is vomiting and great prostration.
You should in treating the child at the breast still keep him to it, and give it no other food. If the mother’s milk is not good, procure if possible a healthy wet nurse. If the child must be fed give it cow’s milk from one healthy cow—fresh from the cow—small quantities at a time and frequently, mixed with gum arabic water. In the commencement a warm bath may be used, or as a substitute you may wrap the child in a blanket that has been previously wrung out of hot water; over this put a dry blanket and keep the child thus enveloped for twenty or thirty minutes.
Formula 74 and 99 may be used, but the dose for a young child must be small to accord with its age.
CHOLERA INFANTUM is more prevalent in the United States than in any other country. The continued heat of summer is a predisposing cause, and improprieties in diet and clothing, worms, premature weaning, and teething are exciting causes.
You may treat this disease in the initial stage by giving F. 80, and also for a child a year old, injections of a gill of warm water in which a teaspoonful of common salt has been dissolved, allowing the patient three or four times a draught of warm water, as much as it desires to drink. Perhaps the drink will be immediately vomited, but it will at least remove irritating matter from the stomach. The injection, too, may operate immediately, but it may bring with it a fecal or bilious discharge, and if several times repeated, its effects will be salutary. A muslin cloth heated almost to scorching and applied once or twice dry to the neck, may stop vomiting, and draughts applied to the extremities may also be of much benefit. After using injections of warm soft water, anodyne injections may be given three or four times a day; but cases of this kind are too serious for any nurse or mother to treat, if the services of a physician can be obtained; and I will only mention one or two things more. When the extremities are cold put the child for a few minutes in a warm bath of mustard water, and then employ friction to the skin.
I have found chicken tea made by boiling the chicken very soon after it is killed, very useful in checking the vomiting and curing the child.
Of course a physician will be obtained in these serious cases if possible.
RETENTION OF URINE in the newly born infant if slight is easily removed by giving two or three drops of spirits of nitre once an hour in a little sweetened water, or if obstinate it may be aided by castor oil and the warm bath. A little pumpkin seed or parsley root tea also succeeds remarkably well.
APTHÆ is usually called the baby’s sore mouth. It generally begins on the inner part of the lower lip or corner of the mouth, as a small white speck which resembles a coagulum of milk. These aphthous white pustules soon appear over the inside of the cheeks and on the tongue and gums. The eruption is very white and looks as if whey or curds were spread over the mouth, which is hot and painful, and the disease sometimes does, and at other times does not cause fever. I regard this complaint as being one of the germ diseases, although the fact has not yet been demonstrated. The children fed upon farinaceous food are most liable to this disease, and during its continuance, if the child is not at the breast it should be kept entirely to the milk of one cow. Medicine should be given with regard to the stomach and bowels. If the passages from the bowels are green, magnesia is a proper kind of physic, and when there is diarrhœa use formula 80, 77, 81.
GENUINE JAUNDICE may attack a young child, but this is to be distinguished from those cases where there is only a generally diffused YELLOW COLOR OF THE SKIN. In the latter class of cases there are no symptoms indicating any serious disease; the yellowness may continue for several days, and this disappears without the aid of any medicine and without leaving any evil behind. But in jaundice the whites of the eyes and the tears are tinged yellow, and, besides, the feces are paler than they should be, the urine is yellow, and other serious symptoms are added. If the bowels be costive, or irritated to frequent efforts, if the abdomen swells and becomes tense, if the child is uneasy and inclined to vomit, if it refuse the breast and frequently moans as if in pain, if it emaciate rapidly, jaundice in a bad form is present, and there is probable disease of the liver. Call the doctor.
I need not continue my instructions any farther in regard to the diseases of infancy, as you are expected to act as far as you can under the directions of a physician. But I must again advise you as to how you are to treat your medical advisor. Give him your entire confidence. Be truthful and candid with him. Have no reservations; give him a plain statement of the symptoms. Be prepared to state the exact time the child showed any illness. Tell him if the child had a chill; if there be any eruption on the skin, note the quantity and appearance of the urine, the number, color, &c., of the stools—all the symptoms of the disease. Strictly obey the doctor’s orders in diet, in medicine, in everything, and never omit any of his suggestions. If the case be severe, never call a second physician without first consulting and advising with the one first chosen; speak in the presence of children with respect and reverence of the doctor, and endeavor to have them like him. Send for the doctor when practicable early in the morning, as the daylight is most favorable for making the examination, but if the illness come in the night do not delay on that account; if you do not know what to do, it is better that the doctor be called early than late.