PART IV

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.

End of Project Gutenberg's The Care and Feeding of Children, by L. Emmett Holt