DISEASES OF INFANTS INFANTS, NEWLY-BORN.- As it often happens that the child is born before the arrival of the doctor, it is very necessary that nurses and others should be able to act in emergencies. The first thing to remember regarding the child is that it is often apparently dead when born, but not really so.
Apparent Death.- If the cord is round the child’s neck, unbind it. If the cord pulsates, leave it uncut. Gently insert the finger into the child’s mouth, and clear out any fluid or membrane that my be there. On withdrawing the finger, there will generally be an effort to breathe. If there is none, cut the cord, and allow it to bleed a little before tying; then place the child in a hot bath and pour a little cold water on the back of the neck. If there is still no effort to breathe, make slow and gentle pressure on the chest, taking it between the two hands and allowing it to expand again. These measures must be persevered with as patience has been rewarded with a living child after two or there hours.
Management of the Child.- As soon as the child has given evidence of vitality by its cry on the rosy flush of its skin, it may be separated from its mother. The cord should be tied about an inch and a half from the child’s body, and again about an inch nearer the mother. The best material is several stands of strong threat, twisted into a coil, or a piece of narrow tape. It should be put once around only, and then firmly tied. Between the two ligatures it should be cut. The child should be washed as soon as possible, and in the meantime wrapped in flannel.
Washing.- As soon as possible after it is born the child should be washed in warm water. It is covered with a sebaceous substance which is difficult to remove. This must be rubbed with a little lard, which will soften it and make it easy to wash off with soap and flannel. The child should be washed once a day in water not too warm; by degrees it may be accustomed to cool or cold water. After washing it should be wiped dry with a soft towel.
The Eyes.- The following directions are taken from the author’s Prescriber:- Immediately after birth the nurse must wash the infant’s eyes with greatest possible care, removing all traces of mucus. For this purpose a fine linen rag, dipped in clean water, may be used. Beginning at the outer corner, the eyelids are gently wiped from side to side, until all traces of mucus are removed, and the eyelids remain perfectly clean. Spongers must never be used. As soon as the child’s eyes are thus washed clean and dried the nurse is to wash her own hands most carefully in water with which carbolic acid, Condy’s fluid, or other disinfectant has been mixed.
If in the first few days after birth signs of inflammation appear-redness, swelling, and sticking together of the lids the greatest care must be taken. If from any reason the doctor cannot be attendance immediately, the nurse must herself cleanse the eyes in the following manner: A perfectly clean and very soft piece of linen is moistened with tepid water; any excess of water is then squeezed out. The muco-purulent discharge between the eyelids if is wiped off very gently-without scrubbing or scratching; special attention being paid to the inner corner of the eyelid, where the mucus particularly accumulates. After repeatedly rinsing the linen in clean water, the upper eyelid is gently raised by means of the thumb placed on the eyelid immediately above the lashes, but without making any undue pressure. The muco-purulent matter which escapes is removed with a rag as often as it appears. In the next place, the lower eyelid is drawn down with the forefinger, and also wiped with great care. If the eyelids stick together, they must be moistened with water until separation takes place without any effort. The water used in cleansing the eyes must be perfectly pure; no milk or soap is to be mixed with it. After each cleansing a drop of the solution of Argent. nit. indicated below is to be introduced into each eye.
Medical Treatment.- Argentum nit. 3, 2h. is to be administered. After well washing, a drop of a solution of Argentum nit. (two grains to the ounce) to be introduced into the eye.
The Navel.- When the child is washed and ready for dressing the navel must be attended to. Take four thicknesses of very fine soft linen, cut a hole in the centre by doubling them into four and snipping off the points.
Nurses insist on charring the edges of the hole thus made, and no objection needed be raised to the practice, though the object of it is not very apparent; place the cord through the hole and turn it up, laying it on one fold of the linen; then turn the sides of the doubled fold thus made over the cord again, so wrapping it up. The child’s clothes will then keep it in place. The navel generally shrivels up and drops off in about a week.
Clothing.- From time immemorial it has been deemed necessary to roll up infants in yards of flannel. Some sturdy hygienic reformers, like Dr. Roth, in England, and Dr. Grosvenor, of Chicago, have raised protests, and with good effect. These gentleman have devised for infants which can be adjusted with one action, and keep the child warm without interfering with the freedom of its movements.
The Passages.- The nurse must observe whether the child passes motion and water without difficulty, as there are sometimes defects in the passages which demand immediate attention. The first motion is peculiar. It consists of a dark green substance, called meconium, which is usually passed a few hours after birth.
Feeding.- The child should be put to the breast very soon after delivery. It is good both for the child and the mother. The child learns to suck, and the secretion of milk is hastened. There is less liability to sore nipples and hardening of the breast. Also it causes the womb to contract more speedily.
It for any reason the mother cannot suckle the child for day or two, it must be nourished with milk, diluted with an equal quantity of water. Nothing else should be given.
If the mother cannot nurse the child at all, some of the preparations of humanised cow’s milk, supplied by the best dairies, are excellent substitutes. The preparations of the Gordon Walker Laboratories are to be recommended.
INFANTS, DISEASES PECULIAR TO.
Breasts, Swelling of:- The breasts of infants are sometimes swollen at birth, or some time after. This is often caused by the folly of ignorant nurses, who think it incumbent on them to “break the nipple strings.”
General Treatment.- Apply a rag saturated with sweet oil. This will generally be sufficient.
Medicines.- (Every few hours.)
– If the child is fretful and irritable.
-If there is much show of redness and swelling.
– If it is due to the squeezing of nurses.
– If there is suppuration or threatening of it.
– This is frequently met with in infants. The commonest causes are errors of diet on the part of the nurse or mother, or injudicious feeding of the infant. Chill is also not infrequently followed by colic. Sometimes it is constitutional, and these cases are generally the most violent.
General Treatment.- Attention must be paid to the diet of the child or the mother. For the proper diet for Infants, see under CHILDREN, Feeding and Management of. The intervals of feeding must also be regular, and not too frequent. It is a very bad habit to feed a child every time it cries. When the child takes the breast or the bottle well, every four hours is often enough. The intervals must be shorter when the stomach can only take a little.
Next in importance to feeding in cases of colic are clothing and warmth. Every care must be taken to avoid chills.
Medicines.- (Every hour or two until relieved; then less often.)
– This is the chief remedy. The indications are swelling of the body, crying, writing and twisting, drawing up the legs towards the abdomen, and coldness of the feet.
-After Chamomilla; brown watery diarrhoea.
-Sickness, diarrhoea; fermenting, putrid stools.
-Distension and hardness of body; attacks more liable to come on in the evening.
Nux. v. 3.
-When there is constipation with the colic.
– Flatulent colic; wind rumbling in the body, which is tender; shivering; paleness of face.
Constipation.- Every child should have a motion at lest once a day. If it has this without pain or difficulty this is quite sufficient, but it delayed longer and if there is pain or difficulty and the motion is hard, remedies should be sought. The condition is sometimes constitutional and sometimes due to errors of diet. Manna should be used for sweetening food instead of sugar.
General Treatment.- If the child is breast-fed, the nurse should try some change of diet-brown bread, figs, green vegetables, Revalenta; or, if hand-fed, the child’s diet should be changed. If one food constipates, another may not. Milk foods only should be given at first Neave’s Food, Proportionalised Milk, Theirhardt’s Infantina, Savory and Moore’s, Allenbury’s. These may be tried in turn. A teaspoonful of cold water may be given two or three times a day. Injections of warm water, or of one-third of a teaspoonful of glycerine, may be given.
Medicines.- (To be given night and morning.)
-In constitutional cases, a good remedy to begin with.,
Nux v. 3.
– Frequent ineffectual urgings, restless sleep, irritability.
-Large motions passed with difficulty.
-Hard, lumpy motions, drowsiness’ often accompanied by retention of urine.
– Obstinate cases; hard, distended abdomen; stools in hard, dark balls.
Antim crud. 3.
-With white coated tongue and disordered stomach.
Convulsions. See SPASMS or CONVULSIONS.
Crying.- Usually when children cry there is a cause for it, but sometimes they cry when no cause can be discovered. Except when it is excessive, crying does not of itself injure a child, and need not be cause for alarm.
General Treatment.- The first thing to be done is to find the cause. The only way infants have of explaining that a pin is sticking into them, or that their dress is not comfortable, is by crying. This should be seen to first of all. Pains of all kinds in infants cause them to cry, and it is only by observation other symptoms that the character or site of the pain can be discovered. If there is a rumbling in the body, passage of flatulence, green motions, or diarrhoea, it may be safely concluded that the pain is in the body. If there is fever, dry skin, that means that there is inflammation somewhere. If there is difficulty of breathing or cough, it is probably the chest; if the child cries when washed or touched in any particular part, as the ear, there is probably some aching or inflammation there.
The treatment of all these affections will be found under their several headings. Never give an opiate or any kind of soothing up to stop a child crying, this not only injures the child but it prevents the possibility of finding out what is the matter with it by obscuring the indications of the disease.
Medicines.- (Every half-hour when the attacks are on. Two or three times a day as preventives.)
– Starting out of sleep and beginning to cry violently.
– Crying, accompanied by uneasiness and heat.
-Fretfulness, wanting to be carried about; when there is reason to suppose the crying is caused by earache.
Diarrhoea.- Three to six motions a day are natural to healthy infants. When there are more, and the character of them is altered, and they becomes watery, green, brown, pasty, offensive, or mixed with blood and mucus, and when the child shows signs of suffering, then the condition is unnatural and requires treatment. Diarrhoea, which is prevalent in summer, is a dangerous disease. It is sometimes called summer diarrhoea. It usually begins with nausea and vomiting. First the food is vomited, then mucus. There may be retching and fruitless efforts to vomit. Diarrhoea comes on after the vomiting, the stools are greenish, thin, watery, or yellowish or slimy and mixed with blood. The food is sometimes passed undigested, and occasionally is very offensive. The child rapidly grows thin; there is great thirst for water which is often vomited; the head is hot, hands and feet cold. Bad air, improper feeding, sudden chills from improper clothing, or sudden changes of weather are the chief causes.
General Treatment.- The child must be kept warm and guarded from chills. If it is on the breast the nurse must be careful in her diet and take nothing of relaxing nature. If it is hand-fed a change in the diet may be tried.
If the discharges are excessive and watery, and the child shows of thirst, water may be given in teaspoonfuls. Sometimes water is the only thing that can be retained on the stomach at first. If the child has been fed on milk a little lime water may be added to it.
Medicines.- (Every hour until better.)
– Diarrhoea attended with fever; after a fright.
– Bilious, watery, pasty, or slimy stools of whitish. green, or yellow colour. Sometimes like beaten-up eggs, and offensive like rotten eggs. With it there is colic, fretfulness, crying, drawing up of the legs, redness of the face or of one cheek, soreness between the legs.
Magn. Carb. 6.
-Profuse, green, watery, frothy stool; with green scum like that of a frog pond; white limps like tallow; colic; sour smell of whole body.
– Watery, painless diarrhoea, with much wind, occurs after each meal; undigested milk in the stools. Stools fetid; much wind in the bowels.
– From overloading the stomach; with nausea and vomiting; paleness of face; frequent crying; bilious, slimy stools, greenish-yellow, blackish, and blood-streaked, putrid.
Remedies especially indicated by summer diarrhoea.
– Child very weak, pale and emaciated; body inflated; limb cold; nausea and vomiting; yellow, watery, or white or brownish; offensive diarrhoea, worse after midnight, towards morning, and after eating and drinking.
Carbo vegetabilis 6.
-Child is cold and blue, stools thin and offensive, vomiting after eating, much first.
-At the commencement. For special indications see above.
-Diarrhoea worse before midnight; colic, straining, perspiration; scanty, greenish, sour, slimy, or bloody stools, with nausea and eructations.
– Thin, light-coloured stools, sour-smelling or like bad eggs; vomiting; sweat on head; body enlarged.
Veratrum a 3.
– Weakness, nausea, vomiting so great as almost to cause fainting great coldness, with cold sweat on the forehead; great exhaustion, vomiting, and diarrhoea; vomiting after swallowing the least liquid; slightest movement excites vomiting; great thirst for cold water; loose, brownish and blackish stools.
– In protracted cases. Stools frequent, greenish, thin and watery, or whitish and slimy.
Discharge from the Ear.- Gathering in the ears frequently occurs in young children. The pains give rise to screaming, rolling, and tossing of the head, sudden starting out of sleep, and fever. When the discharge takes place the gathering has broken and the symptoms cease.
Treatment.- See under EARS.
Excoriation.- Rawness of the skin between the thighs and about the buttocks of infants is a very common affection. It is not a consequence of irritation from the water and motions, but is an independent affection of the skin.
General Treatment.- When the skin is sore it must not be washed with soap, but with plain water merely, and wiped dry with very soft linen, and afterwards dusted with starch powder or the finest fuller’s earth.
Medicines.- (Three times a day.)
-This well cure almost all cases.
-If Chamomilla fails.
Rhus. 3. -If accompanied by red pimples.
-In obstinate cases.
Eyes Sore.- See above, under Management of the Child.
Gum, or Red Gum.- A rash of red pimples chiefly on face, neck, and arms. It is called “gum” because the pimples are tipped with a minute head, looking like a gummy exudation.
General Treatment.- As the disease is often due to improper clothing it will be necessary to see that the child is not too warmly wrapped up. It must be washed regularly.
Medicines.- (Two or three times a day.)
-Will cure most cases.
-If Rhus is not sufficient.
Heat Spots, or Prickly Heat.- An eruption of small vesicles, generally about the size of a pin’s head. They are red and inflamed at the base, and contain watery fluid. After breaking they sometimes form thin scabs. There is usually some fever, and the burning and itching cause much annoyance to the infant. Heat of summer, warm rooms, excess of clothing, are the causes which give rise to it.
General Treatment.- Frequent washing and proper attention to ventilation and dress.
Medicines.-(Every few hours until relief is obtained.)
Aconite 3.-Fever and restlessness.
Chamomilla 6.-Peevishness and fretfulness.
Rhus 3.-If the eruption is extensive.
Sulph. 6.-If the eruption persists. When there is a tendency to the complaint, Sulphur may be given at long intervals to correct this.
Hiccough.-Many infants are a good deal troubled with this. Exposure to cold air will bring it on.
General Treatment.-Wrap the child up warmly and give it the breast or the bottle. If it continues give a teaspoonful of water sweetened with sugar.
Medicines.- If the above measures fail to remove it give a dose of Nux v.3. Repeat if necessary after a few hours.
Jaundice.- New-born children are not infrequently affected with jaundice. It may be brought on by exposure to cold or by the administration of apperients.
Symptoms.- The first symptom noticed is a yellowness of the whites of the eyes and of the urine. Then the whole surface of the body becomes yellow, the stools either confined or too loose, generally light coloured.
General Treatment.- The child must be kept warm and in a well- ventilated room.
Medicines.- (Every few hours.)
-Will often suffice to cure of itself.
-After Chamomilla when the latter fails to complete the cure.
-After the above, if necessary.
Nux v. 3.
– When there is constipation and irritability.
Meconium, Delayed.- Meconium is the name given to the dark green tarry substance of which the first stool of the child is composed. It generally comes away a few hours after birth; the mother’s milk slightly exciting the action of the bowels. Sometimes the evacuation is delayed.
General Treatment.- Retention of the meconium is sometimes due to imperfection in the passage; and the doctor should be asked to ascertain whether this is the case or not. If the passages are right a few teaspoonfuls of warm sugar and water will generally be enough to cause an evacuation. Purgatives must never be given; but if the above measures do not prove sufficient, help will be obtained from the following medicines.
Medicines.–(One or two doses at a few hours’ interval until the effect is produced. This may be given to both mother and child when the child is at the breast.)
Nux v. 3.
–Should be given first.
-After Nux vomica, if necessary.
–If these prove insufficient.
Milk-Crust.–An eruption of numerous small white pustules appearing in clusters on a red ground. They generally appear first on the face, especially cheeks and forehead, whence they sometimes spread over the entire body. In a short time they become darker in colour, burst, and form thin yellow crusts. There is often much redness, swelling, and itching, which renders the child exceedingly restless and fretful, and causes it to rub the affected part constantly, by which the scabs are rubbed off, and the disease is aggravated.
General Treatment.–Only soft water or distilled water should be used to wash the affected parts with. When the crust becomes thick, it should be removed with a linseed poultice. Once a day the part should be washed with a weak infusion of Viola tricolor. (The dried plant may be obtained at the druggist’s, and the infusion or “tea” made of it at home.) The child should be allowed no sweet things, and if it is nursed, the nurse should eat no sweets or pastry; she should also eat little meat, but may have a good supply of fresh vegetables and milk.
Medicines.–(Two or three times a day.)
Viola tricolor 3.
–This is the most generally useful remedy. It should be given internally when the infusion is used locally.
Other remedies may be given intercurrently as indicated.
–Redness and inflammation no subdued by Viola. t. (Rhus sometimes causes aggravation of the symptoms. When this occurs, the medicine must be left off, and, as a rule, improvement will quickly follow. No more medicine must then be given until the improvement ceases, when Rhus may be repeated until improvement again sets in.)
–After Rhus, when the latter ceases to benefit.
–When there are excessive discharges, or when ulcers form.
–Disease extending to nose, face, and neck, or when the eyes and eyelids are inflamed.
Calcarea c. 6.
–In fat, lymphatic, fair children, when the disease is protracted.
–When there is constipation.
Restlessness and Wakefulness.–The causes of restlessness in infants are: improper feeding–giving either improper food or too much or too little; improper feeding on the part of the mother–indulgence in coffee, wine, rich or spiced food; improper dressing of the child, and especially if pins are used; want of cleanliness. It may also be due to inflammation, as of the ear, or to the sufferings of teething. Care must be taken to discover if there is any disease present which will require special treatment.
General Treatment.–The causes named above must be carefully guarded against. The child must be fed at regular times, and carefully washed and dressed. It must not have its head raised, but lie with it low. Medicines.–(Every four hours; shortly before the hours of rest are the best times.)
Aconite 3.–Restlessness, with hot, dry skin.
Coffea 3.–After Aconite.
Opium 3.–When there is redness of the face.
Chamomilla 6.–Flatulence, gripings; starting, and jerkings of the limbs; feverishness, with redness of one cheek.
Belladonna 3.–Child appears drowsy, but cannot sleep, or falls asleep for a few moments and starts up suddenly and cries.
Pulsatilla 3.–From overloading the stomach.
Nux v. 3.–From indulgence in coffee or spirituous liquors on the part of the mother.
Rupture.–Protrusion of a part of the bowel through the inner abdominal wall, causing a projection under the skin. This is found in two places–the groin and at the navel. Both are common in infants. The causes are, unnatural weakness of the walls of the body, improper care of the navel, and improper dressing, especially by tight swaddling bands.
Navel Rupture (Umbilical Hernia).–This is recognised by an unnatural protrusion of the navel.
Diagnosis.–In infant boys there are two conditions which are apt to be mistaken for rupture of the groin –Hydrocele of the spermatic cord and undescended testicle. The last is excluded if the testicle is found in its place in the scrotum. Hydrocele, a localised dropsical swelling in the cord, may form a protrusion in the groin just where rupture occurs; but this always remains in the same place and does not disappear altogether as protrusion of the bowel does when it is put back in its place.
General Treatment.–Navel Rupture.–The skin must be drawn up over the swelling from both sides, and two rather broad strips of strapping drawn over the part cross-wise (the strips crossing each other over the swelling) so as to hold the skin in that position.
This will prevent any protrusion, and, the strain being removed, the opening will contract.
Groin Rupture (Inguinal Hernia.)–The treatment for this is support by means of a truss. If the rupture is only small and the child can be kept from crying or straining, it may be remedied without having recourse to a truss. Homoeopathic remedies can do much to assist the cure.
Nux v. 3.–Night and morning.
Lycopodium 6.–Especially if on right side.
Aurum 6.–Navel rupture.
Scurf on Head.–Some children have a dirty-looking crust formed on the head, usually beginning at the top. Under the crust the surface is red and inflamed. It may be due to want of cleanliness or to keeping the child too warm. It is however, frequently seen in children who are carefully and regularly washed.
General Treatment.–Rub the part affected with lard at night and wash in the morning with a weak solution of soda.
–Night and morning.
Snuffles.–This is a common affection in children. It is a kind of catarrh or “cold” in the head, but it is not always due to catching cold. It gives great annoyance to the child, and prevents sucking.
Medicines.–(Night and morning.)
Nux. v. 3.
–With much running of water from the nose.
Carbo vegetabilis 6
Mercurius sol. 6.
–Sneezing and thickish discharge.
Antim tart. 3.
–When there is rattling in the throat, worse at night, as well as running from the nose.
Spasms or Convulsions.–Infants and children are much more liable to convulsions than persons in adult life. These are, therefore, of less significance in early life than when they occur later. But at any time they are a serious occurrence, and, whenever possible, medical aid should be sought without delay. They may occur in all degrees, from spasmodic twitching of the muscles of the eyes and face, or of the fingers and toes, and the thumb being pressed into the palm, or they may be general, the whole body being thrown into spasms. The commonest causes are disorders of the stomach and bowels, and the irritation of dentition.
General Treatment.–If no doctor is at hand, put the child’s legs into water as hot as can be borne, and let them remain for five or ten minutes until the fit seems to be going off; then let them be wiped perfectly dry and wrapped in a warm wrapper. If the first immersion is followed by no relief, or a second attack speedily follows, it should be repeated, and cold water applied to the child’s head at the same time. This may be repeated several times.
If the cause is known and removable, measures must be taken to remove it. If it is due to eating indigestible food, such as unripe fruit, an emetic or an enema of warm water must be given.