The Care and Feeding of Children Part 24

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 b.l.o.o.d.y, 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 appet.i.te 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 ma.s.sage.

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 gla.s.s 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 sc.r.a.ped 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.

Ma.s.sage 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.