The Maternal Management Of Children, In Health And Disease Part 10

Sect. I.--ON TEETHING.

THE MANNER IN WHICH THE TEMPORARY OR MILK-TEETH APPEAR.--The first set of teeth, or milk-teeth as they are called, are twenty in number; they usually appear in pairs, and those of the lower jaw generally precede the corresponding ones of the upper. The first of the milk-teeth is generally cut about the sixth or seventh month, and the last of the set at various periods from the twentieth to the thirtieth months. Thus the whole period occupied by the first dent.i.tion may be estimated at from a year and a half to two years. The process varies, however, in different individuals, both as to its whole duration, and as to the periods and order in which the teeth make their appearance. It is unnecessary, however, to add more upon this point.

Their developement is a natural process. It is too frequently, however, rendered a painful and difficult one, by errors in the management of the regimen and health of the infant, previously to the coming of the teeth, and during the process itself.

Thus, chiefly in consequence of injudicious management, it is made the most critical period of childhood. Not that I believe the extent of mortality fairly traceable to it, is by any means so great as has been stated; for it is rated as high as one sixth of all the children who undergo it. Still, no one doubts that first dent.i.tion is frequently a period of great danger to the infant. It therefore becomes a very important question to an anxious and affectionate mother, how the dangers and difficulties of teething can in any degree be diminished, or, if possible, altogether prevented. A few hints upon this subject, then, may be useful. I shall consider, first, the management of the infant, when teething is accomplished without difficulty;--and, secondly, the management of the infant when it is attended with difficulty.

MANAGEMENT OF THE INFANT WHEN TEETHING IS WITHOUT DIFFICULTY.

In the child of a healthy const.i.tution, which has been properly, that is, naturally, fed, upon the milk of its mother alone, the symptoms attending teething will be of the mildest kind, and the management of the infant most simple and easy.

SYMPTOMS.--The symptoms of natural dent.i.tion (which this may be fairly called) are, an increased flow of saliva, with swelling and heat of the gums, and occasionally flushing of the cheeks. The child frequently thrusts its fingers, or any thing within its grasp, into its mouth. Its thirst is increased, and it takes the breast more frequently, though, from the tender state of the gums, for shorter periods than usual. It is fretful and restless; and sudden fits of crying and occasional starting from sleep, with a slight tendency to vomiting, and even looseness of the bowels, are not uncommon. Many of these symptoms often precede the appearance of the tooth by several weeks, and indicate that what is called "breeding the teeth" is going on. In such cases, the symptoms disappear in a few days, to recur again when the tooth approaches the surface of the gum.

TREATMENT.--The management of the infant in this case is very simple, and seldom calls for the interference of the medical attendant. The child ought to be much in the open air, and well exercised: the bowels should be kept freely open with castor oil; and be always gently relaxed at this time. Cold sponging employed daily, and the surface of the body rubbed dry with as rough a flannel as the delicate skin of the child will bear; friction being very useful. The breast should be given often, but not for long at a time; the thirst will thus be allayed, the gums kept moist and relaxed, and their irritation soothed, without the stomach being overloaded. The mother must also carefully attend, at this time, to her own health and diet, and avoid all stimulant food or drinks.

From the moment dent.i.tion begins, pressure on the gums will be found to be agreeable to the child, by numbing the sensibility and dulling the pain. For this purpose coral is usually employed, or a piece of orris-root, or sc.r.a.ped liquorice root; a flat ivory ring, however, is far safer and better, for there is no danger of its being thrust into the eyes or nose. Gentle friction of the gums, also, by the finger of the nurse, is pleasing to the infant; and, as it seems to have some effect in allaying irritation, may be frequently resorted to. In France, and in this country also, it is very much the practice to dip the liquorice-root, and other substances, into honey, or powdered sugar-candy; and in Germany, a small bag, containing a mixture of sugar and spices, is given to the infant to suck, whenever it is fretful and uneasy during teething. The constant use, however, of sweet and stimulating ingredients must do injury to the stomach, and renders their employment very objectionable.

THE MANAGEMENT OF THE INFANT IN DIFFICULT TEETHING.

In the child which has been partly or altogether brought up by hand, or who is of a feeble and delicate const.i.tution, or imbued with any hereditary taint, the process of dent.i.tion will be attended with more or less difficulty, and not unfrequendy with danger.

SYMPTOMS.--The symptoms of difficult dent.i.tion are of a much more aggravated description than those which attend the former case; and it is right that a mother should, to a certain extent, be acquainted with their character, that she may early request that medical aid, which, if judiciously applied, will mitigate, and generally quickly remove them.

Difficult dent.i.tion will be attended with painful inflammation and swelling of the gum, which is hotter, of a deeper red, than natural, and intolerant of the slightest pressure. There is often great determination of blood to the head, which a mother may recognise by the cheeks being red, hot, and swollen; the eyes red, irritable, and watery; and the saliva running from the mouth profusely. The fever is great, and the thirst extreme. The child is at one time restless and irritable, and at another heavy and oppressed: the sleep will be broken, and the infant frequently awake suddenly and in alarm from its short slumbers. Such are the chief symptoms of difficult teething, and which will be present to a greater or less degree.

TREATMENT.--As most of the above symptoms are induced by the painful tension of the gum, it would seem that the most rational mode of attempting their relief is by freely lancing the swollen part. Great prejudices, however, still exist in the minds of some parents against this operation. They think it gives great pain, and, if the tooth is not very near, makes its coming through the gum subsequently the more difficult.

With regard to the first objection, the lancet is carried through the gum so quickly, that this is hardly possible; and the fact that the infant will often smile in your face after it is done, although previously crying from pain, is sufficient evidence that it is not a very painful operation. In reference to the second, that the scar which ensues, opposes, by its hardness, the subsequent progress of the tooth, it is quite groundless; for cicatrices, like all other new-formed parts, are much more easily absorbed than the original structure.

Of the practical utility and perfect safety of this operation we have ample proof in its daily performance with impunity, and in the instant relief which it often affords to all the symptoms.

Mere scarifying the gums is sometimes all that is required, and will afford great relief. This operation, therefore, should not be opposed by the mother. She, at the same time, should be acquainted with its precise object, lest the speedy return of the symptoms, and the non- appearance of the expected tooth, might tend to bring the operation of lancing the gums into disrepute.

The parental management of the infant, then, and by which much of the pain and difficulty of teething may be removed or alleviated, consists in attending to the following directions:--

FIRST, TO THE STATE OF THE MOUTH.--To this it is an important part of the mother's duty to pay especial attention; and, by so doing, she will save her child much suffering. The condition of the mouth should be carefully inspected from time to time; and should a swollen gum be discovered, it should immediately be attended to, not waiting till const.i.tutional symptoms appear before she employs proper aid for her child. For this purpose the mother should make herself familiar with the appearances of the gum under distention and inflammation; a matter of no difficulty, accompanied, as this condition usually is, by a profuse secretion of saliva, heat of mouth, and at a time when the age of the child justifies the supposition that it is about to cut its first tooth, or, if it have some teeth, that others are about to appear.

SECONDLY, TO THE FOOD.--If a child is teething with difficulty, it should always have its quant.i.ty of nourishment diminished. If it is being fed, as well as nursed at the breast, at the time, the former should be immediately withheld: if it is being fed alone, the only kind of food that should be allowed is milk and water. These cases are much aggravated by the not uncommon habit of parents giving the infant food whenever it cries from the irritation attending upon the process; and thus a slightly difficult dent.i.tion is converted into serious disease.

THIRDLY, TO THE STATE OF THE BOWELS.--These must be carefully watched, that they may not become confined; it being necessary that they should be gently relaxed at this time. If a slight diarrhoea is present, it must not be checked; if it pa.s.s beyond this, however, medicine must be had recourse to, and great benefit will also arise from putting the child into a warm hip-bath, and warmly clothing the body, but keeping the head cool.

FOURTHLY, TO THE HEAD.--The infant's head should be washed with cold water night and morning, and no other covering than that which nature has provided should be put upon it when within doors or asleep; and on no occasion should warm felt or velvet hats be worn during mild or warm weather, straw or white hats being much lighter and cooler. The child should be much in the open air.

The sponging of the infant's body daily, either with cold or tepid water, must depend upon the season of the year and const.i.tution of the child, as well as upon other circ.u.mstances. Sponging the head with cold water night and morning is almost invariably atttended with great benefit, and may be resorted to in every case without fear; and now and then the use of the warm hip-bath, for several days together, will be ordered by the physician, which, by acting upon the skin, diminishes the determination of blood to the head, and thus forms an important source of relief.

FIFTHLY, OF CONVULSIONS.--If they should occur, and they are not unfrequently excited by difficult teething, and then give great alarm to the parent, relief will be afforded by immersing the hips, legs, and feet of the infant in water as warm as can be borne, and at the same time applying over the head and temples a piece of flannel wet with cold water. I have also often cut the fit short by sprinkling cold water in the child's face while in the bath. The gums should always be looked to, and if they appear swollen, and painful, at once lanced. I have known the most formidable convulsions to cease immediately after this operation.

SIXTHLY, OF THE USE OF OPIATES.--It is the practice with some nurses to administer narcotics to quiet infants while teething. It is not only objectionable, but, from the uncertain effects of sedatives upon infants, a very dangerous practice, and they ought never to be given, except at the suggestion of a medical man. It is far better, if the child is restless at night, to have it frequently taken out of its cot, and carried about in an airy room; for the cool air, and change of posture, will do much to allay the feverishness and restlessness of the child.

From these few hints, it must have been seen how much the sufferings from teething may be mitigated by judicious management. That, if the parent is able to support her infant upon the breast alone, teething will be found comparatively an easy process, and unattended with danger; the mother thus reaping a delightful reward for all the anxieties and privations nursing necessarily involves. That the child brought up partially, or entirely, by hand will always pa.s.s through dent.i.tion with more or less of pain and difficulty; but that even here, if the diet has been properly regulated, much less suffering and inconvenience will arise than when less attention has been paid to it.

And, lastly, that, when teething is difficult, how highly important it is to call in proper aid at an early period, and to carry out fully the directions of the medical attendant, allowing no foolish prejudices to interfere with his prescriptions and management.

If I stood in need of any argument to impress upon the mind of a parent the importance of attending to the last injunction, I would simply state, that its neglect is but too frequently the cause of disease of the brain, terminating in death, or a state of idiotcy far worse than death, of which I know more than one living instance.

It may be as well to add, that eruptions about the ears, head, face, and various parts of the body, very frequently appear during the process of the first teething.[FN#23] If they are slight, they should be left alone, being rather useful than otherwise; if they are troublesome, they must receive that kind of attention from the parent which will be pointed out under the chapter on diseases. The same remark applies to enlargements of the glands of the neck, which frequently appear at this time.

[FN#23] In some infants a rash always precedes the cutting a tooth.

Sometimes it appears in the form of hard elevated pimples as large as peas; in other instances in the form of red patches, of the size of a shilling, upon the arms, shoulders, and back of the neck. They are always harmless, require no particular attention, and prevent, I doubt not, more serious complaints.

SECT. II. HINTS UPON THE PERMANENT OR ADULT TEETH.

Parents are not sufficiently alive to the importance of attending to the condition of the mouth of their children at the period of changing the first for the second set of teeth; they do not seem to be aware how much the comfort, appearance, and future health of the child depends upon it. Nor do they subsequently impress upon the minds of their children how necessary, on their part, is the observance of certain rules for the preservation of the teeth, and how distressing are the effects which result from their neglect. It is proposed, here, to say a few words for the information and guidance of the parent upon this subject.

THE MANNER IN WHICH THEY APPEAR.

The change of the temporary for the permanent or adult teeth commences, in the majority of instances, at about seven years of age; occasionally it occurs as early as five, and as late as eight years and a half. The necessity which exists for this change, and the mode by which it is effected, are striking and beautiful; it is, however, not our object to enter fully upon its consideration here.

It has already been observed, that the infant is born with the rudiments of two sets of teeth in the jaw, although neither make their appearance till long after birth. The time when, and the manner in which the first set appear has been pointed out. Now although these admirably answer the purposes for which they were given up to the seventh year, after this period they fail to do so: they are not sufficiently numerous,--in their structure they are not strong or durable,--nor is their power of mastication sufficiently great.