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.
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.
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.
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.
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.
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.
Weight chart for the first year; the curved line indicates the average rate of gain.
Weight chart, one to fourteen years. The upper line indicates the average for boys; the lower (dotted) line that for girls.
Footnotes:
[1] Weights for the first four years are without clothes.
The weight of girls is on the average about one pound less than boys. They are about the same in height.
Charts showing weight curve for the first year, and from one year to fourteen years are given at the end of this book.
[2] Obtained from any of the Walker-Gordon milk laboratories, from James Dougherty, No. 411 West 59th Street, New York, and from many druggists. Price, 20 cents.
[3] The directions and formulas given in the following pages are intended only for guidance in feeding children who are not suffering from any special disturbance of digestion; directions for such conditions are given in a later chapter.
[4] If the milk sugar be measured in the milk-dipper, two scant dipperfuls may be calculated as one ounce. If measured in a tablespoon, three even tablespoonfuls may be calculated as one ounce.
[5] This can be obtained at 411 West Fifty-ninth Street, New York, with bottles and full directions; a tin one, at a cost of $3.50, and a copper one, which is much more durable, for $7.00.
[6] Obtained at the same prices from any of the Walker-Gordon milk laboratories.