Chapter 12 - Care of Children and Diseases
Care of Children and Diseases
How to Nurse Sick Children
Inflammation of the Mouth
Inflammation of the Gums
Canker of the Mouth
Difficult Teeth Cutting
Croup
Spasm of the Glottis
Whooping Cough
Diarrhoea
Summer Complaint
Colic
Falling of the Bowel
Gastric Fevor
Rickets
Mesenteric Disease
Blue Disease
Fits

12.1 Care of Children and Diseases

WHEN children reach the age of six years it is most important that they be be examined yearly by a competant physician for the following complaints, as many children suffer in silence and become backward in their growth both physically and mentally when by a litle percaution on the the part of their parents such cases could be avoided.

Pure Air. The first want of a child is a plenty of fresh air; and this want never ceases to the end of life. Impure air kills thousands of infants. Out of 7,650 born in the lying in hospital of Dublin, 2,944 were destroyed by impure air within two weeks after birth.
Children should be kept in the open air as much as possible, and in well ventilated rooms when indoors. It is wrong, when infants are sleeping, to cover their faces with bed clothes, or draw curtains around their cots, or to envelop their heads in blankets and shawls when carried in the open air.

The Skin. The health of infants requires that their skin should be kept clean. Unless this is done they are liable to suffer much from cutaneous and other diseases. The skin of a new born child is covered with a white, unctuous matter, called the vernix caseosa. It is injurious to let this remain for any length of time after birth. To remove this, Dr. Dewees recommends that the child be smeared with hog's lard or sweet oil, and then washed with soap and water. Dr. Eberle says, smear with yolk of egg, and then wash with simple warm water.
The young child should be washed every day with warm water, then., after a time, with tepid water, then with temperate, and finally, after it is some months old, with cold water. This, if persevered in through childhood and youth, will ward off a thousand ills and sicknesses to which the young are liable.
The Clothing of Children should be so adjusted as to give their limbs ample play, and should be thick enough to keep them warm. They ought to have flannel next the skin in winter, and cotton in summer. At the risk of wounding some nice people's feelings, I must add that the fashion of a child's clothes is not important.

The Food. The natural and proper food of a young child is its mother's milk. To this it should be confined, unless prohibited by imperative circumstances, until a portion of the teeth are cut. When the mother cannot nurse her child, the breast of a suitable nurse should, if possible, be supplied. If the infant need any more food than is supplied by the breast, give cow's milk and water, sweetened with a little loaf sugar. The nursing bottle, if used must never be permitted to get sour.

Health of a Nursing Woman. During nursing the greatest attention to health is required by the mother or the nurse. A woman of a consumptive constitution should never nurse an infant. Nourished at the breast of such a mother, the child, who has inherited her constitution, will be the more likely to fall a victim to her disease.

Passion of a Nursing Woman. Let the woman who nurses a young child be careful of her passions. An irritable disposition, giving rise to gusts of violent passion, may so alter the character of the milk as to throw the child into convulsions. Grief, envy, hatred, fear, jealousy, and peevishness, unfit the milk for nourishing the child, and often cause the child's stomach to be much disordered.

The Diet of the Nurse should receive strict attention. It should be plain and wholesome, and the amount should never be excessive. Her drink should be simply water and non stimulating and nourishing drinks such as the various preparations of cocoa, etc. She should take gentle daily exercise in the open air.

Wet Nurses. If for any reason it should be necessary to wean the baby, or the mother cannot nurse the child, then we must select a food the most like that of the mother.
Wet nurses formerly were quite popular among the well to do to supply this food; but as in her selection there are so many exacting requirements, she is fast becoming obsolete. There are three requisites for a good wet nurse: she must be of good health, of good moral character, and be able to supply plenty of good healthy milk.
If she has any tubercular, scrofulous, syphilitic, insane or osseous history; if she is menstruating, or pregnant, or is in anywise below par in health, she is necessarily disqualified as a nurse for any child; only your physician may be able to detect these evidences and perhaps not even he. If, on the other hand, she is occasionally given to blues, has a violent temper, is jealous, or fretful, or worries about her own child, or goes into' dangerous company when away from the house, then you have added a second disqualification. Again, her supply of milk must be good as shown by an analysis and the health and growth of her own child. A nurse may pass muster to day in reference to this third requisite, but perhaps not in a week from today.
Seeing that the average wet nurse comes from a lower stratum of society, even if not from the criminal class, that she is in consequence more liable to acquired disease and contagion, that she is more than likely to bring trouble into the household rather than to relieve the household of it, it will be extremely difficult for you to find such a person as can furnish all the required conditions of a safe wet nurse. It has been found, therefore, that artificial feeding gives better satisfaction and is quite as safe.

Nursing Bottles. There are nursing bottles innumerable, few of which are of practical value. A simple bottle with plain black nipple is all that is requisite for successful feeding at the hands of a careful and cleanly mother or nurse. There should be several bottles and several nipples, the latter to be kept in soda water or other Simple alkaline solution when not in use. A pinch of soda to a cup of water is of sufficient strength. After a bottle has been used it should be thoroughly scalded with hot water and soda and finally set away filled to the brim with this same solution, till later in the day. Meanwhile, a fresh bottle and a fresh nipple is used, they having first been cleansed with the above solution. The best bottle, however, for nursing in those cases, where for want of time and means the bottle cannot be held by mother or nurse; is one called 11 The Best." See Figs. 147 and 148, This bottle, like many others, allows of its resting on the bed, but, unlike many others, it is very readily cleansed, is of easy suction and has a nipple which does not collapse. The accompanying cuts and description are worthy of attention. The peculiar feature of the bottle is a valve or air inlet in the end admitting air back of the food, thus rendering suction easy. This valve does not leak and cannot be pulled off by the baby, but is easily cleansed and adjusted. Whatever else you may do with the bottle, above all things keep it clean, not only to outward appearances, but by actually scalding and soaking in soda solution up to the very time of its use.

Food for Infants. It has been found that mother's milk, which of course is the best food for babies, is composed on the average of the following ingredients: water 87, fat, 4, casein 1, sugar 7, ash 1, and slightly alkaline in reaction. Now, ordinary cow's milk has the following composition: water 87, fat 3.7, casein 2.9, sugar 4.9, ash .4; it is slightly acid.
We can therefore see that if we take cow's milk and dilute it with water sufficiently, we diminish the amount of casein to that of mother's milk, and by the addition of cream, milk, sugar and limewater, we raise these constituents to the standard found in human milk. This mixture, known among medical men as the "Meigs Cream Mixture," is the basis of all modern compounds for artificial feeding. INSERTIMAGE3
Milk, as ordinarily received from the milkman, swarms with bacteria and germ life which, under favorable conditions, quickly changes the milk and renders it unfit for easy and proper digestion. Milk from the mother is devoid of these germs, or, as medical men say, it is sterile. This attribute then is in reality quite as important as the proper constituency of milk. The process of making cow's milk sterile is called sterilization, of which we will speak shortly.

Temperature of Milk. Mother's milk is of the same heat as the body, or nearly so; hence common sense dictates that the artificial food must be of that degree of heat, or, about 98' Fahrenheit.

Quantity and Interval of Feedings. The capacity of a baby's stomach and the length of time food remains in it are matters of experience. Herewith is appended a table covering the general rules of feeding infants and especially adapted to milk and cream mixture of which we will now speak.

GENERAL RULES FOR FEEDING.
AGE. Interval.Hours.Feedings in24 ours. Amount at each Feeding. Amount in
24 Hours. Ounces. Ounces.
Ist week . . . . . . . 2 10 1 10
Ist to 6th week . . . . 21 8 11 to 2 12 to 16
6th week to Oth month . . 3 6 3 to 4 18 to 21
At 6 months . . . . . . 3 6 6 36
At 10 months . . . . . 3 5 8 40 -Dr. F. M. Rotch, Keating's Cyc. Dis. Children.

Based on the average analysis of mother's milk, i. e., 7 parts sugar, 4 of fat, and 1 of albuminoids, we must take : cream 11 ounces, milk 1 ounce, water 5 ounces, lime water 1 ounce, sugar of milk 'a to 3 drachms. 2

The milk sugar is to be obtained at the druggist's. This gives an eight ounce mixture, so that for a baby four weeks old (see table) we need to take about one half or three fourths more of this mixture; for a baby six months three times this amount, and so on. For a child newly born, after the first few days, when only a little should be given, only slightly more of these ingredients should be used than in above formula.
The prescriptions which could be used for the first week of nursing would be much changed at the time of weaning, so that one formula is too arbitrary to be of general use. Therefore while the one given is useful at a certain period, it is best to have several formula~ to work upon in order that should one prove too strong or too weak another one may be tried. Therefore, after the first week if the child is not thriving on the mother's breast and it is necessary to feed it artificially we may take a mixture of 5 ounces of cream, 1 ounce of lime water, 14 ounces of plain water sterilized to which we add 8 teaspoonfuls of sugar of milk. About three or four tablespoonfuls should be fed every two hours. For a child two to six months old, we take 16 ounces of cream, 5 ounces of milk, 2 ounces of lime water and 18 ounces of sterilized water to which we add a teaspoonful of sugar of milk. For a child ten months old we take 16 ounces of cream, 15 ounces of milk, 2 ounces of lime water, seven ounces of ordinary water and a teaspoonful of milk sugar. The amount given at each feeding should be according to the table given. It will be noticed that the proportions of milk to water increase in favor of the milk as the age of the child increases, so that by weaning time the child is much better able to digest undiluted milk. Any formula may be modified in any of the proportions given to meet an individual case. The cream that is spoken of, means the top of a can of milk that has stood six or eight hours. It may be scooped off with a cup or removed by siphonage, the addition of lime water is always necessary as cow's milk is usually acid and the child's stomach is constructed to digest an alkaline food.
When the back teeth, or molars, have come through, then, for the first time, bread, rice, and soft boiled egg may be added.
Oatmeal jelly may be prepared by boiling a quarter of a pound of oatmeal, in a quart of water, down to one pint. This mixture is then to be diluted with an equal quantity of boiled water and strained through a cloth. Should the oatmeal prove too laxative for the child, barley jelly may be made in the same way.

Sterilization of Milk. We have seen how much more important than the kind of nursing bottle that may be selected is the kind and quality of food put into that bottle. To complete our consideration of the best artificial food, we must know how to render the milk free from bacterial life; this process is called sterilization, and may be accomplished in a simple way as follows: into as many bottles, which have been previously scalded and cleansed, as there are to be feedings in the twenty four hours, pour that quantity of the milk mixture which is to be given at a feeding; place these bottles, with absorbent cotton in the mouths, into a kettle filled with water up to the level of the milk in the bottles, and allow the water to rise to 170' Fahrenheit, when the kettle is removed to a warm part of the stove and covered for about half an hour. The bottles should then be kept in a cold place till used, when they are to be heated just sufficiently to correspond to the body heat. These bottles come ready made, also a rack in which to rest them in the kettle. They should be, inreality, specially made bottles, and axe to be obtained at any drug, store. They are ready for the baby's use after removing the cotton and attaching the nipple. One may, however, sterilize the entire feeding of the twenty four hours, or for twelve hours, as thought best, in any clean, thin bottle or jar, and pour out the given amount required at each feeding; but there is some danger of spoiling the sterilization by so much handling. Should it be desirable to prepare milk to keep for a longer time, it will then be necessary to sterilize at a greater heat (212'), and to repeat the process two or three times. Such milk is supplied nowadays in the larger cities by companies who will express it daily to one's address.
With the appearance of greenish colored, foul smelling stools, we may assume that fermentation processes are taking place and very little can be accomplished in the way of relief until the trouble has been swept away. A sudden change of weather most likely to occur when a warm day suddenly changes to a cold one, milk that has not been properly sterilized or has been opened in places where it could absorb odors, in an ice chest or near vegetables, or again where it comes from cows more or less unhealthy, or kept in bad surroundings may cause this trouble even without the child having other sickness. Small doses of calomel best given in 1 10 grain doses every half hour until the bowels have moved two or three times or until 12 to 20 doses have been given. Following the movement of the bowels when the calomel is to be stopped we give some simple astringent like bismuth sub nitrate in 5 grain doses every two hours to coat the bowels and soothe Mammation.

Weaning. At the end of twelve months, the first set of teeth are generally so far cut that the child can manage most kinds of plain food; and it may now be taken from the breast. Should the teeth appear earlier, and the infant be healthy, it may be weaned even at the end of the tenth month. Never take the child from the breast in the mi& t of summer heat. A disordered state of the bowels, or cholera infantum, would be likely to be the result. The spring and the autumn are the proper periods for weaning.
If for some months it has been accustomed to other food besides the milk of the mother, it may be taken suddenly from the breast. It must not have any amount of solid food it may crave immediately after weaning. It should still be kept, for some time, upon a simple, bland, half fluid aliment, taken in moderate quantities, and at proper intervals. At first, the food should be bread and milk, boiled rice and milk, soft boiled eggs, oatmeal gruel, plain rice pudding, preparations of arrowroot, tapioca and sago, simple meat broths, mixed with crumbs of bread or grated crackers, or in which rice or barley has been well boiled. From this it may pass gradually to a more solid diet; though, until the age of puberty, the principal part of the diet should be milk, the farinaceous axticles, and vegetables. Sugar has beeu thought to be injurious to children. It is not so. If taken moderately, at meal times, it is wholesome. Lately a new form of chocolate has come into use, called Kraft chocolate, made in Germany. It ~is prepared with cocoa butter and comes in small cakes, is easily digested, nourishing, and supplies sweets in a very acceptable and strengthening form.
Whatever be the food allowed to children, it should never be taken in excess; and to prevent this, they ought not to take their meals alone; for they have very keen appetites, and if permitted to do so, they will generally form habits of gluttony. Three or four light meals a day is enough.
Their drink should be water simply, nothing else.
If parents would observe these rules, and enforce them strictly, they would confer blessings upon their children greater than riches. They would send them into the world with health and good constitutions, and would save them from untold misery and an early death. Such a course would evince more love for their children than those weak concessions which allow tea and coffee, and all sorts of food, in quantities to suit, which occasion early disorders of the stomach and bowels, and bring later derangements of the nervous system, with all its regrets and horrors.

Sleep of Children. During the first period of its existence, an infant sleeps a large portion of the time. This is a wise provision of nature. It withdraws the young child, for a time, from those outward exciting agents, which would too much disturb the nervous system of so tender a being. Whenever a young infant is restless or wakeful much of the time, we may feel sure it has had too much food, or is in some way disturbed by it, or by tight clothes, or that some other cause is giving it uneasy sensations. Do not make the mistake of thinking the child is hungry because it cries.
Its sleep should be the promptings of nature, and should never, except in rare instances, be brought about by opiates. It is wrong and sinful for a mother or nurse to put an infant to sleep with an opiate, merely that she may gain time for pleasure, or even for other duties.

The Infant should be kept Warm while Sleeping. During the first few weeks it should sleep with its mother, especially if the weather be cold. After that, it may be in a cradle or cot. The covering should be warm, but light, so as not to press heavily upon its tender limbs. If laid upon its back, the fluid of it's mouth and throat may get into the windpipe, and obstruct the breathing, or produce coughing. It is better, therefore, to lay the infant upon its side, taking care not to produce distortion of the spine or limbs by always laying it upon the same side.
Children should not be allowed to sleep either with the aged or with sick persons. It is not healthful for them to breathe the exhalations from the bodies of such. For a somewhat similar reason, some kinds of plants, and flowers generally, should be excluded from their sleeping rooms. Their beds should be so placed as to turn their faces away both from the sunlight which comes in at the windows, and from the artificial light in the room.
They should be taught to retire early at night, and to rise immediately after waking in the morning. This habit will be worth much to them through life. Do not form the habit of rocking the child to sleep. After the meconeum has passed, the bowels of an infant should be opened from two to four times in twenty four hours. If the stools are less frequent than twice a day, or, if they are lumpy, some gentle cathartic is called for. From one quarter to one half teaspoonful of castoria, or a dessert spoonful of mixture (24), answers a good purpose. During childhood, the bowels should be moved once or twice a day. When a cathartic is required, a tablespoonful of mixture (25), or a teaspoonful of (17), will be found excellent.

Exercise. During the first few weeks of an infant's life it requires but little exercise; indeed its organization is not sufficiently settled and compacted to permit much without injury. A little gentle rubbing with the hand over the whole body is about all it needs or will bear. To dandle and toss it about, and especially to set it upright, is injurious and wrong. Its bones are all soft, and will not endure to be much twisted about, and its spine is not stiff enough to bear up the weight of its head.

After a few months, riding in a carriage, by a careful and trusty nurse, is both a healthful and pleasurable exercise for children.

Learning to Walk. At the end of the ninth or tenth month, a child may begin to learn to walk. It is not safe to teach it this exercise much earlier than this, as the bones, being soft, may be bent by the weight of the body, and the limbs be permanently deformed.
As soon as the child has learned to walk alone, it should be allowed perfect freedom of exercise. Thenceforward, the open air is its proper place during the day; and such an unrestrained use of its limbs as its own instincts may dictate, is its proper calling. For five years after it has learned to walk, it should do little else than to use its limbs out of doors, as it pleases. The books and the school room will be in season after that. First compact the body, then bring out the mind. The mind is of no use without the body, the body must be developed first, or never.

Moral Treatment. We charge upon nature many of the bad passions which we ourselves implant in children. The moral treatment of children is generally bad. We are apt to begin by either making them our masters or our slaves. Sometimes we do both, allowing them to govern us for a time, and then, getting into a passion, or a mood for playing the tyrant, we turn upon, and govern them as ff we were autocrats. We submit to their whims until we grow irritable, and then, by way of retaliation, we compel them to submit to ours.

This is all wrong. Children should be governed always, but with an even, a gentle, and a loving hand. They should early be subjected to habits of self control, and of regularity in eating and sleeping; and should be taught absolute and continued obedience. All this can be brought about only by firmness, self control, and great gentleness on the part of the parents. If they would make a child cheerful and happy in its disposition, they must themselves be cheerful, and never let it see anger, passion, and fretfulness, marring their conduct. Nothing is more injurious '. o the health of a child than a peevish, complaining, and soured disposition; and these vices are seldom acquired, unless seen in the lives of parents.

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