Anyone in charge of an ailing child must, above all things, win the patient's confidence. A quiet manner is especially necessary in dealing with children, whose nervous systems are easily jarred, and whose progress towards health is very much affected by environment.
A gentle and soothing voice has a great effect upon a child, and it is always better not to worry a small patient too much with useless questions and unnecessary calls upon its attention. Anyone who has much to do with children knows how fretful they become when ill, how they cannot bear questioning, and how much tact is required in managing them.
In dealing with young infants it is most important for the mother to know what to do in the simple diseases of childhood until the doctor comes. Most mothers think that when a child shows symptoms of illness he should be given a sharp dose of castor oil, put to bed, and left till Nature helps him to recover. One of the first rules in nursing babies who are sick is that a purgative should never be given if there are any symptoms of fever. Suppose, for example, the case turns out to be typhoid fever, a purgative is extremely dangerous. In the same way, if it is obstruction of the bowels, or appendicitis, a purgative will do incalculable harm. " A dose of castor oil " has killed many children in the past.
Another rule to be observed in nursing sick children is to guard against chill and collapse by keeping the child warm. The room should be kept warm and well ventilated. Hot-water bottles and hot flannels will counteract any chilliness of the legs and feet.
Thirdly, hot poultices are the safest domestic remedies for pain.
Drugging should, as much as possible, be avoided, and careful dieting is the best measure for dealing with the trivial ailments of childhood. It is sometimes a little difficult to take the pulse and temperature of a child. The best plan is to give one finger to the child to play with and lay another on the wrist, so that the pulsations of the artery can be counted easily. Better still it is to count the pulse when the child is asleep, either at the wrist, or at the artery at the side of the head. The pulse should be counted for four successive quarter-minutes, and the number of beats per quarter of a minute written down. If it is noticed that these vary in each quarter of a minute that means that the pulse is irregular. It must not be forgotten that the pulse rate is much quicker in children than adults. In infancy it may be 100 or 120 per minute. Up till the fifth or sixth year it gradually decreases to 90. By the tenth year it has decreased to 80 or 85. If the pulse is quicker or slower than normal the child should be under the care of a doctor.
Taking: a Child's Temperature
To count the respirations the hand is gently laid upon the abdomen when the child's attention is taken up with something else.
The temperature can generally be taken with a little tact, and once confidence and trust have been established the child is not at all afraid of the thermometer, which he should be allowed to look at, and examine before it is placed in the armpit.
It is best to hold the child's arm placed across the chest and cover him well up with blankets as the thermometer is apt to slip out of place. The temperature should never be taken in a child's mouth. Many doctors prefer that it is taken in the groin, and when the child absolutely refuses to have the arm held against the side, this plan should be applied.
It is important to remember that very little will cause the temperature of a young child to rise above the normal. Mothers are often seriously troubled when the temperature rises above 100, but quite a slight derangement of stomach or bowels will, at times, send it up to 103 or 104. The same is true of colds and throat affections, but the safe plan is to send for the doctor when the temperature is above normal.
All medicines must be prescribed by the doctor, who will probably be careful to give prescriptions which are as little distasteful as possible. Children generally hate taking medicine, but a good deal can be achieved by gentle persuasion and tact. If the child can be persuaded to take the medicine quietly, and without fuss, it is a good thing for everybody concerned, but many mothers and nurses make a mistake in spending ten or fifteen minutes coaxing an excited child to take medicine which he has absolutely made up his mind that nothing on earth will induce him to do. This procedure is bad for the child, and bad for the nurse in charge, and it would have been much better to have quietly given the child his medicine at the very beginning, whether he was willing or not.
This can be done simply, quickly, and without any trouble in the following way :
If the child is small take him on your knee with the head resting in the hollow of your left arm, and your left hand gripping his hands. Tilt the head backwards and put the spoon into the mouth when he opens it to cry, well back against the patient's tongue. Turn the spoon on its side and hold it there until the child swallows. If the child keeps the mouth closed it can easily be opened by holding the nostrils or by pushing the handle of the spoon in at the side of the mouth. This does not mean that unnecessary force is to be exerted upon the child.
All that is required is knack, especially when the child is seriously ill. The giving of medicines containing opium must be very carefully attended to, as children are very susceptible to the narcotic effect of this drug. If the child seems drowsy, the dose should not be repeated until the doctor sees the case and gives his permission.
The bath is one of the most useful remedial measures we have in dealing with ailing children. When a child is cross and sleepless, and difficult to manage, a hot bath has a wonderfully soothing effect.
The temperature of the water should be between 100 and 105 degrees F. A screen ought to be arranged round the bath to prevent any risk of draughts. The child should not be in the bath more than two or three minutes, and the skin should afterwards be rapidly, but thoroughly, dried with soft towels. The patient should then be put to bed, and given a hot drink, and if the room is kept quiet and dark he will probably drop off to sleep very soon.
When a child is too ill to have his usual bath, his skin will require cleansing even more than when he is well. He can be sponged while lying in bed on a bath towel with a waterproof sheet underneath him. The legs and abdomen are first sponged with tepid water and then thoroughly dried. Then the chest can be washed and dried, and the patient turned on one side, so that the back can be easily attended to. Then the neck, face, and arms can be washed and dried, care being taken to keep the child as much covered as possible during the process.
Unless the room is quite warm, however, it is best to wash the child on the nurse's knee in front of the fire, and the patient should afterwards be put to bed between warm blankets.
Bathing is utilised in various illnesses for other purposes besides that of cleanliness. In fevers, cold sponging is of service in reducing the temperature, and many doctors order that a child should be put into a bath of about 90 degrees and cold water gradually added until the temperature is about 70 degrees F. But such bathing should only be carried out under the direction of a doctor or trained hospital nurse, as the child may suffer from collapse and require immediate attention and stimulants.
Hot mustard baths are sometimes ordered in cases of collapse, such as may happen in severe diarrhoea, and in these cases two tablespoonfuls of mustard are mixed into a paste with cold water, and then added to the hot bath, which may be about 105 degrees F. These baths are also useful in heart failure, which sometimes happens in various chest affections such as pneumonia.
Hot-water baths are very often ordered for children who are having convulsive attacks. These should never be given unless the head is well covered up with cloths wrung out of cold water and frequently changed, or the head is fitted with an ice cap. Indeed, of late years some doctors are objecting to hot baths in convulsions, and recommend rather the tepid bath. The question, however, is still in abeyance, and if cold water is liberally applied to the head, the mother can put the child for a short time into a hot bath, especially if the hot water is applied to the lower part of the body and legs rather than the upper part of the body, so as to relieve the congestion of the brain.
Salt water baths are extremely useful for debilitated children, as they have considerable tonic effect. They can be made by adding common salt to the water in the bath, which is generally about 85 degrees F.
The subject of feeding sick children was briefly considered in the last article. A good rule to remember is that when a child's temperature is raised, the amount of food should be reduced, because the digestive powers are always impaired. At the same time, as thirst is always a prominent symptom in feverish cases, the invalid, especially if he is too young to ask for water, should be given teaspoonfuls of plain cold water at regular intervals. Barley-water and albumen-water are exceedingly useful in nursing sick children, as they have nutritive properties and also allay thirst.
A common mistake in feeding children who are past the stage of infancy is to give them nothing but milk when they are ill. Milk is an excellent food for children, it is true, but they can get too much of it. It often causes flatulence and constipation, and it is best to vary milk with broth, koumiss, whey, raw eggs, and beef tea. Whey is in reality milk without curd, and it is made by heating a pint of milk, and then slowly stirring in two teaspoonfuls of essence of rennet. In about fifteen or twenty minutes clotting has taken place. Then the curd can be separated, and the liquid whey strained off.
Always use a feeding-cup when nursing children. It is easier for the nurse and more comfortable for the child.
When a child is ill, restless, and thirsty, a little orange or grape-juice should be given, or lemon-juice and water. The great thing to remember in feeding ailing children is to avoid over-feeding. As a general rule, three hours should be allowed to elapse between each meal, and meal-times should be regularly observed.
Remember that an ailing child, especially in hot weather, requires an abundance of water, and that it is positive cruelty to refuse a child water when his whole system is crying out for it.