The Maternal Management of Children, in Health and Disease. - Thomas Bull, M.D.
It is easy to discover when children have been fed upon spirits: they
are always emaciated; have a lean, yellow, haggard look: the eyes
sunk, the lips pale, and the teeth discoloured, the cadaverous aspect
of the countenance being most fearful. They are continually suffering
from bowel complaints and convulsive disorders; which, under these
circumstances, terminate invariably in an early death.
Sect. IV. SLEEP.
DURING INFANCY.--For three or four weeks after birth the infant sleeps
more or less, day and night, only waking to satisfy the demands of
hunger; at the expiration of this time, however, each interval of
wakefulness grows longer, so that it sleeps less frequently, but for
longer periods at a time.
This disposition to repose in the early weeks of the infant's life
must not be interfered with; but this period having expired, great care
is necessary to induce regularity in its hours of sleep, otherwise too
much will be taken in the day-time, and restless and disturbed nights
will follow. The child should be brought into the habit of sleeping in
the middle of the day, before its dinner, and for about two hours,
more or less. If put to rest at a later period of the day, it will
invariably cause a bad night.
At first the infant should sleep with its parent. The low temperature
of its body, and its small power of generating heat, render this
necessary. If it should happen, however, that the child has disturbed
and restless nights, it must immediately be removed to the bed and care
of another female, to be brought to its mother at an early hour in the
morning, for the purpose of being nursed. This is necessary for the
preservation of the mother's health, which through sleepless nights
would of course be soon deranged, and the infant would also suffer from
the influence which such deranged health would have upon the milk.
When a month or six weeks has elapsed, the child, if healthy, may
sleep alone in a cradle or cot, care being taken that it has a
sufficiency of clothing, that the room in which it is placed is
sufficiently warm, viz. 60 degrees, and the position of the cot itself
is not such as to be exposed to currents of cold air. It is essentially
necessary to attend to these points, since the faculty of producing
heat, and consequently the power of maintaining the temperature, is
less during sleep than at any other time, and therefore exposure to
cold is especially injurious. It is but too frequently the case that
inflammation of some internal organ will occur under such
circumstances, without the true source of the disease ever being
suspected. Here, however, a frequent error must be guarded against,--
that of covering up the infant in its cot with too much clothing
throwing over its face the muslin handkerchief--and, last of all,
drawing the drapery of the bed closely together. The object is to keep
the infant sufficiently warm with pure air; it therefore ought to have
free access to its mouth, and the atmosphere of the whole room should
be kept sufficiently warm to allow the child to breathe it freely: in
winter, therefore, there must always be a fire in the nursery.
The child up to two years old, at least, should sleep upon a feather
bed, for the reasons referred to above. The pillow, however, after the
sixth month, should be made of horsehair; for at this time teething
commences, and it is highly important that the head should be kept cool.
DURING CHILDHOOD.--Up to the third or fourth year the child should be
permitted to sleep for an hour or so before its dinner. After this time
it may gradually be discontinued; but it must be recollected, that
during the whole period of childhood more sleep is required than in
adult age. The child, therefore, should be put to rest every evening
between seven and eight; and if it be in health it will sleep soundly
until the following morning. No definite rule, however, can be laid
down in reference to the number of hours of sleep to be allowed; for
one will require more or less than another.[FN#16] Regularity as to
the time of going to rest is the chief point to attend to; permit
nothing to interfere with it, and then only let the child sleep without
disturbance, until it awakes of its own accord on the following
morning, and it will have had sufficient rest.
[FN#16] The amount of sleep necessary to preserve health varies
according to the state of the body, and the habits of the individual.
As already observed, infants pass much the greater portion of their
time in sleep. Children sleep twelve or fourteen hours. The schoolboy
generally ten. In youth, a third part of the twenty-four hours is spent
in sleep. Whilst, in advanced age, many do not spend more than four,
five, or six hours in sleep.
It is a cruel thing for a mother to sacrifice her child's health that
she may indulge her own vanity, and yet how often is this done in
reference to sleep. An evening party is to assemble, and the little
child is kept up for hours beyond its stated time for retiring to rest,
that it may be exhibited, fondled, and admired. Its usual portion of
sleep is thus abridged, and, from the previous excitement, what little
he does obtain, is broken and unrefreshing, and he rises on the morrow
wearied and exhausted.
Once awake, it should not be permitted to lie longer in bed, but
should be encouraged to arise immediately. This is the way to bring
about the habit of early rising, which prevents many serious evils to
which parents are not sufficiently alive, promotes both mental and
corporeal health, and of all habits is said to be the most conducive to
longevity.
A child should never be suddenly aroused from sleep; it excites the
brain, quickens the action of the heart, and, if often repeated,
serious consequences would result. The change of sleeping to waking
should always be gradual.
The bed on which the child now sleeps should be a mattress: at this
age a feather bed is always injurious to children; for the body,
sinking deep into the bed, is completely buried in feathers, and the
unnatural degree of warmth thus produced relaxes and weakens the
system, particularly the skin, and renders the child unusually
susceptible to the impressions of cold. Then, instead of the bed being
made up in the morning as soon as vacated, and while still saturated
with the nocturnal exhalations from the body, the bed-clothes should be
thrown over the backs of chairs, the mattress shaken well up, and the
window thrown open for several hours, so that the apartment shall be
thoroughly ventilated. It is also indispensably requisite not to allow
the child to sleep with persons in bad health, or who are far advanced
in life; if possible, it should sleep alone.
Sect. V. BATHING AND CLEANLINESS.
DURING INFANCY.--Too much attention cannot be paid to cleanliness; it
is essential to the infant's health. The principal points to which
especial attention must be paid by the parent for this purpose are the
following:--
TEMPERATURE OF THE WATER.--At first the infant should be washed daily
with warm water; and a bath every night, for the purpose of thoroughly
cleaning the body, is highly necessary. To bathe a delicate infant of a
few days or even weeks old in cold water with a view "to harden" the
constitution (as it is called), is the most effectual way to undermine
its health and entail future disease. By degrees, however, the water
with which it is sponged in the morning should be made tepid, the
evening bath being continued warm enough to be grateful to the feelings.
A few months having passed by, the temperature of the water may be
gradually lowered until cold is employed, with which it may be either
sponged or even plunged into it, every morning during summer. If
plunged into cold water, however, it must be kept in but a minute; for
at this period, especially, the impression of cold continued for any
considerable time depresses the vital energies, and prevents that
healthy glow on the surface which usually follows the momentary and
brief action of cold, and upon which its usefulness depends. With some
children, indeed, there is such extreme delicacy and deficient reaction
as to render the cold bath hazardous; no warm glow over the surface
takes place when its use inevitably does harm: its effects, therefore,
must be carefully watched.
DRYING THE SKIN.--The surface of the skin should always be carefully
and thoroughly rubbed dry with flannel,--indeed, more than dry, for the
skin should be warmed and stimulated by the assiduous gentle friction
made use of. For this process of washing and drying must not be done
languidly, but briskly and expeditiously; and will then be found to be
one of the most effectual means of strengthening the infant. It is
especially necessary carefully to dry the arm-pits, groins, and nates;
and if the child is very fat, it will be well to dust over these parts
with hair-powder or starch: this prevents excoriations and sores, which
are frequently very troublesome. Soap is only required to those parts
of the body which are exposed to the reception of dirt.
NAPKINS.--The frequency of the discharges from the bowels and bladder
requires a frequent change of napkins. A nurse cannot be too careful of
this duty from the first, so that she may be enabled to discover the
periods when those discharges are about to take place, that she may not
only anticipate them, but teach the child, at a very early age, to give
intelligent warning of its necessities. Thus a habit of regularity with
regard to those functions will be established, which will continue
through life, and tend greatly to the promotion of health. As the child
grows older, the system of cleanliness must in no particular be
relaxed, and it will be found the best preservative against those
eruptive disorders which are so frequent and troublesome during the
period of infancy.
DURING CHILDHOOD.--When this period arrives, or shortly after, bathing
is but too frequently left off; the hands and face of the child are
kept clean, and with this the nurse is satisfied; the daily ablution of
the whole body, however, is still necessary, not only for the
preservation of cleanliness, but because it promotes in a high degree
the health of the child.
PLAN TO BE PURSUED WITH THE VIGOROUS AND HEALTHY.--A child of a
vigorous constitution and robust health, as he rises from his bed
refreshed and active by his night's repose, should be put into the
shower-bath, or, if this excites and alarms him too much, must be
sponged from head to foot with salt water. If the weather be very cold,
the water may be made slightly tepid, but if his constitution will bear
it, the water should be cold throughout the year. Then the body should
be speedily dried, and hastily but well rubbed with a somewhat coarse
towel, and the clothes put on without any unnecessary delay. This
should be done every morning of the child's life.
If such a child is at the sea-side, advantage should be taken of this
circumstance, and seabathing should be substituted. The best time is
two or three hours after breakfast; but he must not be fatigued
beforehand, for if so, the cold bath cannot be used without danger.
Care must be taken that he does not remain in too long, as the animal
heat will be lowered below the proper degree, which would be most
injurious. In boys of a feeble constitution, great mischief is often
produced in this way. It is a matter also of great consequence in
bathing children that they should not be terrified by the immersion,
and every precaution should be taken to prevent this. The healthy and
robust boy, too, should early be taught to swim, whenever this is
practicable, for it is attended with the most beneficial effects; it is
a most invigorating exercise, and the cold bath thus becomes doubly
serviceable.
PLAN TO BE PURSUED WITH THE DELICATE AND STRUMOUS.--If a child is of a
delicate and strumous constitution, the cold bath during the summer
is one of the best tonics that can be employed; and if living on the
coast, sea-bathing will be found of singular benefit. The effects,
however, of sea-bathing upon such a constitution must be particularly
watched, for unless it is succeeded by a glow,--a feeling of increased
strength,--and a keen appetite, it will do no good, and ought at once
to be abandoned for the warm or tepid bath. The opinion that warm baths
generally relax and weaken, is erroneous; for in this case, as in all
cases when properly employed, they would give tone and vigour to the
whole system; in fact, the tepid bath is to this child what the cold
bath is to the more robust.
In conclusion: if the bath in any shape cannot from circumstances be
obtained, then cold saltwater sponging must be used daily, and all the
year round, so long as the proper reaction or glow follows its use; but
when this is not the case, and this will generally occur, if the child
is delicate and the weather cold, tepid vinegar and water, or tepid
salt water, must be substituted.
Sect. VI. CLOTHING.
IN INFANCY.--Infants are very susceptible of the impressions of cold; a
proper regard, therefore, to a suitable clothing of the body, is
imperative to their enjoyment of health. Unfortunately, an opinion is
prevalent in society, that the tender child has naturally a great power
of generating heat and resisting cold; and from this popular error has
arisen the most fatal results. This opinion has been much strengthened
by the insidious manner in which cold operates on the frame, the
injurious effects not being always manifest during or immediately after
its application, so that but too frequently the fatal result is traced
to a wrong source, or the infant sinks under the action of an unknown
cause.
The power of generating heat in warm-blooded animals is at its minimum
at birth, and increases successively to adult age; young animals,
instead of being warmer than adults, are generally a degree or two
colder, and part with their heat more readily; facts which cannot be
too generally known. They show how absurd must be the folly of that
system of "hardening" the constitution (to which reference has been
before made), which induces the parent to plunge the tender and
delicate child into the cold bath at all seasons of the year, and
freely expose it to the cold, cutting currents of an easterly wind,
with the lightest clothing.
The principles which ought to guide a parent in clothing her infant
are as follows:--
The material and quantity of the clothes should be such as to preserve
a sufficient proportion of warmth to the body, regulated therefore by
the season of the year, and the delicacy or strength of the infant's
constitution. In effecting this, however, the parent must guard against
the too common practice of enveloping the child in innumerable folds of
warm clothing, and keeping it constantly confined to very hot and close
rooms; thus running into the opposite extreme to that to which I have
just alluded: for nothing tends so much to enfeeble the constitution,
to induce disease, and render the skin highly susceptible to the
impression of cold; and thus to produce those very ailments which it
is the chief intention to guard against.
In their make they should be so arranged as to put no restrictions to
the free movements of all parts of the child's body; and so loose and
easy as to permit the insensible perspiration to have a free exit,
instead of being confined to and absorbed by the clothes, and held in
contact with the skin, till it gives rise to irritation.
In their quality they should be such as not to irritate the delicate
skin of the child. In infancy, therefore, flannel is rather too rough,
but is desirable as the child grows older, as it gives a gentle
stimulus to the skin, and maintains health.
In its construction the dress should be so simple as to admit of being
quickly put on, since dressing is irksome to the infant, causing it to
cry, and exciting as much mental irritation as it is capable of
feeling. Pins should be wholly dispensed with, their use being
hazardous through the carelessness of nurses, and even through the
ordinary movements of the infant itself.
The clothing must be changed daily.--It is eminently conducive to good
health that a complete change of dress should be made every day. If
this is not done, washing will, in a great measure, fail in its object,
especially in insuring freedom from skin diseases.
IN CHILDHOOD.--The clothing of the child should possess the same
properties as that of infancy. It should afford due warmth, be of such
materials as do not irritate the skin, and so made as to occasion no
unnatural constriction.
In reference to due warmth, it may be well again to repeat, that too
little clothing (that state of semi-nudity which the vanity of some
parents encourage) is frequently productive of the most sudden attacks
of active disease; and that children who are thus exposed with naked
breasts and thin clothing in a climate so variable as ours are the
frequent subjects of croup, and other dangerous affections of the air-
passages and lungs. On the other hand, it must not be forgotten, that
too warm clothing is a source of disease,--sometimes even of the same
diseases which originate in exposure to cold,--and often renders the
frame more susceptible of the impressions of cold, especially of cold
air taken into the lungs. Regulate the clothing, then, according to the
season; resume the winter dress early; lay it aside late; for it is in
spring and autumn that the vicissitudes in our climate are greatest,
and congestive and inflammatory complaints most common.
With regard to material (as was before observed), the skin will at
this age bear flannel next to it; and it is now not only proper, but
necessary. It may be put off with advantage during the night, and
cotton maybe substituted during the summer, the flannel being resumed
early in the autumn. If from very great delicacy of constitution it
proves too irritating to the skin, fine fleecy hosiery will in general
be easily endured, and will greatly conduce to the preservation of
health.
It is highly important that the clothes of the boy should be so made
that no restraints shall be put on the movements of the body or limbs,
nor injurious pressure made on his waist or chest. All his muscles
ought to have full liberty to act, as their free exercise promotes both
their growth and activity, and thus insures the regularity and
efficiency of the several functions to which these muscles are
subservient.
The same remarks apply with equal force to the dress of the girl; and
happily, during childhood, at least, no distinction is made in this
matter between the sexes. Not so, however, when the girl is about to
emerge from this period of life; a system of dress is then adopted
which has the most pernicious effects upon her health, and the
development of the body, the employment of tight stays, which impede
the free and full action of the respiratory organs, being only one of
the many restrictions and injurious practices from which in latter
years they are thus doomed to suffer so severely.
Sect. VII. AIR AND EXERCISE.
IN INFANCY.--The respiration of a pure air is at all times, and under
all circumstances, indispensable to the health of the infant. The
nursery therefore should be large, well ventilated, in an elevated part
of the house, and so situated as to admit a free supply both of air
and light. For the same reasons, the room in which the infant sleeps
should be large, and the air frequently renewed; for nothing is so
prejudicial to its health as sleeping in an impure and heated
atmosphere. The practice, therefore, of drawing thick curtains closely
round the bed is highly pernicious; they only answer a useful purpose
when they defend the infant from any draught of cold air.
The proper time for taking the infant into the open air must, of
course, be determined by the season of the year, and the state of the
weather. "A delicate infant born late in the autumn will not generally
derive advantage from being carried into the open air, in this climate,
till the succeeding spring; and if the rooms in which he is kept are
large, often changed, and well ventilated, he will not suffer from the
confinement, while he will, most probably, escape catarrhal affections,
which are so often the consequence of the injudicious exposure of
infants to a cold and humid atmosphere."[FN#17] If, however, the child
is strong and healthy, no opportunity should be lost of taking it into
the open air at stated periods, experience daily proving that it has
the most invigorating and vivifying influence upon the system. Regard,
however, must always be had to the state of the weather; and to a damp
condition of the atmosphere the infant should never be exposed, as it
is one of the most powerful exciting causes of consumptive disease. The
nurse-maid, too, should not be allowed to loiter and linger about, thus
exposing the infant unnecessarily, and for an undue length of time;
this is generally the source of all the evils which accrue from taking
the babe into the open air.
[FN#17] Sir James Clark on Consumption.
Exercise, also, like air, is essentially important to the health of
the infant. Its first exercise, of course, will be in the nurse's arms.
After a month or two, when it begins to sleep less during the day, it
will delight to roll and kick about on the sofa: it will thus use its
limbs freely; and this, with carrying out into the open air, is all
the exercise it requires at this period. By and by, however, the child
will make its first attempts to walk. Now it is important that none of
the many plans which have been devised to teach a child to walk, should
be adopted--the go-cart, leading-strings, etc.; their tendency is
mischievous; and flatness of the chest, confined lungs, distorted
spine, and deformed legs, are so many evils which often originate in
such practices. This is explained by the fact of the bones in infancy
being comparatively soft and pliable, and if prematurely subjected by
these contrivances to carry the weight of the body, they yield just
like an elastic stick bending under a weight, and as a natural
consequence become curved and distorted.
It is highly necessary that the young and experienced mother should
recollect this fact, for the early efforts of the little one to walk
are naturally viewed by her with so much delight, that she will be apt
to encourage and prolong its attempts, without any thought of the
mischief which they may occasion; thus many a parent has had to mourn
over the deformity which she has herself created.
It may be as well here to remark, that if such distortion is timely
noticed, it is capable of correction, even after evident curvature has
taken place. It is to be remedied by using those means that shall
invigorate the frame, and promote the child's general health (a daily
plunge into the cold bath, or sponging with cold salt water, will be
found signally efficacious), and by avoiding the original cause of the
distortion--never allowing the child to get upon his feet. The only way
to accomplish the latter intention, is to put both the legs into a
large stocking; this will effectually answer this purpose, while, at
the same time, it does not prevent the free and full exercise of the
muscles of the legs. After some months pursuing this plan, the limbs
will be found no longer deformed, the bones to have acquired firmness
and the muscles strength; and the child may be permitted to get upon
his feet again without any hazard of perpetuating or renewing the evil.
The best mode of teaching a child to walk, is to let it teach itself,
and this it will do readily enough. It will first crawl about: this
exercises every muscle in the body, does not fatigue the child, throws
no weight upon the bones, but imparts vigour and strength, and is thus
highly useful. After a while, having the power, it will wish to do
more: it will endeavour to lift itself upon its feet by the aid of a
chair, and though it fail again and again in its attempts, it will
still persevere until it accomplish it. By this it learns, first, to
raise itself from the floor; and secondly, to stand, but not without
keeping hold of the object on which it has seized. Next it will balance
itself without holding, and will proudly and laughingly show that it
can stand alone. Fearful, however, as yet of moving its limbs without
support, it will seize a chair or anything else near it, when it will
dare to advance as far as the limits of its support will permit. This
little adventure will be repeated day after day with increased
exultation; when, after numerous trials, he will feel confident of his
power to balance himself, and he will run alone. Now time is required
for this gradual self-teaching, during which the muscles and bones
become strengthened; and when at last called upon to sustain the weight
of the body, are fully capable of doing so.
IN CHILDHOOD.--When the child has acquired sufficient strength to take
active exercise, he can scarcely be too much in the open air; the more
he is habituated to this, the more capable will he be of bearing the
vicissitudes of the climate. Children, too, should always be allowed to
amuse themselves at pleasure, for they will generally take that kind
and degree of exercise which is best calculated to promote the growth
and development of the body. In the unrestrained indulgence of their
youthful sports, every muscle of the body comes in for its share of
active exercise; and free growth, vigour, and health are the result.