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 constitution, or imbued with any hereditary taint, the process of dentition will be attended with more or less difficulty, and not unfrequendy with danger.
SYMPTOMS.—The symptoms of difficult dentition 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 dentition 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 constitutional 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 quantity 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 dentition 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 pass 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 constitution of the child, as well as upon other circumstances. 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 pass through dentition 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.