Convulsions are a symptom of several disorders of early infancy, which may occur unexpectedly and which the nurse may suddenly be called upon to relieve in the absence of the doctor. Convulsions may be due to brain lesions; to spasmophilia or a special tendency to convulsive disorders; gastro-intestinal disorders; toxemia or syphilis. They may be the initial symptom of an acute infectious disease or may occur on slight provocation in a frail, undernourished baby or one suffering from rickets or tetany. For this reason one sometimes sees convulsions in a baby who is teething or has colic or indigestion.
As convulsions are a symptom of some abnormal condition, the doctor will often prescribe a sustained treatment designed to remove or relieve the cause. But when an attack occurs unexpectedly, and the doctor cannot come at once, the nurse may often terminate the seizure by employing measures that will quiet and relax the struggling baby. The room should be quiet and darkened and the baby handled with utmost gentleness because of the extreme irritability of his nervous system. As a rule, the most satisfactory course is to immerse the baby in water at 100° F., and keep him there for five or ten minutes, supporting his head and shoulders meantime. Someone else should place cold compresses on his head and change them frequently. When removed from the bath, the baby should be wrapped in a blanket, kept very quiet and the cold applications to his head continued.
When it is known that the convulsions are due to indigestion the stomach is often washed out and a high colonic irrigation given before the baby is quieted by the bath. In tetanoid convulsions the baby may take a long deep inspiration and fail to expire. Respirations should be stimulated, in such a case, by spanking him sharply or by dashing cold water on his face and chest. When the attacks are recurrent the nurse may be instructed to terminate them by giving the baby a few whiffs of chloroform, which, with an inhaler is kept in readiness for instant use.
Mustard baths and packs are sometimes given when the need for counter irritation is indicated. For a bath, one ounce, or six level tablespoonfuls of dry mustard is added to one gallon of water at 105° F. and the baby kept in it for about ten minutes, or until the skin is well reddened. He is then wrapped in a warm blanket and surrounded by hot-water bottles, with cold compresses applied to his head. The mustard pack is given in the manner of other packs, with a sheet wrung from mustard water which is possibly a little warmer and stronger than that for the bath, care being taken that the sheet is not cooled before it is wrapped about the baby. He is usually left in the pack for about ten minutes or until his skin is reddened, and then wrapped in warm blankets, with cold compresses to his head.
It is often helpful to the doctor if the nurse is able to describe the onset of the convulsions and tell him where the twitching began, how it progressed and whether or not it was preceded by a cry.
Vomiting during early infancy is a symptom of any one of several conditions, the nature of which sometimes may be revealed by the character of the attacks. The commonest causes and varieties of vomiting are as follows:
1. Too rapid feeding or too large amounts of food given at one time. The vomiting amounts to little more than regurgitation and is often induced by moving or handling the baby immediately after feeding him.
2. Acute gastric indigestion. Sour stomach contents may be vomited immediately after feeding, or not until several hours later and may be followed by mucus and bile. The baby is usually pale, particularly about the mouth; he may perspire about the forehead and give evidence of pain, being relieved by the vomiting.
3. Stenosis of the pylorus. The vomiting from this cause is projectile in character and may occur immediately after food is taken into the stomach, or, some time later without apparent cause, a larger amount of fluid may be expelled than was given at the preceding feeding. The vomiting may begin a few days after birth or several weeks afterwards in a baby who has been well previously.
4. Intestinal obstruction due to congenital obstruction, which causes persistent vomiting from birth; or due to intussusception of the intestines, when vomitus consists first of stomach contents which later becomes bile stained and sometimes contains fecal matter, blood and mucus. It is attended by prostration, and after fecal matter is passed at the beginning, there is frequent evacuation of blood and mucus.