Thrush or Sprue is a highly communicable disease of the mouth of new-born babies, due to one of the fungi. It is common among sickly, undernourished babies and those living in unhygienic surroundings, but it is seldom seen in healthy babies who are cared for with absolute cleanliness. The disease is characterized by small raised, white spots in the baby’s mouth, frequently on the back of the tongue and inner surface of the cheeks.
Prevention lies in good care and in cleanliness of the mother’s nipples, or the bottles and nipples for artificially fed babies, and of all other articles coming in contact with the baby, particularly his mouth. Some doctors have the baby’s mouth bathed before each feeding, as a preventive measure, while others feel that a gentle swabbing once daily is sufficient, if the nipples are kept clean, since an abrasion of the mucous lining is easily caused and is favorable to the development of thrush.
Treatment consists in cleanliness and in gently swabbing the spots, three or four times a day, with sterile cotton wet with an alkaline solution such as borax (10%), bicarbonate of sodium (6%) and sometimes with formalin (1%) or a weak solution of permanganate of potassium.
Impetigo and Pemphigus are highly infectious skin diseases of early infancy which are seen more often in hospitals than in patients’ homes. The treatment of the raised blisters that appear on different parts of the body is entirely a medical question, but in caring for the patients suffering from either of these infections the nurse must take every precaution to avoid extending the trouble on the skin of the infected baby, himself, and of communicating it to other babies in the ward. Strict isolation is imperative; gentle handling and frequent changing of the underclothing to prevent extending the disease to uninfected areas.
Vaginitis. This highly infectious malady is considered troublesome rather than serious, as a rule, though it may be complicated by ophthalmia or arthritis. Gonorrheal vaginitis is the commonest form seen in early infancy and may be due to infection which the baby acquired during its passage through the birth canal or later from the mother’s hands or clothing. The symptoms are a vaginal discharge, which may be thin and serous or thick and yellow and purulent and it may be scanty in amount or abundant; a reddened, swollen condition of the vagina and vulva and sometimes redness and excoriation of the inner surface of the thighs. The nurse’s chief responsibilities are to be constantly on the alert to detect evidences of the disease and report them promptly to the doctor, and to observe strict isolation in caring for the baby while carrying out the doctor’s orders for douches or suppositories.
COMMON ABNORMALITIES OF THE NEW-BORN
Icterus or Jaundice, which is so frequently seen in new-born babies, is occasionally a symptom of some septic condition; of syphilis or congenital cirrhosis of the liver or obstruction of the bile ducts, but as a rule it is without any serious significance. The jaundiced appearance usually begins on the second or third day and may continue for two or three weeks or it may subside in three or four days. The depth of the color varies, being very pale in some cases and almost green in others. When this discoloration of the skin is unaccompanied by other symptoms, no treatment is given.
A Cephalhematoma is a tumor of blood between the periosteum and the bones of the skull of the new-born baby. It is often due to some injury sustained during birth and is most frequently seen after prolonged labors. Cephalhematoma is sometimes confused with a caput succedaneum, but whereas the caput disappears in a few days the cephalhematoma may not be entirely absorbed for two or three months. Although certain conditions sometimes indicate the advisability of surgical treatment, the nurse’s care consists solely of protecting the tumor from injury.
Club foot is one of the commonest deformities of the extremities of young babies, occurring once in about every 1000 births. It may be congenital or caused by injury or it may be due to such diseases as cerebral paralysis or poliomyelitis. The nurse should watch for any abnormality in the structure or position of the feet, for the earlier treatment is started, the better is the prospect of a cure.
Engorgement of the Breasts. Not infrequently the breasts of new-born babies are engorged, in which state they are easily infected by being rubbed or squeezed. Since the greatest care must be taken to avoid bruising swollen breasts, they are sometimes protected by the application of a pad of sterile cotton. Hot compresses are sometimes applied when there is redness with the swelling, or a tiny ice-bag, made by tying off the fingers and thumb of a rubber glove, and partly filling it with finely crushed ice, after which the wrist is tightly tied.