The paroxysmal cry, very severe for a time and then ceasing absolutely, is probably due to colic, particularly if accompanied by the distention of the abdomen and the movements of the body already referred to. A frequent, peevish, whining cry is heard in children with general poor health or discomfort. A single shrill scream uttered now and then is often heard in inflammation of the brain. In any disease in which there is difficulty in getting enough air into the lungs, as in pneumonia, the cry is usually very short and the child cries but little, because it cannot hold its breath long enough for it. A nasal cry occurs with cold in the head.
A short cry immediately after coughing indicates that the cough hurts the chest. Crying when the bowels are moved shows that there is pain at that time. A child of from two to six years, waking at night with violent screaming, is probably suffering from night terrors. In conditions of very great weakness and exhaustion the baby moans feebly, or it may twist its face into the position for crying, but emit no sound at all. This latter is also true in some cases of inflammation of the larynx, while in other cases the cry is hoarse or croupy. Crying when anything goes into the mouth makes one suspect some trouble there. If it occurs with swallowing, it is probable that the throat is inflamed.
With the act of crying there ought always to be tears in children over three or four months of age. If there are none, serious disease is indicated, and their reappearance is then a good sign.
COUGHING
The character of the cough is also instructive. A frequent, loud, nearly painless cough, at first tight and later loose, is heard in bronchitis. A short, tight, suppressed cough, which is followed by a grimace, and, perhaps, by a cry, indicates some inflammation about the chest, often pneumonia. There is a brazen, barking, "croupy" cough in spasmodic croup. In inflammation of the larynx, including true croup, the cough may be hoarse, croupy, or sometimes almost noiseless.
The cough of whooping cough is so peculiar that it must be described separately when considering this disease. Then there are certain coughs which are purely nervous or dependent upon remote affections. Thus the so-called "stomach cough" is caused by some irritation of the stomach or bowels. It is not nearly so frequent as mothers suppose. Irritation about the nose or the canal of the ears sometimes induces a cough in a similar way. Enlarged tonsils or elongated palate or throat irritation may also produce a cough.
THE BREATHING
The breathing of a young child, particularly if under one year of age and awake, is always slightly irregular. If it becomes very decidedly so, we suspect disease, particularly of the brain. A combination of long pauses, lasting half a minute or a minute, with breathing which is at first very faint, gradually becomes more and more deep, and then slowly dies away entirely, goes by the name of "Cheyne-Stokes respiration," and is found in affections of the brain. It is one of the worst of symptoms except in infancy, and even then it is very serious.
The rate of respiration is increased in fever in proportion to the height of the temperature. It is increased also by pain in rickets, and especially in some affections of the lungs. Sixty respirations a minute are not at all excessive for a child of two years with pneumonia, and the speed is frequently decidedly greater than this.
Breathing is often very slow in disease of the brain, particularly tubercular meningitis. Poisoning by opiates produces the same effect. Frequent deep sighing or yawning occurs in affections of the brain, in faintness, or in great exhaustion, and may be a very unfavorable symptom. Breathing entirely through the mouth shows that the nose is completely blocked, while snuffling breathing is the result of a partial catarrhal obstruction. A gurgling in the throat not accompanied by cough may indicate that there is mucus in the back part of it, the result of an inflammation, sometimes slight, sometimes serious.