"Labored" breathing, in which the chest is pulled up with each breath while the muscles of the neck become tense, the pit of the stomach and the spaces between the ribs sink in, and the edges of the nostrils move in and out, is seen in conditions where the natural ease of respiration is greatly interfered with, as in pneumonia, diphtheria of the larynx, asthma, and the like. Long-drawn, noisy inspirations and expirations are heard in obstruction of the larynx, as from laryngeal diphtheria or spasmodic croup.
THE PULSE
The rate of the pulse is subject to such variations in infants that its examination is of less value than it would otherwise be. In early childhood its observation is of more service, although even then deceptive. Slight irregularity is not uncommon. Unusual irregularity is an important symptom in affections of the brain or heart. Fever produces an increase in the pulse rate, the degree of which depends, as a rule, upon the height of the temperature. Slowing of the pulse is a very significant symptom, seen particularly in affections of the brain, and sometimes in Bright's disease and jaundice.
THE TEMPERATURE
The temperature is of all things important to remember in infancy and childhood because fever is easily produced and runs high from slight causes.
Even slight cold or the presence of constipation or slight disturbances of digestion may in babies sometimes produce a temperature of 103 F. or more. We do not speak of fever unless the elevation reaches 100 F. A temperature of 102 or 103 F. constitutes moderate fever, while that of 104 or 105 F. is high fever, and above 105 F. very high. A temperature of 107 F. is very dangerous, and is usually not recovered from. The danger from fever depends not only upon its height, but upon its duration also. An elevation of 105 F. may be easily borne for a short time, but it becomes alarming if much prolonged.
THE MOUTH
The tongue of newborn infants is generally whitish and continues to be so until the saliva becomes plentiful. After this we usually find it coated in disturbances of the stomach and bowels and in nearly any disorder accompanied by fever. In scarlet fever the tongue becomes bright red after a few days, and in measles and whooping cough it is often faintly bluish. In the latter affection an ulcer may sometimes be found directly under the tongue, where the thin membrane binds it to the floor of the mouth. In thrush the tongue is covered with white patches like curdled milk. A pale, flabby tongue, marked by the teeth at its edges, indicates debility or impaired digestion. In prolonged or very high fever the tongue grows dry, and in some diseases of the stomach or bowels it may look like raw beef.
Grinding of the teeth is a frequent symptom in infants in whom dentition has commenced. It generally indicates an irritated nervous system. Most often this depends upon some disturbance of digestion; less often upon the presence of worms. The symptom is present during or preceding a convulsion, and may occur, too, in disease of the brain. In some babies it appears to be only a nervous habit.