The Sick Child : Breathing, Pulse and Temperature

The Mother and Her Child
by William S. Sadler, M.D., Lena K. Sadler, M.D.

(Page 27 of 44)

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.

"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 spoke 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.

Nursing

The manner of nursing or swallowing frequently affords important information. A baby whose nose is much obstructed or who has pneumonia can nurse but for a moment, and then has to let the nipple go in order to breathe more satisfactorily. If it gives a few sucks and then drops the nipple with a cry, we must suspect that the mouth is sore and that nursing is painful. If it swallows with a gurgling noise, often stops to cough, and does as little nursing as possible, we suspect that the throat may be sore. The ceasing to nurse at all, in the case of a very sick baby, is an evidence of great weakness or increasing stupor, and is a most unfavorable symptom.

The Urine

Urine that is high-colored and stains the diaper, or that shows a thick, reddish cloud after standing, may accompany fever or indigestion. Sometimes the urine under these conditions is milky when first passed. In some babies a diet containing beef juice or other highly nitrogenous food will produce the reddish cloud, or even actual, red, sand like particles. A decidedly yellow stain on the diaper occurs when there is jaundice. A faint reddish stain seldom indicates blood. The amount of urine passed is scanty in fever, in diarrhea, and especially in acute Bright's disease. In the latter disease the urine is often of a smoky or even a muddy appearance. The possibility of the occurrence of this symptom after scarlet fever must always be kept in mind, in order that a physician may be summoned very quickly, since it is a serious matter.

The Stools

We find that the passages are often putty-colored in disorders of the liver, frequently bloody or tarry in appearance in bleeding within the bowel, and liable to be black after taking bismuth, charcoal, or iron, and red after krameria, kino. Infants who are receiving more milk than they can digest constantly have whitish lumps in their stools, or even entirely formed but almost white passages. The presence of a certain amount of greenish coloration of the passages is not infrequent. This is usually an evidence of indigestion, but passages which are yellow when passed and turn to a faint pea green some time later are not an indication of disease.

About the Author

Dr. William S. Sadler M.D. was a well-known American psychiatrist and college teacher in the school of medicine at the University of Chicago. For over sixty years he practiced his profession in Chicago, thirty-three years being associated in practice with his wife, Dr Lena Kellogg Sadler. The doctors were pioneers in the research on the mysterious Urantia Papers.