The Parents' Review
A Monthly Magazine of Home-Training and Culture
"Education is an atmosphere, a discipline, a life."
Nervous Children and Their Training.
by Geo. H. Savage, M.D., F.R.C.P.
* Read before the Belgravia Branch of the P.N.E.U.
Ladies and Gentlemen, I address both, though my paper is chiefly intended for the former. I admit, though I had my choice of the subject on which I was to speak this afternoon, and thought I had no pressure brought upon me in the selection, yet, now that I am face to face with it, I have certain fears and dreads lest I should not handle it in a way which will be useful to my audience and satisfactory to myself. My professional work brings before me so much that is morbid that in speaking of nervousness I shall have to avoid treating it as a disease, for, though it may be a starting-point of disease, it more frequently is but a stage of healthy development. Much nervousness is only slight disorder which may for a time disturb harmonious working, yet under proper conditions it will pass and often by early recognition may be arrested.
There are many defective adjustments in child relationships, some depending on the parents and others on the child, and this afternoon I purpose considering under what conditions of the child's life these may arise. Though definitions frequently do harm by giving too clear an outline to subjects whose border is ever varying, yet we must in some degree mark out the land we intend traversing.
Nervousness in children will be treated as abnormal sensibility to surroundings, leading, as a rule, to undue reaction to such surroundings.
Nerves are the conductors or means by which communications are maintained between the organic self and everything which is not selfthe means by which every animal recognises its position in the world and its physical relationship to other things.
The animal is taught by its nervous system what is outside it, and thus gradually it learns what to avoid and what to seek, and in this way is fitted to maintain the struggle for existence which is before it. Nervous systems are the special possession of animals, for though there are a few plants which seem to be sensitive to their surroundings, yet they have no organised system of nerves. The nervous system marks the higher development in higher animals. We begin with the organic world with its insensitive and fixed nature, then pass to the vegetable world where there is life, but as a rule, immobility; on to the animal kingdom where there is sensitiveness, mobility and power of ready adaptation to changing conditions. With the progress in the animals we see a steady development of the nervous system, which becomes more and more complicated as its surroundings become more varying.
The higher the animal is in the scale, the higher is its nervous relationship, and with this as we might expect in man we have varying delicacy and refinement in the whole arrangement of the nervous system to correspond with the more complicated life which is being led by him.
We are not yet sufficiently experienced to be able to weigh a man's capacity by the volume of his nervous system, but the plan of competitive examinations is being brought to such perfection that we shall not be surprised to learn that in time the rapidity of nervous reaction has become one of the tests of fitness for the Civil Service.
We have been dominated by the idea "evolution" and everything has nowadays to be treated on evolutionary lines. I would at once say that I do not accept it as a fact that because as a whole progress is being made, that every part of the Social State is advancing at an equal rate. Such a belief in our present perfection leads to unjustifiable conceit, for there is no doubt that though in some ways advance of a substantial nature is being made, there is no proof that man is a more intellectual or more virtuous animal than he was in the long past.
The advance in knowledge of nature and of her laws have been vast. We know more of the world we live in and are able to control and adapt nature to our service. We have yoked nature, but as a result, the natural conditions of time and space have been so changed that we are never at rest. The present is the scientific and the nervous age. Nothing is more healthy than the study of nature in all its forms, but with the mastery of the laws of nature have arisen so many wants and so many interests, that there have been a corresponding increase in the calls made upon the receiving organs of sense and the storing organs of brain.
The conductors and receivers are ever called upon for fresh efforts, and this leads to an unstable state which is represented by varying degrees of nervousness. No nervous repair can go on while there is no rest, and consequently the want of the present day is rest. Instability in the nervous system means a readiness to react to slight external impressions; the whole system is in an expectant attitude, but not only is the system thus unstable, thus easily affected by slight outside influence, but the effect of normal excitation is exaggerated, and the nervous system cannot stand the strain which is put upon it.
The nervous system marks the tide of development, but the nervous reaction and its effects depend so much on the physical organism that it is to that we must appeal to overcome the evils of the present. In the future generations, by special selection or survival, a race may arise which either receives the many outside shocks with indifference, or more readily adapts itself to them.
Nervousness may, in fact, be but a prelude to a higher grade of development; it may be a blessing or it may be a curse. It may be a blessing when it acts as the danger signal, pointing to risks which are being run, but as a curse for the present hindering useful work. As a rule, we use the word nervousness to represent a state of weakness. I have decided to confine myself chiefly to states of nervous instability rather than to occupy the larger field of nervous defect and absolute nerve weakness.
The first question is the origin of nervousness in children. The natural tendency of parents is to ask if it comes from them, but the more one studies heredity, the more one is inclined to transfer the responsibility to an earlier generation, and to hide ourselves under the cloak of atavism.
I have no doubt that nervousness has a definite starting-point in many instances in the parents. As I have said, the age is a nervous one, and the constant call on the energies of the nervous system of the parents leaves most certainly a tendency to too ready reaction to surroundings. The inheritance is not that of a real quality, but of a tendency. Parental haste and unrest are elements of danger, but, as I shall point out later, nervous children, like poets and geniuses, often come as accidents in very easy-going families. Mind, I do not say that parents may not be responsible for some of the nervousness, but I am inclined to consider surroundings almost tyrannical in their working as heredity. It may be said that the heredity is permanent, and is, in fact, a tyranny which cannot be changed, whereas the surroundings, though they may be complex, are more readily changed. I do not believe we are unalterably what we are born, I have the hopeful view that we may be improved, if not remade. I would, for my first piece of advice, say, do not consider you have explained much when you have said your child inherits certain qualities from you, or from his other parent. Highly sensitive parents may have highly sensitive children, but they will probably have easy-going ones as well; we know that the seed from old plants not infrequently gives just as good results as that from very vigorous ones.
We must admit that some parents have the unhappy power of transmitting their nervous instability. Nervous children then may be born of healthy parents, and healthy children may be born of nervous ones.
In my professional life I, of course, see a certain number of children whose parents have suffered from brain disorder of various kinds, but I cannot say that many of them come under the class we are now considering of nervous children, and what is of more importance to you to remember is that but few of the more advanced forms of mental disorder occur in the persons who were simply nervous as children. Nervousness, if properly handled, may be outgrown, and may be but a passing stage of growth.
Some children come into the world markedly nervous. Such, as a rule, are the offspring of highly nervous or insane parents. Nervousness of this type is seen in the restless infant who seems to be always awake, always moving, crying or eating. As you know, the first stage of baby-life is without sight or hearing, the infant is simply seeking, his fingers are always on the move, he is feeling the world and slowly finds nourishment and satisfaction as a result; later, his organs of sense come into working, he not only feels the world but he begins to see it and to hear it. Time and space relations are established, and the more definite the sight and hearing are, the less energy is spent in vague, purposeless movements. The truly restless child seems incapable of rest, his movements are started with the slightest stimulus, and once started seem to be able to keep themselves going. There is no power of storing energy and so the nervous system is kept rocking to and fro. Such children never have time to learn to control or to direct themselves. They are exaggerated reflex machines which are influenced by every impression from without. It has been seen that the higher the sensory impression, the less and fewer are the movements resulting from the simpler stimuli, so that the well-developed nervous system only reacts fully to the more highly developed stimuli. The restless infant has not power to resist even the slightest movements outside.
The children who come thus restless into the world have a hard and almost hopeless battle before them, they have little chance of growing strong as their energy is frittered away.
Apart from those who are born nervous, there are many children who become nervous as the result of early physical or moral troubles. I shall now consider some of these causes in detail.
The young child is very loosely knit and is very easily disturbed in its development. In childhood, early febrile illnesses, such as measles or whooping cough, especially if followed by lung complications, often lead to nervousness. Any illness which causes either convulsions or delirium may have the same effect. Nervousness may therefore come on at almost any age. Nurses and servants are a frequent cause of disorder, drugs or alcohol being given to secure peaceful sleep to the servant at the cost of the nervous health of the infant. Injuries to the head may possibly cause such trouble, but fortunately the child's head seems capable of bearing much with impunity.
To my thinking, frights or shocks are very serious agents in the production of nervousness. Take the example of a nurse, who, being disturbed by a restless child, determined to frighten it into quiet by appearing as a ghost, with the result of peace to the nurse, but a shattered nervous system to the child. I have known the presence of a cat in the crib, or resting on the child, cause a terror which had serious results for some time. The ethics of ghost stories for children is one I will not now enter on. Unjust harshness is a serious cause of nervousness, as is also insufficiency of food, or food given irregularly, or of bad quality. I might multiply instances without end, but the one thing I wish to impress on you is that physical or moral illness, or shock, may, in an otherwise healthy child, stop the development of healthy self-control, and lead to nervous instability, and though the effects may be slowly overcome, they require full recognition.
I, at first, thought of giving here a typical specimen of nervousness, a kind of sample, but when I began to consider my instances in the concrete, I found that no one case gave all the characteristics which it is well to note, therefore, I shall only here say that children may be born nervous, may acquire nervousness at any age, and may develop into chronically nervous persons, but that fortunately they generally outgrow the weakness. We must accept it as a fact that the nervous child is unduly sensitive and unduly affected by all its surroundings, and the symptoms which I am now going to describe are those which may be present in any child, occurring singly or combined.
Do not think that all nervous children are diseased children, for fortunately the nervous children may grow to be world influences if not world rulers.
The essentials for a healthy child's development are sufficient food, sufficient rest, sleep, and normal sensory stimuli. Now as to the relationship of nervous children to these essentials. As to food, most nervous children are peculiar in their food appetite, they are often "faddy," cannot take this or that kind of food, are easily made sick. They have capricious appetites, at one time large, at another small or absent altogether. I have met with one nervous family in whom the desire for food seemed to be absent from birth; these children had to be fed for years before they took normally to feeding themselves, yet they were rather brilliant children in other respects. I see nervous children who are really suffering from starvation as the result of improper food or of abstinence altogether. The only treatment in such is to ignore the fancies, and by steady insistence get simple food taken. It is often found that leaving food in the way of the child, not making much fuss about it, leads to normal taking of it. I think abundant milk diet with no great amount of meat is best for these children.
Rest.Fidgetting children. There are degrees of restlessness, as fidgettiness is almost as trying for the nurse or mother as true restlessness. Children show this quite early; they seem, when awake, always on the wriggle, they are never able to soop long in any one attitude, and this state may lead to various troubles, habits and tricks, which may be both injurious and hard to break. I believe the best plan is to try muscular exercises, gymnastics, musical drill or the like, while this is to be followed by increasing periods of rest.
A child may be induced for a reward to stand for two minutes at a time with hands behind his back, or over his head, then for three minutes, and so on, till between each lesson a short period of rest is arranged for. I have found, too, that in some children the lying quite flat on their backs for a few minutes at a time has got them into good ways.
Sleep.Healthy children should spend the greater part of their earlier years in sleep, and the more nervous the child the more rest it should have. Sleep may be encouraged as a habit, and I believe it would be a great boon if more of us had cultivated the habit of spontaneous sleep, which is a kind of self-hypnotism.
The nervous child is often a restless sleeper, one who takes long in getting to sleep, and wakes or turns restlessly about in bed. I have seen a kind of maternal "suggestion" useful in these cases, for after all, whether you gently press on the child's eyelids and quietly whisper that it should go to sleep, or if you simply sing it to sleep, you are in both cases hypnotising, and nothing more.
The nervous child. as I said, often lies awake for hours in a dreamy state, weaving romances or talking to itself, the more imaginative even peopling the room with faces and figures, angels or demons.
The child with many "day-dreams" as a rule gets thin, irritable and unstable, so that he cannot apply himself to lessons, he gets "slack." Sleep must be got without drugs, the maternal suggestion or favourite food being useful, the hot bath or cold, with friction to the feet, may also be of service. Children who have day-dreams may have nightmares as well, but this does not follow. The nervous child has a great tendency to night-dreams which vary in degree from simple momentary horror which passes, leaving no apparent result, to the terror which may even pass into a convulsion. The nightmare often has a serious effect in leaving, if not making, the child nervous. He may thus become afraid of darkness and of solitude.
Somnambulism is another very common symptom in the nervous child. This is often but the active side of a dream. A great deal of nonsense has been written about this subject. There is no doubt it is most common in nervous children, it not uncommonly occurs only at very rare intervals; it is generally outgrown and it is very rarely associated with real physical danger. The somnambulist most frequently goes to its parent's room or to the general dining or sitting room; it also is easily awakened, and this awakening, if judiciously done, need lead to no danger. In my opinion the real danger of somnambulism is for the other children, who, if they happen to be awake, feel a vague terror when they see one of their fellows get up in the solemn silent manner of the somnambulist. The best plan to avoid danger is to have the room of the somnambulist with closed windows, no fire, and a lock on the door, and if possible a nurse should be in an adjoining bed.
The next symptom I will speak of is that of the so-called "rages." This is very common, and like the terrors of nightmare, varies in degree; but I regret to say it is one of the most common and most difficult to treat of all the nervous symptoms. This, like the restlessness of childhood, may begin in the very earliest years, I might almost say months of life. I have known infants in the cradle wake without apparent cause and scream and yell without ceasing for hours, then quietly turn over and go to sleep. In the more ordinary cases some very slight cause seems to loosen the bonds of self-control, and the child at once becomes violent and aggressive, regardless of everything, destructive and maniacal. At first this state is of little moment to the relations, but as the child grows, the rages increase and the modes of expression become dangerous, so that I have met with murderous children of eight or ten. These are perfect examples of the defect in the nervous control. It is in rest our strength is seen. The tremulous movement in old age and in St. Vitus' dance are signs of weakness, and the restless person is often a weak one; as a rule the power of control is the last acquired and the first lost. The rages of some children are the precursors of serious, nervous maladies, but in others they are outgrown.
The treatment of these rages is very difficult, for though a certain amount of judicious neglect is useful, yet serious nervous prostration may follow if such children are allowed to cry themselves to sleep. Every external impression, as a rule, only acts, as might have been expected, on the unstable, by increasing the points of nervous discharge. I believe the best plan is for one person, the least emotional of the family, to be alone with the child to give it, if possible, some food, such as milk with some sugar or sweet, such as it likes. I do not think any good is really effected by giving drugs, though in some very severe cases they have to be resorted to to prevent convulsions or other complications.
If the interest can be diverted by some other sensation, such as the sight of a favourite toy or animal, so much the better, but watch must be kept, as children in these rages will do brutal things or destroy their dearest treasures without apparent remorse.
I would protest against leaving the child, while in the rage, in a room by himself, in the dark. The disorder is a real physical one, and should be treated as such. I have no objection to a moral lesson after, or perhaps a modified punishment in the way of restriction of some pleasure, but, at the time, nothing but consideration must be extended to the sufferer.
(To be continued.)
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