Malformation Of The Heart In Children
( Originally Published 1921 )
It may seem strange but it is nevertheless a fact that at birth a child's heart is always malformed in the sense that there are certain changes which must rapidly take place in its structure if the heart is to be perfect. The circulation before birth does not require that the lungs shall be abundantly supplied with blood because, of course, the unborn child can not breathe except through its mother. As the breathing and the circulation are intimately associated, this implies a different path for the blood, the most important variation being that the blood passes from the right side of the heart to the left side, and that there are several necessary communications between large vessels that are useless and harmful to the circulation after birth.
Trouble may come in two ways: there may be a defect in development, or there may be inflammatory disease of the heart before birth. It is thus evident that heart disease in young children is quite possible. When the malformation is extreme, the children do not live. Those that do survive may have a narrowing of the blood vessels, or there may be an opening between the two ventricles, or there may be a persistence of some of the temporary vessels. A child with heart disease from birth is apt to be blue, to breathe poorly and with effort, and to be subject to fainting attacks, and often backward in development.
If children with heart disease from birth can be kept alive until two years of age, there is a fair prospect that they may live to grow up; such is nature's power to adjust itself that people have reached old age in spite of this trouble. It is important that children with heart disease should be warmly clad; they are better off in an even, mild climate. The diet should be digestible, and the meals light and frequent. Such children should be guarded against the diseases of childhood, and an important point is that their education Should not be neglected because therein lies much unhappiness. It is better to run some risks and give these children exercise than it is to shut them up and make them invalids. Many of these children have a large increase in the number of their blood cells; this seems to be an attempt on the part of nature to make up for defective circulation.
The outlook for children with heart disease is never as desperate as it seems. Some of the happiest children I have known have been those with heart trouble, the redeeming feature being wise management.
In the care of young people with defective hearts, the mother's duties are most important, because she must bring to bear sound judgment in neither exaggerating nor making light of the condition. The mother should always, in such cases, bear in mind the cardinal signs of failure of the heart to meet demands made upon it; she should watch to see if the child is more than usually breathless; in bathing the child she should make pressure over the liver to see if there is tenderness in that place; and she should always be attentive to any swelling of the feet. In doing this, she must know her child, and keep her own counsel as to those dangers against which she can guard without alarming any one. There is a hopeful outlook under the intelligent guidance of one who knows the child.