September 17, 1910.

THE HOSPITAL 735

The General Practitioner's Column.

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PAYOR NOCTURNUS IN CHILDREN.

SOME POINTS IN TREATMENT.
By J. ALLEN.
curbed in their too strenuous efforts after know-
Payor nocturnus is one of the minor affections
ledge. These children should not be allowed to
with in children which, though not dangerous
^et ? enter for
hfe, is liable to entail much suffering on the part and excitement competitive examinations, as the strain
6 and t? cause much anxiety to parents.
accruing to such cannot fail
Tk adversely to affect their unstable nervous systems.
he
treatment, while generally satisfactory, may If a child is having attacks of night terror very fre-
occasionally baffle the resources of the medical quently it may be advisable to order six months'
attendant. rest from school work.
Many conditions seem to act as causative factors, complete The child's amusements should also be carefully
among which may be mentioned enlarged tonsils and The healthy influence of moderate exer-
Adenoids, phimosis, errors of refraction, worms, regulated. cise is undoubted, but any games that tend to cause
yspepsia, and constipation. In a fair percentage excitement should be
?
cases there is a rheumatic
discouraged.
diathesis, while in a General hygienic measures should be enforced.
dumber a neurotic family history is found. Some
are classed as
The sleeping apartment should be well ventilated
idiopathic, while a few appear to be and the window should be kept open night and day.
associated with more grave nervous affections, such,
or"
The child should be encouraged to be in the open air
instance, as epilepsy. as much as possible. Care should be taken not to
J-n
dealing with pavor nocturnus it is necessary to overclothe the child, and at night time especially not
consider the treatment during an attack, and the
to cover him with heavy bedclothes, as sweating
Cleans to be adopted to prevent recurrence.
During may thus be produced, and it has been suggested
attack every effort should be made to calm the
^child by that this may actually cause night terrors. Cold
gentle persuasion. The child should not
e
whipped or punished. A warm foot-bath and sponging (tepid at first if necessary) is invaluable
For some sea-bathing is
douches to the head may assist in allaying the and
co d is most invigorating.
? ate
of nervous terror. excellent, but it should only be permitted if followed
If necessary, the mother or
reaction. A child should not be forced
the bedside until the child falls by healthy
a
lurse should sit
as
by to bathe in the sea if he appears disinclined to do so.
eep again. If there is any suspicion of indiges-
lon- some recommend that an emetic should be A change of residence to the country or seaside is
so as to rid the stomach of its unwelcome
often advantageous.
p^en,
oad. If persuasion fails to pacify the child, a
The beneficial influence in the home of some
can hardly be over-estimated. It
ypnotic such as paraldehyde, bromural, potassium capable person
is most unfortunate if the child is left to the care of
romide, etc., may be given. a neurotic mother or nurse. It would be much
Of much
greater importance is the question of the better to send him away with some friend who would
Management of a child who is subject to attacks of be a congenial companion to him. It requires
night terror. In the first place a very careful a
person of firmness and tact and of a sympathetic
examination should be made in order to find out if nature
there is a possible causative factor, and if any such successfully to undertake the charge of a
child subject to night terrors. It is almost super-
.3e discovered it should at once be remedied. For fluous to mention that the child should not be told
lnstance, enlarged tonsils and adenoids should be about ghosts, and story-books of too exciting a
Removed, errors of refraction corrected, genital nature should, for the time being at any rate, be
lrritation treated, and so on. vetoed.
The diet should be carefully regulated. Plain With regard to drugs, these are of less importance
and easily
digested articles of food are the best. All than the points that have just been considered.
sweets and cakes should be forbidden, and the carbo-
However, if the child regularly suffers from night
hydrate intake should be strictly limited. Tea, terrors it is advisable to prescribe
coffee, and alcoholic beverages should not be bromural, or some similar drug at bedtime.antipyrine, Leonard
allowed. Meals should be taken regularly, and if Guthrie advises that the three bromides should
" "

*he child has been in the habit of eating between

be administered in neurotic cases, and he has found
ttieals this bad practice must be stopped. Care that this combination can be
continued without
should be taken to see that the evening meal is not a for a considerable period if moderate dosesharm are
heavy one. Eustace Smith advises that an alkali given. In rheumatic cases salicylate of quinine
should be given two or three hours after food. will be found useful. In anaemic children iron or
The education of the child must be very carefully iron and arsenic should be
ordered, while for de-
Supervised. It is a great mistake to drive these bilitated subjects cod-liver oil can be
?children too hard at school, and it is a debatable employed with
benefit.
point whether they should be punished for failing to
have adequately prepared their daily task. Some Prognosis is on the whole good, and with careful
treatment the condition can generally be cured. As
these children, far from being backward, are in- the child becomes older there is less
tellectually brilliant, and they rather require to be liability to
 I3G iHE HOSPITAL September 17, 1910.

suffer from pavor nocturnus. If the night terrors
are associated with some other nervous affection,
such as epilepsy, the prognosis will, of course, de-
pend on that. Pavor nocturnus probably does not
occur in the healthy child, and, in conclusion, it
should be borne in mind that the condition is not one
that should be neglected. As Dr. Still very aptly
" "
points out, the affection is the slacken speed to
the engine-driver, which must never pass unheeded.
Therefore thoroughly investigate every case and
promptly treat the condition. Kecollect- also that
prevention is better than cure, and in the case of
neurotic children much can be done by proper care
and training.