THE MOTHER’S CARE OF HER BABY
“The mother is the natural guardian of her child; no other influence can
compare with hers in its value in safeguarding infant life.”—_Sir Arthur
Newsholme._
Before undertaking the care of the new baby, suppose we stop for a
moment, and consider just what he represents; what he has been through;
what struggles and dangers are ahead of him; what are the weaknesses of
his equipment to meet these perils and what must be the character of
your service to him if you are to do quite all in your power to help him
safely over this hazardous period of early infancy.
At the time of birth, the baby makes the most complete and abrupt change
in his surroundings and condition that he will make during his entire
lifetime.
For nine months he has existed under ideal conditions; he has been
safeguarded from injury; kept at the temperature which was best for him,
and above all, has been furnished with exactly the proper amount and
character of nourishment necessary for his growth and development.
Suddenly he emerges from this completely protecting environment into a
more or less hostile world, where he must assume the task of living,
with a frail little body that in many respects is only imperfectly
developed. And yet the baby must not only continue the bodily functions
and activities that were begun during his intra-uterine life, but must
develop certain functions which were imperfect and even establish others
which were performed for him.
You will recall that while within the uterus, the baby received his
nourishment and oxygen and gave up waste material through the placenta.
Accordingly, his organs of digestion, respiration and excretion are
imperfectly developed at birth and are capable of functioning only
within very narrow limits at first.
His respirations are usually established immediately after birth, when
he cries vigorously, for his lungs are thereby filled with air. The
other functions are established more gradually and the care of the baby
must be such that the immature, unused organs will have their
development promoted through activity and yet not be overtaxed.
=The Baby’s Condition at Birth.= The newborn baby boy weighs from seven
and a quarter to seven and a half pounds and is about twenty inches
long, girl babies being perhaps a little smaller. His body is well
rounded and his flesh firm. The skin is a deep pink, or even red, and is
covered with the cheesy substance called vernix caseosa, which is likely
to be thickly deposited over the back and in folds of the skin and
creases, as in the thighs and under the arms. Some babies still have,
when born, the fine downy hair on parts or all of the body, that they
had before birth.
The head and abdomen are relatively large, the chest narrow and the
limbs short. The legs are so markedly bowed that the soles of the baby’s
feet may nearly or quite face each other, but they finally assume a
normal position. The bones are still soft and the entire body is,
therefore, very flexible. Some of the bones which unite later in life
and make the adult skeleton firm and rigid, are separate at birth.
Most newborn babies have faded blue eyes, the permanent color appearing
gradually, but the amount and color of the hair varies greatly, some
babies being bald, while others have abundant hair from the beginning.
The shape of the baby’s head is often badly distorted at birth, being so
long from chin to crown that the mother is deeply concerned. But you may
rest quite assured that even though badly misshapen, your baby’s head in
the course of a few days will assume the lovely, rounded contour so
characteristic of babyhood. The temporary deformity of the head is
caused by a molding and overlapping of the bones of the skull as it is
forced through the narrow part of the pelvis, the inlet, that we learned
about in Chapter III. About the middle of the top of the head you will
be able to feel a soft, diamond shaped spot and farther back another
soft spot, smaller than the one in front and somewhat triangular in its
outline. These soft places are openings between the bones of the skull
and are called the _anterior_ and _posterior fontanelles_. They always
may be felt on the new baby’s head.
=Growth and Development.= The physical progress which is made during the
first year by average, normal babies who are satisfactorily nourished
and cared for is fairly uniform and the average rate of this progress is
somewhat as follows:
=Weight.= There is a loss in weight of 6 to 10 ounces during the first
week of life, after which the baby usually gains from 4 to 8 ounces each
week, during the first five months. From this time the gain is only
about half as rapid, or at the rate of 2 to 4 ounces weekly. At six
months, therefore, the average baby weighs from 15 to 16 pounds, or
double the normal birth weight of 7½ pounds, and at twelve months he
weighs from 20 to 22 pounds, or three times the average birth weight.
Fig. 41 gives an idea of how the baby’s weight drops during the first
week and the rate of the normal weekly gain afterwards, during the first
year.
[Illustration:
FIG. 41.—Baby’s weight chart showing the usual loss during the first
week and subsequent gain during the first year of life.
]
The weight is perhaps the most valuable single index to the baby’s
condition that we have, but at the same time it must be remembered that
a baby whose food contains an excess of sugar or starch may be of normal
weight, or over, but be incompletely nourished and very susceptible to
infection, while other babies who are small and gain slowly are
sometimes very well and vigorous. Moreover, quite commonly there are
periods in the lives of entirely normal babies during which there is
little or no gain in weight. This may occur during the period from the
seventh to the tenth month, for example, or in very warm weather. But
the doctor is likely to want to watch the baby’s weight, for when
studied in conjunction with other conditions it gives a certain amount
of information about the baby’s general state and progress.
=Height.= The height of the average baby at birth is about 20 inches,
though boys may measure a little more and girls a little less; at six
months it is about 25 inches and 28 or 29 inches at the end of a year.
=Head and Chest.= The circumferences of the head and chest are about the
same at birth, the chest being possibly a little the smaller of the two.
Both measure about 13½ inches, gradually increasing to about 16½ inches
in six months and to 18 inches by the end of the first year.
=Fontanelles.= The posterior fontanelle, the one at the crown of the
head, usually closes in six or eight weeks but the larger, anterior
fontanelle is not entirely closed until the baby is about eighteen or
twenty months old.
=Teeth.= Although it occasionally happens that a baby has one or two
teeth at birth, the average infant has none until the sixth or seventh
month, when the two lower, central incisors appear. After a pause of a
few weeks the two upper, central incisors come through, followed by the
two lateral incisors in the upper jaw. At the end of the first year,
therefore, the average baby has six teeth, or eight if the lower lateral
incisors have appeared by the first birthday, as they sometimes do. This
is the usual course of dentition, during the first year, as shown in
Fig. 42, but there are wide variations among entirely well and normal
babies, the first tooth sometimes not appearing before the tenth,
eleventh or even twelfth month. As a rule, however, an entire lack of
teeth by the time the baby is a year old is regarded as an evidence of
faulty nutrition.
[Illustration:
FIG. 42.—Diagram showing first, or “milk,” teeth and the ages at which
they usually appear.
]
The baby who is properly fed and cared for, cuts his teeth with little
or no trouble, in spite of the widely current but seriously mistaken
belief that a teething baby is a sick baby. We have no way of estimating
the number of babies who die, needlessly, as a result of this dangerous
conviction, for if the baby is sick while teething, the trouble is all
too often accepted as a normal occurrence and is not given the attention
it needs until too late. Frail, delicate babies may have convulsions
each time that a tooth is cut and if a baby is having digestive trouble,
this is likely to grow worse while he is teething. But cutting teeth is
a normal process and the healthy, properly fed baby suffers little or no
inconvenience while it is in progress.
=Stools and Urine.= During the first two or three days the stools are of
dark green, tarry material called meconium. In the course of two or
three days they begin to grow lighter and shortly the normal stools
appear, these being bright yellow in color, of a smooth, pasty
consistency and having a characteristic odor. During the first month or
six weeks the baby’s bowels may move three or four times daily, but
after this they usually move but once or twice in the course of
twenty-four hours. As the nourishment is increased, the stools grow
somewhat darker and firmer and finally become formed.
[Illustration:
FIG. 43.—Appearance of cord immediately after birth.
]
The newborn baby’s bladder usually contains urine and this may be passed
immediately after birth or not until several hours later. After the
first urination the bladder may be emptied five or six times a day or
oftener.
=The Cord.= Within a few days after birth the stump of the umbilical
cord that is attached to the baby’s navel, begins to shrivel and turn
black and a red line appears where the cord joins the abdomen. By the
eighth or tenth day, as a rule, the cord has shrunken to a dry, black
string, when it drops off and leaves an ulcer or small red area which
heals entirely in the course of a few days. Figs. 43, 44, 45 and 46 show
these progressive changes.
[Illustration:
FIG. 44.—Appearance of cord four days after birth.
]
[Illustration:
FIG. 45.—Appearance of navel immediately after cord has dropped off.
]
=Skin.= The soft, downy hair that may be remaining on the surface of the
body usually disappears by the end of the first week and there is often
a scaling of the skin which lasts for two or three weeks, while a
delicate pink tint replaces the deeper color of the skin in the course
of ten days or two weeks. The baby does not perspire until after the
first month, ordinarily, when a very slight perspiration begins,
gradually increasing until by the time the baby is a few months old he
is perspiring freely.
[Illustration:
FIG. 46.—Appearance of a normal, well healed navel.
]
=Tears.= There are no tears at birth and opinions differ as to whether
they appear in the course of two or three weeks or three or four months.
The absence of tears is one reason for bathing the baby’s eyes so
carefully during the early days and weeks, for if dust or other foreign
material gets into the eyes it is not washed out by tears as it is after
their flow is established.
=General Behavior.= During the first few weeks the average baby sleeps
most of the time; that is, from 19 to 21 hours daily. He gradually
sleeps less, as the special senses develop and will sometimes lie
quietly for an hour or more with his eyes open, sleeping only 16 or 18
hours, daily, at six months and 14 to 16 hours at the end of a year.
The baby begins to make noises and “coo” at about two months and to
utter various vowel sounds when about six months old. By the end of a
year these indefinite noises and sounds become distinct words. At about
the fourth month he grasps at objects and smiles, and very soon even
laughs. He holds up his head at about the third or fourth month; sits up
and also begins to creep at six or seven months, while sometime between
the ninth and twelfth months he will stand while holding on to something
secure and begin to walk with assistance.
These degrees of development at different ages are not to be taken as
the only measure of normal progress, for some well babies mature more
rapidly and many others more slowly than at the rate which is found to
be average. In addition to these fairly specific evidences of the baby’s
condition and progress, such as weight, height, strength and muscular
development, there are other and less definite indications of his
well-being which should be taken into account.
The baby who is well and is being properly fed in all respects, will
have good color; his flesh will be firm; he will take his nourishment
with a certain amount of eagerness and seem satisfied afterwards. He
will sleep for two or three hours after each feeding; will sleep quietly
at night and while awake, unless he is wet or uncomfortable for some
other good reason, he will seem contented, good-natured and happy.
You have seen how the average, well baby grows and develops, provided he
is given proper care. I want you now to have just a glimpse of the other
side of the question, so that you may realize what happens to the
unfortunate little citizens who are not given such care. This glimpse
will make you realize more than ever, how worth while are all of the
precautions that you take for your baby.
It is estimated that out of every 1000 babies born alive, in this
country, 40 die during the first month of life, and that more than as
many again, or about 85 all told, perish before reaching the first
birthday.
So hazardous is this period of early infancy, in the United States, that
our annual loss of baby life is between seven and eight times as great
as was the yearly loss of our young men in the war, for upwards of
200,000 babies less than a year old die each year. That the first month
is more dangerous than any which follow is shown by the fact that about
100,000 of these baby deaths occur during the first four weeks of life.
The tragedy of these figures is made darker by the fact that at least
half of the babies who are lost die from preventable causes. In other
words, they die from lack of proper care.
That is the point of this for you. These babies die, not by an act of
Providence, but from lack of care—not the difficult, complicated care
needed by sick babies but just the everyday care which any mother may
give—the care that keeps well babies well.
That is what you are going to do—keep your well baby well. And you are
going to be surprised to find how easy it is, after all, to say nothing
of the pleasure of it, for the thing very nearly sums itself up into
feeding your baby as the doctor orders and keeping him clean in every
particular. Bear these two factors in mind for errors in feeding and
lack of cleanliness are the underlying causes of the vast majority of
baby ills.
You will often feel a little like Alice in Wonderland, who found, one
time, that she had to keep running very fast to stay where she was, for
you will not be able to relax in a single detail of your baby’s care if
you are to keep him well. With him, as with you, or anyone else, the
satisfactory use of even ideal food is largely dependent upon the
general condition and mode of living, and we find accordingly, that the
question of keeping the baby well finally resolves itself into the
following common sense requirements:
1. Proper food.
2. Fresh air.
3. Regularity in the daily routine care.
4. Cleanliness of food, clothing and surroundings.
5. Preservation of an even body temperature.
6. Adequate rest and sleep.
7. Periodic consultations with your doctor.
Carve these principles into the tablets of your brain and you cannot
fail to give your baby the kind of care that is literally life-saving. I
am going to describe the tiny, intimate details of this care, for I
think this will help you, in the beginning at least, but if you will
keep these fundamentals in mind and use good common sense you really
need not read another word about baby care, for they give it all in a
nutshell.
Let me warn you emphatically against making the very serious mistake of
acting upon the advice of friends or relatives, no matter how many
children they have had. These counselors are just as dangerous for
babies as they are for expectant mothers, so beware of them!
“Is it not preposterous,” says Herbert Spencer, “that the fate of a
new generation should be left to the chance of unreasoning custom,
impulse, fancy, joined with the suggestions of ignorant nurses and the
prejudiced counsel of grandmothers? To tens of thousands that are
killed, add hundreds of thousands that survive with feeble
constitutions, and millions that grow up with constitutions not so
strong as they should be, and you have some idea of the curse
inflicted on their offspring by parents ignorant of the laws of life.”
It is a very wise precaution to have your doctor see the baby every week
or ten days during the first three months and once a month during the
remainder of the year. Not because he is fragile or ill. Not at all. You
consult your doctor in order to be sure that you are _keeping your baby
well_.
Did you ever hear of the Chinese custom of paying the doctor as long as
one is well, but not paying for attention during illness? It isn’t so
very heathenish—that idea of paying for the skillful care that will
prevent illness.
In addition to taking the general precaution of seeing your doctor
periodically, about the baby, be sure to consult him about anything that
you do not understand or about any new condition that arises. You will
find any number of persons who are ready and eager to advise you, but
your doctor is the only one whose advice it is safe for you to follow.
=The Daily Schedule.= The importance of regularity in the daily routine
of the baby’s care cannot be stressed too often nor too insistently. No
matter how well he is nursed in other respects, nor how skillfully the
doctor directs his care, the baby cannot be expected to progress
satisfactorily if his life is not absolutely regular.
Begin by arranging a daily program for the feedings, fresh air, bath,
sleep and exercise and then allow nothing to interfere with your
carrying it out.
The hours for the nursings, which vary with different doctors, will
constitute the greater part of this daily schedule. For a baby on four
hour feedings, for example, some such program as the following may be
arranged, while for a baby on a three hour schedule a slightly different
program may be arranged.
6 a.m. Feeding.
8 a.m. Orange juice (when ordered).
9 a.m. Bath.
10 a.m. Feeding.
10:30 to 2 p.m. Out of doors.
2 p.m. Feeding.
2:30 to 4 p.m. Out of doors.
4 p.m. Orange juice (when ordered).
4 to 5:30 p.m. Indoor airing and exercises (when ordered).
5:30 p.m. Preparation for the night.
6 p.m. Feeding.
10 p.m. Feeding.
2 a.m. Feeding (when ordered).
YOUR BABY’S FOOD
Proper feeding is probably the most decisive single factor in the
routine care of the baby.
In order that the food shall be satisfactory, it must be not only
suitable in composition for the individual baby, but it must be clean,
fresh and at the right temperature; given in suitable amounts and at
suitable intervals; it must be given properly—not too fast nor too
slowly and it must be given under favorable conditions. Moreover, as has
been stated, the baby, himself, must be kept in a general condition
which will promote the digestion and assimilation of the food that is
given to him. Fresh air, suitable clothing, an even body temperature,
gentle handling, proper bathing, regular sleep, freedom from excitement,
fatigue, and irritation all promote the baby’s ability to use his food
to advantage. Reverse conditions all work against it. Accordingly, the
actual value of the baby’s food to him will be largely dependent upon
the care that you give him.
There are three methods of nourishing the baby: by breast feeding, by
artificial feeding and by a combination of the two, termed mixed or
supplementary feeding.
=Breast Feeding.= From all standpoints, maternal nursing, under normal
conditions, is the most satisfactory method of nourishing a baby. If the
breast milk is suitable it meets all of the baby’s requirements and the
proportion and character of its constituents are exactly suited to his
digestive powers. In order for maternal nursing to be entirely
satisfactory, the condition of both mother and baby must be favorable.
The preparation and care of the mother have been described: her general
condition and state of nutrition; the care and condition of her nipples,
flat or retracted nipples being· brought out if possible, and if not,
the nursing facilitated by the use of a shield. As to the baby, if his
diaper is wet or soiled, it should be changed before he is put to the
breast, partly to make him comfortable and partly to avoid disturbing
him for this after his feeding; and his mouth is gently swabbed with
boric-soaked cotton, if your doctor so orders.[2]
Footnote 2:
Boracic acid solution is made by adding one teaspoonful of the
crystals to one cup (half-pint) of boiling water.
Although nursing is an instinct, the baby may have to learn how to nurse
or to acquire the habit, this being one reason for putting him to the
breast during those first two or three days when he obtains little or no
actual food, as was explained in Chapter IX. As he expresses the milk by
squeezing and suction made possible only when the nipple is well back in
his mouth, he must take into his mouth practically the entire colored
area which surrounds the nipple. To do this he lies in the curve of his
mother’s arm as she turns slightly to one side, and holds her breast
away from his nostrils in order that he may breathe freely.
Sometimes, even when other conditions are favorable, the baby is unable
to nurse because of some physical disability. He may be too feeble, may
have a cleft palate or find suckling painful because of an injury to the
mucous membrane which occurred when his mouth was wiped out just after
birth. The manner in which the baby nurses, therefore, may be
significant and should be described to the doctor if there is any
difficulty.
When the baby has finished nursing he should be taken up very gently,
held upright against the shoulder for a moment or two, to help him bring
up gas if he has any, and then placed in his crib and left to sleep. If
he is nursing satisfactorily, he will be sleepy and contented afterwards
and will sleep for two or three hours; he will seem generally
good-humored and comfortable while awake; he will have good color; gain
weight steadily and have two or three normal bowel movements daily. The
normal stool in breast-fed babies is bright yellow, smooth and has no
evidences of undigested food.
If the baby is not being adequately nourished, he will present exactly
the opposite picture, in some or all of these respects. He will be
unwilling to stop nursing after the normal length of time and will give
evidence of being not satisfied when taken from the breast. He may be
listless and fretful and sleep badly. He will not gain weight as he
should and he may vomit or have colic after nursing.
To ascertain whether or not such a baby is getting enough milk it is
customary to weigh him, without undressing him, before and after each
nursing. Each fluid ounce of milk will increase his weight one ounce. If
the baby is not obtaining a normal amount of milk at each nursing, he is
often given enough modified milk after each meal to supply the shortage,
but at the same time an effort is made to increase the supply of breast
milk by improving the mother’s personal hygiene, as described in Chapter
IX.
The amount which the baby needs at each feeding varies, not only
according to his weight and age, but also according to his vigor and
activity and therefore must be estimated for each baby. A very general
estimate of the amount taken by the average, well baby at each feeding,
is about as follows:
First week 1½ to 2½ ounces
Second and third week 2 to 4 ounces
Fourth to ninth week 3 to 4½ ounces
Tenth week to fifth month 3½ to 5 ounces
Fifth to seventh month 4½ to 6½ ounces
Seventh to twelfth month 6½ to 9 ounces
=Artificial Feeding.= There is no entirely adequate substitute for
satisfactory maternal nursing, and any other food that is given to the
young baby is at best a makeshift. Considering the baby’s delicacy,
therefore, and his urgent needs, no pains should be spared to make any
artificial food that is given to him, as satisfactory as possible. And
no matter what it costs, he should have only the freshest, cleanest and
purest milk that can be bought.
In preparing and giving artificial food it must be borne in mind that
normal breast milk has the following characteristics:
1. It is exactly right in quantity, quality and proportion.
2. It is fresh, clean and sweet.
3. It is free from bacteria.
4. It tends to protect the baby from infection.
5. It definitely protects him from certain nutritional diseases.
Cows’ milk, suitably modified, is apparently the best available
substitute for mother’s milk, but it must first meet certain
requirements and then be handled with scrupulous cleanliness and care,
if it is to be satisfactory.
The requirements are that the milk shall be:
1. Whole milk. It must not be altered by the removal of cream nor the
addition of such preservatives as salicylic acid, formaldehyde or
boracic acid.
2. Its composition must not vary greatly from day to day.
3. It must be clean and free from disease germs; other organisms
should not be present in excessive numbers.
4. It must be fresh; less than 24 hours old when it is delivered.
All of this means that the milk must come from a herd of healthy,
tuberculin-tested cows. The milk from a single cow may vary markedly
from day to day but that from several cows is nearly constant. The
stables and the cows must be kept clean, the udders carefully washed
before each milking; the milkers themselves must wear freshly washed
clothing, scrub their hands thoroughly and milk into sterile
receptacles; the milk must be immediately covered and cooled to a
temperature of 45° F. or 50° F. and kept there.
Milk produced under such conditions is usually described as “certified
milk” and is often prescribed as infant food without being pasteurized
or sterilized. But if there is any doubt about the source of the milk
and the method of its handling, it should be strained into a clean
receptacle through filter paper or a thick layer of absorbent cotton and
subsequently boiled or pasteurized.
Whether certified or not, the milk should invariably be placed in the
refrigerator, or some other place which has a temperature of 50° F., as
soon as it is received, and _it must be kept cool and clean_.
Keeping milk cool means keeping it at a temperature of 50° F. Keeping it
clean implies cleanliness not alone of the milk itself but of your hands
and the utensils that you use as well as the destruction of disease
germs by pasteurization or sterilization. Among the germs which are
likely to be present in infected milk are those that cause diarrhea,
sore throats, typhoid fever, diphtheria and scarlet fever.
When the doctor makes out the formula for the baby’s milk, he will
adjust the proportions of the different ingredients to the baby’s
immediate needs and digestive powers. But his careful estimations will
be set at naught unless you are absolutely _accurate_ in preparing and
giving the milk. Your invariable responsibility in connection with the
baby’s milk, therefore, is to keep it _cool_ and _clean_ and be
_accurate_.
You will appreciate the necessity for modifying cows’ milk before giving
it to your baby if you will note the differences between mother’s milk
and cows’ milk as indicated by the following table and consider, too,
why Nature has made these differences:
_Mother’s Milk_ _Cows’ Milk_
Fats 3.5 to 4. per cent 3.5 to 4. per cent
Sugar 6.5 to 7.5 per cent 4.5 to 4.75 per cent
Proteins 1. to 1.5 per cent 3.5 to 4. per cent
Salts .2 per cent .7 to .75 per cent
Water 87. to 88. per cent 87. per cent
The various tissues of the body and the bony skeleton are built by the
proteins and salt. Accordingly Nature supplies these in greater
abundance to the baby calf, who grows so fast as to double his birth
weight in about forty-seven days, than to the baby boy who scarcely
doubles his birth weight within 180 days. The calf begins life with a
physical need for the large amount of proteins and salts which are
present in cows’ milk and with digestive organs that can cope with them,
but the baby needs less, can digest less and, therefore, should be given
less. There are of course, other and finer differences between the two
milks and an attempt is sometimes make to meet these. For example,
mother’s milk is slightly alkaline and cows’ milk slightly acid and the
curd of cows’ milk is larger, tougher and harder to digest than that
formed by mother’s milk. Some doctors add lime water to cows’ milk,
before giving it to the baby, to make it alkaline and have the curd made
softer, finer and more digestible by boiling.
=Articles Needed in Preparing the Baby’s Food.= A complete equipment for
preparing and giving the baby’s milk should be assembled, kept in a
clean place, separate from utensils in general use, and never put to any
other service. A satisfactory outfit for this purpose comprises the
following articles:
One dozen graduated nursing bottles.
One dozen nipples.
Clean, new corks or a package of sterile, non-absorbent cotton for
stoppers.
Bottle brush.
Covered kettle, capacity one gallon, for boiling bottles and possibly
pasteurizing milk.
Pasteurizer or wire bottle rack.
Small kettle, about one quart size.
Graduated pint or quart measuring glass.
Pitcher, two-quart size.
Long-handled spoon for mixing.
Funnel.
Measuring spoons—table and tea sizes.
Double boiler.
Thermometer which will register at least 212° F.
Cream dipper (if ordered).
Two small covered jars for sterile and used nipples.
Sugar (lactose, maltose or cane sugar according to orders).
Lime water (if ordered).
Utensils of enamel or aluminum ware are probably the most satisfactory
ones to use as they are easily kept clean, while bottles with wide
mouths and curved bottoms and inner surfaces can be thoroughly washed
more easily than those with small necks and sharp corners. Nipples that
can be turned inside out to be washed should be selected as it is almost
impossible to clean thoroughly those with tubes or narrow necks. New
bottles will be rendered less breakable if placed in cold water, which
is gradually heated, allowed to boil for half an hour and cooled before
the bottles are removed.
The bottles should be rinsed with cold water after each feeding and then
carefully washed and scrubbed with the bottle brush in hot soapsuds or
borax water, containing two tablespoonfuls to the pint. They may be kept
full of water while not in use or rinsed with hot water and stood upside
down until they are all boiled on the following morning, preparatory to
being filled with the freshly prepared milk. The baby’s bottles should
never be washed in dishwater nor dried on a towel. The nipples should be
rinsed in cold water, turned inside out and scrubbed with a brush, in
hot soapsuds or borax water; rinsed and placed in a jar ready to be
boiled with the bottles.
=Preparing the Milk.= The full quantity of milk which the baby will take
in the course of twenty-four hours is prepared at one time and the
prescribed amount for each feeding poured into as many separate bottles
as there will be feedings.
You should begin by assembling on a table everything that you will use
in preparing the milk formula, as the nurse has in Fig. 47. Boil for
five minutes all of the articles that will come in contact with the
milk, including the full number of bottles and nipples and the jars in
which the nipples are kept; remove them with the long-handled spoon
without touching the edges or inner surfaces, dropping the nipples into
one of the sterile jars.
Wash the mouth of the milk bottle before removing the cap and pour the
amount which the formula calls for into the sterile pitcher. To this is
added the sterile water in which the sugar has been dissolved in the
measuring glass and then the potato or barley water, the lime water or
soda solution as ordered. This mixture is thoroughly stirred and the
amount for one feeding at a time, measured in the measuring glass and
poured into the specified number of bottles, which are then stoppered.
[Illustration:
FIG. 47.—Preparing the baby’s milk. (From a photograph taken at Johns
Hopkins Hospital.)
]
If certified milk is used for the milk mixture it is often given to the
baby without being pasteurized, in which case the bottles are placed in
the refrigerator as soon as they are filled and stoppered. Very
frequently, however, the milk is sterilized or pasteurized. You will
feel surer of keeping the mouths of the bottles clean if you cover them
with squares of gauze or muslin before they are sterilized, holding the
caps in place with tapes or rubber bands.
Pasteurization as applied to infant feeding consists of heating the milk
to 140–165° F. and keeping it at that temperature for 20 to 30 minutes.
There are many excellent pasteurizers for home use on the market, but
entirely satisfactory results may be obtained by improvising one from
the wire bottle rack seen in Fig. 47, and the large kettle already
provided. One method is to place the rack, containing the bottles, in
the kettle which is filled with cold water to a level a little above the
top of the milk in the bottles, and allow the water to come to the
boiling point. The kettle is removed from the fire, covered tightly and
the bottles allowed to stand in the hot water for twenty minutes. Cold
water is then run into the kettle to cool the milk gradually and avoid
breaking the bottles, after which they are placed in the refrigerator,
well or spring-house and kept at a temperature of 50° F. until they are
taken out, one at a time, for feedings. If a wire rack is not available
the bottles may be stood on a saucer or a thick pad of folded newspapers
in the bottom of the kettle.
Pasteurization does not destroy all germs that may be in the milk, but
it kills the more important ones and apparently impairs the nutritive
and protective properties of the milk less than boiling. However,
pasteurized milk must be kept cold and must be used within twenty-four
hours, for the aging of milk is quite as undesirable as souring.
Scalding is another method of destroying germs in milk. The milk is
placed in an open vessel and the temperature raised to about 180° F., or
until bubbles appear around the edge and the milk steams in the center,
after which it is cooled and kept at a temperature of 50° F.
Many doctors prefer to have the baby’s milk boiled, since boiling
insures absolute sterilization and also renders the curd more
digestible. Other changes are produced by boiling, however, which make
it important to add orange juice and cod-liver oil to the baby’s diet at
an early date, as will be explained in the next chapter.
Milk may be boiled directly over the flame for a time varying from three
to forty-five minutes, or it may be placed in a double boiler, the water
in the lower receptacle being cold, and allowed to remain until the
water has boiled from six to forty-five minutes.
When milk is boiled or scalded, the other ingredients are added
beforehand, as a rule, after which it is measured and poured into the
bottles. Or the milk mixture may be poured into the bottles as for
pasteurization and the bottles kept in the actively boiling water for
any desired length of time.
All of these points, however, are definitely specified by the doctor.
=Giving the Baby His Bottle.= At feeding time, the bottle should be
taken from the refrigerator, the stopper removed and a sterile nipple
taken up by the margin and put on the bottle without touching the
mouthpiece. The milk is brought to a temperature of about 100° F. by
standing the bottle in a deep cup or kettle of warm water and placing it
on the fire. The temperature of the milk may be tested by dropping a few
drops on the inner side of the wrist or forearm where it should feel
warm but not hot. This dropping will also indicate if the hole in the
nipple is of the proper size to allow the milk to drop rapidly in clean
drops but not to pour. If the hole is too small, the drops will be small
and infrequent and the baby will be obliged to work too hard to obtain
it; while if the hole is too large the baby will feed too rapidly and
may have colic as a result. If the hole is too large the nipple will
have to be discarded; if too small or if there is no hole, one of the
proper size may be made by piercing the nipple with a heated darning
needle or small steel knitting needle.
[Illustration:
FIG. 48.—Proper position in which to hold baby and bottle during
feeding.
]
[Illustration:
FIG. 49.—Holding the baby upright immediately after feeding, and
gently patting his back to help him bring up air in order to prevent
colic.
]
The baby’s diaper should be changed if it is soiled or wet before he is
given the bottle and he should be held comfortably on your arm, in a
reclining position, while you hold the bottle with your free hand as
shown by the nurse in Fig. 48. The bottle should be inclined
sufficiently to keep the neck full of milk; otherwise the baby may draw
in air as he nurses. He should be kept awake while feeding but he should
be allowed to pause every three or four minutes in order not to take his
milk too rapidly. Not less than ten nor more than twenty minutes is
devoted to a feeding, as a rule, and if the baby refuses a part of his
milk, it should be thrown away; never warmed over for another time.
After being fed, the baby should be held upright against your shoulder
for a moment or two, as in Fig. 49, and ever so gently patted on the
back to help bring up any air which he may have swallowed. He should on
no account be rocked nor played with after taking the bottle, but should
be placed gently in his crib, warm and dry and left alone to sleep.
Turning him or moving him about even to the extent of changing his
diaper at this time may cause vomiting.
The evidences of satisfactory and unsatisfactory feeding in the
bottle-fed baby are about the same as in the baby who is fed at the
breast, except that the gain in weight on artificial food may be a
little slower and less steady than on maternal nursing; the stools have
a characteristic sour odor; are a little lighter in color and may
contain white lumps of undigested fat; are usually dryer than in breast
feeding and may be formed, in even a very young baby.
Many doctors feel that all babies, whether breast-fed or on the bottle,
require a certain amount of cool boiled water to drink between feedings.
A small amount is given at first and gradually increased according to
the doctor’s instructions, and it may be given from a bottle, a medicine
dropper or poured slowly from the tip of a teaspoon.
I feel sure that you have realized, long before this, that the entire
question of planning the baby’s food is such an important and
complicated matter that it cannot with safety to the baby be undertaken
by any one but your doctor. Unexpected situations do arise, however,
when the doctor is not within immediate reach and the mother has to plan
the baby’s food, temporarily, to the best of her ability.
Should you find yourself in such an emergency, you will find help in the
milk formulas contained in a pamphlet issued by the American Medical
Association, remembering that they are intended for the average, normal
baby and are not necessarily suitable for all babies. A large, vigorous
baby may need more food and a small, frail baby have to take less than
the amounts specified in the following directions:[3]
Footnote 3:
From “Save The Babies” by Dr. L. Emmet Holt and Dr. H. K. L. Shaw.
Copied by courtesy of The American Medical Association.
“The simplest plan is to use whole milk (from a shaken bottle) which
is to be diluted according to the child’s age and digestion.
“Beginning on the third day, the average baby should be given 3 ounces
of milk daily, diluted with seven ounces of water. To this should be
added one tablespoonful of lime water and 2 level teaspoonfuls of
sugar. This should be given in 7 feedings.
“At one week, the average child requires 5 ounces of milk daily, which
should be diluted with 10 ounces of water. To this should be added 1½
even tablespoonfuls of sugar and one ounce of lime water. This should
be given in 7 feedings.
“The milk should be increased by ½ ounce about every 4 days.
“The water should be increased by ½ ounce about every 8 days.
“At 3 months the average child requires 16 ounces of milk daily, which
should be diluted with 16 ounces of water. To this should be added 3
tablespoonfuls of sugar and 2 ounces of lime water. This should be
given in 6 feedings.
“The milk should be increased by ½ ounce about every 6 days.
“The water should be reduced by ½ ounce about every 2 weeks.
“At 6 months the average child requires 24 ounces of milk daily, which
should be diluted with 12 ounces of water. To this should be added 2
ounces of lime water and 3 even tablespoonfuls of sugar. This should
be given in 5 feedings.
“The amount of milk should be increased by ½ ounce every week.
“The milk should be increased only if the child is hungry and
digesting his food well. It should not be increased unless he is
hungry, nor if he is suffering from indigestion even though he seems
hungry.
“At 9 months, the average child requires 30 ounces of milk daily,
which should be diluted with 10 ounces of water. To this should be
added 2 even tablespoonfuls of sugar and 2 ounces of lime water. This
should be given in 5 feedings.
“The sugar added may be milk sugar or, if this cannot be obtained,
cane (granulated) sugar or maltose (malt sugar).
“At first plain water should be used to dilute the milk.
“At 3 months, sometimes earlier, weak barley water may be used in the
place of plain water; it is made with ½ level tablespoonful of barley
flour to 16 ounces of water and cooked 20 minutes.
“At 6 months the barley flour may be increased to 1½ even
tablespoonfuls, cooked in the 12 ounces of water.
“At 9 months, the barley flour may be increased to 3 level
tablespoonfuls, cooked in the 10 ounces of water.
“A very large baby may require a little more milk than that allowed in
these formulas. A small delicate baby will require less than the milk
allowed in the formulas.”
These formulas may be tabulated as shown on p. 177.
=Mixed Feeding.= Under some conditions the breast-fed baby is given also
a certain amount of modified milk, and this combination of natural and
artificial feeding is termed mixed or supplementary feeding.
A deficiency in the breast milk, ascertained by weighing the baby before
and after each nursing, may be supplied by following each nursing with a
bottle feeding; or for some reason, one or two breast feedings, in the
course of the day are sometimes replaced by entire bottle feedings. In
any case the milk mixture to be used as supplementary feeding is
prepared with exactly the same painstaking care as is the milk for
entire artificial feeding.
If supplementary food is given because of an inadequate supply of breast
milk, it is of great importance that the baby be put to the breast
regularly, no matter how little food he obtains, for his suckling is the
best possible means of stimulating the breasts to secrete more milk, and
of equal importance is the fact that they will tend to dry up if the
baby nurses less than about five times in twenty-four hours. Moreover,
even a little breast milk is valuable to him and he should have the
benefit of all there is to be had.
─────────┬────────┬────────┬───────┬───────┬─────────┬─────┬──────────────────
_Age_ │ _Milk_ │_Water_ │_Barley│ _Lime │ _Sugar_ │_No. │ _Hours_
│ │ │Water_ │Water_ │ │ of │
│ │ │ │ │ │feed-│
│ │ │ │ │ │ings_│
─────────┼────────┼────────┼───────┼───────┼─────────┼─────┼──────────┬───────
│ │ │ │ │ │ │ _Day_ │_Night_
═════════╪════════╪════════╪═══════╪═══════╪═════════╪═════╪══════════╪═══════
3–7 days │3 ozs.│7 ozs.│ │½ ozs.│2 tea- │ 7 │6–9–12–3–6│10–2
│ │ │ │ │ spoons│ │ │
2d week │5 „ │10 „ │ │1 „ │1½ table-│ 7 │6–9–12–3–6│10–2
│ │ │ │ │ spoons│ │ │
3d „ │6 „ │10½ „ │ │1 „ │1½ „ │ 7 │6–9–12–3–6│10–2
1 month│7 „ │11 „ │ │1 „ │2 „ │ 7 │6–9–12–3–6│10–2
2 „ │11 „ │13 „ │ │1½ „ │2½ „ │ 7 │6–9–12–3–6│10–2
3 „ │16 „ │ │16 ozs.│2 „ │3 „ │ 7 │6–9–12–3–6│10–2
4 „ │19 „ │ │15 „ │2 „ │3 „ │ 6 │6–9–12–3–6│10
5 „ │21½ „ │ │14 „ │2 „ │3 „ │ 6 │6–9–12–3–6│10
6 „ │24 „ │ │12 „ │2 „ │3 „ │ 5 │6–10–2–6 │10
7 „ │26 „ │ │12 „ │2 „ │3 „ │ 5 │6–10–2–6 │10
8 „ │28 „ │ │11 „ │2 „ │2½ „ │ 5 │6–10–2–6 │10
9 „ │30 „ │ │10 „ │2 „ │2 „ │ 5 │6–10–2–6 │10
─────────┴────────┴────────┴───────┴───────┴─────────┴─────┴──────────┴───────
An entire bottle feeding is sometimes given to a baby who is nursing
satisfactorily at the breast, in order to give his mother an opportunity
to take longer outings than are possible between the regular nursings.
And sometimes it is to the mother’s advantage, and therefore to the
baby’s, to give him a bottle during the night and thus allow her to
sleep undisturbed.
COMMERCIAL BABY FOODS
Since the baby’s nourishment is prescribed by the doctor, you have no
reason to concern yourself with the various proprietary baby foods and
canned and powdered milks that are so persuasively advertised to young
mothers. And I earnestly hope that by the time you finish this little
book, no one will be able to make you believe that any of these foods is
likely to be satisfactory if used as a sole article of diet throughout
the bottle-feeding period.
Unquestionably there are many times and circumstances when the temporary
or supplementary use of a prepared infant food or canned or powdered
milk is advantageous.
In some cases of intestinal disturbance a proprietary food may be a
great boon, or while the mother is traveling and is unable to have
freshly prepared milk formulas supplied to her along the way. These
foods may be valuable, also, during the summer, while one stays at a
hotel or boarding house where the freshness, cleanliness or purity of
the milk are uncertain, or during a sudden shortage of fresh milk, as
may occur during a strike or severe storm when transportation is
interrupted. But you should not use a prepared infant food for any
length of time without your doctor’s order.
If you are confronted with the necessity of choosing a prepared food,
for temporary use, you may be guided by considering the general objects
and principles of baby feeding and the character of the various foods at
your disposal.
=The proprietary foods= may be divided into two general groups: one kind
contains milk powder and is usually added to water, while the other
consists largely of sugar and starch and is added to fresh milk before
being given to the baby.
=Canned milk= is of two kinds; evaporated, which is unsweetened, and
condensed, which is sweetened. _Evaporated milk_ is whole milk from
which part of the water has been removed, the milk then being canned and
sterilized. The addition of water to evaporated milk restores it to the
composition of whole milk in many respects, but it is still milk that
has been heated. _Condensed milk_ is evaporated milk to which cane sugar
has been added to aid in its preservation. Since bacteria do not grow
well in highly sweetened foods, it is not necessary to bring sweetened
condensed milk to as high a temperature as the unsweetened product, to
prevent subsequent bacterial decomposition. The high percentage of sugar
in condensed milk quite obviously renders it unsuitable for continuous
use as the sole article in a baby’s dietary.
=Milk powders or dried milks= are prepared by rapidly evaporating the
water from whole milk, skimmed milk or partly skimmed milk, leaving the
solid constituents in the form of a light, white powder. Milk powder
readily dissolves in water, forming a “reconstructed milk” which closely
resembles the fresh milk from which it was prepared. But it must not be
forgotten that reconstructed milk has been heated. Many doctors consider
whole milk powder the most satisfactory form of preserved milk which is
available for baby food. Should it be used, however, the importance of
keeping it tightly covered and in a cold place must be recognized, for
the presence of fat renders it likely to become rancid if not kept cold.
ARTICLES OF FOOD WHICH ARE SOMETIMES INCLUDED IN THE BABY’S DIETARY
=Barley water=, sometimes used to dilute whole milk, is made by mixing
the barley flour to a smooth paste in cold water, adding boiling water
and boiling for twenty minutes or cooking in a double boiler for an
hour, straining and adding enough water to replace the amount lost in
cooking. The proportions for different ages are as follows:
Three months, ½ level tablespoonful barley flour to 16 oz. water.
Six months, 1½ level tablespoonfuls barley flour to 12 oz. water.
Nine months, 3 level tablespoonfuls barley flour to 10 oz. water.
=Potato Water.= One tablespoonful of thoroughly boiled potato is mashed
into one pint of the water in which the potato was boiled and carefully
strained.
=Spinach.= Spinach is carefully washed, steamed for half an hour and
mashed through a fine sieve. It is sometimes started at the sixth month;
one teaspoonful daily, gradually increased to one or two tablespoonfuls
daily.
=Orange Juice.= The orange should be dipped in boiling water and wiped
on a clean towel before being cut and squeezed, to avoid possible
infection of juice. It is usually given to babies, sometimes as young as
one month old, who take heated milk. It is carefully strained and
started gradually by giving one teaspoonful in water once or twice daily
between feedings and increasing to ½ or 1 ounce by the sixth month and
1½ to 2 ounces by the end of the first year.
=Infusion of Orange Peel.= This is sometimes used instead of orange
juice, and is made by boiling one ounce of finely grated orange peel in
two ounces of water, adding a little sugar to counteract the bitter
taste and adding enough sterile water to bring it up to two ounces.
=Tomato Juice.= Canned tomato strained through a fine sieve, is
sometimes given to a baby a few weeks old, starting with one teaspoonful
and gradually increasing to four to six ounces daily.
=Whey.= One quart of whole milk heated to 98° F. or 100° F. and one half
ounce of liquid rennet or one junket tablet stirred into it and allowed
to stand half an hour or until firm and solid, is poured into a
cheesecloth bag and allowed to drain for about an hour without being
squeezed.
=Protein Milk.= The curd from one quart of milk, which remains after the
whey is drained, as directed above, is mashed through cheesecloth in a
fine wire sieve, with a potato-masher or bowl of a spoon and the curd
washed through with one pint of water. A pint of buttermilk is added and
the mixture boiled while being stirred constantly. This is sometimes
given in diarrhea.
=Beef Juice.= One pound of thick round steak, slightly broiled, is cut
into small pieces and the juice expressed with a meat press or a lemon
squeezer, the amount varying from 2 to 3 ounces. It may be diluted with
an equal amount of warm water, or slightly warmed by being placed in a
cup standing in hot water, and salted to taste.
=Broths.= One pound of lean meat, all fat and gristle removed, is
allowed to one pint of water. The meat is cut finely and put on in cold
water, heated slowly and allowed to simmer for three or four hours, when
water is added to replace what was lost in cooking. It is strained, the
fat removed and slightly salted.
=Oatmeal Water.= Two level tablespoonfuls of oatmeal in a pint of
boiling water is cooked in a double boiler for two hours, strained and
enough boiling water to replace the amount lost in cooking.
BATHING AND DRESSING YOUR BABY
By the time you assume your baby’s care he will probably be having his
daily bath in a tub. It may be given under a spray, however, or the
doctor may prefer to have him sponged. The sponge bath may be given in
your lap or on a table covered with a pad, either method being
satisfactory if the baby is kept warm and comfortable. But one inclines
to the idea of having the baby bathed in the lap for he seems happier
there; more comfortable and less frightened and we cannot be sure that
these factors are unimportant to even a tiny baby.
The best time for the daily bath, during the first three or four months,
is about an hour before the second feeding in the morning. After this
age the full bath is sometimes given before the six o’clock feeding, in
the evening, for a bath at this hour is soothing and restful and often
helps toward giving the baby a good night.
Preparation for the bath should be made with its possible effects, both
good and bad, in mind, for the baby may be helped or harmed according to
the skill with which he is bathed. He must not be chilled during his
bath, and fatigue and irritation must be avoided by giving it quickly
and with the least possible handling and turning. These ends may be
served by conveniently arranging all of the articles which will be
needed, on a low table at the right hand side of your chair, before the
baby is undressed.
There should be a pitcher of hot and one of cold water; a bath
thermometer; two soft washcloths; soft towels; bath blankets; Castile,
or some other mild soap; boracic acid solution; sterile cotton pledgets;
large and small safety-pins, or large ones and a needle and thread if
the band is to be sewed on; unscented talcum powder; sterile albolene or
olive oil; soft hair brush and a complete outfit of clothing. The little
garments should be arranged in the order in which they will be put on,
the petticoat slipped inside the dress, and in cold weather, all hung
before the fire or heater, to warm.
The temperature of the room should be about 72° F. and if it is possible
to bathe the baby before an open fire or a heater, so much the better.
In any case he must be protected from drafts and a sheet hung over the
backs of two straight chairs will serve very well as a screen if no
other is available.
The tub or basin should be about three-quarters full of water at 100° F.
for the new baby; about 95° F. after the third month and gradually
lowered to 85° F. or 90° F. for the baby a year old. The temperature of
the water should not be guessed at, but tested with a thermometer,
though in an emergency you may safely use water that feels comfortably
warm to your elbow.
Lay a folded towel in the bottom of the tub, before beginning, as babies
are often frightened by coming in contact with the hard surface.
It is a good plan to wear a waterproof apron, covered with one of
flannel over which is laid a soft towel, until the bath is finished. The
towel is then slipped out, leaving the dry, flannel apron to wrap about
the baby. Wash your hands thoroughly with hot water and soap, before
beginning; sit squarely, with your knees together, on a chair without
arms; take the baby in your lap and undress him under a blanket. In
order that the bath may be given deftly and quickly it is well to bathe
the different parts in the same order every day, for practice makes
perfect.
It is usually a routine to weigh the baby every morning, during the
first two or three weeks and once or twice a week afterwards, though
premature babies and those who are frail are sometimes weighed at longer
intervals because of the inadvisability of disturbing them so often. The
baby is undressed for his bath, wrapped in a blanket, and laid in the
scoop or basket of a beam scale and a note made of the entire weight,
for if he is placed in the scales without protection he is likely to be
chilled and frightened. The weight of the blanket is ascertained
separately and deducted from the total thus giving the baby’s exact
weight.
The eyes should be bathed first, with pledgets of sterile cotton dipped
in warm boracic acid solution, each pledget being used but once. To
prevent the solution from running from one eye into the other, the
baby’s head is turned slightly to one side and the lower eye wiped
gently from the nose outward. The lids may then be separated by placing
one thumb below the brow and lifting it slightly, and the eye flushed
with a gentle stream by squeezing a freshly soaked pledget just above
it. The head is turned to the other side and the eye on that side bathed
in like manner.
The mouth is swabbed out _very gently_ with boric-soaked cotton wrapped
about the tip of the little finger, care being taken not to injure the
delicate mucous lining. The nostrils are cleaned with little spirals of
cotton dipped in mineral oil or olive oil.
The face is then washed with warm water, no soap, and patted dry. The
scalp, neck and ears are washed with soap and water and thoroughly dried
by patting and by wiping gently in the creases. The body should then be
soaped with your hand, only one part being uncovered at a time in order
to avoid chilling.
To place the baby in the tub, slip your left hand under his head in such
a way that it will rest upon your wrist as your fingers spread out to
support his shoulders. Your thumb naturally curves over and holds the
upper part of the baby’s arm without pulling or straining it. Grasp his
ankles with the right hand and lower the little body into the water,
feet first, as shown in Fig. 50. This gradual lowering of the baby into
the water is worth while, for he is likely to be frightened if he is
plunged in suddenly. If the baby’s arm and shoulder are firmly held and
supported by your left hand, it is an easy matter to steady his entire
body and keep his head out of the water while giving the bath with your
right hand, as in Fig. 51.
[Illustration:
FIG. 50.—Method of holding baby and lowering him into his bath.
]
[Illustration:
FIG. 51.—Method of comfortably supporting the baby’s head above the
water while giving his bath.
]
The new baby is not usually kept in the tub for more than two or three
minutes, but when he is three or four months old he may stay in for five
minutes and still longer as he grows older.
Hot water should never be poured into the tub after the baby has been
placed in his bath but cold water is often added, for a three or four
months old baby, or the warm bath followed by a quick sponge with cold
water. The little body is quickly patted dry, afterwards, and rubbed
briskly with the palm of the hand; the legs and arms stroked toward the
body; the back from the neck downward and the chest and abdomen with a
circular motion. Babies who react well to cold baths are benefited by
them, but those who do not, may be harmed. Such “toughening” methods, to
be beneficial, therefore, must be adjusted very carefully to the
individual baby and should be employed only in accordance with the
doctor’s directions.
The =genitals= should be bathed and dried with care; inspected daily and
any unusual appearance reported to the doctor. It is not uncommon for
girl babies to have a slight bloody discharge from the vagina. Although
this is unimportant and soon disappears, your doctor should be told of
any discharge, however slight. The doctor often wishes to have the
foreskin of boy babies retracted every morning at the time of the bath,
by gently rubbing it back with gauze or cotton, taking pains that it is
pulled forward to the original position after the part underneath has
been thoroughly bathed with boracic acid solution. If retraction is
impossible after several daily attempts, the baby is not infrequently
circumcised.
The care of the baby’s =teeth= is a part of the bath and should begin
when the first tooth appears. It should be wiped front and back with a
piece of gauze or cotton dipped in boracic acid or soda solution or some
other weak alkaline wash, to neutralize the acid secretions of the mouth
as these favor decay. After the baby has five or six teeth, the use of a
very soft brush with tooth paste is often advised, the teeth being
brushed with a circular motion or from the gums toward their edges. The
teeth should be wiped, or brushed, morning and evening and after
feedings. The reason for such close care of the temporary teeth is that
they serve as a mold or brace to hold the jaws in proper shape for the
permanent teeth which appear later. If the “milk” or first teeth decay
or crumble away before the jaws are developed to the point when the
permanent teeth appear, these second teeth are likely to be crowded,
crooked and uneven.
After all of these details have been attended to and the entire body,
including creases and folds, has been patted quite dry, it may be dusted
with an unscented talcum powder, but this powdering must not be resorted
to as an aid in drying the skin. In order to prevent chafing, the
buttocks and thighs should be wiped clean with oil, or bathed with warm
water, no soap, patted dry and powdered or oiled each time that the
diaper is changed.
The =cord= has dropped off, in all probability, by the time you begin to
bathe your baby, and the navel so well healed that you need do nothing
to it, but you may be interested to know what painstaking care the nurse
has given to this important detail of the baby’s toilet. The form and
method of cord dressings vary somewhat with different doctors but in
practically all cases the dressings are sterile, to prevent infection,
and porous in order that air may gain access to the cord and promote the
drying process. The dressing itself may consist of dry, sterile gauze or
gauze wet with alcohol wrapped about the cord, as shown in Fig. 52; or
it may consist of squares of sterile gauze or muslin with holes in the
centers to fit around the cord, and dusted with some such powder as
boric acid, bismuth or salicylic acid and starch. The dressed cord is
laid flat on the abdomen and directed upward to prevent its being wet
with urine; a gauze sponge is placed over the dressing and the flannel
binder applied, being sewed on or held in place with safety-pins, as
shown in Fig. 53.
[Illustration:
FIG. 52.—Cord dressed with dry sterile gauze. (From photograph taken
at Johns Hopkins Hospital.)
]
[Illustration:
FIG. 53.—Straight flannel binder applied over cord dressing.
]
The band is put on firmly and with even pressure, but not tightly. It is
a mistake to think that a tight band strengthens the baby’s abdominal
muscles, for it has quite the opposite tendency and in addition may give
pain and even cause vomiting. The band is removed every morning at the
time of the bath, or whenever it is soiled, but the cord dressing is not
usually taken off unless it is soiled. When the cord finally drops off,
the straight flannel binder is replaced by a knitted band with shoulder
straps. This is usually worn for three or four months, particularly in
cold weather, to provide a little extra warmth over the abdomen. Thin,
delicate babies sometimes need this band for a year or more.
[Illustration:
FIG. 54.—Putting on the diaper which has been folded straight through
the middle.
]
After the band has been applied, the warmed shirt is put on and then the
diaper. There are two methods of putting on the diaper.
One is to fold the square diagonally and bring the diagonal fold around
the baby’s waist. One of the lower corners is drawn up between the
thighs, the two corners from the sides brought over this, straight
across the waistline and not carried down between the thighs. The fourth
corner is brought up over these and all are pinned securely with a
safety-pin, while two other safety-pins hold the margins of the diaper
together above the knees. The other method is to fold the diaper
straight through the center, forming a rectangle twice as long as it is
wide; to lay the baby on it lengthwise, draw the lower half up between
his thighs as shown in Fig. 54, and pin it on each side at the waistline
and above the knees. (See Fig. 55.)
In either case the diaper must be put on smoothly and care taken to
avoid forming a thick pad between the thighs as this will tend to curve
the bones of legs, which, as you know, are still soft. Squares of soft,
absorbent material, which may be burned, when soiled, placed inside the
diapers will greatly facilitate the laundry work.
[Illustration:
FIG. 55.—How the diaper in Fig. 54 looks after it has been put on.
]
The baby’s diaper should be changed whenever it is wet or soiled, for in
addition to making him restless and fretful for the time being, the skin
about the thighs and buttocks will grow red and chafed if he is allowed
to wear wet diapers. Wet diapers should not be dried and used again but
washed with mild soap, boiled and whenever possible, dried in the open
air and sunshine. All of this makes it apparent that the regular use of
waterproof protectors is to be condemned since a baby so protected may
wear a wet diaper for some time before it is discovered. Under special
circumstances such as a drive, a short journey or visit the diaper may
be covered by waterproof drawers but their habitual use will make the
baby unhappy and uncomfortable and may even result in a serious
condition of the skin.
Coming back to dressing the baby, after his bath, we find that after the
band, shirt and diaper have been adjusted the petticoat and dress are
put on with the fewest possible motions and the baby’s hair brushed
upward from his neck and back from the forehead. He should be wrapped in
a small blanket, fed and laid quietly in his crib to sleep. If his hands
and feet are cold a hot water bottle at 125° F. with a flannel cover,
may be placed beside him.
When the baby is made ready for the night he may have a sponge bath or
simply have his face and hands sponged with warm water, according to the
wishes of the doctor. The clothing which the baby has worn during the
day should be entirely replaced. The day and night clothing may be worn
more than once, if clean and if aired between times, but it is better
not to have the baby wear the same set of clothes for twenty-four hours
at a stretch. In cold weather a tape is often run through the hem of the
stockinette or flannel nightgown in order that it may be drawn up, bag
fashion, to keep the baby’s feet warm. During very warm weather the baby
sleeps in a thin cotton slip.
YOUR BABY’S CLOTHES
Your baby’s clothes were made long since, of course, but a word about
their use is worth while as they may be very influential in promoting
the baby’s well-being. In order that his body may be kept at an even
temperature the warmth of his clothing must always be adjusted to the
needs of the moment. The general tendency is to dress the baby too
warmly and the usual result is that he perspires; is listless, pale, and
fretful; sleeps badly; is susceptible to colds and other infections and
has poor recuperative powers. His digestion is likely to be deranged and
he may have prickly heat. On the other hand, if the baby is not dressed
warmly enough his hands and feet will be cold and his lips blue; he will
cry from discomfort and the general result may be lowered vitality and
disturbed digestion. If the baby’s clothes are not comfortable, if they
pull and drag or have tight bands, he will be fretful and restless, with
disturbed sleep and upset digestion in consequence.
The little wardrobe will be entirely adequate, under ordinary
conditions, if it consists of shirts, bands, diapers, flannel
petticoats, dresses, nightgowns, flannel wrappers and sacques. As the
petticoats and dresses are cut twenty-seven inches long, many doctors
feel that they offer enough protection for the feet of the average baby
to make stockings unnecessary until he is from four to six months old.
The skirts are then shortened to ankle length and stockings added to the
baby’s attire. Other doctors think it wiser to put knitted socks or part
wool stockings on the new baby, particularly if he is born during cold
weather.
When the baby begins to creep, he should wear soft soled shoes, part
wool stockings in cold weather and thin cotton or silk ones during the
summer, and firm but flexible soled shoes as soon as he tries to stand
alone or to walk.
During the first month or two the baby scarcely needs special clothing
for outdoor wear as he may be wrapped in one of the flannel squares with
a casing run in one corner to form a hood, or he may be placed on a
square diagonally and the upper corner folded about his head and held
under the chin with a safety-pin. The corners on the sides are folded
about his shoulders, the lower one brought up over his feet and limbs
and the additional blankets tucked in over all. But as the baby grows
older and moves about in his carriage, he will need a cap and cloak or
wrap with hood attached. In cold weather the cap should be knitted or
wool lined and the cloak of soft woolen material or wool lined. In
moderate weather the cap may be of one thickness of cotton or silk, or
very light flannel, while on very warm days he will need no head
covering at all.
To sum up: The baby’s clothes should be simple in design, hang from the
shoulders, fit smoothly but loosely and have no constricting bands; they
should be of soft, light, porous material; their warmth always adjusted
to the immediate temperature so that the baby will be protected from
being either chilled or overheated. And his clothing must always be
clean and dry.
AIRING YOUR BABY
An abundance of fresh air is one of the baby’s greatest needs as it
increases his resistance to disease and his recuperative powers,
improves his appetite and aids digestion. In general, the more the baby
is in the open air and the more fresh air he has while in the house, the
better.
The two factors which must be considered in supplying the baby with
fresh air are the condition and vigor of the baby himself and the
immediate temperature and state of the weather. His age and the season
of the year can be only partial guides because of the difference between
individual babies of the same age and the variations in temperature,
winds and moisture during any one season.
The air of the room which the baby occupies should be changing
constantly in order that it may always be fresh, but the temperature
should be equable and the baby protected from drafts. As the tendency
here, as with the baby’s clothes, is toward overheating, you will do
well to remember that the young baby who lies covered up in his crib,
may usually be kept in a colder room than is advisable for an older one
who is creeping or walking about.
During cold weather the baby’s bed should not be directly in front of an
open window and he should be protected from direct currents of cold air
by a sheet hung over the head and side of his crib.
Two or three times daily, while the baby is out of the room, the windows
should be opened wide to air the room thoroughly, one of these airings
being just before the baby is put to bed for the night.
The doctor’s usual instructions concerning the temperature of the
nursery are to keep it from 68° F. to 70° F. during the day and about
65° F. at night, during the first three months and lower it gradually to
64° F. during the day and about 55° F. at night as the baby grows older.
It is customary to begin to open the nursery window at night when the
baby is three or four months old, if he is well and the temperature is
above freezing.
In planning to take the baby out of doors it is wiser, as a rule, to
begin with the indoor airing when he is about a month old, except, of
course, during the moderate or mild months of the year, when he is taken
out at once. If the weather is cold, the baby may be protected with
extra wraps and carried in the arms, into a room in which the windows
are open and kept there for fifteen or twenty minutes. This indoor
airing is increased by being gradually lengthened to two or three hours
and by having the windows opened wider and wider. By the time he is two
or three months old he is taken out of doors on clear, bright days, the
best time being between ten and three o’clock, when the sun is high. If
he is carried in the nurse’s arms at first the warmth of her body serves
as a protection and helps to accustom him to the out-of-door life, when
he spends a good deal of his time out of doors in his carriage.
On windy, stormy days or when there is melting snow on the ground, the
baby may be given his airing on a protected porch or in a room with the
windows open. He is not usually taken out if the temperature is below
freezing until the third or fourth month. After this time the average
baby is taken out when the temperature is not lower than 20° F.
When the baby is dressed in his extra wraps he must be taken out of
doors or the windows opened immediately, for otherwise he will become
overheated and be in danger of chilling when taken into the colder air.
Warm hands and feet, a good color and the baby’s tendency to sleep most
of the time while out of doors are evidences of his being adequately
clothed for his airing, while the reverse is true if he is not warm
enough.
A robust baby who has been gradually accustomed to being out of doors
during the day will usually be much benefited by sleeping out at night.
But he must be protected from winds and his clothing so arranged that he
cannot be chilled. Knitted or flannel sleeping garments or sleeping bags
(See Fig. 20) are valuable and in addition, the blankets which cover the
baby should be securely pinned to the mattress with safety-pins and
tucked well under it at the sides and foot. The baby should wear a warm
cap and the bed should be warmed before he is put into it. Or better
still, he may be dressed for the night, put to bed in a warm room and
the crib then moved out on the sleeping-porch.
An excellent device for protecting the baby’s arms and chest, and
keeping him generally well covered, is the poncho (Fig. 56) devised by
Dr. Lucy Porter Sutton of Bellevue Hospital. The poncho is a rectangle
made of flannel, outing flannel or an old blanket and cut large enough
to tuck well under the head and sides of the mattress and extend below
the baby’s feet. The baby’s head slips through an opening, which is
almost a right-angled slit, equally distant from the sides of the poncho
and about 20 inches from the top. The slit is firmly bound and provided
with tapes to tie it together after the baby is put in. The poncho
should be put on loosely enough to permit the baby to move about at will
beneath it. After it is adjusted the bed is made up as usual with
additional blankets.
[Illustration:
FIG. 56.—The “Sutton Poncho” which keeps even a restless baby well
covered. The insert shows how to make the slit for his head to pass
through. The regular bedding is turned back in this picture. (From a
photograph taken at Bellevue Hospital.)
]
Under all conditions the baby’s airings must be increased gradually,
both as regards lowering the temperature and lengthening the time, and
always adjusted to the vigor and reaction of the individual baby. He
must be warm, but not too warm; he must be protected from wind and dust,
and his eyes shielded from glare and from flickering light, such as may
be caused by a tree in a light breeze.
EXERCISING YOUR BABY
Although the baby should not be handled unnecessarily nor tossed about
and played with by friends and relatives, it is important that his
muscular development be promoted by regular and carefully planned
exercise. It is usually considered best for the baby to lie quiet and
undisturbed in his crib most of the time during the first three or four
weeks. Dr. Griffith begins the baby’s exercise about that time by having
the nurse or mother take him in her arms on a pillow and carry him about
for a few moments several times daily. After a week or two of this form
of exercise the baby is carried in the arms without a pillow but with
his head and back carefully supported as the nurse is doing in Fig. 57.
The position of the baby’s body is changed by his being carried about in
this way and the movement of the nurse or mother as she walks, causes a
certain amount of motion of the baby’s muscles which constitutes a
gentle exercise. The baby should be carried first on one arm and then on
the other in order that both sides of his body may be equally exercised.
This semi-passive form of exercise by means of being carried about is
regarded by many doctors as almost indispensable to the baby’s welfare.
There is a possibility that lack of this form of “mothering” is one
reason why babies in institutions sometimes fail to progress as they
should. Certainly, it is inadvisable for the baby to be allowed to lie
for very long in one position.
By the third or fourth month the baby sits up in his mother’s arms, as
she carries him about, and he may be placed on the outside of his crib
coverings for a little while every day, to kick and struggle at will.
His skirts should be rolled up under his arms, or removed entirely, to
leave his legs quite free, care being taken that the room is warm and
that he has on stockings.
[Illustration:
FIG. 57.—Method of carrying baby to support his head and back.
]
By about the sixth month he will usually begin to make an effort to
creep, if turned over on his stomach and helped a little, and he may be
propped up in the sitting position, in his crib, for a few moments every
day. As he gives evidence of having enough energy to creep farther than
the limits of his crib permit, he may be put into a creeping pen, or
upon the floor under certain conditions. It must be remembered that the
floor is likely to be cold, drafty and dusty. You should assure
yourself, therefore, that the floor is warm and that all drafts are cut
off, and then spread a clean sheet or quilt on the floor before the baby
is put down to creep. When the sheet is taken up, be sure that it is
folded with the upper surface inside in order that when it is again put
down the baby will play on that side and not on the side that has been
next the floor.
A creeping pen or cariole or some such provision is often more
satisfactory than the floor, consisting as it does of a railed-in
platform raised about six or eight inches from the floor.
The suggestions for exercise, like those for the baby’s airing, must be
very general since it should always be adjusted to the powers of the
individual baby and directed by the doctor.
TRAINING YOUR BABY
=Bowels.= It is possible to train even a very young baby to have
regular, daily bowel movements; and this training should be started when
the baby is about a month old. At the same hour each day he may be laid
on a padded table, or taken in your lap, a small basin being placed
against or under the buttocks and a soap stick introduced an inch or two
into the rectum and moved gently in and out. This slight irritation will
usually result in the baby’s emptying his bowels almost immediately.
Another method is to hold the baby in a comfortable, reclining position,
on a small chamber in your lap, as in Fig. 58 or with his back supported
against your chest, and the desire to empty his bowels stimulated by
using the soap stick as described. (A soap stick is simply a piece of
soap about three inches long whittled down to about the size and shape
of a lead pencil with a blunt point.)
[Illustration:
FIG. 58.—A comfortable position for the baby who is being trained to
use a chamber.
]
It is of considerable importance that the position and method which are
adopted, be employed at exactly the same time each day in order to
establish a habit. If this is done and the baby is being properly fed,
it will usually be found that before he is many months old, his bowels
will move freely and regularly without the stimulation of the soap stick
and only when he is resting on the small chamber or basin that he is
accustomed to using. This establishment of a regular bowel movement not
only simplifies the laundry work and the care of the baby but is of
great moment to his health.
[Illustration:
FIG. 59.—Stiff cuffs on the baby’s elbows keep him from sucking his
thumbs.
]
=Thumb Sucking.= It is scarcely necessary nowadays to tell a mother that
her baby must not be allowed to suck on an empty bottle or a pacifier
nor be permitted to suck his thumb. These habits are very dirty and help
to spread disease. The baby may swallow air while practicing them, with
colic as a result, and he may so deform the shape of his upper jaw that
later in life, the upper and lower teeth will not meet as they should
for satisfactory mastication; his front teeth may protrude in a
disfiguring manner; and by narrowing and elongating the roof of his
mouth, the structure of the air passages may be altered, with
respiratory troubles and adenoids as a probable consequence. Thumb
sucking may be prevented by the simple procedure of putting stiff cuffs
on the baby’s elbows, such as are shown in Fig. 59, and which make it
impossible for him to reach his mouth with his thumb. These cuffs are
easily made by covering pieces of cardboard with muslin and attaching
tapes with which to tie them on the baby’s arms. Another method is to
put the baby’s hands into celluloid or aluminum mitts made for this
purpose, or little bags made of stiff, heavy material, which in turn are
tied to his wrists; or his sleeves may be drawn down over his hands and
sewed or pinned with safety-pins. It should be borne in mind that a baby
sometimes sucks his thumb because he is hungry or thirsty and will give
up the practice when his food is increased or when he is regularly given
water to drink.
=Ear pulling= is not uncommon among young babies and, if allowed to
continue, a long, misshapen ear may result. This may be prevented by
using a thin close fitting cap which ties under the chin, or by using
the same kind of elbow splints as for thumb sucking.
=Crying.= It is very easy to allow the baby to develop the crying habit
but very difficult to break it up. The first step toward prevention is
general good care, for a baby who is properly fed and exercised, kept
dry and warm, but not too warm, and whose clothes are comfortable, will
usually cry very little if wisely handled in other respects. But a baby
may cry because he is hungry, thirsty, wet, cold, overheated, sick or in
pain or simply because he wants to be taken up and entertained and has
learned that the way to realize his wish is to cry. By examining the
baby’s condition and observing his habits, it is usually possible to
discover the cause of his crying. Very often a drink of fairly warm
water will quiet him, particularly at night. But unless he seems to have
colic and stops crying because of the relief due to the upright position
in your arms, you should hesitate to take the crying baby up and carry
him about and hold him when it is discovered that this attention stops
his crying.
Persistent crying should be reported to your doctor as it may be of some
significance.
KEEPING YOUR BABY WELL IN SUMMER
Notice that I say _keeping him well_. There was a time when we looked
upon the scourge, variously known as “summer complaint,” “summer
diarrhea” and “cholera infantum” as a seasonal visitation that was to be
accepted with resignation. But happily those dark days are past, for
though the condition itself is a complicated one, the one big factor in
its causation was dirty milk—milk that was infected or spoiled or
both—given to a baby whose forces were lowered by the heat.
It is perfectly clear, then, isn’t it, that a baby is no more likely to
be ill during the summer than at any other time, if he is given proper
care, the kind of care that we have been going over in detail? Each of
these details is important but just bear in mind that during warm
weather it is particularly urgent to:
1. Feed the baby properly.
2. Keep him clean.
3. Keep him cool.
4. Keep him quiet.
The end and aim of these precautions is to prevent disturbance of the
baby’s digestion. As babies suffer from the heat more than adults do and
are often excessively irritated and exhausted on warm days, these
results of the heat are sometimes enough to upset his digestion unless
he is safeguarded with greatest care.
It is much the same as with grown people, who often find that their
digestions are upset solely by their being tired or excited.
The baby should have maternal nursing if possible, during the summer,
for breast-fed babies fall victim to summer complaint much less
frequently than de bottle babies. Quite evidently, then, you should
regulate your own life with even more care than usual—for the baby’s
sake. He should be fed with absolute regularity, and as a rule, no
matter what the nature of his food, it should be reduced one quarter to
one third in amount when the days are very hot, and he should have an
increased amount of cool, boiled water to drink. His weight may increase
only slightly, or even stand still for a short time, as a result of his
decreased food, but you need not worry about this if he keeps well, for
the important thing is to avoid digestive disturbances. It is just the
same as with grown people who are advised to eat less and lighter food
than usual, while the weather is very warm, in order to keep well.
Cleanliness, as at other times, applies to the baby’s food, clothing and
surroundings. Many doctors think it safer to have all milk boiled during
the summer, and of course expect scrupulous cleanliness in its
preparation and administration.
The baby’s soiled napkins should be placed immediately in a covered
receptacle containing water, or a disinfecting solution and not left for
even a moment where they may be reached by flies. They should be washed,
boiled and dried in the open air and sunshine as promptly as possible.
The baby should be protected from flies and mosquitoes by screens in the
windows and netting over his crib and carriage, both because these
insects make him restless and irritable and because flies, particularly,
are carriers of filth and disease—the kind of disease that kills so many
babies during the summer. Accordingly, you should regard dies with
deadly fear.
The baby should be kept away from dusty places and from cats and dogs.
And since he will put his fingers into his mouth, in spite of you, it is
a wise precaution to wash his hands several times a day.
The baby should be in the country, in the mountains or at the seashore,
if possible during the warmest part of the summer at least, but if he is
in town there is much that you can do to keep him cool and comfortable.
His clothing at this season must be adjusted to his condition and the
temperature of the moment just as it is in cold weather. A thin shirt,
band, diaper and cotton slip will usually be enough for out-of-door
wear, while in the house he may often dispense with the slip, and
sometimes with everything but his diaper.
It is usually best to take the baby out of doors early in the morning
and late in the afternoon, but to keep him indoors during the warmest
part of the day, when it is likely to be cooler inside than out,
particularly if the blinds are closed.
During excessively hot days, the baby will usually be more comfortable
if he has two or three cool sponge baths, in addition to the soap and
water bath, one of the sponges being given just before he is put to bed
for the night. He should sleep on a firm mattress, preferably curled
hair but never feathers, and in the coolest, best ventilated room
available.
He must not be played with, held on hot laps nor subjected to the
entertainment and attention which well-meaning but misguided mothers and
friends are so eager to lavish on a hot, fretful baby.
=Prickly Heat.= Very often during warm weather a fine rash, known as
“prickly heat” or heat rash, appears on the back of the baby’s neck and
spreads over his head, neck, chest and shoulders. As this rash is due to
too warm clothing or to the hot weather or to both, less clothing and
frequent baths will often give relief. If the baby is very uncomfortable
he may he greatly soothed by being immersed, for two to four minutes in
baths, at the temperature he is accustomed to, containing soda, bran or
starch in the following proportions:
_Soda Bath._ Two tablespoonfuls of baking soda to one gallon of water.
_Bran Bath._ A cheesecloth bag about six inches square, partly filled
with bran, is soaked and squeezed in the bath until the water is
milky.
_Starch Bath._ About a cupful of cooked laundry starch to one gallon
of water.
The baby should be placed in the tub as for his daily bath and his
entire body submerged, as shown in Fig. 60, care being taken that his
ears are above the surface of the water.
No soap should be used while the baby has prickly heat and after the
bath he should be patted thoroughly dry and powdered with some such
soothing powder as the following:
Powdered starch one ounce
Oxid of zinc one ounce
Boracic acid powder 60 grains
[Illustration:
FIG. 60.—Method of holding the baby in the tub to keep all but his
head covered, in giving a bran, starch, soda or mustard bath.
]
=Diarrhea.= If your baby has an increase in the number of his movements,
or if they become watery in character, something is wrong. It may be
only a mild disturbance or it may be the beginning of an attack of
summer diarrhea, and as at first you cannot possibly tell which it is,
you must not take it lightly. Notify your doctor at once, but if you are
remotely situated or he is delayed in communicating with you, there are
certain helpful things that you can do for the baby while waiting for
the doctor. The first is to give an enema of half a pint of water, at
110° F., containing ½ teaspoonful of salt. (See Fig. 64, page 217, for
method of giving enema.) If the baby seems to have only a slight
diarrhea it may be enough to reduce his food one half, whether he is
breast-fed or bottle-fed, and to give him an abundance of cool boiled
water to drink. If he is bottle-fed it is a wise precaution to make up
his formula with skimmed milk and leave out the sugar.
[Illustration:
FIG. 61.—Putting the baby into a wet pack.
]
If the baby has frequent loose movements; seems feverish; vomits and
cries as though he had pain, stop all food and give nothing by mouth but
water, until the doctor comes.
If you care for your baby, yourself, through an attack of summer
complaint you will find that the doctor’s instructions are directed
toward keeping the baby cool, clean and quiet, while he, himself, gives
very careful attention to the question of feeding.
It is clear, then, that the baby should be lightly clad and kept quiet
and undisturbed, in a cool shady place, out of doors as much as
possible. During the warmest part of the day, however, he will often he
better off in the house, in a room with the shutters closed. But while
keeping the baby cool, you must bear in mind the harm that may be done
by chilling him or exposing him to a cold draft or wind. The doctor may
want him to have several baths daily, possibly tub baths, at a
temperature of 100° F., or cool sponge baths. Packs, also, are given,
for they not only cool the baby but quiet him as well, if he is
restless. These packs may be cool (80° F.); tepid (100° F.) or hot (105°
to 108° F.) according to the baby’s needs.
[Illustration:
FIG. 62.—The baby in a wet pack with a hot water bag at his feet and
cold compress on his head.
]
It is a simple matter to give a pack and you will enjoy doing it for you
will actually see that your baby will grow quieter and more comfortable
as you give it. Cover the bed with a rubber and sheet and bring to the
bedside a basin containing a sheet wrung from water of the specified
temperature; a basin containing ice and compresses for the baby’s head
and a flannel covered hot water bottle at 125° F., for his feet. The
baby is laid on the upper half of the folded wet sheet, and an upper
corner wrapped about each arm, as in Fig. 61, and the sides folded
around his legs. The lower half is brought up between his feet and used
to cover his entire body, being tucked around his shoulders. The hot
water bottle is placed at his feet and an ice compress on his head, as
in Fig. 62. If the sheets are wrung from warm or hot water, the baby is
covered with a blanket after he is put into the pack.
[Illustration:
FIG. 63.—Diagrams shoving the successive steps in putting the baby
in a pack.
]
Should your baby have summer complaint, remember that even a mild attack
predisposes to another and you will have to be even more watchful and
painstaking than ever, in your care of him. He will have to return to
his customary diet very slowly, or he may not be able to take his usual
amount of nourishment at all until the weather turns cool. Even though
he gains no weight it is important to avoid taxing his digestion since
it is already being threatened by the heat.
KEEPING YOUR BABY WELL IN WINTER
There are certain evils that beset the baby’s way during the winter just
as there are seasonal pitfalls in summer, but the truth is that if you
care for yourself and him according to the suggestions that have been
set down in the foregoing pages, you are doing practically everything
necessary to make his way safe and comfortable. A baby who has proper
food, plenty of fresh air, is kept clean and whose daily life is
regular, is not likely to be ill during the winter or any other time.
The chief baby ills that come with the blustery weather are colds and
the troubles that are likely to follow in their wake, such as bronchitis
and pneumonia. Colds are infectious, you know, so keep the baby away
from sneezy people and out of crowds and dusty places. If he should take
cold in spite of you, send for the doctor at once. It may amount to
nothing and clear up in a day or two, but if you let it run on, the
dreaded bronchitis or pneumonia may result.
RELIEVING COLIC, CONSTIPATION AND CONVULSIONS
I have tried to impress upon you, at every step, that it is very unwise
for you to delay in sending for the doctor when your baby seems ill, or
to attempt to treat him according to your own ideas or those of your
neighbors. But if the baby should begin to scream with colic or have a
spasm, you would want to know what to do at the moment, and in case of
constipation there are a few simple nursing procedures that you may
employ to the baby’s advantage.
=Colic= is always due to indigestion, whether the baby is breast-fed or
bottle-fed, because of the food itself being wrong in some respect or
because it is not properly given. The milk may contain too much of the
material that forms the curd, or so much starch and sugar that
fermentation takes place, the pain itself usually being due to
undigested food or gas in the intestines. This condition may also result
from the baby’s being fed too rapidly or too frequently, or from his
swallowing air while sucking on a pacifier or an empty bottle. Colic may
be caused, too, by chilling the baby as this is likely to disturb his
digestion.
Most babies have colic at some time during the first year, usually
before the fifth month. The attacks may occur several times a day, after
feeding, or they may not come on until the late afternoon or evening
when the baby is tired. Colic is so common that most people are familiar
with the symptoms: violent crying and a flushed drawn face; cold hands
and feet; tightly clenched fists and a hard, swollen abdomen. As the
pain is cramp-like, the baby stops crying every little while, and then
suddenly begins again, drawing up his legs, doubling up his body and
then straightening out with a jerk.
For immediate relief, you may give the baby a tablespoonful of hot water
in which half a soda mint tablet has been dissolved, and an enema of
half a pint of water, at 110° F., containing one half teaspoonful of
salt, given through a small rubber tube introduced about six inches.
This empties the lower bowel and enables the baby to expel a good deal
of the gas that is troubling him so. Rub his abdomen with a little oil
and apply a compress of several thicknesses of flannel, wrung from hot
water, covering this with a larger piece of dry flannel, and change it
every three or four minutes for a while. Place a flannel covered hot
water bottle (at 125° F.) at his feet, cover him warmly, darken the room
and he will almost certainly go to sleep. It is often a good plan to
substitute barley water for one or two feedings, after an attack of
colic, in order to give the disturbed digestive tract a rest.
Quite naturally, you must tell your doctor if your baby has colic for
the cause may lie in the character of his food. But it may lie in some
error on your part. Go over all the details of your share of the baby’s
care and see if you can discover anything to correct.
With breast-fed babies, prevention is often accomplished by the mother’s
nursing her baby more slowly, lengthening the intervals between nursings
and by improving her own hygiene, particularly by relieving constipation
and increasing her recreation and out-of-door exercise. Nursing mothers
who lead sedentary lives and eat rich food very often have colicky
babies as do those who are nervous, irritable and inclined to worry.
If the baby is bottle-fed he may be taking his food too fast because of
an over-large hole in the nipple; he may not pause often enough during
his meal or he may take in air as he nurses because the bottle is not
properly held, as shown in Fig. 48.
In any event do not stop until you get at the cause of the trouble for
though the colic itself may not necessarily be serious, a continuation
of the cause may result in a run down condition or even in malnutrition.
Don’t forget the importance of holding the baby upright over your
shoulder after each feeding, to help him bring up gas, and of placing
him immediately in his crib to be left quiet and undisturbed. And ask
your doctor about drinking water. Very often the tendency toward colic
is lessened by increasing the amount of cool boiled water given between
meals.
=Constipation= is very common among babies and may be manifest by the
stools being too small, too dry or too infrequent. It is more difficult
to cope with than colic, though it, too, may have its origin solely in
unsuitable food. In some cases, however, the constipation is due to
absence of habit in emptying the bowels regularly; to weakness of the
intestinal muscles; to long-continued undernourishment or to some such
disease as rickets.
It becomes apparent that the prevention of this troublesome condition is
accomplished largely by giving suitable food; constant fresh air;
regularity in the daily routine and training the baby to empty his
bowels at the same time every day.
When constipation is due to insufficient fat in the food, cod-liver oil
is sometimes given, 15 to 30 drops three or four times a day; or a
teaspoonful of olive oil two or three times a day. Maltose, malt soup,
malted milk, milk of magnesia, mineral oil, oatmeal water and orange
juice are all found among the remedies for constipation; while soap
sticks, suppositories and enemas of oil or soapsuds sometimes have to be
resorted to.
In giving an =enema= to relieve constipation, the baby should be
protected from chilling, laid on a pillow and the bed-pan so placed that
he will be comfortable and not inclined to move, and from half a cup to
a cup of soapsuds, at 105° F., given with a small hard-rubber nozzle, as
in Fig. 64. When warm olive oil is given at night (2 to 4 tablespoonfuls
slowly through a small rubber tube introduced about six inches), it is
very often retained until morning when the baby empties his bowels
freely with little or no assistance.
=Abdominal massage= will often relieve constipation by strengthening the
intestinal muscles, this in turn tending to make the bowels move. The
abdomen should be rubbed with a firm but not hard, circular stroke,
beginning in the right groin and working up to the margin of the ribs,
across to the left side and down to the groin. This massage is often
given for about ten minutes every day, preferably at night, but never
just after feeding.
[Illustration:
FIG. 64.—Giving the baby an enema. He is well protected, to prevent
chilling, and lies comfortably on a pillow which reaches to the
bed-pan, the latter being covered with a diaper where he rests upon
it.
]
Constipation is sometimes entirely cured by nothing more than a suitable
dietary; an abundance of drinking water; an out-of-door life; massage,
and above all, the unceasing effort to establish a regular habit. These
are all things which you, yourself, may do for the baby. The longer
constipation persists, the harder it is to cure, so do all in your power
to prevent it and if it develops, try to end it at once.
=Convulsions= are a symptom of several disorders of infancy and they may
occur unexpectedly. Although at the moment, they are more distressing
than serious, you should notify your doctor at once. If he cannot come
promptly you may end the seizure by employing measures that will quiet
and relax the struggling baby. The room should be darkened, kept
absolutely quiet and the baby handled with the utmost gentleness. As a
rule the most satisfactory course is to immerse the baby in water at
100° F. and keep him there for five or ten minutes, supporting his head
above the level of the water as shown in Fig. 60. (See p. 209.) Have
some member of the household place cloths, wrung from cold or iced
water, on the baby’s head and change them frequently. When removed from
the bath, the baby should be wrapped in a blanket, kept very quiet and
the cold applications to his head continued.
If the baby often has convulsions the doctor may instruct you to give
him either a mustard bath or pack whenever he has an attack.
For a bath, one ounce, or six level tablespoonfuls of dry mustard is
added to one gallon of water at 105° F. and the baby kept in it for
about ten minutes, or until the skin is well reddened. He is then
wrapped in a warm blanket and surrounded by hot water bottles, with cold
compresses applied to his head. The mustard pack is given in the manner
shown in Figs. 61 and 62, with a sheet wrung from mustard water which is
possibly a little warmer and stronger than that for the bath, care being
taken that the sheet is not cooled before it is wrapped about the baby.
He is usually left in the pack for about ten minutes or until his skin
is reddened, and then wrapped in warm blankets, with cold compresses to
his head.
THE PREMATURE BABY
All of the precautions and gentleness which are necessary in the care of
the normal baby, born at term, must be greatly increased in caring for
the baby who is born prematurely. The premature baby is not only small,
but in general is imperfectly developed, having slenderer powers than
the full term baby, and at the same time much greater needs. His
respiratory and digestive organs are less ready to act than those of the
normal baby; his muscles and nerves are feeble; his heat-producing
machinery is unstable and yet he loses an excessive amount of body heat.
Accordingly, the baby who has been deprived of those valuable last weeks
of growth and development within the uterus, is small and limp; lies
quietly most of the time; moves very feebly, if at all, and needs
special care. To help him in maintaining a normal body temperature it is
usually necessary for him to be oiled with warm olive oil and entirely
wrapped in cotton batting or flannel or enveloped in a quilted garment,
with hood attached, made of cheesecloth or flannel and cotton batting,
such as is shown in Fig. 65. Diapers are often omitted in caring for
very feeble babies, a pad of cotton, instead, being slipped under the
buttocks, as this may be changed with less disturbance to the baby than
a diaper.
A satisfactory bed may be devised from a basket or box with the bottom
well padded with several inches of cotton, a small pillow or a soft
blanket folded to the proper size, covered with rubber or oiled muslin
and a cotton sheet. The sides of the basket may be lined with heavy
quilted material, to shut out drafts and help to preserve an even
temperature of the air immediately around the baby, or such a basket as
is shown in Fig. 66 may be used. A flannel covered hot water bag at 110°
F. may be placed beside the baby, or two, three or four glass bottles,
each holding about a pint, containing water at 100° F. and securely
stoppered, may be hung in the corners of the basket. A thermometer,
also, should hang in the basket and the temperature kept between 80° F.
and 90° F. The temperature varies less if the bottles are filled in
rotation than if all are reheated at the same time.
[Illustration:
FIG. 65.—Quilted robe, with hood, for the premature baby. It may be
made of flannel or cheesecloth with cotton batting for the padding.
]
The amount of heat needed around the baby is decided by taking his
temperature (by rectum) at regular intervals; supplying more heat if the
temperature is low and less if it is at or above normal. Some doctors
have the temperature taken every four hours; others twice daily. As the
baby grows able to maintain a temperature of 98° F. to 100° F.,
unassisted, the surrounding heat is gradually reduced and finally
removed, and flannel clothing replaces the quilted robe.
[Illustration:
FIG. 66.—An improvised bed for the premature baby, consisting of a
closely woven clothes basket with padded bottom and four flannel
covered bottles of hot water, attached to the sides. The necessary
thermometer and special feeder are shown in the basket. (By courtesy
of Dr. Alan Brown, Hospital for Sick Children, Toronto.)
]
The basket in which the baby lies should be placed in a darkened, well
ventilated room and should be carefully screened from drafts. As the
baby needs moist air there should be a large, open vessel of water in
the room.
Since the premature baby’s lungs are not fully expanded, respirations
are likely to be shallow and irregular, thus failing to supply the
amount of oxygen which he needs. And as crying always causes deep
breathing, it is a common practice to make the baby cry at regular
intervals during the day.
In feeding the premature baby, breast milk is the most desirable food.
In fact, many doctors feel that his life virtually depends upon it. If
the baby is too feeble to nurse, the milk may be expressed from the
mother’s breast, being immediately covered and placed in the
refrigerator unless used at once. Breast milk is sometimes used whole
and sometimes diluted with sterile water and is often given from a
medicine dropper or through a special feeder. Such a feeder consists of
a glass tube with a small nipple on one end and a rubber bulb on the
other, by means of which the milk may be gently expressed into the
baby’s mouth. (See Fig. 66.)
The premature baby’s bath is of considerable importance. It almost
always consists of sponging him with warm olive oil as he lies in his
bed and with the least possible exposure and turning. It is given every
day or every second or third day, according to his condition. The eyes
are wiped with boric pledgets and the nostrils with spirals of cotton
dipped in oil. The buttocks are wiped with an oil sponge each time the
diaper is changed.
It must be borne in mind constantly that the premature baby is
particularly susceptible to infection. He should be safeguarded by
having everything that comes in contact with him scrupulously clean;
being protected from drafts, chilling and dust, and allowing no one with
a trace of a cold to come near him. The person who cares for him should
wear a freshly laundered gown and protect her nose and mouth with a
gauze mask while attending him.
TRAVELING WITH YOUR BABY
Babies should not travel; that is obvious. But if a journey is
unavoidable, the attendant difficulties and disadvantages may be greatly
lessened by making certain preparations. If the baby is bottle-fed, the
preparations will depend upon the length of the journey and whether or
not it will be possible to have freshly prepared feedings, for each
twenty-four hours, put on the train from laboratories along the way. If
this is not possible and the journey is not to take more than
twenty-four hours, the entire quantity of food, ice-cold, may be carried
in a thermos bottle. The requisite number of sterile nursing bottles may
be taken or one bottle which is boiled before each feeding. Or the milk
may be prepared as usual and the bottles packed in a portable
refrigerator. Such a refrigerator may be bought or one may be
improvised. The bottles are placed in a covered pail and packed solidly
in crushed ice; this is placed in a second pail or a box with a diameter
which is at least two inches larger than the inner pail and the space
between the two packed firmly with sawdust. Several thicknesses of
newspapers should be pressed down over the top and a tight cover fitted
to the outer receptacle.
The sterile nipples may be taken in a sterile jar and a deep cup or
kettle will be needed in which to warm the bottle before each feeding.
It is usually possible to obtain water on the train which is hot enough
for this, or cans of solid alcohol, a stand and a metal tray may be
added to the traveling outfit. If fresh formulæ cannot be delivered to
the train, daily, and the journey is to last more than twenty-four
hours, one of the proprietary foods or a powdered milk will often prove
to be a satisfactory solution to the problem of feeding the baby while
traveling. The course to be followed, however, should be selected by
your doctor.
[Illustration:
FIG. 67.—If traveling is unavoidable the baby will be comfortable and
undisturbed in a basket converted into a bed. (By courtesy of the
Maternity Centre Association.)
]
The baby will usually travel more comfortably and sleep better if he is
carried in a basket. A large market basket with a handle or a small
clothes basket will serve. It may be lined with a sheet or a blanket;
have a small hair pillow or folded blanket in the bottom and be made up
like a crib. (Fig. 67.) If this basket stands on the car seat during the
day, and on the foot of your berth at night, the baby will be cleaner,
quieter and less exposed to drafts than if carried in the arms.
As we look back over these pages of somewhat detailed description of the
baby’s care it is borne in upon us that the nursing of this unfailingly
delightful and engaging little person has special adjustments and
adaptations for different seasons and circumstances. But that on the
whole the care of all babies, the year round, resolves itself into the
observation of a few general principles, namely: proper feeding; fresh
air, rest and quiet; regularity in the daily routine; cleanliness of
food, clothing and surroundings; preservation of an even body
temperature; consultation with the doctor at regular intervals and also
whenever the baby seems ever so little ill.
If you are guided constantly by these general principles and apply them
conscientiously, you may revel in the satisfying consciousness that you
are keeping your pledge to your baby by giving him the best possible
start on his life’s journey.