HYGIENE AND DEVELOPMENT OF THE BABY
What to Prepare for the Coming Baby--Care of the Newly-born
Baby--The First Bath--Dressing the Cord--Treatment After the
Cord Falls off--A Pouting Navel--Bathing Baby--Clothing the
Baby--Baby's Night Clothes--Care of the Eyes--Care of the Mouth
and First Teeth--Care of the Skin--Care of the Genital
Organs--Amusing Baby--Temperature in Children--The Teeth--The
Permanent Teeth--Care of the Teeth--Dentition--Treatment of
Teething--How to Weigh the Baby--Average Weight of a Male
Baby--Average Weight of a Female Baby--Average Height of a Male
Child--The Rate of Growth of a Child--Pulse Rate in
Children--Infant Records, Why They Should be Kept--"Growing
Pains."
WHAT TO PREPARE FOR THE COMING BABY.--The physician should instruct the
young wife just what to provide for the coming baby. The following list
will be found useful as a general guide.
An ordinary clothes basket, padded and lined, is quite
sufficient for the first month; or, a baby crib, which may be
cheap or expensive as the individual taste dictates. The Taylor
crib is probably the handiest and best one on the market.
Pin cushion;
Puff-box and puff;
Soap box containing pure castile soap;
Hair brush and fine comb;
Two wash cloths;
Four ounces of crystal boracic acid, a saturated solution of
which is used for cleansing baby's eyes and mouth;
One pound of good absorbent cotton;
A flexible tube of white vaseline;
A bath thermometer;
A package of sterile gauze;
A half dozen baby towels, good quality;
A soft, white, good blanket,--one and one-half yards square;
One pair small blunt pointed scissors;
A package of the best safety pins;
Three or four dozen bird's-eye cotton diapers. First size,
eighteen inches square. Second size, twenty-five inches square;
One yard of soft white flannel for belly bands; each band
should be five inches wide, by twenty-four inches long.
Two silk and wool shirts;
Three flannel shirts (all shirts should be high necked, long
sleeved, and open down the front);
Three Eiderdown wrappers;
Three Cashmere sacques;
Three pads for crib;
Six dresses;
Six petticoats (they should be thirty-three inches long from
neck to hem; they should be turned up at the bottom for about
four inches and should button there to keep the feet warm; if
it is desired to use pinning blankets for the first two months
in place of the petticoats, they should be made of soft white
flannel with cotton bands);
Six night slips;
Six pair socks;
Two cloaks;
Two hoods;
One dozen bibs.
Simplicity, warmth, and freedom are the essentials in latter-day baby
clothes. It is cheaper to make the clothes than to buy them. Excellent
and accurate paper patterns can be obtained, giving the quantity of
material necessary and suggesting the kind and quality best suited for
the purpose. These patterns may be obtained from the Butterick
Publishing Company in New York City.
CARE OF THE NEWLY-BORN BABY.--After the nurse has completed her duties
with the mother after the confinement, she will prepare to give baby its
first bath.
The bath should be given in a warm room. This is a matter that should
receive more consideration than has been given it. Nurses do not as a
rule attach much importance to this duty, while in reality it is a most
important one. I have seen trained nurses make ready to give baby its
first bath in rooms, during the night, that were not heated adequately.
I am convinced that many babies have been victims of this careless habit
to the extent of grafting on them the tendency to catarrhal colds and
bronchitis because of undue exposure at this critical period. If one
will remember that a baby has just been removed from an environment
where the temperature was suitable and constant, to one in which it
needs a large degree of artificial heat until such time as it may become
accustomed to the change, one may appreciate the risk taken in exposing
the child for even a short time. The mother should therefore warn the
nurse not to undertake the baby's first bath until the temperature and
other conditions are favorable. Many nurses and other individuals have
the impression, without knowing why, that the baby should be cleansed
and bathed immediately after birth. This is not at all necessary. If the
conditions are not favorable, it would be far better to wrap the baby
snugly in a warm blanket--first having put a diaper on--and place it in
its crib with a hot water bottle near it and defer the bathing until the
following forenoon. By that time the baby will be adapted to its new
surroundings; its lungs will have become accustomed to the air which it
is breathing for the first time; the mother will have been rendered
comfortable; in other words, the conditions and the environment will be
favorable for the baby and for a better performance of the duty.
The next important feature of the first bath is that it should be done
in the quickest time consistent with efficient service. Only the
necessary exposure should be indulged in. It is not necessary that the
baby should be exposed to the admiring inspection of every member of the
household--there will be plenty of time for that without risking the
health of the child. A pan of water at a temperature of 100 deg. F. should
be placed on a stool in front of the nurse. The nurse should have on a
rubber apron, and on top of this, an ordinary apron and a warm bath
towel laid over her knees. The child should be gently rubbed with warm
sweet oil to remove the _vernix caseosa_ (the greasy substance which is
on all babies when born to a lesser or greater extent). Particular
attention is to be given to all folds of the skin, as under the arms, in
the fold of the neck, in the groin, behind the ears, etc., because in
these parts the substance is thickest and if not carefully removed it
will cake, and cause painful eruptions and sores, which may bleed and
render the infant extremely uncomfortable. It is not necessary to
expose the whole body at one time while applying the oil. The lower half
may be covered with a warm soft towel while the nurse is oiling the
upper part, and vice versa. After the body has been thoroughly oiled it
should be cleansed with water at the proper temperature, in which pure
castile soap has been dissolved. Absorbent cotton only should be used to
wash the baby. All the washing is done with the baby on the nurse's
knee; it is not put into the water.
The baby should be mopped dry with sterile gauze, or with a soft sterile
towel, the cord dressed and the flannel band adjusted. It should then be
completely dressed and put to the nipple and later to sleep.
DRESSING THE CORD.--The cord should be covered with powder and sterile
gauze. The powder to use should be plain subnitrate of bismuth. If there
is any reason to use another powder the physician will write a
prescription for it according to indications. The subnitrate of bismuth
will be found much better than any ordinary talcum or toilet powder,
many of which do not make good dressing powders.
Very few nurses know how to dress the cord. It seems to be impossible to
impress them with the need of frequent attention to the cord. Fresh
powder should be put on every time the diaper is removed, every time the
infant urinates, and at other times during the day. The cord should be
kept absolutely dry. Putting on powder twice daily will not keep the
cord dry and many nurses are too lazy to bother to do it oftener. You
cannot make a mistake in putting on too much powder, you can make a
serious mistake by not putting on enough. Every time the cord is
powdered it should be lifted up, away from the skin of the abdomen, and
the powder put below it. The cord should be slightly drawn out and the
powder applied round its base where it meets the skin. Many nurses are
afraid to touch or handle the cord--they find it easier to neglect it.
The mother should see that the nurse dresses the cord at least five
times every day.
APPLYING THE STERILE GAUZE TO THE CORD.--A piece of gauze, six inches
square is taken, a hole is cut the size of a ten-cent piece out of the
center, the cord is drawn through the hole, the gauze folded lengthwise
over the cord and then sidewise, and this is held in place by the
binder. This piece of gauze will adhere to the cord and will most likely
be removed with the cord on the fifth day. If it should fall off,
another piece may be put on in the same way.
If the cord does not fall off until very late it is because it has not
been attended to rightly or because it was a very thick cord.
TREATMENT AFTER THE CORD FALLS OFF.--The stump of the cord should be
powdered with the same powder used on the cord; a pad two inches square
of sterile gauze and quite thick should be held over the stump for a
number of days by the abdominal binder. This is used to prevent a
possible rupture. After a week the size of the pad may be reduced, but a
small pad should be used over the stump of the cord for a month or more.
A POUTING NAVEL.--If the stump of the cord should protrude, a piece of
strong pasteboard, the size of a fifty-cent piece, should be wrapped in
soft gauze and placed over the navel, over this a gauze pad, and if
necessary this should be held in place by a strip of adhesive plaster,
though the binder is usually sufficient if it is put on carefully. If
this pad is held properly and worn for a month the tendency to
protrusion or rupture will have passed away. These pads may of course,
be removed when the baby is being bathed and put back again before the
binder is applied.
BATHING BABY.--A baby should not be put into water for a bath until
after the cord has been off for forty-eight hours.
During the first few months the temperature of the water should be 98 deg.
F. The temperature of the water should be taken with a bath thermometer;
it should not be guessed at. A bath thermometer is an inexpensive
commodity and it will be in daily use in many ways in a home where there
is a baby--it should therefore be procured wherever possible. The room
should be warm; there should be no draughts. The mother or nurse should
cultivate the habit of bathing baby quickly and with system. Everything
should be ready and at hand. A little salt in the water will tend to
strengthen the skin; it will also relieve any superficial rashes or
excoriations which may be on the skin. Four tablespoonfuls to a gallon
of water will be sufficient. The sea salt sold in the stores may be used
in lesser quantities.
By the end of the fifth month the temperature of the water may be
reduced to 95 deg. F., and by the end of the first year to 90 deg. F. After the
first year the mother should accustom the child to a quick sponge with
cool water on the chest and spine immediately after the bath. This
simple means, if kept up, will often prevent the development of colds
and bronchial troubles so common to children in temperate latitudes.
The best time to give the warm bath is at night. In the morning a cold
sponge bath is desirable. This should be given as described in the
chapter on cold sponge or shower baths.
In certain children bathing seems to depress their entire system. They
do not react well even to a warm bath. They remain blue or pale around
the mouth and eyes; bathing should therefore be carefully undertaken
with these children until such time as they acquire strength.
CLOTHING OF BABY.--The baby should wear a woolen shirt, with a high neck
and long sleeves. The abdominal binder may be worn for the first three
months. It is not necessary after that time. If worn longer the habit is
acquired and chronic indigestion may ensue when it is ultimately taken
off. If the baby is very thin it may be wise to leave it on, simply for
its warming effect, for a few months longer. If the child is normal and
healthy the binder should be left off permanently after three months.
The band for the first four weeks should be made of plain flannel; after
this period a knitted band with shoulder straps is the better article.
All petticoats and skirts should be supported from the shoulders.
Stockinet is a good material for diapers; it is soft, warm, and pliable.
Baby's feet should be warm always. Cold feet are frequently responsible
for colic and gastro-intestinal troubles. A hot water bottle should be
placed in the carriage if the weather is cold, but care should be taken
to see that it does not touch the feet, otherwise it may burn them. The
same measure may be adopted in the baby's crib if the feet are cold.
During the summer the outer clothing should be made of the thinnest
quality of material possible, and the underclothing of the finest
flannel or gauze. Body heat may be maintained during changes of
temperature by extra outer wraps--not by dressing the baby in clothes
that keep it too hot and uncomfortable all the time.
The main object to be attained in clothing the baby is to ensure a
sufficient protection, but the clothing must be light, warm, loose, and
non-irritating. Don't bundle up the arms and legs so that they cannot be
moved; don't pin them so tight that the child cannot breathe properly
and don't put the band on so that the child is in torture all the time
from inability to move the abdomen.
BABY'S NIGHT CLOTHES.--The night clothing should be the same as that
worn during the day, but it should be loose and of the lightest flannel
material. For older children a thin woolen shirt (not the one worn
during the day) and a suit of union clothing with feet is best.
The mistake must not be made to cover children too warmly at night. They
can do with relatively less than adults. Too much covering will render
the sleep restless, will encourage nightmare, and in older children will
engender bad habits. Delicate children especially must not be
over-covered at night.
For the first few months children should sleep in a darkened room.
CARE OF THE EYES.--The eyes should be cleansed for the first few days
with a saturated solution of boracic acid. They should be protected from
the direct light for two or three weeks after birth.
CARE OF THE MOUTH AND FIRST TEETH.--Boiled cooled water should be used
to cleanse the mouth every morning after the bath. A soft piece of
sterile gauze should used for this purpose. The mother must guard
against using too much force in cleaning the mouth of an infant.
The milk teeth should receive attention. If they are allowed to become
dirty they will become carious and cause bad breath and neuralgia.
Teeth of this character are a menace to health because they harbor germs
and in this way infect the mouth and cause stomach troubles. Teeth that
are carious should be filled or removed.
CARE OF THE SKIN.--The skin of a baby, because of its delicate
character, is susceptible to the slightest changes in the weather or to
the condition of the digestive organs. Babies are frequently subject to
rashes, intertrigo, excoriations, eczema, and other skin affections. It
is much easier to prevent these conditions than to cure them.
Cleanliness, not only in giving a daily efficient bath, but in every
other respect, is essential. Castile soap only should be used, and no
rubbing indulged in, simply mopping the parts with gauze well saturated
with soapy water. All napkins should be removed as soon as soiled. If
the skin is easily chafed the child should be bathed in salt water or
water in which bran is mixed as explained in the chapter on bran baths.
The baby should be well powdered with a good quality of toilet powder.
Ordinary starch, or talcum, or the stearate of zinc is suitable. Fat
infants should be powdered in all the skin folds; otherwise they are
sure to chafe.
CARE OF THE GENITAL ORGANS.--The mother should make it a habit to remove
any dirt from the genitals of the baby during the morning bath. Fecal
matter sometimes gets into the folds of the female baby; this should be
removed promptly. In older female children, dirt and dust get into the
genitals which often has to be removed carefully with a soft piece of
cloth. An exceedingly chronic form of inflammation is often seen in poor
children because of neglect of these parts.
In male babies the mother must daily push back the foreskin and clean
under it. If this is not done the natural secretion will gather there
and cause much trouble. If the foreskin is long, the child should be
circumcised; if it is not long it must be pushed back daily for a number
of weeks; otherwise it will contract and it may be necessary to operate
on it at a later date. If this is not faithfully attended to the prepuce
will become adherent, the child becomes nervous and irritable, and it
may become addicted to self-abuse at a very early date--simply because
the mother is derelict in the performance of her duty. If you are afraid
to do your duty, don't neglect it, ask the doctor to show you just what
has to be done and just how it should be done. You will find it to be a
simple matter when you know how, as most things are.
AMUSING BABY.--Mothers should understand that it is not necessary to
amuse a baby under one year of age. Their nervous systems are not ready
for any such sport. To excite a baby to laughter is to subject it to a
shock which may injure it. The healthy development of the brain of a
child demands quiet and restful surroundings. It should sleep, eat, and
be allowed to amuse itself in a natural way.
TEMPERATURE IN CHILDREN.--The normal temperature in a child varies more
than it does in an adult. The rectal range may be between 98 deg. and 99.5 deg.
F. and may be normal to that particular child. A rectal temperature of
97.5 deg. F. or of 100.5 deg. F. is of no importance unless it continues.
The best place to take the temperature in a child is the rectum and the
next best place is in the groin. The temperature will always be from a
half to a full degree higher in the rectum than in the groin. The
thermometer should be left in the rectum for two minutes, and in the
groin for five minutes.
The temperature in a child is a very fair guide as to the severity of
the disease. It must be remembered, however, that a child will develop a
temperature of two or three degrees from a very slight cause. It is not
the height of the fever that is significant, but rather the duration of
the fever that is important. A fever of 102 deg. F. in a child may only mean
a slight indigestion which will wholly disappear after a laxative is
given, while the same degree of temperature in an adult usually means
something much more serious. The degree of the temperature therefore
should not occasion unnecessary worry; if, however, it continues and if
the child shows other signs of illness, it may be regarded as indicating
an abnormal condition which should be immediately found out. A
temperature of 100 deg. F. to 102 deg. F. usually means a mild illness, and one
of 104 deg. F. or over, a serious sickness.
It is not advisable that the ordinary mother should possess a clinical
thermometer. There are many occasions when a child will have a fever
which should not cause any worry; if the mother gets the thermometer
habit, she will many times occasion unnecessary calls of the physician
only to learn that they are false fears.
THE TEETH.--There is no definite time at which the first teeth appear.
They usually come between the sixth and eighth months. They may not,
however, come until much later; or they may come earlier than the sixth
month; and yet the child may be perfectly healthy. They come as a rule
in the following order:
1. The two lower middle teeth, 6 to 8 months.
2. The four upper middle teeth, 8 to 10 months.
3. One on each side of two lower middle teeth, 8 to 12 months.
4. One on each side, above and below, back of
above teeth (four in all), 12 to 15 months.
5. The next one on each side, above and below, back of
those already in (four in all), 18 to 24 months.
6. The four back teeth on each side, above and below, 24 to 30 months.
At 1 year a child should have 6 teeth
At 1-1-2 years a child should have 12 teeth
At 2 years a child should have 16 teeth
At 2-1-2 years a child should have 20 teeth
They may not come in the above regular order even in well children. The
upper front teeth may come first. If the child is sickly there may be
marked irregularity in the order in which they appear. Twenty teeth
comprise the first set.
THE PERMANENT TEETH.--This set consists of thirty-two teeth. They begin
about the sixth year and they are usually not complete until the
twentieth year. They appear in the following order:
First molars 6 years
Incisors 7 to 8 years
Bicuspids 9 to 10 years
Canines 12 to 14 years
Second molars 12 to 15 years
Third molars 17 to 25 years
CARE OF THE TEETH.--The teeth should be given attention as soon as they
appear. It is an excellent custom to wash the teeth and gums twice daily
with a piece of clean absorbent cotton rolled round the finger of the
mother and dipped in a saturated solution of boracic acid. This should
be done up to the second year. After the second year a soft brush should
be used and the teeth thoroughly cleaned morning and night with pure
castile soap or a powder. The teeth of every child should be examined by
a dentist every six months. All cavities should be filled with a soft
filling. The milk teeth should not decay, but should fall out, or be
forced out by the second set. A child should be taught to gargle early
and a mouth wash should be used morning and night.
DENTITION.--As a general rule the process of teething is accompanied by
some symptoms. There may be fever, restlessness, and loss of appetite;
though in many cases there are absolutely no symptoms. Some children
seem to teethe hard, others easily. The same child may have some teeth
without pain, and with others it may suffer severely. The condition of
the child at the time, its age, and the season of the year undoubtedly
have an influence. Children who are sickly and puny may have much
difficulty while teething.
The degree of sickness varies quite considerably. There may only be, as
stated above, slight fever, restlessness, with loss of appetite; or
there may be, in addition to these symptoms, a pronounced fermentative
diarrhea, which may lead to serious intestinal diseases; frequently
there is a cough. This is more apt to be the case if the child is
teething during the hot season.
TREATMENT.--When dentition affects the child's disposition it is a good
plan to reduce the feeding in quantity and quality for the time being.
If the child is bottle-fed, two ounces can be taken out of each bottle
and one ounce of boiled water added. If the child is breast-fed, he
should be given two ounces of warm, boiled water before each feeding,
and the actual feeding time at the breast shortened.
Rubbing the gum over the erupting tooth with a clean cloth may aid in
helping it through. If the child is very restless and has lost sleep,
the cloth may be moistened with brandy and water. Lancing the gum,
though it is seldom done now-a-days, is justified in a few cases.
Teething is not the cause of actual disease as was once thought, but it
must be remembered that a child whose vitality is reduced by fever,
restlessness, loss of appetite, loss of sleep, and irregular bowels, is
more susceptible to disease than when enjoying robust health.
Sometimes a child will have a fever for one or two weeks during a hard
dentition. There is apt to be more or less intestinal indigestion and
fermentation at this time and as a consequence actual intestinal disease
may develop. To avoid such a possibility it is an excellent plan to give
an occasional dose of castor oil to clean thoroughly the whole
intestinal canal. This should be done irrespective of the condition of
the bowel, because frequently a diarrhea is caused by retained
fermenting products.
Mothers must not acquire the habit of attributing all symptoms to the
teething process simply because the child is teething. It must be
remembered that a child may get a disease, or an ailment, while
teething, that has nothing to do with teething. If this is neglected,
serious consequences may result. Many children have lost their lives by
a mother's carelessness in this way. Be on the safe side, consult your
doctor; let him assume the responsibility.
HOW TO WEIGH THE BABY.--The test of weight is one of the most
satisfactory we possess as an indication of physical progress and
health. It is not an absolute test, but it may safely be relied upon.
The fattest baby is not necessarily the healthiest. A gradual and a
uniform increase is a satisfactory growth. At birth a baby weighs, on an
average, from seven to eight pounds, though some babies weighing less
are equally healthy. The normal and customary gain is from four to six
ounces every week after birth.
The baby should be weighed about the same time of the day each week, and
before a meal.
The average weight of a male child at different ages is as follows:
Birth 7-1/2 lbs.
3 weeks 8 lbs.
1 month 8-1/2 lbs.
3 months 12 lbs.
4 months 13-1/2 lbs.
5 months 15 lbs.
6 months 15-1/2 lbs.
7 months 17 lbs.
9 months 19 lbs.
1 year 21 lbs.
1-1/2 years 23 lbs.
2 years 26-1/2 lbs.
3 years 31-1/2 lbs.
4 years 35-1/2 lbs.
5 years 40 lbs.
6 years 45 lbs.
7 years 49 lbs.
8 years 54 lbs.
9 years 59 lbs.
10 years 65-1/2 lbs.
A female child weighs about one-fifteenth less than a male child, as a
rule.
Table showing the average height of a male child, at different ages:
At birth 20-1/2 in.
6 months 26 in.
1 year 29 in.
2 years 32-1/2 in.
3 years 35 in.
4 years 38 in.
5 years 41-1/2 in.
6 years 44 in.
7 years 46 in.
8 years 48 in.
9 years 50 in.
10 years 52 in.
THE RATE OF GROWTH OF A CHILD.--A child grows most rapidly during its
first year--six to seven inches; from fourth to sixteenth, about two
inches annually; thence to twentieth, one inch. Commonly, a child at two
and a half years has attained half of its ultimate adult stature. The
diseases of youth always accelerate growth.
PULSE RATE IN CHILDREN AND ADULTS.--Normal Pulse,--of new born, 130 to
140, per minute; first year, 105 to 115; second year, 106 to 115; third
year, 95 to 105; fifth to twelfth year, 80 to 90; thirteenth to
twenty-first year, 75 to 80; twenty-first to sixtieth year, 70 to 75; in
old age, 75 to 85.
INFANT RECORDS.--A record should be kept by the mother of every child
which would embrace exact data as to weight, diet, size, development of
mental power, teeth, ailments, sickness, pains, etc., with dates and any
information which would aid in recalling exact conditions. Such records
are of the utmost value in a number of ways. They help in giving
suggestions as to diet, general health, and mental qualities of the
child in question, and they aid in furnishing what physicians call "past
history," which past history has a very valuable significance in
estimating the character and importance of sickness during later years.
Such a record is also of importance in comparing a child's development
with what is regarded as standard development, and also with the growth
and development of other children in or out of the family.
If a child should thus be found to fall seriously below the standard and
yet not appear actually sick, a very thorough and routine investigation
should be instituted to discover if possible the cause. Some error might
thus be detected which might seriously affect the child's future growth
and well-being.
The date of the closing of the soft spot on the baby's head should be
noted, and if it is still open, when it should be closed, it might mean
that the child has a serious brain condition. The soft spot should close
between the eighteenth and twenty-fourth months. The family physician
should be notified if the soft spot is open later than the second year,
as he may want to investigate the cause.
Should the child be unusually backward in walking, and when it does so
should limp and feel pain in the knees, it should be examined for any
symptom of hip joint disease, of which these are the earliest signs.
If the child complains of so-called "growing pains," keep in mind that
these are rheumatic and may need attention. There are no such pains as
actual "growing pains," that is, pains caused by the child growing.