Getting ready to be a mother

by Carolyn Conant Van Blarcom

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].

Fig. 50.—Method of holding baby and lowering him into his bath.

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].

Fig. 52.—Cord dressed with dry sterile gauze. (From photograph taken at Johns Hopkins Hospital.)

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.

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.

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.