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.
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.
CHAPTER XI
THE NUTRITION OF MOTHER AND BABY
Perhaps you are wondering, just a little, why I devote even a short chapter to the subject of nutrition when I have already given you suggestions about dietaries for yourself and your baby. I am doing so because this question of nutrition is one of such enormous importance in relation to the baby’s future well-being that I want to give it special emphasis.
It is probably safe to say that the two most influential factors in creating and maintaining a satisfactory state of health are suitable nutrition and the prevention of infection. Although we shall concern ourselves solely with nutrition, in this chapter, it may be stated in passing that a state of good nutrition goes far toward protecting one from infection.
It will help to make the entire matter clearer to explain in the beginning that a state of good nutrition is not necessarily evidenced by one’s being tall nor by being fat. But it is evidenced by normal size and development; sound teeth and bones; hair and skin of normal color and texture; blood of the normal composition; stable nerves; vigor both mental and physical; normally functioning organs; resistance to disease, and above all that indescribable condition which is summed up as a state of general well-being.
That this degree of nutritional stability is not as prevalent in this country as might be desired is disclosed by reports upon findings of the examining boards for army service, over a period of three years, and physical examinations of various groups of school children throughout the country. It was found in the first case, that about sixteen per cent. of the apparently normal young men who were inspected for military service, were undernourished in some degree, and according to Dr. Thomas W. Wood, Professor of Physical Education, Columbia University, “Five million children in the United States are suffering from malnutrition.” This army of undernourished children, which represents about one third of the children of the country, is on the broad highway to ill health, invalidism of various kinds and degrees, instability and inefficiency. They are certainly not developing into the clear-eyed, alert, buoyant individuals that go to make up good citizenry.
The tragic aspect of this state of undernourishment is that though a great deal can be done to nourish and build up the malnourished child or adult, a certain amount of damage that results from inadequate nourishment during the early, formative weeks and months cannot be entirely repaired later on in life.
As the baby grows and develops, certain substances are needed at the various stages of his progress, and if these are not supplied at these stages, there will always be some degree of inadequacy in the adult make up. It is much like the futility, when building a house, of using bricks without straw for the foundation instead of firm, durable rock, and then trying to make the structure substantial and secure later on by using good materials when building the upper stories.
The solid foundation and substantial beams and girders for men and women are put in during infancy and early childhood in the shape of good material that forms good nerves, muscles, bones, teeth and general physical stability. It is practically impossible to make up to the older child or adult for damage caused by failure to supply sufficient nourishment to the growing, developing, infant body.
“The moving finger writes; and, having writ,
Moves on; nor all thy piety nor wit
Shall lure it back to cancel half a line,
Nor all thy tears wash out a word of it.”
We see all about us, the results of this form of neglect of babies, in the bow-legged, knock-kneed, undersized, misshapen, chicken-breasted adults and in those who are nervous and below par in endurance; are susceptible to colds and other infections and may be summed up as being “not strong.”
The reasons for much of the undernourishment among people in this country to-day are to be found in certain widespread misconceptions of long standing as to what constitutes a state of good nutrition or malnutrition and the value and purposes of different foodstuffs. For malnutrition does not necessarily describe a simple condition due to an insufficient amount of food, but to any one of several complex conditions due to a lack in the food of one or more essential substances.
One may eat a large amount of food and even have a well-padded body and yet be seriously in need of certain food factors—in other words, be incompletely nourished in some particular.
That was possibly the first misconception—the belief that one simply needed enough food, and accordingly was well nourished if three large meals were eaten daily, irrespective of the composition of those meals. A step forward was taken when housewives and people generally accepted the fact that quantity alone was not enough to consider in providing food, but that the dietary should consist of balanced amounts of the five food materials: fats, carbohydrates, proteins, minerals and water, in order to build and maintain the body in a state of health.
But this, too, was found to be an error, in so far as it was only a part of the truth, for it was next ascertained that even provision for a suitable balance of the five food groups was not enough to nourish us, but that we must consider the heat-and-energy-producing properties of these component parts, as measured by the caloric unit, and that we must daily take in the requisite number of calories if we would keep our engines going.
It is now known that even this is not enough, for we may eat food in ample quantities, consisting of the properly balanced fats, proteins, carbohydrates, minerals and water, and it may daily yield the required number of calories, and still we may suffer from seriously faulty nutrition.
We find an explanation for this fact in the comparatively recent recognition of three substances, as yet not clearly understood, which are contained in a certain few articles of food, each one of which is essential to growth and normal health and well-being, though not necessarily concerned in the production of heat or energy. Various terms have been applied to these mysterious, but necessary substances, such as vitamines, accessory food substances, as applied to all, or fat-soluble A, water-soluble B and water-soluble C to designate them separately.
A surprisingly small amount of each of these substances is sufficient to meet the needs of an individual, but no one of these, even in this small amount, can be safely dispensed with, for if the diet is deficient, or lacking in one or more of them some form of nutritional disturbance will result. It may be severe enough to be diagnosed as a disease, or it may be only enough to keep the individual below a normal state of health.
When the disturbance is profound enough to produce a definite, recognizable condition, it is designated as a deficiency disease, of which there are three: scurvy, beri-beri and xerophthalmia. With these are sometimes included rickets and pellagra. The exact cause of the two latter disorders is not definitely known but both are associated with faulty nutrition. Poor hygienic conditions may enter into the causation of rickets, and infection may be a factor in the occurrence of pellagra, but neither disease appears in people who are suitably fed while both diseases may be produced by faulty diet and both may be cured with suitable food.
But probably of graver importance to the public welfare than the well defined nutritional disturbances, themselves, is the fact that between a state of good health and the level upon which a disease is recognizable is a long scale, along which is ranged an uncounted army of under-par, half-sick people. These are the ones who are tired, nervous, susceptible to infections, with feeble recuperative powers, and in general are more or less ineffective in the business of life.
It is this borderline state, or as Dr. Goldberger terms it, “the twilight zone,” which cannot quite be called disease but is not health, that is serious to the masses, for diagnosed disease is given treatment, but nervousness, lack of energy and endurance, weakness and inefficiency are not treated; as a rule they are merely tolerated. The sufferers fail to reach their highest possible development and they fail to be of highest value to society.
This is the condition which can be so largely prevented by giving the baby a good nutritional foundation. This must be started during his prenatal existence, carried through the nursing period and then continued throughout the rest of his life.
It will mean much to the coming generation if the expectant and nursing mothers at large are able so to compose their diets that they will provide not only the requisite fats, proteins, carbohydrates, minerals and water and yield the necessary calories, but will contain, also, all three protective substances: fat-soluble A, water-soluble B and water-soluble C. It can be demonstrated that when these food factors are not present in the mother’s diet, they will not appear in her milk, and accordingly will not be supplied to her baby.
That is the crux of the whole question. If your diet is faulty, your milk will be faulty in the same respect and your baby, being incompletely nourished, will start life with tissues that are lacking in those substances that are needed to make them sound and to promote health. That is what we have in mind when we say that the mother’s milk must be satisfactory not alone in quantity but in quality as well, if the baby is to be well nourished.
In order to make quite clear how damaging are the results of diets which are deficient or lacking in protective substances we shall have a word about rickets and scurvy, the two diseases due to faulty diet, that are so serious for babies.
Rickets is a nutritional disturbance, common among babies who are fed solely or continuously on heated milk, either boiled or canned, and on proprietary food and sweetened condensed milk. Rickets may develop, also, among nursing babies whose mothers are on faulty diets.
The chief characteristics of the disease are arrested growth and softening of the bones, with dwarfism and deformities as a result. It is essentially a disease of infancy, occurring as a rule, between the fourth and eighteenth months but some of its unfavorable effects, such as bone deformities and poor resistance to disease, may persist throughout life. Although babies rarely die of rickets alone, it is one of the most serious of all health problems since it predisposes to such diseases as bronchitis, pneumonia, tuberculosis, measles and whooping cough and in general greatly weakens the powers of resistance and recuperation.
The common, early symptoms of rickets are irritability; restlessness, particularly at night; a tendency to have convulsions from very slight causes; digestive disturbances and profuse perspiration about the head. The baby may be fat, but is likely to be flabby and have a characteristically white, “pasty” color. The fontanelles are large and late in closing; the abdomen is large and the chest narrow; teething is usually delayed and the teeth may be soft, when they do come in, and decay early. But the most conspicuous effect of rickets is upon the bones which are soft, easily bent and broken and often misshapen. Their growth is likely to be retarded and the ends of the long bones may be enlarged, causing swollen wrists and ankles and the little lumps on the chest, so commonly called a “rickety rosary.” The bones in the arms and legs may become curved as the baby lies or sits in his crib, making him either bow-legged or knock-kneed. Since the soft bones are easily bent their deformity is increased by the baby’s walking or by the bunch which may be formed between the thighs by a large, improperly applied diaper. The spinal column may be curved, or too weak to permit the baby to sit straight or stand alone. The entire chest wall is often deformed, producing the familiar “chicken-breast” and so decreasing the size of the chest that the baby’s breathing space is cut down. This is one reason why pneumonia is so serious with a baby who has, or has had rickets. The forehead is prominent and the whole head looks square and larger than normal, while the pelvic deformities in girl babies often give rise to very serious obstetrical complications later in life.
All of this, with the misery which it entails, is due to faulty nutrition.
The sovereign remedies in rickets are cod-liver oil and sunshine, in addition to general good care. But the treatment is a long, slow process, taking from three to fifteen months, and it is doubtful if the damage which the disease works can ever be repaired.
Rickets is more common during the cold months of the year, winter and spring, than during the milder summer and autumn seasons. A possible explanation for this lies in the higher value of the cows’ food during the warm months when green things form the diets of animals. Since it is now recognized that milk is not a constant product, but that its properties vary with the food of the animals that produce it, cows’ milk would be favorably influenced by their being put to pasture.
Similar evidence of such an influence is seen in the fact that although rickets is not seen among breast-fed babies whose mothers are on satisfactory diets, it may and does occur in breast-fed babies who are nourished by mothers who are, themselves, on dietaries which are poor in milk and fresh fruit and vegetables.
It is quite plain that a baby who is fed and cared for in accordance with the suggestions offered in the preceding chapters is not likely to develop rickets.
Infantile scurvy is seen among babies who are fed solely on milk that has been heated, boiled, pasteurized or canned, since the vitamine, in milk, that prevents scurvy is practically destroyed by heating or aging. That is one reason why it is dangerous to give stale milk to babies and why you should not use canned milk on your own responsibility. If the doctor orders it for your baby, he will know what to give in addition to the milk to keep the baby from having scurvy.
The disease develops slowly, the first symptoms appearing between the seventh and tenth months. Tenderness or pain in the legs is perhaps the most common symptom and may be detected first by the baby’s crying when his diaper is changed or his stockings put on. And a baby who has been cheerful, playful and active will prefer to lie quietly and will cry whenever he is touched. He grows pale, listless and weak and fails to gain in weight or length. His large joints are likely to be swollen and tender; his swollen gums may bleed; his urine be diminished in amount and contain blood. But it is entirely possible for a baby to be in serious need of the vitamine that prevents scurvy and still not present these well defined symptoms of the disease. In such a case there may be stationary weight, fretfulness, a muddy complexion and perhaps tenderness of the bones.
Scurvy, of itself, does not often cause death among babies, but it is serious, nevertheless, for it makes the babies very susceptible to infection, particularly nasal diphtheria and “grip.”
The disease may be either prevented or cured by giving orange juice, potato water, spinach or tomato juice to a baby whose diet consists of milk that has been heated and is therefore lacking in the vitamine that prevents scurvy.
Although scurvy is seldom seen in breast-fed babies it is believed that an infant who is nursing at the breast of a woman whose diet is lacking or deficient in fresh milk, oranges and leafy vegetables will suffer a certain degree of starvation and thus be sickly and susceptible to infection without actually having scurvy.
The significance to you, of this complicated and enormously important question of nutrition may be summed up as follows:
1. There are five recognized diseases resulting from faulty nutrition, which may be either prevented or cured by a diet which contains the protective substances, called vitamines, which are now regarded as essential to normal growth, development and well-being. 2. These essential substances are not necessarily provided in adequate amounts by a diet that is satisfactory in bulk or in its balance of fats, carbohydrates, proteins, salts and water or that yields the requisite number of calories. The familiar diet of meat, potatoes, peas, beans, bread, pie and coffee is so far from providing complete nourishment that those who are limited to it are in a state of partial starvation. 3. Although the breast tissues are capable of converting into milk certain substances which they extract from the blood, they cannot create the protective substances which we have been considering. They can merely excrete these substances if they are contained in the mother’s diet. The absence, or shortage of these food essentials in the mother’s diet, and therefore in her milk, may result in rickets or other malnourished conditions in the baby, or in a degree of faulty nutrition which is not marked enough to be diagnosed, but enough to keep him frail; enough to give him the poor start that is so likely to put him, ultimately, in the class of those adults who are more or less unfit, though not actually ill. 4. The great protective foods are milk and leafy vegetables and any diet which is poor in these is incapable of nourishing satisfactorily.
By milk we mean fresh milk, first and foremost and also cream, butter, buttermilk, cream soups and sauces, custards, ice-cream and all dishes and beverages made of milk.
By leafy vegetables we mean lettuce, romaine, endive, cress, celery, cabbage, spinach, onions, string beans, asparagus, cauliflower, Brussels sprouts, artichokes, beet greens, dandelions, turnip tops and the like.
Other foods which are rich in protective substances are fresh fruit, egg-yolks and glandular organs, as liver and sweetbreads.
Nearly all of the common foods are deficient in some respect, but as the shortcomings of the various groups are different, we can arrange entirely satisfactory diets by combining foods which supplement each other’s deficiencies. This explains to us why the meat-potato-peas-beans-bread-and-pie type of meals fail to supply adequate nourishment. These foods belong in the same general group and are deficient in about the same kind of food factors, thus tending to duplicate, rather than supplement each other.
If such a fare is enriched by the addition of the protective foods, milk and leafy vegetables, we have a well rounded diet in which the deficiencies of one group of foods are supplied by the properties of the other groups. In fact, it is only by such a supplementing combination that an entirely satisfactory diet can be secured.
It is generally agreed that the two big problems of babyhood are proper nutrition and the prevention of infection, but nutrition is perhaps the greater problem, since any form or degree of malnutrition lessens the baby’s powers to resist and to recover from infection. Whether breast-fed or bottle-fed, therefore, it is imperative that the baby be nourished in the complete sense of being given all of the food materials which are essential to normal growth, development and protection against disease.
If your baby is artificially fed on milk that has been heated you will understand why the doctor adds such protectives as cod-liver oil and orange juice, since the protective properties of milk are impaired by heating. If he is breast-fed, you will be able to supply to your baby the requisite nourishment and protective substances only if you yourself are adequately nourished and in good condition.
That is the point of this discussion; the fact that you must be on a satisfactory diet or you cannot satisfactorily nurse your baby. Satisfactory nursing means to give to your baby, from the beginning, through your milk, the materials necessary to build well and securely that temple, in the form of his body, which he will occupy throughout life; a structure so substantially built, from the foundation up through each successive stage, that it will be able to withstand the attacks of disease and weather the inevitable storm and stress of life, for perhaps even more than the allotted three score years and ten.
“The race marches forward on the feet of little children.”
TRANSCRIBER’S NOTES
- Silently corrected obvious typographical errors and variations in spelling.
- Retained archaic, non-standard, and uncertain spellings as printed.
- Re-indexed footnotes using numbers.