FOOTNOTES:
CHAPTER VII
CARE OF THE BABY[6]
“Everything in after life depends upon uninterrupted healthy growth during infancy.”
—Doctor F. Truby King.
“There is no young creature in the world so ignorantly and cruelly nurtured as the average infant.”
—Ibid.
“Since what is needed most is intelligent care, all proper means should be employed to educate mothers and those caring for infants, in proper methods of doing this.”
—Doctor L. Emmett Holt.
The baby is a unity of body, mind, and soul, and these cannot be separated in his actual life. During every minute of his care, in every detail, his whole nature is being influenced and his character shaped. It is only for convenience of discussion that the physical régime is separated from the rest of his care.
The régime here outlined is for normal, well babies, for their first year or two. Delicate, feeble, or sickly infants must receive special care, under the physician’s directions, in their feeding, bathing, clothing, and outdoor living.
There are only a few fundamental principles, but these are to be practiced with conscientious thoroughness by every one who has anything to do with the child. It is the little details in the routine of his daily life that produce vigor or weakness. Errors in his care now easily cost his life; or apparently they may not harm him now but will be paid for in suffering, deformities, or weakness in childhood or adulthood. The woman who has this responsibility needs special preparation in self-sacrifice, self-control, gentleness, regularity, thoroughness, and accuracy in little details. She should be in good health, free from any contagious disease.
Fundamental Principles.
1. Regularity, particularly in feeding, sleep, stools
2. Cleanliness of baby, food, clothing, utensils, toys, nursery
3. Fresh air and sunshine, Nature’s great disinfectants and vitalizers
4. Gradual, moderate changes in temperatures, clothing, food, régime
5. Quiet, because the brain and nervous system are yet incomplete in their development, and are very sensitive; the maximum of sleep, with little stimulation while awake. The brain grows as much during the first year as during all the rest of life.
6. Gentleness in handling, to prevent any curvature or misshaping of the soft bones, or shocks to the nerves
7. Moderate warmth, which avoids either chilling or coddling
8. Freedom of movement, for only thus can body and mind normally develop
9. Training in self-control, which can begin the first day and needs daily attention
10. Mothering, cuddling, fondling, regularly every day, before feeding, at bath or dressing times, an hour previous to bedtime
11. Holding and Lifting. The whole length of the spine and the weight of the head must be well supported until the baby is strong enough, at six or seven months of age, to support these himself. In lifting a young baby, the left hand and arm are slipped under the head, neck, and upper back, the right hand under the lower back. He may be carried in one arm by supporting the head in the crook of the elbow and supporting the entire length of the back with the forearm, wrist, and hand. If held in an upright position at this early age, the wobbly head should always be supported. Never lift a baby or little child by his arms.
Daily Régime. The following schedule is in general typical for the first year. It will vary somewhat with the age of the baby, the climate and season. In varying from this schedule, note that the following factors are important and to be observed strictly:
1. Regularity in feeding
2. Interval of one hour after a feeding before bath
3. Interval of one hour between feeding and fruit juice
4. Interval of twenty to thirty minutes between feeding or water and urinating; this interval should be observed for the individual child, that the habit of control (and the saving of wet diapers) may be established as early as possible
5. Regular time for stools; by beginning the week after birth this can be early established, and much unnecessary work saved
6. Regular time for the bath, scheduled for mid-morning or for evening, according to which time is found to agree best with the baby
7. Regular times for play, kicking, cuddling
8. Regular time for weighing, that conditions may be the same
9. Note that in cool weather the baby should not be put outdoors until one hour after the bath; and that an oil rub may be given instead of the cool sponge at night
A daily schedule card is of assistance in maintaining regularity, noting new developments or unusual conditions. It is advisable to record it at least once a week, on the day for the weekly weighing.
Typical Schedule
Conditions. Season: June Age of Baby: Four Months
| A.M. |
| 5:30 Wakened; changed. (Some babies will sleep until 6:00, others will waken early, and should be changed but not fed; may be given water if they cry, and left to play in bed.) |
| 6:00-6:15 Feeding |
| 6:30 Urinated (cuspidor) |
| 6:45-8:00 Slept |
| 8:00 2 teaspoons water; stool (cuspidor) normal |
| 8:00-8:30 Kicking in bassinet (or on nursery table); crying 10 minutes |
| 8:30 Weighing, exercise, rub |
| 8:40 Urinated (cuspidor) |
| 8:40 Bath (temperature 98° F.); cool sponge (84° F.); dressed; crying 10 minutes |
| 9:00-9:15 Feeding |
| 9:30 Put outdoors; asleep |
| 11:55 Wakened; changed |
| 12:00-12:15 Feeding |
P.M. |
| 12:40 Urinated (cuspidor) |
| 12:45 Put outdoors |
| 1:00-2:00 Slept |
| 2:00 Changed; 2 tablespoons prune juice |
| 2:00-3:00 Kicking on nursery table (or in pen) in open air |
| 3:00-3:15 Feeding |
| 3:30 Urinated (cuspidor) |
| 3:30-4:30 Put outdoors; slept; crying 10 minutes |
| 4:30-5:30 Cuddled |
| 5:00 2 teaspoons water |
| 5:30 Urinated; stool (cuspidor) normal |
| 5:45 Rub; sponge bath (90° F.); dressed for night |
| 6:00-6:15 Feeding |
| 6:30 In bassinet, asleep (Change if wet) |
| 10:00 Changed |
| 10:00 Feeding |
| Totals. Sleep: 17 hrs. Water: 3 T. Stools: 2. Crying: 30 minutes. |
Clothing. The designs previously suggested for the baby clothes (page 83) are adapted to ease in dressing, laundering, making, and to freedom of movement. With these, the baby need be turned only once in dressing, or not at all, if the dress is fastened in front. Use only flat, protected safety pins, no common, straight, or ridged pins. With tapes and snappers, pins may be eliminated.
It is much easier and more comfortable to dress and change a baby on the nursery table than on a low bed or the lap.
The clothes should be put on and off over the feet, not over the head.
The clothing should be changed completely at the morning bath and at night. The day outfit is the same as the night during the first three months. Later the day slip is worn, as the baby is awake longer. The nightgown may be of Viyella flannel, the petticoat then being unnecessary, except with the temperature below 40°-50° F.
Overdressing, like overfeeding, is a common and serious mistake. If the baby’s skin is moist to the touch, he is overwarmly dressed and thereby made highly susceptible to “colds” and pneumonia. If his feet are cold, skin “goose-fleshed”, and lips blue, he needs more clothing. With a room temperature of 68°-70° F., duly humidified, a baby four months or over usually needs only a diaper, cotton or quarter-wool double-breasted shirt, flannel petticoat and cotton slip. The binder is needed only until the navel heals,—about three weeks. It should be loosely applied, fastened by tapes rather than by pins or sewing. If applied tightly or worn longer it hinders the development of the trunk muscles, interferes with digestion and breathing, and, contrary to superstition, will not prevent but may cause rupture. For babies under four months or with a room temperature below 68° F. a wrapper, sweater, or sack should be added. The cotton petticoat is only for ornamental purposes with fine slips.
On warm summer days (over 72° F.) he may dispense with the petticoat. In very hot weather, also, substitute a cotton, half-sleeve vest for the long-sleeved shirt, or after three months dispense with all but the diaper while awake, adding a cotton slip during naps, and a cotton shirt at night.
For outdoors, he should not be bundled until the minute before he departs. A thin cap of cotton, linen, or silk may be worn in warm weather (or none at all after three months) and a double one for winter, not thick enough to cause perspiration. For the first twelve months a kimono-sleeved coat, with drawstrings at shoulder and wrist, will provide protection, with the blankets, for cold weather. The nightgown pattern may be used to make a sleeping bag of eiderdown, broadcloth, or flannel. This allows much more freedom than the usual type of sleeping bag, and is better ventilated. The hood should be of lighter fabric, knitted or of flannel, broadcloth, cashmere; eiderdown or angora is overheating.
Stockings and booties ordinarily are not needed during the first year except when the baby is kicking and creeping about with a temperature below 68° F., or for appearance when he is taken out in arms. See that the feet are warm, but not hot or moist. Stockings are always coming off or getting wet from the diaper; they keep the feet perspiring, making them tender and increasing the possibility of colds. When worn, they should be of cotton, or in very cold weather, one quarter or one half wool; all wool are overheating and shrink badly. When the baby begins standing or creeping, the leather Indian moccasins may be used. Other baby shoes on the market have many faults,—tightness across toes and instep, seams turned inside, non-porous patent leather; slippery, stiff, or rough soles; they produce only discomfort at the time and are productive of callouses, corns, bunions, and misshaped feet. At twelve or fifteen months a heavier-soled Indian moccasin may be worn or sandals with flexible, corrugated soles, roomy at the toes, shaped like the foot, right and left, soft, porous (not patent) leather, perfectly smooth inside, using gaiters or leggings with these for out-of-doors in damp or cold weather.
Diapering. Reduce the number of wet and soiled diapers by training.
Begin training at one week of age.
Hold a small (warmed) cuspidor firmly in the lap.
Hold the baby above this, the legs extended in the hands, back resting against the mother’s chest.
Do this at regular time for stool, early morning or late afternoon.
The use of a suppository for a few days will assist; use a little roll of soft, clean paper dipped in liquid vaseline.
Note on daily record the interval between feeding or drinking, and urinating (20 to 30 minutes).
Hold the baby for urinating at these regular times when awake and before beginning the bath.
In a few months he will learn to control the bladder as well as the bowels for these times, when awake.
At eight or ten months the baby may be supported on the toilet seat, by using the baby’s detachable toilet chair now manufactured. A nursery chair for this purpose is not advised. They are usually wrongly proportioned and constructed; and the child is usually left alone to sit for half an hour or more, thereby inducing local irritation, deferred action, prolapsis of the rectum through straining, or bad habits. The mother or nurse should always stay with the child, and the least possible time should be permitted.
Change the diaper as soon as the baby wakes or immediately, if it becomes wet while he is awake. (The urine is salty, sometimes acid, and always irritating.)
Before removing diaper, have at hand everything needed, viz.:
Clean, dry, warm, folded diaper
Diaper preferably folded oblong and fastened at the sides
Diaper handbasin with warm water
Special wash cloth and towel kept only for diapering
Powder, zinc ointment
Diaper bucket
Lay the baby on the nursery table, on a Turkish towel.
If pins are used, put into blanket at right hand, removed from baby’s reach.
Remove the diaper and drop it into bucket.
Wash baby clean and pat dry, especially in creases.
Use powder very sparingly or not at all.
Use albolene or zinc ointment for chafed places.
Put on dry diaper.
Leave baby in safe position while putting away utensils.
Never use a diaper a second time without washing; the acid and salty urine deposit will cause chafing.
Avoid pulling tight about the waist; the pelvic bones are now only cartilage, easily misshaped; if pelvis is narrowed in girls, childbirth will be made more difficult for them.
Avoid tightness in front, especially for boys, as this will produce irritation.
Avoid much thickness between the legs; it will cause bow legs.
Never use rubber or other waterproof diapers; they are overheating and may cause bad habits.
A small pad of cotton batting folded into sterilized cheesecloth, or a double fold of Turkish toweling or stockinet placed in the diaper will absorb moisture and avoid the extra thickness of a heavy diaper; this pad may be burned if soiled.
A quilted or stockinet pad placed between the diaper and petticoat will prevent drenching of clothes while asleep.
If diaper is fastened to shirt, make sure of ample length; avoid any pull on shirt or diaper.
Throw water from basin into toilet or slop bucket, not into lavatory.
Wash out cloth, disposing of water in same way; or put cloth into diaper bucket.
If diaper is soiled, flush off in toilet before putting to soak.
Wash hands thoroughly in the special basin, with soap and water, after changing diaper.
If marked congestion of genitals, or a discharge appears, take special care to disinfect hands and burn cloths and diapers. Report the condition at once to the physician; these symptoms may indicate a serious disease.
Never let a child use a public toilet without placing paper or cloth over the seat; children’s detachable seats may be purchased that can be carried in traveling.
Laundering. Baby clothes should be washed with a mild white soap, such as Ivory, and thoroughly rinsed. Diapers require special care. They should be thoroughly boiled and rinsed. Laundry soap, soda, or bluing should not be used, but Ivory soap, with borax or ammonia if necessary. Dry in sun if possible. Ironing is not necessary.
Boiling, outdoor sunshine, and pressing with a hot iron, are all sterilizing processes.
Starch is never to be used in baby clothes, which should always be soft and non-irritating.
For woolens, use warm water; add soap in solution, not rubbing on clothes; add one teaspoonful of borax or ammonia per gallon of water, if very soiled. Squeeze, or wash with vacuum washer; do not rub, but use hand brush on very soiled places. Squeeze or press without twisting. Rinse through two waters, same temperature as the first. A teaspoonful of glycerine per gallon of water, added to the last rinsing water, preserves softness.
Dry at once by moderate heat; avoid freezing or extreme heat. Stretch into shape, and lay on frames or towels to dry, turning once or twice. If pressing is desired, use a moderately hot iron. Cheesecloth between iron and fabric preserves softness.
Bathing.
One bath every day
Sponge bath until cord heals; later, tub bath
Not within an hour after feeding
Not when greatly fatigued
Tub bath preferably in morning, before second feeding; otherwise, before third or evening feeding
In warm weather an additional sponge bath at night (same as lower temperature of morning) is advisable.
In hot weather give two or three sponge baths 70° to 90° F., according to age, in addition.
In cold weather, an oil rub at night may be given instead of sponge[7] bath.
Temperature for bath is always to be regulated by bath thermometer. Changes to be gradual, by 1° F., from day to day.
Until sixth or eighth month, tub bath 98° to 100° F., followed by cool. Then reduce 1° a fortnight, to 90° F.
After second week, a dash of cool water (90° F.) applied by hand to back (begin at lower end), chest and buttocks. At two months lower by 2° F. and apply with wash cloth; lower 2° F. each month to 80° F., so long as baby reacts well—skin rosy and warm, not blue lips, goose flesh, cold feet.
Cool water may be added slowly while baby is in tub, but not hot water.
Giving the Bath. Before beginning to undress the baby, have everything ready, and just before undressing the baby, wash the hands thoroughly.
Costume: wash dress, sleeves to elbow, bib apron, bath apron.
Room: no drafts; temperature about 70° F. (65°-72°).
Equipment: Clean tub or basin filled with bath water; enamel, tin, or rubber tub may be used; after six months, large tub may be used. Heavy bath towel may be placed in bottom of tub.
Prepare tray with toilet articles and rolled gauze.[8]
Bath thermometer; supply of hot and cold water.
Fresh wash cloths for face and body, kept only for baby.
Soft face towel; two large bath towels spread on nursery table.
Laid out in order for dressing; dry, warm clothes, petticoat placed inside of dress; wrapper or shawl.
Allow fifteen to twenty minutes for undressing, exercises, bathing, dressing.
Allow five to ten minutes for rubbing and exercise.
Allow two to ten minutes for clearing away after bath.
Undress the baby on the nursery table; have a large, warm, Turkish towel under him; leave the diaper on, unpinned, until put into tub.
Rubbing. ½ minute to 2 minutes. Use only the hand until 9-12 months.
Hands warmed; anoint with cold cream or cocoa butter, if rough.
Give 2 to 6 long strokes, each arm and leg, beginning at extremity and rubbing towards heart;
4 to 6 long stokes down back;
4 to 6 long stokes across chest;
4 to 6 long strokes on abdomen, gently, beginning at lower right, and ending at lower left;
2 to 4 strokes on ribs, from back to front.
Exercises. 3 to 10 minutes. (Begin at one month, see page [112].) Fill tub to depth covering abdomen of baby; note temperature with thermometer.
Wrap the towel around the baby and put on cuspidor to urinate. Keep towel around the baby until ready for the tub. Ears, eyes, and head are washed before going in the tub; also the buttocks, if soiled, using the diaper basin and cloth, not the bath water.
Ears. Use sterilized cheesecloth or old soft muslin squares, little or no soap.
Use warm water from tub.
Wash carefully in all creases and behind the ears; let no dirt remain.
Apply albolene or liquid vaseline for scurf.
Never use a pointed instrument; “never put anything smaller than your elbow in the ear.”
Put soiled gauze in tissue paper receptacle.
Nose. Clean each nostril with a fresh cheesecloth square rolled to a point.
Dip the gauze in the liquid vaseline or albolene, and then push gauze gently into the nostril and twist around, until nostril is clean.
Never dip the gauze a second time into the oil; put used gauze into tissue paper receptacle.
If the nose accumulates dirt or mucus during the day, repeat.
Eyes. Use a fresh square of sterilized cheesecloth for each eye.
Wet the gauze in the weak boric solution (2 per cent.), and squeeze a drop into the corner of the eye.
Wash eyelids gently, toward outer corner, and carefully remove dirt or secretion.
Never put gauze in solution a second time; put gauze into tissue paper receptacle.
If eyelids are sticky or with slight secretion, anoint with vaseline, avoiding eyes.
Repeat boric wash at night, or at hourly intervals, if eyelids are inflamed.
Report severe redness or discharge to physician immediately.
Head. Use face cloth, soap, water from tub.
Soap wet cloth and rub over head, avoiding pressure over fontanel or getting soapy water in eyes.
If head has scurf, anoint at night with vaseline, olive oil, or fresh lard, and put on a thin muslin cap.
Never use a comb or harsh rubbing.
Body Bath. Note temperature of water and modify with supply at hand to exact degree. Place the baby in the tub, supporting the head and upper back with left hand. Baby may be lowered in the towel, if afraid.
If giving only sponge bath, hold head face upward over basin to rinse, and wash and dry each part of body separately.
Rinse the head several times very thoroughly with cloth.
Wash the body gently; use a little soap two or three times a week.
Wash under arms, in creases of neck, thighs, fingers, and toes; turn baby over and wash the back.
After six months, baby may splash or attempt swimming for one to four minutes.
Lift baby on to bath apron and give cool sponge very quickly.
Lay baby on table and wrap in dry Turkish towel.
Wipe face and ears with soft face towel; pat body dry with towel. Dry the head thoroughly.
Do not rub with towel before ten months.
Dry carefully under arms, in creases of neck, thighs, knees, fingers, and toes.
Remove wet towel.
In warm weather, after two months, allow an air bath one to three minutes, patting or gently rubbing skin with the hand.
Avoid the use of powder, except in hot weather, in creases, for fat babies; powder clogs the pores.
Put zinc ointment or albolene on chafed places.
If there is any bulging of the umbilicus, put two strips of surgeon’s plaster across, to hold in place and prevent rupture.
During first four to six weeks, gently draw back foreskin in boys and cleanse with boric acid; wash genitals of girls with boric solution; apply vaseline. Later, general bathing is usually sufficient, and special attention is not desirable.
Dress with dry, warm clothes; brush hair; put on wrapper or shawl.
Cleaning Room. Empty tub, scrub, dry thoroughly, put away.
Put toilet articles carefully away from dust.
Remove soiled clothes.
Wrap soiled gauze in paper receiver and burn.
Leave room in order; lower temperature to 68°-70° F.
Avoid. Washing the mouth; the saliva keeps it naturally clean; the delicate membrane is easily injured.
Getting soapy water in eyes.
Removing wax from ears with instruments; soft wax is needed; hard wax may be softened with a few drops of olive oil or liquid vaseline.
Special washing of genitals after six weeks unless hard secretion develops, which should be softened and removed with olive oil or liquid vaseline. The usual daily bath and washing when diapering will cleanse sufficiently; further attention may lead to irritation or to bad habits. Unusual redness or secretion or adhesions should be immediately reported to the physician. Circumcision may be needed. Never let the child touch these parts.
Opening of doors, or other sources of draft, during bath.
Bathroom too warm—above 72° F.
Sudden change to cool temperature after bath; or taking outdoors in less than an hour after bath, in cold weather.
Public bathtub, as in hotel; infection is possible.
At any time putting the fingers into the baby’s mouth unless necessary, and then only after thorough washing.
Care of Nursery. Watch the temperature, humidity, and ventilation; keep the room well sunned.
Air the room and bedding thoroughly with a strong air current from ten to thirty minutes twice a day, while baby is out of the room.
Keep clothing, towels, bedding, and furniture orderly and clean.
Drying of clothing and bedding, or cooking, should not be done here.
When baby is creeping or walking, take special care that pins, needles, scissors, matches, and other small objects are not on floor or in reach.
Clean daily while baby is out of room; dust is the baby’s worst enemy.
Dust-raisers, such as corn or whisk brooms, feather or dry cloth dusters, are not to be used.
Carved woodwork or furniture, bric-a-brac or other dust catchers are out of place in the nursery.
Use a vacuum cleaner, dustless mop, oiled or damp dusting cloths; for toys, use a clean damp cloth.
Wipe floor, window-sills, furniture and toys, and vacuum-clean rugs.
Weekly Cleaning. Vacuum-clean rugs, floor, moldings, ledges, and walls.
Hang rugs out of doors from one to three hours.
Wash or wax floor; wash window-sills, doors, picture frames.
Hang fresh window curtains, screen curtains, crib draperies.
Wash bassinet canopy; brush bassinet thoroughly outdoors.
Clean carriage frame with vacuum, brush, and damp cloth.
Feeding. The kinds of food, quantity, intervals, and times of feeding are important.
The only natural and adequate food is mother’s milk. No thoroughly satisfying substitute has ever been found, or is likely to be. Mother’s milk has the following advantages:
1. It is germicidal—it contains no harmful bacteria, and it has elements which destroy disease germs in the baby. The babies that are nursed have a special protection against such diseases as influenza, whooping-cough, measles, scarlet fever, diphtheria.
2. It is always clean, and therefore greatly reduces the possibility of diarrhea. Only one breast-fed baby dies to ten bottle-fed babies.
3. It does not sour.
4. It requires no time for preparation or care of bottles.
5. It is always ready.
6. It is balanced in proteins, fats, carbohydrates, for the baby’s needs, and the proportion of these elements changes with his development.
7. It is in fine, soft curds, adapted to the baby’s stomach and digestion.
8. It contains vitamines, the living, organic principles essential to growth, and found only in fresh or slightly cooked foods.
9. It has growth-producing properties found in no substitute. In a study made not long since of 100,000 French soldiers, it was found that the group of those who in their infancy had been nursed for six months averaged heavier and taller than those nursed only three months; the group nursed nine months likewise exceeded in height and stature those nursed only six months. Similar phenomena have been noted by many observers.
10. It produces better teeth, less subject to decay, both first and second set.
11. Nursing her baby promotes the return of pelvic organs to their normal condition, and thus promotes the mother’s comfort, shapeliness and health.
12. It fosters her love for her baby, and the baby’s love for her.
Patent baby foods are usually either some form of dried or condensed milk, or a dextrinized cereal. The constituents having been subjected to a high temperature, the vitamines have been destroyed; there are frequent cases of scurvy among babies so fed. These preparations usually contain a high percentage of starch or sugar, with an insufficiency of proteins, fats, and minerals; this produces plump babies that look flourishing in pictures, but that are lacking in solid muscles, bone and nerve tissue, and are subject to rickets, With little resistance for pneumonia or other germ diseases. Patent baby foods, condensed or powdered milk, are the last makeshift.
If artificial feeding becomes necessary, clean cow’s milk is the best substitute. Cow’s milk is made for the calf, whose stomach and digestion are much coarser, and development much more rapid, than the baby’s. As produced, it contains too high a percentage of protein and lime, too low a percentage of sugar and phosphorus, and the curd is too large and coarse for the baby’s digestion. It is difficult to produce perfectly clean, and to keep perfectly sweet until feeding. It must be modified carefully, according to the age and condition of the baby.
The formula is a technical matter for the medical or dietetic specialist to work out and prescribe in each individual case, and to change as the individual baby requires; it is no more a subject for experiment by a novice than is a case of fever. The formula prescribed must be prepared with scrupulous cleanliness and exactness.
As about ninety mothers in every hundred are fitted and able, with wise prenatal and postnatal hygiene, to nurse their babies, the subject of artificial feeding merits relatively less attention.
Ability to nurse is affected by conditions long before motherhood begins. An active, out-of-door life, with freedom from nervous strain or worry, and with clothing that does not compress or overheat the breasts, is important from childhood. Alcoholism in the mother’s father, or Cæsarean birth of the child, usually inhibit nursing.
The ability is increased by a moderate, nutritious diet,[9] including cereals, milk, water (not exceeding an additional quart of liquid daily beyond the mother’s normal need); by quiet mind, outdoor living, moderate exercise; by regularity in nursing, and the complete emptying of a breast at a nursing. It is decreased by a contrary régime, by fatigue, nervousness, or by interrupting or discontinuing the effort to nurse.
Fats are increased by more nutritious diet; proteins, by diet and decreasing the intervals between nursings. Fat in the diet does not affect the proportion in the milk. Indoor life, with overfeeding and insufficient exercise, will unduly increase the proportion of protein and cause colic. A too hearty diet, especially if high in sugars and starches, will unduly increase the fat. Irregular nursing, nervousness, not completely emptying the breast, decreasing the liquids in the diet, will decrease the supply.
Every drop of the mother’s milk is of great value to the baby. If the quantity or quality is not sufficient, nursings should not be stopped, but one or more supplemented with modified milk, prescribed by the physician or dietitian, to furnish the balance. Contagious disease, except tuberculosis, is not necessarily a contraindication to nursing. Unless the milk disagrees with the baby, nursing need not be suspended during menstruation; otherwise, modified milk may be used temporarily, and the milk regularly withdrawn. Weaning should be done slowly, substituting one feeding for a nursing, and discontinuing other nursings at intervals of two or three days. In this way the baby is gradually accustomed to other food, and the mother’s milk gradually disappears. Reducing the diet and omitting liquids for a few days will stop the flow of milk.
While the mother is in bed no more food is needed than under ordinary circumstances, as the food requirement is low during rest and the quantity needed by the baby is very small (page 118). An excess of food is likely to produce indigestion and constipation, and actually interfere with nursing. Foods easily digested, laxative, rich in minerals (especially lime and iron) should be selected through the nursing period. The diet list as for children six to eight years of age is a desirable one to follow.[10] No patent nostrums should ever be experimented with; they are worthless when not harmful. Beer and all forms of alcohol are particularly to be avoided; they do not increase the amount of fluid more than would an equal quantity of water or milk; any increase they produce is of fluid, not of nutriment; the alcohol enters the baby’s system unchanged, and may injure his sensitive nerve cells. Doctor D. D. Bezzola, of Switzerland, who has made extensive studies of the effects of alcohol upon infancy, concludes: “The time may come when we shall see that every drop of alcohol taken by the parent means a drop of stupidity for the child.”[11] Malt liquors are apt to disturb the mother’s digestion and cause her to put on superfluous fat.
Constipation in the mother will produce constipation in the baby, and laxatives or drugs taken by the mother are likely to affect the baby. Anger, worry, excitement produce poisons that render the milk indigestible, even poisonous; if these are indulged in, the baby should be given only plain or barley water, and the milk withdrawn and thrown away for one or two nursings.
Before a nursing the mother should wash her hands thoroughly with soap and hot water, and then wash the nipples with a saturated boric solution. The feeding should be done in a quiet room where there is no noise or conversation to disturb the baby, and the mother should be composed and relaxed. After the feeding, give the baby a swallow of water to rinse out the mouth. Wash the nipple again with the boric solution and dry thoroughly with a clean towel. A triple fold of clean, sterilized gauze, or surgeon’s lint, should be pinned to the undervest, covering each nipple, thus protecting both the nipple and the clothing; this should be changed every day. Cleanliness will prevent thrush in the baby’s mouth, and local soreness and discomfort for the mother.
The quantity normal at a feeding will depend upon the baby’s age, and consequently the size of his stomach and the amount needed for his growth and maintenance. (See page [118].) The quantity taken at one feeding may be ascertained by weighing the baby just before and just after a feeding.
Until recently, two-hour intervals for feeding were prescribed for babies at one or two months, with two night feedings. Extensive studies in France and Germany (where the raising of babies for replenishing the army has made infant hygiene a subject of State investigation) have proven that babies usually thrive better on longer intervals, allowing time for the stomach to rest. Some continental specialists advise four-hour intervals from the beginning, and with some babies this is quite satisfactory. The Table on page [118] presents the more usual schedule now recommended. It provides for a three-hour schedule at the start, changing to four hours at five months, with no feeding after 10 P.M. The 10 P.M. feeding can usually be dropped with advantage at about nine months. To drop a feeding, substitute water for a few nights if the baby wakes or cries.
Regularity is of the greatest importance in the feeding. Clock schedule should be observed from the first day and maintained thereafter. The digestive system is much like a machine, pouring out its digestive fluids at regular habitual intervals, and doing good work so long as this regularity is respected and observed in the feeding. Feeding the baby whenever he cries produces indigestion, colic, irritability, self-indulgence.
Ten to fifteen minutes is the usual duration of a feeding. The first milk is thinner, the latter part of the nursing richer. Generally one breast is taken at a feeding, the other breast at the succeeding feeding; if the quantity in one is insufficient, both may be used at one feeding. Neither the mother nor the baby should go to sleep during the nursing. If the baby dawdles, the food may be taken away until the next time. He should stop a minute at the end of each five minutes, to rest and breathe. If he regurgitates or vomits up after nursing, he is being fed too much, or the intervals are too short.
When the baby has finished, he should be handled very gently for the succeeding hour. His condition is not unlike that of an uncorked bottle. He should lie or sit quietly without jolting or rocking, much less tumbling or other vigorous manipulations. Lay, him on his right side if he is inclined to eructation; on the left side in diarrhea or intestinal trouble, to open the rectal valves and allow gas to escape.
Between feedings, the baby should be given pure water, 65° to 70° F., at regular intervals, several times a day; or during the night if he cries. It can be given the first month from a sterilized medicine dropper, then from a spoon; the use of a cup may begin at five or six months.
If the water is not perfectly pure, it should be boiled twenty minutes; to remove sediment, strain through several thicknesses of sterilized cheesecloth.
Strained orange juice or prune juice, without sugar, at first diluted one half with water, may be given daily at six months, or earlier if the baby is constipated. Begin with one teaspoonful and gradually increase to four tablespoonfuls at six months. It should be given an hour before feeding time.
At six months a scraped, clean chicken or chop bone (after being cooked) may be given once or twice a day, a quarter hour before feeding, to exercise the jaws (being very careful that it is not dropped on the floor). At ten months this may be replaced once a day by a hard crust to be sucked after feeding, watching that the baby does not break off any pieces, or removing these from his mouth.
No other food should ordinarily be given until nine months, when weaning may usually begin by substituting for one nursing a feeding of milk and strained cereal, given with a spoon or from a cup. The formula should be prescribed by the physician or dietitian. Whether a baby should be completely weaned at nine months or at twelve will depend upon the condition of the baby, quality of the mother’s milk, and the season. The baby and the milk should be examined, and the physician’s or dietitian’s advice followed. Starch is not normally digested under nine months; solid food or lumps may cause convulsions.
Stools. There should be at least one normal movement every day; some babies have two or three.
Begin the second week to establish regularity.
A movement is most likely to follow a feeding in early morning and the afternoon.
Normal stools are yellow, soft, and smooth.
If gray or brown, with mucus, blood, or undigested food, report to the physician.
If green or with foul odor, report immediately and substitute barley water for feedings. Spinach will cause green stools, or they may turn green an hour after removal; this is normal.
Keep the bowels in good condition by giving plenty of water, fruit juice, and abdominal exercises; avoid enemas, suppositories, and laxative drugs, all of which are detrimental.
Sleep. During his first year this should be the baby’s chief occupation. Any period of rapid growth involves much work on the part of all internal organs, and a low power of resistance. In this twelve months, the weight trebles, and the length increases about one half; the brain increases its weight nearly three times, and has by far more work in learning new adjustments than in any similar period later in life.
The amount of sleep required at different stages is shown in the table on page [118].
The baby should always have his own bed, and if possible, his own room. He should preferably sleep outdoors except (1) in rain or falling snow, (2) damp, fogging weather, (3) with snow melting, (4) dusty, windy weather, (5) temperature below 40° F. or above 90°. The night air is as healthful as that of the day with these same provisions. A sleeping porch is an investment that will pay high dividends all through his life.
In dry, still weather, 68° to 95° F., the baby may be taken outdoors two or three days after his arrival; otherwise he must gradually be accustomed to the cooler outer air by being taken into a room with windows open on one side (wrapping him up judiciously), reducing the temperature every few days, until at one month he is breathing a temperature of 65° F., at two months of 55° F., and at three months, he can breathe it nearly at freezing (32° F.). Abrupt changes should be carefully avoided. Pure cold air is invigorating; stale air is poisonous; air too dry injures the mucous membrane of the nose and throat; air too moist is oppressive; all of these develop colds and pneumonia.
When the baby is indoors, there should be a constant, quiet current of fresh air, except during dressing and bathing. The air should be regulated, not by guess, but by a reliable thermometer (tested at the baby’s head), and the equally important hygrometer for humidity, when there is not a constant intake of fresh, outside air.
The room temperature should not exceed 70° F. the first three months, and 68° F. later, when the baby is dressed. It may advantageously thereafter be 65°-68° ordinarily. When the baby is sleeping, or playing with wraps on, it is of vital value to have it lower, graduating it from 40° to 60° according to circumstances. Cold air is vitalizing; warm air is devitalizing. An open fireplace, with one window lowered from the top, or a six-inch window board for very cold or windy weather, will provide reasonable ventilation.
A baby has more room and sleeps more comfortably in his basket or crib than in a carriage. When awake, he needs more space to roll, kick, creep, walk. In the open country, he is much better off on the veranda or in the nursery with windows open, lying in his basket or pen, than rolled up in a carriage. Babies unfortunately housed in city apartments or crowded tenements must sometimes be confined in a carriage for the sake of getting to the open air. In a sunny, open-aired room or by an open window is better for a baby than down in a dusty street. The air at higher levels has less dust and fewer germs. The roof of an apartment house, if there is protection from chimney gas, hot sun, and high winds, is preferable to the street. He should never be put on the ground without the protection of a waterproof and blanket or rug to prevent chilling.
Making and Care of Bed. Lay in the mattress—preferably a washable folded quilt, laid smooth, or a floss, hair, or straw-filled mattress.
Cover mattress with papricloth nursery blanket or light-weight rubber sheeting, laid smooth.
Over this, lay the large quilted pad or felting.
Lay on the lower sheet, tucking it under the mattress.
Lay a small quilted pad under the baby’s hips, or use a large size pad for older, tossing babies.
Lay a flat quilted or hair pad (which may be covered with a cotton or linen slip) or a folded diaper or soft folded towel for the head and face; a pillow is inadvisable.
Put on the top sheet and the coverlet, folding the sheet back six inches over the top of the coverlet for protection, and tucking in at sides (not tight) and at foot.
For cold weather, especially outdoors, put in first a woolen blanket. Lay several newspapers between this and the mattress, and when the baby is in, fasten this over the coverlet like a sleeping bag; for cold weather a knit or woolen sleeping bag is desirable.
When the baby is out of his bed, it should be taken apart, both morning and afternoon, shaken, thoroughly aired, and sunned.
In cold weather, the bed should be warmed before putting the baby in, and flannelette may well be used instead of muslin sheets.
Change sheets and pads whenever they are wet.
The crib bed is cared for in the same way. Padded side protectors should not be used, as they prevent good ventilation. The light-weight, washable side curtains may be used, but these on only one side and end; they should be removed and washed every week. The screen will furnish ample protection from drafts.
The bed should always be placed where it has a quiet current of fresh air but not a draft, strong wind, or hot sun. The basket should rest firmly on its stand, or a large table, or dry surface, never on the floor. Protection should be provided against flies, mosquitoes, cats, dogs, falling objects; and after eight months, against the baby’s climbing and falling out.
“Putting the baby to sleep” should consist in laying the baby in his stationary bed,—warm, dry, comfortable, protected,—to go to sleep by himself. Rocking disturbs the circulation in the brain, produces only light sleep, and is bad for the nervous system. Babies often cry at first, when laid in bed, merely to be taken up, rocked, or played with. To humor them in this way is to cultivate in them self-indulgence, irritable temper, and tyranny. If let alone they may cry themselves to sleep for a few nights, but this will do them no physical harm; they will have learned their lesson, and the family will be spared further trouble.
The baby should not always be laid on his back, but may be laid on one side, or on his stomach, turning his head to one side and putting a flat pad under his chest. The latter position is not only a restful change, but also promotes digestion and encourages development of the muscles at the base of the head and in the upper back.
Disturbed sleep may be caused by bad air, overclothing, rough clothing, cold feet, indigestion, thirst, need of circumcision, a habit of rocking. It is not necessary to keep the house in silence while the baby is sleeping. Sudden and boisterous noise should be avoided, but the baby outdoors or in his own room learns to sleep undisturbed by ordinary conversation, music, household activities.
The baby should be gently wakened, if asleep at feeding or bath time. After a few weeks, his system will be so trained that he will naturally waken at these times.
The regular waking of the baby should be anticipated, and the mother or nurse should be there at the time to take him up, change the diaper, and make him comfortable before he begins to cry. Waking time should be a smiling time.
Play and Exercise. The first play is simple, muscular play of limbs.
After the first month, arrange clothing and covers so there is great freedom for kicking, twisting, rolling, stretching, pulling.
After two months, baby will not sleep so much and will be more active with hands, arms, legs.
He should have a pen or yard, raised six inches above the floor; or a board may be made to fit over mattress of crib. Pen or board should have woolen blanket and quilted pad over it; let baby kick and roll freely. The floor is bad because of drafts and dust. A large dry-goods box, raised, is better than the floor.
Do not prop a baby up in a sitting position until he is strong enough to hold himself up five minutes without support; then allow sitting position for only ten minutes at a time, not on the table or bed with the feet extended in front, but in a carriage or chair, legs bent at knee.
After two months place objects for him to grasp toward, upward, and forward.
As soon as the baby learns to smile, this becomes a little game. At six or eight months, he begins to play with vocal sounds, at peek-a-boo and pat-a-cake. Boisterous play, tossing, tumbling, tickling, are too severe for the delicate nerves; his laughing at this is a symptom rather of nervousness than of joy. The baby is not a plaything for his elders. The hour before bedtime is a good time for quiet mothering.
Motor development during the first year normally approximates the following plan.
Eyes begin to focus at about six weeks; coördination not well developed until three months or later; real tears, from the lachrymal glands, begin at about three months; knows mother or nurse by sight at about three months. Voluntary smiling begins at about five weeks, laughing at five or six months. Ability to sit alone develops at from six to eight months, to stand alone at twelve to fourteen, and to walk alone at fourteen to eighteen months.
Exercises. Special exercise may begin at three or four weeks of age. Begin with one exercise, and three-minute periods. Each fortnight time may be increased two minutes up to twenty-minute limit. Add new exercises gradually, at two-week intervals.
All exercises should be given slowly, rhythmically, two hours after a feeding, when baby is in happy mood; before bathing in mid-morning, or in mid-afternoon, is a good time. Do not permit fatigue or test endurance.
Always do the exercises in the same order, thus cultivating motor memory.
Lay the child on the padded nursery table; have clothing loose, or preferably without clothing; diaper unfastened; no drafts; temperature at 70° to 72° F.
Arm movements. For development of chest, upper back, upper arms.
1. Take hold of each hand; extend arms straight on table, at right angles to body, saying “down”, 4 times; bring hands together in front of body as in clapping, saying “up”, 4 times. (Figures 1, 2.)
2. At “down”, bring arms down to sides, parallel with body; at “up” stretch arms upward to table above the head (if baby objects, each arm may be done separately) 4 times. Keep his elbows straight in both exercises. (Figure 4.)
Leg movements. For trunk and leg muscles; overcoming constipation.
1. Grasp foot, bend knee to body; do alternately with right and left, each 4 times; then both together 4 times. (Figure 3.)
2. Grasp leg, keep knee straight, bring leg to right angles with body; take each leg alternately, 4 times; then together, 4 times. Avoid sidewise movement. (Figures 5, 6.)
When the child is able to lift his head, he may be allowed to pull himself up as far as he can, holding the nurse’s hands. Grasp his hands firmly so he will not suddenly lose his hold and fall back; do not pull him, but let him develop strength to pull himself to a sitting position. (Figures 7, 8.)
At first let him immediately lower himself to lying position, gradually sitting up one minute, and slowly increasing by one minute.
Many babies at about eleven months go on all fours, bear-fashion. At this stage the wheelbarrow exercise can begin, grasping the baby’s feet and lifting them up while he supports himself on his hands and arms. This is strengthening for arms, chest, back, and trunk. At this age the substituting of rompers for dresses permits more freedom of action and minimizes accidents from tumbling.
Crying. Every baby does some crying, and every cry has some meaning. The wise mother will find the cause and will, if necessary, remove it. She will never use pacifiers, sugar, soothing syrups, loud noise, trotting, bouncing, tossing, irregular feeding, all of which are injurious to the baby’s sensitive nerves.
| Causes of Crying | Nature of Cry; Treatment |
| Painless, spontaneous exercise | Vigorous, red-faced. Usually at feeding, bathing, dressing; 3-20 minutes. Necessary |
| Physical discomfort. | Fretful or sharp; continued |
| Clothing wet; pins in clothes | Remove cause |
| Clothing wrinkled, tight, oppressive | Practice better hygiene |
| Clothing rough, hot | Rub the back, with downward strokes |
| Bed rough, covers tight | |
| Tired of one position | |
| Air oppressive, stale, too warm, dry | |
| Cold feet, thirst, overfeeding | |
| Sleepiness, overtired, hunger | |
| Teething, constipation | |
| Colic, gas, indigestion | Sharp, intermittent; feet drawn up |
| Illness | Moan, wail, feeble, intermittent |
| Psychological: | Lusty, continued |
| Desire for attention, especially at night | Stops when desire is granted |
| Desire for things forbidden | Will soon stop if ignored |
A pernicious habit of self-indulgence and tyranny is cultivated if the baby learns that he can get his desires by crying. If indulged, even at a few weeks of age, he develops temper, self-indulgence, and disrespect for authority. If no attention is paid to such crying, or desires cried for are denied, he soon learns self-control, self-reliance, respect for law and authority.
Exercises for the Baby.
Infant Mortality.[12] Chief causes presented in the order of their frequency.
| Immediate Causes as Given in Mortality Statistics | Underlying Causes |
| 1. Diarrhea and indigestion | Ignorance; poor hygiene |
| Low Vitality | |
| Bottle feeding | |
| Unclean milk and preparation | |
| Solid food too early | |
| Irregular feeding | |
| 2. Pneumonia, croup, colds | Ignorance; poor hygiene |
| Congenital debility | |
| Indoor living | |
| Overheated, overdry rooms | |
| Tobacco smoke in rooms | |
| Overclothing; overfeeding | |
| Playing on floor | |
| Sitting on unprotected ground | |
| Adenoids, enlarged tonsils | |
| 3. Congenital debility (weakness at birth) | Ignorance; inadequate prenatal hygiene |
| Weak heredity | |
| Poor health of parents | |
| Use of alcohol by parents | |
| Syphilis | |
| Self-indulgence of parents | |
| Lack of continence during pregnancy | |
| Poor nutrition of mother | |
| Overwork of mother | |
| Too short interval between births (less than two years) | |
| 4. Contagious diseases: whooping cough, diphtheria, measles | Ignorance; poor hygiene |
| Lack of resistance | |
| Indoor living | |
| Infections in crowds, streetcars, stores, dusty streets | |
| Infection of colds from family or visitors; kissing | |
| Adenoids, enlarged tonsils |
| Defects Easily Acquired in Infancy[13] | Causes |
| Spinal curvature | Careless lifting, holding, or laying down |
| Sitting up too early or too long | |
| Bow legs | Diapers too thick |
| Standing too early | |
| Inadequate feeding | |
| Narrow pelvis | Diapers too tight |
| Binders too tight | |
| Misshapen ribs and chest | Clothes too tight |
| Rickets | |
| Rupture | Binder too tight |
| Binder worn too long | |
| Rough handling | |
| Internal displacements | Careless lifting or holding |
| Jogging, tossing | |
| Too long sitting | |
| Enlargement of stomach | Overfeeding |
| Tender or deformed feet | Feet kept too warm, perspiring |
| Shoes tight, rough, non-porous | |
| Shoes worn too early | |
| Use of “baby walker” | |
| Walking too early | |
| Nervousness | Irregularity |
| Indoor living | |
| Wrong feeding | |
| Lack of training in self-control | |
| Nervousness of attendant | |
| Disturbance of sleep | |
| Need of circumcision | |
| Excitement; tickling, tossing, rocking |
Frequent among preventable illnesses of infancy are colds, constipation, colic, rickets, scurvy, marasmus.
| Bad Habits to be Guarded Against | Remedies |
| Putting fingers in mouth | Give suitable toys |
| Thumb sucking (produces ugly mouth, self-indulgence; may cause infections, adenoids) | Put aloes or golden seal on fingers |
| Put on sleeveless sack dress | |
| Put on aluminum mitts | |
| Screaming, tantrums | Leave alone |
| Deny object desired | |
| Masturbation | Medical examination |
| Circumcision | |
| Local cleanliness | |
| Toys; occupation |
To state the underlying causes of infant mortality and defects is at the same time to emphasize their preventability and to indicate the method of prevention. The pathos is less in the high rate of death and illness than in their needlessness,—if only young women and young men were provided with even a meager preparation for this responsibility! The following are representative judgments expressed repeatedly by physicians everywhere.
“The problem of infant mortality is not one of sanitation alone or housing or indeed of poverty as such, but is mainly a question of motherhood.”
—Doctor G. Newman (English).
“The parents in their homes are largely responsible for the high infant mortality.”
—Doctor Ira S. Wile (American).
It is advisable to have the baby examined by the physician once a week during the first three months and at least once a month thereafter during the first year. If the daily régime is followed carefully, with judgment, the baby will probably gain normally in weight, be rosy and happy, free from any illness. The first year is the critical year, the time for every precaution both to prevent defects and promote vigor.
Table of Feeding, Sleep, and Weight[14]
| Average Weight of Baby in Pounds | Age of Baby | No. of Feedings | Ounces at Each Feeding | Total Ounces in 24 Hours | Intervals in Hours | Hours | Sleep |
| 7½ | Birth and 2d day | 4 | 1 | 4 | 6 | 22 hours | |
| 7 | 3d day | 6 | 1 | 6 | 3 | 6, 9, A.M., 12 noon; 3, 6, 10 P.M. | ” |
| 4th ” | 6 | 1½ | 9 | 3 | ” | ” | |
| 5th ” | 6 | 2 | 12 | 3 | ” | ” | |
| 7¼ | 7th ” | 6 | 2½ | 15 | 3 | ” | ” |
| 7½ | 10th ” | 6 | 3 | 18 | 3 | ” | ” |
| Begin 3d week | 6 | 3½ | 21 | 3 | ” | ” | |
| ” 4th ” | 6 | 4 | 24 | 3 | ” | 21 ” | |
| 8¾ | ” 2d month | 6 | 4¼ | 25½ | 3 | ” | 20 ” |
| 10½ | ” 3d ” | 6 | 4½ | 27 | 3 | ” | 19 ” |
| 14¼ | ” 4th ” | 6 | 5 | 30 | 3 | ” | 18 ” |
| 13¾ | ” 5th ” | 5 | 6½ | 32½ | 4 | 6, 10, A.M.; 2, 6, 10 P.M. | 16 ” |
| 15 | ” 6th ” | 5 | 7 | 35 | 4 | ” | ” |
| 16 | ” 7th ” | 5 | 7½ | 37½ | 4 | ” | ” |
| 16¾ | ” 8th ” | 5 | 8 | 40 | 4 | ” | 15 ” |
| 17½ | ” 9th ” | 5 | 8¼ | 41¼ | 4 | ” | ” |
| 18 | End 9th ” | 5 | 8½ | 42½ | 4 | ” | ” |
| 21 | ” 12th ” | 5 | 4 | ” | ” |