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