She must begin with a definite knowledge of just what she intends doing; she must know, however, what must be done and she must begin at the beginning and build from a sure foundation. It is therefore absolutely essential to ascertain if there is any actual disease underlying the reduced vitality which is responsible for the delicacy of the child; this necessitates a thorough examination by a competent physician. If you are assured there is no disease present, no tuberculosis, no syphilis, no malaria, and that debilitating conditions, such as adenoids, sexual abnormalities, the results of self-abuse, skin disease, do not exist, then certain fixed rules can be laid down, and definite principles followed in the daily management.
Weight, as a Standard of Development.—It has been stated elsewhere in this book that one of the safest guides to follow, as to whether a child is thriving, is its weight. This can be relied upon as a general rule. A child should therefore be weighed regularly every week. If it is not gaining an average of four ounces weekly it is not thriving up to standard. When the average is below four ounces there is something wrong with the quality or quantity of the food.
How to Feed the Delicate Child.—If the child is breast-fed and the weight standard, as evidenced by the weekly averages, is persistently below normal, we must find a substitute for the mother's milk. If the child is bottle-fed and it is demonstrated that it is impossible to maintain normal development on cow's milk, a wet-nurse should be obtained. After the child is weaned, or put upon a more liberal diet, milk should continue to be the chief article of diet. From the first to the third year a child should take one quart of milk daily in addition to the other food. There are some children, however, who seemingly cannot take milk without getting indigestion; they should be put on skimmed milk, to which may be added a small quantity of sugar to make up for the loss of fat. Mothers must be certain that too much milk is not given, or the desire for other necessary food will diminish.
After the first year it is a very good plan to give one teaspoonful of scraped beef daily. If this is well borne, two may be given and later three. It can be given immediately before the regular feeding of cereal and milk. From the twelfth to the sixteenth month eggs may be given: at first one-half, and later a whole egg mixed with bread crumbs. Various vegetables should also be given cooked in the form of a purée. If at any time the child should refuse the food, or act as if it had no appetite, leave the milk out of the diet; this may then restore the appetite and it will take the other food freely; the milk can be resumed later.
As the child grows older, the distaste for milk may grow, or he may be one of those children with whom milk really does not agree; in either event, do not hesitate to leave it out of the child's dietary. These children should be encouraged to eat plenty of good butter on their bread and crackers. Butter will not only agree with them, but it will supply any fat deficiency in the general diet. The diet may now consist of milk (unless it disagrees), cereals cooked three hours, raw or rare meat, poultry, eggs, vegetables, purées, cooked and raw fruit, bread, crackers.
How to Bathe the Delicate Child.—Regular daily baths are particularly of benefit to the delicate child, despite the prevailing fear that they may catch cold. The salt bath is advised and the time to take it is just before retiring. The room should be warm and the temperature of the water should be 90° F.: it should not last longer than five minutes, and the water should be cooled down to 70° F., before the child is removed from the bath. While the cold water is running in, the surface of the body should be briskly rubbed with the mother's hands and after removal the child should be dried with a fairly coarse bath towel to ensure a good reaction. Very delicate children need not have the temperature of the water reduced; others may stand water of 80° F., but no lower. In the poorly nourished it is frequently advantageous to rub the body, after drying, with olive oil or goose oil. This aids nutrition and because of the massage it aids circulation. In some older children a daily cold spinal douche seems to act particularly well. If the child does not promptly react from the effect of the cold water it is best to discontinue it.
Airing the Delicate Child.—Delicate children should, above all things, be assured of the maximum amount of fresh air and sunlight. Many mothers entertain the idea that these children are disposed to take cold easily, if in the open air,—which is not the case. All children need an abundance of fresh air and the delicate need it particularly. The season of the year and the character of the weather will, of course, dictate just how much open-air exercise they may take.
If the weather is very cold and the air damp, or if there is a very cold high wind, it is best to remain indoors; otherwise the child should remain out for four or five hours. Indoor airing is obtained by dressing the child to go out-doors, putting him in his carriage, and leaving him before an open window in a room of good size with all the doors closed so as not to create a draught.
Habits of the Delicate Child.—The amount of sleep necessary for a delicate child is the same as for a normal child of the same age. The room should always be well aired, night and day, and should be devoted to the exclusive use of the child.
These children should never be allowed to sit on the floor. It is always a difficult matter to avoid this, but it must be religiously guarded against; otherwise a cold is the inevitable result.