American Red Cross Text-Book on Home Hygiene and Care of the Sick Part 6

INTERVALS OF FEEDING.--Little milk is secreted during the first two days after the birth of a child. The baby should, nevertheless, be put to the breast as soon as he has had his first bath, if the mother is sufficiently rested. Always before and after nursing the mother's nipples should be washed in water that has been boiled. Nursing should be repeated at intervals of six hours during the first two days.

The following schedule for the feeding of healthy babies is given by Holt in "Care and Feeding of Infants." (1917.)

SCHEDULE FOR HEALTHY INFANTS FOR THE FIRST YEAR

------------------+--------+----------+----------+-----------+-------- | | | | | |Interval| Night | No. of | Quant.i.ty |Quant.i.ty Age |between | feedings,| feedings,| for one | for 24 |meals by| 6 p.m. | in 24 | feeding | hours | day | to | hours | | | | 6 a.m. | | | ------------------+--------+----------+----------+-----------+-------- | Hours | | | Ounces | Ounces 2d to 7th day | 3 | 2 | 7 | 1-2 | 1-14 2d and 3d weeks | 3 | 2 | 7 | 2-3 | 14-24 4th to 6th week | 3 | 2 | 7 | 3-4 | 21-28 7th week to 3 mos.| 3 | 2 | 7 | 3-5 | 25-35 3 to 5 months | 3 | 1 | 6 | 4-6 | 27-36 5 to 7 months | 3 | 1 | 6 | 5-6 | 33-39 7 to 12 months | 4 | 1 | 5 | 7-8 | 35-43 ------------------+--------+----------+----------+-----------+--------

During the period when seven feedings are given in 24 hours the following hours will be found convenient: 6 a.m., 9 a.m., 12 m., 3 p.m., 6 p.m., 10 p.m. and 2 a.m. The 2 a.m. feeding is the one omitted when the number of feedings is reduced from seven to six. Food should be given on exact schedule time; the baby if asleep should be waked for any meal except the one due at 2 a.m.

WATER.--Pure boiled water should be given regularly even to a young baby. He is often satisfied with a little warm water if he is fretful between the hours of nursing. Water may be given from a cup, a spoon, or a bottle; it is desirable, however, for the baby to learn to drink from a cup before the period of weaning begins.

WEANING.--Ordinarily, a baby should be fed from the breast until he is seven months old, either exclusively or with the exception after the second month of one bottle-feeding in twenty-four hours. This exception will do the baby no harm and may be a great relief to his mother.

Partial breast-feeding should continue if possible through the ninth month, but every baby should be entirely weaned by the time he is one year old. It may be necessary, if either the baby or the mother is not thriving, to change the food before the ninth month; but it is desirable not to make the change in hot weather. Healthy babies, it should be remembered, increase in weight constantly, and steady gain in weight is the best indication that a baby's food is suitable.

NURSING BOTTLES AND NIPPLES.--Nursing bottles should be of heavy gla.s.s, cylindrical in shape, without angles or corners to make cleaning difficult. The number of bottles provided should be two or three more than the number of feedings given in 24 hours.

Short black rubber nipples which slip over the neck of the bottles should be selected. They should be of such a shape that they can easily be turned inside out; a nipple turner costs little, and is well worth the price. Nipples should be discarded when they become soft or when the opening grows so large that the milk runs in a stream rather than drop by drop.

As soon as the baby has finished his meal, the bottle should be removed from his mouth, rinsed in clear hot water, and left standing filled with cold water until a convenient time for boiling all the bottles to be used during the next 24 hours. Sufficient time must be allowed for the bottles to cool thoroughly between the time when they are boiled and the time when they are refilled. When it is time to boil the bottles they should be placed in an agate or other suitable kettle, covered with water, and boiled vigorously for three minutes. A cloth placed in the bottom of the kettle will help to prevent the bottles from breaking.

After the bottles have been removed from the boiling water, they should be stoppered at once, either with rubber stoppers or plugs of sterile cotton. The stoppers, if used, should be boiled with the bottles; sterile cotton may be purchased by the package.

An easy and satisfactory method to care for rubber nipples is the following: Provide as many nipples as the number of feedings given in 24 hours, and another, if desired, to be used in case of accident; provide also two cups of ordinary white enamel, each one large enough to hold all the nipples at once. One cup should have a cover; the other should not. To avoid mistakes it is well to have the cups different in shape.

As soon as each feeding is finished the nipple should be thoroughly cleansed under running water by scrubbing it inside and out with a nipple brush. The nipple thus cleansed is placed in the cup without a cover. When all the nipples have been used, cleansed, and collected in the uncovered cup, they are transferred into the other cup; water is added, the cup is covered and its contents are boiled for three minutes.

The nipples remain covered in the boiled water until needed; they are removed one by one for the successive feedings. Care must be used in removing a nipple to take it by the rim, not to touch other nipples during the process and not to dip the fingers into the water. The best way is to remove them by means of a gla.s.s rod, which is boiled with the nipples and kept with them in the cup when not in use. There are several advantages of this method of caring for nipples: it is easy; it reduces to a minimum the necessary handling of the nipples after boiling; and it reduces the probability of using the wrong nipple, since boiled nipples are always in one kind of receptacle and used nipples in another. It also prevents the too common practice of continuing to keep nipples in a supposedly antiseptic solution long after the solution has become badly soiled.

TABLES of diet for children over one year of age may be found in the Appendix, page 322.

BATHING.--Usually the cord has separated and the navel has entirely healed by the time a baby is 10 days old. After this time a daily tub bath should be given; it should be given not less than one hour after feeding. The temperature of the room should be from 70-72, measured by a thermometer placed in the part of the room where the bath is to take place. In order to avoid chilling or tiring the baby the bath should be given quickly, without confusion or interruption; success can be achieved by using even a moderate amount of foresight. Before undressing the baby everything to be used should be collected and placed within easy reach,--clean clothing, soft towels, 2 wash cloths, pure white soap, powder, absorbent cotton, etc. The bath tub should last of all be filled with water, and its temperature tested by means of a bath thermometer. The temperature of the water should be from 98 to 100.

After the baby is three months old slightly cooler water should be splashed over his chest, back, neck, and arms just after he is removed from the tub, and as he grows older the temperature of his cool splash can be reduced. Children who become accustomed to cool water in this way take kindly to their cold showers later.

The baby's face should be washed first and dried carefully, while his body is still covered. Next the head should be washed; a little soap should be used, but it must on no account enter the eyes. Next the entire body should be soaped with the hand; and then the baby should be placed gently in the bath, his head and shoulders supported by the attendant's left hand and forearm. Care should be taken to rinse off all the soap. The baby should not stay in the tub more than 2 or 3 minutes; after he has been removed from the tub he should be wrapped at once in a soft bath towel. He should be dried gently but thoroughly by patting with soft, warm towels rather than by rubbing. Folds of the skin should be dried with special care. A little powder may be applied, but a baby who is kept both clean and dry will not need much powder, if any. The baby should next be quickly dressed, with as little turning and moving as possible. Clothing should be drawn on over the feet instead of over the head, and the petticoat should be placed inside the slip so that the two garments may go on simultaneously.

EYES.--Secretion acc.u.mulating in the corners of a baby's eyes should be removed by means of a bit of absorbent cotton moistened in boiled water.

The secretion should be wiped away gently; a different piece of cotton should be used for each eye, and a piece that has been used should not be put back into the water. Further than this, eyes in a normal condition do not need cleansing.

Every person who handles a baby should be very sure that her hands are clean; she should be doubly sure before she touches his eyes, since a baby's eyes are peculiarly susceptible to infection from any source.

More than a quarter of all totally blind persons in the United States became blind by infection of the eyes at birth. Blindness of the new born can be prevented in practically all cases if the doctor uses a preparation of silver in the baby's eyes immediately after birth. This treatment is effective and entirely safe.

If at any time the eyelids look red or swollen, or if a drop of matter appears between the lids, the physician should be summoned at once.

Total blindness may result if treatment is delayed even a few hours.

MOUTH.--The mouth should be rinsed after feeding by giving the baby a teaspoonful of boiled water. Until the teeth come it does not require other cleansing, and attempts to clean it may injure the delicate membranes that line it. Indeed, except in an emergency, fingers should not be inserted into a baby's mouth. The teeth when they appear should be cleaned by means of a soft tooth-brush.

NOSTRILS.--The nostrils need no cleaning other than removal of mucus that can easily be reached by means of a piece of cotton. If a little vaseline is placed in the nostrils on a small piece of absorbent cotton in the early morning, collections of mucus will usually be softened so that they can be removed easily at bath time.

GENITAL ORGANS.--The genital organs of girl babies should be gently washed twice a day, using absorbent cotton, and tepid water. Treatment other than cleanliness is ordinarily unnecessary. Vaseline may be applied if the genitals are slightly reddened; any discharge or abnormal appearance should be reported to the doctor. In the case of boy babies the foreskin should be gently drawn back twice a week after immersion in the tub; after the parts have been gently washed with absorbent cotton, it should be drawn forward again. No force should be employed in retracting the foreskin; the physician should be consulted if it cannot be retracted easily.

THE DEVELOPMENT OF HABITS.--During his first few months crying is a child's only means of expression, and he quickly learns to make effective use of his limited opportunities. It is important for the mother to distinguish between crying caused by pain, illness, or hunger, and crying caused by temper. These cries are more or less distinctive, but no one can be sure in every case just what a crying baby is attempting to express.

A cry caused by hunger is fretful and often interrupted by sucking the thumb; it ceases when the child is fed. A cry caused by indigestion is similar; the child is relieved for a short time by feeding, but soon begins to cry again. If he has acute pain, such as earache, the cry is sharp, repeated at frequent intervals and accompanied by other symptoms of distress, such as restlessness, contraction of the features, and drawing up the legs. In serious illness the cry is usually feeble, fairly constant except when the child is asleep, and exaggerated by slight causes.

A limited amount of crying is useful exercise for a baby, and should not distress his mother unduly. Moreover, crying may be merely the expression of a wish to be taken up, to be played with, carried about or otherwise amused, to be given a pacifier, or to be indulged in other bad habits. If not indulged in these ways he may cry from temper. The cry of temper is loud and violent, accompanied by vigorous kicking or by holding the body rigid. Proper treatment of the baby may prevent many months of discomfort, and spare him the formation of his first bad habit. All other possible causes for crying should be eliminated. If the child continues to cry when he is warm and dry and comfortable, "It should simply be allowed to cry it out. This often requires an hour and in extreme cases two or three hours. A second struggle will seldom last more than ten or fifteen minutes and a third will rarely be necessary"

(Holt). Gas may form in the child's stomach during prolonged crying. It is consequently permissible to take him up after 15 minutes, and hold him erect; he generally expels gas at once, and immediately experiences relief. As soon as he is relieved, he should go back to his crib.

EXERCISE.--Exercise is essential to the development of the body, but during the first few weeks warmth and quiet are so important that a baby should not be disturbed except for necessary care. His position, however, should be changed occasionally; if he lies on the same side constantly the soft bones of the head may become misshapen from pressure. As the baby grows older he needs more exercise, and he may be given an opportunity for it by removing his outer clothing and placing him on a bed in a warm room for a short time each day. Unnecessary handling is not good for a baby at any age.

After he becomes more active, he may play on a mattress or thick blanket placed on the floor. The blanket should be covered with a washable pad or rubber cloth and clean sheet, and the whole should be surrounded by a fence at least two feet high. In such an enclosure a baby may safely be left to play if protected from draughts and cold. Elevated pens that can be folded when not in use are more convenient but more expensive than the home-made arrangement. As soon as a child begins to run about he takes ample exercise, and he may even need to be guarded from too great fatigue, especially toward bedtime. Games and play should be adapted to the age of the child and sufficiently varied to exercise all portions of the body; but they should not be too violent nor too prolonged. Some supervision of children's play is necessary, but they should be given as much freedom as possible and allowed to develop their own initiative.

PLAY AND TOYS.--The desire for play does not develop until a child is about six months old. At this age toys that can be washed, such as those of hard or soft rubber, should be selected. A baby instinctively carries everything to his mouth,--first his thumb, then playthings, and later whatever he may find, no matter how unsuitable. For his safety and protection this habit should be overcome as soon as possible, and he must learn to put nothing in his mouth except food and drink. Relatives are nearly always tempted to give too many and too fragile toys; they merely teach a child to be destructive and constantly to expect something new. Toys are the first possessions of which a child is conscious, and through them many desirable qualities may be developed: neatness and order, gentleness and a feeling of protection toward the helpless doll or Teddy bear, and unselfishness in sharing special treasures with playmates. Later the child may be given pets and made responsible for their care; but animals should not be subjected to unintentional cruelties from small children.

EXERCISES

1. What two factors are chiefly responsible for the deaths of babies under a year old? What other factors contribute? In your city or town what is the number of deaths per 1000 births of babies under one year old?

2. Why is birth registration important to an individual? to a community? Is it required by law in your city?

3. What is the average weight of babies at birth? Describe the rate at which they should gain.

4. At what age may a normal child be expected to sit erect? to stand? to walk? to speak? When should his first teeth appear? his permanent teeth?

5. Describe normal bowel movements of a baby.

6. How should a young baby be dressed?

7. Describe a baby's bath and toilet.

8. Describe the surroundings that are suitable for a baby.

9. What is the best food for a healthy baby? Why?

10. Describe in detail a good daily program for a healthy baby four months old.

11. What habits are desirable for a baby to form, and how may he be trained so that he will form them?

12. Name all the indications that would tell you when a baby was not thriving, and in each case tell what you would do about it.

FOR FURTHER READING

The Care and Feeding of Children--Holt.

The Care and Feeding of the Baby--Truby King.

The Baby's First Two Years--R. M. Smith.

The Care and Feeding of Children--J. L. Morse.