CHAPTER X. The Mother’s Care of Her Baby

THE MOTHER’S CARE OF HER BABY

“The mother is the natural guardian of her child; no other influence can compare with hers in its value in safeguarding infant life.”—Sir Arthur Newsholme.

Before undertaking the care of the new baby, suppose we stop for a moment, and consider just what he represents; what he has been through; what struggles and dangers are ahead of him; what are the weaknesses of his equipment to meet these perils and what must be the character of your service to him if you are to do quite all in your power to help him safely over this hazardous period of early infancy.

At the time of birth, the baby makes the most complete and abrupt change in his surroundings and condition that he will make during his entire lifetime.

For nine months he has existed under ideal conditions; he has been safeguarded from injury; kept at the temperature which was best for him, and above all, has been furnished with exactly the proper amount and character of nourishment necessary for his growth and development. Suddenly he emerges from this completely protecting environment into a more or less hostile world, where he must assume the task of living, with a frail little body that in many respects is only imperfectly developed. And yet the baby must not only continue the bodily functions and activities that were begun during his intra-uterine life, but must develop certain functions which were imperfect and even establish others which were performed for him.

You will recall that while within the uterus, the baby received his nourishment and oxygen and gave up waste material through the placenta. Accordingly, his organs of digestion, respiration and excretion are imperfectly developed at birth and are capable of functioning only within very narrow limits at first.

His respirations are usually established immediately after birth, when he cries vigorously, for his lungs are thereby filled with air. The other functions are established more gradually and the care of the baby must be such that the immature, unused organs will have their development promoted through activity and yet not be overtaxed.

=The Baby’s Condition at Birth.= The newborn baby boy weighs from seven and a quarter to seven and a half pounds and is about twenty inches long, girl babies being perhaps a little smaller. His body is well rounded and his flesh firm. The skin is a deep pink, or even red, and is covered with the cheesy substance called vernix caseosa, which is likely to be thickly deposited over the back and in folds of the skin and creases, as in the thighs and under the arms. Some babies still have, when born, the fine downy hair on parts or all of the body, that they had before birth.

The head and abdomen are relatively large, the chest narrow and the limbs short. The legs are so markedly bowed that the soles of the baby’s feet may nearly or quite face each other, but they finally assume a normal position. The bones are still soft and the entire body is, therefore, very flexible. Some of the bones which unite later in life and make the adult skeleton firm and rigid, are separate at birth.

Most newborn babies have faded blue eyes, the permanent color appearing gradually, but the amount and color of the hair varies greatly, some babies being bald, while others have abundant hair from the beginning.

The shape of the baby’s head is often badly distorted at birth, being so long from chin to crown that the mother is deeply concerned. But you may rest quite assured that even though badly misshapen, your baby’s head in the course of a few days will assume the lovely, rounded contour so characteristic of babyhood. The temporary deformity of the head is caused by a molding and overlapping of the bones of the skull as it is forced through the narrow part of the pelvis, the inlet, that we learned about in Chapter III. About the middle of the top of the head you will be able to feel a soft, diamond shaped spot and farther back another soft spot, smaller than the one in front and somewhat triangular in its outline. These soft places are openings between the bones of the skull and are called the anterior and posterior fontanelles. They always may be felt on the new baby’s head.

=Growth and Development.= The physical progress which is made during the first year by average, normal babies who are satisfactorily nourished and cared for is fairly uniform and the average rate of this progress is somewhat as follows:

=Weight.= There is a loss in weight of 6 to 10 ounces during the first week of life, after which the baby usually gains from 4 to 8 ounces each week, during the first five months. From this time the gain is only about half as rapid, or at the rate of 2 to 4 ounces weekly. At six months, therefore, the average baby weighs from 15 to 16 pounds, or double the normal birth weight of 7½ pounds, and at twelve months he weighs from 20 to 22 pounds, or three times the average birth weight. Fig. 41 gives an idea of how the baby’s weight drops during the first week and the rate of the normal weekly gain afterwards, during the first year.

FIG. 41.—Baby’s weight chart showing the usual loss during the first week and subsequent gain during the first year of life. ]

The weight is perhaps the most valuable single index to the baby’s condition that we have, but at the same time it must be remembered that a baby whose food contains an excess of sugar or starch may be of normal weight, or over, but be incompletely nourished and very susceptible to infection, while other babies who are small and gain slowly are sometimes very well and vigorous. Moreover, quite commonly there are periods in the lives of entirely normal babies during which there is little or no gain in weight. This may occur during the period from the seventh to the tenth month, for example, or in very warm weather. But the doctor is likely to want to watch the baby’s weight, for when studied in conjunction with other conditions it gives a certain amount of information about the baby’s general state and progress.

=Height.= The height of the average baby at birth is about 20 inches, though boys may measure a little more and girls a little less; at six months it is about 25 inches and 28 or 29 inches at the end of a year.

=Head and Chest.= The circumferences of the head and chest are about the same at birth, the chest being possibly a little the smaller of the two. Both measure about 13½ inches, gradually increasing to about 16½ inches in six months and to 18 inches by the end of the first year.

=Fontanelles.= The posterior fontanelle, the one at the crown of the head, usually closes in six or eight weeks but the larger, anterior fontanelle is not entirely closed until the baby is about eighteen or twenty months old.

=Teeth.= Although it occasionally happens that a baby has one or two teeth at birth, the average infant has none until the sixth or seventh month, when the two lower, central incisors appear. After a pause of a few weeks the two upper, central incisors come through, followed by the two lateral incisors in the upper jaw. At the end of the first year, therefore, the average baby has six teeth, or eight if the lower lateral incisors have appeared by the first birthday, as they sometimes do. This is the usual course of dentition, during the first year, as shown in Fig. 42, but there are wide variations among entirely well and normal babies, the first tooth sometimes not appearing before the tenth, eleventh or even twelfth month. As a rule, however, an entire lack of teeth by the time the baby is a year old is regarded as an evidence of faulty nutrition.

FIG. 42.—Diagram showing first, or “milk,” teeth and the ages at which they usually appear. ]

The baby who is properly fed and cared for, cuts his teeth with little or no trouble, in spite of the widely current but seriously mistaken belief that a teething baby is a sick baby. We have no way of estimating the number of babies who die, needlessly, as a result of this dangerous conviction, for if the baby is sick while teething, the trouble is all too often accepted as a normal occurrence and is not given the attention it needs until too late. Frail, delicate babies may have convulsions each time that a tooth is cut and if a baby is having digestive trouble, this is likely to grow worse while he is teething. But cutting teeth is a normal process and the healthy, properly fed baby suffers little or no inconvenience while it is in progress.

=Stools and Urine.= During the first two or three days the stools are of dark green, tarry material called meconium. In the course of two or three days they begin to grow lighter and shortly the normal stools appear, these being bright yellow in color, of a smooth, pasty consistency and having a characteristic odor. During the first month or six weeks the baby’s bowels may move three or four times daily, but after this they usually move but once or twice in the course of twenty-four hours. As the nourishment is increased, the stools grow somewhat darker and firmer and finally become formed.

FIG. 43.—Appearance of cord immediately after birth. ]

The newborn baby’s bladder usually contains urine and this may be passed immediately after birth or not until several hours later. After the first urination the bladder may be emptied five or six times a day or oftener.

=The Cord.= Within a few days after birth the stump of the umbilical cord that is attached to the baby’s navel, begins to shrivel and turn black and a red line appears where the cord joins the abdomen. By the eighth or tenth day, as a rule, the cord has shrunken to a dry, black string, when it drops off and leaves an ulcer or small red area which heals entirely in the course of a few days. Figs. 43, 44, 45 and 46 show these progressive changes.

FIG. 44.—Appearance of cord four days after birth. ]

FIG. 45.—Appearance of navel immediately after cord has dropped off. ]

=Skin.= The soft, downy hair that may be remaining on the surface of the body usually disappears by the end of the first week and there is often a scaling of the skin which lasts for two or three weeks, while a delicate pink tint replaces the deeper color of the skin in the course of ten days or two weeks. The baby does not perspire until after the first month, ordinarily, when a very slight perspiration begins, gradually increasing until by the time the baby is a few months old he is perspiring freely.

FIG. 46.—Appearance of a normal, well healed navel. ]

=Tears.= There are no tears at birth and opinions differ as to whether they appear in the course of two or three weeks or three or four months. The absence of tears is one reason for bathing the baby’s eyes so carefully during the early days and weeks, for if dust or other foreign material gets into the eyes it is not washed out by tears as it is after their flow is established.

=General Behavior.= During the first few weeks the average baby sleeps most of the time; that is, from 19 to 21 hours daily. He gradually sleeps less, as the special senses develop and will sometimes lie quietly for an hour or more with his eyes open, sleeping only 16 or 18 hours, daily, at six months and 14 to 16 hours at the end of a year.

The baby begins to make noises and “coo” at about two months and to utter various vowel sounds when about six months old. By the end of a year these indefinite noises and sounds become distinct words. At about the fourth month he grasps at objects and smiles, and very soon even laughs. He holds up his head at about the third or fourth month; sits up and also begins to creep at six or seven months, while sometime between the ninth and twelfth months he will stand while holding on to something secure and begin to walk with assistance.

These degrees of development at different ages are not to be taken as the only measure of normal progress, for some well babies mature more rapidly and many others more slowly than at the rate which is found to be average. In addition to these fairly specific evidences of the baby’s condition and progress, such as weight, height, strength and muscular development, there are other and less definite indications of his well-being which should be taken into account.

The baby who is well and is being properly fed in all respects, will have good color; his flesh will be firm; he will take his nourishment with a certain amount of eagerness and seem satisfied afterwards. He will sleep for two or three hours after each feeding; will sleep quietly at night and while awake, unless he is wet or uncomfortable for some other good reason, he will seem contented, good-natured and happy.

You have seen how the average, well baby grows and develops, provided he is given proper care. I want you now to have just a glimpse of the other side of the question, so that you may realize what happens to the unfortunate little citizens who are not given such care. This glimpse will make you realize more than ever, how worth while are all of the precautions that you take for your baby.

It is estimated that out of every 1000 babies born alive, in this country, 40 die during the first month of life, and that more than as many again, or about 85 all told, perish before reaching the first birthday.

So hazardous is this period of early infancy, in the United States, that our annual loss of baby life is between seven and eight times as great as was the yearly loss of our young men in the war, for upwards of 200,000 babies less than a year old die each year. That the first month is more dangerous than any which follow is shown by the fact that about 100,000 of these baby deaths occur during the first four weeks of life. The tragedy of these figures is made darker by the fact that at least half of the babies who are lost die from preventable causes. In other words, they die from lack of proper care.

That is the point of this for you. These babies die, not by an act of Providence, but from lack of care—not the difficult, complicated care needed by sick babies but just the everyday care which any mother may give—the care that keeps well babies well.

That is what you are going to do—keep your well baby well. And you are going to be surprised to find how easy it is, after all, to say nothing of the pleasure of it, for the thing very nearly sums itself up into feeding your baby as the doctor orders and keeping him clean in every particular. Bear these two factors in mind for errors in feeding and lack of cleanliness are the underlying causes of the vast majority of baby ills.

You will often feel a little like Alice in Wonderland, who found, one time, that she had to keep running very fast to stay where she was, for you will not be able to relax in a single detail of your baby’s care if you are to keep him well. With him, as with you, or anyone else, the satisfactory use of even ideal food is largely dependent upon the general condition and mode of living, and we find accordingly, that the question of keeping the baby well finally resolves itself into the following common sense requirements:

1. Proper food.

2. Fresh air.

3. Regularity in the daily routine care.

4. Cleanliness of food, clothing and surroundings.

5. Preservation of an even body temperature.

6. Adequate rest and sleep.

7. Periodic consultations with your doctor.

Carve these principles into the tablets of your brain and you cannot fail to give your baby the kind of care that is literally life-saving. I am going to describe the tiny, intimate details of this care, for I think this will help you, in the beginning at least, but if you will keep these fundamentals in mind and use good common sense you really need not read another word about baby care, for they give it all in a nutshell.

Let me warn you emphatically against making the very serious mistake of acting upon the advice of friends or relatives, no matter how many children they have had. These counselors are just as dangerous for babies as they are for expectant mothers, so beware of them!

“Is it not preposterous,” says Herbert Spencer, “that the fate of a new generation should be left to the chance of unreasoning custom, impulse, fancy, joined with the suggestions of ignorant nurses and the prejudiced counsel of grandmothers? To tens of thousands that are killed, add hundreds of thousands that survive with feeble constitutions, and millions that grow up with constitutions not so strong as they should be, and you have some idea of the curse inflicted on their offspring by parents ignorant of the laws of life.”

It is a very wise precaution to have your doctor see the baby every week or ten days during the first three months and once a month during the remainder of the year. Not because he is fragile or ill. Not at all. You consult your doctor in order to be sure that you are keeping your baby well.

Did you ever hear of the Chinese custom of paying the doctor as long as one is well, but not paying for attention during illness? It isn’t so very heathenish—that idea of paying for the skillful care that will prevent illness.

In addition to taking the general precaution of seeing your doctor periodically, about the baby, be sure to consult him about anything that you do not understand or about any new condition that arises. You will find any number of persons who are ready and eager to advise you, but your doctor is the only one whose advice it is safe for you to follow.

=The Daily Schedule.= The importance of regularity in the daily routine of the baby’s care cannot be stressed too often nor too insistently. No matter how well he is nursed in other respects, nor how skillfully the doctor directs his care, the baby cannot be expected to progress satisfactorily if his life is not absolutely regular.

Begin by arranging a daily program for the feedings, fresh air, bath, sleep and exercise and then allow nothing to interfere with your carrying it out.

The hours for the nursings, which vary with different doctors, will constitute the greater part of this daily schedule. For a baby on four hour feedings, for example, some such program as the following may be arranged, while for a baby on a three hour schedule a slightly different program may be arranged.

6 a.m. Feeding. 8 a.m. Orange juice (when ordered). 9 a.m. Bath. 10 a.m. Feeding. 10:30 to 2 p.m. Out of doors. 2 p.m. Feeding. 2:30 to 4 p.m. Out of doors. 4 p.m. Orange juice (when ordered). 4 to 5:30 p.m. Indoor airing and exercises (when ordered). 5:30 p.m. Preparation for the night. 6 p.m. Feeding. 10 p.m. Feeding. 2 a.m. Feeding (when ordered).

YOUR BABY’S FOOD

Proper feeding is probably the most decisive single factor in the routine care of the baby.

In order that the food shall be satisfactory, it must be not only suitable in composition for the individual baby, but it must be clean, fresh and at the right temperature; given in suitable amounts and at suitable intervals; it must be given properly—not too fast nor too slowly and it must be given under favorable conditions. Moreover, as has been stated, the baby, himself, must be kept in a general condition which will promote the digestion and assimilation of the food that is given to him. Fresh air, suitable clothing, an even body temperature, gentle handling, proper bathing, regular sleep, freedom from excitement, fatigue, and irritation all promote the baby’s ability to use his food to advantage. Reverse conditions all work against it. Accordingly, the actual value of the baby’s food to him will be largely dependent upon the care that you give him.

There are three methods of nourishing the baby: by breast feeding, by artificial feeding and by a combination of the two, termed mixed or supplementary feeding.

=Breast Feeding.= From all standpoints, maternal nursing, under normal conditions, is the most satisfactory method of nourishing a baby. If the breast milk is suitable it meets all of the baby’s requirements and the proportion and character of its constituents are exactly suited to his digestive powers. In order for maternal nursing to be entirely satisfactory, the condition of both mother and baby must be favorable. The preparation and care of the mother have been described: her general condition and state of nutrition; the care and condition of her nipples, flat or retracted nipples being· brought out if possible, and if not, the nursing facilitated by the use of a shield. As to the baby, if his diaper is wet or soiled, it should be changed before he is put to the breast, partly to make him comfortable and partly to avoid disturbing him for this after his feeding; and his mouth is gently swabbed with boric-soaked cotton, if your doctor so orders.

Footnote 2:

Boracic acid solution is made by adding one teaspoonful of the crystals to one cup (half-pint) of boiling water.

Although nursing is an instinct, the baby may have to learn how to nurse or to acquire the habit, this being one reason for putting him to the breast during those first two or three days when he obtains little or no actual food, as was explained in Chapter IX. As he expresses the milk by squeezing and suction made possible only when the nipple is well back in his mouth, he must take into his mouth practically the entire colored area which surrounds the nipple. To do this he lies in the curve of his mother’s arm as she turns slightly to one side, and holds her breast away from his nostrils in order that he may breathe freely.

Sometimes, even when other conditions are favorable, the baby is unable to nurse because of some physical disability. He may be too feeble, may have a cleft palate or find suckling painful because of an injury to the mucous membrane which occurred when his mouth was wiped out just after birth. The manner in which the baby nurses, therefore, may be significant and should be described to the doctor if there is any difficulty.

When the baby has finished nursing he should be taken up very gently, held upright against the shoulder for a moment or two, to help him bring up gas if he has any, and then placed in his crib and left to sleep. If he is nursing satisfactorily, he will be sleepy and contented afterwards and will sleep for two or three hours; he will seem generally good-humored and comfortable while awake; he will have good color; gain weight steadily and have two or three normal bowel movements daily. The normal stool in breast-fed babies is bright yellow, smooth and has no evidences of undigested food.

If the baby is not being adequately nourished, he will present exactly the opposite picture, in some or all of these respects. He will be unwilling to stop nursing after the normal length of time and will give evidence of being not satisfied when taken from the breast. He may be listless and fretful and sleep badly. He will not gain weight as he should and he may vomit or have colic after nursing.

To ascertain whether or not such a baby is getting enough milk it is customary to weigh him, without undressing him, before and after each nursing. Each fluid ounce of milk will increase his weight one ounce. If the baby is not obtaining a normal amount of milk at each nursing, he is often given enough modified milk after each meal to supply the shortage, but at the same time an effort is made to increase the supply of breast milk by improving the mother’s personal hygiene, as described in Chapter IX.

The amount which the baby needs at each feeding varies, not only according to his weight and age, but also according to his vigor and activity and therefore must be estimated for each baby. A very general estimate of the amount taken by the average, well baby at each feeding, is about as follows:

First week 1½ to 2½ ounces Second and third week 2 to 4 ounces Fourth to ninth week 3 to 4½ ounces Tenth week to fifth month 3½ to 5 ounces Fifth to seventh month 4½ to 6½ ounces Seventh to twelfth month 6½ to 9 ounces

=Artificial Feeding.= There is no entirely adequate substitute for satisfactory maternal nursing, and any other food that is given to the young baby is at best a makeshift. Considering the baby’s delicacy, therefore, and his urgent needs, no pains should be spared to make any artificial food that is given to him, as satisfactory as possible. And no matter what it costs, he should have only the freshest, cleanest and purest milk that can be bought.

In preparing and giving artificial food it must be borne in mind that normal breast milk has the following characteristics:

1. It is exactly right in quantity, quality and proportion.

2. It is fresh, clean and sweet.

3. It is free from bacteria.

4. It tends to protect the baby from infection.

5. It definitely protects him from certain nutritional diseases.

Cows’ milk, suitably modified, is apparently the best available substitute for mother’s milk, but it must first meet certain requirements and then be handled with scrupulous cleanliness and care, if it is to be satisfactory.

The requirements are that the milk shall be:

1. Whole milk. It must not be altered by the removal of cream nor the addition of such preservatives as salicylic acid, formaldehyde or boracic acid.

2. Its composition must not vary greatly from day to day.

3. It must be clean and free from disease germs; other organisms should not be present in excessive numbers.

4. It must be fresh; less than 24 hours old when it is delivered.

All of this means that the milk must come from a herd of healthy, tuberculin-tested cows. The milk from a single cow may vary markedly from day to day but that from several cows is nearly constant. The stables and the cows must be kept clean, the udders carefully washed before each milking; the milkers themselves must wear freshly washed clothing, scrub their hands thoroughly and milk into sterile receptacles; the milk must be immediately covered and cooled to a temperature of 45° F. or 50° F. and kept there.

Milk produced under such conditions is usually described as “certified milk” and is often prescribed as infant food without being pasteurized or sterilized. But if there is any doubt about the source of the milk and the method of its handling, it should be strained into a clean receptacle through filter paper or a thick layer of absorbent cotton and subsequently boiled or pasteurized.

Whether certified or not, the milk should invariably be placed in the refrigerator, or some other place which has a temperature of 50° F., as soon as it is received, and it must be kept cool and clean.

Keeping milk cool means keeping it at a temperature of 50° F. Keeping it clean implies cleanliness not alone of the milk itself but of your hands and the utensils that you use as well as the destruction of disease germs by pasteurization or sterilization. Among the germs which are likely to be present in infected milk are those that cause diarrhea, sore throats, typhoid fever, diphtheria and scarlet fever.

When the doctor makes out the formula for the baby’s milk, he will adjust the proportions of the different ingredients to the baby’s immediate needs and digestive powers. But his careful estimations will be set at naught unless you are absolutely accurate in preparing and giving the milk. Your invariable responsibility in connection with the baby’s milk, therefore, is to keep it cool and clean and be accurate.

You will appreciate the necessity for modifying cows’ milk before giving it to your baby if you will note the differences between mother’s milk and cows’ milk as indicated by the following table and consider, too, why Nature has made these differences:

Mother’s Milk Cows’ Milk Fats 3.5 to 4. per cent 3.5 to 4. per cent Sugar 6.5 to 7.5 per cent 4.5 to 4.75 per cent Proteins 1. to 1.5 per cent 3.5 to 4. per cent Salts .2 per cent .7 to .75 per cent Water 87. to 88. per cent 87. per cent

The various tissues of the body and the bony skeleton are built by the proteins and salt. Accordingly Nature supplies these in greater abundance to the baby calf, who grows so fast as to double his birth weight in about forty-seven days, than to the baby boy who scarcely doubles his birth weight within 180 days. The calf begins life with a physical need for the large amount of proteins and salts which are present in cows’ milk and with digestive organs that can cope with them, but the baby needs less, can digest less and, therefore, should be given less. There are of course, other and finer differences between the two milks and an attempt is sometimes make to meet these. For example, mother’s milk is slightly alkaline and cows’ milk slightly acid and the curd of cows’ milk is larger, tougher and harder to digest than that formed by mother’s milk. Some doctors add lime water to cows’ milk, before giving it to the baby, to make it alkaline and have the curd made softer, finer and more digestible by boiling.

=Articles Needed in Preparing the Baby’s Food.= A complete equipment for preparing and giving the baby’s milk should be assembled, kept in a clean place, separate from utensils in general use, and never put to any other service. A satisfactory outfit for this purpose comprises the following articles:

One dozen graduated nursing bottles. One dozen nipples. Clean, new corks or a package of sterile, non-absorbent cotton for stoppers. Bottle brush. Covered kettle, capacity one gallon, for boiling bottles and possibly pasteurizing milk. Pasteurizer or wire bottle rack. Small kettle, about one quart size. Graduated pint or quart measuring glass. Pitcher, two-quart size. Long-handled spoon for mixing. Funnel. Measuring spoons—table and tea sizes. Double boiler. Thermometer which will register at least 212° F. Cream dipper (if ordered). Two small covered jars for sterile and used nipples. Sugar (lactose, maltose or cane sugar according to orders). Lime water (if ordered).

Utensils of enamel or aluminum ware are probably the most satisfactory ones to use as they are easily kept clean, while bottles with wide mouths and curved bottoms and inner surfaces can be thoroughly washed more easily than those with small necks and sharp corners. Nipples that can be turned inside out to be washed should be selected as it is almost impossible to clean thoroughly those with tubes or narrow necks. New bottles will be rendered less breakable if placed in cold water, which is gradually heated, allowed to boil for half an hour and cooled before the bottles are removed.

The bottles should be rinsed with cold water after each feeding and then carefully washed and scrubbed with the bottle brush in hot soapsuds or borax water, containing two tablespoonfuls to the pint. They may be kept full of water while not in use or rinsed with hot water and stood upside down until they are all boiled on the following morning, preparatory to being filled with the freshly prepared milk. The baby’s bottles should never be washed in dishwater nor dried on a towel. The nipples should be rinsed in cold water, turned inside out and scrubbed with a brush, in hot soapsuds or borax water; rinsed and placed in a jar ready to be boiled with the bottles.

=Preparing the Milk.= The full quantity of milk which the baby will take in the course of twenty-four hours is prepared at one time and the prescribed amount for each feeding poured into as many separate bottles as there will be feedings.

You should begin by assembling on a table everything that you will use in preparing the milk formula, as the nurse has in Fig. 47. Boil for five minutes all of the articles that will come in contact with the milk, including the full number of bottles and nipples and the jars in which the nipples are kept; remove them with the long-handled spoon without touching the edges or inner surfaces, dropping the nipples into one of the sterile jars.

Wash the mouth of the milk bottle before removing the cap and pour the amount which the formula calls for into the sterile pitcher. To this is added the sterile water in which the sugar has been dissolved in the measuring glass and then the potato or barley water, the lime water or soda solution as ordered. This mixture is thoroughly stirred and the amount for one feeding at a time, measured in the measuring glass and poured into the specified number of bottles, which are then stoppered.

FIG. 47.—Preparing the baby’s milk. (From a photograph taken at Johns Hopkins Hospital.) ]

If certified milk is used for the milk mixture it is often given to the baby without being pasteurized, in which case the bottles are placed in the refrigerator as soon as they are filled and stoppered. Very frequently, however, the milk is sterilized or pasteurized. You will feel surer of keeping the mouths of the bottles clean if you cover them with squares of gauze or muslin before they are sterilized, holding the caps in place with tapes or rubber bands.

Pasteurization as applied to infant feeding consists of heating the milk to 140–165° F. and keeping it at that temperature for 20 to 30 minutes.

There are many excellent pasteurizers for home use on the market, but entirely satisfactory results may be obtained by improvising one from the wire bottle rack seen in Fig. 47, and the large kettle already provided. One method is to place the rack, containing the bottles, in the kettle which is filled with cold water to a level a little above the top of the milk in the bottles, and allow the water to come to the boiling point. The kettle is removed from the fire, covered tightly and the bottles allowed to stand in the hot water for twenty minutes. Cold water is then run into the kettle to cool the milk gradually and avoid breaking the bottles, after which they are placed in the refrigerator, well or spring-house and kept at a temperature of 50° F. until they are taken out, one at a time, for feedings. If a wire rack is not available the bottles may be stood on a saucer or a thick pad of folded newspapers in the bottom of the kettle.

Pasteurization does not destroy all germs that may be in the milk, but it kills the more important ones and apparently impairs the nutritive and protective properties of the milk less than boiling. However, pasteurized milk must be kept cold and must be used within twenty-four hours, for the aging of milk is quite as undesirable as souring.

Scalding is another method of destroying germs in milk. The milk is placed in an open vessel and the temperature raised to about 180° F., or until bubbles appear around the edge and the milk steams in the center, after which it is cooled and kept at a temperature of 50° F.

Many doctors prefer to have the baby’s milk boiled, since boiling insures absolute sterilization and also renders the curd more digestible. Other changes are produced by boiling, however, which make it important to add orange juice and cod-liver oil to the baby’s diet at an early date, as will be explained in the next chapter.

Milk may be boiled directly over the flame for a time varying from three to forty-five minutes, or it may be placed in a double boiler, the water in the lower receptacle being cold, and allowed to remain until the water has boiled from six to forty-five minutes.

When milk is boiled or scalded, the other ingredients are added beforehand, as a rule, after which it is measured and poured into the bottles. Or the milk mixture may be poured into the bottles as for pasteurization and the bottles kept in the actively boiling water for any desired length of time.

All of these points, however, are definitely specified by the doctor.

=Giving the Baby His Bottle.= At feeding time, the bottle should be taken from the refrigerator, the stopper removed and a sterile nipple taken up by the margin and put on the bottle without touching the mouthpiece. The milk is brought to a temperature of about 100° F. by standing the bottle in a deep cup or kettle of warm water and placing it on the fire. The temperature of the milk may be tested by dropping a few drops on the inner side of the wrist or forearm where it should feel warm but not hot. This dropping will also indicate if the hole in the nipple is of the proper size to allow the milk to drop rapidly in clean drops but not to pour. If the hole is too small, the drops will be small and infrequent and the baby will be obliged to work too hard to obtain it; while if the hole is too large the baby will feed too rapidly and may have colic as a result. If the hole is too large the nipple will have to be discarded; if too small or if there is no hole, one of the proper size may be made by piercing the nipple with a heated darning needle or small steel knitting needle.

FIG. 48.—Proper position in which to hold baby and bottle during feeding. ]

FIG. 49.—Holding the baby upright immediately after feeding, and gently patting his back to help him bring up air in order to prevent colic. ]

The baby’s diaper should be changed if it is soiled or wet before he is given the bottle and he should be held comfortably on your arm, in a reclining position, while you hold the bottle with your free hand as shown by the nurse in Fig. 48. The bottle should be inclined sufficiently to keep the neck full of milk; otherwise the baby may draw in air as he nurses. He should be kept awake while feeding but he should be allowed to pause every three or four minutes in order not to take his milk too rapidly. Not less than ten nor more than twenty minutes is devoted to a feeding, as a rule, and if the baby refuses a part of his milk, it should be thrown away; never warmed over for another time.

After being fed, the baby should be held upright against your shoulder for a moment or two, as in Fig. 49, and ever so gently patted on the back to help bring up any air which he may have swallowed. He should on no account be rocked nor played with after taking the bottle, but should be placed gently in his crib, warm and dry and left alone to sleep. Turning him or moving him about even to the extent of changing his diaper at this time may cause vomiting.

The evidences of satisfactory and unsatisfactory feeding in the bottle-fed baby are about the same as in the baby who is fed at the breast, except that the gain in weight on artificial food may be a little slower and less steady than on maternal nursing; the stools have a characteristic sour odor; are a little lighter in color and may contain white lumps of undigested fat; are usually dryer than in breast feeding and may be formed, in even a very young baby.

Many doctors feel that all babies, whether breast-fed or on the bottle, require a certain amount of cool boiled water to drink between feedings. A small amount is given at first and gradually increased according to the doctor’s instructions, and it may be given from a bottle, a medicine dropper or poured slowly from the tip of a teaspoon.

I feel sure that you have realized, long before this, that the entire question of planning the baby’s food is such an important and complicated matter that it cannot with safety to the baby be undertaken by any one but your doctor. Unexpected situations do arise, however, when the doctor is not within immediate reach and the mother has to plan the baby’s food, temporarily, to the best of her ability.

Should you find yourself in such an emergency, you will find help in the milk formulas contained in a pamphlet issued by the American Medical Association, remembering that they are intended for the average, normal baby and are not necessarily suitable for all babies. A large, vigorous baby may need more food and a small, frail baby have to take less than the amounts specified in the following directions:

Footnote 3:

From “Save The Babies” by Dr. L. Emmet Holt and Dr. H. K. L. Shaw. Copied by courtesy of The American Medical Association.

“The simplest plan is to use whole milk (from a shaken bottle) which is to be diluted according to the child’s age and digestion.

“Beginning on the third day, the average baby should be given 3 ounces of milk daily, diluted with seven ounces of water. To this should be added one tablespoonful of lime water and 2 level teaspoonfuls of sugar. This should be given in 7 feedings.

“At one week, the average child requires 5 ounces of milk daily, which should be diluted with 10 ounces of water. To this should be added 1½ even tablespoonfuls of sugar and one ounce of lime water. This should be given in 7 feedings.

“The milk should be increased by ½ ounce about every 4 days.

“The water should be increased by ½ ounce about every 8 days.

“At 3 months the average child requires 16 ounces of milk daily, which should be diluted with 16 ounces of water. To this should be added 3 tablespoonfuls of sugar and 2 ounces of lime water. This should be given in 6 feedings.

“The milk should be increased by ½ ounce about every 6 days.

“The water should be reduced by ½ ounce about every 2 weeks.

“At 6 months the average child requires 24 ounces of milk daily, which should be diluted with 12 ounces of water. To this should be added 2 ounces of lime water and 3 even tablespoonfuls of sugar. This should be given in 5 feedings.

“The amount of milk should be increased by ½ ounce every week.

“The milk should be increased only if the child is hungry and digesting his food well. It should not be increased unless he is hungry, nor if he is suffering from indigestion even though he seems hungry.

“At 9 months, the average child requires 30 ounces of milk daily, which should be diluted with 10 ounces of water. To this should be added 2 even tablespoonfuls of sugar and 2 ounces of lime water. This should be given in 5 feedings.

“The sugar added may be milk sugar or, if this cannot be obtained, cane (granulated) sugar or maltose (malt sugar).

“At first plain water should be used to dilute the milk.

“At 3 months, sometimes earlier, weak barley water may be used in the place of plain water; it is made with ½ level tablespoonful of barley flour to 16 ounces of water and cooked 20 minutes.

“At 6 months the barley flour may be increased to 1½ even tablespoonfuls, cooked in the 12 ounces of water.

“At 9 months, the barley flour may be increased to 3 level tablespoonfuls, cooked in the 10 ounces of water.

“A very large baby may require a little more milk than that allowed in these formulas. A small delicate baby will require less than the milk allowed in the formulas.”

These formulas may be tabulated as shown on p. 177.

=Mixed Feeding.= Under some conditions the breast-fed baby is given also a certain amount of modified milk, and this combination of natural and artificial feeding is termed mixed or supplementary feeding.

A deficiency in the breast milk, ascertained by weighing the baby before and after each nursing, may be supplied by following each nursing with a bottle feeding; or for some reason, one or two breast feedings, in the course of the day are sometimes replaced by entire bottle feedings. In any case the milk mixture to be used as supplementary feeding is prepared with exactly the same painstaking care as is the milk for entire artificial feeding.

If supplementary food is given because of an inadequate supply of breast milk, it is of great importance that the baby be put to the breast regularly, no matter how little food he obtains, for his suckling is the best possible means of stimulating the breasts to secrete more milk, and of equal importance is the fact that they will tend to dry up if the baby nurses less than about five times in twenty-four hours. Moreover, even a little breast milk is valuable to him and he should have the benefit of all there is to be had.

─────────┬────────┬────────┬───────┬───────┬─────────┬─────┬────────────────── Age │ Milk │Water │Barley│ Lime │ Sugar │No. │ Hours │ │ │Water │Water │ │ of │ │ │ │ │ │ │feed-│ │ │ │ │ │ │ings│ ─────────┼────────┼────────┼───────┼───────┼─────────┼─────┼──────────┬─────── │ │ │ │ │ │ │ Day │Night ═════════╪════════╪════════╪═══════╪═══════╪═════════╪═════╪══════════╪═══════ 3–7 days │3 ozs.│7 ozs.│ │½ ozs.│2 tea- │ 7 │6–9–12–3–6│10–2 │ │ │ │ │ spoons│ │ │ 2d week │5 „ │10 „ │ │1 „ │1½ table-│ 7 │6–9–12–3–6│10–2 │ │ │ │ │ spoons│ │ │ 3d „ │6 „ │10½ „ │ │1 „ │1½ „ │ 7 │6–9–12–3–6│10–2 1 month│7 „ │11 „ │ │1 „ │2 „ │ 7 │6–9–12–3–6│10–2 2 „ │11 „ │13 „ │ │1½ „ │2½ „ │ 7 │6–9–12–3–6│10–2 3 „ │16 „ │ │16 ozs.│2 „ │3 „ │ 7 │6–9–12–3–6│10–2 4 „ │19 „ │ │15 „ │2 „ │3 „ │ 6 │6–9–12–3–6│10 5 „ │21½ „ │ │14 „ │2 „ │3 „ │ 6 │6–9–12–3–6│10 6 „ │24 „ │ │12 „ │2 „ │3 „ │ 5 │6–10–2–6 │10 7 „ │26 „ │ │12 „ │2 „ │3 „ │ 5 │6–10–2–6 │10 8 „ │28 „ │ │11 „ │2 „ │2½ „ │ 5 │6–10–2–6 │10 9 „ │30 „ │ │10 „ │2 „ │2 „ │ 5 │6–10–2–6 │10 ─────────┴────────┴────────┴───────┴───────┴─────────┴─────┴──────────┴───────

An entire bottle feeding is sometimes given to a baby who is nursing satisfactorily at the breast, in order to give his mother an opportunity to take longer outings than are possible between the regular nursings. And sometimes it is to the mother’s advantage, and therefore to the baby’s, to give him a bottle during the night and thus allow her to sleep undisturbed.

COMMERCIAL BABY FOODS

Since the baby’s nourishment is prescribed by the doctor, you have no reason to concern yourself with the various proprietary baby foods and canned and powdered milks that are so persuasively advertised to young mothers. And I earnestly hope that by the time you finish this little book, no one will be able to make you believe that any of these foods is likely to be satisfactory if used as a sole article of diet throughout the bottle-feeding period.

Unquestionably there are many times and circumstances when the temporary or supplementary use of a prepared infant food or canned or powdered milk is advantageous.

In some cases of intestinal disturbance a proprietary food may be a great boon, or while the mother is traveling and is unable to have freshly prepared milk formulas supplied to her along the way. These foods may be valuable, also, during the summer, while one stays at a hotel or boarding house where the freshness, cleanliness or purity of the milk are uncertain, or during a sudden shortage of fresh milk, as may occur during a strike or severe storm when transportation is interrupted. But you should not use a prepared infant food for any length of time without your doctor’s order.

If you are confronted with the necessity of choosing a prepared food, for temporary use, you may be guided by considering the general objects and principles of baby feeding and the character of the various foods at your disposal.

=The proprietary foods= may be divided into two general groups: one kind contains milk powder and is usually added to water, while the other consists largely of sugar and starch and is added to fresh milk before being given to the baby.

=Canned milk= is of two kinds; evaporated, which is unsweetened, and condensed, which is sweetened. Evaporated milk is whole milk from which part of the water has been removed, the milk then being canned and sterilized. The addition of water to evaporated milk restores it to the composition of whole milk in many respects, but it is still milk that has been heated. Condensed milk is evaporated milk to which cane sugar has been added to aid in its preservation. Since bacteria do not grow well in highly sweetened foods, it is not necessary to bring sweetened condensed milk to as high a temperature as the unsweetened product, to prevent subsequent bacterial decomposition. The high percentage of sugar in condensed milk quite obviously renders it unsuitable for continuous use as the sole article in a baby’s dietary.

=Milk powders or dried milks= are prepared by rapidly evaporating the water from whole milk, skimmed milk or partly skimmed milk, leaving the solid constituents in the form of a light, white powder. Milk powder readily dissolves in water, forming a “reconstructed milk” which closely resembles the fresh milk from which it was prepared. But it must not be forgotten that reconstructed milk has been heated. Many doctors consider whole milk powder the most satisfactory form of preserved milk which is available for baby food. Should it be used, however, the importance of keeping it tightly covered and in a cold place must be recognized, for the presence of fat renders it likely to become rancid if not kept cold.

ARTICLES OF FOOD WHICH ARE SOMETIMES INCLUDED IN THE BABY’S DIETARY

=Barley water=, sometimes used to dilute whole milk, is made by mixing the barley flour to a smooth paste in cold water, adding boiling water and boiling for twenty minutes or cooking in a double boiler for an hour, straining and adding enough water to replace the amount lost in cooking. The proportions for different ages are as follows:

Three months, ½ level tablespoonful barley flour to 16 oz. water. Six months, 1½ level tablespoonfuls barley flour to 12 oz. water. Nine months, 3 level tablespoonfuls barley flour to 10 oz. water.

=Potato Water.= One tablespoonful of thoroughly boiled potato is mashed into one pint of the water in which the potato was boiled and carefully strained.

=Spinach.= Spinach is carefully washed, steamed for half an hour and mashed through a fine sieve. It is sometimes started at the sixth month; one teaspoonful daily, gradually increased to one or two tablespoonfuls daily.

=Orange Juice.= The orange should be dipped in boiling water and wiped on a clean towel before being cut and squeezed, to avoid possible infection of juice. It is usually given to babies, sometimes as young as one month old, who take heated milk. It is carefully strained and started gradually by giving one teaspoonful in water once or twice daily between feedings and increasing to ½ or 1 ounce by the sixth month and 1½ to 2 ounces by the end of the first year.

=Infusion of Orange Peel.= This is sometimes used instead of orange juice, and is made by boiling one ounce of finely grated orange peel in two ounces of water, adding a little sugar to counteract the bitter taste and adding enough sterile water to bring it up to two ounces.

=Tomato Juice.= Canned tomato strained through a fine sieve, is sometimes given to a baby a few weeks old, starting with one teaspoonful and gradually increasing to four to six ounces daily.

=Whey.= One quart of whole milk heated to 98° F. or 100° F. and one half ounce of liquid rennet or one junket tablet stirred into it and allowed to stand half an hour or until firm and solid, is poured into a cheesecloth bag and allowed to drain for about an hour without being squeezed.

=Protein Milk.= The curd from one quart of milk, which remains after the whey is drained, as directed above, is mashed through cheesecloth in a fine wire sieve, with a potato-masher or bowl of a spoon and the curd washed through with one pint of water. A pint of buttermilk is added and the mixture boiled while being stirred constantly. This is sometimes given in diarrhea.

=Beef Juice.= One pound of thick round steak, slightly broiled, is cut into small pieces and the juice expressed with a meat press or a lemon squeezer, the amount varying from 2 to 3 ounces. It may be diluted with an equal amount of warm water, or slightly warmed by being placed in a cup standing in hot water, and salted to taste.

=Broths.= One pound of lean meat, all fat and gristle removed, is allowed to one pint of water. The meat is cut finely and put on in cold water, heated slowly and allowed to simmer for three or four hours, when water is added to replace what was lost in cooking. It is strained, the fat removed and slightly salted.

=Oatmeal Water.= Two level tablespoonfuls of oatmeal in a pint of boiling water is cooked in a double boiler for two hours, strained and enough boiling water to replace the amount lost in cooking.

BATHING AND DRESSING YOUR BABY

By the time you assume your baby’s care he will probably be having his daily bath in a tub. It may be given under a spray, however, or the doctor may prefer to have him sponged. The sponge bath may be given in your lap or on a table covered with a pad, either method being satisfactory if the baby is kept warm and comfortable. But one inclines to the idea of having the baby bathed in the lap for he seems happier there; more comfortable and less frightened and we cannot be sure that these factors are unimportant to even a tiny baby.

The best time for the daily bath, during the first three or four months, is about an hour before the second feeding in the morning. After this age the full bath is sometimes given before the six o’clock feeding, in the evening, for a bath at this hour is soothing and restful and often helps toward giving the baby a good night.

Preparation for the bath should be made with its possible effects, both good and bad, in mind, for the baby may be helped or harmed according to the skill with which he is bathed. He must not be chilled during his bath, and fatigue and irritation must be avoided by giving it quickly and with the least possible handling and turning. These ends may be served by conveniently arranging all of the articles which will be needed, on a low table at the right hand side of your chair, before the baby is undressed.

There should be a pitcher of hot and one of cold water; a bath thermometer; two soft washcloths; soft towels; bath blankets; Castile, or some other mild soap; boracic acid solution; sterile cotton pledgets; large and small safety-pins, or large ones and a needle and thread if the band is to be sewed on; unscented talcum powder; sterile albolene or olive oil; soft hair brush and a complete outfit of clothing. The little garments should be arranged in the order in which they will be put on, the petticoat slipped inside the dress, and in cold weather, all hung before the fire or heater, to warm.

The temperature of the room should be about 72° F. and if it is possible to bathe the baby before an open fire or a heater, so much the better. In any case he must be protected from drafts and a sheet hung over the backs of two straight chairs will serve very well as a screen if no other is available.

The tub or basin should be about three-quarters full of water at 100° F. for the new baby; about 95° F. after the third month and gradually lowered to 85° F. or 90° F. for the baby a year old. The temperature of the water should not be guessed at, but tested with a thermometer, though in an emergency you may safely use water that feels comfortably warm to your elbow.

Lay a folded towel in the bottom of the tub, before beginning, as babies are often frightened by coming in contact with the hard surface.

It is a good plan to wear a waterproof apron, covered with one of flannel over which is laid a soft towel, until the bath is finished. The towel is then slipped out, leaving the dry, flannel apron to wrap about the baby. Wash your hands thoroughly with hot water and soap, before beginning; sit squarely, with your knees together, on a chair without arms; take the baby in your lap and undress him under a blanket. In order that the bath may be given deftly and quickly it is well to bathe the different parts in the same order every day, for practice makes perfect.

It is usually a routine to weigh the baby every morning, during the first two or three weeks and once or twice a week afterwards, though premature babies and those who are frail are sometimes weighed at longer intervals because of the inadvisability of disturbing them so often. The baby is undressed for his bath, wrapped in a blanket, and laid in the scoop or basket of a beam scale and a note made of the entire weight, for if he is placed in the scales without protection he is likely to be chilled and frightened. The weight of the blanket is ascertained separately and deducted from the total thus giving the baby’s exact weight.

The eyes should be bathed first, with pledgets of sterile cotton dipped in warm boracic acid solution, each pledget being used but once. To prevent the solution from running from one eye into the other, the baby’s head is turned slightly to one side and the lower eye wiped gently from the nose outward. The lids may then be separated by placing one thumb below the brow and lifting it slightly, and the eye flushed with a gentle stream by squeezing a freshly soaked pledget just above it. The head is turned to the other side and the eye on that side bathed in like manner.

The mouth is swabbed out very gently with boric-soaked cotton wrapped about the tip of the little finger, care being taken not to injure the delicate mucous lining. The nostrils are cleaned with little spirals of cotton dipped in mineral oil or olive oil.

The face is then washed with warm water, no soap, and patted dry. The scalp, neck and ears are washed with soap and water and thoroughly dried by patting and by wiping gently in the creases. The body should then be soaped with your hand, only one part being uncovered at a time in order to avoid chilling.

To place the baby in the tub, slip your left hand under his head in such a way that it will rest upon your wrist as your fingers spread out to support his shoulders. Your thumb naturally curves over and holds the upper part of the baby’s arm without pulling or straining it. Grasp his ankles with the right hand and lower the little body into the water, feet first, as shown in Fig. 50. This gradual lowering of the baby into the water is worth while, for he is likely to be frightened if he is plunged in suddenly. If the baby’s arm and shoulder are firmly held and supported by your left hand, it is an easy matter to steady his entire body and keep his head out of the water while giving the bath with your right hand, as in Fig. 51.

FIG. 50.—Method of holding baby and lowering him into his bath. ]

FIG. 51.—Method of comfortably supporting the baby’s head above the water while giving his bath. ]

The new baby is not usually kept in the tub for more than two or three minutes, but when he is three or four months old he may stay in for five minutes and still longer as he grows older.

Hot water should never be poured into the tub after the baby has been placed in his bath but cold water is often added, for a three or four months old baby, or the warm bath followed by a quick sponge with cold water. The little body is quickly patted dry, afterwards, and rubbed briskly with the palm of the hand; the legs and arms stroked toward the body; the back from the neck downward and the chest and abdomen with a circular motion. Babies who react well to cold baths are benefited by them, but those who do not, may be harmed. Such “toughening” methods, to be beneficial, therefore, must be adjusted very carefully to the individual baby and should be employed only in accordance with the doctor’s directions.

The =genitals= should be bathed and dried with care; inspected daily and any unusual appearance reported to the doctor. It is not uncommon for girl babies to have a slight bloody discharge from the vagina. Although this is unimportant and soon disappears, your doctor should be told of any discharge, however slight. The doctor often wishes to have the foreskin of boy babies retracted every morning at the time of the bath, by gently rubbing it back with gauze or cotton, taking pains that it is pulled forward to the original position after the part underneath has been thoroughly bathed with boracic acid solution. If retraction is impossible after several daily attempts, the baby is not infrequently circumcised.

The care of the baby’s =teeth= is a part of the bath and should begin when the first tooth appears. It should be wiped front and back with a piece of gauze or cotton dipped in boracic acid or soda solution or some other weak alkaline wash, to neutralize the acid secretions of the mouth as these favor decay. After the baby has five or six teeth, the use of a very soft brush with tooth paste is often advised, the teeth being brushed with a circular motion or from the gums toward their edges. The teeth should be wiped, or brushed, morning and evening and after feedings. The reason for such close care of the temporary teeth is that they serve as a mold or brace to hold the jaws in proper shape for the permanent teeth which appear later. If the “milk” or first teeth decay or crumble away before the jaws are developed to the point when the permanent teeth appear, these second teeth are likely to be crowded, crooked and uneven.

After all of these details have been attended to and the entire body, including creases and folds, has been patted quite dry, it may be dusted with an unscented talcum powder, but this powdering must not be resorted to as an aid in drying the skin. In order to prevent chafing, the buttocks and thighs should be wiped clean with oil, or bathed with warm water, no soap, patted dry and powdered or oiled each time that the diaper is changed.

The =cord= has dropped off, in all probability, by the time you begin to bathe your baby, and the navel so well healed that you need do nothing to it, but you may be interested to know what painstaking care the nurse has given to this important detail of the baby’s toilet. The form and method of cord dressings vary somewhat with different doctors but in practically all cases the dressings are sterile, to prevent infection, and porous in order that air may gain access to the cord and promote the drying process. The dressing itself may consist of dry, sterile gauze or gauze wet with alcohol wrapped about the cord, as shown in Fig. 52; or it may consist of squares of sterile gauze or muslin with holes in the centers to fit around the cord, and dusted with some such powder as boric acid, bismuth or salicylic acid and starch. The dressed cord is laid flat on the abdomen and directed upward to prevent its being wet with urine; a gauze sponge is placed over the dressing and the flannel binder applied, being sewed on or held in place with safety-pins, as shown in Fig. 53.

FIG. 52.—Cord dressed with dry sterile gauze. (From photograph taken at Johns Hopkins Hospital.) ]

FIG. 53.—Straight flannel binder applied over cord dressing. ]

The band is put on firmly and with even pressure, but not tightly. It is a mistake to think that a tight band strengthens the baby’s abdominal muscles, for it has quite the opposite tendency and in addition may give pain and even cause vomiting. The band is removed every morning at the time of the bath, or whenever it is soiled, but the cord dressing is not usually taken off unless it is soiled. When the cord finally drops off, the straight flannel binder is replaced by a knitted band with shoulder straps. This is usually worn for three or four months, particularly in cold weather, to provide a little extra warmth over the abdomen. Thin, delicate babies sometimes need this band for a year or more.

FIG. 54.—Putting on the diaper which has been folded straight through the middle. ]

After the band has been applied, the warmed shirt is put on and then the diaper. There are two methods of putting on the diaper.

One is to fold the square diagonally and bring the diagonal fold around the baby’s waist. One of the lower corners is drawn up between the thighs, the two corners from the sides brought over this, straight across the waistline and not carried down between the thighs. The fourth corner is brought up over these and all are pinned securely with a safety-pin, while two other safety-pins hold the margins of the diaper together above the knees. The other method is to fold the diaper straight through the center, forming a rectangle twice as long as it is wide; to lay the baby on it lengthwise, draw the lower half up between his thighs as shown in Fig. 54, and pin it on each side at the waistline and above the knees. (See Fig. 55.)

In either case the diaper must be put on smoothly and care taken to avoid forming a thick pad between the thighs as this will tend to curve the bones of legs, which, as you know, are still soft. Squares of soft, absorbent material, which may be burned, when soiled, placed inside the diapers will greatly facilitate the laundry work.

FIG. 55.—How the diaper in Fig. 54 looks after it has been put on. ]

The baby’s diaper should be changed whenever it is wet or soiled, for in addition to making him restless and fretful for the time being, the skin about the thighs and buttocks will grow red and chafed if he is allowed to wear wet diapers. Wet diapers should not be dried and used again but washed with mild soap, boiled and whenever possible, dried in the open air and sunshine. All of this makes it apparent that the regular use of waterproof protectors is to be condemned since a baby so protected may wear a wet diaper for some time before it is discovered. Under special circumstances such as a drive, a short journey or visit the diaper may be covered by waterproof drawers but their habitual use will make the baby unhappy and uncomfortable and may even result in a serious condition of the skin.

Coming back to dressing the baby, after his bath, we find that after the band, shirt and diaper have been adjusted the petticoat and dress are put on with the fewest possible motions and the baby’s hair brushed upward from his neck and back from the forehead. He should be wrapped in a small blanket, fed and laid quietly in his crib to sleep. If his hands and feet are cold a hot water bottle at 125° F. with a flannel cover, may be placed beside him.

When the baby is made ready for the night he may have a sponge bath or simply have his face and hands sponged with warm water, according to the wishes of the doctor. The clothing which the baby has worn during the day should be entirely replaced. The day and night clothing may be worn more than once, if clean and if aired between times, but it is better not to have the baby wear the same set of clothes for twenty-four hours at a stretch. In cold weather a tape is often run through the hem of the stockinette or flannel nightgown in order that it may be drawn up, bag fashion, to keep the baby’s feet warm. During very warm weather the baby sleeps in a thin cotton slip.

YOUR BABY’S CLOTHES

Your baby’s clothes were made long since, of course, but a word about their use is worth while as they may be very influential in promoting the baby’s well-being. In order that his body may be kept at an even temperature the warmth of his clothing must always be adjusted to the needs of the moment. The general tendency is to dress the baby too warmly and the usual result is that he perspires; is listless, pale, and fretful; sleeps badly; is susceptible to colds and other infections and has poor recuperative powers. His digestion is likely to be deranged and he may have prickly heat. On the other hand, if the baby is not dressed warmly enough his hands and feet will be cold and his lips blue; he will cry from discomfort and the general result may be lowered vitality and disturbed digestion. If the baby’s clothes are not comfortable, if they pull and drag or have tight bands, he will be fretful and restless, with disturbed sleep and upset digestion in consequence.

The little wardrobe will be entirely adequate, under ordinary conditions, if it consists of shirts, bands, diapers, flannel petticoats, dresses, nightgowns, flannel wrappers and sacques. As the petticoats and dresses are cut twenty-seven inches long, many doctors feel that they offer enough protection for the feet of the average baby to make stockings unnecessary until he is from four to six months old. The skirts are then shortened to ankle length and stockings added to the baby’s attire. Other doctors think it wiser to put knitted socks or part wool stockings on the new baby, particularly if he is born during cold weather.

When the baby begins to creep, he should wear soft soled shoes, part wool stockings in cold weather and thin cotton or silk ones during the summer, and firm but flexible soled shoes as soon as he tries to stand alone or to walk.

During the first month or two the baby scarcely needs special clothing for outdoor wear as he may be wrapped in one of the flannel squares with a casing run in one corner to form a hood, or he may be placed on a square diagonally and the upper corner folded about his head and held under the chin with a safety-pin. The corners on the sides are folded about his shoulders, the lower one brought up over his feet and limbs and the additional blankets tucked in over all. But as the baby grows older and moves about in his carriage, he will need a cap and cloak or wrap with hood attached. In cold weather the cap should be knitted or wool lined and the cloak of soft woolen material or wool lined. In moderate weather the cap may be of one thickness of cotton or silk, or very light flannel, while on very warm days he will need no head covering at all.

To sum up: The baby’s clothes should be simple in design, hang from the shoulders, fit smoothly but loosely and have no constricting bands; they should be of soft, light, porous material; their warmth always adjusted to the immediate temperature so that the baby will be protected from being either chilled or overheated. And his clothing must always be clean and dry.

AIRING YOUR BABY

An abundance of fresh air is one of the baby’s greatest needs as it increases his resistance to disease and his recuperative powers, improves his appetite and aids digestion. In general, the more the baby is in the open air and the more fresh air he has while in the house, the better.

The two factors which must be considered in supplying the baby with fresh air are the condition and vigor of the baby himself and the immediate temperature and state of the weather. His age and the season of the year can be only partial guides because of the difference between individual babies of the same age and the variations in temperature, winds and moisture during any one season.

The air of the room which the baby occupies should be changing constantly in order that it may always be fresh, but the temperature should be equable and the baby protected from drafts. As the tendency here, as with the baby’s clothes, is toward overheating, you will do well to remember that the young baby who lies covered up in his crib, may usually be kept in a colder room than is advisable for an older one who is creeping or walking about.

During cold weather the baby’s bed should not be directly in front of an open window and he should be protected from direct currents of cold air by a sheet hung over the head and side of his crib.

Two or three times daily, while the baby is out of the room, the windows should be opened wide to air the room thoroughly, one of these airings being just before the baby is put to bed for the night.

The doctor’s usual instructions concerning the temperature of the nursery are to keep it from 68° F. to 70° F. during the day and about 65° F. at night, during the first three months and lower it gradually to 64° F. during the day and about 55° F. at night as the baby grows older. It is customary to begin to open the nursery window at night when the baby is three or four months old, if he is well and the temperature is above freezing.

In planning to take the baby out of doors it is wiser, as a rule, to begin with the indoor airing when he is about a month old, except, of course, during the moderate or mild months of the year, when he is taken out at once. If the weather is cold, the baby may be protected with extra wraps and carried in the arms, into a room in which the windows are open and kept there for fifteen or twenty minutes. This indoor airing is increased by being gradually lengthened to two or three hours and by having the windows opened wider and wider. By the time he is two or three months old he is taken out of doors on clear, bright days, the best time being between ten and three o’clock, when the sun is high. If he is carried in the nurse’s arms at first the warmth of her body serves as a protection and helps to accustom him to the out-of-door life, when he spends a good deal of his time out of doors in his carriage.

On windy, stormy days or when there is melting snow on the ground, the baby may be given his airing on a protected porch or in a room with the windows open. He is not usually taken out if the temperature is below freezing until the third or fourth month. After this time the average baby is taken out when the temperature is not lower than 20° F.

When the baby is dressed in his extra wraps he must be taken out of doors or the windows opened immediately, for otherwise he will become overheated and be in danger of chilling when taken into the colder air.

Warm hands and feet, a good color and the baby’s tendency to sleep most of the time while out of doors are evidences of his being adequately clothed for his airing, while the reverse is true if he is not warm enough.

A robust baby who has been gradually accustomed to being out of doors during the day will usually be much benefited by sleeping out at night. But he must be protected from winds and his clothing so arranged that he cannot be chilled. Knitted or flannel sleeping garments or sleeping bags (See Fig. 20) are valuable and in addition, the blankets which cover the baby should be securely pinned to the mattress with safety-pins and tucked well under it at the sides and foot. The baby should wear a warm cap and the bed should be warmed before he is put into it. Or better still, he may be dressed for the night, put to bed in a warm room and the crib then moved out on the sleeping-porch.

An excellent device for protecting the baby’s arms and chest, and keeping him generally well covered, is the poncho (Fig. 56) devised by Dr. Lucy Porter Sutton of Bellevue Hospital. The poncho is a rectangle made of flannel, outing flannel or an old blanket and cut large enough to tuck well under the head and sides of the mattress and extend below the baby’s feet. The baby’s head slips through an opening, which is almost a right-angled slit, equally distant from the sides of the poncho and about 20 inches from the top. The slit is firmly bound and provided with tapes to tie it together after the baby is put in. The poncho should be put on loosely enough to permit the baby to move about at will beneath it. After it is adjusted the bed is made up as usual with additional blankets.

FIG. 56.—The “Sutton Poncho” which keeps even a restless baby well covered. The insert shows how to make the slit for his head to pass through. The regular bedding is turned back in this picture. (From a photograph taken at Bellevue Hospital.) ]

Under all conditions the baby’s airings must be increased gradually, both as regards lowering the temperature and lengthening the time, and always adjusted to the vigor and reaction of the individual baby. He must be warm, but not too warm; he must be protected from wind and dust, and his eyes shielded from glare and from flickering light, such as may be caused by a tree in a light breeze.

EXERCISING YOUR BABY

Although the baby should not be handled unnecessarily nor tossed about and played with by friends and relatives, it is important that his muscular development be promoted by regular and carefully planned exercise. It is usually considered best for the baby to lie quiet and undisturbed in his crib most of the time during the first three or four weeks. Dr. Griffith begins the baby’s exercise about that time by having the nurse or mother take him in her arms on a pillow and carry him about for a few moments several times daily. After a week or two of this form of exercise the baby is carried in the arms without a pillow but with his head and back carefully supported as the nurse is doing in Fig. 57. The position of the baby’s body is changed by his being carried about in this way and the movement of the nurse or mother as she walks, causes a certain amount of motion of the baby’s muscles which constitutes a gentle exercise. The baby should be carried first on one arm and then on the other in order that both sides of his body may be equally exercised.

This semi-passive form of exercise by means of being carried about is regarded by many doctors as almost indispensable to the baby’s welfare. There is a possibility that lack of this form of “mothering” is one reason why babies in institutions sometimes fail to progress as they should. Certainly, it is inadvisable for the baby to be allowed to lie for very long in one position.

By the third or fourth month the baby sits up in his mother’s arms, as she carries him about, and he may be placed on the outside of his crib coverings for a little while every day, to kick and struggle at will. His skirts should be rolled up under his arms, or removed entirely, to leave his legs quite free, care being taken that the room is warm and that he has on stockings.

FIG. 57.—Method of carrying baby to support his head and back. ]

By about the sixth month he will usually begin to make an effort to creep, if turned over on his stomach and helped a little, and he may be propped up in the sitting position, in his crib, for a few moments every day. As he gives evidence of having enough energy to creep farther than the limits of his crib permit, he may be put into a creeping pen, or upon the floor under certain conditions. It must be remembered that the floor is likely to be cold, drafty and dusty. You should assure yourself, therefore, that the floor is warm and that all drafts are cut off, and then spread a clean sheet or quilt on the floor before the baby is put down to creep. When the sheet is taken up, be sure that it is folded with the upper surface inside in order that when it is again put down the baby will play on that side and not on the side that has been next the floor.

A creeping pen or cariole or some such provision is often more satisfactory than the floor, consisting as it does of a railed-in platform raised about six or eight inches from the floor.

The suggestions for exercise, like those for the baby’s airing, must be very general since it should always be adjusted to the powers of the individual baby and directed by the doctor.

TRAINING YOUR BABY

=Bowels.= It is possible to train even a very young baby to have regular, daily bowel movements; and this training should be started when the baby is about a month old. At the same hour each day he may be laid on a padded table, or taken in your lap, a small basin being placed against or under the buttocks and a soap stick introduced an inch or two into the rectum and moved gently in and out. This slight irritation will usually result in the baby’s emptying his bowels almost immediately. Another method is to hold the baby in a comfortable, reclining position, on a small chamber in your lap, as in Fig. 58 or with his back supported against your chest, and the desire to empty his bowels stimulated by using the soap stick as described. (A soap stick is simply a piece of soap about three inches long whittled down to about the size and shape of a lead pencil with a blunt point.)

FIG. 58.—A comfortable position for the baby who is being trained to use a chamber. ]

It is of considerable importance that the position and method which are adopted, be employed at exactly the same time each day in order to establish a habit. If this is done and the baby is being properly fed, it will usually be found that before he is many months old, his bowels will move freely and regularly without the stimulation of the soap stick and only when he is resting on the small chamber or basin that he is accustomed to using. This establishment of a regular bowel movement not only simplifies the laundry work and the care of the baby but is of great moment to his health.

FIG. 59.—Stiff cuffs on the baby’s elbows keep him from sucking his thumbs. ]

=Thumb Sucking.= It is scarcely necessary nowadays to tell a mother that her baby must not be allowed to suck on an empty bottle or a pacifier nor be permitted to suck his thumb. These habits are very dirty and help to spread disease. The baby may swallow air while practicing them, with colic as a result, and he may so deform the shape of his upper jaw that later in life, the upper and lower teeth will not meet as they should for satisfactory mastication; his front teeth may protrude in a disfiguring manner; and by narrowing and elongating the roof of his mouth, the structure of the air passages may be altered, with respiratory troubles and adenoids as a probable consequence. Thumb sucking may be prevented by the simple procedure of putting stiff cuffs on the baby’s elbows, such as are shown in Fig. 59, and which make it impossible for him to reach his mouth with his thumb. These cuffs are easily made by covering pieces of cardboard with muslin and attaching tapes with which to tie them on the baby’s arms. Another method is to put the baby’s hands into celluloid or aluminum mitts made for this purpose, or little bags made of stiff, heavy material, which in turn are tied to his wrists; or his sleeves may be drawn down over his hands and sewed or pinned with safety-pins. It should be borne in mind that a baby sometimes sucks his thumb because he is hungry or thirsty and will give up the practice when his food is increased or when he is regularly given water to drink.

=Ear pulling= is not uncommon among young babies and, if allowed to continue, a long, misshapen ear may result. This may be prevented by using a thin close fitting cap which ties under the chin, or by using the same kind of elbow splints as for thumb sucking.

=Crying.= It is very easy to allow the baby to develop the crying habit but very difficult to break it up. The first step toward prevention is general good care, for a baby who is properly fed and exercised, kept dry and warm, but not too warm, and whose clothes are comfortable, will usually cry very little if wisely handled in other respects. But a baby may cry because he is hungry, thirsty, wet, cold, overheated, sick or in pain or simply because he wants to be taken up and entertained and has learned that the way to realize his wish is to cry. By examining the baby’s condition and observing his habits, it is usually possible to discover the cause of his crying. Very often a drink of fairly warm water will quiet him, particularly at night. But unless he seems to have colic and stops crying because of the relief due to the upright position in your arms, you should hesitate to take the crying baby up and carry him about and hold him when it is discovered that this attention stops his crying.

Persistent crying should be reported to your doctor as it may be of some significance.

KEEPING YOUR BABY WELL IN SUMMER

Notice that I say keeping him well. There was a time when we looked upon the scourge, variously known as “summer complaint,” “summer diarrhea” and “cholera infantum” as a seasonal visitation that was to be accepted with resignation. But happily those dark days are past, for though the condition itself is a complicated one, the one big factor in its causation was dirty milk—milk that was infected or spoiled or both—given to a baby whose forces were lowered by the heat.

It is perfectly clear, then, isn’t it, that a baby is no more likely to be ill during the summer than at any other time, if he is given proper care, the kind of care that we have been going over in detail? Each of these details is important but just bear in mind that during warm weather it is particularly urgent to:

1. Feed the baby properly.

2. Keep him clean.

3. Keep him cool.

4. Keep him quiet.

The end and aim of these precautions is to prevent disturbance of the baby’s digestion. As babies suffer from the heat more than adults do and are often excessively irritated and exhausted on warm days, these results of the heat are sometimes enough to upset his digestion unless he is safeguarded with greatest care.

It is much the same as with grown people, who often find that their digestions are upset solely by their being tired or excited.

The baby should have maternal nursing if possible, during the summer, for breast-fed babies fall victim to summer complaint much less frequently than de bottle babies. Quite evidently, then, you should regulate your own life with even more care than usual—for the baby’s sake. He should be fed with absolute regularity, and as a rule, no matter what the nature of his food, it should be reduced one quarter to one third in amount when the days are very hot, and he should have an increased amount of cool, boiled water to drink. His weight may increase only slightly, or even stand still for a short time, as a result of his decreased food, but you need not worry about this if he keeps well, for the important thing is to avoid digestive disturbances. It is just the same as with grown people who are advised to eat less and lighter food than usual, while the weather is very warm, in order to keep well.

Cleanliness, as at other times, applies to the baby’s food, clothing and surroundings. Many doctors think it safer to have all milk boiled during the summer, and of course expect scrupulous cleanliness in its preparation and administration.

The baby’s soiled napkins should be placed immediately in a covered receptacle containing water, or a disinfecting solution and not left for even a moment where they may be reached by flies. They should be washed, boiled and dried in the open air and sunshine as promptly as possible.

The baby should be protected from flies and mosquitoes by screens in the windows and netting over his crib and carriage, both because these insects make him restless and irritable and because flies, particularly, are carriers of filth and disease—the kind of disease that kills so many babies during the summer. Accordingly, you should regard dies with deadly fear.

The baby should be kept away from dusty places and from cats and dogs. And since he will put his fingers into his mouth, in spite of you, it is a wise precaution to wash his hands several times a day.

The baby should be in the country, in the mountains or at the seashore, if possible during the warmest part of the summer at least, but if he is in town there is much that you can do to keep him cool and comfortable. His clothing at this season must be adjusted to his condition and the temperature of the moment just as it is in cold weather. A thin shirt, band, diaper and cotton slip will usually be enough for out-of-door wear, while in the house he may often dispense with the slip, and sometimes with everything but his diaper.

It is usually best to take the baby out of doors early in the morning and late in the afternoon, but to keep him indoors during the warmest part of the day, when it is likely to be cooler inside than out, particularly if the blinds are closed.

During excessively hot days, the baby will usually be more comfortable if he has two or three cool sponge baths, in addition to the soap and water bath, one of the sponges being given just before he is put to bed for the night. He should sleep on a firm mattress, preferably curled hair but never feathers, and in the coolest, best ventilated room available.

He must not be played with, held on hot laps nor subjected to the entertainment and attention which well-meaning but misguided mothers and friends are so eager to lavish on a hot, fretful baby.

=Prickly Heat.= Very often during warm weather a fine rash, known as “prickly heat” or heat rash, appears on the back of the baby’s neck and spreads over his head, neck, chest and shoulders. As this rash is due to too warm clothing or to the hot weather or to both, less clothing and frequent baths will often give relief. If the baby is very uncomfortable he may he greatly soothed by being immersed, for two to four minutes in baths, at the temperature he is accustomed to, containing soda, bran or starch in the following proportions:

Soda Bath. Two tablespoonfuls of baking soda to one gallon of water.

Bran Bath. A cheesecloth bag about six inches square, partly filled with bran, is soaked and squeezed in the bath until the water is milky.

Starch Bath. About a cupful of cooked laundry starch to one gallon of water.

The baby should be placed in the tub as for his daily bath and his entire body submerged, as shown in Fig. 60, care being taken that his ears are above the surface of the water.

No soap should be used while the baby has prickly heat and after the bath he should be patted thoroughly dry and powdered with some such soothing powder as the following:

Powdered starch one ounce Oxid of zinc one ounce Boracic acid powder 60 grains

FIG. 60.—Method of holding the baby in the tub to keep all but his head covered, in giving a bran, starch, soda or mustard bath. ]

=Diarrhea.= If your baby has an increase in the number of his movements, or if they become watery in character, something is wrong. It may be only a mild disturbance or it may be the beginning of an attack of summer diarrhea, and as at first you cannot possibly tell which it is, you must not take it lightly. Notify your doctor at once, but if you are remotely situated or he is delayed in communicating with you, there are certain helpful things that you can do for the baby while waiting for the doctor. The first is to give an enema of half a pint of water, at 110° F., containing ½ teaspoonful of salt. (See Fig. 64, page 217, for method of giving enema.) If the baby seems to have only a slight diarrhea it may be enough to reduce his food one half, whether he is breast-fed or bottle-fed, and to give him an abundance of cool boiled water to drink. If he is bottle-fed it is a wise precaution to make up his formula with skimmed milk and leave out the sugar.

FIG. 61.—Putting the baby into a wet pack. ]

If the baby has frequent loose movements; seems feverish; vomits and cries as though he had pain, stop all food and give nothing by mouth but water, until the doctor comes.

If you care for your baby, yourself, through an attack of summer complaint you will find that the doctor’s instructions are directed toward keeping the baby cool, clean and quiet, while he, himself, gives very careful attention to the question of feeding.

It is clear, then, that the baby should be lightly clad and kept quiet and undisturbed, in a cool shady place, out of doors as much as possible. During the warmest part of the day, however, he will often he better off in the house, in a room with the shutters closed. But while keeping the baby cool, you must bear in mind the harm that may be done by chilling him or exposing him to a cold draft or wind. The doctor may want him to have several baths daily, possibly tub baths, at a temperature of 100° F., or cool sponge baths. Packs, also, are given, for they not only cool the baby but quiet him as well, if he is restless. These packs may be cool (80° F.); tepid (100° F.) or hot (105° to 108° F.) according to the baby’s needs.

FIG. 62.—The baby in a wet pack with a hot water bag at his feet and cold compress on his head. ]

It is a simple matter to give a pack and you will enjoy doing it for you will actually see that your baby will grow quieter and more comfortable as you give it. Cover the bed with a rubber and sheet and bring to the bedside a basin containing a sheet wrung from water of the specified temperature; a basin containing ice and compresses for the baby’s head and a flannel covered hot water bottle at 125° F., for his feet. The baby is laid on the upper half of the folded wet sheet, and an upper corner wrapped about each arm, as in Fig. 61, and the sides folded around his legs. The lower half is brought up between his feet and used to cover his entire body, being tucked around his shoulders. The hot water bottle is placed at his feet and an ice compress on his head, as in Fig. 62. If the sheets are wrung from warm or hot water, the baby is covered with a blanket after he is put into the pack.

FIG. 63.—Diagrams shoving the successive steps in putting the baby in a pack. ]

Should your baby have summer complaint, remember that even a mild attack predisposes to another and you will have to be even more watchful and painstaking than ever, in your care of him. He will have to return to his customary diet very slowly, or he may not be able to take his usual amount of nourishment at all until the weather turns cool. Even though he gains no weight it is important to avoid taxing his digestion since it is already being threatened by the heat.

KEEPING YOUR BABY WELL IN WINTER

There are certain evils that beset the baby’s way during the winter just as there are seasonal pitfalls in summer, but the truth is that if you care for yourself and him according to the suggestions that have been set down in the foregoing pages, you are doing practically everything necessary to make his way safe and comfortable. A baby who has proper food, plenty of fresh air, is kept clean and whose daily life is regular, is not likely to be ill during the winter or any other time.

The chief baby ills that come with the blustery weather are colds and the troubles that are likely to follow in their wake, such as bronchitis and pneumonia. Colds are infectious, you know, so keep the baby away from sneezy people and out of crowds and dusty places. If he should take cold in spite of you, send for the doctor at once. It may amount to nothing and clear up in a day or two, but if you let it run on, the dreaded bronchitis or pneumonia may result.

RELIEVING COLIC, CONSTIPATION AND CONVULSIONS

I have tried to impress upon you, at every step, that it is very unwise for you to delay in sending for the doctor when your baby seems ill, or to attempt to treat him according to your own ideas or those of your neighbors. But if the baby should begin to scream with colic or have a spasm, you would want to know what to do at the moment, and in case of constipation there are a few simple nursing procedures that you may employ to the baby’s advantage.

=Colic= is always due to indigestion, whether the baby is breast-fed or bottle-fed, because of the food itself being wrong in some respect or because it is not properly given. The milk may contain too much of the material that forms the curd, or so much starch and sugar that fermentation takes place, the pain itself usually being due to undigested food or gas in the intestines. This condition may also result from the baby’s being fed too rapidly or too frequently, or from his swallowing air while sucking on a pacifier or an empty bottle. Colic may be caused, too, by chilling the baby as this is likely to disturb his digestion.

Most babies have colic at some time during the first year, usually before the fifth month. The attacks may occur several times a day, after feeding, or they may not come on until the late afternoon or evening when the baby is tired. Colic is so common that most people are familiar with the symptoms: violent crying and a flushed drawn face; cold hands and feet; tightly clenched fists and a hard, swollen abdomen. As the pain is cramp-like, the baby stops crying every little while, and then suddenly begins again, drawing up his legs, doubling up his body and then straightening out with a jerk.

For immediate relief, you may give the baby a tablespoonful of hot water in which half a soda mint tablet has been dissolved, and an enema of half a pint of water, at 110° F., containing one half teaspoonful of salt, given through a small rubber tube introduced about six inches. This empties the lower bowel and enables the baby to expel a good deal of the gas that is troubling him so. Rub his abdomen with a little oil and apply a compress of several thicknesses of flannel, wrung from hot water, covering this with a larger piece of dry flannel, and change it every three or four minutes for a while. Place a flannel covered hot water bottle (at 125° F.) at his feet, cover him warmly, darken the room and he will almost certainly go to sleep. It is often a good plan to substitute barley water for one or two feedings, after an attack of colic, in order to give the disturbed digestive tract a rest.

Quite naturally, you must tell your doctor if your baby has colic for the cause may lie in the character of his food. But it may lie in some error on your part. Go over all the details of your share of the baby’s care and see if you can discover anything to correct.

With breast-fed babies, prevention is often accomplished by the mother’s nursing her baby more slowly, lengthening the intervals between nursings and by improving her own hygiene, particularly by relieving constipation and increasing her recreation and out-of-door exercise. Nursing mothers who lead sedentary lives and eat rich food very often have colicky babies as do those who are nervous, irritable and inclined to worry.

If the baby is bottle-fed he may be taking his food too fast because of an over-large hole in the nipple; he may not pause often enough during his meal or he may take in air as he nurses because the bottle is not properly held, as shown in Fig. 48.

In any event do not stop until you get at the cause of the trouble for though the colic itself may not necessarily be serious, a continuation of the cause may result in a run down condition or even in malnutrition.

Don’t forget the importance of holding the baby upright over your shoulder after each feeding, to help him bring up gas, and of placing him immediately in his crib to be left quiet and undisturbed. And ask your doctor about drinking water. Very often the tendency toward colic is lessened by increasing the amount of cool boiled water given between meals.

=Constipation= is very common among babies and may be manifest by the stools being too small, too dry or too infrequent. It is more difficult to cope with than colic, though it, too, may have its origin solely in unsuitable food. In some cases, however, the constipation is due to absence of habit in emptying the bowels regularly; to weakness of the intestinal muscles; to long-continued undernourishment or to some such disease as rickets.

It becomes apparent that the prevention of this troublesome condition is accomplished largely by giving suitable food; constant fresh air; regularity in the daily routine and training the baby to empty his bowels at the same time every day.

When constipation is due to insufficient fat in the food, cod-liver oil is sometimes given, 15 to 30 drops three or four times a day; or a teaspoonful of olive oil two or three times a day. Maltose, malt soup, malted milk, milk of magnesia, mineral oil, oatmeal water and orange juice are all found among the remedies for constipation; while soap sticks, suppositories and enemas of oil or soapsuds sometimes have to be resorted to.

In giving an =enema= to relieve constipation, the baby should be protected from chilling, laid on a pillow and the bed-pan so placed that he will be comfortable and not inclined to move, and from half a cup to a cup of soapsuds, at 105° F., given with a small hard-rubber nozzle, as in Fig. 64. When warm olive oil is given at night (2 to 4 tablespoonfuls slowly through a small rubber tube introduced about six inches), it is very often retained until morning when the baby empties his bowels freely with little or no assistance.

=Abdominal massage= will often relieve constipation by strengthening the intestinal muscles, this in turn tending to make the bowels move. The abdomen should be rubbed with a firm but not hard, circular stroke, beginning in the right groin and working up to the margin of the ribs, across to the left side and down to the groin. This massage is often given for about ten minutes every day, preferably at night, but never just after feeding.

FIG. 64.—Giving the baby an enema. He is well protected, to prevent chilling, and lies comfortably on a pillow which reaches to the bed-pan, the latter being covered with a diaper where he rests upon it. ]

Constipation is sometimes entirely cured by nothing more than a suitable dietary; an abundance of drinking water; an out-of-door life; massage, and above all, the unceasing effort to establish a regular habit. These are all things which you, yourself, may do for the baby. The longer constipation persists, the harder it is to cure, so do all in your power to prevent it and if it develops, try to end it at once.

=Convulsions= are a symptom of several disorders of infancy and they may occur unexpectedly. Although at the moment, they are more distressing than serious, you should notify your doctor at once. If he cannot come promptly you may end the seizure by employing measures that will quiet and relax the struggling baby. The room should be darkened, kept absolutely quiet and the baby handled with the utmost gentleness. As a rule the most satisfactory course is to immerse the baby in water at 100° F. and keep him there for five or ten minutes, supporting his head above the level of the water as shown in Fig. 60. (See p. 209.) Have some member of the household place cloths, wrung from cold or iced water, on the baby’s head and change them frequently. When removed from the bath, the baby should be wrapped in a blanket, kept very quiet and the cold applications to his head continued.

If the baby often has convulsions the doctor may instruct you to give him either a mustard bath or pack whenever he has an attack.

For a bath, one ounce, or six level tablespoonfuls of dry mustard is added to one gallon of water at 105° F. and the baby kept in it for about ten minutes, or until the skin is well reddened. He is then wrapped in a warm blanket and surrounded by hot water bottles, with cold compresses applied to his head. The mustard pack is given in the manner shown in Figs. 61 and 62, with a sheet wrung from mustard water which is possibly a little warmer and stronger than that for the bath, care being taken that the sheet is not cooled before it is wrapped about the baby. He is usually left in the pack for about ten minutes or until his skin is reddened, and then wrapped in warm blankets, with cold compresses to his head.

THE PREMATURE BABY

All of the precautions and gentleness which are necessary in the care of the normal baby, born at term, must be greatly increased in caring for the baby who is born prematurely. The premature baby is not only small, but in general is imperfectly developed, having slenderer powers than the full term baby, and at the same time much greater needs. His respiratory and digestive organs are less ready to act than those of the normal baby; his muscles and nerves are feeble; his heat-producing machinery is unstable and yet he loses an excessive amount of body heat.

Accordingly, the baby who has been deprived of those valuable last weeks of growth and development within the uterus, is small and limp; lies quietly most of the time; moves very feebly, if at all, and needs special care. To help him in maintaining a normal body temperature it is usually necessary for him to be oiled with warm olive oil and entirely wrapped in cotton batting or flannel or enveloped in a quilted garment, with hood attached, made of cheesecloth or flannel and cotton batting, such as is shown in Fig. 65. Diapers are often omitted in caring for very feeble babies, a pad of cotton, instead, being slipped under the buttocks, as this may be changed with less disturbance to the baby than a diaper.

A satisfactory bed may be devised from a basket or box with the bottom well padded with several inches of cotton, a small pillow or a soft blanket folded to the proper size, covered with rubber or oiled muslin and a cotton sheet. The sides of the basket may be lined with heavy quilted material, to shut out drafts and help to preserve an even temperature of the air immediately around the baby, or such a basket as is shown in Fig. 66 may be used. A flannel covered hot water bag at 110° F. may be placed beside the baby, or two, three or four glass bottles, each holding about a pint, containing water at 100° F. and securely stoppered, may be hung in the corners of the basket. A thermometer, also, should hang in the basket and the temperature kept between 80° F. and 90° F. The temperature varies less if the bottles are filled in rotation than if all are reheated at the same time.

FIG. 65.—Quilted robe, with hood, for the premature baby. It may be made of flannel or cheesecloth with cotton batting for the padding. ]

The amount of heat needed around the baby is decided by taking his temperature (by rectum) at regular intervals; supplying more heat if the temperature is low and less if it is at or above normal. Some doctors have the temperature taken every four hours; others twice daily. As the baby grows able to maintain a temperature of 98° F. to 100° F., unassisted, the surrounding heat is gradually reduced and finally removed, and flannel clothing replaces the quilted robe.

FIG. 66.—An improvised bed for the premature baby, consisting of a closely woven clothes basket with padded bottom and four flannel covered bottles of hot water, attached to the sides. The necessary thermometer and special feeder are shown in the basket. (By courtesy of Dr. Alan Brown, Hospital for Sick Children, Toronto.) ]

The basket in which the baby lies should be placed in a darkened, well ventilated room and should be carefully screened from drafts. As the baby needs moist air there should be a large, open vessel of water in the room.

Since the premature baby’s lungs are not fully expanded, respirations are likely to be shallow and irregular, thus failing to supply the amount of oxygen which he needs. And as crying always causes deep breathing, it is a common practice to make the baby cry at regular intervals during the day.

In feeding the premature baby, breast milk is the most desirable food. In fact, many doctors feel that his life virtually depends upon it. If the baby is too feeble to nurse, the milk may be expressed from the mother’s breast, being immediately covered and placed in the refrigerator unless used at once. Breast milk is sometimes used whole and sometimes diluted with sterile water and is often given from a medicine dropper or through a special feeder. Such a feeder consists of a glass tube with a small nipple on one end and a rubber bulb on the other, by means of which the milk may be gently expressed into the baby’s mouth. (See Fig. 66.)

The premature baby’s bath is of considerable importance. It almost always consists of sponging him with warm olive oil as he lies in his bed and with the least possible exposure and turning. It is given every day or every second or third day, according to his condition. The eyes are wiped with boric pledgets and the nostrils with spirals of cotton dipped in oil. The buttocks are wiped with an oil sponge each time the diaper is changed.

It must be borne in mind constantly that the premature baby is particularly susceptible to infection. He should be safeguarded by having everything that comes in contact with him scrupulously clean; being protected from drafts, chilling and dust, and allowing no one with a trace of a cold to come near him. The person who cares for him should wear a freshly laundered gown and protect her nose and mouth with a gauze mask while attending him.

TRAVELING WITH YOUR BABY

Babies should not travel; that is obvious. But if a journey is unavoidable, the attendant difficulties and disadvantages may be greatly lessened by making certain preparations. If the baby is bottle-fed, the preparations will depend upon the length of the journey and whether or not it will be possible to have freshly prepared feedings, for each twenty-four hours, put on the train from laboratories along the way. If this is not possible and the journey is not to take more than twenty-four hours, the entire quantity of food, ice-cold, may be carried in a thermos bottle. The requisite number of sterile nursing bottles may be taken or one bottle which is boiled before each feeding. Or the milk may be prepared as usual and the bottles packed in a portable refrigerator. Such a refrigerator may be bought or one may be improvised. The bottles are placed in a covered pail and packed solidly in crushed ice; this is placed in a second pail or a box with a diameter which is at least two inches larger than the inner pail and the space between the two packed firmly with sawdust. Several thicknesses of newspapers should be pressed down over the top and a tight cover fitted to the outer receptacle.

The sterile nipples may be taken in a sterile jar and a deep cup or kettle will be needed in which to warm the bottle before each feeding. It is usually possible to obtain water on the train which is hot enough for this, or cans of solid alcohol, a stand and a metal tray may be added to the traveling outfit. If fresh formulæ cannot be delivered to the train, daily, and the journey is to last more than twenty-four hours, one of the proprietary foods or a powdered milk will often prove to be a satisfactory solution to the problem of feeding the baby while traveling. The course to be followed, however, should be selected by your doctor.

FIG. 67.—If traveling is unavoidable the baby will be comfortable and undisturbed in a basket converted into a bed. (By courtesy of the Maternity Centre Association.) ]

The baby will usually travel more comfortably and sleep better if he is carried in a basket. A large market basket with a handle or a small clothes basket will serve. It may be lined with a sheet or a blanket; have a small hair pillow or folded blanket in the bottom and be made up like a crib. (Fig. 67.) If this basket stands on the car seat during the day, and on the foot of your berth at night, the baby will be cleaner, quieter and less exposed to drafts than if carried in the arms.

As we look back over these pages of somewhat detailed description of the baby’s care it is borne in upon us that the nursing of this unfailingly delightful and engaging little person has special adjustments and adaptations for different seasons and circumstances. But that on the whole the care of all babies, the year round, resolves itself into the observation of a few general principles, namely: proper feeding; fresh air, rest and quiet; regularity in the daily routine; cleanliness of food, clothing and surroundings; preservation of an even body temperature; consultation with the doctor at regular intervals and also whenever the baby seems ever so little ill.

If you are guided constantly by these general principles and apply them conscientiously, you may revel in the satisfying consciousness that you are keeping your pledge to your baby by giving him the best possible start on his life’s journey.