 |
THE CORD DRESSING
The cut end of the tied umbilical cord is swabbed and squeezed with a sterile sponge saturated with pure alcohol. It is then wrapped in a sterile dressing made as follows: Four or five thicknesses of sterile cheese cloth are cut into a four-inch square with a small hole cut in the center and one side cut to this center. This is slipped about the stump of the cord and wrapped around and about in such a manner as entirely to cover the stump of the cord. The wool binder is then applied and sewed on, thus avoiding both pressure and the prick of pins. If it remains dry this dressing is not disturbed until the seventh or eighth day, when the cord ordinarily drops off. Should it become moistened the dressing is removed and the second dressing is applied exactly like the first.
THE EYES
The closed eyes of the newly born child are generally covered with mucus which should be carefully wiped off with a piece of sterile cotton dipped in boracic acid solution, in a manner not to disturb the closed lid. A separate piece of cotton is used for each eye and the swabbing is done from the nose outward. The physician or nurse drops into each opened eye two drops of twenty per cent argyrol, the surplus medicine being carefully wiped off with a separate piece of cotton for each eye. The baby should now be placed in a darkened corner of the room, protected from the cold.
The eyes are washed daily by dropping saturated solution of boracic acid into each eye with a medicine dropper. Separate pieces of gauze or cotton are used for each eye.
THE FIRST OIL BATH
As soon as the cord and the eyes have received the proper attention and the mother has been made comfortable, the baby is given its initial bath of oil. This oil may be lard, olive oil, sweet oil, or liquid vaseline. The oil should be warmed and the baby should be well covered with a warm blanket and placed on a table which is covered with a thick pad or pillow. The temperature of the room should be at least eighty degrees Fahrenheit. Quickly, thoroughly, and carefully the entire body is swabbed with the warmed oil—the head, neck, behind the ears, under the arms, the groin, the folds of the elbow and knee—no part of the body is left untouched, save the cord with its dressing. This oil is then all gently rubbed off with an old soft linen towel.
THE FIRST CLOTHING
After the oil bath, the silk and wool shirt (size No. 2), the diaper and stockings are quickly put on to avoid the least danger of chilling. The band having been applied at the time of the dressing of the cord, our baby is now ready for the flannel skirt. This should hang from the shoulders by a yoke of material adapted to the season, cotton yoke without sleeves if a summer baby, and a woolen yoke with woolen sleeves if a winter baby. The outing-flannel night dress completes the outfit and should be the only style of dress worn for the first two weeks. Loosely wrapped in a warm shawl, the baby is about ready for its first nap, save for a drink of cooled, boiled water.
This cooled, boiled, unsweetened water should be given in increasing amounts every two hours until the child is two or three years of age. It is usually given the child in a nursing bottle. In this way it is taken comfortably, slowly, can be kept clean and warm, and should the babe be robbed of its natural food and transferred to the bottle as a substitute for mother's milk, it will already be acquainted with the bottle and thus one-half of a hard battle has already been fought and won.
BABY'S FIRST NAP
The baby's bed should be separate and apart from the mother's. It may be a well-padded box, a dresser drawer, a clothes basket, or a large market basket. A folded comfortable slipped in a pillow slip makes a good mattress. A most ideal bed may be made out of a clothes basket; the mattress or pad should come up to within two or three inches of the top, so the baby may breathe good fresh air and not the stale air that is always found in a deeply made bed. Into this individual bed the baby is placed as soon as it is dressed; and a good sleep of four to six hours usually follows.
Frequent observations of the cord dressing should be made as occasionally hemorrhage does take place, much to the detriment of the babe. If bleeding is at any time discovered the cord is retied just below the original tying. By the time baby has finished a six- or eight-hour nap the mother is wondrously refreshed and is ready to receive it to her breast.
PUTTING TO THE BREAST
During the first two days the baby draws from the breasts little more than a sweetened watery fluid known as the colostrum; but its intake is essential to the child in that it acts as a good laxative which causes the emptying of the alimentary tract of the dark, tarry appearing stools known as the meconium. On the third day this form of stool disappears and there follows a soft, yellow stool two or three times a day.
The child should be put to the breast regularly every four hours; two things being thus encouraged: an abundant supply of milk on the third day and the early shrinking of the uterus. More than once a mother has missed the blessed privilege of suckling her child because some thoughtless person told her "why trouble yourself with nursing the baby every four hours, there's nothing there, wait until the third day;" and so when the third day came, there was little more than a mere suggestion of a scanty flow of milk, which steadily grew less and less.
THE URINE
The urine of the very young child should be clear, free from odor and should not stain the diaper, nor should it irritate the skin of the babe. Often urination does not take place for several hours, sometimes not at all during the first twenty-four hours. If the infant does not show signs of distress, there is no cause for alarm; the urine should pass, however, within thirty hours. As a rule there are usually between ten and twenty wet diapers during each twenty-four hours. The following table shows about the amounts of urine at different ages:
Birth to two years 8 to 12 ounces Two to five years 15 to 25 ounces Five to ten years 25 to 35 ounces
GENITALS OF THE MALE CHILD
The foreskin of the male child is often long, tight, and adherent, and is often the direct cause of irritability, nervousness, crying, and too frequent urination. It should be closely examined by both physician and nurse and when the foreskin does not readily slip back over the acorn-like head of the organ, circumcision is advised early in the second week. This simple operation will start the child out on his career with at least one moral handicap removed and one desirable possibility established—that of being able to keep himself clean.
POST-OPERATIVE CARE OF CIRCUMCISION
The dressings that are loosely applied at the time of the operation should remain untouched (especially those next to the skin), unless otherwise directed by the physician, until the seventh or eighth day when the babe is placed in a warm soap bath, at which time the dressings all come off together. Clean sterile gauze is so placed as entirely to protect the inflamed skin from the diaper at all times before this bath, and these same dressings should be continued for at least another week. Sterile vaseline (from a tube) should be applied twice a day after the original dressings are removed in the bath at the end of the first week. There should be little or no bleeding following the operation, neither should the penis swell markedly; if either complication should occur, the physician should be promptly notified.
CARE OF THE FEMALE GENITALS
The girl baby is often neglected in respect to the proper care of the genitals. The lips of the vulva should be separated and thorough but careful cleaning should be the daily routine. The foreskin or covering of the clitoris should not be adherent; while the presence of mucus, pus, or blood in the vulva should be at once reported to the physician; in his absence, the application of twenty per cent argyrol should be made daily.
HANDLING THE BABY
Let us thoroughly come to understand the very first day the little one's life, that it was not sent to us because the family needed something to play with; it is not a ball to toss up, neither is it a variety show. It is a tiny individual, and your responsibilities as parents and caretakers are very great. The child was sent to be fed, clothed, kept warm, dry, and otherwise cared for by you, until such a time as it will become able to care for itself. Remember, what we sow, that shall we also reap. If we sow indulgence we shall reap anger, selfishness, irritability, "unbecomingness"—the spoiled child. At two or three days the baby learns that when it opens its mouth and emits a holler, someone immediately comes. If we do it on the second and third day, why should we object to run, bow, and indulge on the one hundredth and second day?
Handle the baby as little as possible. Turn occasionally from side to side, feed it, change it, keep it warm, and let it alone; crying is absolutely essential to the development of good strong lungs. A baby should cry vigorously several times each day. If the baby is to be handled, support the back carefully (Fig. 6).
THE EARLY BATHS
During the first week the baby is oiled daily over his entire body, with the exception that the cord dressing remains untouched. The face, hands, and buttocks are washed in warm water. After the third week the bathroom is thoroughly warmed and the small tub is filled with water at temperature of 100 F. The baby having been stripped and wrapped in a warm turkish towel, is placed on a table protected by a pillow, while the caretaker stands by and vaselines the creases of the neck, armpits, folds of the elbows, knees, thighs, wrists, and genitals; and then, with her own hands, she applies soap suds all over the body—every portion of which is more quickly and readily reached—than by the use of a wash cloth. And now, with the bath at 100 F., with a folded towel on the bottom of the small tub, the soapy child is placed into the water and after a thorough rinsing is lifted out again to a warm fresh towel on the table and the careful drying is quickly begun. After the bath all the folds and creases are given a light dusting with a good talcum.
During hot weather the bath should be given daily, soap being used twice a week. On the other days there should be the simple dipping of the child into the tub. During the cold weather the full bath is given but twice a week, while on the other days a sponge bath or an oil rub may be administered.
A weak, delicate child should not be exposed to the daily full bath, but rather the semi-weekly sponge bath and the daily oil rub should be administered. We have found the late afternoon hour to be better than the early morning hour for baby's bath. It requires too much vital resistance to react to an early morning bath, especially when the house is cool.
REGARDING SOAP
The use of soap is very much abused with young babies. I recall one mother who came into the office with her poor little baby which was constantly crying and fretting because of a greatly inflamed body—all a result of the too frequent use of soap. I said, "I am afraid you do not keep your baby clean." "O Doctor!" she replied, "I wash him with soap every time I change him; I am sure he is clean." And come to find out, the poor little fellow's tender skin had been subjected to soap several times a day. We ordered the use of all soap discontinued, vaseline and talcum powder to be used instead, and the child's skin got well in a very short time.
CARE OF THE UMBILICUS
Tight bands should not be placed about the babe. If the umbilicus protrudes, do not endeavor to hold it in by a tight band, but consult your physician about the use of a bit of folded cotton and adhesive plaster, and then allow the child the freedom of the knitted bands, with skirts suspended from yokes. The day of tight bands and pinning blankets with their additional and traditional windings is over. After the complete healing of the cord, the need for a snug binder to hold the dressings in place is over. Should the baby cry violently, the umbilicus should be protected in the manner described above—the fold of cotton and the adhesive plaster.
The diaper, stockings, shirt, skirt, and dress with an additional wrapper for cold days completes the outfit at this age.
BIRTH REGISTRATION
"One of the most important services to render the newborn baby is to have his birth promptly and properly registered."
In most states the attending physician or midwife is required by law to report the birth to the proper authority, who will see that the child's name, the date of his birth, and other particulars are made a matter of public record. Birth registration may be of the greatest importance when the child is older, and parents should make sure this duty is not neglected.
A public health official some time ago epitomized some of the uses of birth registration as follows:
There is hardly a relation in life from the cradle to the grave in which such a record may not prove to be of the greatest value. For example, in the matter of descent; in the relations of wards and guardians; in the disabilities of minors; in the administration of estates; the settlement of insurance and pensions; the requirements of foreign countries in matters of residence, marriage, and legacies; in marriage in our own country; in voting and in jury and militia service; in the right to admission and practice in the professions and many public offices; in the enforcement of laws relating to education and to child labor, as well as to various matters in the criminal code; the irresponsibility of children under ten for crime or misdemeanor; the determination of the age of consent, etc., etc.
CHAPTER XIII
THE NURSERY
We wish it were possible for every mother who reads this book to have a special baby's room or nursery. Some of our readers have a separate nursery-room for the little folks, and so we will devote a portion of this chapter to the description of what seems to us a model arrangement for such a room; but, realizing that ninety-five per cent of our readers can only devote a corner of their own bedroom to the oncoming citizen, we have also carefully sought to meet their needs and help them to take what they have and make it just as near like the ideal nursery as possible.
THE SEPARATE NURSERY
The nursery should be a quiet room with a south or southwesterly exposure. The bathroom should adjoin or at least be near. A screened-in porch is very desirable.
Draperies that cannot be washed, and upholstered furniture, do not belong in the baby's room. A hardwood floor is better than a carpet or matting; while a few light-weight rugs, easily cleaned, are advisable. Enameled walls are easily washed and are, therefore, preferable to wall paper or other dressings.
The windows should be well screened, for by far the greatest dangers to which the baby is exposed, are flies and mosquitoes—carriers of filth and disease. Flies, mosquitoes, cockroaches, bed bugs, cats, dogs, lice, and mice are all disease carriers and must therefore be kept out of baby's room.
NURSERY EQUIPMENT
At each window should be found dark shades, and if curtains are desired they should be of an easily washable material, such as mull, swiss, lawn, voile, or scrim. The hardwood floor may be covered where necessary with easily handled rugs which should be aired daily. The other necessary articles of furniture are a crib of enameled iron whose bedding will be described elsewhere in this chapter, a chest for baby's clothes and other necessary supplies, a screen or two, a low table and a low rocker, a small clothes rack on which to air the clothes at night, a pair of scales, and a medicine chest placed high on the wall.
If the room will conveniently admit it, a couch will add greatly to the mother's comfort; and, if possible, it should be of leather upholstery; otherwise, it should possess a washable cover, for all articles that promote the accumulation of dust are not to be allowed in the nursery. In these early weeks and months baby will not benefit from pictures or other wall decorations, and so let him have clean walls that are easily washed and quickly dusted.
The necessities for baby's personal care are:
Talcum powder. Castile soap. Soft wash cloths. Soft linen towels. Bottle of plain vaseline. Boracic acid, oz. IV (Saturated Solution). Olive oil. Sterile cotton balls in covered glass jar. Safety pins of different sizes. Hot water bag with flannel cover. Baby scales. Drying frames for shirt and stockings.
BABY'S BED
Since the days of Solomon, accidents have occurred where mother and babe have occupied the same bed. Not only is there the ever-present danger of smothering the babe, but there are also many other reasons why a baby should have its own bed. The constant tendency to nurse it too often and the possibility of the bed clothing shutting off the fresh air supply, are in and of themselves sufficient reasons for having a separate bed for baby.
The first bed is usually a basinet—a wicker basket with high sides—with or without a hood. A suitable washable lining and outside drape present a neat as well as sanitary appearance. The mattress of the basinet is usually a folded clean comfort slipped into a pillow slip; this is to be preferred to a feather pillow, as it is cooler and in every way better for the babe.
Drapes about the head of the basinet are not only often in the way, shutting out air, etc., but they also gather dust and are unsanitary. Screens are movable—they may be used or put away at will—and are, therefore, very convenient about the nursery.
The basinet may be dispensed with entirely if the sides of the enameled crib are lined to cut off draughts and the babe is properly supported by pillows. After the baby is four to six months of age it is transferred to the crib. The basinet has an advantage over the crib during those early weeks in that its high sides protect the babe from draughts, and the comforts and blankets can be more easily tucked about the little fellow to keep him warm. The sides should not extend more than four inches above the lying position of the child.
THE CRIB
The enameled iron crib should be provided with a woven-wire mattress, over which is placed a mattress; hair is best as a filling for the mattress, wool next, and cotton last. Over the mattress should be placed a rubber sheet, and over all a folded sheet.
A pillow of hair or down is not to be discarded; for recent investigation has shown that the pillow favors nasal drainage, while lying flat encourages the retaining of mucus in the nose and nasal chambers—the sinuses. The pillow slip should be of linen texture.
During the winter a folded soft blanket over the rubber sheet increases both softness and warmth. No top sheet is used during the first months, particularly if the first months are the winter months. The baby is wrapped loosely in a light weight clean blanket or shawl, and other blankets—as many as the season demands are tucked about the child. These blankets should be aired daily, and the one next to the baby changed, aired, or washed very often.
THE SLEEPING BLANKET
To prevent baby from becoming uncovered the sleeping blanket has been devised. The blanket is folded and stitched in such a way as completely to envelop the sleeping babe, and at the same time afford the utmost freedom (Fig. 7). The babe may turn as often as he desires, but cannot possibly uncover himself. Bed clothes fasteners are also used—an elastic tape being securely fastened to the head posts and then by means of clamps or safety pins attachment is made to the blankets on either side. The elasticity allows considerable freedom to the child in turning (See Fig. 8).
NURSERY HEATING AND VENTILATION
The subject of ventilation has been so fully discussed by the authors in another work that we refer the reader to The Science of Living, or the Art of Keeping Well.
For the first two or three weeks the nursery temperature should be maintained at seventy degrees Fahrenheit by day and from sixty degrees to sixty-five degrees by night. In the third week the day temperature should be sixty-eight degrees Fahrenheit measured by a thermometer hanging three feet from the floor. After three months the night temperature may go as low as fifty-five degrees Fahrenheit, and after the first year it may go as low as forty-five degrees.
The heating of the nursery is usually controlled by the general heating plant, and no matter what system of heating is maintained, humidifiers must be used, the necessity for which is doubled when the system is that of the hot-air furnace.
These shallow pans of water with large wick evaporating surfaces will evaporate from three to four quarts during the twenty-four hours. The humidity should be fifty throughout the seasons of artificial heating.
Many colds may be entirely avoided by the use of humidifiers or evaporators. The open grate is one of the very best means of nursery heating. Gas and oil heaters should not be depended upon for nursery heat. Only in an emergency should they be used at all, and the electric heater is by far the best device for such occasions.
BABY'S CORNER IN MOTHER'S ROOM
It is probably a conservative estimate to say that ninety-five per cent of all the babies occupy a corner of mother's and father's bedroom for the first two or three years. And believing this estimate to be correct, it is advisable to give the matter some consideration. To begin with, a lot of the non-essentials, ruffles and fluffles of the average bedroom, must go. The good father's chiffonier may have to be put in the bath room; heavy floor coverings must be discarded, to be replaced by one or two small, light-weight rugs; wall decorations and the usual bric-a-brac of dressers, tables, etc., should be carefully packed away. In fact, there should be nothing in the room save the parents' bed, dresser (several drawers of which must be devoted to baby's necessities), table, low rocker, a stool, baby's bed and a good big generous screen, made out of a large clothes horse enameled white and filled with washable swiss.
Window draperies must be taken down and packed away, while they are replaced with simple muslin which can go to the laundry twice a month. If it be within the means of the family purse, it is well to renovate the walls just prior to the advent of the little stranger.
And now the baby's bed is placed in the corner most protected from draughts and the glare of the sunlight. If it can be so arranged that baby looks away from the light, and not at it, we are guarding it from defective vision in the future.
CRIB SUBSTITUTES
Many a beautiful artistic creation so much admired in this world is found to be, on closer inspection, a very ordinary thing which has received an artistic touch; and so, many convenient, sanitary, and beautiful cribs are fashioned from market baskets fastened to tops of small tables whose legs are sawed off a bit; from soap boxes fastened to a frame, and from clothes baskets. A can of white enamel, a paint brush and the deft hand of a merry, cheery-hearted expectant mother can work almost miracles. Remember, please, that all draperies must be washable and attached with thumb tacks so as to admit of easy and frequent visits to the laundry.
A medium-sized clothes basket will take care of our baby for four or five months. The same general plan for the mattress and bedding is followed as before described.
EXTRA HEAT TO THE CRIB
If necessary—and it usually is, especially during the winter months—a hot-water bottle may be placed underneath the bedding on top of the mattress. This insures a steady, mild, uniform warmth and it not only saves the baby from the danger of being burned, but it also obviates the temporary overheating of the child which usually occurs when the bottle is placed inside the bed, next to the baby. If the bed is properly made—the blankets coming from under the babe up and over—there is little or no need for extra heat for well babies after the first month.
LIGHTING BABY'S ROOM
If electric lighting is not an equipment of the home neither gas or oil lamps should be allowed to burn in the room for long periods. For emergency night lighting a well-protected wax candle should be used. However, don't go to sleep and allow a candle to burn unprotected as did one tired, exhausted mother. The father, suddenly aroused from his sleep, saw a large flame caused by the overturning of a wax candle into a box of candles, while the lace drapery of the basinet was within a few inches of the flame and the baby just beyond. Grabbing a pillow he smothered the flames and saved baby and all.
FRESH AIR
Plenty of fresh air and lots of sunshine should enter baby's room. The large screen amply shields from draughts, and when thus protected there need be no unnecessary concern about cool fresh air, especially after two or three months, as it is invigorating and prevents "catching cold." Warm, stuffy air is devitalizing and even during the early weeks when the fresh air must be warm, an electric fan should be advantageously placed so that many times each day the warm fresh air may be put in motion without creating a harmful draught.
Warm stuffy air makes babies liable to catch cold when taken out into the open.
Throw open the windows several times each day and completely change the air of baby's room. In the absence of the large screen, a wooden board five or six inches high is fitted into the opening made by raising the lower window sash. Then as the upper sash is lowered the impure air readily escapes while fresh air is admitted.
THE BATH EQUIPMENT
Make early preparations for bathing the baby in the easiest possible manner; in fact, the young mother should seek to attend to all her duties—the family, the home, and the baby—in the easiest way. For the administration of a bath during the early months, a table is needed, protected by oilcloth on which is placed a roomy bathtub with a folded turkish towel on the bottom for baby to sit on. In addition to the tub, have:
An enameled pitcher for extra supply of warm water. A small cup for boracic acid solution. Castile soap. A soft wash cloth. Several warmed soft towels. A bath thermometer. A medicine dropper for washing baby's eyes. Talcum powder. Oil or vaseline. Sterile cotton. Tooth picks. A needle and thread for sewing on the band. All of the clean clothing needed.
See that the bathtub is clean and enamel unbroken, and if it has been used by another babe, freshen it with a coat of special enamel sold for that purpose.
BATH TEMPERATURES
During the first eight weeks Temperature 100 F. From two to six months Temperature 98 F. From six to twenty-four months Temperature 90—97 F.
A bath at ninety-eight degrees is a neutral bath, and after the baby is six months and over, the bath may be given at this temperature, and at the close quickly cooled to ninety degrees.
NURSERY CLEANLINESS
The nursery should furnish the baby's first protection from contagious diseases. It must be a veritable haven of safety. Therefore, no house work of any kind should be done in the room, such as washing or drying the baby's clothes. The floors and the furniture should be wiped daily with damp cloths. A dry cloth or feather duster should never be used to scatter dust around the room.
All bedding and rugs should receive their daily shaking and airing out of doors, remembering that particles of dust are veritable airships for the transportation of germs. In every way possible avoid raising a dust. So much of the lint which commonly comes from blankets may be avoided with the daily shaking out of doors.
Soiled diapers should not accumulate in a corner or on the radiator; their removal should be immediate, and if they must await a more opportune time, soak them in a receptacle filled with cold water. Even those diapers slightly wetted should never be merely dried and used again, but should be properly washed and dried. No washing soda should be used in the cleansing of diapers—just an ordinary white soap, a good boil, and plenty of rinse water, with drying in the sun if possible. They require no ironing. Hands that come in contact with soiled or wet diapers must be thoroughly cleansed before caring for the baby or preparing his food.
As before mentioned, and it will bear repetition often, all windows and doors must be well screened, for flies and mosquitoes are dreaded foes in any community and in babyland in particular. All used bottles and nipples as well as used cups, pitchers, bits of used cotton, should be removed at once. The washcloth is a splendid harbinger of germs. There should be one for the face, and one for the body and bath, and both should receive tri-weekly boiling. Bath towels should not be used more than twice, better only once.
The technic of bathing, together with the location, furnishings, and cleanliness of the baby's sick room, will be taken up in later chapters.
CHAPTER XIV
WHY BABIES CRY
It is surprising how soon even a young and inexperienced mother will learn to distinguish between the pain cry and the plain cry of her baby; for most crying can easily be traced to some physical discomfort which can be relieved, or to some phase of spoiling and indulgence which can be stopped.
NORMAL HEALTHY CRYING
The young baby can neither walk, talk nor engage in gymnastics, except to indulge in those splendid physical exercises connected with a good hearty cry. To be good and healthy, an aggregate of an hour a day should be spent in loud and lusty crying. He should be allowed to kick, throw his arms in the air and get red in the face; for such gymnastics expand the lungs, increase general circulation and promote the general well-being of the normal child. As the child grows older and is able to engage in muscular efforts of various sorts, these "crying exercises" should naturally decrease in frequency and severity. When baby cries, see that the abdominal band is properly applied, that rupture need not be feared.
THE BIRTH CRY
The sound most welcomed by both doctor and nurse is the cry of the newly born child, for it shows that the inactive lungs have opened up and the baby has begun to use them, for all the time baby was living in the uterine room he did not breathe once, the lungs having been in a constant state of collapse; and not until now, the very moment the air comes in contact with his skin, do the lungs begin to functionate as he emits his first lusty holler.
ABNORMAL CRYING
The cry is said to be abnormal when it continues too long or occurs too often. It may be strong and continuous, quieting down when he is approached or taken up; or it may be a worrying, fretful cry, a low moan or a feeble whine. And now as we take up the several cries, their description, cause, and treatment, we desire to say to the young mother: Do not yourself begin to fret and worry about deciding just which class your baby's cry belongs to; for help, knowledge, and wisdom come to every anxious mother who desires to learn and who is willing to be taught by observation and experience.
THE HUNGER CRY
The continuous, fretful cry, accompanied by vigorous sucking of the fists, both of which stop when hunger has been satisfied, is without question the hunger cry.
If this cry is constant with regular feedings, then the quantity of the food must be increased, or the quality improved. The tired, fretful hunger cry must not be neglected; the cause must be removed, for it points to malnutrition.
THE CRY OF THIRST
One day when lecturing at an Iowa chautauqua, I remained in the beautiful park for the noonday meal. It was a warm day and the tables in the well-screened dining tent were filled with mothers who, like myself, preferred the cool shade of the park to the hot ride through the city to the home or hotel dinner. At my table a baby was pitifully crying. The mother had offered the little child seated in a small uncomfortable go-cart, milk, bread, and a piece of cake—all of which were ruthlessly pushed aside. My little son, then only four and a half, said "Mamma, maybe the baby's thirsty," and up he jumped, hurried to the mother's side with his glass of water, saying, "I haven't touched it, maybe the baby's thirsty." The mother brushed the boy aside, saying, "No, I never give the baby water." In spite of the mother's remonstrance, the baby cried on and on, and finally on "trying" the water, the child drank fully one-half the glass and the crying was hushed.
Babies should be given water regularly—many times every day—from birth, in varying amounts from two teaspoons to one-half cup, according to the age of the child. The water should be boiled for the first few months, and longer if there is any suspicion of impurities.
Milk to the nursing infant is like beefsteak and potatoes to the adult; and many times the milk bottle or the breast is just as nauseating to the thirsty babe, as meat would be to the very thirsty adult whose hunger has previously been fully satisfied.
THE FRETFUL CRY
The babe who is wet, soiled, too hot, or is wrapped too tightly, or who has on a tight, uncomfortable belly band, or whose clothing is full of wrinkles, has only one way to tell us of his discomfort, and that is to cry. It is a fretful cry and should command an immediate investigation as to the possible cause. It takes but a moment to discover a wet diaper; to run the hand up the back under the clothes; to sprinkle with talcum if perspiring; to straighten out the wrinkled clothing; to find the unfastened pin that pricks; or to loosen the tight band. Acquire the art of learning to perform these simple tasks easily, and any or all of these services should be rendered without taking the child from its bed.
Let the child early learn to rest happily and quietly in his own bed. The pillow or mattress may be turned or perhaps the mattress be raised nearer the edge of the basinet. One poor youngster instantly stopped his fretful cry when his mattress was raised four or five inches so he could get the air, at the same time taking him out of his hot room to a cooler room with raised windows. Babies like cold air. They cry when the air is hot, or even warm and close. Every day—rain or shine, wind or sleet—babies should nap out of doors on the porch, in a well-sheltered corner. A screen or a blanket protects from the wind, sleet, or rain; and if the baby's finger tips are warm, you can rest assured the feet and body are warm. Scores of babies will sleep out on the porch, on the protected fire escape, or in a room with opened windows, from one bottle or feeding to another; being aroused at the end of the three or four hour interval just enough to nurse, when back they go to their delightful, warm nest in the cool, fresh air to sleep for another period. Babies should never sleep in a room with closed windows.
One of the incidents that surprised me most in my early work with dispensary babies was the utter misconception of the purpose of the belly band. Invariably it was put on so tightly that I could not slip a finger between it and the babe. It is not a surgical instrument, neither is it a truss. These tight belly bands are a source of much fretting and crying.
THE PAIN CRY
The little pinched look about the face, the drawing up of the legs, the jerking of the head, arms, or legs, associated with a strong, sharp, unceasing or intermittent cry, demands immediate attention Our first work should be to go about quietly, painstakingly, and systematically to locate the cause of this "cry of pain."
There are often some accompanying symptoms to the cry of pain which demand skilled medical advice and attention, such as the arching of the body backward, the drawing of the head strongly to one side, the inability to use one side of the body, or the presence of fever. There may be an earache, an abdominal complication, or a sore throat, any one of which will be detected by the skilled doctor.
Earache frequently occurs in young babies who have been taken out of doors without proper protection to the ears; or, it may be associated with a cold in the head, which is not detected until the mischief has already been done, while the resulting running ear tells the tale of woeful suffering. Earache must always be thought of as a possible cause when the cry of pain accompanies a cold in the head, and if medical aid is secured early, the abscess may be aborted and the deafness of later years entirely avoided. There is only one home remedy for earache, and that is the application of external heat, either by a hot-water bottle or hot-salt bag. Medical advice should be sought before anything whatsoever is dropped into the baby's ear.
In this connection should be mentioned the wild cry at night which so often accompanies tuberculosis of the bone. A careful X-Ray examination will reveal the disease, and proper medical measures should be instituted at once. Other fretful night crying will be mentioned further on.
HABIT CRYING
By the frequent repetition of actions, habits are formed. When the baby is two or three days old, he is so new to us and we have waited for him so long, and it is such a great big world that he has come into, that we jump, dance, and scramble to attend to his every need and adequately to provide for his every want. At this very early, tender age whenever he opens his mouth to cry or even murmur—some fond auntie or some overly indulgent caretaker flies to his side as if she had been shot out of a gun, grabs him up and ootsey tootsey's him about as she endeavors to entertain and quiet him. The next time and the next time and the succeeding time he whimpers—like a flash someone dashes to the side of the basket, and baby soon learns that when he opens his mouth and yells, somebody comes. In less than a week the mischief has been done and baby is badly spoiled. No other factor enters so largely into the sure "spoiled" harvest as picking a new baby up every time he cries. Often in the early days some indulgent parent will say, "Oh, don't turn out the light, something might happen to the dear little thing"—and old Mother Nature sees to it that a constant repetition of "leaving the light on" brings its sure harvest of "he just won't go to sleep without the light." And then, "just once" he had the pacifier—perhaps to prevent his crying disturbing some sick member of the family—and so we go on and on. If a thing is bad, it is bad, and a supposedly good excuse will not lessen the evil when the habit has been thus started and acquired.
The rocking of babies to sleep may be a beautiful portrayal of mother love, but we all pity the child who has to be rocked to sleep as much as we do the mother who sits and rocks, wanting, Oh, so much! to do some work or go for a walk—but she must wait till baby goes to sleep.
THE TEMPER CRY
And so now we come to the temper cry—that lusty, strong outburst of the cry of disappointment when he finds that all of a sudden people have stopped jumping and dancing for his every whim. The baby is not to blame. We began something we could not keep up, and he—the innocent recipient of all our indulgences—is in no sense at fault. It is most cruel to encourage these habits of petty indulgence, which must cause so much future disappointment and suffering on the part of the little fellow as he begins to grow up.
Nobody is particularly attracted to the spoiled baby. After the over-indulgent parent and caretaker have completed their thoughtless work, they themselves are ashamed of it and not infrequently begin to criticise the product of their own making—the formation of these unpleasant bad habits. More than anything else, the spoiled child needs a new environment, new parents, and a new life.
THE SPOILED BABY
Seek to find out if possible—and it usually is possible—just what he is crying for. It may be for the pacifier, for the light, or to be rocked, jolted, carried, taken up and rocked at night, or a host of other trifles; and if he is immediately hushed on getting his soul's desire—then we know he is "spoiled."
The unfortunate thing about it all is that the one who has indulged and spoiled the baby usually does not possess the requisite nerve, grit, and will power to carry out the necessary program for baby's cure. And the pity of it all is that overindulgence in babyhood so often means wrecked nerves and shattered happiness in later life. So, fond, indulgent parents, do your offspring the very great kindness to fight it out with them while they are young, even if it takes all summer, and thus spare them neurasthenia, hysteria, and a host of other evils in later life.
This sort of "spoiled baby crying" can be stopped only through stern discipline—simply let the baby "cry it out." The first lesson may require anywhere from thirty minutes to an hour and thirty minutes. The second lesson requires a much shorter time, and, in normal babies with a balanced nervous system, a third or fourth lesson is not usually required.
THE CRY OF SERIOUS ILLNESS
The cry of the severely sick child is the saddest cry of all. The low wail or moan strikes terror to the saddened mother-heart. It is often moaned out when the child is ill with "summer complaint" or other intestinal disturbances. Instant help must be secured, and, if medical help is not obtainable, remember, with but one or two exceptions, you are safe in carefully washing out the bowels, in applying external heat and giving warmed, boiled water to drink.
Another cry which demands immediate attention, and the faithful carrying out of the doctor's orders, is the hoarse, "throaty" cry indicative of croup or bronchitis.
THE COLICKY CRY
Perhaps the greatest cause of the most crying during infancy, next to that of over-indulgence, is ordinary colic which—
... manifests itself in every degree of disturbance from mere peevishness and fretfulness to severe and intensely painful attacks in which restlessness passes into grunting, writhing, and kicking; the forehead becomes puckered and the face has an agonized expression; the baby tends to scream violently and draws his thighs up against his belly, which will usually be found to be hard and more or less distended.
A colicky baby completely upsets the household and greatly disturbs the mother, who requires both quiet and rest that she may the better produce the life-sustaining stream so much needed for the upbuilding and development of the growing child.
COLIC IN THE BREAST-FED
While colic is so often seen in the bottle-fed babe, it often occurs in the breast-fed child, and is usually traceable to some error in the mother's diet or to some other maternal nutritional disturbance. One mother who was sure she had eaten nothing outside the diet suggestions she had received, was requested to bring to the office a fresh voiding of her own urine which was found to be highly acid. The administration of an alkaline such as simple baking soda or calcined magnesia to the mother, corrected this acidity, and the colic in the baby entirely disappeared. I recall the case of one mother who ate her dinner in the middle of the day, with a light meal in the evening and thereby stopped the colic in her babe.
Another source of colic in the breast-fed baby is the unclean nipple. The nipples should be washed with soap and water and rinsed in boracic acid solution before each nursing. If the mother worries greatly, or thoughtlessly "gets very angry" just before the nursing hour, there is a substance known as "epinephrin" secreted by the glands located just above the kidneys which is thrown into the blood stream and which raises the blood pressure of the mother and often produces not only colic in the babe, but many times throws him into severe convulsions.
COLIC IN BOTTLE-FED BABIES
There are many opportunities for colic in the bottle-fed baby; for instance, dirty bottles, dirty nipples, careless cleansing of utensils used in the preparation of baby's food, improper mixtures, too much flour, the wrong kind of sugar, too much cream or too little water—all these things help to produce wind under pressure in the intestine, which is commonly known as colic. Underfeeding or overfeeding, too rapid feeding or too frequent feeding also contribute their mite in producing colic.
As a rule, the bottle-fed child is fed too often. In the new born, the interval between feeds should be three hours from the start; after six months the interval may be lengthened to four hours.
COLIC AND CHILLINESS
Hiccough—a spasm of the diaphragm—often accompanies colic, and, in the case of infants, is usually due to the swallowing of air or over-filling the stomach; gentle massage, external heat, and a few sips of very warm water usually corrects the condition.
The chilling of the skin very often produces a temporary intestinal congestion with colic as the result. Cold feet, wet diapers, and loitering at bath are all very likely to produce colic; and when it is thus caused by chilling, quickly prepare a bath at 100 F., and after immersing the child for five minutes, wrap up well in warm blankets.
THE TREATMENT OF COLIC
Those of my mother readers who have electric lights in their home, will find the photophore to be a source of great comfort and convenience; for this simple contrivance is usually able to banish colic in a few moments. The photophore is simply radiant heat—heat plus light (See Fig. 3)—and as this heat is applied to legs and buttocks of the crying child the diaper is warmed, the abdomen relaxes, gas is expelled, intestinal contractions relieved, and the baby is soon fast asleep.
Occasionally with the aid of the photophore, and even without it, the warm two-ounce enema containing a level teaspoon of baking soda and a level teaspoon of salt to a pint of water when allowed to flow into the bowel, will soon bring down both gas and feces to the great relief of the baby. Warm water to drink is also very helpful. Putting the feet in very warm water is also quieting to the crying colicky babe.
It is often necessary in cases of repeated and persistent colic, to give a full dose of castor oil to clear out the bowel tract. Do not jolt or bounce the baby, do not carry him about, and don't walk the floor with him.
Heat him up inside and outside, warm his clothing and his bedding, and thus bring about relief without sowing seeds for future trouble—the sorrow of a spoiled child.
One very quiet little baby was one day brought to the dispensary whose mother said: "Doctor, I didn't bring him 'cause he's sick, but 'cause he looks so pale; he's as quiet as a mouse; he never cries any more since I got to giving him medicine." On examination of the baby and on inquiring about the medicine, we found that the baby was dead drunk all the time. Some "neighbor friend" had told the tired out mother, "Give him a teaspoon of whiskey at each feeding and that'll fix him all right." If a few more states go dry maybe it will not be so easy for the ignorant mother to dope and drug her helpless baby.
And neither is paregoric to be administered wholesale for colic. It contains an opiate, and should not be given without definite orders from a physician. And so as a parting word on "Why Babies Cry," we ask each mother to run over the following summary of the chapter, and thus seek to find out why her baby cries.
BABY CRIES BECAUSE:
He is hungry. He is thirsty. He has been given a dirty bottle. His mother has failed properly to cleanse the nipples. His food is not prepared right. His food is too cold. His bowels are constipated. His band is too tight. His clothes are wrinkled. His diaper is wet. He is too hot. He wants fresh air. He is too cold. He is in pain. He is very sick. His throat is sore. His ear aches. He has been rocked, carried, or bounced. He has been given a pacifier. He has had too much excitement. His mother has eaten the wrong food.
CHAPTER XV
THE NURSING MOTHER AND HER BABE
Happy is the mother, and thrice blessed is the babe when he is able to enjoy the supreme benefits of maternal nursing. The benefits to the child are far reaching; he stands a better chance of escaping many infantile diseases; the whole outlook for health—and even life itself—is greatly improved in the case of the nursing babe, as compared with the prospect of the bottle-fed child. Maternal nursing lays the foundation for sturdy manhood and womanhood.
Out of every one hundred bottle-fed babies, an average of thirty die during the first year, while of the breast-fed babies, only about seven out of every one hundred die the first year. At the same time, nursing the babe delivers the mother from all the work and anxiety connected with the preparation of the artificial food, the dangers and risks of unclean milk, and the ever-present fear of disease attendant upon this unnatural feeding. The mother who nurses her child can look forward to a year of joy and happiness; whereas, if the babe is weaned, she is compelled to view this first year with many fears and forebodings. Mother's milk contains every element necessary for the growth and development of the child, and contains them in just the proportions required to adapt it as the ideal food for that particular child.
A dirty baby, properly fed, will thrive. A baby deprived of fresh air, but wisely fed, will survive and even develop into a strong healthy man or woman. But the baby raised according to the latest and most approved rules of sanitation and hygiene, if improperly fed, will languish and die.
HYGIENE OF NURSING MOTHERS
Outings and Exercise. It is most highly important that the nursing mother should be able thoroughly to digest her food; otherwise the flow of milk is likely to contain irritants that will disturb the baby's digestion, even to the point of making him really sick. In order to avoid these complications, exercise and outings are absolutely essential for the mother. A vigorous walk, gardening, light housework or other light athletics, greatly facilitate digestion and increase the bodily circulation, as well as promote deep breathing, all of which are of paramount importance to a good appetite and good digestion.
The Bowels. The bowels should move regularly and normally once or twice during the twenty-four hours. Unfortunately, this is not usually the case: and in this connection we would refer our reader to the chapter on "The Hygiene of Pregnancy," particularly those sections relative to the care of the bowels, recipes for bran bread, lists of laxative foods and other suggestions pertaining to the hygiene of the nursing mother.
Sleep. Nothing less than eight hours sleep will suffice for the nursing mother, and during the day she should take at least one nap with the baby.
Care of the Skin. Salt-rub baths are very beneficial taken once a week. The daily cold-friction rub described elsewhere, will tone up the system and increase digestion and improve the general well being. The soap wash may be taken once a week. The thorough cleansing of the breasts, and the frequent changing of the undergarments, will help to keep the baby happy; for oftentimes it is the odor of perspiration as well as the smell of soiled clothing that spoils the appetite of the baby, causing it to refuse food.
Recreation. Pleasant diversion is very essential for the mother, and should be indulged in at least once a week. The bedtime hours, however, should not be interfered with and the recreation should be selected with a view to amuse, refresh and create a harmless diversion for the mother's mind. Under no circumstances should the mother settle down to the thought: "No, I can't go out any more. I can't leave my baby." You should get away from the baby a short time each day, and go out among your former friends and acquaintances. Many a wrecked home—a shattered domestic heaven—dates its beginnings back to the days when the over-anxious young mother turned her back on her husband and looked only into the face of her (their) child. Nothing should come in between the filial friendship of husband and wife, not even their child. So, dear mother, if you can, go out occasionally, away from the baby, and enjoy the association of your husband and keep in touch not only with his interests, but with the outside world. You will come back refreshed and wonderfully repaid, and the face of the adored infant will appear more beautiful than ever.
DIET OF THE NURSING MOTHER
The general suggestions on diet which we made to the expectant mother are also valuable for the nursing mother. The food should be appetizing, nutritious, and of a laxative nature. Three meals should be eaten: one at seven A. M., one at one P. M. and one about six-thirty at night, with the heaviest meal usually at one P. M. As the mother usually wakens at five o'clock, or possibly earlier, she should be given a glass of milk, cocoa, or eggnog. If she awakens at six, nothing should be taken until the breakfast, which should consist of a good nourishing meal, such as baked potatoes with white sauce, poached eggs, cereal, milk or cocoa, prunes, figs, or a baked sweet apple, with bread and butter, etc.
From that hour until one P. M. only water is taken, and several glasses are urged during this interval. With nothing between meals but water and a little outdoor exercise, a good appetite is created for the one P. M. meal which should abundantly supply and satisfy the hungry mother; and then again, nothing is to be taken between dinner and supper but water. And after the supper hour, a walk out into the cool night air should be enjoyed with the husband and on going to bed about ten P. M., an eggnog or glass of milk may be taken. At the close of the other meals a cup of oatmeal gruel or milk or any other nourishing liquid may be enjoyed.
The eating of food or the drinking of nourishing drinks between the meals not only interferes with digestion and disturbs the mother, but it also upsets the baby; and it is often the reason why the appetite of the mother is so deranged at the meal time, her spirits depressed, and her milk diminished. Plenty of good nourishing food, taken three times a day with an abundance of water drinking between the meals, together with a free happy frame of mind occasioned by the recreation before mentioned, usually produces good milk and plenty of it. A nap between meals will probably produce more milk than eating between meals.
OBJECTIONABLE FOODS
All foods that cause indigestion in the mother or babe should be avoided.
Some mothers continue to eat tomatoes, peaches, sour salads, acid fruits, and it appears in no way to interfere with baby's comfort; but they are the exception rather than the rule. Usually tomatoes, acid salad dressings, and mixed desserts must be avoided. Each mother is a law unto herself. Certainly none of our readers will selfishly continue any food she feels will make her baby cry. All acid fruits, rich desserts, certain coarse vegetables, concoctions of all descriptions such as rarebit, condiments, highly seasoned sauce, etc., should be avoided.
Acid fruitades, such as lemonade, limeade and orangeade, can be taken by a small per cent of nursing mothers; and, since fruit acids are neutralized and alkalized in the process of digestion and assimilation, and since they are the very fruit-drinks we prescribe for patients suffering with an increased acidity, it would appear that they were in every way wholesome for the mother—if they in no way interfere with the baby. Practically, they do as a rule disturb the baby's digestion and should be avoided by those mothers who have found this to be the case.
CAKED BREASTS
During the first week of lactation the milk tubes of the breasts very often become blocked and the breasts become engored with milk, this condition being known as "caked breasts." At this particular time of the baby's life, he takes little more than an ounce of milk at a feed; so, beside the incoming engorgement of milk, an additional burden is thrown upon the milk tubes of the breasts in that they are not entirely emptied each nursing time by the young infant. When the breasts threaten to "cake," immediate steps must be taken to relieve the condition—to empty the breasts—and this is usually accomplished in the following manner: with hands well lubricated with sweet oil or olive oil the nurse begins gentle manipulation of the breasts toward the nipple in circular strokes, with the result that the milk soon begins to ooze out. This massage should be continued until relief is obtained; or the breast pump may be applied. Hard nodules should not be allowed to form or to remain in the breasts. Hot compresses (wrung from boiling water by means of a "potato ricer") may be applied to the caked breast which is protected from the immediate heat by one thickness of a dry blanket flannel. These hot compresses should be removed every three minutes until three have been applied, then an ice water compress is quickly applied, to be followed by more hot ones and then a cold; and so on, until as many as four sets each have been administered.
Gentle massage may again be administered and it will be found that they empty now with greater ease because of the preceding heat. After the breasts have been emptied, and thoroughly washed with soap suds and carefully dried, they should be thickly covered with cotton batting and firmly compressed against the chest wall by a snug-fitted breast binder, which serves the double purpose of relieving pain by not allowing the breasts to sag downward, at the same time preventing an over-abundant secretion of milk by diminishing the blood supply to the glands of the breast. In case the persistent manipulation of the breast and the use of the breast pump do not relieve the condition, and if the repeated effort day after day seems to avail nothing; then, as a rule, we must look for a breast abscess to follow if the breasts are not immediately "dried up." In all such cases of engorgement, the attending physician should be notified at once.
SORE NIPPLES
The nipple must be kept dry between nursings, which should be limited to twenty minutes. Regularity should be maintained. The nipples should never be touched or handled by hands that have not been scrubbed with soap and a nail brush. During the early nursing days they are wet much of the time and are subject to much stress and strain in the "pulling effort" of the baby, as a result of which they become very tender, chapped, cracked, and often bleed. Allowing the baby to go to sleep with the nipple in his mouth also exposes the nipple to unnecessary moisture which increases the possibility of painful cracking. The pain occasioned by nursing at this time is truly indescribable, and is most often the cause of absolute refusal on the part of the mother to nurse her babe—with the result that it is put on the bottle. Again, the fear and dread of being hurt so often tends to diminish the flow of milk. It is entirely possible so to prepare the nipple for this exposure, during the last months of pregnancy, that all this discomfort and pain may be entirely avoided (See chapter, "The Hygiene of Pregnancy").
Before the mother is put to rest after the birth of the baby the breasts are prepared as follows: A thorough cleansing with soap and water is followed by a careful disinfection with alcohol which leaves the nipple perfectly dry. A soft sterile pad is then applied and held in place by a breast binder. Before and after each nursing the nipple and surrounding area is swabbed with boracic acid (saturated solution) and carefully dried by applying a clean, dry, sterile pad.
Painful cracks and fissures are nearly always due to lack of the care described above, and are almost wholly preventable. When the first crack appears and nursing becomes painful, the baby's mouth should not touch the nipple again until healing has taken place. A thorough cleansing with boiled water should be made and then the sterile nipple shield should be applied through which baby will get abundant satisfaction, while the mother is spared the pain, and the nipple has an opportunity to get well.
In the case of sore and cracked nipples, thorough cleansing with boiled water and boracic acid solution follows each nursing seance; and, after careful drying, balsam peru—equal parts with glycerine—may be applied with a tiny piece of sterile gauze or cotton; a sterile cotton pad is then applied to each breast which is held in place by a breast binder.
The nipple shield, when employed, is boiled after each nursing and washed in boracic acid solution just before each nursing. The strictest cleanliness must be observed, and then we hope to bring relief and comfort to the mother, and effect the saving of nature's best food for the baby.
CONSTITUENTS OF MOTHER'S MILK
Mother's milk—that wonderfully adaptable, ever-changing food, so accurately and scientifically suited to the hourly and daily needs of the growing child—is composed of five different parts, totally unlike in every particular, and each part exactly suited to the needs which it supplies. The cream of the milk, as well as the lactose or sugar, builds up the fatty tissues of the body as well as helps provide the energy for crying, nursing, kicking, etc. The proteins (the curd of the milk) are exceedingly important; they are especially devoted to building up the cells and tissues of the body of the growing child. The salts form a very small part of the baby's food, but an important one, for they are needed chiefly for the bones and the blood. The fats, sugars, proteins, and salts, taken together, form the solids of mother's milk, and are held in solution in the proportion of thirteen parts of solids to eighty-seven parts of water; which so holds these solids in solution that the baby can digest and assimilate these necessary food elements. The mother's milk increases in strength day by day and month by month as the baby grows, and is the only perfect infant food on earth.
THE TIME OF THE FIRST FEEDING
Soon after the birth of the baby the wearied mother seeks rest—she usually falls into a quiet, restful slumber; the baby likewise goes to sleep and usually does not awaken for several hours. After six or eight hours the child is put to the breast and he begins to nurse at once, without any special help. This first nursing should be discontinued after four or five minutes, while he is put to the other breast for the same length of time.
If there is difficulty in sucking, a bit of milk may be made to ooze out on the clean nipple, while the baby's lips are pressed to it, after which the nurse gently presses and rubs the breasts toward the nipple. After the nursing, the nipples should be elongated, if necessary, by rubbing, shaping, or breast pump.
The baby gets but little nourishment during the first two days, but that which he does get is essential; for the colostrum—the first milk—is highly laxative in nature and serves the important purpose of cleaning out the intestinal tract of that first tarry, fecal residue, the meconium. This early sucking of the child accomplishes another purpose besides the obtaining of this important laxative—it also reflexly increases the contractibility of the muscles of the womb, which is an exceedingly important service just at this time.
Should the mother or caretaker feel that baby will starve before the milk comes, or that it is necessary to provide "sweetened water;" let us assure them that nothing is needed except what nature provides. Nature makes the babe intensely hungry during these first two days, so that he will suck well, and if he is fed sweetened water, gruel, or anything else, he will not suck forcefully; and so nature's plan for securing extra or increased uterine contractions and the stimulation of the breast glands will be seriously interfered with.
WATER DRINKING
As soon as the new born babe is washed and dressed he is given two teaspoons of warmed, boiled water; and this practice is continued every two hours during the day, until as much as two to four ounces of unsweetened water is taken by the tiny babe during the twenty-four hours. Inanition fever—the fever that sometimes follows a failure to give water to the new born infant—is thus avoided. The bottle from which the water is given should be scalded out each time, the nipple boiled, and just before the "water nursing" the nipple should be swabbed with boracic acid solution.
REGULARITY IN FEEDING
From earliest infancy the baby should be nursed by the "clock," and not by the "squawk." Until he reaches his sixth-month birthday, he is fed with unerring regularity every three hours during the day. Asleep or awake he is put to the breast, while during the night he is allowed to sleep as long over the three-hour period as he will. Babies are usually nursed at night: during the early weeks, at nine o'clock in the evening, at midnight, and at six o'clock in the morning. After four months all nursing after ten P. M. may be omitted.
The baby is ordinarily allowed to remain at the breast for about twenty minutes. He may often be satisfied with one breast if the milk is plentiful; if not, he is given both breasts; and may we add the following injunction? insist that nothing shall go into your baby's mouth but your own breast milk and warm or cool-boiled water; no sugar, whiskey, paregoric, or soothing syrup should be given, no matter how he cries. Never give a baby food merely to pacify him or to stop his crying; it will damage him in the end. More than likely he is thirsty, and milk to him is what bread and meat are to you, neither of which you want when you are thirsty.
POSITION OF MOTHER DURING THE NURSING
A perfectly comfortable position during nursing for both mother and babe is necessary for satisfactory results. During the lying-in period the mother should rest well over on her side with her arm up and her hand under her head, the other hand supports the breast and assists in keeping the nipple in the baby's mouth, as well as preventing the breast from in any way interfering with baby's breathing. A rolled pillow is placed at the mother's back for support.
After the mother leaves the bed, she will find a low chair most convenient when nursing the baby, and if an ordinary chair be used, she will find that a footstool adds greatly to her comfort. Once during the forenoon and once during the afternoon the nursing mother will find it a wonderful source of rest and relaxation if she removes all tight clothing, dons a comfortable wrapper, and lies down on the bed to nurse her babe; and as the babe naps after the feed, she likewise should doze and allow mother nature to restore, refresh, and fit her for restful and happy motherhood.
Worry, grief, fatigue, household cares, loss of sleep, social debauches, emotional sprawls—all debilitate the mother, and usually decrease the flow of milk.
NURSING WHEN ANGRY AND OVERHEATED
Overheating, irritability, and sudden anger, almost invariably tend to raise the blood-pressure, which means the entry into the blood stream of an increased amount of epinephrin, which disturbs the baby greatly, often throwing him into convulsions or other sudden, acute illness.
Menstruation often interferes with the nursing mother, the milk becoming weaker at this time; however, if the infant continues to gain and the mother feels comparatively well, no attention need be paid to this fact.
Another pregnancy demands a drying up of the breast at once, as the tax is too great on the mother.
THE STOOLS
The stools of the breast-fed baby do not require as much attention as those of the bottle-fed child. In cases of constipation, after four months, from one teaspoon up to one-half cup of unsweetened prune juice may be given one hour before the afternoon feed.
In instances of colic with signs of fermentation in the stool, the mother may take several doses (under her physician's orders) of common baking soda; or, if she is constipated, calcined magnesia will usually right the condition. Nature's mother milk is so beautifully adapted to the baby's needs that it is the rule for baby to have perfectly normal stools.
SYMPTOMS OF SUCCESSFUL NURSING
A happy baby is a satisfied baby. He lies quietly in a sleepy, relaxed condition if he has enough to eat, provided he is otherwise comfortable and dry. He awakens at the end of two hours and perhaps cries; but plain, unsweetened, warm, boiled water quenches his thirst, and he lies content for another hour, when he is regularly nursed. He gains on an average of about one ounce a day.
EARMARKS OF UNSUCCESSFUL NURSING
Constant discomfort, vomiting, fretful crying, passing and belching of gas, colicky pain, disturbed sleep, greenish stools with mucus, are among the more prominent earmarks of unsuccessful nursing. These symptoms appearing in a pale, flabby, listless, indifferent or cross baby, with steady loss of weight continued over a period of three or four weeks, point to "nursing trouble;" which, if not corrected, will lead to that much dreaded infantile condition—malnutrition.
Bolting of food or overeating results in vomiting and gas, and thus interferes with normal nursing, as also may tongue-tie. A condition in the mouth, medically known as "stomatitis," and commonly known as "thrush," often gives rise to a fretful cry when nursing is attempted. In the first place, the baby cannot "hold on" to the nipple; while, in the second place, it hurts his inflamed mouth when he makes an effort to nurse.
Long continued nursing covering three-fourths of an hour or more, seizing of the nipple for a moment and then discarding it, apparently in utter disgust, are the earmarks of very scanty milk supply and should receive immediate attention.
AIDS TO THE MILK SUPPLY
Believing that many more mothers than do so should nurse their babies, we have carefully tabulated a number of aids to the milk supply, which we hope will be most earnestly tried before the baby is taken from the breast—for so many, many more bottle-fed babies die during the first year than the breast fed. The dangers of infection, the worry of the food preparation, the uncertainty of results, all call for a most untiring effort on the part of every doctor, nurse, and mother, in their endeavors to secure maternal nursing. The following is a summary of "aids to the milk supply:"
1. Regular periodical sucking of the breasts from the day of baby's birth.
2. Systematic applications of alternate hot and cold compresses, followed by massage to the breasts.
3. Three good nourishing meals each day, eaten with merriment and gladness of heart.
4. A glass of "cream gruel," milk, cocoa, or eggnog at the close of each meal, with a glass just before retiring.
5. Three outings each day in the open air.
6. Nurse the baby regularly and then turn its care over to another, you seek the out of doors and engage in walking, rowing, riding and other pleasurable exercise.
7. Take a daily nap.
8. You can bank on fretting and stewing over the hot cook stove to decrease your milk. It seldom fails to spoil it.
9. Regular body bathing, with cold friction rubs to the skin.
10. A happy, carefree mental state. Nothing dries up milk so rapidly as worry, grief, or nagging.
11. The administration, preferably in the early days, of desiccated bovine placenta; although it may be given at any time during the period of nursing.
WHEN THE BABY SHOULD NOT BE NURSED
As much as we desire maternal nursing for the babe, there do occur instances and conditions which demand a change to artificial feeding, such as the following:
1. A new pregnancy. 2. Mothers with uncontrollable tempers. 3. Cases of breast abscess. 4. Prolonged illness of the mother with high fever. 5. Wasting diseases such as tuberculosis, Bright's disease, heart disease, etc. 6. Maternal syphilis. 7. When maternal milk utterly fails, or is wholly inadequate.
When a maternal anesthetic is to be administered, or in case of inflammation of the breast or during a very short illness not covering more than two or three days, then the breast pump may be used regularly every three hours to both breasts; the baby may be artificially fed and then returned to the breast after the effects of the anesthetic has worn off or the temperature has been normal for twenty-four hours.
There may also appear definite indications in certain children which make it imperative that the nursing child should early be weaned. These manifestations of disordered nutrition and failing health admonish us to put the baby on properly modified milk, or to transfer it to a wet nurse.
These conditions are:
1. Progressive loss in weight.
2. A bad diarrhea of long standing; one which does not yield to the usual remedies, at least not as long as the baby continues to feed from the breast. These diarrheas are especially serious when accompanied by a steady loss in weight.
3. Excessive vomiting accompanied by progressive loss in weight.
THE WET NURSE
Because of the rarity of good, healthy wet nurses, it is always better to attempt to feed the baby with scientifically modified milk (not proprietary foods), good, clean, cow's milk properly modified to suit the weight and age of the child. We put weight first, for we prepare food for so many pounds of baby rather than for the number of months old he is.
If modified food has failed and the best specialist within your reach orders a wet nurse; she must have the following qualifications:
1. She must be free from tuberculosis and syphilis. 2. She should be between twenty and thirty years of age. 3. She should abstain from all stimulants. 4. She should be amiable, temperate, and should sense her responsibility.
If an unmarried mother of her first child is engaged as a wet nurse, she should not be "stuffed" or allowed to overeat, which is commonly the result of moving her from her lower life into more comfortable surroundings, or given ale or beer to increase her milk. She should continue her normal eating, take light exercise, which does not mean the scrubbing of floors or doing the family washing, and live under the same hygienic regime outlined for the nursing mother. Should she be the mother of the second or third illegitimate child, then she is quite likely to be mentally deficient and she should not be engaged. Her own babe will have to be fed artificially as very few mothers can endure the strain of two suckling children.
The baby's own mother should keep general supervision and not turn her babe entirely over to the care of the wet nurse. Remember always that no one in the wide world will ever take the same mother interest in your offspring that can spring from your own mother heart.
CHAPTER XVI
THE BOTTLE-FED BABY
In taking up the subject of the bottle-fed baby, we must repeat that the only perfect baby food on earth is the milk that comes from the breast of a healthy mother.
But sudden illness, accident, chronic maladies, or possibly the death of the mother, often throw the helpless babes out into a world of many sorts and kinds of artificial foods—foods that are prepared by modifying cow's, ass', or goat's milk; foods arranged by the addition to the milk of various specially prepared cereals, albumens or malted preparations, otherwise known as "proprietary foods." We shall endeavor, then, in this chapter and in that on "the feeding problem," to lay down certain general suggestions to both the nurse and the mother, which may assist them in their effort to select the food which will more nearly simulate nature's wondrous mother-food, and which will, at the same time, be best suited to some one particular baby.
THE HOURLY SCHEDULE
The normal baby, from birth to six months, should receive properly prepared nourishment every three hours, beginning the day usually at six A. M., the last feeding being at nine P. M. During the early weeks an additional bottle is given at midnight, but this is usually discarded at four months, at which time the last feeding should be given at about ten instead of at nine at night.
Should the baby continue to awaken during the night before six in the morning, unless he is under weight, a bottle of warm, boiled, unsweetened water should be given.
QUANTITY OF FOOD
The quantity of food to be given is always determined by the size of the baby's stomach, which, of course, depends somewhat upon the age of the child; for instance, the stomach of the average baby one week old holds about one ounce, while at the age of three months the stomach holds five ounces; so it would not only be folly to give two ounces at one week and seven ounces at three months, but it would also be very detrimental to the babe, causing severe symptoms due to the overloading of the stomach.
Careful study of the size of the stomach at different ages in infancy, together with the quantity of milk drawn from the breast by a nursing baby, has led to the following conclusions regarding the capacity of the baby's stomach:
AGE QUANTITY
1—4 weeks 1—2 ounces 4 weeks—3 months 21/2—4 ounces 3 months—6 months 4—6 ounces 6 months—1 year 6—8 ounces
REFRIGERATOR NECESSITY
It is highly important that the day's feedings be kept in a cold place, free from the odors of other foods as well as free from dust, flies, and filth. In order that this may be accomplished, the well-protected bottles, each containing its baby-meal, are placed in a covered pail containing ice and water. This covered receptacle is now put in an ice box; and, in order that our most economical reader—one who may feel that she cannot afford to keep up the daily expense of the family refrigerator—may herself prepare a simple home refrigerator, the following directions are given (Fig. 9).
HOMEMADE ICE BOX
Procure a wooden box about eighteen inches square and sixteen or eighteen inches deep and put four inches of sawdust into the bottom; now fill in the space between a ten-quart pail, which is set in the middle of the box with more sawdust. A cover for the box is now lined with two or three inches of newspaper, well tacked on, and is fastened to the box by hinges. We are now ready for the inside pail of ice, into which is carefully placed the well-protected bottles of milk, all of which is then set into the ten-quart pail in the box. Five cents worth of ice each day will keep baby's food cool, clean, and provide protection against the undue growth of germs.
PREPARING THE BOTTLE
At each feeding hour, one of baby's bottled meals is taken from the ice box and carefully dipped in and out of a deep cup of hot water. A very convenient receptacle is a deep, quart aluminum cup, which may be readily carried about. The hot water in the cup should amply cover the milk in the bottle (Fig. 10).
To test the warmth allow a few drops to fall on the inner side of the arm, where it should feel quite warm, never hot. A baby's clean woolen stocking is now drawn over the bottle, which keeps it warm during the feeding. No matter how great the danger of offending a fond grandparent or a much adored friend never allow anyone to put the nipple in her mouth to make the test for warmth of baby's food.
There are many contrivances, both electrical and alcoholic, for heating baby's bottle, many of which are both convenient and inexpensive.
POSITION DURING FEEDING
And now we realize that we are about to advise against the time-honored injunction which has been handed down from "Grandma This" and "Mother That" to all young mothers who have lived in their neighborhoods: "My dear young mother, if you can't nurse your precious infant, you can at least 'mother it' at the nursing time by holding it in your arms and gently rocking it to and fro as you hold the bottle to its lips." This so-called "mothering" has resulted in regurgitation, belching, and numerous other troubles, as well as the formation of the "rocking habit."
A young mother came running into my office one day saying: "Doctor, it won't work, the food's all wrong; my baby is not going to live, for he throws up his food nearly all the time." We arranged to be present when the next feeding time came and watched the proceedings. A dear old friend had told her "she must 'mother' her baby at the nursing time," and so she had held the child in a semi-upright position as she endeavored to hold the bottle as near her own breast as was possible. The hole in the nipple was a bit large, which occasioned the subsequent bolting of the food, and then to continue the "mothering" she swayed him to and fro, all of which was interrupted suddenly by the vomiting of a deluge of milk.
I drew the shade in an adjoining room, opened the windows, and into a comfortable carriage-bed I placed the baby on his side. Seating myself beside him I held the warm, bottled meal as he nursed. Several times I took it from his mouth, or so tipped it that "bolting" was impossible. Gradually, carefully, and slowly, I took the empty bottle away from the sleepy babe, and as I closed the door the mother said in anxious amazement: "He won't forget I'm his mother if I don't hold him while he nurses?" You smile as I smiled at this girl-mother's thought; but, nevertheless there are many like her—anxious, well-meaning, but ignorant.
The infant stomach is little more than a tube, easily emptied if the baby's position is not carefully guarded after nursing. No bouncing, jolting, patting, rocking, or throwing should take place either just before, during, or immediately after meals.
TIME ALLOWANCE FOR ONE FEEDING
From twelve to twenty minutes is long enough time to spend at a bottle meal. The nipple hole may have to be made larger, or a new nipple with a smaller hole may have to be purchased. When new, you should be able to just see a glimmer of light through the hole, and if the infant is too weak to nurse hard, or the hole too small, it may be made larger by a heated hatpin run from the inside of the nipple out; great care must be taken, else you will do it too well. If the nipple hole is too large, bolting is the sure result; while too small a hole results in crying and anger on the part of the hungry child, because he has to work too hard to get his meal.
AFTER THE FEED
We have seen some mothers, in their anxiety to prevent the sucking in of air from the emptied bottle, rush in and jerk the nipple from the going-to-sleep babe so forcibly that all thoughts of sleep vanished and a crying spell was initiated. The tactful mother is the quiet one who slowly, quietly, draws the empty bottle with its "much loved nipple" from the lips. If you observe that the babe is going to sleep, with an occasional superficial draw at the nipple, wait a moment; he will drop it himself, and you can pick it up as you quietly leave the room. In all instances, whether it be indoors or out of doors, arrange the babe in a comfortable sleeping position, remembering that nursing is warm exercise and the babe gets uncomfortably sweaty if overbundled, especially about the head and neck. No one should unnecessarily touch the babe immediately after feeding; even his diaper may be changed without awakening him while he is thus lying quietly in his bed.
INTERVALS BETWEEN MEALS
The three-hour interval is reckoned from the beginning of the meal, and not from its close. More than two hours is spent in the stomach digestion, and any food or sweetened water which may enter between meals only tends to cause indigestion and other disturbances. And that this important organ may have a bit of rest, we fix the interval at three hours, which in our experience and that of many other physicians, has yielded good results. As a rule we have no regurgitation and no sour babies on the three-hour schedule. Sick babies, very weak babies, and their feeding time, will be discussed in a later chapter.
ADDITIONAL FOODS
At six months, and often as early as four, in cases of constipation, unsweetened, well-strained prune juice may be given, beginning with one-half teaspoon one hour before the afternoon feed and increasing it daily until two tablespoons are taken. At six months, both orange juice and vegetable broths are given, whose vegetable salts add a very important food element to the baby's diet—an element which our grandmothers thought could only be obtained through the time-honored "bacon rind" of by-gone days. |
|
