Full text of Infant Care, Bureau Publication No. 8
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UNITED STATES DEPARTMENT OF LABOR
F r a n c es P e r k in s , Secretary
CHILDREN’S BUREAU
-
-
K atharine F. Lenroot, Chief
INFANT CARE
+
Bureau Publication No. 8
(WITH ALPHABETICAL INDEX)
UNITED STATES
GOVERNMENT PRINTING OFFICE
WASHINGTON : 1940
For sale by the Superintendent of Documents, Washington, D. C.
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Letter of Transmittal
United States D epartm ent of L abor,
Ch ild ren ’s B ureau ,
Washington, November 24, 1939.
M ADAM : There is transmitted herewith a revised edition of Infant Care, which
follows in the main the edition of 1938, differing chiefly in the addition of an
index and in the recommendation of the larger quantities of vitamin C, which
recent research has shown to be necessary.
Infant Care was first published in 1914 and was rewritten in 1929 by Dr.
Martha M. Eliot, now Assistant Chief of the Bureau.
The present revision and that of 1938 are the work of Dr. Ethel C. Dunham,
Director of the Division of Research in Child Development of the Children’s
Bureau, and Dr. Marian M. Crane of that Division, with the assistance of the
Bureau’s advisory committee of pediatricians: Dr. Julius H. Hess, representing
the section of diseases of children of the American Medical Association; Dr.
Richard M. Smith and Dr. Barnet E. Bonar, representing the American Pediatric
Society; Dr. J. H. Mason Knox, representing the American Academy of Pediatrics;
and Dr. Howard Childs Carpenter, for many years representing the American
Child Health Association until that organization dissolved in 1935. Dr. Bonar’s
death» early in 1938, deprived the committee of the newest member, whose
counsel had been most helpful.
Respectfully submitted.
KATH ARINE F . LENROOT, Chief.
Hon. FRANCES PERK IN S,
Secretary of Labor.
ii
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Contents
Page The home—Continued.
Pase
See that the birth of your baby is regis
The baby’s room—Continued.
tered .................................. Inside front cover
Ventilation.....................................
17
II
Letter of transm ittal....................................
Walls and floors............................
17
1
The new baby......................... Sj..................
Furnishings...............
18
3 Clothes........................... ........................ .....
Development of the b ab y .............. .
20
3
The baby at birth .......................... ..
Diapers..................................................
21
3
The baby a t 4 months................. .
How to fold and put on the
4
The baby at 8 months........... .
diaper.........................................
21
4
The child at 1 year...................... .
Care of diapers..............................
22
5
The second year....................... ...........
Rubber “baby pants” ................
22
6
Baby’s daily s c h e d u l e ..........
Bands and sh irts..................................
22
6
First 4 months......................................
Stockings............................................... '.
23
6
Fifth and sixth months........................
Shoes......................................................
23
7
Seventh, eighth, and ninth m onths...
Dresses and slips or petticoats...........
24
7
Tenth, eleventh, and twelfth months.
Night clothing.......................................
24
8
Keeping the baby well.................................
Coats, sweaters, and caps....................
24
8 B aths.................. ...........................................
Medical supervision.............................
25
9
Visits to the doctor. .....................
Safety for the baby during his b ath ..
27
9 The teeth and special organs................
Weighing the baby.......................
28
How the doctor judges the baby’s
T e e t h . . . . .............................................
28
10
physical condition............................
Mouth and nose........ ........ ......... ..... ..
29
11
How to prevent diseases......................
Eyes..................................................... .%
29
Prevention of digestive disturb
E ars....................
29
11
ances.
...........
Genital organs.......................................
29
Prevention of diseases due to
Sleep...........................................
.....
30
11
vitamin deficiency....................
Amount..................................................
30
12
Prevention of anemia...............
Sleeping conditions...............................
30
12
Prevention of goiter......................
Bedclothes.............................................
31
Prevention of colds.......................
12
In cold weather.............................
31
12
Prevention of tuberculosis.. . . . .
In warm weather.........................
32'
Protection against smallpox........
13
Sleeping bags.................................
32
13
Protection against diphtheria.. ..
Fresh air and sunshine................................
33
Prevention of whooping cough...
13
How to give sun baths........................
34
Prevention of measles..................
13
Indoor sun baths at an open
Prevention of ophthalmia neona
window.......................................
34
14
torum. ............ .....................
Outdoor sun baths........................
35
Prevention of congenital syphilis.
14
36
How to prevent accidents....................
14 Exercise and play.........................................
38
15 Habits, training, and discipline..................
Burns..........................................
Beginning training at birth.................
38
15
Poisonings.....................................
The formation of habits......................
39
15
Fires...........................................
Feeding habits...............................
40
16
The home....................... !— .. ; , . . . . . . . . .
Sleeping habits..........................
41
16
A house for the child..................
Toilet habits..................................
41
16
The baby’s room..................................
Undesirable habits........................
42
16
Temperature.................. ...............
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h i
IV
IN FA N T CARE
Page
Feeding......................... ........... . ............... ..
Breast feeding..................................... ,
Importance of breast feeding___
Production of breast milk............
Hygiene of the nursing m other. .
Wet nurses and breast-milk
agencies......................................
How to nurse the baby................
Amount of food............................
Feeding intervals..........................
Drinking water.............................
Stools..............................................
Weight............... . . . .......................
Underfeeding................... .............
Overfeeding............. . . .................
Spitting u p .............. . . .................
Hiccoughs....................................
Colic..................... .....................
Mixed feeding...............................
Weaning........................................
Additional foods...........................
Teaching the baby to eat solid
foods..........................................Artificial feeding...................................
W hat milk to use for babies.......
Proprietary or patent infantfoods.
The problem of a good freshmilk supply...............................
Care and handling of milk on the
farm ...........................................
Pasteurization...............................
Care of milk in the home............
The milk mixture.........................
Plan for artificial feeding of a
well baby.................................
What milk mixture to use during
weaning......................................
Preparation of milk mixture........
Giving the feeding......................
Additional foods..... ......... ..........
Drinking water.............................
Stools...............................
Daily schedule. ............................
Underfeeding................................
Overfeeding........... ............. . . .
Spitting up and colic....................
W eight.......................... ..............
Weight-height-age tables............................
How to use the tables.........................
The premature baby....................................
Care immediately after birth.........
Keeping the premature baby warm ..
The premature baby’s room.......
Heated beds.................. ............ .
Clothing.................................................
Bathing..................................................
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44 The premature baby—Continued.
45
Protecting from infection....................
86
45
Feeding........................
86
45
Human milk.....................
86
45
Number and amount of feedings..
87
Suggested feeding schedule for
49
premature babies......................
88
50
Drinking water..............................
89
Weight of baby.............................
89
51
Additional foods............................
89
51
Outdoor life...........................................
90
51
91
52 The sick baby....................................................
52
What a mother should note....................
91
52
Early signs of illness in a baby...............
91
53
What to do before the doctor comes..
92
53
Care for a sick baby.............................
92
53
Bed care.............................
92
53
B aths...................................
92
54
Elimination....................................
92
55
Food.......................................
93
57
W ater...............................
93
Common disorders................................
93
60
Vomiting..................
93
61
Diarrhea.........................................
94
62
Scurvy............................
94
63
Rickets...........................................
94
Convulsions...................................
95
63
Heat rash or prickly heat............
95
Chafing...........................................
95
64
Eczema...........................................
95
65
Scabies (the itch).........................
95
65
Impetigo....................
95
66
Thrush.......................
96
69
Worms............................................
96
Colds.......................................
96
72
Enlarged or diseased adenoids...
96
72
Earache..........................................
96
75
Croup.............................................
97
76
Asthma........................
97
17
Accidents...............................................
97
77
Swallowing foreign bodies............
97
77
Swallowing pills or poisons..........
97
77
Burns.......................
98
78
Communicable diseases........................
98
78
Whooping cough and measles__
98
78
Pneumonia.................
98
79
Dysentery.....................................
98
80
Tuberculosis......................
98
81
D iphtheria.. . . ; . ........
99
81
Gonococcus infection....................
99
82
Syphilis..........................................
99
83
100
83 Traveling with the baby.................................
85 Children’s Bureau publications of interest
85
to parents............................ Inside back cover
INFANT CARE
The New Baby
H O W FAST does a baby grow, in weight, in height, in “wisdom and under
standing”? What should we feed him? How should we clothe him? How can
we keep him well? How can we prevent or cure illness? How can we teach
good habits? What danger signals should we watch for? These are some of the
questions that parents ask and that this bulletin will try to answer.
When a baby is born, whether it is the first one in the family or not, the first
questions that must be answered are—how to help him develop normally and how
to keep him well. For months the parents have been looking forward to the
arrival of the baby and have been making plans for his care. (For care before
birth see Prenatal Care, U. S. Children’s Bureau Publication No. 4.) Now that
the baby is born the responsibilities of the parents with regard to his care and
bringing up become more immediate. They have in their charge a helpless infant
who for a long time will be dependent upon them for supplying all his needs. At
first only the physical needs are obvious, but the parents must remember that the
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INFANT CARE
character building of their child is closely tied up with the way his physical needs
are met. His future mental health, as well as physical health, will depend largely
on the habits he builds during the first year of life, especially the early months.
Every child carries in his inherited make-up many qualities. Which ones are
to predominate in his future life will depend largely on his surroundings—the
food and care he gets, the persons he learns to imitate, the ideals and standards of
his home. As soon as the baby is born he begins to live in the surroundings that
the parents have provided. Immediately he begins to learn by his experiences.
From the hour of birth he learns from everything around him.
The care of a baby is a great responsibility, which can be carried successfully if
the parents regularly seek the advice of a physician trained in the care of infants
and if they follow simple rules for feeding, sleep, out-of-door life, and general
care. The rules outlined in this bulletin are the result of the experience of
physicians over many years and are offered as a help to parents in the care of
young babies; but they are not intended in any way to take the place of regular
visits to the family physician.
Sometimes a young mother has so much advice from earnest and well-meaning
friends that she is bewildered. Their advice may or may not be good. Some
times the advice of one friend conflicts with that of another. The doctor should
be the mother’s guide, and this book is intended to help her carry out his orders
intelligently.
Baby care is a great art. It is the most important task any woman ever under
takes, and she should apply to this work the same diligence, intelligence, and
sustained effort that she would give to the most exacting profession. Her husband
shares the responsibility for the child’s training, whether or not he helps with the
child’s physical care. The parents should work together from the baby’s birth to
teach him good habits.
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Development of the Baby
1 HE FIRST year of life is probably the most important because it is during
this period that the baby grows fastest and undergoes the remarkable develop
ment that transforms him from a helpless little being into an individual who
laughs, plays, stands, and tries to talk.
Not only does a baby grow a great deal during this year, but he learns a great
deal. He learns to eat and sleep at regular times and to eat a number of new
foods, to hold up his head, to sit up, to stand, and sometimes to walk. He learns
to handle objects, to reach for them, and pick them up; to know what various
things around him are used for, such as spoon, cup, bed, ball,' blocks, and to use
some of these without help; to know one person from another; to know and use a
few words. He learns also whether crying will make his mother pick him up
whenever he wishes, or whether crying is useless as a means of getting her atten
tion. He learns to be part of a family group and to accept new experiences
every day.
TH E BABY A T B IR T H
At birth the average baby weighs about 7 pounds and measures 20 to 21 inches
in length. He has a good pink color; he squirms and wriggles when handled, pulls
up his legs, stretches them out, clenches his fists, puckers his face, and cries lustily.
He sucks and swallows food and sleeps. He has no habits at birth. Habits are
formed only by doing the same thing over and over again. Immediately after
birth he will begin to form habits, which if they are the right kind will be useful to
him all his life. Regularity from birth on is of first importance.
Through training in regularity of feeding, sleeping, and elimination (emptying
the bowels and bladder) the tiny baby will receive his first lessons in character
building. He should learn that
hunger will be satisfied only so
often, that when he is put into
his bed he must go to sleep, that
crying will not result in his being
picked up or played with when
ever he likes. He will begin to
learn that he is part of a world big
ger than that of his own desires.
TH E BABY A T 4 M O N T H S
If parents watch the baby for
signs of development they see
marked changes during the first
3 or 4 months. At 4 months the
baby has nearly doubled his
weight and has grown2
to 3 V2 inches in length; his head has grown about 2
inches larger around. At 4 months his muscles are much stronger, so that he kicks
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INF AN T CARE
more vigorously, he tries to turn over, and he can hold up his head steadily if his
body is supported. The 4-month-old baby looks about, discovers his own hands,
begins to recognize his mother and perhaps other members of the family, and is
learning to reach for objects around him. He makes known his likes and dislikes
by gestures and facial expressions; he usually has begun to laugh aloud. In 4 short
months he has changed from the little wriggler to a baby with definite individual
ity. He has already begun to form habits of daily living, such as eating, sleeping,
and elimination. The parents should see that these habits are the right ones.
(See p. 38 for discussion of habits.)
TH E BABY A T 8 M O N T H S
During the period from 4 months to 8 months of age the baby is still growing
rapidly in weight and height. At 8 months the average baby weighs between 16
and 19 pounds and measures between 25 and 27
inches in length, depending on his type—whether
tall and slender or short and stocky. His head is
growing but not quite so fast as in the first 4 months.
His muscles are stronger; he is able to sit up without
support. He probably has begun to creep. He is
using his hands better by 8 months and has learned
to pick up and handle large objects, like rattles,
The baby at 8 months w ill
blocks, balls, and dolls, then gradually smaller and
creep after his ball
smaller objects, such as spools. He is interested in
looking at objects and feeling them and in learning what things around him are
like. Most babies at 8 months have discovered their own voices and make var
ious sounds, such as “ma-ma-ma” and “da-da-da,” but they do not say words to
which they attach any meaning. Many babies have cut one or two teeth. During
the period from 4 months to 8 months the baby should begin to learn to eat solid
foods. By 8 months he has nearly reached the end of the breast-feeding period,
and weaning has been begun.
©
TH E CH ILD A T 1 YEAR
From the ninth to the twelfth month of his first year the baby continues to gain
weight but not so fast as before. When he is 1 year old the average child weighs
about 21 pounds (three times his birth weight). He measures 25 to 35 inches
in height, and his head is much larger than at birth. Many children by the time
they are 12 months old have lost some of their chubbiness and are lengthening
out into the slenderer type of body build seen in the second year. Some children
remain fat during this period, and some grow tall without gaining greatly in weight.
Children vary considerably according to the family type and the nationality and
race. No two are exactly alike in growth.
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I N F A N T CARE
5
During the period from 8 months to 1 year the baby learns to take cow’s milk
and various solid foods, which will be the basis of his diep for the next 3 or 4 years.
By the end of the first year he has given up the bottle and is learning to hold his
cup of milk and perhaps to help hold his spoon (an ordinary teaspoon). He is
entering the period of early childhood and should no longer be treated as a baby.
The parents should help him grow up by teaching him to do things for himself.
He should be learning to pull off his stockings at bedtime. It is good for a little
child to learn to be independent in feeding and dressing himself, in picking up his
toys, and in playing alone. Training in
self-reliance should have begun by the
time he is a year old.
The muscles have developed rapidly.
At 1 year the average child creeps and
pulls himself up to a standing position.
Many children of this age can stand alone,
and occasionally a child of the small, wiry
type can walk. At 1 year the child can
use his hands well and has begun to do
things with a ball and boxes and blocks.
(See back cover.) He may be able to
say one or two words and associate them
with the persons or objects to which they
belong, such as mamma, dada, kitty,
milk, water.
At 1 year, if the mother has been training the baby properly, he has learned
control of his bowels and may have begun to learn control of his bladder. (See
P- 41.)
*
Most children at 1 year have six teeth.
TH E SECOND YEAR
When your child begins to stand and walk and talk he is no longer a baby.
Though he is still dependent on you for almost everything, he is daily becoming
less so and is daily learning to do more for himself. He should be encouraged in
this increasing desire for independence. It is much better that a child should be
helped to grow up by his parents than that he should be “babied” too long.
Parents who look upon the little child as “too little to be taught” or “too young
to understand are piling up trouble for him as well as for themselves. The
second year is the beginning of the preschool years when many of the most impor
tant life habits will be learned. During this time the parents are the child’s
teachers, and they should continue to plan together and work together to help
the child to have a healthy body and a healthy mind.
For suggestions on the care of children from the first birthday to the sixth send
to the United States Children’s Bureau, Washington, D. C., for The Child From
One to Six (Bureau Publication No. 30).
103255°— 40---2
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Baby’s Daily Schedule
IT IS advisable to establish a t an early age a schedule for the baby’s daily
program. This time table is made for mother and baby, and certain adjustments
must be made in compliance with the life of the family. It is important, however,
that the infant should be fed at regular intervals and at the same intervals each
day. The usual interval between feedings is 4 hours, but during the early months
some physicians prescribe a 3-hour feeding interval. The first feeding is usually
given at 6 a. m., but if the day for baby and mother begins at 7 a. m. then the
schedule must be adjusted accordingly, keeping the intervals between feedings
the same.
Following is a suggested schedule during the first 4 months for a baby on a 4hour schedule. This may be varied according to the directions of the physician.
FIRST FO U R M O N T H S
6.00 a. m .........Breast feeding. P ut in crib to sleep.
9.15 a. m .......... Undress baby for bath. Give plain codrliver oil or other source of vitamin D (to
be ordered by physician), followed by orange juice or tomato juice. Before bath
let baby kick and exercise for a few minutes while lying on bed. Bath.
10.00 a. m ......... Breast feeding.
10.20 a. m ........ Long nap indoors with window open or out of doors according to weather. Sun bath
may be given before nap. (For time out of doors and in sun see p. 33.)
Drink of water after nap.
2.00 p .m . . . . . . Breast feeding.
2.20 p. m ...........Long nap indoors with window open or out of doors. After nap, drink of water.
5.15 p. m .......... Undress for night. *Before putting on baby's night clothes let him play a few
minutes.
Cod-liver oil or other source of vitamin D and orange juice or tomato juice.
6.00 p. m ........... Breast feeding.
6.20 p. m ........... Bed; lights out, window open, door shut.
10.00 p. m ......... Breast feeding.
2.00 a. m ...........Breast feeding. (This feeding need not be given after the baby is 2 months old.)
FIFTH A N D SIX T H M O N T H S
6.00 a. m ........... Breast feeding. Leave baby alone in crib to sleep or play.
9.15 a. m ...........Plain cod-liver oil or other source of vitamin D (to be ordered by physician), then
orange juice or tomato juice.
Bath. Before bath let baby kick and play freely on bed a few minutes without
clothes.
10.00 a. m .........Cooked cereal, then breast feeding.
10.20 a. m .........Sun bath and long nap out of doors if weather permits, or nap indoors with window
open. Drink of water after nap.
2.00 p. m ...........Egg yolk, vegetables mashed through a strainer (from sixth month on), breast
feeding.
2.20 p. m ............Out of doors if weather permits—in sun part of the time on very hot days. Short
nap. Sun bath may be given before nap. Drink of water after nap. Play.
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5.15 p. m .......... Undress for night. Before putting on baby’s night clothes let him kick and play
quietly on bed a few minutes.
Cod-liver oil or other source of vitamin D and orange juice or tomato juice.
6.00 p. m ............Breast feeding.
6.20 p. m .......... Bed; lights out, window open, door shut.
10.00 p. m ......... Breast feeding. (If the baby does not waken this feeding may be omitted.)
SEVENTH, E IG H T H , A N D N IN T H M O N T H S
6.00 a. m ............Breast feeding. Leave baby alone in crib to sleep or play.
9.15 a. m .......... Plain cod-liver oil or other source of vitamin D (to be ordered by physician), then
orange juice or tomato juice.
Bath. Before bath let baby kick and play freely on bed a few minutes without
clothes.
10.00 a. m ......... Cooked cereal, then breast feeding.
10.20 a. m .........Out of doors till feeding time if weather permits. Long nap, followed by drink of
water. Play.
2.00 p. m ...........Vegetable and egg yolk, then breast feeding.
2.20 p. m .......... Out of doors if weather permits—in sun part of the time except on very hot days.
Short nap. Drink of water after nap. Play.
5.15 p. m .......... Undress for night. Before putting on baby’s night clothes let him play on bed a
few minutes. Play must not be exciting nor rough.
Cod-liver oil or other source of vitamin D and orange juice or tomato juice.
6.00 p. m ........... Cooked cereal, then breast feeding.
6.20 p. m . ........ Bed; lights out, window open, door shut.
10.00 p. m ......... Breast feeding. (This feeding may be omitted during this period.)
T E N T H , ELEVENTH, A N D TW ELFTH M O N T H S
6.00 a. m ...........Boiled whole milk. Leave baby alone in crib to sleep or play.
8.15 a. m ............Plain cod-liver oil or other source of vitamin D (to be ordered by physician), then
orange juice or tomato juice. Bath.
9.00 a. m ............Breakfast: Cooked cereal with boiled whole milk.
9.20 a. m . . . . . . Out of doors till dinner, if weather permits. Sun bath may be given before nap.
Long nap. Play.
1.00 p. m ............Dinner: Egg yolk; green vegetable; baked potato; boiled whole milk.
1.20 p. m_......... Out of doors if weather permits, in sun part of the time except on very hot
days. Short nap. Drink of water after nap. Play in crib.
5.00 p. m ........... Undress for night. Play and exercise on bed or on blanket on the floor.
5.15 p. m ........... Cod-liver oil or other source of vitamin D and orange juice or tomato juice.
5.30 p. m ........... Supper: Cereal, zwieback, or dry toast; applesauce or prune pulp; boiled wholemilk.
6.00 p. m ........... Bed; lights out, window open, door shut.
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Keeping the Baby W ell
T H E LARGE majority of babies are well when they are bom. It is impor
tant to know how to keep them well. Preventing illness in babies is better from
every point of view than curing it. Many diseases of infancy are much less
common today than they used to be because modern science has found out how
they can be prevented. Some diseases can be prevented by feeding the baby
properly and by giving him plenty of direct sunlight and some by vaccinating or
inoculating him with protective substances. Some diseases can be avoided only by
keeping the baby away from places where he may come in contact with persons
who have the diseases, by keeping flies and other disease-carrying insects away
from him, and by sterilizing (boiling) all artificial food and everything he is likely
to put into his mouth—in other words, by keeping the germs which cause the
diseases away from the baby.
The best way to prevent infection is to prevent exposure. Never take a baby
into a crowded place, for some one in the crowd may have a cold and the baby is
likely to catch it. Avoid baby shows. In selecting a nurse or a maid who will
help with the care of the baby take great pains to get one who is healthy. Before
such a person is engaged she should be examined by your doctor and should have
a blood test for syphilis and an X-ray of the lungs.
In addition, regularity in the care of the baby and the establishment of routine
health habits are necessary if he is to be kept well. The daily round of bathing,
dressing, feeding, sleeping, outdoor life, play, exercise, and elimination must be
always regular. The times at which these routine activities are carried out do
not need to be the same for all babies. They should be planned in connection
with the mother’s day and with that of the rest of the family, and one must never
forget that every baby is an individual and should be studied and planned for as
such.
MEDICAL SU PER V ISIO N
To keep a baby well there should be continued supervision by a doctor trained
in the care of babies. The mother cannot know nor recognize many of the early
signs of trouble because she is not trained to do this and because she is too near
the baby and sees him too often to realize that any change is taking place. The
doctor, who sees the baby once or twice a month, looks at him with a trained
eye and can see whether his color is as good as usual, whether his activity is as
it should be, or whether he shows any early signs that are the forerunners of
trouble. A mother may not know just when her particular baby needs to have
his food changed or increased, nor when is the best time for her baby to be pro
tected from diphtheria and smallpox. Such things as these the doctor will know,
8
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and his advice is of the greatest importance to every mother who would keep
her baby well. The doctor’s supervision of a baby should begin as soon as the
baby is born.
VISITS TO THE DOCTOR
Regular visits to the doctor, either at his office or at a child-health center,
should be made for general supervision and advice at least once a month so that
the mother may discuss with him the baby’s diet and outdoor schedule, as well
as his habits of eating, sleeping, exercise, and elimination. Complete health
examinations should be made at least four times during the first year—at 3, 6, 9,
and 12 months of age—in addition to the complete examination made at birth
and at the end of the neonatal period (1 month).
At the first visit to the doctor the weight will always be taken and recorded
and certain measurements of the baby will be made. The doctor will measure
the height (length), also the circumference of the head, and in certain instances
he will make other measurements of the body.
WEIGHING THE BABY
From birth to 6 months of age every baby should be weighed once a week,
whether at home, at the doctor’s office, or at one of the well-baby conferences
or child-health centers that are
conducted in many places for
mothers unable to obtain these
services otherwise. (Ask at your
city or county health department
for the address of the well-baby
conference or child-health center
nearest your home.) At the reg
ular visit to the doctor the mother
should report the baby’s weekly
weights since the last vi s i t .
Continued failure to gain should be
reported to the doctor promptly.
To weigh the baby at home
undress him completely. Put a
soft cloth or clean paper in the pan of the scales and lay him on it, or if the room
is not warm wrap him in a blanket. Weigh him carefully and write down the
weight. Remove the baby, weigh the blanket or cloth, and subtract this amount
from the first weight.
If the progress in weight is satisfactory until the baby is 6 months old, weigh
him once every 2 weeks from this time until he is a year old. Steady gain in
weight throughout the first year of life is one of the best indications of health.
Figures for weight and height are chiefly valuable to the doctor if he can com
pare them with a record of the baby’s earlier weight and height and thus learn
whether the baby is growing and gaining satisfactorily.
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H O W TH E D O C T O R JU D G ES T H E BABY’S PHYSICAL
C O N D IT IO N
The baby’s physical condition is best determined through examination by a
doctor, who will take into account not only his present weight and height but
his rate of gain in weight and height.
When the doctor makes a health examination he will undress the baby com
pletely, weigh him, measure his height, and examine his head, eyes, ears, nose,
neck, mouth, gums, teeth, tongue, throat, glands, heart, lungs, abdomen, genitals,
back, arms, legs, feet, bones, skin, and posture (if he is old enough to stand).
The doctor will also carefully note the amount and firmness of the tissues, the
color of the skin and the mucous membranes, as well as the activity of the baby
and the presence or absence of defects or diseases.
The doctor will then determine whether the baby is gaining weight at a proper
rate. There are marked variations in the weights of different healthy infants of
the same age, and no satisfactory standard can be set up for what babies should
weigh at different ages. Race and sex affect the height and weight, and heredity
is an important factor. The child of tall slender parents has a different body build
from that of the baby whose parents are short and stocky. Weight-height-age
tables are based on the average heights and weights of a large number of babies.
(See p. 79.) Such a table may not provide a suitable standard for comparison
with your baby. The important point to determine is that the baby is gaining
regularly in weight. An average gain of 4 to 8 ounces a week during the first
6 months and of 3 to 5 ounces a week during the second 6 months can be considered
satisfactory. Gain in weight is the best single index of physical well-being during
the period of infancy.
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H O W T O PR EV EN T DISEASES
PREVENTION OF DIGESTIVE DISTURBANCES
Digestive disturbances, such as diarrhea and vomiting, may be due to a variety
of causes. They are more likely to occur during hot weather, but they may occur
at any time. They are sometimes due to improper food, or they are likely to
precede or accompany some infection such as a cold or an abscess in the ear, or they
may be evidence of other infections such as dysentery and typhoid fever. They
may usually be prevented by proper feeding and care, by avoiding infections, and
by cooking all food and boiling milk and water given to the baby. (For pre
vention of infections, such as colds, see p. 12.)
Breast-fed babies do not have digestive troubles so much as artificially-fed babies.
Most well mothers can nurse their babies and thus save them from much sickness.
If the baby is artificially fed, boiling the milk will prevent many digestive
disturbances. A good grade of clean milk, pasteurized, should be bought. All
milk should be placed in the ice box and kept there. In summer special care must
be taken to get good clean milk and to prepare it properly. Most of the danger
for which hot weather is ordinarily blamed, especially during weaning time, can
be avoided if the baby’s milk is boiled and protected from contamination.
PREVENTION OF DISEASES DUE TO VITAMIN DEFICIENCY
Certain diseases are caused by the lack of necessary vitamins (for vitamins
see pp. 44 and 57) and are therefore called deficiency diseases. Such diseases
are scurvy, rickets, pellagra, beriberi, and xerophthalmia.
Scurvy is a nutritional disease caused by lack of vitamin C in the food. It pre
vents the baby from gaining weight satisfactorily, makes him pale and irritable,
brings about a tendency to bleed, and has other unfavorable effects. To prevent
this disease orange juice, tomato juice, lemon juice, or other fruit juice containing
large amounts of vitamin C should be used daily. (See p. 57.)
Rickets is a nutritional disease affecting especially the bones and muscles and
resulting in deformities such as bowlegs. It may be prevented by the daily use of
cod-liver oil or some equally effective substance (to be recommended by the doctor)
that is known to contain vitamin D, the “antirachitic factor,” and by daily sun
baths. In the Temperate Zones, where rickets affects many babies, if children
are to grow normally and avoid this disease it is advisable that they have both
sun baths and cod-liver oil or some equally effective substance from the first month
of life to the end of at least the second year. (See pp. 33 and 57.)
Beriberi is still another of these deficiency diseases, which affects the appetite and
the digestive and nervous systems. It is due to lack of vitamin B, which is
present in human milk and cow’s milk, egg yolk, green leafy vegetables, ¡and most
fruits and whole-grain cereals. Infants taking the usual amounts of these foods
are protected. Breast-fed infants whose mothers take the usual amounts of these
foods are protected.
Xerophthalmia.—Certain abnormal eye conditions are caused by insufficient
amounts of vitamin A. Changes may take place in the interior of the eye (the
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INFANT CARE
retina) causing night blindness or in the exterior part (the cornea) causing destruc
tion of its tissue (xerophthalmia). Vitamin A is contained in cod-liver oil and
other fish oil, in butter (but not in vegetable fats), and in green leafy vegetables,
yellow tubers, and a number of other vegetables and fruits. Babies receiving
cod-liver oil in the usual doses are amply protected.
Pellagra, a disease due to food deficiencies, is rare in infants. Under ordinary
conditions, human milk and cow’s milk protect the infant against this disease.
PREVENTION OF ANEMIA
Anemia is a condition in which the child’s blood has less coloring matter than it
has under normal conditions. If the baby looks pale the blood should be tested
by the doctor. Anemia is often seen in babies who are on a diet deficient in iron,
such as milk, sugar, and cereal only. Giving the baby enough green leafy vege
tables, egg yolk, and fruit juice helps to prevent anemia of this type. (For sugges
tions regarding these foods, see p. 57.)
PREVENTION OF GOITER
In the region of the Great Lakes and other so-called “goiter regions” mothers
and babies may need small amounts of iodine daily, in addition to that in the food,
to prevent goiter. Ask your doctor whether you and your baby need this, and if
so, how it should be given.
PREVENTION OF COLDS
Babies are very susceptible to common colds and are frequently made very ill
by what is “just a cold” in an adult. All persons having colds or coughs should
be kept away from the baby. No one should talk or lean over a baby, or breathe
in his face, since breath carries a fine spray which may be loaded with germs.
Some persons, though they apparently have no colds themselves, are carrying
germs in their noses or throats which will produce disease in a baby.
It is important not to overheat the room in which the baby lives. It is also
important to keep the air fresh and to prevent excessive dryness. Even in cold
weather the windows should be kept open a little way at the top, or at the bottom
if a screen or a window board is used. (See p. 17.)
Do not overheat the baby by wrapping him up too warmly when he goes out.
If he perspires too freely outdoors he may be chilled when he comes indoors and
has his wraps removed.
PREVENTION OF TUBERCULOSIS
Tuberculosis is a very serious and often fatal disease in infancy. Babies get
tuberculosis by being near a person who has tuberculosis or by drinking unboiled
or unpasteurized milk from tuberculous cows. (See section on how clean cow’s
milk is produced, p. 63.) To keep a baby from getting tuberculosis keep him
away from anyone who has the disease, even if it is his mother or his father or
some other relative, and from anyone who has a cough. See that he drinks no
cow’s or goat’s milk that has not been boiled.
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A tuberculous person may infect an infant directly through germs in the
droplets of spray which he breathes or coughs out, and for this reason a baby
should not live in the house with a person suffering from active tuberculosis.
The germs may be present on the floor or in rugs and may infect the baby when
he creeps. If any member of the household has the disease, either the baby or
the patient should be removed from the home. If the mother has active tubercu
losis when the baby is born, the baby should be taken away from her at once.
She should neither nurse him nor take care of him. Babies should be kept away
from any person who has a chronic cough, since frequently such a cough is due
to tuberculosis, whether recognized or not. Many mothers who do not know
that tuberculosis may occur in old persons fail to keep the baby away from an
old person with a cough.
PROTECTION AGAINST SMALLPOX
Every baby should be vaccinated against smallpox before he is 12 months old,
This should be done whether there is any smallpox in the community or not.
as exposure to smallpox may occur when least expected.
PROTECTION AGAINST DIPHTHERIA
Every baby should be protected against diphtheria. Immunization should be
started when he is 9 months old. This is done by the injection of three doses of
toxoid 1 to 4 weeks apart. Six months after the last dose the baby should be given
a Schick test to see whether the treatment has protected him against the disease.
One year later the Schick test should be repeated. In the majority of cases the
test shows that the baby has been protected, but in a few the test will show that
he needs to have the injections repeated. Be sure, to have the two Schick tests
done in order to be certain that your baby is protected. Some doctors may
advise repeating the Schick test every year or so.
PREVENTION OF WHOOPING COUGH
Whooping cough is a serious disease in a baby under 1 year. If a baby is ex
posed to whooping cough your doctor may advise giving a vaccine. Many physi
cians believe that the vaccine may make the disease less severe when it develops.
PREVENTION OF MEASLES
Measles is a serious disease in a baby or a very young child, and it is often
wise to try to make the attack less severe. If within a week after exposure to
measles some blood serum from a person who has recovered from measles or some
immune globulin (placental extract) is injected into the muscles of the back or the
thigh the disease will usually be made less severe. If the inoculation is given in
the first 4 days after known exposure, the disease may be prevented for the time
being but not permanently. The doctor should be consulted with regard to this.
Do not allow the baby to be exposed to measles (or any other disease) with
the idea that “he is sure to get it some time.” It is wise to ward it off as long
as possible, for the younger the child the more serious the disease is likely to be.
If you know that the baby has been exposed to measles, consult your doctor
immediately.
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PREVENTION OF OPHTHALMIA NEONATORUM
Ophthalmia neonatorum (infection of newborn babies’ eyes) may be prevented
by putting 2 drops of 1-percent silver-nitrate solution into each of the baby’s eyes
immediately after birth. This will be done by the doctor or the nurse.
PREVENTION OF CONGENITAL SYPHILIS
Congenital syphilis is a preventable disease. With proper examination and
treatment of the mother before and during her pregnancy congenital syphilis
would be entirely done away with. Every mother should have a blood test for
syphilis as soon as she knows that she is pregnant. If there is no clinic or
laboratory in her community the doctor can send a sample of the mother’s blood
to the laboratory of the State department of health. If the test shows that she
has syphilis, intensive treatment for the disease should be begun at once and
continued under the direction of her doctor or a clinic throughout her pregnancy.
If she is not treated it is likely that she will have a miscarriage or that the baby
will be born either dead or diseased. If the mother is known to have or to have
had syphilis, regardless of whether she has been treated, it is important to have a
Wassermann or Kahn test of the baby’s blood made when he is about 2 or 3
months old, even if he appears healthy.
H O W T O PR EV EN T ACCIDENTS
A baby should never be left in the house alone. Reports are heard only too
often of babies who were smothered or burned while the mother was out of the
house. Do not leave a baby alone while you go to the store or to a neighbor’s,
and do not leave him with only small brothers or sisters to take care of him. When
he is sleeping the baby should be alone in his room or on the porch, but the mother
should look at him from time to time, to see that all is well. When a baby is
taken out in a baby carriage he should always have an adult to take care of him,
not a young child. He should never be left alone for a moment in the bathtub.
Special precautions should be taken to prevent smothering. Babies have been
smothered when in bed with an older person who, while sleeping, rolled onto the
baby or pulled the covers over him. A baby should have a bed of his own.
Sometimes a baby is smothered when his head becomes buried in a feather pillow.
He does not need any pillow, and the mattress on which he sleeps should be firm.
(See Bed, p. 19.)
Straps for keeping the baby in bed and drawstrings at the neck of sleeping bags
and outdoor garments have caused choking as a result of their getting twisted
and tight around the baby’s neck. Small toys, beads, coins, pins, and other
small objects should be kept away from the baby, because he might choke on
them. (See Toys, p. 37.)
If the baby is to be kept safe everyone in the family should be careful that
nothing is brought near him that might injure him in any way. The other
children in the household should be trained to keep scissors and knives out of
the baby’s reach, and the younger ones should be trained to let matches alone,
for their own safety and the baby’s.
A play pen (see p. 37) will keep the baby away from many dangers.
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Never use a baby powder containing stearate of zinc, because if stearate of
zinc is inhaled, a serious and often fatal form of pneumonia develops. Never
give a baby a can of baby powder as a plaything, even one that is apparently
empty. If he puts the top in his mouth he may inhale the powder.
So that the baby will not be scratched, the mother should see that her finger
nails and the baby’s are short and smooth, and also that there are no unprotected
pins or needles in her clothing or anywhere near the baby.
BURNS
To prevent burns, which are far too common among babies, take every care,
first, to prevent accidental fires in the house (see below), and secondly, to keep the
baby away from such dangerous things as heaters, kettles of boiling water, hot
soup and hot coffee, and flames of all kinds. Older babies frequently are burned
as a result of pulling at tablecloths and overturning hot coffee or soup.
POISONINGS
Keep all bottles of medicines or boxes of pills on high shelves or in cupboards
well out of the baby’s reach. Do not leave the bottle of iodine on the washstand
or the table. A baby who chews painted toys or a painted crib or other furniture
may get lead poisoning. If such things are painted, only paint which contains no
lead should be used.
Always keep poisons, as well as medicines, on high shelves out of the baby’s
reach. Never leave a can of lye or one of kerosene on the floor or in any place
where a creeping child might get hold of it. Lye causes a type of burn in the
mouth and throat that may cause death.
To avoid gas poisoning, be sure that gas fixtures do not leak and that any gas
flame which might be blown out accidentally is not left burning. When gas is
burning in a room see that the room is very well ventilated. Never leave a baby
alone in the room with a gas heater.
FIRES
Whether or not the house can be reached easily by a public fire department,
fire precautions should be the rule in every family. Fire-resistant construction
is the best defense, but much can be done in an ordinary house to prevent fires.
The chief causes of home fires are careless use of matches and cigarettes, careless
burning of refuse, and use of defective stoves and chimneys. Use metal containers
for matches, trash, and ashes. Have stoves and chimneys inspected regularly.
See that heating equipment of any kind is properly installed and cared for.
If gas is used, have metal pipe connections rather than flexible tubing. Do not
place a gas stove or heater near a curtain. Have electric appliances inspected
regularly by an electrician.
Do not allow rubbish to accumulate, and destroy as soon as possible all cloths
and papers used in cleaning with oil or wax, for a pile of such cloths or papers is
likely to take fire of itself.
Have at least one fire extinguisher and have it charged once a year.
See that all stairways and doors are kept clear all the time, so that they can
be used as exits in case of fire.
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The Home
A HOUSE FO R TH E CHILD
T h e h o u s e that is to be the home of children should be chosen so that some
of the rooms will be sunny. If possible there should be a yard or porch where the
children may play and where the baby may have sun baths. Plumbing and heat
ing devices, drainage, and other conveniences should be in good repair; the cellar
should be dry; there should be no breeding place for flies and mosquitoes near the
house, such as manure
piles, open privies, or
open water barrels.
All doors and windows
should be screened.
The water supply, if
a well or spring, should
be so located as to pre
vent the water from
being polluted by bac
teria or drainage from
barns, stables, cesspools,
or outhouses. The most
satisfactory m e t h o d
a voiding the pos
sibility of water pollu
tion is to make certain that the cesspool or outhouse is on a lower level them the
well or water supply. In no case should a cesspool or outhouse be closer to a well
than 50 feet.
TH E BABY’S R O O M
A cottage in the suburbs is a good place for the baby
Whenever possible the baby should have a room to himself. It is hard to give
him the quiet he should have in a room that must be used also by other members
of the family. A room which is bright and sunny for most of the day should be
chosen for the nursery.
TEMPERATURE
In order that the baby may be covered properly at night and dressed suitably
during the daytime, the temperature of his room should be known. A thermometer
should be hung on an inside wall at the level of the crib—about 3 feet from the floor.
Do not put it near the register or the radiator. The baby’s clothing and covering
should be adjusted to the temperature of the room, which should be kept even.
A very young baby, or a delicate one, requires a warmer room than an older or
more robust baby. For the first weeks of the baby’s life the temperature of the
room should be kept between 70° and 75° F. day and night. For older and
for stronger babies the day temperature may be from 68° to 70° F., and the
night from 55° to 60° F. A baby should be protected by screens against drafts
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of cold air. The temperature and moisture of the room should be kept as even
as possible.
Oil or electric heaters are convenient to give quick temporary heat. A gas
heater should not be used in a baby’s room unless there is no other method of quick
heating. It is likely to leak and give off poisonous fumes that are very dangerous;
a slight leak day after day may make anyone exposed to it very ill.
In summer, when it is very hot, the baby should be kept in the coolest part of
the house or porch, and he should wear only the lightest clothing, such'as a sleeve
less shirt and a diaper or just a diaper.
Electric fans may be used in hot weather to keep the air in motion. They
should be placed high enough to be out of reach and should be tilted so that the
current of air is directed toward the ceiling. Fans with rubber blades are safer
than those with metal blades.
•VENTILATION
The best way to ventilate the baby’s room is to keep the window open. Most
of the time the window may be left open at the top or at the bottom. Except in
warm weather some method of shielding the baby from drafts should be used,
such as a window board or a cloth window screen.
A window board is a piece of wood or glass, 10 or 12 inches high, resting on the
window sill, slanting toward the inside of the room, and held in place by a triangular
support at each end. The board turns the air upward and keeps it from cooling
the lower part of the room too suddenly. By another plan the window is opened
a few inches, at either the top or the bottom, and a board cut to fit the opening
is inserted. This permits the air to enter through the space between the sashes
at the middle of the window and distributes it so that it does not fall directly
upon the head of the baby.
To make a cloth screen tack one or more thicknesses of cheesecloth on a wooden
frame like that of an ordinary wire screen and insert in the open window. The
cloth breaks up the air current and distributes it in various directions, thus
preventing drafts. A narrow cloth screen a few inches wide may be inserted in
an opening at the top of the window, thus making it possible to keep the window
open most of the time even in very cold weather.
WALLS AND FLOORS
The baby s room should be kept scrupulously clean. If the family moves into
an old house, the nursery should be freshly papered and painted.
A bare floor that is smooth is easily kept clean. If the floor is old, it may be
covered with linoleum, which is easily cleaned. Hardwood floors are best,
for they do not splinter, but a softwood floor painted or varnished will do.
Heavy rugs and carpets are not suitable for a nursery, but washable rugs may be
used. When the baby is old enough to sit on the floor to play, a folded blanket
should be placed under him.
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FURNISHINGS
Everything not actually needed for the care of the baby should be kept out of
the nursery. Furnishings should be washed often with soap and water and
exposed to sunshine and open air. For cribs and play pens it is well to use paint
not containing lead, as a baby may bite the railing and swallow paint and if it
contains lead he may be poisoned.
The following articles should be provided for the baby’s room:
Bed or crib and bedclothes.
Mosquito netting to cover entire bed (if windows are unscreened).
Bureau or chest of drawers for clothing.
Bed or couch for nurse or mother, so that she can sleep in the same room if the baby is sick.
Wall thermometer.
Low chair for the mother.
Folding or stationary table on which to bathe and dress the baby.
Bathing equipment. (See p. 25.)
Toilet equipment (kept in bathroom if possible):
Covered enameled-ware pail (2-gallon size) for diapers.
Small enameled-ware chamber.
Covered soiled-clothes hamper.
Painted nursery toilet chair or for the older baby a small toilet seat with back and sides,
which can be firmly fastened on the regular toilet, with a safety strap that goes around
the baby’s hips, and a footrest.
Other useful articles are:
Clothes rack.
Balance scales on table.
Screen.
Nursery ice box.
Bath thermometer.
Little chair and table.
Hinged gate for top of stairway.
Bed.
The first requisite is to have a separate bed for the baby. The first bed may
be a bassinet, a large flat clothes basket, or even a wooden box. Several thick
nesses of quilted cotton padding or a cotton blanket may be used as a mattress;
it must be clean, flat, and smooth. The basket or
box should stand on a table or on two chairs placed
with seats together so that the front legs can be tied.
It should never be left on the floor while the baby
is in it.
A larger bed will be needed as soon as the baby
tries to sit up, so that it is just as well to start with
the crib and a firm mattress that does not sag and
enables the baby to lie perfectly flat. The bed
should be large enough to permit him to turn over,
stretch his arms and legs, and kick freely. If the
crib side lets down, the catch that fastens it should be well out of reach of the child.
The crib bars should be fairly close together, so that the baby cannot get his head
between them. It is well to pad the ends and sides, particularly if the crib is metal.
To make the baby’s bed, cover the middle section or all of the mattress with
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oilcloth or soft rubber sheeting, with a strong tape sewed to each corner. Tie
these tapes together under the mattress to hold the rubber cover smooth. (Or
the rubber cover may be made like a pillowcase, covering the mattress entirely.)
Over this place a cotton pad. Cover this with a sheet, which should be tucked
under the mattress on all four sides, so that the bed is perfectly smooth. If a
sleeping bag is used no other covers are needed, except in cold weather, when
extra blankets may be added. For weather when sleeping bags are too warm,
lightweight wool blankets should be provided. Such blankets are much warmer
than heavy cotton ones. In very hot weather no covering is necessary, not even
a top sheet. The bed may have a dimity or seersucker spread, which is easily
washed and requires no ironing. Do not use a heavy spread.
It is better not to use a pillow, as the baby will* lie more nearly flat without one.
A clean folded cloth, which can be changed easily, may be placed under his head.
A combination bed and play pen, with a bedspring and a mattress, may be used
for a young baby. Such a bed usually is covered with wire netting on all four
sides, the bottom, and the top, to keep out insects; the top opens like the cover of a
box. The top should have an automatic lock so that, when the baby begins to
stand up, he cannot raise it with his head and possibly injure himself. This bed
may be fitted with casters or wheels so that it can be moved readily from place to
place. After the baby is 6 or 7 months old, a larger bed with high sides and firm
mattress should be provided so that the baby can sit up or stand.
Dressing table.
A table on which to change the baby’s diaper and to bathe and dress him is a
great help. It should have a smooth enameled top or be covered with oilcloth
so that it may be scrubbed. A soft pad should be put under the baby.
Clothes rack.
A small clothes rack is convenient for use while the baby is being dressed and
undressed.
Baby carriage.
The choice of a baby carriage is very important. It should be at least 2 feet
from the ground. It should be large enough for the baby, with the necessary
wrappings, either lying full length or sitting up. Its cover should be adjustable,
to protect him from wind. It should have strong, well-balanced springs and
should stand squarely on four wheels. It should be used as a bed only if abso
lutely necessary and only for the little baby. If it is to be used for the little baby’s
outdoor naps, it should have a good full-length mattress that will lie flat. As a
baby is more cramped in a carriage than in a bed, he should be turned once or
twice during every nap. He should not be sent out in a carriage in charge of a
child or other person not able to judge of his comfort. The carriage should be
covered with a net to keep out flies or mosquitoes.
For the baby that is old enough to sit up, a small mattress should be used as a
seat. A safety strap that fastens about his waist gives greater protection than the
ordinary carriage strap.
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Clothes
CLOTHING should be simple, washable, and adapted to the climate and
season, the temperature of the house, and the baby’s age and condition. In hot
climates and those in which the range in temperature is nearly constant night
and day for most of the year, the dressing of an infant is a simple matter. In
parts of the country where seasonal and even daily variations in temperature
are considerable and sudden—conditions found over the greater part of the
United States—the proper dressing of the baby requires considerable
thought and judgment. The baby should be dressed lightly in warm weather
in summer. In the hottest weather only a sleeveless shirt and a diaper need
be worn, or just a diaper. In cold weather the clothes should be warmer—a
long-sleeved shirt, petticoat, dress, stockings, and if the house is not well heated,
a sweater.
If the house is well heated it is important not to dress the baby too warmly
when inside the house. If a baby perspires so that his body is moist he is too
warmly dressed. If he is too warmly dressed while out of doors so that he per
spires, his damp clothes may cause him to be chilled when he comes indoors.
Be sure that the baby’s hands, feet, and ears are warmly covered when he
is outdoors in cold weather. Very small and feeble babies who lie very still
most of the time must be closely watched to be sure that they are warm
enough. Robust and active babies, on the other hand, are easily dressed too
warmly.
The clothing should consist of as few pieces as possible. The following list
gives the clothing necessary for the average baby:
Sleeveless shirts...........................................
Long-sleeved shirts......................................
Dresses...........................................................
Sweaters............................................. ...........
D iapers........................................... dozens..
Stockings..........................................pairs..
Nightgowns........................................... .
Petticoats or s lip s .......................................
Coat and cap, th in .......................................
Coat and cap, heavy......................................
Flannel squares (outdoor wraps for new
born) 36 by 36 inches..............................
2-4
2- 4
3-
4
2
3-4
4
23- 4
3
1
1
2-3
Pins are used for the diapers, but buttons or tapes are better for fastening the
other garments.
Babies’ undergarments may be of cotton, of wool and cotton, of wool and
silk, or of silk. Rayon, alone or combined with cotton or wool, is being used
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21
more and more. All-cotton garments are used widely. In very cold climates,
or for very young or weak babies, the shirts may be at least part wool unless
wool irritates the skin.
If garments are bought ready-made, size 2 should be selected, as size 1 will be
outgrown soon. If they are made at home they should be made large enough
at the start to fit the baby for a few months. They do not need to be longer
than to cover the feet—20 to 24 inches.
No garment should have trimming
that can scratch or irritate the baby’s
tender skin, nor should any garment
be starched.
DIAPERS
Diapers should be soft, absorbent,
light in weight, and not bulky. (Bulky
diapers may cause thigh deformities.)
They should be made of material which
is easy to wash and which dries quickly.
Diapers of cotton bird’s-eye cloth are
satisfactory in these respects. If the edges
are pinked instead of hemmed, the diaper is less bulky and also is easier to wash.
Several types of satisfactory diapers are on the market, such as a diaper made
of two layers of soft, fine-meshed, gauze-like cotton material, finished without
hems, woven together at all the edges.
Many mothers put pieces of old cotton goods or absorbent paper inside the
diaper to catch the stool.
The shape of the diaper depends largely upon the mother’s preference. Some
choose square diapers, some oblong. The size depends partly upon the size of
the baby; a diaper that is too large for the baby is bunchy and uncomfortable.
Many square diapers are 27 inches each way (after shrinking); others are smaller.
Oblong diapers are usually 20 by 40 inches.
HOW TO FOLD AND PUT ON THE DIAPER
I f the diaper is square, fold it triple thickness. Then fold one end back about
one-third, so as to make a pad of six layers of cloth. For a girl baby this sixlayer pad is to go behind the baby; for a boy baby, in front. The part that is
to pass through the legs is only three layers thick. Lay the baby on the folded
diaper (the turned-back flap may be either on the inside or on the outside). Draw
the other end up between the baby’s legs, over the abdomen, and pin the front
and back of the diaper together at each side at the waistline with safetypins,
keeping your hand between the baby’s body and the point of the pin. The pins
should be placed crosswise and should pass through both shirt and diaper. The
back fold of the diaper should overlap the front. Pin the front and the back of
the diaper together at each knee.
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22
IN FAN T CARE
I f the diaper is oblong, it may be folded to form a center panel of extra thickness.
(See illustration, A, B, C, D.) To form this panel, using a 20- by 40-inch diaper
(A) , fold the diaper crosswise, bringing one end to about 8 inches from the other
(B) . The folded diaper will then be 20 by 24 inches. Turn back the same end
to about 3 inches from the fold (C). Bring the other end of the diaper over to the
first fold. The diaper is then 12 by 20 inches, with a panel about 6 inches wide
in the center (D). It may then be
pinned on like a square diaper, except
\
^
that there is no flap.
20'
Care should be taken not to hamper
*
the free movements of the baby’s
©
body or legs by pinning the diaper too
tightly.
CARE OF DIAPERS
The diaper should be changed as
often as it is wet or soiled. At night
it should be changed when the baby is taken up to be fed. (See Toilet habits,
p. 41.) Used diapers should be washed at least once a day. No diaper should
be used a second time before being washed. Used diapers should never be left
lying about the room nor dried on radiators.
Wet diapers should be placed at once in a covered pail and left to soak in cold
water until they can be washed.
Diapers soiled with stool should be held over the toilet and shaken, brushed, or
scraped so that as much stool as possible may be removed. If the family has a
toilet that flushes, the diaper may be held by one end inside the toilet and the
toilet flushed so that the water flows over the diaper. When only a stain is left,
the soiled diaper should be placed in a covered pail containing a solution of borax
(1 tablespoonful to 2 gallons of water).
All the diapers should be washed in very hot water with plenty of mild, unmedi
cated soap, with no washing powder or strong soap. They should be rinsed
through four waters to be sure that all the soap is rinsed out and then they should
be boiled 10 to 20 minutes. Much of the irritation of thighs and buttocks from
which babies suffer severely is caused by not rinsing diapers enough or by not
boiling them after rinsing. Diapers should be dried in sunshine and open air.
If shaken and pulled into shape they need not be ironed.
©
RUBBER “BABY PANTS”
Rubber pants are bad for the baby’s skin, as they prevent evaporation of
moisture and also cause extra sweating; they become wet with perspiration and
irritate the skin. They should be worn only occasionally, such as during a journey.
During the journey the diaper should be changed when wet or soiled.
BANDS A N D SHIRTS
The baby’s first band is usually a strip of gauze or soft flannel 6 inches wide and
18 to 20 inches long. Its only purpose is to hold the navel dressing in place. The
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INF AN T CARE
23
band should never be tight enough to bind. The abdominal muscles of a healthy
baby need little support; rather they need free play in order to be strengthened.
A sleeveless shirt may be substituted for the band as soon as the navel has
healed. If the navel dressing is held with surgical-gauze bandages the sleeveless
shirt may be used from the start.
During cold weather a shirt with sleeves is usually worn over the sleeveless
shirt. It should open all the way down the front and should be large enough
so that the sleeves will slip on and off easily.
STO C K IN G S
The little baby does not need stockings in warm weather nor in a well-heated
house. In cold weather and indoors when the house is not well heated stockings
should be worn— cotton or wool depending on the climate. When the baby
begins to sit up, crawl about, and try to stand up, stockings protect the feet from
rough surfaces and help to keep them warm. Stockings, after washing, should
be one-half inch longer than the baby's foot, and therefore to allow for shrinking
it is wise to buy them at least three-fourths of an inch longer.
Woolen stockings should be washed quickly and dried on stocking stretchers
to prevent them from shrinking. A loop of tape may be sewed to the top of each
stocking, through which to slip the safetypin that holds it to the diaper.
SHOES
When the baby begins to stand and walk he will need shoes for protection (not
for support). After he begins to stand he should not wear soft shoes such as
moccasins, which have the sole and the upper cut in one piece. The soles of his
shoes should be firm but moderately flexible; the shanks should not be stiff. Soles
should be shaped like the natural outline of the foot, straight along the inner
line. They should be made of rough leather such as elk so as not to be slippery.
They should be reasonably thick for protection and good wearing qualities. Heels
are not advisable, as they limit the range of motion of the ankle joint.
Shoes should always be long enough, wide enough, and deep enough (at the toe)
not to crowd the baby’s toes. Before buying shoes for a baby old enough to
stand, make a tracing of his foot as he stands on a paper. Shoes when purchased
should be about a half-inch longer than the baby’s foot and at least one-fourth
inch wider at the toes. Notice the thickness of the baby’s toes and see that the
shoes provide ample space for them up and down. This is very important;
sometimes shoes are correct in shape of sole and in length and width but are not
high enough at the toe. Check the fit of the shoe carefully and frequently to see
that the toes are not crowded as the feet grow. As soon as the baby’s toes come
within one-fourth of an inch of the end of the shoes, longer ones should be bought.
The heel of the shoe should be narrow enough to fit snugly; this will prevent
rubbing and help to hold the foot in place in the shoe. If the child’s heel is very
narrow, fitted pieces of chamois may be glued on the counter of the shoe.
Low shoes give greater freedom for the ankle muscles; they should be of the
type, such as the laced oxford, that will fit closely around the instep. High shoes
are necessary if the child persists in taking off his low shoes.
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IN FAN T CARE
The best leathers for a baby’s shoes are soft, pliable calf, elk, or kid. Patentleather shoes should not be worn by babies since they are finished with a varnish
that prevents evaporation of the natural moisture from the feet.
Parents should examine the children’s feet frequently to see whether there is a
“pressure spot” ; that is, a pink or red area possibly due to pressure from the shoes.
The wearing of proper shoes from the beginning may prevent crooked toes, which
may later overlap or turn under. If trouble develops and does not clear up with
different shoes consult a physician.
When the doctor gives the baby a health examination (see p. 10) ask him whether
the baby’s shoes are the right style and size.
DRESSES A N D SLIPS O R PETTIC O A TS
Dresses may be made of fine white cotton materials such as nainsook, longcloth,
batiste, or crinkle crepe, or of pongee or other silk. The dress can be worn with
out a petticoat except when one is needed for warmth. Dresses and petticoats,
especially those used in the first few weeks, should open all the way down; they
are easier to put on and easier to launder, and can be folded from under the baby
when he is in bed. .Flannel petticoats are necessary only in extremely cold weather.
After the baby begins to creep or stand, skirts are in his way and rompers, creepers,
or play suits should be provided.
N IG H T C L O T H IN G
Any soft material may be used for nightgowns, such as cotton or part-wool
flannel, or single stockinet—or in warm weather thin white cotton goods such as
batiste. In hot weather a nightgown is unnecessary.
Winter nightgowns for a very young baby may be made with a drawstring
though the hem at the bottom, but they must be long enough to come well below
the feet so as to permit him to kick freely.
COATS, SWEATERS, A N D CAPS
The extra clothing that a baby needs outdoors depends on the weather and on
his age and vigor. For a very young baby a square of blanketing may be used as
an outdoor wrap.
In parts of the country where the weather may be cold one day and mild the
next the baby’s clothes should be adjusted accordingly. It is therefore wise to
have a sweater for a light extra wrap, indoors or outdoors.
The baby should have also a lightweight flannel coat for spring and fall and a
heavy coat of warm woolen material, with or without a thick interlining of wool,
for winter. An older baby may wear a knitted woolen suit in cold weather, but
he may need a coat over it to keep out the wind.
A warm woolen cap or hood should be worn in winter. In warm weather a soft
muslin or silk cap may be used, or, if it is warm enough, none at all. On hot days
the baby’s head should be protected from the sun.
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Baths
DATHE the baby every day unless your doctor gives other directions.
When bathing and dressing the baby do everything gently and quickly so as not
to tire him too much. Having everything ready beforehand helps in giving the
bath quickly and with comfort for both mother and baby.
While the baby is undressed examine every part of his body; if anything seems
wrong, tell the doctor. (For care of mouth, eyes, ears, nose, and genitals, see p. 29.)
Bathe the baby before feeding him. He should not be bathed within an hour
after feeding. Give the bath at about the same time every day. Many mothers
like to give the bath before the 10 a. m. feeding, after the baby’s bowels have
moved; others, just before putting the baby to bed. In hot weather it may make
the baby more comfortable to bathe him both morning and afternoon.
The following equipment will be needed for the baby’s bath:
Tub—tin, enameled ware, or rubber (a rubber tub should not be used if the inside becomes
rough). The tub may be folding or stationary.
Tray or box about 12 by 15 inches, for such things as—
Four covered glass jars, 6- to 8-ounce size, for absorbent cotton balls, oil, boiled water!
and four nipples (for water).
Two nursing bottles (for water), with rubber caps
Small flat dish for oil.
Soap and soap dish with cover. (Mild, unmedicated soap is best.)
Soap to use as pincushion (any white soap).
Safetypins (two sizes).
Paper bags for waste.
Absorbent cotton (good grade).
Mineral oil or olive oil.
4 to 6 soft towels.
4 to 6 soft washcloths.
Bath aprons.
Bath blankets.
Bath towels for mother’s lap or bath table.
The room should be comfortably warm—75° to 80° F.—and not drafty. (See
p. 16.) If the room is drafty, the baby should be protected by a screen. (A
sheet or blanket draped across two chairs or on a clotheshorse will serve as a screen.)
It is not wise to have the room so warm that the baby perspires.
The method of preparing the baby for the bath and for giving the bath varies
somewhat according to the age of the baby. (See pp. 26—27.)
Before beginning the bath have within reach everything needed, such as:
Tub on table or chair, according to mother’s convenience.
Low chair without arms (if mother wishes to sit down).
Toilet tray, containing soap, absorbent cotton, oil, safetypins, and so fo rth ., (See above.)
Washcloth, bath towels, bath blanket, and clean clothes.
Diaper pail (under the table may be a convenient place).
Newspaper spread on floor, for clothing taken off baby.
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INFANT CARE
It is a good idea for the mother to wear a rubber apron to protect her clothes
and over it an apron made of soft material such as outing flannel or bath toweling
to protect the baby.
Half fill the tub with water at a little above body temperature (about 105° F.).
Test the temperature of the water by dipping your elbow into it or with a bath
thermometer if you have one.
The mother should wash her hands with soap and hot water and dry them just
before picking up the baby.
While being gotten ready for the tub the baby may be placed on the table or
held in the mother’s lap, whichever seems more convenient. Some mothers
believe that the lap bath gives the mother more rest, exposes the baby less, and
is safer for the baby because in case the mother is called away she will carry him
with her instead of leaving him alone on the table. Others believe that it is
easier to do all the necessary things when the baby is on the table and that he
can be handled more quickly and skillfully. Some mothers prefer to use the
table only when the baby is being dipped into the tub and to sit down while
undressing and dressing him.
If a table bath is given, the table should be at a height convenient for the
mother so that she can stand at the table and bathe the baby easily. It should be
large enough to provide space for the tub and the toilet tray, as well as for dressing
the baby. The table should be placed against the wall and with the tub at one
end and the toilet tray at the other. The space between them is used for dressing
the baby.
The part of the table on which the baby is to lie should be covered with a piece
of rubber sheeting, and a soft bath towel, folded, should be placed on this for the
baby to lie on.
If a lap bath is given, the mother should sit on a low comfortable chair. The
necessary equipment, including the tub, may be conveniently arranged on chairs
or a low table so that she does not need to stand at all during the baby’s bath.
During the baby's first 2 wee\s of life a sponge bath instead of a tub bath is
usually given, because the baby’s navel is not yet healed and a tub bath would
wet the dressing. (To give a sponge bath, wash the baby as described below
but rinse the soapy water away by wiping him with a washcloth dipped in clear
water instead of dipping him into the tub.)
While the baby is very young (under 1 month) it is important that he be kept
warm and that he be uncovered as little as possible. The bath can be given step
by step, with the baby always partly dressed or under a bath towel, so that the
only time he is entirely uncovered is when you are putting him into the tub and
taking him out again.
When bathing a baby younger them 1 month, loosen the neck of the dress, then
wash his face with water but without soap, using a small soft washcloth. Lather
his scalp thoroughly with your hand; then, holding the baby up with his head over
the side of the tub, dip the washcloth into the water and rinse the scalp quickly.
In this way the head is easily washed without getting soap into the eyes. Use the
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I N F A N T CARE
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towel gently to dry the face and head. Do not be afraid to wash the top of the
baby’s head thoroughly.
Next remove the diaper; and if the buttocks are soiled, cleanse them with cotton
dipped in oil.
Next undress the baby and cover him lightly with a bath blanket or a towel.
Then go over his entire body with your soapy hand. (A soapy washcloth may be
used if preferred.) Little soap is needed. Be sure to wash the creases in his
neck and arms, between his fingers, between his toes, and in each groin. Then
place him in the tub, supporting his head and shoulders on your left wrist and
forearm and holding him securely, your left hand grasping his left arm at the
shoulder, your left arm resting on the side of the tub. Lift the feet and legs with
your right hand. Gently lower him into the tub, placing first his feet and then
his body in the water. Go over his body with the washcloth, this time not
soaped; then lift him out and wrap him at once in a towel. It is very important
that the skin be thoroughly rinsed so that all the soapy water is washed away.
Dry the baby carefully with soft, warm towels, patting his skin gently. After
the skin is well dried, a little powder or mineral oil may be used in the creases and
folds of the skin, under the arms, and on the buttocks. Wipe off excess powder
or oil with absorbent cotton. Do not powder between the folds of a girl baby’s
genitals. Do not use too much powder, as it may cake and cause irritation. If
the baby tends to chafe or have a “diaper rash,” oil is better than powder as it
protects the skin from urine and stool.
Usually babies enjoy their baths, especially if nothing unpleasant has occurred
during the bath, such as being in water that is too hot or not being supported
firmly. When putting the young baby into the tub hold him firmly, and until
he is able to sit up steadily by himself hold him firmly all the time he is in the tub.
A folded bath towel put on the bottom of the tub will make it more comfortable
for the baby.
After the baby is about a month old, if he is vigorous and if the room is warm,
take off all his clothes when you are ready to bathe him and let him kick and play
for a while before the bath. He may then be soaped and rinsed as the younger
baby is, except that he need not be kept covered so much.
When the baby is old enough to sit up (usually after he is 8 months old) he may
be put into the tub for his bath without being soaped first.
For the older baby, toys that float may help him to enjoy his bath. If a baby
is unwilling to be put into the tub, do not force him but let him sit by the tub and
play over the side of it with the water and soap and floating toys. Force or
harshness is worse than useless in the training of a baby.
S A F E T Y FOR T H E B A B Y D U RIN G H IS B A T H
Never add hot water to the bath while the baby is in the tub.
Never put the baby into the bath while the tub is standing on a stove or a
heater; he might be seriously burned in this way.
Never bathe a baby close to a stove.
Never leave a young baby alone in the tub.
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The Teeth and Special Organs
TEETH
T h e development of the teeth begins at least 6 months before birth. It
is probable that the proper foods in the diet of the prospective mother help to
lay the foundation for healthy teeth in the baby and that lack of proper food
will affect the condition of her own and the baby’s teeth. After the baby is
born, in order that the teeth may continue to develop normally, it is of utmost
importance that he himself receive the best diet possible, namely, his mother’s
milk. The material of which the teeth are built depends largely upon the
nourishment of the body.
The child’s first set of teeth are the 20 deciduous, or “milk” teeth. Most of
them come through the gums during the first 2 years and are replaced, beginning
at about the sixth year, with the second or permanent teeth.
At birth every tiny tooth of both sets has already begun to form; nearly all
the first set are already partly or wholly hardened. As the baby grows, the
teeth grow also; and if the baby is healthy they are ready to cut through the
gums, beginning at about the sixth or seventh month of life.
Teething is a normal process which continues from about the age of 6 months
to 21/2 years. While a tooth is coming through the gum the baby may be
irritable or fretful and may not eat well, but teething alone rarely accounts
for illness. If, during the period from 6 to 18 months when the first 12 teeth are
coming through, the baby is feverish or sick, a doctor should be consulted. The
illness should not be attributed to teething until all other possible causes such
as colds, abscess in the ear, and other diseases have been ruled out by the doctor.
By the time a baby is 1 year old he may have 6 front teeth. The mother need
not be alarmed if her baby does not follow the average given here; but if he
has no teeth at the end of the first year the doctor should be consulted. The
diet may be at fault, or some disease may be retarding the baby’s growth.
Racial and family traits account for some of the differences.
The first teeth should be cleansed gently each day with a small soft brush.
If the child is to have good permanent teeth—straight, strong, and regular,
with the upper and lower sets meeting to form a good chewing machine—his
baby teeth must be kept in good condition. The permanent teeth come in from
the sixth to the tenth year. Until then the child needs his baby teeth to chew
his food and to hold the jaws in shape so that the permanent teeth will have
plenty of room. Exercise in biting and chewing helps to develop strong, healthy
teeth and jaws. There is often a tendency to keep a baby too long on soft diet.
When he is about 8 months old begin giving him some dry, hard toast at the end
of a feeding but watch him carefully until he learns how to eat hard food.
The child’s gums should be smooth, firm, and a light pink in color.
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INFANT CARE
29
M O U T H A N D NOSE
The inside of a baby’s mouth should never be cleaned unless the doctor orders
it. The saliva is a cleansing fluid, intended to keep the mouth healthy. It is
possible to injure the delicate membrane of the mouth by attempting to clean it
with a cloth. If the membrane is injured a disease called thrush may develop.
(See p. 96.) A drink of water after feedings will help to keep the mouth clean.
Do not clean the inside of the baby’s nose unless he has a cold. (See Colds,
p. 96.)
EYES
If during the first few days of life the eyes and lids are somewhat red this may
be due to irritation from the drops of silver nitrate put in at birth. The doctor
may advise washing the eyes during this time with a weak boric-acid solution
dropped on the lower lids with a medicine dropper. In most infants all that is
necessary is to wipe the corners of the eyes with a piece of cotton moistened with
plain tepid water. No other washing of the eyelids is necessary. In bathing
the baby take care not to allow any soapy water to enter his eyes. Swelling or
redness of the eyelids or any discharge should have a doctor’s attention at once.
The young baby’s head should always be turned away from direct light, whether
sunlight or artificial light, and his eyes should be shielded from dust and wind.
(See p. 14 for care of newborn baby’s eyes and p. 33 for sunlight.)
EARS
Wash the outer portions of the baby’s ears with a soft cloth, but never attempt
to put any hard instrument inside the ear to clean it. Always dry the ears and
the creases behind them very carefully.
G EN ITA L ORGANS
The genital organs in babies of both sexes should be kept scrupulously clean
with as little handling as possible. Boys should be examined by a physician to
see whether the penis is normal or whether adhesions are present between the
foreskin and the glans which should be separated. The physician will decide
whether circumcision is needed. Two or three times a week at bathing time or
as often as is necessary for cleanliness, the foreskin should be drawn back until
the raised edge of the glans (end of the penis) is visible and the organ then cleansed
by wiping with cotton moistened with plain tepid water. If the mother finds
it difficult to draw back the foreskin she should not attempt to do it until the
doctor has shown her how.
The genitals of a girl baby should be washed carefully every day with cotton
moistened with plain tepid water. Any swelling or redness of the parts, or a dis
charge, however slight, should be brought at once to the doctor’s attention. Do
not use talcum powder between the folds of the genitals.
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-5
Sleep
AMOUNT
I HE BABY should have the best possible sleeping conditions so that the hours
of sleep may be of the greatest value. He should always sleep in a bed by himself
and whenever possible in a room by himself, where he need not be disturbed by
the presence of other persons and where light, heat, and ventilation may be
adjusted to his needs.
The mother should arrange the baby’s schedule so that it will not conflict with
preparations for the family supper. Until he is 2 years old the baby should be
fed and in bed by 6 p. m. or as soon thereafter as his schedule calls for, and the
sooner this schedule is arranged the easier it will be for the mother and the better
for the baby.
Some parents are in the habit of taking the baby out with them in the evening
to motion pictures or for an automobile ride. This should not be done. If the
baby is taken out in the evening his habit of going to bed immediately after the
6 o’clock feeding is broken, he loses some part of the long unbroken sleep that he
needs, and he is overstimulated by lights and noise. Furthermore, he is likely
to be kept for an hour or more in a close, hot atmosphere and may be exposed to
communicable disease. Babies should not be taken into crowds of any sort.
A very young baby should sleep from 20 to 22 hours out of the 24; during
the second and third months, about 18 to 20 hours. When the baby is 6 months
old he should sleep about 16 to 18 hours—12 hours at night with only one inter
ruption for a feeding, 2 or 3 hours in the morning, and 1 or 2 hours in the after
noon. Babies vary in their need for sleep. Some require less than these amounts;
some require more. The baby should be trained from birth to have his longest
unbroken sleep at night. The long night sleep should be continued throughout
childhood, but the daytime naps may be gradually shortened. At 1 year of age
the baby may require one long nap and one short one during the day, but the
short nap may be given up soon after. On cold or cool days at least one of the
naps, if not both, may be taken out of doors if the sun is shining, with the baby
protected from the wind. If the sun is not shining, both naps should be taken
indoors. In the hottest weather the naps may be taken outdoors in the shade.
SLEEPING C O N D IT IO N S
The conditions that make sleep refreshing to older persons help the baby’s
sleep also; namely, plenty of fresh air passing in a constant current through the
room, no light shining in the eyes, quiet, a clean body, clean, comfortable clothing,
a good bed, and suitable covering.
A baby should never be put to sleep in all his clothes. At bedtime and at
naptime he should be undressed and his diaper should be changed and his night
gown put on. A sponging off with a washcloth wrung out of lukewarm water
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before he goes to bed at night will add to his comfort; he should be carefully dried.
He will sleep better both day and night if he is comfortable.
The baby should be taught to sleep through the ordinary household noises.
It should not be necessary to walk on tiptoe and talk in whispers while he sleeps,
but he should have a reasonably quiet place for his daytime naps as well as for
his long night sleep.
He should be made comfortable, his covers adapted to the temperature of the
room, the light put out, the window opened, the window shade raised to the
level of the window sash, and the door shut.
The baby will then go to sleep if he is comfortable. If he cries he may be
wet, too warm or too cold, or sick, and the mother should go to him and attend to
his needs. He may cry to get attention, and the mother should soon learn to
distinguish this cry from that of real discomfort or illness. Effort should be made
to find the cause of the crying. If none can be found, the baby should not be
picked up. Under these circumstances a little crying will not harm the well baby.
He should never be taken up to “show off” to visitors. For the first few months
he will get a feeding at 10 p. m. or 4 hours after his bedtime feeding, but after
that he should not be taken up at night except for changing the diaper. (See
Sleeping habits, p. 41.)
Never give the baby any sort of medicine to make him sleep. All soothing
sirups and other similar preparations contain drugs that are bad for the baby,
and many of them are exceedingly dangerous.
Never allow a baby to go to sleep with anything in his mouth. He should not
be allowed to suck a pacifier, nor his fingers, nor even his bottle.
If the baby sleeps lightly, wakens often, and seems uncomfortable, he may have
been overexcited from having been played with too vigorously or too much in the
latter part of the day. All play from 4 o clock on should be quiet (overstimula
tion is to be avoided at all times no matter what its source nor what the age of
the baby). If the baby is restless he may be wet, or too warm, or too cold.
Something may be scratching him. There may be wrinkles in the bed clothing.
He may be lying in a cramped position. The band or the diaper may be too
tight. He may have been overfed or may have had something unsuitable to
eat or may be hungry or thirsty. The room may be too light, too noisy, or not
sufficiently aired. The mother must not be overanxious about these details.
Having made the baby comfortable, she should leave him to go to sleep by him
self. She should not go back unless she thinks there is some real necessity to be
attended to.
BEDCLOTHES
IN COLD WEATHER
To keep a baby warm all night in cold weather and at the same time have
sufficient fresh air is somewhat difficult. When the weather is moderately cold
several lightweight wool blankets will be needed. The temperature in the
room should not be below 55° F. If it is not possible to heat the room the baby
should wear a shirt and stockings as well as a warm nightgown, and a soft,
roomy sweater may be put on over the nightgown. When the baby is sleeping
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out of doors in cold weather his hands should be covered, either by the sleeves
of the sweater or nightgown or by mittens. A sleeping bag made of an all-wool
blanket will help to keep him warm, but blankets will probably be needed also.
A hot-water bottle or a warmed bag of sand may be used to warm the bed
before the baby is put in; but if it is left in the bed to keep his feet warm it must
be well wrapped up and must be only warm, not hot, for the baby’s flesh is delicate
and is easily burned. Hot-water bottles must be carefully stoppered. Electric
heating pads are not safe to leave in a baby’s crib.
A nightcap may be needed in very cold weather; a wool stocking cap or a
flannel hood, lined with cotton or silk and tied under the chin, may be used. A
little cape sewed to the bottom of the cap will help to protect the neck in cold
weather. This cape may be fastened to the sleeping bag at the neck.
IN WARM WEATHER
In warm weather the baby should be put to bed in very light clothes. On
the hottest nights a diaper and a lightweight sleeveless shirt are enough or just a
diaper. On nights a little cooler a thin nightgown and a lightweight blanket will be
needed. The room should be made as cool as possible. An electric fan will keep
the air in motion and thus relieve the worst of the heat. The fan should be
arranged so that the current of air blows upward—toward the ceiling, not toward
the baby.
If there is a sleeping porch on which the baby can be protected from the wind,
his crib may be put on it when the weather is warm enough. Unless the porch
is screened the crib should be covered with a netting to keep off flies and mos
quitoes. When a baby is sleeping on a porch the mother must be on her guard
against a sudden drop in temperature and be ready to put extra covering on him
or to bring him indoors if necessary.
SLEEPING BAGS
After the baby is 5 or 6 months old, or whenever he cannot be depended upon
to remain under his blankets all night, he should have a sleeping bag. For the
winter the bag may be made of any woolen material, preferably a soft blanket
(an old one will do). For ordinary summer nights a bag made of muslin or
outing flannel may be used.
The simplest and best plan for making a sleeping bag for a young baby is to
cut a slit in the middle of a blanket, wide enough to permit it to slip easily over
the baby’s head, and bind or stitch the cut edges. The blanket is slipped over
the baby’s head, smoothed down under and over him, and the lower corners
folded toward the middle and fastened with safetypins. This makes it possible
to change the baby’s diaper without taking him out of the blanket.
Sleeping bags with drawstrings at the neck are dangerous and should not be
used.
In the hottest weather the baby should not be put into a sleeping bag, as it
prevents the air from circulating around him. A sheet may be put over him
and pinned so that he will not kick it off, but it should be loose enough to allow
him to turn freely. Even a sheet may be unnecessary on some hot nights.
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Fresh Air and Sunshine
IT IS important to give infants and young children the benefit of fresh air and
sunshine, since both are essential for health. Even very young infants—3 or 4
weeks old—can be put out of doors if the weather permits. In cold weather
the young baby must not be out of doors unless he is in the sun. The older baby
may be out in colder weather but care must
be taken to keep the hands and feet warm.
The sun must be shining and the infant
must be protected from wind. In summer,
care must be taken that he does not get too
warm and that his skin is not burned from
too much exposure to the sun. A slight
reddening of the skin precedes tanning.
The heat of the sun is produced by certain
long, or infrared, rays. The shortest, or
ultraviolet, rays are the ones that give the
baby power to utilize food so as to help
build straight bones and a strong body. Slight reddening and tanning show
that the baby is receiving benefit from the ultraviolet rays of the sun. Not
all babies tan, even though exposed to the sun. It is well to give babies and
young children sun baths for prevention of rickets and for other beneficial
effects. A child needs sunlight most when he is growing fastest—in babyhood
and early childhood.
The ultraviolet rays of the sun cannot pass through cloth (unless it is, loosely
woven or very thin) or ordinary window glass. Dust and moisture in the air
weaken the effect of these rays. During the winter in the North Temperate Zone
and in the far north the ultraviolet rays
are weaker and are useful only during
the short part of the day when the sun is
overhead.
6 '¿>0
In most parts of the country direct
sunlight cannot be relied upon as the only
means of preventing rickets, and it should
be supplemented by some source of vi
tamin D, such as cod-liver oil. Indeed it
tU i
IS only in the tropical and subtropical
parts of the country—Puerto Rico and parts of the South and Southwest, for
example—that the sun gives to the growing child sufficient protection against
rickets throughout the year. In all parts of the country, even in the warmer
regions, it is well to give cod-liver oil, since it has food value in the form of an
easily digestible fat and in addition contains vitamin D, the vitamin that prevents
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INF AN T CARE
rickets, and another vitamin (vitamin A) that is important for children’s health.
Giving cod-liver oil is especially important in winter in most parts of the country,
where the baby cannot get enough direct sunlight to prevent rickets. In northern
parts of the country it should be given throughout the year. (See Cod-liver oil,
p. 57, and Prevention of rickets, p. 11.)
Artificial sunlight in addition to cod-liver oil may be considered desirable in
rainy or very cold seasons for certain babies, especially for the premature. Sun
lamps, ultraviolet or carbon-arc, may be used under the direction of a doctor.
The same effect, however, can be obtained by giving sufficiently large doses of
cod-liver oil or some other source of vitamin D (to be prescribed by the doctor).
H O W T O GIV E SUN BATHS
Sun baths may be given indoors beside an open window or out of doors.
In starting sun baths remember that a baby’s skin is delicate and burns easily.
Expose at first a small part of the body for a short time. If the baby is fair,
with thin white skin, be even more cautious than with the darker-skinned baby.
A baby’s eyes will not be injured by sunlight unless the rays enter the eyes
directly. This occurs only when the eyes are turned toward the sun and are
open. If the eyelids are closed or if the face is turned away from the sun no
harm will be done. If the baby lies with his feet directed away from the sun
and his head slightly raised, his eyes will be adequately protected from the direct
rays by the shadow cast by forehead and eyelids. A baby that is old enough to
sit up during the sun bath will protect his own eyes by turning and bending his
head.
INDOOR SUN BATHS AT AN OPEN WINDOW
In the winter a sun bath can be given indoors at a window opened at top or
bottom, the baby being placed in the patch of sunlight coming through the open
space. If the room is heated
and the doors closed to prevent
drafts, the baby need not be
completely wrapped up. First
the face, then the hands, and later
arms and legs can be exposed
daily. If the sun is sufficiently
warm even the baby’s shirt may
be taken off. Begin with 2 to 3
minutes’ exposure back and front
and increase the time 2 to 3 min
utes a day, until the sun bath is
given for an hour once or even
twice a day. It is thus possible
to produce tanning in winter. The mother should sit beside the baby and watch
him. If the sun goes behind a cloud the baby must be covered. By holding her
own hands in the sun the mother can tell how warm it actually is.
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OUTDOOR SUN BATHS
In some parts of the United States it is possible for babies to begin outdoor
sun baths by the middle of March or the first of April, if the place chosen for the
sun baths is protected from the wind. In southern parts of the country outdoor
sun baths may be started earlier or even given the year around.
On the first sunny day in early spring the baby may be given an outdoor
sun bath for a few minutes held in the mother’s lap or in the carriage with the
hood pushed well back. Each day there
after the time of the sun bath should be
increased by 2 to 3 minutes for a fair
skinned baby and 4 to 5 minutes for a
darker-skinned baby. Every few days the
amount of body surface exposed may be
increased, at first slowly, but as the days
grow warmer more rapidly. Later the
shirt may be taken off and the sun bath
given with the baby wearing only a diaper.
Care must be taken not to burn the skin.
The little baby should not be given a sun
bath longer than 15 minutes on the front
and 15 minutes on the back, and then only if the sun baths have been increased
very gradually. Older babies may be given longer sun baths, but not more than
half an hour twice a day.
If the baby has been getting direct sunlight through an open window and is
used to the sun, the first outdoor sun bath may last longer than the 3 to 5 minutes
that are allowed for a baby unused to exposure, and the time for later sun baths
can be increased accordingly. Sun baths may be given by putting the baby in
the sun twice a day, at first using half the required time at each period, later the
full time.
In the winter sun baths should be given between 12 noon and 2 p. m., when the
sun is warmest. In summer, on the hottest days, early in the morning and late
in the afternoon are the best times. On the hottest days the time of exposure
should be shortened.
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Exercise and Play
T h e normal baby exercises constantly when awake. At a very early age he
moves his arms and legs about aimlessly; he closes and uncloses his hands, stretches
himself, and turns his head and neck. He gets a good deal of his exercise by cry
ing. Some crying every day does not hurt a baby but is good for him, as it expands
his lungs thoroughly and stimulates vigorous use of his arms and legs. A baby
should not be so wrapped about with clothing and blankets that he cannot move
every part of the body freely. For this reason also, the baby should not be left in
his chair or carriage for any length of time.
The position of a little baby should be
changed occasionally. Twice a day (at
bathing time and at bedtime) every baby
should be allowed to exercise for 10 min
utes in a safe place, such as on a large
bed, with the mother watching him, or on
a blanket in a play pen, with almost all
his clothes removed. He should be en
couraged to kick and turn and, as he
grows older, to crawl and pull himself
Baby can amuse him self in a
about (but not to stand until he shows
play pen
that he is ready).
A few minutes of gentle play now and then is good for the baby, and father as
well as mother should play with him each day. However, all babies need a great
deal of rest and quiet, and much of the usual kind of play is too exciting. It is
a great pleasure to hear the baby laugh and crow; but often the tickling, punching,
or tossing that produces the laughter makes him irritable and restless. Rocking
him, jumping him up and down on one’s knee, tossing him, and shaking his bed
or carriage form bad habits, as they make him depend on attention. This does
not mean that he should be let alone completely. For a few minutes before
feeding he should be held quietly in his mother’s arms—in several positions, so
that no set of muscles may be tired. He is more likely to grow up happy and
cheerful if those about him are happy and cheerful.
The morning is the best time for play. Play in the late afternoon should be
quiet and gentle; otherwise the baby will be overexcited and his night rest may
be disturbed. If two or three times a day are set aside for play he will learn to
play then. Play periods should be very short when the baby is little. He should
learn early that feeding and sleeping times are pleasant but serious occasions, not
meant for play.
The older baby should learn to play for half an hour to an hour by himself.
He should be left alone in his pen or crib with one or two toys that are tied to the
crib by short tapes. As he grows older this becomes more and more important.
It is not good for a baby to be entertained or waited on all the time. He should
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learn to do things for himself. His mother may watch him from an adjoining
room without letting him know that he is being watched.
Play pen.—By the time a baby is 9 or 10 months old it is very desirable to have
a play pen, either bought ready-made or built at home, so that he may learn to
creep and stand and pull himself up while his feet are on a firm surface. Such a
pen gives the baby room for exercise and keeps him from creeping into dangerous
places, such as near a heater or the kitchen stove. The pen consists of a fence
made in four sections, each 18 to 24 inches high and 4 feet long, hinged at three
corners and latched at the fourth corner or hinged at all four corners and latched
at the center of one side, surrounding a wooden floor raised about 2 inches from
the room floor. Ready-made pens have spindles, so that the baby may have
something to take hold of when he tries to climb to his feet. These pens fold
together, and then can be moved about readily. The pen floor should have a cover
of washable goods, such as denim or ticking, tied to the corners by strong tapes.
A combination play pen and bed may be used for a baby to play in until he is
about 6 or 7 months old, when he begins to try to pull himself up (see p. 19).
At this age he needs a firm floor to stand on.
If a peri cannot be bought nor built at home, a smooth board 6 or 8 feet long
and 1 foot wide may be used to fence off a corner of the baby’s room as a pen.
Learning to walk•—A baby should not be taught to walk until he shows that he
is ready for it. Too early walking may keep the natural bowing of a little baby’s
legs from straightening or may even increase it. (At birth the normal baby’s legs
are somewhat bowed. As he grows older they straighten unless he has rickets.)
No “baby walker” should be used, nor any other device that forces the baby to
walk with the legs spread apart. A baby walker may overtire a child, because
it holds him too long in a confined space and in a more or less rigid position.
Toys.—As a baby wants to suck and bite everything, all his toys must be of the
kind that can safely be put into his mouth. They should be washable and have
no sharp points or corners. They should not be small enough to be swallowed
nor have parts, such as bells or the whistles in rubber toys, that may be swallowed.
They should be washed often. Rubber or bone toys are excellent. Painted
articles (if the baby bites them) are unsafe unless paint containing no lead is used.
A baby should not have more than one or two kinds of toys at a time, and they
should be simple. Clothespins or spools on a string or a rubber doll will probably
please him more than an expensive toy. Give him time to explore one toy
thoroughly before giving him another. Floating celluloid toys for the bath
are of great interest, but the older baby will bite them unless he is watched.
The older baby needs toys with which he can learn to do things, such as blocks,
a cup and spoon, a pie pan, a box with a cover which he can take off and put on
easily, a large ball, a small horse and wagon, a string of large wooden beads, a
cloth book with large colored pictures of animals or familiar objects.
Tie toys to the crib or pen with short tapes and let the baby find out for himself
how to get them back when he has dropped them. Do not pick up toys, or he
will throw them down to see you pick them up. It is a good plan to have a box or
a basket for empty spools and other household objects that will interest the baby.
103255°— 40-- 6
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Habits, Training, and Discipline
H A B IT S are the result of repeated actions. A baby, like a grown person, has
a tendency to do again something that he has done before if he has found satis
faction in doing it the first time. The health, happiness, and efficiency of the
older child and of the adult depend largely on the habits formed in early childhood.
The habits of the little child are begun in the first year of life, some of them directly
after birth. The parents cannot postpone planning the child’s training until he is
“old enough to understand.” If the child is to have desirable habits of health
and of behavior and grow into a healthy, happy, useful adult* training must begin
immediately after birth and be regular throughout infancy so that certain attitudes
and acts may become habitual.
Though some habits seem to relate more closely to health and others to behavior,
the principles that underlie them are the same. Desirable habits must be
established consciously by the efforts of the parents and the formation of undesirable
habits prevented. The problems of discipline in infancy are part of the general
program of habit formation. The important habits that may be established in the
first year have to do with eating, sleeping, and elimination. Good habits in all
these aspects of the baby’s life may be built up if regularity is observed in the
performance of each act, if the parents are consistent and logical in their demands
and absolutely honest with the baby, and if he can find satisfaction in the act.
B E G IN N IN G T R A IN IN G A T B IR T H
The first 3 months of life are perhaps the most important of all. The habit of
regularity in feeding and sleeping can be begun almost immediately and, once
established, it should not be interrupted or broken for any reason except a real
emergency such as illness. If the baby wakes between feedings and begins to
cry but has no signs of illness, turn him over, change his diaper, give him water to
drink, and put him back into bed. Do not hold him nor rock him to stop his
crying, and do not nurse him until the hour for the feeding comes. It will not
hurt the well baby to cry. Crying is the younger baby’s one means of expressing
his needs and his dislikes.
Every now and then when the baby is lying quietly in his crib, awake, the
mother or the father should pick him up and play with him. The baby will
learn before long that he is likely to be picked up when he is not crying and
ignored when he is crying.
If a baby is picked up every time he cries he will soon develop the habit of cry
ing each time he wakes until his mother does pick him up and fondle him or rock
him. This is not a good habit either for the baby or for the mother. It inter
feres with the baby’s sleep and with the mother’s work or rest. It teaches the
baby that crying will give him control over his parents.
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Sometimes crying because of colic will start the habit of crying to be picked up.
As one of the methods of treating colic is to pick the baby up and raise him over
the shoulder so that swallowed air may escape and as it is difficult for the mother
to tell whether the baby is crying with pain or not, it is only too easy for him to
form the habit of crying to be picked up. If she is doubtful whether he is in pain,
she should try to make him comfortable and then put him back in his bed.
Nothing is gained by walking the floor with him.
When a baby cries very hard he sometimes holds his breath so long that he gets
blue and stiffens out. This breath-holding spell is one form of tantrum. It is
terrifying to parents and usually makes them give in to the baby at once. The
baby who has such spells is usually old enough to get satisfaction from the anxiety
and excitement that he has caused. If he has gained his own way by having this
form of tantrum, he will repeat it whenever his wants are not immediately supplied.
To handle such a spell, be as calm as possible, put the baby in his bed, leave him
alone, but watch him quietly from a little distance. He will soon relax and
breathe normally. See to it that the spell does not gain for the baby the thing
that he wants.
If the little baby learns that crying does not get him what he wants he will not
use it to control his parents later. He will learn in the same way that temper
tantrums will not get him what he wants.
T H E F O R M A T IO N OF H A BITS
When a desirable habit is to be formed the act must be done in the best way
possible the first time and repeated consistently until it becomes “second nature.”
If the baby gets satisfaction from the act, such as having his hunger satisfied or
his desire for pleasure and attention gratified by a pat or a smile or a word of
approval, the habit will be established more readily. For example, if the baby is
fed and put to bed at the same time every day he will learn to expect these things
regularly and will form his first important health habits—regularity in eating
and sleeping. If, on the other hand, a baby is usually put to bed right after his
6 o’clock feeding but is sometimes kept up to be shown off to friends or is taken
to the movies with his parents, the routine is broken, the baby begins to stay
awake in the evening, and then he objects to being put to bed early. As he grows
older and wiser his objections to going to bed become more insistent, and soon his
mother will say, “The baby just won’t go to bed at 6,” or “The baby won’t go to
bed until I do.”
As babies get older they get more and more satisfaction from their parents’
words and smiles of approval and from any kind of attention. The mother
should give the baby attention and approval when he is doing what she wants
him to do. This will have a more beneficial effect on his training than scolding
him and making a scene over him when he does what she does not want him to do.
If an undesirable habit has been formed the way to get rid of it is to substitute
a desirable habit for it. The parents should see that the baby gets no satis-
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INFANT CARE
faction from doing the undesirable thing, even from the attention he gets while
being scolded, and that he does get satisfaction through approval for doing the
desirable thing.
Desirable behavior should be rewarded by words and acts of approval. The
baby will quickly learn the difference between right (acceptable) behavior and
wrong (unacceptable) behavior and will be willing to do the right thing for the
sake of praise and approval.
Punishment has little place in the first year of life, but whatever punishment
is given must be given consistently. If parents demand one form of behavior
today and another tomorrow, laugh at the baby today for doing a “cute
trick” and tomorrow punish him for the same thing, the baby will be completely
confused as to what he should and should not do. The problem of discipline
is part of the problem of regular habit formation. Slapping or other corporal
punishment should never be resorted to with babies.
FEEDING HABITS
Good eating habits should be established from the start. Feeding from the
second or third day of life should be given regularly. If this is done the tiny
baby will wake at feeding time and sleep between times. A definite schedule
of feedings should be followed. (See Baby’s daily schedule, p. 6.) The baby’s
diet should be carefully planned. He should have foods other than milk as
soon as he is able to eat them. (See p. 57.) Semisolid or solid foods, when given,
should be offered with the breast milk or cow’s milk and not between feedings.
At first they will be new and strange to the baby. He must learn how to manage
solid foods and to eat many kinds.
Mealtime should always be a happy time, but not a playtime. The business
of a baby’s eating is an important one. A baby should be fed alone, without
distractions from visitors or from other members of the family.
A mother’s desire to have her baby gain weight and grow may make her over
anxious if he does not eat everything she offers him. The baby may learn early
that he can create excitement and get attention from his parents and power over
them by refusing to eat some particular food. Do not coax the baby to eat, for
he is likely to enjoy the coaxing and to refuse food as long as he can command this
pleasant form of attention. Show no anxiety nor excitement if he refuses food,
but quietly take the food away after he has had ample opportunity to eat it.
If, however, the baby persistently refuses a food which he should be eating,
more definite steps may need to be taken to teach him to eat it. At the begin
ning of the meal offer a small amount of the kind of food that he refused before.
Show him without excitement that he can have the rest of his meal after he eats
the special food, but unless he eats it he cannot have anything else, not even his
milk. This can be done even if he is only 7 or 8 months old. If he refuses give
him nothing but water. At the next meal offer him again a small amount of the
same kind of food. If he again refuses it give him nothing but water. It is safe
to allow a well baby to go 24 hours without food if he has water to drink. (No
milk or other foods should be given between feedings.) The baby will finally eat
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the food. When he does eat it, show your approval and give him* the rest of his
meal. Show no anxiety nor excitement throughout. If no fuss is made over him,
he will get no satisfaction out of refusing and his appetite will soon make him
give in.
SLEEPING HABITS
As with feeding, regularity is of first importance in teaching a baby good sleeping
habits. Every night at the same time, immediately after the feeding, the baby
should be put to bed while still awake. The mother should see that he is com
fortable, warm enough in cold weather and as cool as possible in hot weather,
and that his room is well aired. Then she should turn the lights out and leave
him alone. If this routine is followed without interruption from birth, the baby
will go to bed without complaint and will not cry to be picked up. Good sleeping
habits formed in infancy will usually continue through childhood.
If the baby is allowed to go to sleep in his mother’s arms or if he is rocked to
sleep before being put into his bed, he does not associate going to bed with going to
sleep. He must therefore be awake when put in his bed and must go to sleep there.
If he is kept up late frequently to see visitors or to go out with his parents, or is
taken up after he has been put to bed he soon learns to enjoy the evening excite
ment and does not want to go to bed as usual.
Parents must not start the habit of coaxing a baby to sleep by rocking him,
walking with him, holding him, lying down with him, or holding his hand after he
is put into bed. He should not be put to sleep with his bottle. He should never
be given a nipple to suck nor anything else to put into his mouth. If any of these
habits is started, it will be hard to break and may interfere with the child’s sleep.
If a baby becomes ill, irregular sleeping habits may result. As soon as possible
the regular routine should be started again and held to all the more strictly
because of the interruption of it by illness.
The daytime naps should be just as regular as the night sleep.
TOILET HABITS
Training fo r control of the bowels.
Training the baby so that the diapers will not be soiled may be begun as early
as the sixth month or even earlier. The first essential in training is regularity.
The training requires patience, but the result is well worth the effort. The training
is usually completed by the time the baby is a year old.
To begin the training the mother should notice at what time the baby usually
soils his diaper. She may even observe signs that he is about to have a bowel
movement, such as grunting and getting a little red in the face. At that time
she should hold him over the chamber for a few minutes. The mother holds the
chamber in her lap and places the baby over it with his back against her chest.
This makes it possible for the mother to support the young baby before he is able
to sit alone. The baby should be held over the chamber in this way each day for
a short period until he establishes the habit of a regular bowel movement.
As soon as a baby is able to sit alone (at the age of 6 to 8 months) he should be
taught to use the nursery chair.
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Such bowel'training, together with a proper diet, usually will prevent con
stipation. Constipation, which may occur in both breast-fed and bottle-fed babies,
means failure to empty the bowels regularly, or the passing of hard material from
the bowels, or the passing of a very small amount of material.
Most babies will have at least one bowel movement every day, but for some
babies it is normal to have a movement only every second day. Often increasing
the water the baby takes will relieve constipation.
The doctor should be consulted when constipation is persistent, so that he may
advise about regulating the diet. The juice of cooked prunes (1 to 6 teaspoonfuls),
or for older infants, prune pulp, is a good laxative food.
Until diet and habit formation correct constipation, it may be necessary to
resort to temporary measures. Mineral oil does not act as a drug but merely
softens the stool. One or two teaspoonfuls may be given every day for a few
days; as the stool becomes softer the amount should be decreased and the dose
finally omitted. For immediate relief a soap stick or an enema may be used oc
casionally. Castor oil or other cathartics should not be given except on the order
of the doctor.
Training for control of the bladder.
When the baby is 10 months old begin training him to control his bladder. It
takes longer to teach him control of the bladder than of the bowels, but the method
is the same. The baby should be given the chamber regularly, at first once an
hour while awake and gradually at longer intervals. Some simple word should
be used each time so that he may associate the word with the act and learn to use
this word himself a little later.
Most children should have daytime control of the bladder by the time they are
2 years of age. By this time also the child may have learned to indicate his need.
As soon as he can stand he should wear drawers instead of diapers. This will
help in his training. Many children continue to wet their clothes only as long as
they wear diapers.
As a rule a child will not learn to control his bladder at night until between the
second and third birthdays, after control during the day is well established. (See
Children’s Bureau bulletin, The Child From One to Six, p. 35, for control of
the bladder in the older child, and Child Management, p. 51, for treatment of bed
wetting.) The mother should remember that as she is trying to establish a ‘ dry
habit it will not help to leave the wet clothing on. If the child wets himself by
accident the drawers or diaper should be changed at once. He should be praised
when he keeps dry but not scolded when he has an accident.
UNDESIRABLE HABITS
Sucking on “pacifiers.”
The habit of sucking on a rubber nipple, a “pacifier,” or any other article of this
kind is extremely bad for the baby, and this kind of thing should not be given to
him. Some of the evil effects of this habit are that it spoils the natural arch of
the mouth by causing protrusion of the upper jaw; it causes constant flow of
saliva and keeps the baby drooling; it may readily carry the germs of disease into
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the baby’s mouth; and it is a habit which is particularly disfiguring to the baby’s
appearance. If he has formed the habit it mu6t be broken at once by taking away
the pacifier and never letting him see it again. He will cry for it at first but will
forget it eventually.
Thumb sucking.
Thumb sucking or finger sucking may begin soon after birth, and if it is not
stopped early it may persist for months or years. It is a natural habit for the
baby to acquire, but may become a very bad habit if carried over into childhood.
It is more easily prevented than cured. Though it is important to prevent it,
or to overcome it if it does start, it should not excite parents unduly. When a
baby first discovers his thumb or finger he naturally starts sucking it. When
ever he does this, the mother should put a toy in his hand to divert him. As the
baby gets older it sometimes happens that thumb sucking continues merely
because the habit is firmly fixed. It is not desirable to punish the baby, nor to
use anything that hampers the free movement of his hands and arms. Giving
the baby a toy to keep his hands occupied is one of the best ways to break the
habit. Usually when the child no longer has the baby need for sucking he will
outgrow the habit if not too much fuss is made over it.
Masturbation.
Frequently at an early age—sometimes as early as 6 months—children discover
accidentally that pleasurable sensations can be aroused by handling or rubbing
the genitals, squeezing the thighs together tightly, riding on some one’s foot,
or in other ways. This handling or rubbing of the genitals is called masturbation.
This early habit will not persist unless it is unwisely treated by adults. It should
play no more important part in the life of the child than does the early habit of
bed wetting.
A child who has this habit should be carefully examined by a doctor to determine
whether there is any physical cause, such as irritation, constipation, or intestinal
worms. The urine should be tested. The genitals should be kept clean. (See p. 29.)
Punishment and physical restraint are of little value in dealing with this habit,
as they tend to fix the baby’s attention on what he is doing and may strengthen
the habit rather than stop it. Masturbation in infancy may be prevented if the
mother is watchful and keeps the baby’s attention focused on other things. The
best method of treatment is occupation and diversion. The baby’s attention
should be turned to some other activity. When he is put to bed his hands should
be kept outside the covers. (If it is cold, he should wear mittens or a jacket with
sleeves that cover the hands.) He may be given a toy to hold until he goes te
sleep and when he wakes in the morning. Different toys should be given, so that
he may not become so fond of one that he will not go to sleep without it. When
he is having his bath floating toys will distract his attention from his genitals.
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Feeding
T H E health and development of the baby are closely related to the way he
is fed during his first year. For this reason a physician experienced in the care
and feeding of infants should be consulted as soon as the baby is born and at
regular intervals thereafter—at least once a month. He will advise the mother
with regard to all the details of feeding, and she should follow his advice with the
greatest care.
To help the baby’s body develop properly, with well-formed bones, good
teeth, strong muscles, and good color, to rebuild worn-out tissues, to warm him
and provide him with energy, to prevent deficiency diseases (see p. 11), and to
regulate the discharges of waste from the body a number of food factors are
needed. The factors that the baby’s diet should contain are:
Proteins, which repair worn-out tissue and build new tissue (proteins also supply
energy and warm the body).
Fats, which supply energy, warm the body, and build body fat.
Starches and sugars, which supply energy for muscular activities, warm the
body, and build body fat.
Minerals, such as iron (which helps to build red blood cells), calcium and
phosphorus (which help to build bones and teeth), and many other minerals.
The body needs minerals for many purposes.
Vitamins, which control growth and health. Certain vitamins are called by
the letters A, B, C, D, and so forth. All these vitamins, and possibly others
not yet well known, are necessary for the growth and health of babies. The
vitamins prevent and cure certain diseases. For example, vitamin C prevents
and cures scurvy, and vitamin D prevents and cures rickets.
Water, which is necessary for good health in babies. Some babies get enough
water in the breast milk and additional foods, but water should be offered regu
larly to every baby, whether he takes it or not.
Breast milk, if the baby gets enough and if the mother’s hygiene and diet are
good, or a proper cow’s milk mixture supplies enough protein, fat, and sugar and
some of the other food elements needed for health and growth in the first months
of life. But some elements are likely to be scarce or lacking in milk, and therefore
at the proper ages the baby should be given additional foods (see p. 57).
The baby should learn soon after birth to take food at regular hours. If the
mother gives the baby his feeding at the times decided on, the average baby
will learn very early in life to wake regularly for food and to sleep most of the
time between feedings.
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BREAST FEEDING
IMPORTANCE OF BREAST FEEDING
The food best suited to the normal development of the young of every mammal,
including man, is secreted for it by its mother. The milk of each animal is
different from that of every other, and each is especially adapted to the needs of
its own young. Cow’s milk is suited to the needs of newborn calves; human
milk, for newborn babies. The best method of feeding a baby for his first 7 or
8 months is at his mother’s breast.
Breast milk is easily assimilated and clean, and breast feeding is convenient
for the mother. Breast feeding gives a baby a better chance for life and for
steady and normal growth.
In order to be able to nurse her baby a mother should try to get enough rest,
to eat the proper food, and to follow the doctor’s directions in taking care of her
breasts.
PRODUCTION OF BREAST MILK
The baby is not placed at the mother’s breast until both he and the mother
have had a number of hours’ rest after his birth—6 to 12 at least, depending
on the doctor’s orders. For the first few days the mother’s breasts secrete a
thick, yellowish fluid called colostrum. When the baby is first put to the breast
he draws the colostrum. After the first nursing he should be put to the breast
regularly every 4 hours, unless the physician advises that he be fed more fre
quently. The regular sucking stimulates the mother’s breasts, and gradually
the true milk, which is thin and bluish, comes into the breasts, taking the place
of the colostrum. By the third or fourth day there is usually enough milk for
the baby. During these first few days before the mother’s milk comes, the baby
should be given tepid boiled water, as much as he will take in 5 minutes, at regular
intervals of 3 to 4 hours. Some doctors advise sweetening the water.
As the baby grows the amount of milk in the mother’s breasts gradually in
creases. Some milk is in the breast at the beginning of a nursing, but most of it is
actually formed during the nursing. The quantity that the baby gets at a feeding
depends largely on the energy, strength, and persistence with which he sucks.
Emptying the breast completely helps more than anything else to produce milk.
(For feeding hours see p. 51.)
The amount of milk produced and its quality depend not only upon the de
mands of the baby but also on the diet and hygiene of the mother and on her
determination to nurse her baby.
HYGIENE OF THE NURSING MOTHER
Diet.
A nursing mother needs an abundance of food that is nutritious and appetizing.
She should eat three regular meals in 24 hours, and a midmorning or midafternoon
lunch.
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Unless the doctor orders a special diet, each day’s food should include—
A quart of milk, which may be used in cooking foods as well as for drinking.
Fresh milk should be pasteurized or boiled. Canned milk—evaporated
or dried—may be used.
A serving of meat or fish.
A raw vegetable or a green salad.
A cooked vegetable, green leafy or yellow.
An egg.
An orange or half a grapefruit, or a tomato. (Tomatoes may be fresh or
Canned.)
A serving of whole-grain cereal or bread.
Other foods, such as potatoes, bread and butter, and dried or fresh fruits.
The doctor will decide how much of these foods should be eaten daily.
The following is a sample day’s food plan for a nursing mother:
BREAKFAST
Orange.
Oatmeal with whole milk.
Toast and butter.
One cup of coffee or tea, or a glass of whole milk.
DINNER
Pot roast of beef, or other lean meat.
Baked potato.
String beans or carrots or both.
Bread and butter.
Glass of whole milk.
Baked custard.
SUPPER OR LUNCHEON
Baked rice and cheese.
Apple and celery salad.
Whole-wheat muffins and butter.
Stewed apricots.
One cup of cocoa made with whole milk, or a glass of whole milk.
A glass of whole milk may be taken before bedtime.
The above is only a sample. Try to vary your meals from day to day.
Every effort should be made to get liberal amounts of vegetables, as no other
food can adequately replace them in the diet of the nursing mother. Turnips,
carrots, parsnips, cabbage, cauliflower, beets, eggplant, celery, and squash can
usually be bought all winter. Canned tomatoes also, and other canned
vegetables may be used.
When fresh fruit is too expensive or out of season, dried or canned fruit, or
canned fruit juice, may be used, but small oranges for squeezing can usually be
obtained at relatively low cost all the year round.
Evaporated or dried milk may be used if safe fresh milk is not available at mod
erate cost. If a full quart of milk has not been consumed with the three meals,
either plain or in cooking, another glass should be taken in the midmorning, in the
midafternoon, or before going to bed.
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At least one quart of fluid in addition to milk should be taken daily. Water
and fruit juices should be taken, and coffee or tea (one or two cups a day) is
allowable.
Cod-liver oil, or some other form of vitamin D, is often needed. It should be
taken under a doctor’s direction.
The mother may eat anything that does not upset her or the baby. The oldfashioned belief that a nursing mother cannot take certain classes of food, such
as acid fruits or vegetables, for fear of upsetting the baby is now known to be
erroneous. Occasionally a certain food in the mother’s diet may cause distress
to a particular baby, and if the mother is sure of this, the food should be cut out
of her diet. Sometimes food gives the mother indigestion because it has not
been cooked properly or because too large amounts of it have been eaten.
Bowels.
Constipation in the nursing mother is very common and must be guarded
against. Every effort should be made to regulate the bowels through food and
exercise. Bulky vegetables are helpful, and also fruits, particularly figs and
prunes. Eating whole-grain bread and cereals will usually correct constipation.
Some people find bran effective. A glass of water taken regularly the first thing
in the morning may help. Regularity of habits is important, and a daily hour for
the stool should be established. Daily walks or setting-up exercises are helpful.
Baths.
Baths should be taken often by the. nursing mother. She may find that she
perspires very freely, and she should make special effort to keep herself free from
odors of perspiration and stale milk. Frequent changes of underclothing are
desirable.
Sleep and rest.
Sufficient sleep is most necessary for the nursing mother. The 2 a. m. nursing
should be given up as soon as possible. There will then be only one nursing
between 6 p. m. and 6 a. m., so that the mother may have a long, unbroken sleep
after the night feeding. At least 8 hours’ sleep at night and 1 hour’s rest during
the day are desirable for every nursing mother. A tired mother cannot
produce the proper food for her baby.
If the baby has not been trained to sleep all night or if he is fretful, it may be
best for some one other than the mother to get up with him at night. Even
when the mother must take care of him at night he should sleep in a bed by him
self, preferably in the next room.
Work.
The mother should not overwork during the nursing period. Often mothers
who have plenty of milk for their babies at first find that the amount is greatly
reduced when they go back to household duties. Many mothers are not strong
enough to undertake their regular duties until at least 6 weeks after childbirth.
By this time the milk flow has been well established. Many mothers have to
work hard during the nursing period, but they should resume their duties gradually.
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Fatigue should be avoided by taking short rests between tasks. Lying down for
5 minutes several times a day may enable the mother to do more than she would
otherwise be able to do safely. To get more rest it is well for her to nurse her
baby in a half-reclining or other comfortable position. This will give her 15 or
20 minutes’ relaxation every few hours.
Fresh a ir and exercise.
Moderate exercise in the open air and sunshine, especially walking, is desirable
for the sake of good health. If a mother has much work to do inside the house
she will not have strength for much walking or other exercise outdoors. She
should try, however, to spend some time each day in the open air and sunshine.
Fresh air indoors is needed for health, and sleeping and living rooms should be
kept well ventilated.
Recreation.
Some form of recreation is good for everyone. Outdoor life and recreation help
to keep the mother happy and contented. A moderate amount of diversion
favors contentment of spirit, which is one of the essentials in maintaining the
supply of breast milk. The mother who can lead an even, regular life without
emotional upsets will probably nurse her baby the more successfully on that
account.
The care of the mother's breasts.
Upon the care given the breasts, in many cases, depends the success of breast
feeding.
Before the baby is born.—The mother can prepare to nurse the baby by seeing
to it that the breasts themselves are in the best possible condition. By wearing
loose clothing she can allow them plenty of room to develop; a tight, flattening
brassiere may prevent free circulation. The doctor will examine breasts and
nipples to see whether special treatment is necessary, and the mother will notice
if anything seems wrong with her breasts and should report it to the doctor
at once.
After the baby is born.—The nipples should be washed with boiled water before
and after each nursing. Between nursings they should be covered with clean
linen. The care of the nipples should be given only with very clean hands.
In some cases, when the milk first comes in, the breasts may become painful.
Usually this condition rights itself without difficulty as soon as the regular empty
ing of the breasts is established. During this period of adjustment the mother
can help to relieve the pain by wearing a brassiere that lifts and supports the
breasts and by drinking less water and other fluids than usual. Regularity in
nursing the baby helps to prevent pain in the breasts.
If a supporting brassiere is used in time and the mother takes little fluid in her
diet for a few days it is rarely necessary to empty the breasts by hand in order to
relieve pain. Emptying the breasts by hand tends to increase the production of
milk, which is just what is not desired when the breasts are painful. Unnecessary
handling of the breasts should be avoided. If the trouble does not disappear
and the breasts become more painful and tense (“caked”), a doctor should be
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consulted. With proper care caked breasts will soon get well. A baby should
never be weaned because of caked breasts, as it is only a temporary condition.
The baby’s first efforts to nurse often make the nipples sore. Great care must
be taken to keep the nipples free from infection, or the tiny cracks of a sore nipple
may develop into a fissure, resulting sometimes in a breast abscess. A doctor
should be consulted if the nipples are sore or cracked or the breasts are abscessed
or if anything else interferes with satisfactory nursing. Never allow the baby’s
mouth to come in direct contact with a sore nipple. Let him draw the milk
from the breast through a shield. The nipple shield should be cleaned thor
oughly after nursing and boiled before being used again. If the baby cannot
obtain milk when the shield is used the mother should express the rfiilk from her
breast by hand or with some type of breast pump and feed it to the child from
a nursing bottle.
Before expressing the milk by hand scrub the hands and nails with soap and
warm water for 1 full minute, using a brush. Wash the nipple with fresh cotton
and boiled water. Dry the hands on a clean towel. Have a sterilized glass and
bottle ready to receive the milk. If the glass you are using has no lip, you should
have ready a sterilized funnel also.
Place the balls of the thumb and forefinger on opposite sides of the breast 11/2
inches from the nipple. This is usually at the edge of the pigmented area. Press
deeply and firmly into the breast until the resistance of the ribs is felt. Then
bring the thumb and fingers tightly together well behind the base of the nipple.
When the fingers and thumb are pressed deeply into the breast keep them there
and repeat the “together” motion 60 to 100 times per minute. Speed is impor
tant and is attained after some practice. The fingers should not slip forward on
the breast lest the skin be irritated. It is not necessary to touch the nipple. If
the stripping of the breasts is done in this way it will cause no discomfort. If
the milk expressed is not to be used at once it should be kept on ice in a
stoppered sterilized bottle.
WET NURSES AND BREAST-MILK AGENCIES
Some newborn babies, especially those prematurely born, and some babies who
are very delicate or who suffer from chronic digestive disturbances cannot be
made to thrive on artificial food. If such babies cannot be nursed by their mothers
it is wise to provide breast milk, either by engaging a wet nurse or by buying
breast milk from a hospital or a breast-milk agency. In some large cities there
are agencies where breast milk can be bought or wet nurses engaged. In small
towns or in the country wet nurses or breast milk can be had by advertising or by
inquiring at a maternity hospital in some nearby city. Sometimes breast milk
may be obtained from a friend or a relative. It is often more satisfactory to buy
breast milk than to employ a wet nurse in the home. If it is bought from an
individual, it is desirable that the woman should come to the baby’s home, so that
there may be supervision of the expression of the milk. All breast milk obtained
from a wet nurse or other individual should be boiled and kept on ice in sterile
bottles. If it is bought from a hospital or other agency where the milk is boiled
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or pasteurized and delivered in sterile bottles, the bottles should be kept on ice
without being opened until used.
When a wet nurse is employed it is not necessary that her own baby should be
of the same age as the baby to be nursed. It is best to engage a nurse whose baby
is at least 6 weeks old and not more than 9 months old. The condition of the nurse’s
own baby should be such as to indicate that his mother can produce an abundant
milk supply.
The general health of the wet nurse and of her baby should be considered before
she is engaged. Good health in her baby usually indicates that she has an ade
quate supply of breast milk. The wet nurse must not have any disease that she
could transmit to the nursling. Both the wet nurse and her baby should be given
a complete examination by a doctor, including examination of the lungs, a blood
test for syphilis, and examination for gonorrhea and tuberculosis. No nurse
should be employed who has a cough or
a cold or who has had tuberculosis. The
wet nurse should follow the rules of hygiene
(including diet) for a nursing mother that
are given on pages 45—49.
Every wet nurse should nurse her own
baby as well as the baby she is engaged to
nurse. Her peace of mind will insure a
better supply of breast milk. Also, if the
baby to be wet-nursed is small and weak,
it may help to increase the milk supply to
have the wet nurse’s breasts emptied after
ward by a more vigorous baby. Profes
sional wet nurses in hospitals often furnish
enough milk for several babies at a time; there need be no fear that a wet nurse
cannot supply milk for two if she has good breasts and follows the rules of hygiene.
HOW TO NURSE THE BABY
During the first 2 weeks after the baby’s birth the mother necessarily nurses him
while lying down and she should place him on the bed at her side. He must
always be able to breathe freely, and therefore the mother should keep the breast
from covering his nostrils.
After the mother is up, the position for nursing should be as comfortable as pos
sible, so that she may relax during the nursing period. It is best that she sit in a
comfortable chair with her feet on a low stool, and hold the baby on her lap in a
reclining position so that his head rests against her arm. Holding the baby up
over her shoulder both before and after nursing and patting him on the back for
a minute or two will help him to expel any air that is in his stomach. This will
help to prevent “spitting up.”
Neither the mother nor the baby should be disturbed while nursing, and the
baby should not be encouraged to play nor be allowed to sleep while at the breast.
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The usual time of nursing should be between 10 and 20 minutes. Occasionally
a vigorous child may take enough milk in 5 minutes, and a feeble baby may nurse
so slowly that it will take him the full 20 minutes to obtain a meal. It is usually
not wise to allow a baby to nurse more than 20 minutes. It is important that each
breast be emptied completely at least twice every 24 hours in order to keep up the
supply of milk. If the milk is plentiful, only one breast should be given at a feeding,
the other being given at the next feeding. If the baby is not strong enough to
empty the breast completely, it should be emptied completely by hand. As the
time for weaning approaches, or if the milk supply is scanty, it is often necessary
to give both breasts at each feeding in order to satisfy the baby, but the breast
given first should be alternated so that one at least is emptied completely at each
nursing. Give either the first breast for 15 minutes and the second for 5, or each
for 10 minutes.
AMOUNT OF FOOD
The amount of food a normal breast-fed baby takes in the 24 hours varies with
the age and size of the baby and also varies with the individual baby. To find
out how much milk a breast-fed baby gets at a feeding, weigh him just before and
just after each feeding; his increase in weight in ounces gives the number of ounces
of food taken. No change should be made in clothes between these weighings;
the diaper should not be changed. The amounts taken at different feedings vary.
Conclusions must not be drawn from weighing the baby before and after a single
nursing; he should be weighed before and after each feeding for 1 or 2 full days
until it can be settled how much he receives in 24 hours. To find out how much
milk he is getting in 24 hours add together the amounts taken at each feeding
in the 24-hour period.
Regular gain in weight is the most satisfactory indication that the baby is getting
enough food. If his gain is not satisfactory (see p. 52) it may be necessary to find
out in this way how much milk he is getting. After the first week he should have
from 2 to 3 ounces of breast milk a day for every pound of weight.
FEEDING INTERVALS
The baby should be put to the breast about 6 to 12 hours after birth (see p. 45).
After this first nursing he should be fed every 4 hours, unless the physician advises
shorter intervals, such as every 3 hours. Hours for feeding commonly used are
6 a. m., 10 a. m., 2 p. m., 6 p. m., 10 p. m., and 2 a. m. The baby should be
wakened for each feeding except the one at 2 a. m. The 2 a. m. feeding may
usually be dropped by the time the baby is 2 months old, or sooner if he is gaining
well. He may cry the first night or two, but after that he will learn to sleep
through the night. The 4-hour schedule should be continued throughout the
first year. The 10 p. m. feeding should be dropped when the baby is 9 months
old and may be omitted much earlier.
DRINKING WATER
A breast-fed baby should be offered boiled water (unsweetened) regularly
between feedings—in winter two or three times a day, in hot weather four or
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five times, since he perspires freely then and needs more. Some breast-fed babies
get enough water from the milk and will refuse water from a bottle. Even if
water is refused it should be offered regularly.
STOOLS
The newborn baby’s first stools are known as meconium. They are very
dark green, thick, and sticky, with little or no odor. They soon change to the
normal yellow stool of the healthy baby as he begins to feed at his mother’s
breast. If any blood is seen in the stool of a newborn baby the fact should be
reported to the doctor immediately.
A well, breast-fed baby ordinarily has one to three stools a day; he may even
have four. Some well babies have infrequent stools; they may have one only
every other day. Such a baby is not to be considered constipated, if his stools
are soft and pasty. If they are hard and dry and the baby passes them with
difficulty he is constipated and the doctor should be told. Do not give any
drugs except on the advice of a doctor.
The normal stools of a breast-fed baby are bright orange-yellow, though
occasionally they may be tinged with green. They are soft and pasty and may
contain very small, soft curds.
WEIGHT
The weight of a baby at birth averages about 7 pounds. For the first few days
the mother’s milk is not sufficient to allow him to gain or even to maintain his
weight. Therefore most babies lose about one-tenth of the birth weight during
the first days of life. It is usually regained by the end of the second week.
Gain in weight is the only reliable indication that a baby has sufficient food.
Weighing him once a week will settle this question. A normal breast-fed baby
gains 4 to 8 ounces a week during the first year. During the earlier months his
gain is more rapid than during the latter half of the year. A simple rule is that a
baby doubles his birth weight by the end of the fifth or sixth month and trebles
it by the end of the first year. It is best to weigh the baby once a week for the
first 6 months of life and every 2 weeks for the second 6 months.
No two infants are exactly alike in development or in power to make use of
food, and the same baby will not always gain an equal amount every week. It is
a fairly good indication that a baby is not having the proper kind or amount of
food or has some other condition requiring attention, if he fails to gain for 2
successive weeks or if his gain is unsatisfactory for more than 2 weeks.
UNDERFEEDING
A baby who shows no gain or a loss in weight may be underfed. He either
nurses for a short time and then gives up and falls asleep, or he cries after an
exhausting attempt to obtain food. The stools are scanty, often only brown stains.
The baby seems weak, his body may feel flabby, and his skin may look pale.
He may cry a great deal or very little or he may sleep a great deal.
To find out whether he is getting enough food weigh him before and after
feeding during a period of 24 to 48 hours. (See p. 51.) It may be that the mother
has not enough milk, or it may be that he is not able to nurse properly, because
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he is not vigorous enough, because he has a deformed mouth, or because his nose
is stopped up. If the supply of breast milk is scanty, steps should be taken to
increase the supply, and until this is brought about additional food should be
given to the baby. (See Mixed feeding, p. 54.) If the baby is not able to suck
properly, the mother’s milk should be expressed by hand regularly, and a medicine
dropper used to feed this milk to the baby. The baby’s nose and mouth should
be examined by a doctor.
To increase the milk supply attention should be paid to the diet and hygiene
of the mother. She should have plenty of rest and sleep and take the proper
amounts of food and liquids. (See p. 45.) The breasts should be emptied
thoroughly at regular intervals. If the baby does not empty the breast this
should be done by hand. (See p. 49.) If the supply of milk from one breast is
inadequate both breasts should be used at each feeding. Persistent efforts to
increase the amount of milk will usually be successful.
It is frequently possible to bring back the flow of breast milk even when it
seems to have ceased. This is done by putting the baby to both breasts,, for 7
to 10 minutes each, every 4 hours and by following each nursing with expression
of milk to insure complete emptying and adequate stimulation of the breasts.
The daily routine and hygiene of the mother should be regulated to insure suffi
cient rest, proper diet, and a quiet normal life.
OVERFEEDING
Overfeeding is comparatively rare in the breast-fed baby. When it occurs it
usually means that the nursing periods are too frequent or that the quantity taken
at one time is too large. To remedy it, the time at the breast should be decreased
and the interval between feedings increased if it is less than 4 hours. (Less
frequent feedings will help to regulate the overabundant supply of milk.)
SPITTING UP
Spitting up or spilling over (not the same as vomiting) is usually caused by
pressure of air in the stomach. It may be due to feeding too much or too often.
Spitting up is very common in breast-fed babies. It can nearly always be pre
vented by holding the baby in an upright position over the mother’s shoulder
before and after feeding, and patting him on the back until the air swallowed is
expelled. If it is due to overfeeding, lengthening the interval between feedings or
shortening the period at the breast may be all that is necessary.
HICCOUGHS
Hiccoughs occur in many babies and should not cause anxiety. Give the baby
a few spoonfuls of warm water or turn him over and pat him on the back. It
may be necessary to lengthen the interval between feedings if it is less than
4 hours.
COLIC
Colic is the term used by many people who care for babies to signify that the
baby appears to be in pain. The legs may be drawn up and air may be passed
by mouth or gas by rectum. No doubt babies sometimes have pain from 'gas”
103255°— 40-- 8
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in the stomach or intestines just as older children do. It is usually not serious;
but if it is persistent, the advice of a doctor should be sought. Colic usually
disappears as the baby grows older. Treatment of the immediate symptoms
consists in getting rid of the air or gas. The baby may be held up over the
shoulder to aid in expelling the gas from the stomach. The pains are frequently
relieved when the baby passes gas by rectum or has a stool. Sometimes it is
necessary to give a soap stick or a small enema (see p. 93) to relieve colic. An
enema is much more effective than medicine. Medicine for colic should never
be given except on the advice of a doctor.
MIXED FEEDING
Before mixed feeding (part breast feeding and part artificial) is begun every
effort should have been made to keep up the supply of breast milk. If the
baby is not getting enough breast milk, however, the doctor should be consulted
and may advise mixed feeding.
The method that is usually most satisfactory is to give a small bottle feeding—
1 to 3 ounces of cow’s milk mixture—immediately after the breast feeding. This
may be done at as many feedings a day as the doctor recommends. The amount
and strength of milk mixture to be given at each feeding will depend on the age
and weight of the baby and the amount of breast milk that he is getting. To help
the doctor calculate how much additional food must be given, weigh the baby
before and after each nursing for 1 or 2 days. The doctor will prescribe a milk
mixture to give in addition to the breast milk. If it is impossible to consult
the doctor immediately, give in addition to the breast feeding enough of a mix
ture suitable to the baby’s age and weight to make up the amount of food which
he needs. The following example shows the mother how to meet the baby s
needs temporarily:
The baby is 4 months old and weighs 12 pounds. He needs 2 to 3
ounces of breast milk per pound of weight. Therefore he needs at
least 12 times 2 ounces, or 24 ounces of milk in 24 hours. If he takes
only 2 1/2 ounces from the breast at each feeding, or 121/2 ounces of
breast milk a day, he is getting only about half as much food as he
needs. Since half of his feeding must be supplied by a cow’s milk
mixture he may be given half of the mixture appropriate to his age
and weight. (See p. 70.)
The other method of mixed feeding is to omit one or two breast feedings a day
and replace them with a bottle feeding suitable for the baby’s age and weight.
This method should not be used except on the doctor’s advice, for omitting a
breast feeding may dry up the breasts, partly or wholly.
Babies receiving mixed feeding rarely have digestive disturbances if the cow’s
milk mixture is boiled.
In order to accustom the baby to taking a cow’s milk mixture, because of the
possibility of having to wean him rapidly later, some physicians advise the intro
duction of one bottle feeding a day by the fourth month of age. This may work
to the advantage of the baby, in that it gives the mother a longer period for rest
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or recreation and so indirectly helps to keep up her supply of breast milk. If
the mother has plenty of breast milk, not more than one bottle feeding a day
should be given until it is time to begin weaning, as the amount of mother’s milk
is likely to decrease if each breast is not emptied at least twice every 24 hours.
When boiled cow’s milk feedings are added to the diet of a breast-fed baby the
stools begin to change in character and gradually become more pasty, darker yel
low or brownish in color, and less frequent. If the stools become loose and
greenish and too frequent (more than three or four a day) or if they become hard
and dry, the dootor should be consulted.
WEANING
Breast feeding should be continued until the baby is 7 or 8 months old, even if
the mother has only enough milk for two breast feedings a day and the other feed
ings are artificial. Then, with the doctor’s advice, weaning may be gradually
completed in the next month or two. It is of great importance that a baby should
not be fully weaned in the first 6 months of life unless it is absolutely necessary, as
it is during this period of rapid growth that digestive disturbances resulting from
artificial feeding are most serious. (For directions as to artificial feeding see p. 61.)
Weaning should be done gradually, and it should be completed by the end of the
ninth month or the beginning of the tenth month. It is usually wise not to start
weaning in very hot weather, but if necessary it can be done if it is carried on
gradually, if the cow’s milk mixture is carefully prepared and is always boiled,
if the drinking water given to the baby is boiled, and if the doctor’s directions are
carried out exactly.
Insufficient reasons fo r weaning.
Failure to gain in weight or decrease in the supply of breast milk is not always
a good reason for weaning the baby before he is 6 months old. If the mother
does not have enough breast milk to allow the baby to gain weight, he should be
given a cow’s milk mixture in addition to breast feeding (see p. 54), and an effort
should be made to increase the supply of breast milk by attention to the mother s
diet and general hygiene.
Many babies are weaned unnecessarily because the breast milk looks blue or is
thought to be “too thin.” Breast milk is always thinner and bluer than cow’s
milk. Its quality cannot be determined by looking at a few drops, nor can it be
satisfactorily told even by a laboratory examination. Rarely, if ever, does analysis
of breast milk help. If difficulties arise during the breast-feeding period, they
are much more likely to be caused by a shortage of milk than by poor quality.
Colic, spitting up, increase in the number of stools, and green stools are not in
themselves causes for weaning. Menstruation may return during the nursing
period, but it should not be considered a reason for weaning.
Temporary discontinuance of breast feeding.
It may be necessary for the mother temporarily to discontinue nursing the baby
from the breast if she contracts an acute illness such as pneumonia or some other
communicable disease. In such cases, if the mother is not too ill, it is wise to make
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every effort to keep up the supply of breast milk by emptying the breasts com
pletely by hand or by breast pump at regular intervals. During the mother’s
illness, while the baby is off the breast, regular feedings of cow’s milk mixture
should be given, prepared according to a formula given by the doctor. Breast
feeding should be resumed at the first possible moment.
Early weaning.
There are only a few good reasons for permanently weaning an infant under 6
months. Among them may be classed the following conditions of the mother:
Another pregnancy; any chronic illness of a debilitating nature, such as cancer,
chronic Bright’s disease, chronic heart disease, or severe anemia; severe prolonged
infectious diseases, such as typhoid fever and tuberculosis of the lungs; and epilepsy.
A mother with active tuberculosis of the lungs should never come in contact with
her baby, and therefore should neither nurse nor take care of him, because of the
great susceptibility of the baby to the disease. A mother who is the subject of
epileptic attacks or dementia should not be left alone with her baby; unless there is
someone in the house who can take charge of the baby, it may be necessary to sepa
rate him from the mother while he is still very young, and therefore to wean him.
How to wean the baby.
Before the baby is weaned consult a physician with regard to the formula for
the cow’s milk mixture to be used. A mixture of cow’s milk, water, and sugar,
boiled, usually is satisfactory. (See p. 66.) The following plan for weaning
can be used for most babies:
For a week give one feeding of cow’s milk a day and three breast feedings. Then
for 4 or 5 days give two feedings of cow’s milk a day and two breast feedings.
For the next 4 or 5 days give three feedings of cow’s milk a day and one breast
feeding. After that (15 to 17 days after the beginning of weaning) the baby
should get no breast feedings, but should get four feedings of cow’s milk a day, as
well as the additional foods mentioned on pages 57—60.
Rapid weaning may occasionally be necessary. Additional substitutions of
bottle feedings for breast feedings may have to be made at shorter intervals. The
rapid method of weaning should not be used except for some very urgent reason.
Sudden weaning, when the baby has to be taken off the breast all at once, is fre
quently very difficult, especially with young babies, and of course should be done
only in an emergency.
When a baby 7 or 8 months old is being weaned his milk may be given him in
either a bottle or a cup. If he already has had water from a bottle or a cup, he
will probably like whichever one he is used to. Many babies at 8 or 9 months
can learn at once to drink from a cup and thus will not need to learn to give up the
bottle a few months later. All babies should drink from a cup at 1 year.
If the baby refuses the bottle or cup the mother must not give in and allow him
to nurse. If the weaning is to be successful she must offer the cup or bottle
regularly at the time decided on and must omit breast feedings according to plan.
Soon the baby will be hungry enough to give in and take the cup or bottle. The
mother should not get excited nor upset if the baby refuses; he will finally yield
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ADDITIONAL FOODS
As the baby grows older other foods are added to his diet to provide those food
elements that milk does not supply in adequate amounts. The foods that the
baby needs during his first year, in addition to breast milk, are as follows:
Orange juice or tomato juice, or certain other fruit juices, given chiefly to supply
vitamin C, the factor that prevents scurvy.
Cod-liver oil, given chiefly because it supplies vitamin D, the factor that
prevents rickets.
Egg yolk, given chiefly because it supplies iron.
Cereals and bread, given chiefly because they supply starch and minerals.
Dark wheat cereals and bread are especially valuable for minerals, vitamin B,
and roughage.
Dark-green leafy vegetables, given chiefly because they supply iron. These
and other vegetables such as carrots, peas, and string beans supply other minerals
and vitamins A, B, and C.
Stewed fruits, such as prunes, apricots, and apples, given chiefly because they
help to regulate the bowels. These fruits also supply iron and other minerals
and vitamins as well as roughage.
Potatoes, given chiefly because they supply starch and minerals.
Fruit juices.
Orange juice (strained) or tomato juice or other source of vitamin C should be
given before the end of the first month. The juice may be fresh or canned;
tomato juice may also be obtained by straining the pulp of fresh or canned
tomatoes.
If orange juice is used, begin with 1 teaspoonful a day. Gradually increase the
amount until by the third month and thereafter 2 tablespoonfuls are given
twice a day. Orange juice may be diluted with an equal amount of cool boiled
water.
If tomato juice is used, give twice as much as you would of orange juice. Begin
with 1 teaspoonful twice a day and increase until by the third month 4 table
spoonfuls are given twice a day. Tomato juice is given without water.
Grapefruit juice or lemon juice—but not prune juice—may be given instead
of orange juice. Either fresh or canned juice may be used. Grapefruit juice
and lemon juice are used in the same amounts as orange juice. They may be
diluted with an equal amount, or more, of boiled water, and may be sweetened.
Pineapple juice may be used. If fresh pineapple juice is used, give twice as
much as you would of orange juice; if canned, give three times as much. Pine
apple juice need not be diluted.
Occasionally fruit juice causes a digestive disturbance. If it is certain that
the disturbance is due to a particular fruit juice, another juice may be given, or,
if the baby is breast fed, juice may be omitted for a few weeks.
Cod-liver oilf
Cod-liver oil should be begun before the end of the first month, preferably at
2 weeks. Begin with % teaspoonful once a day and increase to ){ teaspoonful
1 Other substances containing vitamin D may be ordered by the doctor instead of cod-liver oil. They should never be
given except under a doctor’s direction.
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twice a day at 3 weeks. At 1 month the amount may be increased to 1 tea
spoonful twice a day. This amount may be given until the baby is 3 months old,
when it may be increased to 1% teaspoonfuls twice a day. Continue this amount
throughout the first 2 years. Use pure plain cod-liver oil which the label shows
to contain at least 85 United States Pharmacopoeia units of vitamin D per gram.
Cod-liver oil, like direct sunlight, prevents rickets. In climates where children
cannot have enough direct sunlight the year around, cod-liver oil or some other
substance containing vitamin D should be given regularly throughout the first
2 years of the child’s life.
How to give cod-liver oil to a little baby.—With the baby lying across her lap with
the head higher than the feet, the mother pours out the cod-liver oil in a spoon
held in her right hand. With her left hand she opens the baby’s mouth by pressing
the cheeks together with her thumb and fingers. The oil may then be given very
gradually. If his mouth is not held open until the oil entirely disappears the baby
may spit out what is left. The mother must not let him know by her facial
expression that she does not like the smell of the oil because that will teach him
not to like it. She must take for granted that he will like it even if she herself does
not. The cod-liver oil may be followed by orange juice, but it is better not to
try to disguise the taste of the oil by adding anything to it. If it is given regularly
the baby will accept it and like it as he does other foods. As he grows older he
can take the oil sitting up.
Keep a special towel or two, or use paper towels for protecting the baby’s
clothes, as cod-liver oil leaves a stain; or, better, give the oil when the baby is
undressed for the bath or for bed.
Cereals.
Cooked cereals, such as farina or oatmeal, or other kinds, may be started
when the baby is 4 months old. The darker-colored cereals should be used
frequently. Begin with 1 or 2 tablespoonfuls just before the 10 a. m. nursing and
increase until the baby takes 4 or 5 tablespoonfuls twice a day when he is 7 months
old.
A satisfactory recipe for cereal is as follows:
Water, 8 ounces.
Farina, 2 level tablespoonfuls (or oatmeal, % cup).
Salt, 1/4 teaspoonful.
Bring the salted water to a boil and sprinkle in the cereal. Stir until the mixture comes to a boil
again. Transfer to a double boiler and cook 45 minutes with the water bubbling in the lower section
of the boiler.
The mixture should be thin enough to run off the end of a spoon. If it is too
thick it may be thinned by adding boiling water, or if the baby is artificially fed
part of the milk may be poured over the cereal. As the baby grows older the
cereal should be made thicker so that he may learn to take semisolid foods.
Egg yolk.
Egg yolk may be added to the baby’s diet when he is 4 months old. Some
physicians add it in the third month or even earlier. The egg may be soft boiled
or hard boiled and mashed.
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The first time egg yolk is given, give a very small amount (one-fourth teaspoon
ful or less) at the 2 p. m. feeding and increase the amount gradually each day.
A very few babies are made sick by eggs. If your baby seems sick after he
first gets egg yolk, do not give it again until you have told the doctor about it.
Vegetables.
Vegetables, cooked and mashed through a strainer, should be started when
the baby is 5 months old and given once a day at the 2 p. m. feeding. Give a
green leafy vegetable such as spinach, chard, beet greens, or cooked lettuce two
or three times a week. On the other days give carrots, green peas, green lima
beans, asparagus, or string beans. Canned vegetables prepared by approved
methods in the canning factory may be used.
Begin by giving 1 teaspoonful of mashed vegetable once a day and increase the
amount fairly rapidly to 1 tablespoonful when the baby is 6 months old, 2 table
spoonfuls when he is 7 months old, and 3 tablespoonfuls when he is 8 months old.
From this time on give 3 tablespoonfuls daily. When the baby is 1 year old he
may have also summer squash, Hubbard squash, celery, beets, cauliflower, kale,
and cabbage.
Mothers can often save time in preparing the baby’s meals and give the baby
a greater variety by using some of the vegetables cooked for the family table.
The length of cooking will vary with the kind of vegetable and its age. It is
important to boil vegetables only long enough to make them tender (test by
pricking with a fork). It is also well to use only a small amount of water that
has been lightly salted (not more than one-fourth teaspoonful of salt to 1 cup of
water). Soda, fat, pepper (or other seasoning) should not be used. For cooking
green-colored vegetables and cauliflower use an uncovered pan. It is usually not
necessary to add any water to greens because sufficient water clings to the leaves
after washing. Force the cooked vegetables through a sieve or strainer before
feeding them to the baby. The water in which vegetables are cooked contains
valuable minerals and vitamins and should therefore be served with the vegetables.
When a baby is 10 months old, baked white potato (2 tablespoonfuls) may be
given three or four times a week at the 2 p. m. feeding. After a month or so he
may have potato every day, but it must not take the place of green vegetables.
If a child does not eat the green vegetables offered him, it is wise to withhold
potatoes.
Bread.
After the baby’s first tooth has come, at meal times give him bread dried in the
oven, or zwieback. If commercial zwieback is used, it is better to buy the un
sweetened kind.
Fruits.
Bananas provide sugar in a form easily digested by the infant and are also a
good source of several vitamins. Only thoroughly ripened bananas which have
yellow skins flecked with brown and soft pulp should be given to babies. The
banana should be mashed and fed to the baby with a spoon. The doctor will
tell you at what age to give bananas to the baby.
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Applesauce, apricot or prune pulp, and some other stewed fruits such as peaches,
passed through a sieve or strainer, may be given once a day beginning when the
baby is 9 months old. Prunes and apricots should be soaked all night and cooked
until soft enough to mash through a strainer.
TEACHING THE BABY TO EAT SOLID FOODS
When you give the baby his first taste of cereal you are confronting him with the
first of a series of new experiences. He will eventually meet these with satisfaction
and enjoyment but they are as yet entirely unknown to him. Much of his future
health, both physical and mental, depends on how you teach him to meet new
experiences.
Up to the age of 5 months, when most babies should begin to eat semisolid foods,
the average baby has never taken any food except liquids and knows but one way
of satisfying his appetite—namely, suck
ing, from which he gets his greatest satis
faction. When you put a small amount
of cereal into his mouth he does not know
what to do with it. When the spoon
touches his lips it at once stimulates suck
ing movements, but sucking movements
do not necessarily result in his swallowing
the cereal.. They are more likely to result
in his spitting it out, not willfully, but be
cause he does not yet know how to swal
low it.
If the cereal stays in his mouth, you
can see him feeling it with his tongue,
turning it over, finding out for himself
what it is. His face often shows an expression of surprise or curiosity. If now
you will encourage him by looking pleased and speaking of the “nice cereal” and
by telling him to “swallow the cereal,” you will let him see that you are pleased
with his attempt. If he pushes it out of his mouth with his tongue, do not look
surprised nor scold him—say nothing. Give him another small portion to try
again. Do not laugh at him because he makes funny faces. Treat the situation
as a serious but pleasant lesson in eating. Praise him for trying; do not scold him
for not doing it right the first time. He will thus learn to associate eating with
pleasant words and looks. Remember that it is a new experience to him.
When giving a new food, give only a small amount—two or three tastes the
first day and four or five tastes the second'day. Gradually the baby will get used
to the new food and learn to swallow it. If he continues to make faces and push it
out, it is because it is still new to him, not because he does not like it. He must
learn how to eat it. Whether he learns to like it or not depends upon whether he
learns to associate pleasure and satisfaction with eating it. This association
depends largely upon your attitude. Take for granted that he will like every new
food. Offer it to him in small amounts every day until he eats it well. Never ask
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him whether he likes it. Do not say in front of him that you do not think he
likes it. Do not let the expression of your face show that you think he does not
like it. Do not suggest to him in any way that he may not like it. A little baby
is not too young to understand your attitude, even though he may not understand
your words.
If the vegetables given the baby during the first year are not put through too
fine a sieve they will provide an introduction to solid foods. By allowing the
baby to become accustomed during the first year to eating some foods that are not
in liquid form, later difficulties of feeding may be avoided.
Many babies learn very quickly and well to eat new foods, but some babies
learn slowly. Do not be anxious nor worried if your baby is slow in learning or
if he refuses to eat. If you are, the baby will know it, and he will soon learn to
get extra attention from you by continuing to refuse. All babies want attention,
and this is one of the ways in which they get it. Be patient and persistent. Do
not coax. If the baby refuses to eat a food, take the food away without showing
any excitement, but offer the same kind of food every day until he learns to take it.
Always give the new food before the nursing or the bottle feeding, which the baby
likes. If a baby 8 or 9 months old persistently refuses a new food, it may become
necessary to keep his milk or other food that he likes away from him for several
feedings until he eats the new food. (See Feeding habits, p. 40.) Even under
these circumstances do not get excited nor coax, but let him understand plainly
that when he eats a little of the new food he may have his milk. Give plenty of
water when you are withholding milk. Do not make his mealtime unhappy by
scolding him and forcing him to eat foods that he has not yet learned to eat, but
let him go without his other foods until he is hungry enough to eat a little of the
new one. Praise him and then give him his milk.
A baby can learn to like all the foods that are good for him. He will not cry for
foods that he has never tasted, so do not give him tastes of foods that you know
are not good for him.
A R TIFIC IA L FEEDING
Every baby should be under the supervision of a doctor, particularly when
artificial feeding is begun.
During the first 6 months of a baby’s life there is no perfect substitute for breast
feeding. Therefore no baby should be taken off the breast during this time unless
there is a very good reason (see p. 55). After the baby is 6 months old artificial
feeding can be begun more safely, but it is best that a baby should be at least
partly breast fed until he is 7 or 8 months old.
The most important problems in connection with artificial feeding are: (1) The
choice of a good milk supply; (2 ) the planning of the milk mixture so that it may
be adequate in quantity and quality; (3) preparation of the milk mixture so that
it may be safe and digestible. The problem of the milk supply may be met by
buying a good grade of milk (preferably from a mixed herd) that has been pasteur
ized. Cow’s milk is most commonly used, but in some sections of the country
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goat’s milk is abundant and may be used. The doctor should decide upon the
ingredients of the feeding and upon the amounts to be used. It is the consensus
of opinion among child specialists today that any milk or milk mixture fed to a
baby should be boiled to render it absolutely safe and at the same time more
digestible.
WHAT MILK TO USE FOR BABIES
Fresh milk.
In cities and towns a good grade of pasteurized milk should be bought. In
places where pasteurized milk cannot yet be had, only bottled milk from tuberculintested cows, produced and handled under good conditions by healthy workers
(see p. 64), should be used. As a rule it is better to use milk taken from a herd
rather than from a single cow, since that from a herd is more uniform in quality.
Milk averaging not more than 3 V4 to 4 percent fat is best for babies. All milk
should be boiled.
Canned milk.
Canned whole milk, either evaporated or dried, may also be used for infant
feeding.
Evaporated milk is whole milk cooked until reduced to less than half its original
bulk and canned without the addition of sugar. The long cooking makes evaporated
milk a very digestible and safe form of milk. Before using a can of evaporated
milk, pour boiling water over the top, and in the same way sterilize a sharp
instrument (such as an ice pick), then punch two holes, one on each side of the
top of the can, and pour out the required amount of milk. After the can is opened
the contents must be kept on ice and must be used within 24 hours. The milk
should be diluted with boiled water according to the directions on the can and then
used as if it were fresh milk, sugar and boiled water being added according to the
doctor’s formula. As it was well cooked before being canned it need not be boiled.
Dried milk or milk powder is manufactured by removing water; nothing is
added. Commercial dried milks vary in composition according to the kind from
which they are prepared—whole, skimmed or partly skimmed, sweet or sour.
After a can has been opened it should be kept tightly covered and should be put in
a cool place away from dust. Scrupulously clean utensils should be used to dip it
out and prepare it for use. The powder should be made liquid by adding enough
water (see directions on the package) to give the mixture the value of the liquid
milk from which it was made—whole milk, skimmed milk, or half-skimmed milk.
It may be used then as if it were fresh milk—water and sugar being added according
to the doctor’s formula—and boiled.
Dried milk and evaporated milk are very convenient to use when traveling by
train or automobile and to use in a new locality before the source of a good freshmilk supply has been selected.
In parts of this country and in certain foreign countries where the supply of fresh
milk cannot be depended on or is known to be poor some type of canned milk
should be used.
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Other forms of milk.
Some doctors recommend buttermilk or lactic-acid milk for certain babies.
These should be given according to the doctor’s directions.
Milk (fresh pasteurized, evaporated, or dried) may be fortified with vitamin D
in a variety of ways. When the milk contains (as shown on cap and label) as
much as 400 United States Pharmacopoeia units of vitamin D to the quart (for
evaporated or dried milk, 400 units to the quart after water has been added) it is
commonly believed th at 1% pints daily is adequate to prevent the development
of rickets in most babies. Many physicians believe, however, that milk containing
even as much as 400 units of vitamin D should not be relied on as the only source
of this vitamin.
PROPRIETARY OR PATENT INFANT FOODS
There are two kinds of proprietary or patent infant foods. One kind, commonly
called a “milk modifier,” contains no milk. It consists largely of sugar and should
be used only as sugar and not as a substitute for milk. This type of patent food
may be added to milk as a substitute for other sugars*only under a doctor’s order.
Another kind contains dry milk, sugar, and other ingredients and is not intended
to be mixed with liquid milk. To some foods of this type important vitamins
have been added. Most patent foods of this second kind contain a great deal of
sugar, and for this reason a baby may like them. A high proportion of sugar may
be desirable under certain conditions, but the average baby does better on a
diet in which the doctor can regulate at will the proportion of sugar, by reducing
or increasing the amount added to fresh milk, rather than on a feeding in which
the amount of sugar is fixed, as in patent foods.
Proprietary foods are expensive. If the sugar and starch that they contain
are bought separately and added to fresh milk, the total cost of the feeding is much
less and the results usually better. No proprietary food should be given to a baby
except under the direction of a doctor.
THE PROBLEM OF A GOOD FRESH-MILK SUPPLY
The problem of the milk supply varies greatly, depending on whether one lives
in a large city, a small city or town, or a village or rural district. In most large
cities and in many small cities and towns, laws have been passed regulating the
production and care of all milk sold and establishing standards for certain grades
of milk. These standards take into consideration the composition of the milk
(especially the percentage of fat), the conditions under which it is produced, the
number of bacteria in it at the time of delivery, and whether it is to be sold raw or
pasteurized. Several grades of milk are on the market in cities, but the standards
for a given grade are not altogether uniform from city to city.
Milk labeled “certified” has been produced under such good conditions that it
meets the requirements of a medical milk commission. These requirements include
cleanliness of cows, barns, dairy, and milk handlers, certain standards of washing
and sanitary facilities, medical inspection of milk handlers, veterinary inspection
of cows—including tuberculin testing of the cows every 6 months—and a low
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bacterial count in the milk. Certified milk, however, is expensive. It is usually
sold raw but is better if pasteurized (see p. 65).
Grade A milk is milk from tuberculin-tested cows, which is produced under
very good conditions and which has a low bacterial count. Grade A milk, either
pasteurized or raw, is sold in most cities and towns.
Other grades of milk are of poorer quality and have higher bacterial counts.
Bottled milk should always be bought, as “dipped” milk, dispensed from a large
container, is likely to be contaminated.
In villages and rural districts where milk is supplied from small herds or single
cows, public regulation of production and care of the milk is more difficult. It is
as important, however, to regulate the supply of milk in small towns and rural
districts as in cities, because the majority of epidemics of milk-borne diseases such
as typhoid fever, septic sore throat, and scarlet fever occur in small towns. All
milk-borne epidemics, whether in cities, towns, or villages, are preventable if the
milk supply is properly safeguarded.
All milk, pasteurized or raw, should be boiled before being fed to babies.
•
CARE AND HANDLING OF MILK ON THE FARM
Milk is a very perishable food and is easily contaminated with disease germs
from cows or from human beings. As much care should be taken with milk which
is to be used on the premises or for distribution to neighbors as is taken in the
larger dairies.
Milk should be chilled immediately after milking and kept clean, cold, and
covered until delivery. It should be taken only from healthy animals. A sick
animal should be immediately isolated and its milk discarded. Animals should
be well fed and well cared for in clean, healthful surroundings. Well-built, wellaired stables are necessary. The udder and teats of the cow should be washed and
wiped dry before milking. This prevents dust and hair from dropping into the
pail during the milking.
Cows are very susceptible to tuberculosis, and if a cow has this disease the
milk may be contaminated. If such milk is given raw to babies they may develop
tuberculosis, which in babies is even more serious than in adults. If the owner
is to be certain that the herds or even single animals are constantly free from
tuberculosis, they should be examined and tested every 6 months. Undulant
(Malta) fever is another disease which may exist in the cow and which the baby
can acquire from the milk. Goat’s milk as well as cow’s milk may contain the
germs of tuberculosis or undulant fever if the animal is infected. To safeguard
the baby against these infections the milk should always be boiled.
M ilk handlers.
Milk should be handled only by perfectly healthy persons. If a milk handler
has tuberculosis, septic sore throat, typhoid fever, scarlet fever, or diphtheria,
he may contaminate the milk and be the cause of a severe epidemic if the milk
is consumed raw. Frequent examinations of milk handlers by physicians should
be required as part of the routine. The milkers should wash their hands with
soap and dry them carefully before milking. Milking with wet hands is almost
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certain to carry impurities into the milk. A clean washable suit should always
be worn while milking. The milker should be very careful not to raise dust nor
permit anything to fall into the milk.
M ilk utensils.
The pail, strainers, milk cans, and all other utensils should be washed clean
and sterilized by boiling or with steam before use.
The water used in washing the utensils and bottles, the udder of the cow, and
the hands of the milker—everything touching the milk—must be clean and un
contaminated by disease-producing bacteria. Serious outbreaks of disease have
been caused by use of contaminated water for washing.
Refrigeration.
After milking, the milk should be cooled quickly by placing the cans in a
cooler or in cold water. Milk should be kept at 50° F. or below but not frozen.
Bottles.
The bottles should be thoroughly washed and sterilized daily. Clean caps
should be used. The type of cap which covers the whole top of the bottle is
the best, as it insures perfect cleanliness of the lips of the bottle over which the
milk flows. When milk is to be used on the premises where it is produced it
should be kept in sterilized, covered bottles or glass jars.
PASTEURIZATION
Because of the great danger of transmitting diseases through milk, all milk—
even certified milk—should be properly pasteurized before it is delivered to the
householder. Proper pasteurization—heating for 30 minutes at a temperature
that kills disease germs (142° to 145° F.)—is necessary to make milk safe. It
does not make poor milk a good food, nor does it justify the use of dirty milk—
the quality and conditions of production should be as good for milk that is to be
pasteurized as for milk that is to be sold raw—but it adds an important factor
of safety to any milk. In some small cities and towns conditions of production
are often so insanitary that pasteurization is doubly necessary if the milk is to
be given to babies. Milk should not be used for babies more than 36 hours
after pasteurization.
Pasteurization does not take the place of boiling milk before giving it to a
baby. All milk given to a baby should be boiled.
CARE OF MILK IN THE HOME
Milk must be given proper care after it is delivered. If frozen it may disagree
with some infants. If the frozen milk must be used, pour off the cream after
thawing and boil the milk. This will usually make it digestible.
If allowed to stand in the sun on the doorstep or in a warm kitchen, milk will
spoil. Immediately after delivery the bottles of milk for the baby should be
placed in the ice box, where the temperature should be 50° F. or below.
An ice box to hold the baby’s milk can be made at home if there is no other
place to keep ice. (Instructions for making such an ice box have been prepared
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by the Bureau of Maternal and Child Welfare of the District of Columbia Health
Department and may be obtained from the Children’s Bureau.)
If ice is not available, the bottles of
milk may be placed in running spring
water or in a springhouse or well if the
water is sufficiently cold. The bottles
must be covered with water up to the
neck, but care should be taken not to wet
the caps. In cool climates the bottles
may be placed in a can or pail of water
in an open window on the cool side of the
house or in the cellar. If the bottle is
placed in a shallow pan of water and
covered by winding a strip of cloth around
S ectional v ie w of hom e-m ade ice box a n d m a te ria l f o r m akin g it.
it, with one end of the cloth in the water, the damp cloth will keep the bottle
of milk cool.
If the cap of the bottle does not cover the edges of the bottle, before milk is
poured out the cover or cap of the bottle should be wiped off so that no dust may
fall into the milk when the cap is removed, and the edge of the bottle or jar
should be wiped off with a clean dish towel wrung out of hot water. All bottles
and utensils and the ice box itself must be kept scrupulously clean. Milk bottles
must not be used for any purpose but to hold milk.
THE MILK MIXTURE
Artificial feeding should be planned with the advice of a doctor. His advice
is especially important during and after the weaning period. If the baby is not
weaned until after he is 6 months of age, adjustment to cow’s milk feeding will
probably be made easily. If, however, weaning has had to take place earlier
the feeding should be even more closely supervised by the doctor. It is more
difficult to feed a young baby successfully on a cow’s milk mixture than an older one,
and the plan for this feeding often requires the doctor’s most careful judgment.
No single method of feeding can possibly meet the needs of all infants. The
methods given in the following pages are adaptable to the needs of most well
infants:
Cow’s milk (or goat’s milk) should be the principal food of the baby who is not
being nursed. A boiled mixture of cow’s milk (whole), water, and sugar—the
amounts varying according to the doctor’s directions—is usually suited to the
baby under 9 months of age. After the baby is 9 months old and sometimes
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much earlier cow’s milk (whole) can usually be given without being mixed with
Water and sugar; it should be boiled.
For the very young baby it is usually better to use milk that does not have a
very high percentage of fat, not more than 4 percent. Milk from Jersey and
Guernsey cows is sometimes too rich for young babies. If used, it should have
about half the cream removed.
Importance of boiling milk mixture.
It is of utmost importance to any baby who must be artificially fed that the
milk mixture be boiled to make it safe. Boiling milk kills all the disease germs
that the milk contains. It also makes milk more digestible. The curds formed
in the baby’s stomach in the process of digestion of raw cow’s milk are apt to be
large and hard. They are frequently found undigested in the baby’s stool. Such
undigested raw-milk curds found in stools look very much like white or yellowish
lima beans. After milk has been boiled for 3 minutes in a single boiler or cooked
for 20 minutes in a double boiler it is made more digestible. The curds that are
formed in the baby’s stomach from boiled milk are small and soft and more like
the curds from breast milk. When a baby is fed boiled milk no large tough curds
appear in the stools. Because boiling makes milk both safe and more digestible,
many of the digestive disturbances and other difficulties of artificial feeding dis
appear when this procedure is rigidly followed in preparing the baby’s feedings.
(See p. 72 for preparation of feedings.) It is perhaps the one rule that can
be laid down for all artificially-fed babies. The constipation that occasionally
accompanies the use of boiled milk is unimportant in comparison with the
more serious disturbances that may follow the use of raw milk. (See p. 42 for
dealing with constipation.)
Planning the formula.
To plan a formula intelligently for an artificially-fed baby the following points
should be varied according to the age and weight of the baby:
1. The quantity of milk to be used in the total amount of milk mixture given
in 24 hours.
2. The quantity of sugar to be used in the total amount of milk mixture given
in 24 hours.
3. The number of feedings a day and the interval between feedings.
4. The amount of milk mixture to be given at each feeding.
5. The total amount of milk mixture to be given in 24 hours (amount at each
feeding multiplied by the number of feedings).
6 . The total amount of water which must be added to the milk to bring the
quantity up to the total amount of mixture required.
1.
Quantity of mil\ .—The baby on the first day of life is usually given water,
sweetened or unsweetened. (See p. 45.) On the second and third days of life
milk is begun— 1 ounce of milk for each pound of the baby’s weight; that is, a
7-pound baby gets 7 ounces of milk in 24 hours, with water and sugar added as
described on pages 68 and 69.
From the fourth to the seventh day a baby needs 1% to 11/ 2 ounces of milk daily
for each pound of his weight.
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During the second, third, and fourth weeks the average baby needs not less
than 11/2 ounces of milk daily for each pound of his weight.
From the beginning of the second month to the end of the ninth month most
babies need l 3/* to 2 ounces of milk daily for each pound of their weight. No
baby should be given more than 2 ounces of milk per pound or more than 32
ounces (1 quart) of milk in 24 hours. When the baby is 9 months old he will be
taking a variety of other foods, so that it is not necessary to increase the amount
of milk further. Some doctors prefer to give the water between the feedings rather
than in the formula after the baby is 6 months old. In any case, after the beginning
of the tenth month, whether the baby has been breast fed or artificially fed, he
may be given daily 32 ounces of cow’s milk (boiled) unmixed with water or sugar.
Some of this milk may be used in cooking the cereal or poured over it.
2. Kind and quantity of sugar.—Several kinds of sugar are commonly used in
feeding babies: Common granulated sugar, mixtures of malt sugar and dextrin,
corn sirup, and milk sugar. Granulated sugar and corn sirup are satisfactory for
most babies and are the cheapest sugars. One level tablespoonful of granulated
sugar or corn sirup weighs the same as V/2 tablespoonfuls of malt sugar or of milk
sugar; therefore if malt sugar or milk sugar is used, one and one-half times as
much will be needed as of granulated sugar or corn sirup.
During the first week of life the average 7-pound baby will need 1 level table
spoonful of granulated sugar added to the whole day’s allowance of milk mixture.
During the first month this may be gradually increased to 2 level tablespoonfuls,
during the second month to 2 '/ j level tablespoonfuls, and during the third or fourth
month to 3 level tablespoonfuls. The average baby will not require more than
3 tablespoonfuls of granulated sugar a day at any time, or 4^/2 tablespoonfuls of
malt sugar or milk sugar.
At the beginning of the seventh month the amount of sugar should be decreased
gradually, until at the beginning of the ninth month no sugar will be added to
the milk.
3. Number of feedings and intervals between feedings.—The average baby will do
well if fed every 4 hours regularly from birth. This interval between feedings
should be used and adhered to unless the doctor orders more frequent feedings.
The very young baby may need six feedings in 24 hours—usually given at 6 a. m.,
10 a. m., 2 p. m„ 6 p. m., 10 p. m., and 2 a. m. The baby should be awakened
for each feeding except the one at 2 a. m. The 2 a. m. feeding may usually be
omitted by the time the baby is 2 months old, or sooner if he is gaining well.
Five feedings are therefore all that will be necessary, and this number will be
continued until he sleeps through the 10 p. m. feeding, usually at 4 or 5 months.
After this give only four feedings a day, according to the schedule arranged to
suit the individual family.
4. Amount of m il\ mixture to be given at each feeding.—The amount of milk
mixture given to a baby at each feeding is small at first and is gradually increased
as the baby gets older. The baby who is fed at 4-hour intervals receives larger
feedings than the one who is fed at 3-hour intervals. Babies vary considerably
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in the number of ounces which they will take at a feeding. For all babies it is
well to begin with small amounts, 2 to 2 */2 ounces, and increase gradually month
by month up to 8 ounces at a feeding as a maximum. The baby should take the
feeding in 15 to 20 minutes.
b a b y f e d a t 4-hour in terva ls
First week...........................................................................................
Second, third, and fourth weeks........................................................
Second month.............................................................................
Third month.............................................................................
- Fourth month................................................. ...........
Fifth andsixth months...................................................................
Seventh to twelfth month.................................................
Ounces
2-2 1/ 2
3_4
1/2-5
3
4_6
5_7
_g
_g
6
7
5.
Total amount of milk mixture in 24 hours— It is important to calculate the
total amount of mixture that should be given to a baby in a day in order to know
how much water must be added to the milk to make up the total quantity of the
feeding for the 24-hour period. This is done by multiplying the amount that has
been decided on for each feeding by the number of feedings. For example, if a
baby who is 4 months old has 5 feedings of 6 ounces each, the total amount for
24 hours will be 30 ounces.
Amount of water to he added to m ilk—After calculating the total amount of milk
mixture to be given in 24 hours, subtract from it the amount of milk to be given
during the same time; the result will be the amount of water that must be added.
For example, in planning the feeding for a 4-month-old baby weighing 121/ 2
pounds, the following subtraction will be made:
Ounces
Total amount of mixture given in 24 hours: Amount given at each feeding (6 ounces) multiplied
by the number of feedings (5).......................................................................................
Milk required: 1% ounces multiplied by the baby’s weight (12 j/ 2 pounds)..............................
Water to be added........................................................
30
22
g
Many doctors give milk undiluted with water from the sixth or seventh month
on. The water is then given between the feedings. This plan is especially good
if the infant is small and will not take the calculated amount of the formula (milk
and water), and also if the infant is slow in taking the full amount at each feeding.
PLAN FOR ARTIFICIAL FEEDING OF A WELL BABY
The following plan for the artificial feeding of a well baby is given as an example
which may assist the mother in following her doctor’s instructions, not as a sub
stitute for them. The doctor should be consulted very frequently with regard to
the artificial feeding of any baby.
The baby should be weighed frequently (see p. 9) and the formula for his
feeding should be adjusted with his increase in weight, not merely with his
increase in age. The weights given in this section are intended as examples, not
as indications of the weight a baby should have at the different ages.
The formulas for milk mixtures have been calculated according to the instruc
tions on pages 67—69. They can be altered to suit the individual baby by following
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the instructions given there. The milk mixtures should be boiled. (For a dis
cussion of the foods suggested in addition to the milk or milk mixture see p. 57.)
The term whole milk is used to mean fresh cow’s milk, or unsweetened evapo
rated milk mixed with an equal quantity of water, or dried whole milk made up
according to directions on the can to the equivalent of fresh milk.
F irst d a y — A baby w eigh in g 7 pounds
Boiled water, 10 ounces.
Granulated sugar, 1 level tablespoonful.
O ffe r ) / 2 to 2 ounces every 4 hours (6 fee d in g s in 2 4 h ou rs).
Second to seventh d a y — A baby w eigh in g 7 pou n ds or slightly less
Whole milk, 8 ounces.
Offer 2 /
2
Granulated sugar, 1 level tablespoonful.
Water, 7 ounces.
ounces every 4 hours (6 fe e d in g s in 2 4 h ou rs).
A 1-w eek-old baby w eigh in g 7 pounds
Whole milk, 10 ounces.
Granulated sugar, IJ/2 level tablespoonfuls.
Water, 5ounces.
Offer 23/2 ounces every 4 hou rs (6 fe e d in g s in 2 4 h ou rs).
A 2-w eek-old baby w eigh in g 7 Va pounds
Whole milk, 11 ounces.
Granulated sugar, 2 level tablespoonfuls.
Water, 7ounces.
Offer 3 ounces every 4 hou rs (6 fee d in g s in 2 4 h ou rs).
Orange juice, 1 teaspoonful a day (or tomato juice, 1 teaspoonful twice a day; see p. 57).
Cod-liver oil, V l teaspoonful once a day.
A 3-w eek-old baby w eigh in g 7 V2 pounds
Whole milk, 12 ounces.
Granulated sugar, 2 level tablespoonfuls.
Water, 6ounces.
Offer 3 ounces every 4 hou rs (6 feed in g s in 2 4 hou rs).
Orange juice, 1 teaspoonful twice a day (or tomato juice, 2 teaspoonfuls twice a day).
Cod-liver oil, V l teaspoonful twice a day.
A 1-m onth-old baby w eigh in g 7 % pounds
Whole milk, 14 ounces.
Granulated sugar, 2 '/2 level tablespoonfuls.
Water, 6ounces.
Offer 4 ounces every 4 hours ( 5 fe e d in g s in 2 4 hours or, i f 2 a. m . fe e d in g is s till given, use 10 ounces
o f w ater in the m ilk m ix tu re a n d give 6 fe ed in g s).
Orange juice, 2 teaspoonfuls twice a day (or tomato juice, 4 teaspoonfuls twice a day).
Cod-liver oil, 1 teaspoonful twice a day.
A 2-m onth-old baby w eigh in g 9 V2 pounds
Whole milk, 16
Vl
ounces.
Offer 4 72 ounces every 4 hours
Granulated sugar, 3 level tablespoonfuls.
(5 fee d in g s in 2 4 hou rs).
Water, 6 ounces.
Orange juice, 2 tablespoonfuls twice a day (or tomato juice, 4 tablespoonfuls twice a day).
Cod-liver oil, 1 teaspoonful twice a day.
A 3-m onth-old baby w eigh in g 11 pounds
Whole milk, 19 ounces.
Offer 5 ounces every 4 hours
Granulated sugar, 3 level tablespoonfuls.
(5 feed in g s in 2 4 h ou rs).
Water, 6 ounces.
Orange juice, 2 tablespoonfuls twice a day (or tomato juice, 4 tablespoonfuls twice a day).
Cod-liver oil, 1Vo teaspoonfuls twice a day.
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A 4-m onth-old baby w eigh in g 1 2 1 / 2 pounds
Whole milk, 22 ounces.
Granulated sugar, 3 level tablespoonfuls.
Water, 8 ounces.
Offer 6 ounces every 4 hours (5 fee d in g s in 2 4 hou rs).
Orange juice, 2 tablespoonfuls twice a day (or tomato juice, 4 tablespoonfuls twice a day).
Cod-liver oil, 1 l/j teaspoonfuls twice a day.
Cooked cereal, 1 or 2 tablespoonfuls once a day, usually just before 10 a. m. bottle.
Egg yolk, once a day (for amounts when first given see p. 58), usually at 2 p. m. or 6 p. m. feeding.
A 5-m onth-old baby w eigh in g 14 pounds
Whole milk, 24 1/2 ounces.
Offer 6 Y i ounces every 4 hours
Granulated sugar, 3 level tablespoonfuls.
(5 feed in g s in 2 4 hours).
Water, 8 ounces.
Orange juice, 2 tablespoonfuls twice a day (or tomato juice, 4 tablespoonfuls twice a day).
Cod-liver oil, 1 ty-j teaspoonfuls twice a day.
Cooked cereal, 2 to 4 tablespoonfuls once a day.
Egg yolk, 1/2 to 1, once a day.
Mashed vegetable, 1 teaspoonful once a day (see p. 59), usually just before 2 p. m. bottle.
A 6-m onth-old baby w eigh in g 15
'/ 4
pounds
At this age water may be offered only between feedings or may be added to the formula.
example:
Whole milk, 28 ounces.
Granulated sugar, 2 level tablespoonfuls.
Water, between feedings only.
or
Offer 7 ounces every 4 hours (4 feed in g s in 24
hou rs).
Whole milk, 28 ounces.
Granulated sugar, 2 level tablespoonfuls.
Water, 4 ounces.
Offer 8 ounces every 4 hours ( 4 feed in g s
For
in 2 4
hours).
Orange juice, 2 tablespoonfuls twice a day (or tomato juice, 4 tablespoonfuls twice a day).
Cod-liver oil, 1 1/2 teaspoonfuls twice a day.
Cooked cereal, 3 to 4 tablespoonfuls twice a day (second cereal usually before 6 p. m. bottle).
Egg yolk, one, once a day.
Mashed vegetable, 1 tablespoonful once a day.
A 7-m onth-old baby w eigh in g 16 % pounds
At this age water may be offered only between feedings or may be added to the formula,
example:
Whole milk, 28 to 32 ounces.
Whole milk, 28 ounces.
Water, between feeding only.
Granulated sugar, 1 level tablespoonful.
Granulated sugar, 1 level tablespoonful.
Water, 4 ounces.
Offer 7 to 8 ounces every 4 hou rs (4 feed in g s
For
Offer 8 oun ces every 4 hou rs ( 4 fee d in g s in 2 4
in 2 4 h ou rs).
h ou rs).
Orange juice, 2 tablespoonfuls twice a day (or tomato juice, 4 tablespoonfuls twice a day).
Cod-liver oil, 1 '/ j teaspoonfuls twice a day.
Cooked cereal, 4 or 5 tablespoonfuls twice a day.
Egg yolk, one, once a day.
Mashed vegetables, 2 tablespoonfuls once a day.
A n 8-m onth-old baby w eigh in g 17 V2 pounds
Whole milk, 28 to 32 ounces.
1
Offer 7 to 8 oun ces every 4 hours {4 fe e d in g s in
2 4 h ou rs).
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Whole milk, 28 ounces.
I
Water, 4 ounces.
| 0r
Offer 8 ounces every
in 2 4 h o u rs).
4 hou rs (4 fee d in g s
72
INFANT CARE
Orange juice, 2 tablespoonfuls twice a day (or tomato juice, 4 tablespoonfuls twice a day).
Cod-liver oil, P / j teaspoonfuls twice a day.
Cooked cereal, 4 or 5 tablespoonfuls twice a day.
Egg yolk, one, once a day.
Mashed vegetable, 3 tablespoonfuls once a day.
Dry toast or zwieback occasionally with meals.
A 9-t 10-, or 11-m onth-old baby
Whole milk, 28 to 32 ounces in 4 feedings of 7 or 8 ounces each.
Water, to be offered between feedings.
Orange juice, 2 tablespoonfuls twice a day (or tomato juice, 4 tablespoonfuls twice a day).
Cod-liver oil, 1
teaspoonfuls twice a day.
Cooked cereal, 4 or 5 tablespoonfuls twice a day.
Egg yolk, one, once a day.
Mashed vegetables, 3 tablespoonfuls once a day.
Dry toast, zwieback, stewed fruit, baked potato.
A d d n ew articles to d ie t one a t a tim e ( see p . 6 0 ).
WHAT MILK MIXTURE TO USE DURING WEANING
When a breast-fed baby is to be weaned, it is well to begin with a milk mixture
that is not full strength for his age, increasing soon to the full strength; at the start
of weaning, the amount of milk required is calculated on the basis of not more than
1V2 ounces a day for each pound of the baby’s weight. As has been told in the
section on Weaning (p. 55), only one artificial feeding a day is given at the begin
ning of weaning, the other three feedings being given at the breast. The amount
of milk to be given in this single feeding can be found by multiplying P /2 ounces
by the number of pounds in the baby’s weight and dividing the resulting number
of ounces by the number of feedings (usually four) that he receives during the day.
For instance, if an 8-month-old baby, weighing 171/2 pounds, is to be weaned,
find the amount of milk needed fqr one feeding as follows: Multiply 1 1/2 ounces
by 171/2» which gives 26 V4 ounces. Divide this by 4, the number of feedings
received by an 8 -month-old baby. The result, about 6 I/2 ounces, is the amount
of milk to be given in the one artificial feeding at the beginning of weaning.
As an 8 -month-old baby should receive 7 to 8 ounces of milk mixture at each
feeding, enough water should be added to make up 7 or 8 ounces— or 11/2 ounces
of water.
As time goes on, and the baby gets used to cow’s milk, not only is he given more
artificial feedings a day, as shown on page 62, but he is given a stronger milk mix
ture. The mixture is gradually strengthened until the baby receives 28 to 32
ounces of whole milk a day, unmixed with sugar and water, as suggested in the
section above.
PREPARATION OF MILK MIXTURE
Equipment.
If possible, a mother should buy the proper utensils for preparing artificial food,
and these utensils should be kept together and not used for anything else. To do
this may cost a few dollars extra, but it will save much time and trouble every day.
The following utensils are needed:
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Nursing bottles holding 8 ounces. It is cheaper to buy them by the dozen. At least there should
be two or three more than the number of feedings in 24 hours, as they will be used for water also.
Nipples. Freshly boiled nipple for each feeding and for each bottle of water. (At least a dozen.)
Two small, wide-mouthed, covered glass jars such as mason jars or mayonnaise jars (one for boiled
nipples and one for used ones).
Teaspoon to take boiled nipples from jar (to be kept in jar with boiled nipples).
Rubber caps, rubber corks, or wax paper to cover top of nursing bottles. Rubber caps are the
most satisfactory covers.
Bottle brush.
Bottle rack for holding bottles when boiling and filling them and for keeping them in the ice box.
If this cannot be had, a pail or pan may be used for keeping bottles in the ice box.
Measuring glass holding 8 or 16 ounces, marked off in half ounces, for measuring milk and water
(sometimes called a graduate).
Pitcher to hold milk mixture after boiling.
Tablespoon and teaspoon for measuring sugar. Accurate measuring spoons may be purchased
very cheaply and are best.
Knife for leveling spoonfuls of sugar.
Two-quart saucepan for boiling milk.
Saucepan or teakettle for boiling water.
Strainer to strain milk mixture if scum forms.
Covered flat-bottomed kettle or pail, large enough to hold bottle rack and utensils to be boiled.
Long-handled spoon for removing utensils from sterilizing kettle and for stirring milk mixture.
Bottles.—A kind of bottle should be bought that can be cleaned thoroughly
with the bottle brush; there should be no corners that are hard to clean. (The
neck of the bottle should gradually slope into the body and the bottom should
slope into the side without a sharp corner.) After each bottle is used, it should
be well rinsed at once with cold water, and then filled with cold water and put in a
clean place away from flies and dust until all the bottles used for the day’s feeding
can conveniently be washed in hot soapsuds and rinsed in clear hot water.
Nipples.—The most important thing about choosing nipples is to select the kind
that can easily be turned inside out to be cleaned. It is best to buy nipples with
out holes and to make one hole near the top with a red-hot sewing needle. If
nipples with holes are bought, it is often necessary to enlarge the holes with a
large needle or hairpin heated in a flame. The hole should be large enough to
allow the milk to drip rapidly when the bottle is turned upside down but not to
flow in a steady stream. New nipples should be washed and boiled before use.
As every nipple must be boiled before it is given to the baby, and as a baby gets
5 or 6 bottles of milk every day and several bottles of water, it will save trouble
to have at least 8 or 10 nipples on hand. They can be boiled together once a day
with the bottles and other utensils. After each feeding turn the nipple inside
out and rinse it in cold water or brush it out with the bottle brush, making sure
that the hole is not plugged with milk. Then put it away in the jar for used
nipples until time for sterilizing.
Cleanliness.
Everything that touches or comes near the baby’s food should be perfectly
clean. Clean milk can be spoiled by dirty handling. The mother should wash
her hands before beginning to prepare the feeding. If she has a cold she should
wash her hands with special care and should not cough nor sneeze over the baby’s
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INFANT CARE
food. A mask of soft cloth or several thicknesses of gauze tied over her nose and
mouth is a wise precaution when the mother has a cold.
How to sterilize bottles, nipples, and so forth.—Every utensil that is to be used
after the milk mixture is boiled must be boiled 5 minutes. This includes the
bottles, nipples, strainer, mixing spoon, and pitcher into which the boiled milk
mixture is measured. The glass jar that holds the boiled nipples must be boiled,
as well as the teaspoon used to take boiled nipples from the jar. Utensils to be
used before the mixture is boiled need only be washed.
Sterilization of the bottles and other utensils should not be done until the mother
is ready to make up the day’s feeding. They should be placed in water in a
covered kettle or pail large enough to allow the water to cover them completely.
The large mixing spoon also should be placed in the pail, the handle resting on
the edge of the kettle, so that when sterilization is complete the spoon may be
used to take out the articles one by one. It is convenient to have the bottles
stand upside down in a rack. They should be filled with cold water and turned
upside down in the rack, which is standing in the kettle of water, and the whole
heated and allowed to boil 5 minutes. When sterilization is complete the rack
may be lifted out and the bottles drained without being touched. After the milk
mixture has been prepared and cooled, turn the bottles right side up in the rack,
being very careful not to touch the neck or lip. They can be filled and placed in
the ice box while standing in the rack.
If the mother has no rack the bottles should be filled with water and placed
in the kettle lying on their sides with the other utensils. When sterilization is
finished some of the water may be poured off and the bottles taken out with the
long-handled spoon which has been boiled with them.
The nipples, as well as the rubber caps or corks for the nursing bottles, should
be boiled for 5 minutes before they are used, either in a small tightly covered sauce
pan or with the other articles in the large sterilizing kettle. After the boiling
take the nipples out of the water with the large spoon, drain them without touching
them with the fingers, drop them into the empty sterilized glass jar, and then cover
the jar. The nipples should be kept dry. When one is to be used take it out
of the jar with a teaspoon which has been boiled and which can be kept in the
same glass jar.
Preparing the feeding.
Always have a copy of the doctor’s written order for the feeding pinned up in
a convenient place so that you may refer to it every day. Have all utensils ready.
The bottles, strainer, pitcher to hold the boiled milk mixture, and large mixing
spoon should have been boiled already in the large sterilizing kettle. A single
saucepan for boiling the milk mixture is usually most convenient, although a
double boiler may be used.
The feeding should be prepared as soon after the milk has been delivered as
possible. Take the bottle of milk from the ice box and, before removing the cap,
wipe the top carefully with a clean cloth. Shake the bottle, to mix the cream
well. Have at hand the sugar and any other ingredients ordered by the doctor.
Measure into the saucepan the required amount of sugar in level spoonfuls,
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smoothing each with a knife. Measure carefully in the graduated measuring
glass the required amount of milk and of water and pour these also into the sauce
pan. (The total amount of mixture—milk, water, and sugar—should be noted,
since during boiling some will boil away and this amount must be made up by
adding boiled water.) Stir the mixture to dissolve the sugar. Place the saucepan
on the stove; allow the mixture to boil (bubble) actively for 3 to 5 minutes, stirring
it constantly. Take the saucepan off the stove and set it in a pan of cold water,
stirring the mixture constantly. The pan of cold water will need to be changed
frequently until the milk mixture is cool. Stirring the mixture while it is cooling
helps to prevent scum from forming.
While the milk mixture is boiling and cooling put the graduated measuring glass
into the large sterilizing kettle, which is still on the stove, and boil it for 5 minutes.
When the milk mixture is cool, measure it a second time, with the sterilized measur
ing glass, pouring it into the pitcher that has been boiled for this purpose. If
there is any scum, strain the milk mixture while pouring it into the pitcher. Then
measure into it enough water, freshly boiled (and cooled so as not to break the
glass), to bring up the total amount of mixture to the number of ounces noted at
the first measuring. Measure the water in the measuring glass.
When filling the bottles it is better to measure the number of ounces to be given
at each feeding in the measuring glass and pour this amount directly from the
measuring glass into the bottle than to depend on the ounce marks on the nursing
bottles, which are not always accurate.
Cover the bottles at once with rubber bottle caps or rubber stoppers or with
squares of wax paper held down by rubber bands. Rubber caps or stoppers
must be boiled every day before they are used.
After the bottles have been filled as they stand in the rack, place them in the ice
box close to the ice.
A double boiler may be used if. it is not convenient to boil the milk or milk
mixture in a single saucepan. Milk cooked in a covered double boiler is held at a
temperature just under the boiling point. If it is cooked for 20 minutes in this
manner, disease-producing germs will be killed and also the milk will be made more
digestible, as in boiling. When the water begins to boil note the time and allow
the mixture to cook 20 minutes, covered tightly. Cool, strain, and measure the
mixture into the feeding bottles.
GIVING THE FEEDING
Warming the feeding.
At feeding time take the baby’s bottle of milk mixture from the ice box, shake to
mix well, remove the rubber cap or stopper, and put on instead a sterile
nipple from the covered sterile jar. The mother’s hands should be freshly washed
before handling the nipple. She should touch only the rim of the nipple in putting
it on. Stand the bottle of milk mixture in a small deep saucepan of warm water.
Special bottle warmers may be purchased, but they are no better than the ordinary
saucepan. Heat the mixture rapidly. It is not necessary to wait until the water
boils. Usually the contents of the bottle become sufficiently warm (100° F.)
in a few minutes. Its warmth may be tested by letting a few drops trickle from
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the nipple on the mother’s wrist, where it should feel pleasantly warm but not hot.
Shake the bottle to be sure the milk is of uniform temperature throughout before
testing. The nipple should not be touched by anyone nor come in contact with
anything until it reaches the baby’s mouth.
If bottle feeding is to be given in addition to a breast feeding as in “mixed
feeding” (p. 54) it should be prepared and warmed before the nursing is started so
that it will be ready to give as soon as the nursing is finished.
How to give the bottle.
Hold the baby in a partly upright position in your lap while he is taking the
bottle. Hold the bottle in place for him. The bottle should be so held that the
nipple is constantly full of milk and not half full of air. If you allow the bottle
to drop to a horizontal position so that air enters the nipple, the baby will suck in
air, which later must be brought up. If he brings up air when lying down he is
likely to spit up some of his food. This spitting up that comes from swallowing air
is not vomiting. To prevent this, raise the baby carefully to your shoulder after
feeding and pat him on the back with the flat of the hand for 2 or 3 minutes. He
will bring up any air that he has swallowed. Then lay him down gently in his
bed. Do not handle him much or quickly after a feeding, as such treatment
tends to make him spit up. Even when not being fed some babies swallow air by
sucking on their fingers or hands and will bring up air at any time if held up and
patted on the back. Such babies should be held up regularly before feeding as
well as after. Occasionally a baby needs to be raised up and patted for this
purpose during a feeding.
Twenty minutes is the longest time and 5 minutes the shortest time that should
be allowed for taking a bottle. If there seems to be delay about taking the
feeding be sure that the hole in the nipple is not clogged. If at the end of 20
minutes the baby has not finished, remove the bottle quietly. He may refuse it
because he is not well. If he is just playing with it, he will be hungry before the
next feeding and take it well when the time comes. Do not give him anything
but water until the next regular feeding time.
Never let a baby go to sleep over his bottle. Do not go off and leave him sucking
his bottle as he may fall asleep before it is finished. Do not give him a bottle with
the idea of putting him to sleep. If this is done, he will learn to associate going to
sleep with his bottle; and when the time comes to wean him from the bottle it
will be difficult to get him to go to sleep without it. It is best to give him his
bottle while sitting or half reclining in your.lap, not in his bed. After he has
finished his feeding and gotten rid of the air in his stomach, put him into his bed
to sleep. He should associate sleep with being put to bed and not with a bottle.
ADDITIONAL FOODS
The artificially-fed baby needs to have foods other than milk added to his diet
even more than the breast-fed baby, as the tendency toward the development of
deficiency diseases (scurvy, rickets, and so forth) is greater in the artificially-fed
baby and he is more likely to be malnourished. The foods to be added to his diet
are the same as those added to the diet of the breast-fed baby. (See p. 57.)
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Cod-liver oil and orange juice (or tomato juice) should both be begun at the
end of the second week. For the artificially-fed baby orange juice or tomato
juice is begun somewhat earlier than for the breast-fed baby. If orange juice is
used begin with one teaspoonful a day in an equal quantity of water. If tomato
juice is used begin with 2 teaspoonfuls a day without water. Increase the quan
tities as described on page 57. The artificially-fed baby is given the same
amounts of cod-liver oil as the breast-fed baby. (See p. 57.)
At the beginning of the fifth month cooked breakfast cereals and egg yolk may
be begun.
During the sixth month strained or mashed vegetables may be started, and baked
white potatoes at the tenth month. Potatoes are to be given not instead of other
vegetables but in addition to them. (See p. 59.)
At the tenth month stewed fruit, such as apple sauce and prune pulp, may also
be started.
Dry toast may be given as soon as the first teeth have come through.
DRINKING WATER
Drinking water should be offered to the artificially-fed baby frequently, just
as it is to the breast-fed baby. (See p. 51.) Water should be boiled before being
given to the baby, and it should not be sweetened.
STOOLS
The stools of an artificially-fed baby are different from those of a breast-fed
baby. They are almost always fewer in number, frequently only one in 24 hours.
The material passed is much firmer, often formed, and with slight odor. The
color varies from lemon yellow, if cow’s milk is the sole food, to dark or light brown
if malt sugar or cereal is used. The stool should be smooth and somewhat pasty
in character, as this shows that the food is well digested. It may be either formed
or unformed.
Loose, green, frequent stools are symptoms of disturbance, and a doctor should
be consulted at once so that some change in diet may be made. Diarrhea is often
a symptom of some serious disease, and it should not be neglected. Constipation
may occur in the artificially-fed baby but is not to be looked upon as a serious con
dition. It can nearly always be dealt with by changing the formula for the food.
Ask your doctor to correct the constipation. Do not give castor oil or other
cathartics except on the doctor’s order. Prune juice may be given or occasion
ally mineral oil for short periods.
DAILY SCHEDULE
The daily schedule for the artificially-fed baby should be just as regular as for
the breast-fed baby. On the whole, the same daily program can be adopted. It
is of great importance to his future health that the baby learn early in life to eat
cereals, vegetables, and egg yolk. (See p. 60 for suggestions on how to teach him
to eat these foods and p. 6 for daily schedule.)
UNDERFEEDING
Underfeeding may mean that the baby is not getting enough of the right food
or is getting the wrong kind of food. Some underfed infants sleep for short periods
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and fret and cry before the regular feeding period, and others may sleep a good deal.
If the baby fails to make regular gains in weight, the food needs to be increased
in quantity or properly modified to suit the baby’s needs or he may be sick.
Consult the doctor.
OVERFEEDING
If a baby after feeding spits up, vomits, has colic, or is fretful, it may be that
his stomach is overloaded. A baby’s appetite will usually regulate fairly satis
factorily the quantity of food taken. If his milk mixture is a weak one he will
want a large amount and may have to take more than his stomach will comfort
ably hold to satisfy his hunger. After he has taken a large amount of weak milk
mixture he may cry either because he is still hungry or because his stomach is
distended and he feels pain. He may spit up or even vomit part of the feeding.
Smaller feedings containing the same amount of milk and sugar but less water
will usually overcome this difficulty.
Sometimes as the bulk and strength of feedings are repeatedly increased the
milk mixture will exceed the needs of a baby both in food value and in quantity,
and the same signs of overfeeding may result. The baby, though taking a large
amount of food, may vomit some of it and possibly make a poor gain in weight.
He may refuse part of the feeding. Smaller feedings should be given so that he
will be really hungry. The amount may be increased again very gradually.
SPITTING UP AND COLIC
Spitting up and colic occur in the artificially-fed baby as well as the breast-fed
baby. They are usually caused by pressure of air in the stomach or of gas in the
intestines or by overfeeding. The methods of treatment are the same as for the
breast-fed baby. (See p. 53.)
WEIGHT
The standards for growth of the artificially-fed baby should be the same as for
a breast-fed baby, but it is often more difficult to reach them. If an artificifillyfed baby receives a diet such as has been outlined on pages 76—77, including all
the additional foods, his growth may be satisfactory. His gain in weight may
not be quite so rapid as that of the breast-fed baby, especially during the early
months, and unless his diet is adjusted very carefully he may not thrive so
well. An artificially-fed baby should be expected to make the same average
weekly gain as a breast-fed baby. He should double his birth weight in 5 or 6
months and treble it in a year.
It is of greatest importance that an artificially-fed baby should be weighed
regularly to make sure that his gain in weight is adequate. If possible he should
be weighed at home once a week and the weight reported to the doctor. If this
is not possible he should be weighed at regular intervals by the doctor. He should
be taken frequently and regularly to a doctor trained in the care of babies. The
feeding should be discussed with the doctor to insure correct modification of the
formula and the addition of the proper foods at the right time.
Child-health centers are provided in many places for mothers who cannot afford
to go to a private doctor for these regular weighings and consultations.
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W eight—Height—Age Tables 1
WEIGHT-HEIGHT-AGE TABLE FOR WHITE BOYS FROM BIRTH TO 1 YEAR
[Without clothes]
17......................
18................
19......................
20......................
21......................
22......................
23.......................
24......................
25......................
26.......................
27 ...................
28......................
29......................
30......................
31......................
32......................
33......................
5«
6«
7«
8
9
10
10«
11«
12«
7«
8«
9«
10«
11«
12«
13«
14
9
10
11
12
13
14
15
16
10«
11«
12«
13«
14«
15«
16«
17«
10«
11«
13
14
15
16
17
18
19«
ii«
13
14
15«
16«
17«
19
20
21«
12
13
14«
15«
16«
18
19
20
21«
22«
14
13«
15
14«
16
15«
17
17
18
18«
19
19«
20«
20«
.
2
1«
21«
23
23
24
24
15
16
17
18«
19«
20«
21«
23
24
15
16
17«
18«
19«
20«
22
23
24
25«
11 months but
less than 12
10 months but
less than 11
9 months but
less than 10
8 months but
less than 9
7 months but
less than 8
6 months but
less than 7
5 months but
less than 6
4 months but
less than 5
3 months but
less than 4
2 months but
less than 3
Height in
inches
1 month but
less than 2
Less th a n 1
month
Average weight in pounds (or each month of age
¡8 *
19
20
21
22
23
24
25
WEIGHT-HEIGHT-AGE TABLE FOR WHITE GIRLS FROM BIRTH TO 1 YEAR
[Without clothes]
17.......................
18......................
19......................
20.......................
21.......................
22.......................
23.......................
24.......................
25.......................
26......................
27............... .
28.......................
29......................
30.......................
31.......................
32........... ...........
33......................
5«
6«
7
8
8«
9«
10
11
11«
6«
7«
8«
9«
10
11
12
13
14
8
9
9«
10«
11«
12«
13«
14«
15«
9
10
11
12
13
14
15
16
17
10«
11«
12«
13«
14«
15«
16«
17«
19
11
12
13
14
15
16
17
18
19
20
11
12
13
14
15
16
17
18«
19«
20«
21«
12
.13
14
15«
16«
17«
18«
20
21
22
12«
13«
14«
15«
16«
. 17«
19
20
21
22
23
13«
14«
15«
16«
18
19
20
21
22
23«
13«
14«
16
17
18
19
20
21
22«
23«
11 months but
less than 12
10 months but
less than 11
9 months but
less than 10
8 months but
less than 9
7 months but
less than 8
6 months but
less than 7
5 months but |
less than 6 j
4 months but
less than 5
3 months but
less than 4
2 months but
less than 3
1 month but
less than 2
Height in
inches
Less th a n 1
month
Average weight in pounds for each month of age
14«
16
17
18
19
20
21«
22«
23«
24«
1 Reanalysis of the weight, height, and age of 20,299 white boys and of 19,493 white girls under 12 months of age, examined
in Children’s Year (1918-19). The number of Negro boys and girls measured and weighed was not sufficiently large to
provide comparable data.
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HOW TO USE THE TABLES
First measure the length or height of your baby by laying him on a table
which has been pushed up close to the wall. Place the baby with the top of his
head touching the wall, his body and legs straight and flat on the table, and hold
him still. Place a book upright against the soles of his feet and mark the spot
to which his heels come. Measure the distance from the wall to the mark with
a yardstick or tape measure.
Find your baby’s age in months at the top of the table (boys or girls).
Find your baby’s height in inches at the left-hand column of the table.
Run your finger straight across from his height to the figure in the column
under his age. The number found at this point-represents the average weight in
pounds of babies of the same age and of the same height as your baby.
When using these tables remember that each weight figure given represents an
average. If your baby’s weight is a little above or a little below the average
weight of babies of his height and age, he probably is within normal limits.
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The Premature Baby
A
BABY who is born more than 2 weeks before the end of 9 months of pregnancy
is called a premature baby. He is r*pt so well developed at birth as the baby who
is born at full term. Since the eighth and ninth months of prenatal life are espe
cially important in the growth of the baby, every effort should be made to prevent
premature birth. However, in spite of such effort and for some causes that are
unavoidable,-a certain number of babies are born prematurely. The earlier the
baby is born, the more difficult it is to keep him alive. A baby born only 2 or 3
weeks before the expected date of birth may be quite strong and little different
from a full-term baby. A baby born 7 or 8 or more weeks early may be very small
and difficult to save. Occasionally a baby born at full term is exceptionally small
and feeble. All babies weighing less than 5 ty-j pounds at birth should be treated
as if premature.
As the premature infant grows older he should gradually become more and
more like a full-term baby. Though small, he should have good color, his muscles
should be firm, and he should gradually become active and alert. He may be
slower than a full-term baby in learning to do some things like holding up his
head and sitting up. If he is protected from infection and gets the proper food
and care he will catch up to the full-term baby in course of time. The time that
this will take will depend on how many weeks before term he was born.
CARE IM M EDIATELY AFTER B IR T H
A premature baby should be given proper care immediately after birth or he
may die from exposure. He should be wrapped at once in a clean, soft blanket
that has been warmed. The cord should be cut and dressed with stèrile gauze.
Mucus should be removed from his mouth and upper throat by means of a small
rubber suction bulb. He should then be placed in a warm bed, and his head
should be turned to one side and lowered slightly by raising the foot of the bed.
A pad of absorbent cotton covered with soft gauze should be used as a diaper.
If the baby is born at home the decision must now be made whether he is to be
cared for at home or in a hospital.
Premature babies that weigh more than 4 pounds and are vigorous can usually
be taken care of satisfactorily at home if the conditions are favorable and certain
precautions are taken. Some smaller babies also do well at home; in fact, they
are often cared for best at home unless a hospital suitably equipped for the care
of such babies is available. If, however, the baby is feeble and difficulty is encoun
tered in making him breathe, very special care is needed which can usually best
be had in a hospital.
A hospital properly equipped for the care of premature babies will have a room
in which these babies can be cared for separately from other babies. It will have
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IN FAN T CARE
doctors and nurses on the staff who are trained to care for premature babies and
who will be able to feed them properly. Some premature babies have cyanotic
attacks (blue spells) and must be given oxygen. Oxygen is always available in a
well-equipped hospital, but it may also be obtained in tanks and administered in
the home, under the supervision of the doctor or the nurse.
The baby should not be taken to the hospital until his breathing is sufficiently
well established to make such a trip safe. Great care should be taken to keep
him warm during the trip, as chilling at this time decreases the chances of saving
his life. To prevent him from losing any of his body heat he should be wrapped
in several soft, clean blankets which have been warmed and he may be carried
in a basket lined with warm-water bottles (115° F.). To prevent burns, a
folded blanket or towel should be placed between the baby and the bottles.
If the premature baby is to be cared for at home, he should be put at once into
a warm bed which has been already prepared for him in a Warm room. (See p.
84 for home-made heated bed.) A physician, preferably one specially trained in
the care of babies, should be called at once and his directions should be followed
closely. If a nurse who has been trained in the care of premature babies can be
engaged, her experience will be a great help to the mother.
The baby’s temperature should be taken by rectum soon after birth. The baby
should not be bathed with water. He may be given an oil bath when his tem
perature becomes normal (98° to 99.6° F.) and stays normal, but only if his general
condition is good and the room temperature is not lower than 80° F. It is much
more important to keep him warm than to give him a bath. The complete oil
bath need not be given for several hours or even several days after birth.
A premature baby should be exposed and handled as little as possible—only
when it is necessary to feed him, give him drinking water, change his diaper, and
give an oil bath. These can be done when he is in bed. The baby’s head should
be raised for feeding. He should be turned from one side to the other as often
as every 2 to 3 hours but should not be picked up and handled unnecessarily.
In caring for a premature baby there are three main problems which must be
kept in mind constantly:
1. How can he be kept warm?
2. How can he be protected from infections?
3. How can he best be fed?
K E E PIN G TH E PREM ATURE BABY W ARM
As the premature baby’s body temperature is easily influenced by his sur
roundings, it is important to keep him warm and at a constant temperature.
The temperature of the room must be maintained between 75° and 80° F. day and
night. A thermometer should be hung on the wall over the baby’s bed but not
near a radiator or a window. Frequent readings of the thermometer should be
made and recorded on a chart. Proper clothing must be used to prevent loss of
heat (see p. 85), and the use of external heat also may be required. The proper
maintenance of body temperature is most important in the first hours and days
of life.
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The temperature inside the crib should be between 80° and 90° F. A thermom
eter should be kept in the crib near the baby so that the temperature in the bed
can be known at any time. The baby’s body temperature should be taken by
rectum every 4 to 8 hours and recorded on a chart. The body temperature should
be kept between 98° and 99° F. If it goes as low as 97° or as high as 100°, this
need not cause alarm. Overheating, however, may be as dangerous as chilling.
The amount of moisture in the air in relation to its temperature is important
to the welfare of the premature b^by. In cold weather the air in rooms heated
artificially becomes dry. When the temperature of an artificially heated room is
75° or over it is well to increase the moisture in the air by boiling water in an open
pan or teakettle or by putting some other type of vaporizer in the room. In hot
weather the air may become too moist. To decrease moisture is difficult, but an
electric fan running slowly will keep the air in motion and make the room more
comfortable. It should be placed so that the air does not blow on the baby’s bed.
THE PREMATURE BABY’S ROOM
The premature baby’s room should be small and should have a good source of
heat, preferably hot-water radiators. A small room is easily heated and is easier
to maintain at a constant temperature than a large room. One window, or prefer
ably two, allows for sunlight and for ventilation by opening at the top. A narrow
cloth screen (2 inches or more, according to the climate) may be used at the top
of the window. (See p. 17 for Construction of screens.)
HEATED BEDS
Some provision must be made for keeping the premature baby’s bed warm.
It is important to keep the temperature constant, at a point to be decided on
from about 80° to 90° F., or even higher, depending on the size and vigor of
the baby. In many hospitals special beds are used, which are heated electrically
and regulated automatically. In the hospital or the home less expensive and
simpler types of heated beds may be used with success.
The simplest type of warm bed for a small baby is a small clothes basket lined
with cotton cloth or a thin blanket. This basket may then be placed inside of a
bassinet or a box lined with
quilting or a blanket (see il
lustration). Between the sides
of the basket and the box, hotwater bottles of rubber or met
al, heated bricks, or bags of
heated sand should be put. In
this way the source of heat will
be kept in place and there will
be no danger of its coming in
contact with the infant. Bricks
or bags of sand should not be
made so hot that they cannot
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INF AN T CARE
be handled with bare hands. If hot-water bottles are used they must be .refilled
frequently to keep the temperature inside the bed constantly between 80° and
90° F. It is best to refill one bag at a time, so as not to cool the bed. The
bottles should be at 120° to 130° F. (Electric pads are not safe for this purpose.)
A folded sheet or blanket should be put over the baby but not over his head.
Another type of warm bed can be arranged by using a small box, well padded
inside and outside with quilting, into which is fitted a removable platform about
4 inches above the padded floor. A thin,
flat hair pillow or several layers of wool
blankets should be used as a mattress to
cover the platform. Beneath the plat
form, on the floor of the box, two or three
hot-water bottles may be placed. An
opening should be cut in the side of the
box below the platform so that the hotwater bottles can be removed for refill
ing without disturbing the baby. (See
illustration.)
If, in an emergency, warm-water bottles must be placed beside the baby they
should never be warmer than 115° F. and should be so arranged that they will not
come in contact with the baby. The baby should be well wrapped in a blanket
to keep the bottles from touching any part of him. A rolled bath towel placed
between the baby and the warm-water bottles will give added protection.
If the house is wired for electricity, an electrically heated wooden box can be
made at home and used as a cover or hood by inverting it over an ordinary
F o o t e n d and TOP
(Sm all siz e )
E le c tric a lly h e a te d ■wooden box to be u sed on bed.
crib or bed. One end of the box should have an opening-—about 6 by 8 inches—
large enough to allow the baby’s head to be outside the box. Hang or tack over
this opening a washable cotton curtain, the end of which should be tucked in
around the baby’s neck to keep the warmth from escaping. (See illustration.)
There should be an electric socket at the foot end of the box, into which a bulb
covered with a wire guard is fitted. As a rule a 40-watt bulb will produce suffi
cient heat. The cord should be well insulated, especially at the point at which
it passes into the bed. Cut a square opening in the top of the box and lay
over this opening a piece of glass or mica, large enough to be pushed back and.
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IN FAN T CARE
85
forth so that the size of the opening can be altered. The heat can then be reg
ulated by turning the bulb on or off and by opening or closing the top window.
The temperature inside the box should be determined by means of a long
thermometer, which is inserted through a cork placed in a hole in the top of the
box and pushed down 2 to 3 inches into the box. Place the thermometer at about
the middle of the box away from the electric bulb. Readings can be made from
the outside if the section above the 70° mark remains above the cork. Since the
baby’s head is outside the box he will be breathing the air of the room. The
room should be kept warm but it should be ventilated, when possible, by having
the window open a little way at the top.
C L O T H IN G
The premature baby should be wrapped in a warm blanket immediately after
birth. A sleeveless padded jacket may be prepared, and it may be best to con
tinue the use of such a jacket for a week or two
after the baby’s birth. The jacket may be made
of two squares of cheesecloth or of some very soft
cotton material (18 inches square) with a thick
layer of cotton batting stitched between and a
piece of the padded material arranged as a hood.
It should be long enough to cover the feet well
and wide enough to lap over and be pinned in
front. (See illustration.) It may be opened at
the bottom for changing the baby’s diaper. When
the jacket is soiled, it may be burned and a new
one substituted.
Small squares of absorbent cotton covered with
soft gauze may be used as diapers. These pads
can be easily changed when they become soiled.
The clothes that have been prepared for the baby are as a rule much too large
if he is born prematurely, and substitutes should be prepared which can be put
on and taken off with the least possible handling of the baby. Nightgowns of
flannel or stockinet are all that the small baby will need for several weeks. They
should open in the back and have tape ties. When a special warm bed is no longer
necessary, the premature baby may be dressed as any newborn baby would be
dressed. (See p. 20.)
B A T H IN G
For very small and weak babies it is advisable not to give any bath for 2 or
3 days, unless it is necessary for the doctor or the nurse to use a warm bath to
stimulate the baby because he does not breathe well. Later, when his breathing
is well established and his temperature is normal, a partial oil bath may be given
daily; only the buttocks, genitals, and folds of the skin are washed—without
removing the baby from the heated bed and without exposing the rest of the body.
The oil should be warm but rtot hot and only one part of the body should be
exposed at a time to prevent chilling. Care should be taken to apply the oil
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INF AN T CARE
gently with cotton and not to rub the skin. The larger and more vigorous pre
mature babies may be given complete oil baths daily after the first few days.
P R O T E C T IN G FRO M IN F E C T IO N
Premature babies have very little resistance to disease. They are particularly
subject to infections, especially colds. A cold is serious in a premature baby
because it is very likely to develop into pneumonia, which may prove fatal.
Every person who cares for a premature baby or comes in contact with him in
any way must be careful to wash the hands before touching him lest some infection
be carried to him. No one who has even a slight cold or other infectious illness
should be allowed to take care of or go near a premature baby. Visitors, especially
young children, should never be permitted in the room where a premature baby is
kept. These rules cannot be kept too strictly. Colds, ear infections, and
pneumonia are common causes of death in premature babies.
FEEDING
HUMAN MILK
The proper feeding of a premature baby is especially important. Until the
mother’s milk is established, every effort should be made to get at least a few
ounces of milk daily from some other nursing mother or from a breast-milk
agency. Any milk except that of the premature baby’s own mother should
be boiled for 1 to 2 minutes in an open saucepan or cooked in a double
boiler for 10 minutes.
It is wise to delay putting a premature baby to the breast until his
breathing and swallowing are well established; otherwise the effort of nursing may tire him or he may even be smothered. If the baby is too weak
to nurse at the breast or to draw milk from the nipple of a bottle, the
mother’s milk should be expressed by hand or by means of some type of
breast pump and fed to the baby slowly by means of a medicine dropper.
(For hand expression, see p. 49.) If a medicine dropper is used, it is well to
slip a short piece of soft rubber tubing over the end to prevent injury to the
baby’s mouth. The medicine dropper and rubber tip must be boiled each time
before being used and carefully cleaned after use. Care must be taken not to
give the milk faster than the baby is able to swallow it. Some babies are so
weak that feeding must be given with a stomach tube (so-called catheter feeding);
this should be done only by a trained person. A strong premature baby may
be able to nurse or to take breast milk from a bottle.
As it may be some weeks before the baby is able to draw even small amounts
of milk from the breast it may be necessary for the mother to empty her breasts
at regular intervals by hand or by breast pump, not only to obtain milk for the
baby during the early weeks of life but to keep up the milk flow until the baby is
strong enough to nurse.
Expression of milk from the mother’s breasts should be begun at the end of
12 hours; and the colostrum—and the milk when it comes—should be given to
the baby.
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Care should be taken that the baby is not overtired during feeding.
If breast milk cannot be obtained, artificial feeding will become necessary.
(See p. 61.) The doctor will decide upon the milk mixture to be used.
NUMBER AND AMOUNT OF FEEDINGS
The time at which it is safe to begin to give water and milk to a premature baby
depends upon his size and vigor. For feeble babies some authorities consider it
well to withhold water for as long as 12 hours and then to give small amounts with
a medicine dropper 0/2 to 1 teaspoonful) at 3- or 4-hour intervals. If the baby is
vigorous he may be given water 6 to 8 hours after birth and then at 3 - or 4 -hour
intervals. Milk feedings may usually be begun after the baby is 18 hours old.
The schedule on page 10 has been prepared for temporary use. The doctor
will give a schedule suited to the baby’s needs. The premature baby needs daily a
total amount of fluid (milk and water) equal to about one-sixth to one-seventh of
his body weight in pounds. For instance, if the baby weighs 3 pounds he will need
daily one-sixth of 3 pounds, or three-sixths (one-half) of a pound of fluid. As 1
pound is equal to 16 ounces, one-half pound will be equal to 8 ounces. The
3-pound baby’s full requirement of fluid during 24 hours therefore will be 8
ounces.
Such quantities, although needed, cannot always be given to the premature
baby during the first days of life. The amount given daily will at first be small
and the increase gradual. In fact, it is fortunate if the baby can take one-eighth
of his body weight in total fluid (2 ounces for each pound of body weight) by the
fourth day. If the baby is unable to take sufficient fluid by mouth the doctor
may give additional fluid by injecting it under the skin (normal salt, Ringer’s, or
a comparable solution).
The quantity of milk given to very small babies in 24 hours for the first few
days will be half an ounce to an ounce of milk for each pound of body weight.
This will be divided into 7 to 12 feedings; each feeding will therefore be very
small—1 to 3 teaspoonfuls of breast milk. The total amount of milk given in 24
hours may be increased daily by one-eighth to one-fourth ounce for each pound
of body weight, until by the tenth day the total amount of milk taken in 24 hours
usually will be 2 to 3 ounces per pound of body weight. The rapidity with which
the amounts can be increased will vary with the size and development of thè
individual baby.
If it is not possible to get breast milk for the premature baby, some form of
cow s milk may be used. Various milk mixtures have been used with success,
but they must be ordered by the physician. If it is not possible to get the physi
cian s advice at once, one of the following milk mixtures may be used temporarily,
in the same amounts and at the same intervals as given in the schedule for breast
feeding:
Evaporated milk, 3 ounces.
Water, 6 ounces.
Granulated sugar, level tablespoonful.
1
j (Half-skimmed cow’s milk,* 8 ounces.
lor j Water, 2 ounces.
[Granulated sugar, level tablespoonful.
J
1
* Half-skimmed cow s milk is obtained by removing half of the cream from the top of the bottle.
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OO
Oo
SUGGESTED FEEDING SCHEDULE FOR PREMATURE BABIES
B a b y w eighing less than
Breast milk
Number of
feedings
Amount
3y2 0>s.
B a b y w eighing
Number of
times given
Amount
Number of
feedings
Amount
Number of
feedings
Amount
3
>/2 - l
Vo
1
>/2
| p
Vo
1/ 2
3d d a y ....................
4th d a y ...................
5th-7th d ay ............
8th—10th d a y ..........
11th—14th d a y . . . .
8
8
8
8
8
8
V2-I
1 -IV 2
1'/ 2- 2’/ 2
6
2 -3
3 -4
3</2-5
6
6
6
2 - 21/2
2>/2-3
2 -3
.2 -3
15th—17th day . . . .
18th—
21 st day . . . .
8
8
4 -5 </2
4>/2-6
6
6
2 -3
2 -3
6
1 -iy 2
6
i
p
8
8
8
8
8
8
1
1
1
1-2
l
1 -2
—1
1 -2
6
1>/2-3
2’/ 2-4
3 -5
4 -6
5 -7
6
6
6
6
4
1
- l '/ 4
8
1
-lv S f
3V2-4
3
3
4
3
2
3
4
5
-3
-4
6
6
-6
-8
6
6 -9
6 -9
6
6
6
8
F8
'A
'A
or
\6
1 '/ 4 - 1 3/4
l'/2 - l3/4
2
—
iy 2
2-3
2-4
3-4
4
3
3
Ounces
O unces
Ounces
Ounces
8
8
8
8
8
8
8
1 -2
2 - 2 y2
21/ 2-3 '/2
3
3
3
1A
'A
y2
N o t e — The schedule is arranged so that milk is given every 3 hours, at 3, 6 , 9, and 12 o’clock. Water is given midway between feedings except at 1:30 a. m. and 4:30
a. m. It may be necessary to feed very small or weak infants every 2 hours. Increases in the feeding should be made gradually, not more than y2 teaspoonful a t a feeding.
For infants weighing less than 2'/2 pounds the increase should not be more than '/4 teaspoonful at a feeding. When the baby is taking 2 '/2 to 2% ounces of breast milk
per pound he is receiving as much as is usually necessary for gain in weight. Further increase in feeding is made as the baby gains weight and therefore requires more food
to supply 2 >/2 to 2 % ounces per pound. After the baby has begun to gain satisfactorily and is taking his feedings well, the interval between feedings may be increased and
more milk given at each feeding.
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i
I N F A N T CARt,
y2
Amount
Teaspoonfu ls
y2
Vi
2d d a y ....................
Number of
times given
Teaspoonfu ls
T easpoonf u ls
2
4y2-5y2 lbs.
Boiled water
Breast milk
Number of Amount
times given
Teaspoonf u ls
Teaspoonfu ls
T easpoon f u ls
B a b y w eighing
Boiled water
Breast milk
Boiled water
3y2-4tf2 lbs.
I N F A N T CARE
89
Sugar may be used in the form of granulated sugar or corn sirup or in any other
form ordered by the doctor.
If a cow’s milk mixture is ifted it must be thoroughly cooked for 20 minutes in
a double boiler. The boiler should be covered to prevent evaporation. Evapo
rated milk has been cooked in canning so that it is necessary only to boil the water
when making the mixture.
DRINKING WATER
During the period when the baby is receiving very small feedings of breast
milk, special care must be taken to give him small quantities (j/2 to 2 teaspoonfuls)
of tepid boiled water between feedings. He will need this to bring his total intake
of fluid up to even the lowest requirement— 2 ounces for each pound of body
weight. As he takes more milk he may take less water, but it is well to offer
water to him between feedings even when he is strong enough to take an adequate
amount of fluid at his feedings.
WEIGHT OF BABY
Although occasionally premature babies will hold their birth weight, most of
them will lose weight and should not be expected to regain their birth weight until
the second week or—what is more likely—the end of the third week or even later.
For very small premature babies an average daily gain of one-third to one-half
ounce, with a doubling of birth weight in 75 to 100 days, may be considered satis
factory. The baby should be weighed daily if he is vigorous; otherwise he should
be weighed every 2 to 3 days.
ADDITIONAL FOODS
Premature babies are very likely to develop rickets, and therefore it is impor
tant that some form of antirachitic treatment should be begun at the end of the
first week of life. Premature babies usually require about twice as many units of
vitamin D— 1,000 to 1,500 units—as do babies born at term. For the premature
baby it is best to give vitamin D in some concentrated form (tested), a few drops
of which will contain the necessary number of units. Some form of fish-liver oil
that has a high concentration of vitamin D or some other form of vitamin D may
be used, but the doctor should be consulted about the form and the exact amount
of vitamin D to be given.
If a concentrated form of vitamin D is not available and if the infant is vigorous
and swallows well pure cod-liver oil may be given. Begin with one-fourth tea
spoonful of cod-liver oil twice a day, and after 2 to 3 weeks increase this amount
to one-half teaspoonful twice a day. When the baby is 6 weeks old this amount
may be increased to 1 teaspoonful twice a day, and in the third month to V/2 tea
spoonfuls twice a day. At first the cod-liver oil may be given with a medicine
dropper, the tip of which is covered by a short piece of rubber tubing; later a
teaspoon may be used.
Orange juice—one-half teaspoonful in water once a day—should be begun when
the baby is 2 weeks old. As rapidly as the baby is able to take more orange
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INFANT CARE
juice the amount should be increased until he is taking the amount recom
mended for a full-term baby of his same age. As the premature baby grows
older other foods should be added to his diet as tHfey are to the diet of the fullterm baby. (See p. 57.)
O U T D O O R LIFE
Since changes in temperature are to be avoided for the premature baby, he
should not be taken outdoors while very small. The age at which he may be
put outdoors varies with the size and degree of prematurity of the baby and with
the weather and season of the year. After he has attained the size and vigor of a
2 -month-old baby, he may be put outdoors in the same way that a full-term baby
of this size would be.
Sun baths cannot be given to small premature babies. When the baby grows
larger and more vigorous sun baths can be given just as they are given to
full-term babies. (See p. 34.) Because the sun baths cannot be given early in
life, special effort must be made to give some form of tested vitamin D. Sun
baths with artificial sun lamps may also be ordered by the doctor.
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The Sick Baby
W H A T A M O TH ER SHOULD N O T E
W h e n the baby is well the mother should observe the usual position of his body, his usual
activity, the usual amount of sleep, the expressions of his face, and the color and condition of his skin,
so that signs of discomfort, pain, irritability, or unusual drowsiness can be noticed quickly. The
character and number of bowel movements and the amount and color of the urine should also be
watched.
The mother should learn to read a clinical thermometer. She can purchase a rectal thermometer
(one with a thick bulb) at any drug store, and the doctor or the druggist will be glad to show her how
to read it. It is best not to make a practice of taking the temperature unless the baby seems to be ill
Before using the thermometer shake it down until the mercury is below 97° F., and smear the bulb
with petroleum jelly or oil. To take the baby’s temperature place him face downward on your lap
separate the buttocks with one hand and with the other put the bulb end of the thermometer about
one inch into the rectum (the lower part of the bowel). Hold it there for 5 minutes. Keep the baby
quiet and hold his legs firmly so that the thermometer will not be broken. Do not leave the baby
nor even let go of the thermometer while it is in the rectum.
A baby’s temperature normally ranges from 98.6° to 99.6° F. If it is higher than 100° F. the
doctor should be notified. A baby is more likely to have fever when he is ill than an adult, and when
he has fever it is likely to be higher than with an adult. A rise in temperature frequently accompanies
even a slight upset. A daily rise of temperature, even if slight, lasting for a long period, is often
just as important a symptom as a higher temperature for a short period, or even more important.
A baby who is sick may have fever at any time of the day or night, but it is likely to be higher in
the evening than in the morning.
EARLY SIGNS OF ILLNESS IN A BABY
If a baby develops any of the following signs he should be put to bed, his temperature taken, and
the doctor called:
1. Fever. If the baby’s face is flushed or his skin is hot to the touch—the whole body, not merely
the hands or feet—he may have fever and his temperature should be taken.
2. I r r ita b ility or drow sin ess. If a baby shows unusual restlessness, is irritable and cries consid
erably, or if he is unusually drowsy and wants to be let alone, h t may be ill.
3. V om itin g. Any sudden or unusual vomiting should be considered a sign of illness. It may be
the first sign of a contagious disease or of a digestive upset. It should not be confused with mere
spitting up of food. (See p. 53 for spitting up.)
4. D iarrh ea. A sudden increase in the number of stools, especially if they are loose and watery,
is a sign of illness. Such diarrhea may mark the beginning of a digestive disturbance or of an acute
infection. Pus, blood, or an unusually large amount of mucus in the stools is a sign of disease of the
intestines (bowels).
5. R e fu s a l o f food. Sudden refusal of the accustomed food may be the first sign of illness. This
is not the same as refusal to eat a particular food because of unfamiliarity with it. Pain or swelling
in the throat may be a cause. Food should never be forced, whether the baby refuses it through
illness or for any other reason, even temper. (See p. 40 for method of dealing with refusal to eat.)
b- P a in . If a baby cries and is restless and pulls his legs up over his abdomen he may have pain
in the abdomen. If he holds his legs or arms very still, he may have pain in them. The legs may be
held in one position, and when the mother touches them the baby may cry. Pain in the ear may be
shown by constant turning of the head or by pulling at the ear. Very often the mother cannot tell
just where the pain is, as the baby shows it only by sharp crying and general irritability.
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INF AN T CARE
■ 7. C o ld in h ead w ith fever. A running nose or redness or discharge from the eyes, coughing, or
unusually rapid breathing is a sign of illness. It may be the beginning of a cold or of a contagious
disease such as measles, or of some other severe infection.
8. H oarsen ess or cro u p y cough. If a baby’s voice becomes in the least hoarse, the doctor should
be called a t once, as this may be an early sign of diphtheria.
9. R a sh w ith fever. Any rash or breaking out on the baby’s skin should be considered a sign of
illness, and his temperature should be taken.
10. C onvulsions. Spasms, spells, or twitching of face or arms or legs may be a very early sign of
some serious disease in a baby. C a ll the doctor im m ediately.
W H A T T O D O BEFORE TH E D O C T O R COMES
Follow these rules while waiting for the doctor to come:
1. Keep the baby quiet and leave him in his bed in a cool room away from the other children.
2. If there is vomiting or diarrhea, stop all food.
3. Give small amounts of boiled water frequently, at least every hour, unless the baby vomits
persistently; in that case do not give even water for 2 hours. If the doctor has not arrived by the
end of that time, begin giving small amounts of water (1 to 2 teaspoonfuls) every half hour. If the
vomiting has stopped, increase this amount gradually and lengthen the interval until he is taking
2 to 3 ounces or more every hour.
4. Keep a record on paper of the baby’s temperature, the number and kind of his stools, and the
number of vomiting spells.
5. Save the baby’s stools for the doctor to see.
6. If the baby has pain in the abdomen or if it is distended (puffed out) and the doctor is long in
coming, give a small enema of warm water (see p. 93). N ever give a cathartic.
C A R IN G FOR A SICK BABY
A sick baby should be kept in bed in a cool (60° to 65° F.), quiet, well-ventilated room and should
be allowed to sleep or rest undisturbed as much as possible. The sickroom should not be a gathering
place for the family or the neighbors. Even if no contagious disease is suspected, a sick baby should
be kept away from other children.
The doctor’s orders should be carried out carefully and exactly.
The following are general directions for nursing care, which should be observed unless the doctor
orders otherwise.
BED CARE
A baby should be kept in bed as long as he has a rectal temperature higher than 99.6° F. If his
illness has been at all severe, he should stay in bed from 3 days to 1 week after his temperature has
remained normal (98.6° to 99.6° F.) for 24 hours. The after effects of many diseases may be largely
prevented by this precaution.
The baby’s position in bed should be changed occasionally not only to rest him but also to prevent
congestion in any part of his body and to prevent soreness of the skin.
BATHS
A sponge bath should be given daily instead of the usual tub bath. If the baby has a high fever
(over 104° F.), a sponge bath with water at about 90° F. may be given once or twice a day or oftener.
Every precaution should be taken in bathing a sick baby not to chill him. If his hands and feet are
cold, well-wrapped warm-water bottles may be used.
ELIMINATION
If a sick baby is not taking much food his bowels may not move as frequently as usual. If there has
been no movement for 48 hours or if the abdomen is distended, an injection or enema of warm water
may be given. If the baby urinates less frequently than usual more water should be given him to
drink unless he is vomiting everything taken by mouth.
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How to give an enema, or injection.
For an enema, or injection, buy a bulb syringe holding 1 to 3 ounces. Prepare warm, soapy water,
using mild unmedicated soap. To fill the syringe, squeeze the bulb while holding the tip under
water; then release it and it will fill with water by suction. Let the baby lie on his back across your
lap or on a table with the buttocks somewhat raised by a folded towel under his hips. (This position
will cause the water to run up into the bowel more readily and the towel will catch any drip.) Grease
the tip of the syringe with petroleum jelly. Lift the baby’s legs with the left hand and with the
right introduce the tip into the rectum for about an inch, and slowly squeeze 2 or 3 ounces of the water
from the bulb. If gently and slowly done, this causes the baby little or no discomfort. If he is badly
constipated the starting of the bowel movement may be somewhat painful.
When the liquid has been injected, remove the syringe and hold the buttocks together for a few
minutes to keep the water in before placing over the chamber. The water sometimes comes out as
the syringe is withdrawn and therefore the mother’s clothing should be well protected. If the first
injection does not bring about a bowel movement, give one more.
A soap stick or other suppository may be used instead of an enema. Neither enemas nor supposi
tories should be used over long periods of time, as they may cause irritation of the rectum.
FOOD
If the baby has fever the strength of the milk mixture should be reduced, and all solid foods cut out
of the diet until the nature of the illness is known. If a bottle-fed baby vomits or has diarrhea all
food should be stopped and small amounts of boiled water given every hour. The doctor should be
consulted, if possible, before the feedings are given again. If a doctor cannot be seen soon and the
vomiting or diarrhea stops, small feedings may be begun. If a breast-fed baby vomits or has diarrhea,
one or two feedings should be omitted and a small amount of water given every hour. As soon as
the vomiting or diarrhea stops the breast feedings may be started again at the regular hour. For a
few feedings it may be wise to allow the baby to nurse only 5 minutes. (See section on Diarrhea,
p. 94.) Illness accompanied by fever often lessens the baby’s ability to digest food. He may not
want to take as much as usual and should not be urged to do so. Unless the illness is a long one it is
better for him to take only as much food as he wants.
In illness involving no digestive disturbance the baby should have the regular milk mixture, and he
may have solid foods, such as cereal, vegetable, egg, and the pulp of stewed fruits, if he is already used
to them, unless the doctor orders a special diet.
WATER
Drinking water is of the greatest importance in illness. Unless there is continuous vomiting boiled
water should be offered at very frequent intervals while the baby is awake, possibly every hour, and
the amount taken in 24 hours should be written down. If there is no digestive disturbance, orange
juice may be added to the water if the baby will take more this way.
C O M M O N DISORDERS
VOMITING
Vomiting should be distinguished from spitting up or spilling over, which has been discussed on page
53. Vomiting is the sudden throwing up of the previous feeding or a large part of it, or of water, and
may occur immediately after a feeding or even several hours later. It may be a symptom of digestive
disturbance or an early symptom of an infectious disease. When a baby that has been previously
well vomits, it is best to stop the food, giving only boiled water until the cause is determined. In all
cases of repeated vomiting or sudden vomiting with fever a physician should be consulted.
Repeated explosive or “projectile” vomiting in a very young baby may mean that there is an ob
struction in the stomach. Such an obstruction may require an operation.
The loss of body fluids from persistent vomiting, especially when accompanied by diarrhea, may
rapidly reduce the baby to a critical condition. Extreme restlessness or drowsiness in a vomiting
baby is a sign of a serious condition. There should be no delay in seeking a doctor’s advice in any
case of repeated vomiting.
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DIARRHEA
Diarrhea is the passage of too frequent or too loose stools. Serious attacks of diarrhea may occur
in any season, but they are especially common in warm weather. They may accompany fever due
to any infection. Severe diarrhea may result in acidosis.
Whenever a baby has watery stools, or mucus and blood in his stools, or if an artificially-fed baby
has even a slight diarrhea all food should be stopped. The doctor should be called at once, for the
diarrhea may be caused by an acute infection or some other condition th at should be treated
promptly. He will regulate the feeding.
Diarrhea should always be considered serious and should therefore be treated by a doctor. If none
is available allow the baby no milk for 24 hours and return to normal feeding very gradually. At
first give diluted skimmed milk that has been boiled for 5 minutes. The mixture should be started
at half the previous strength, and the feeding at first should be smaller than usual. The strength and
amount of the feeding should be increased gradually.
Constipation should not be considered a disorder. (For habit training and regulation of the bowels
see p. 41.)
SCURVY
Scurvy is a disease which results from an insufficient amount of vitam in C in the food. It is pre
vented or cured by giving foods which contain this vitamin. Breast-fed babies whose mothers have
a good diet rarely get scurvy; it is found chiefly in babies who have been fed artificially for long
periods and who have had insufficient amounts of foods which contain vitamin C in their diet. Of the
foods which prevent scurvy the most convenient are orange juice and tomato juice. Lemon juice and
grapefruit juice are as effective but are more difficult to give. Pineapple juice, raw apples, bananas
and some other fruits contain vitamin C but in smaller amounts. Canned fruit juices, if prepared
by a reliable firm, may be used to supply vitamin C. Prune juice does not contain this vitamin in
satisfactory amounts. Vitamin C is also found in many vegetables.
The chief symptom of scurvy is a tendency to bleed. Because the bleeding most frequently occurs
around the bones the first thing that is noticed is usually soreness of the legs or arms; the baby cries
when he is picked up or the diaper is changed; he does not like to be handled. In more severe cases
there is failure to gain, there may be bleeding from the skin, and if the baby has teeth the gums around
them may bleed. Improvement is rapid when sufficient vitamin C is given.
RICKETS
Rickets is a common nutritional disease occurring during the period of most rapid growth in infancy
and early childhood. It affects the whole body but most strikingly the bones, which may become
greatly deformed, and the muscles, which become weak and flabby. Rickets usually starts in the first
months of life, when the baby is growing most rapidly, but may not be recognized until later, when the
weakness of the muscles and the deformities of the bones (such as bowlegs) become pronounced.
The baby with rickets may be restless, irritable, and pale. He may be slow in teething and in
learning to walk. His weight may be normal.
If a child’s chest bones áre greatly deformed by severe rickets, the deformity may prevent his lungs
from expanding properly. A child who has rickets is often not able to throw off infections as a norma]
child does. Thus, although rickets does not cause death it may have complications that do. A
severe complication of rickets is a serious disease called tetany, sometimes resulting in convulsions.
Artificially-fed babies are more likely to develop rickets than breast-fed babies, but breast feeding
does not prevent it.
A rapidly growing baby is more likely to develop rickets than a baby who is growing more
slowly. A premature baby is especially likely to develop rickets, as he grows faster during his early
months than a full-term, normal baby.
The disease is caused by lack of a certain factor, called the antirachitic factor or vitamin D, provided
by cod-liver oil and some other substances and by certain rays of the sun, the ultraviolet rays. It
occurs chiefly in climates where the sun’s rays are not very strong except in the spring and summer;
namely, the Temperate Zones.
Rickets may be prevented or cured by giving cod-liver oil or other substances containing vitamin
D or by giving sufficient direct sunlight, or still better, both.
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CONVULSIONS
Convulsions in babies are frequently associated with serious diseases, such as pneumonia, menin
gitis, and tetany, and may vary in length from a few seconds to an hour or two. A doctor should be
called a t once even though the convulsion has ceased. After a seizure of this kind a baby should stay
quietly in bed for several days. He should be given nothing but water for the first 24 hours and for
several days the amount of food given should be considerably less than usual.
It is important that the cause of the convulsions be determined. Sometimes the cause is hard to
find, but it is unwise to attribute convulsions in an otherwise apparently normal child to “teething.”
HEAT RASH OR PRICKLY HEAT
Heat rash may appear either in summer or in winter; it is usually caused by excessive perspiration
due to too warm clothing. A rash of fine red spots usually comes out first on the neck or the chest.
The parts affected should be sponged frequently, or dabbed with bicarbonate of soda and water
(1 teaspoonful of soda to a pint of water), or powdered with starch. Using lighter clothing for the
baby usually relieves the condition, but it may be necessary for a while to put soft muslin or linen next
to the skin.
CHAFING
Chafing is a redness or irritation of the skin appearing in the folds of the skin or on parts of the skin
that are rubbed by the clothing. It is frequently found in fat babies. Chafing may occur on the
buttocks if wet diapers are not removed soon enough, if the skin is not carefully cleaned and dried
after a bowel movement, or if the soap has not been carefully rinsed out of the diapers. (For care of
diapers see p. 22.) Rubber pants may cause irritation of the skin by preventing evaporation. Clean
liness is of the first importance in preventing this condition. Little or no soap should be used in bathing
the chafed parts. Bran instead of soap may be put into the water for bathing, or oil may be used for
cleaning the irritated skin instead of water. The buttocks and thighs should be wiped off with mineral
oil each time the diaper is changed. Talcum powder or dry starch powder should be used sparingly,
if a t all, because powder cakes in the creases.
ECZEMA
A variety of skin disorders common in infancy are grouped under the general name of eczema. It
is a roughness of the skin usually accompanied by itching which appears most often on the face but
also on other parts of the body. Certain babies show a tendency to eczema from birth. It may occur
in either breast-fed or artificially-fed babies. The cure is frequently a long, slow process. All infants
with eczema should be under the care of a doctor, who will regulate the diet and direct the local
treatment. Eczema may come and go, but it is always increased by dirt and scratching.
In general, it is well to use oil instead of water in bathing a baby that has eczema. Scratching and
rubbing must be prevented, and usually some restraint of the hands is necessary for this. To keep
the hands from reaching the face, cuffs or tubes, made of cardboard or other stiff material that pre
vent the elbows from bending, may be fastened to the baby’s sleeves. (See illustration, p. 43.)
SCABIES (THE ITCH)
Scabies, commonly called “the itch,” is an infection of the skin caused by a mite that burrows under
the skin. This results in a fine red eruption, and severe itching.
Scabies is always contracted from some person who has the infection. It is easily spread and if any
person in the family has it prompt treatm ent is necessary to prevent others from getting it. The
doctor should be consulted for advice regarding treatment. Boiling or baking of all bedclothes and
clothing should be done daily until all signs of the infection have disappeared.
IMPETIGO
Impetigo is another skin infection which is usually very contagious. It begins with one or more
papules (pimples) topped by small blisters that contain clear or yellowish fluid. In a few days these
dry and form a crust. If not treated, the condition may spread over the body and last for several
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weeks, but with proper treatm ent it usually clears up in a few days. A doctor should be consulted.
Great care should be taken to keep the baby away from any child who has this disease.
The infant’s nails should be kept cut short and scrubbed with a nail brush and soap and water.
Great care should be taken to prevent scratching. Scratching of the skin infected with scabies may
cause impetigo in addition and the two conditions are very difficult to treat when combined.
THRUSH
Thrush is a disease of the mucous membrane caused by putting dirty objects into the mouth.
When a baby has thrush small white spots are found on the inside of the cheeks and, less frequently,
on the lips, gums, and tongue. Great care should be taken not to hurt the mucous membrane, for if
it is irritated the condition will become worse. If the condition is severe, feedings may be given by a
spoon or cup until the disease has disappeared. Give the baby 4 or 5 teaspoonfuls of water to
drink after each feeding to rinse his mouth, but never swab nor wipe out the mouth except under the
direction of a doctor.
To prevent thrush, sterilize (boil) everything that is likely to be put into the baby’s mouth. Never
allow a baby to put an unboiled rubber nipple into his mouth. Never give him a pacifier. Do not
wipe the inside of his mouth with a cloth or gauze.
WORMS
Pinworms are practically the only worms common in infancy. When they are present, examina
tion of a stool recently passed will reveal tiny threadlike worms less than half an inch in length. These
worms come out of the rectum and lay their eggs on the skin in this region.
Worm medicines must not be given except on the advice of the doctor. A medicine powerful
enough to kill worms may harm a baby unless it is given with great care under a doctor’s orders.
COLDS
Babies frequently have colds in the head because they are thoughtlessly permitted to be near
someone with a cold. Colds are contagious, and the baby should be kept away from a child or an
adult who has one. What is “only a cold” in an adult may be serious illness for a baby and develop
into bronchitis or pneumonia. The infection may involve the throat and cause tonsillitis. Earache
and “running ear” are commonly caused by colds. If a baby has colds often, the adenoids may be
enlarged or infected.
Colds in the head cause difficulty in breathing and nursing. The baby’s nose should be wiped
gently with a soft cloth or tissue. The doctor may order some drops to be put in the nose with a
medicine dropper which will shrink the lining of the nose so th at breathing will be easier. Do not
put mineral oil in the baby’s nose.
Rest in bed is an essential part of the treatm ent of any bad cold. The baby should be put to bed
and the temperature of the room kept even day and night at 65° to 70° F., while he has the cold.
Many contagious diseases besides colds begin with sore throat or a running nose, and any baby
with either of these symptoms should be put in a room by himself away from other children.
If a baby has “snuffles” at birth or within the first few weeks after birth a blood test should be made
by a doctor to determine whether the condition is due to syphilis.
ENLARGED OR DISEASED ADENOIDS
If a baby’s sleep is disturbed considerably, if he sleeps with his mouth open, snores and is unable
to nurse for any length of time without having to stop to get air through the mouth, or if he has fre
quent colds in the head, ear infections, or discharges from the nose, the mother may suspect that he
has enlarged or diseased adenoids. A doctor should be consulted if the air passages are obstructed
from any cause.
EARACHE
If the baby screams and puts his hands to the side of his head and rolls his head from side to side or
pulls at his ear, he may have earache. Warm compresses or a well-wrapped hot-water bag may relieve
the pain. If a doctor’s advice cannot be obtained soon, a few drops of warm (not hot) mineral oil
may be put into the ear. Nothing else should be put into the ear except by a doctor s order.
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CROUP
There are two kinds of croup, the simple spasmodic type and the severe type which is really laryn
gitis. Both kinds must be taken seriously, for it is often impossible at the beginning to tell them apart.
Simple spasmodic croup is not dangerous, but the other type is very dangerous and requires a doctor’s
immediate care. Whenever a baby’s cry or voice becomes hoarse or weak and husky, a doctor should
be called at once, so that he may treat him and give diphtheria; antitoxin, if he thinks that the laryn
gitis may be due to diphtheria.
Simple spasmodic croup.
An attack of simple spasmodic croup usually comes on suddenly between bedtime and midnight,
when a baby who went to bed apparently well wakes up with harsh noisy breathing or a dry, barking
cough and some difficulty in breathing. The cry and voice are usually strong but hoarse. The baby
may be frightened, and his fright increases the symptoms. The symptoms of croup frequently recur
for 2 or 3 nights, and a baby who has one attack of croup is likely to have others.
Before the doctor comes the baby should be placed in an atmosphere filled with water vapor.
This may be done by placing him in a small warm room in which water is boiling or a bathroom with
hot water running. The doctor will advise with regard to treatment.
The day after the attack the baby should be kept quiet in a warm room at even temperature, if
necessary in bed. For 2 or 3 days after an attack the child should not breathe very cold air; even the
air in his sleeping room should be kept warm and moist.
Laryngitis.
•
If a baby who has had an attack of croup in the night is still hoarse the next morning, he probably
has laryngitis—a serious condition due to diphtheria or to other infections. It often accompanies
or follows a sore throat. A baby with this serious form of croup usually has hoarseness, loss of voice,
and noisy, labored breathing, and seems increasingly sick. He often becomes worse during the night.
Exhaustion and weakness are signs of great seriousness. He should be seen by a doctor at once.
Every hour’s delay in treatm ent may involve a risk to his life.
If the baby has been given diphtheria toxoid and 6 months later the Schick test is negative (see
p. 13), he will probably have been protected from diphtheria.
ASTHMA
Asthma occurs in very few babies under 1 year. It is caused by sensitivity to some food, such as
cow’s milk or egg, or by material inhaled, such as powder, dust, or pollen. If a baby has asthma, the
doctor will advise as to treatment and will make special tests to determine the cause if possible.
ACCIDENTS
SWALLOWING FOREIGN BODIES
If such objects as coins and pins are swallowed they usually pass through the intestines without
causing any damage, but occasionally damage may occur, so that a child who has swallowed any
article should be watched carefully. If no symptoms develop no treatment is necessary. The
stools should be examined for the swallowed article. No medicine should be given nor should any
change be made in the diet except as ordered by the doctor. If the object swallowed is sharp or
pointed, the doctor should be called immediately.
If a baby gets a small object in his windpipe he will cough or choke. A doctor should be called at
once or the baby should be taken to a hospital.
SWALLOWING PILLS OR POISONS
If a baby accidentally swallows a pill or anything else that might possibly poison him, a doctor
should be called a t once or the child taken a t once to a hospital. While waiting for the doctor try
to make the baby vomit by tickling the back of his throat; giving him |plain warm water may make
him vomit, or warm water with common salt or mustard dissolved in it—a teaspoonful of the salt or
mustard to a glass of water. Give him as much as he will drink.
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BURNS
The treatment of burns varies with their severity. A mild burn that causes only redness of the
skin or small blisters may be treated first by applying a paste of bicarbonate of soda and water.
Later oil may be applied for a day or two. After this a clean dry bandage without oil is best. Do
not break the blisters as they may become infected.
For burns that are severe enough to cause much blistering or that affect much skin surface a doctor
should be consulted. For home treatm ent before the doctor sees the child pour a solution of freshly
prepared tea, very strong, which has been cooled to body temperature, over the burned area, or
apply a paste of baking soda and water. If the part can be kept clean and the baby’s hands can be
kept away from it, it is better to use no bandages. Otherwise clean lightweight sterile bandages or
freshly ironed linen should be used. Never use absorbent cotton on a burn.
For deep burns that affect large skin surfaces the baby should be taken to a hospital immediately,
A solution of tea may be applied if delay in reaching the physician or hospital is unavoidable. D o n o t
use o ily substances on deep burns.
It is important to keep the surfaces that have been burned absolutely clean to avoid infection.
After a severe burn has begun to heal the child should be kept under the doctor’s care in order that
he may see that everything possible is done to prevent the scars from causing deformities.
CUTS AND WOUNDS
A break in the skin should be cleaned thoroughly with boiled >vater, mild soap, and a piece of
freshly boiled cloth. It may be painted with fresh tincture of iodine and washed off with alcohol
and a sterile bandage applied. All stfvere cuts, deep puncture wounds, and wounds into which dirt
has entered should be treated by a doctor.
COM M UNICABLE DISEASES
Communicable diseases occurring in babies under 1 year of age should be regarded as serious.
(For prevention, see p. 12.) The younger the baby the more serious the disease. Those which occur
commonly in babies under 1 year of age are whooping cough, measles (in babies over 6 months)*
pneumonia, dysentery, and tuberculosis. Others occurring less commonly are diphtheria, infantile
paralysis, cerebrospinal meningitis, and rarely, scarlet fever, smallpox, mumps, typhoid fever, and
malaria. Chickenpox occurs in infants but is usually not serious.
These diseases spread largely through direct contact with the excretions or secretions of a patient
who has the disease or through foods such as raw milk, fruit, or vegetables contaminated by an
infected person or by flies or mosquitoes which carry the germs from an infected person.
A baby with any communicable disease should be under the care of a physician.
WHOOPING COUGH AND MEASLES
Whooping cough and measles are more serious diseases in infancy than in later childhood, on
account of the fact that they are more frequently complicated with broncho-pneumonia in infancy.
Great effort should be made to prevent them (see p. 13). A baby with measles should be kept in
bed a t least 10 days; a baby with whooping cough needs bed care only if he has fever. A baby with
whooping cough should be outdoors as much as possible in suitable weather and under quarantine
regulations.
PNEUMONIA
Pneumonia is a disease for which especially careful nursing is necessary. Bed care and medical
treatment are essential throughout the disease. If proper care cannot be given at home it is advisable
to send the baby to a hospital.
DYSENTERY
Dysentery is a disease of the bowels which occurs generally in hot weather and hot climates. It
usually results from contact with someone who has the disease or from infected milk or other food.
It often is spread by flies. It causes fever, severe diarrhea which is often bloody, and loss of weight.
A doctor should be called if a baby has diarrhea. He will decide whether or not it is due to dysentery
and will direct the treatment accordingly.
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TUBERCULOSIS
Tuberculosis also is contracted in infancy by contact with someone who has the disease or through
milk. A baby who persistently does not gain in spite of good care or who has an unexplained daily
rise in temperature should be taken to a doctor and tested for tuberculosis. He should be kept
under the close supervision of the doctor.
DIPHTHERIA
Diphtheria occurs less commonly in infancy than after 1 year of age. If it is suspected that a
baby has diphtheria, because of a bloody discharge from the nose or because the baby’s voice or cry is
hoarse, or because grayish-yellow patches are seen in the throat, a doctor should be called at once,
for antitoxin must be given early if the baby is to be cured. (For prevention, see p. 13.) In infants
and young children diphtheria of the throat often looks like simple tonsillitis, and cultures should
always be taken if a baby has patches in the throat.
GONOCOCCUS INFECTION
Two forms of gonococcus infection occur in infancy—ophthalmia neonatorum (infection of newborn
babies’ eyes) and vaginitis (white or yellowish white discharge from the genital tract).
Ophthalmia neonatorum may cause permanent blindness, if not treated promptly. It may usu
ally be prevented by putting 2 drops of 1-percent silver-nitrate solution into each of the baby’s eyes
immediately after birth. If there is redness or discharge from the baby’s eyes within the first 2 or 3
weeks after birth, the doctor should.be called at once so that intensive treatment can be given if he
finds th at it is a gonococcus infection.
Girl babies not infrequently have a white discharge from the vagina at birth, which soon disap
pears. A discharge which persists or is yellowish is caused in some cases by gonorrhea, contracted
usually from the mother a t birth or from some member of the, household who has the disease. The
germ may be carried on the hands, or on washcloths, towels, or diapers. Microscopic examination
should be made of any vaginal discharge to determine whether it is gonococcus infection. Prompt
local treatment under the direction of a doctor is necessary to cure this form of gonorrhea, which is
often most persistent. A baby who has it should wear a pad to catch the discharge, and the pads
should be burned.
Unless the utmost precautions are taken gonococcus infection will spread to other infants, espe
cially girls, who may come in contact with the baby or the person caring for the baby. A child with
this disease even under treatment should be considered a possible source of infection as long as there
is a discharge, and every care should be taken to prevent the spread of the disease.
The mother or nurse caring for a baby with gonococcus infection should scrub her hands thoroughly
with hot water and soap every time she has handled the baby. Every article of soiled clothing and
bedding used by the baby should be boiled half an hour. The entire bath equipment should be
strictly separated from that used by any other person.
SYPHILIS
Congenital syphilis, which is syphilis acquired by the baby from the mother before birth, unfor
tunately is a fairly common disease. It is preventable. (See p. 14.)
Many babies who have congenital syphilis either die before birth (that is, are stillborn) or die
within the first few weeks after birth; and those that survive may have lasting effects from the disease
which handicap them, sometimes throughout life.
The disease can be prevented in the baby if the mother has adequate prenatal treatment. If the
mother is known to have syphilis, whether she has been treated for it or not, the baby’s blood should
be tested for syphilis (usually by the Wassermann or Kahn test) when the baby is about 2 or 3 months
old, even if he has remained healthy. If the test is positive at this time he should be treated for
syphilis even though he is still apparently well; if the test is negative, it should be repeated every 6
months for at least 2 years.
If a baby is born with snuffles, a skin eruption, or peeling of the palms and soles or if he develops
them shortly after birth, a doctor should be consulted and a blood test made. No baby is too young
to be treated for syphilis. Treatment should be started as soon as the disease is known to be present
and should be continued for a long time—until repeated tests show the baby’s blood to be normal.
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Traveling W ith the Baby
In traveling with a baby the most important thing to remember is the necessity for boiling all milk
mixture, drinking water, bottles, stoppers, nipples, measuring glass, and funnel. Remember that
even if the baby is breast fed, provision must be made for boiling his drinking water as well as the
bottles and nipples used for drinking water.
For a trip no longer than 24 hours the boiling of milk mixture, drinking water, bottles, and nipples
may be done at home, and vacuum bottles used to carry the cold milk mixture and drinking water.
If refrigeration is available, as in the buffet car of a train, the nursing bottles may be prepared in
advance. These bottles after boiling should be stoppered with rubber corks or covered either with
rubber caps that have been boiled or with wax paper held with rubber bands. The bottles should then
be wrapped in a clean cloth. The nipples after boiling should be wrapped in sterile gauze or put into a
glass jar with screw-on top (both the jar and the top must be boiled). When preparing for the day’s
trip, boil a day’s supply of milk mixture as usual and chill it thoroughly before putting it into the
vacuum bottle. Milk mixture for a baby must not be put into a vacuum bottle while it is warm, 4s
it may sour. The vacuum bottle must be cleaned, scalded, and cooled before the cold milk mixture is
put into it. Milk from a vacuum bottle should not be used after 24 hours.
At each feeding time fill one of the nursing bottles from the vacuum bottle and warm it. If there
is no other way of obtaining hot water to warm the bottle, a solid-alcohol stove can be used to heat
water in a small saucepan. It should be placed on a metal tray before being lighted.
For a longer trip it is usually convenient to take a supply of canned milk, either dried or evaporated.
It will be necessary to boil the bottles and nipples once a day. Arrangements for the boiling can
usually be made on a train, a boat, at a hotel, or a t a tourist camp. It may be possible to boil a whole
day’s supply of the milk mixture as you would a t home and keep it in an ice box. If this cannot be
done, each feeding will have to be prepared separately. If evaporated milk is used, it can be prepared
by adding boiling water. If dried milk is used, each feeding can he made up separately. The mixture
of dried milk and water must be boiled before being used.
The following supplies for a journey longer than 24 hours may be packed in a small suitcase:
Small cans of evaporated or dried milk.
Jar of sugar.
Small egg beater for mixing dried milk.
Strainer for dried-milk mixture.
Funnel.
Enough nursing bottles and stoppers for a day’s
feedings and for drinking water.
A day’s supply of nipples in covered glass jar.
Vacuum bottle for a day’s supply of boiled water.
Tablespoon and teaspoon.
Cup.
Solid-alcohol stove.
Metal tray for stove.
Pint-size utensil, for heating food. .
Cans of mashed vegetable.
Oranges or canned tomato juice.
Be sure to take the doctor’s written directions for the feeding.
Be sure to obtain accurate information as to the leavipg and arriving times of all trains and boats
to be used in the journey. When a night trip is to be taken berths should be reserved in advance.
If possible a stateroom should be engaged, even if something else has to be given up. The privacy
and quiet will make the journey easier for the baby.
A market basket is more comfortable for the little baby than his mother’s arms and more con
venient for the mother. The basket should be deep, so that the baby will not roll out. It should be
placed carefully so that it will not fall. Arrange the basket like a bed, with a thin pillow for a mattress
and a piece of rubber sheeting. A cotton mosquito netting should be brought along to cover the
basket. A young baby can stay in the basket during much of the journey.
For a journey in hot weather the baby should be dressed lightly. A diaper and a thin dress are
enough. A wash-silk or thin cotton-seersucker dress is easy to wash when soiled. A sweater or a
coat and a blanket should be at hand in case the day suddenly cools. A bag lined with rubber should
be used for diapers. Disposable inner pads may be useful.
100
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M
Index
A
A
B
Abdomen, 10, 23.
Pain, 53-54, 78. S ee also 39, 55, 91, 92.
See also Navel.
Abscess:
Breast, in nursing mother, 49.
Ear, in baby, 11, 28.
Accidents, 14-15, 97-98. S ee also 18, 19, 27, 3237.
Aotdosis, 94.
Additional foods, besides milk, 57-61, 76-77.
Premature baby, 89.
S ee also 28, 40, 44, 78.
Adenoids, 96.
Age, 3-5. See also Birth registration, Growth,
Height, a n d Weight.
Air, outdoor, see Outdoor life.
Air in room, see Ventilation.
Air in stomach, 39, 50, 53-54, 76, 78.
Alcohol to wash off iodine, 98.
Allergy, see Asthma.
Anemia, 12.
In nursing mother, 56.
S ee also 44, 57.
Ankle, 23.
Antirachitic factor, see Vitamins.
Antiscorbutic factor, see Vitamins.
Antitoxin, see Diphtheria.
Appetite, 11, 56. See also Feeding habits, Hunger,
a n d Refusal of food.
Apples, 57, 94.
In nursing mother’s diet, 46.
See also 7, 60, 77.
Applesauce, 7, 60, 77.
Apricots, 57, 60.
In nursing mother’s diet, 46.
Apron, bath, 25, 26.
Arms, 10, 18, 36, 91, 92, 94.
Artificial feeding, 61-78.
Premature baby, 87, 88, 89.
Sick baby, 93, 94, 95.
See also 8 , 11, 42, 49, 54, 55, a n d Weaning.
Asparagus, see Vegetables.
Asthma, 97.
Attention, see Habit formation.
Baby carriage, 19. See also 14, 35, 36.
Baby pants, rubber, 22, 95.
Baby shows to be avoided, 8 .
“Baby walker” not to be used, 37.
Back, 10, 13.
Bacterial count, milk, 63-64.
Baking soda (bicarbonate of soda), 59, 95, 98.
Ball, see Toys.
Bananas, 59, 94.
Bandages, 98.
Bands and shirts, 22-23. S ee also 20, 21 (illus.),
31.
Bassinet, see Bed and bedclothes.
Bath, 25-27, 30-31.
Nursing mother, 47.
Premature baby, 82, 85-86.
Sick baby, 92.
See also 6-7, 8, 14, 18, 19, 43, 95.
Beans, lima or string, see Vegetables.
Bed and bedclothes, 18-19, 30-32.
Premature baby, 83-85. See also 81.
See also 3, 14, 15, 16, 36, 37, 47, 95, 99, 100,
a n d Sleeping habits.
Bed care in illness, 91, 92, 96. S ee also 95, 97, 98.
Bed wetting, see Bladder training.
Beets and beet greens, see Vegetables.
Beriberi, 11. See also Vitamin B.
Bicarbonate of soda, 59, 95, 98.
Birth registration, Inside front cover.
Bladder training, 42. See also 3-5, 43.
Blanket, see Bed and bedclothes.
Bleeding:
Blood in stool, 52, 91, 94, 98.
Bloody discharge from nose, 99.
Skin or gums, 11, 94.
Blindness, see Ophthalmia neonatorum.
Blister, see Burns.
Blocks, see Toys.
Blood, see Anemia, Bleeding, a n d Blood test.
Blood test:
For anemia, 12.
For syphilis, 8 , 14, 50, 96, 99.
Blue spells, 39.
Premature baby, 82.
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101
102
I N F A N T CARE
Body build, 4, 5, 10. S ee also 79—80.
Boiled milk, 62, 67, 70, 74-75.
For nursing mother, 46.
For premature baby, 86 , 89.
Traveling, 100.
See also 8 , 11, 12, 49, 54-56, 65, 66.
Boiled water, see Water, drinking.
Boiling milk utensils, see Sterilization.
Bones, 44. S ee also 10, 94, a n d Rickets.
Bonnet, see Cap.
Book, cloth, see Toys.
Books for parents, Inside back cover.
Borax, 22.
Boric acid, 29.
Bottle:
Milk, 65, 66. See also 50.
Nursing, 73—76. See also 25, 41, 100.
Vacuum, 100.
Bottle brush, 73.
Bottle cap:
Milk bottle, 65.
Nursing bottle, 25, 73-75. 100.
Bottle feeding, see Artificial feeding.
Bottle rack, 73-75.
Bottle warmer, 75.
Bowel training, 41-42. See also 3-5 a n d Consti
pation.
Bowels, see Bowel training, Constipation, Diar
rhea, Dysentery, a n d StooL
Bowlegs, 11, 37, 94.
Bran:
In bath, 95.
In nursing mother’s diet, 47.
Brassiere for nursing mother, 48.
Bread or toast, 28, 57, 59, 77.
In nursing mother’s diet, 46.
See also 7, 72.
Breast feeding, 45-61.
Premature baby, 86- 88.
See also 4, 6-7, 11, 12, 13, 18, 28, 40, 42, 67,
72, 76, 93, 94, 95, 100.
Breast milk:
Composition, 44. See also 11, 45, 47, 67.
Hand expression, 49. See also 48, 51, 53,
56, 86.
Breast-milk agencies, 49-50, 86 .
Breast pump, 49, 86. See also Hand expression
of breast milk.
Breasts, care of mother’s, 48-49. See also 45.
Breath-holding spell, see Temper.
Breathing, difficult or rapid, 92, 96, 97.
Premature baby, 81, 82. See also 85.
See also Nose a n d Smothering.
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Bright’s disease in nursing mother, 56.
Bronchitis, 96.
Broncho-pneumonia, see Pneumonia.
Brush:
Bottle, 73.
Hand, 49.
Tooth, 28.
Build, body, 4, 5, 10. See also 79-80.
Burns, 98. See also Burns, prevention.
Burns, prevention, 14, 15, 82, 83-84.
Bath, 27.
Hot-water bottle, 32, 82.
Stove, 15, 27, 37.
Sunburn, 33-35.
Butter, 12, 46.
Buttermilk, 63.
Buttocks, 22, 27, 85, 95.
Buttons, 20.
C
Cabbage, see Vegetables.
Caked breasts, 48-49.
Calcium in diet, 44.
Cancer in nursing mother, 56.
Canned foods:
Fruit and fruit juice, 46, 57, 94, 100.
Milk, see Dried milk a n d Evaporated milk.
Vegetables, 46, 59, 100.
Cap, 20, 24, 32.
Carpets and rugs, 13, 17.
Carriage, 19. See also 14, 35, 36.
Carrots, see Vegetables.
Castor oil and other cathartics, 42, 77, 92.
Catheter feeding, premature baby, 86 .
Cauliflower, see Vegetables.
Celery, see Vegetables.
Center, child-health, 9, 78.
Cereal, 57, 58, 60-61, 71-72.
In nursing mother’s diet, 46, 47.
S ee also 6-7, 12, 68 , 77, 93.
Cerebrospinal meningitis, 98. S ee also 95.
Certificate, birth, Inside front cover.
Certified milk, 63-64, 65.
Chafing, 27, 95. S ee also 21, 22.
Chair, toilet, 18, 41.
Chair for mother, 18, 25, 26, 50.
Chamber, 18, 41, 42, 93.
Character building, see Habit formation.
Chard, see Vegetables.
Cheese in nursing mother’s diet, 46.
Chest:
Rash, 95.
Deformed, see Rickets.
I N F A N T CARE
103
Chewing, 28. S ee also 59, 77.
Constipation— Continued.
Chickenpox, see Communicable disease.
In nursing mother, 47.
Child From One to Six, the (U. S. Children’s
See also 42, 43, 57, 67, 92, 93, 94, a n d Bowel
Bureau Publication 30), 42 a n d Inside back
training.
cover.
Contagious disease, see Communicable disease.
Child-health center, 9, 78.
Convulsions, 95. See also 92, 94.
Child Management (U. S. Children’s Bureau Cooking:
Publication 143), 42 a n d Inside back cover.
Cereal, 58, 68.
Children in household besides baby, 14, 19, 86, 92.
Egg, 58.
S ee also 30, 36, 40, 99.
Fruit, 60.
Children’s Bureau, United States, 1, 5, 42, 66,
Milk mixture, 74-75, 89.
a n d Inside back cover.
Vegetables, 59.
Choking, 14, 97.
See also 46.
Circumcision, 29.
Cord, premature baby, 81.
City health department, see Birth registration, Corn sirup, 68, 89.
Child-health center, a n d District of Columbia Cotton, absorbent, 25, 27, 29, 81, 85, 86 , 98.
Health Department.
Cotton-batting wrapping for premature baby, 85.
Clinic, child-health, see Child-health center.
Cotton clothes, see Clothes.
Clothes, 20-24.
Cough, see Colds, Croup, Tuberculosis, a n d
Nursing mother, 47, 48.
Whooping cough.
Premature baby, 82, 85.
Cough or cold in adults, 12-13, 50, 73-74, 86 , 96.
S ee also 1,5, 12, 16, 17, 18, 36, 95, a n d Night County health department, see Birth registration
clothes.
a n d Child-health center.
Clothes rack, 18, 19.
Cow’s milk, 61-78, 97.
fj) Coat, 24. See also 20 , 100.
Learning to drink, see Feeding habits.
Cocoa in nursing mother’s diet, 46.
Nursing mother, 46.
Cod-liver oil and other fish oils, 57-58.
Premature baby, 86 , 87, 89.
For nursing mother, 47.
Sick baby, 93, 94.
For premature baby, 89.
S ee also 5, 7, 11, 12, 40, 42, 44, 45, 55, 56,
S ee also 6-7, 11, 12, 33-34, 70-72, 77, 94.
a n d Milk-borne disease.
Coffee or tea in nursing mother’s diet, 46, 47.
Cream, 62, 65, 67, 87, 94.
Cold weather:
Creeping, 4, 13, 23, 24, 37. S ee also 17.
Bedclothes, 19, 31-32.
Crib, see Bed and bedclothes.
Clothes, 20, 21, 23, 24.
Croup, 97.
Drinking water, 51.
Crowds to be avoided, 8, 30.
Milk, 65, 66.
Crying, 38-39.
Sleeping habits, 30, 31-32, 41.
Sick baby, 91, 94, 97, 99.
Sun bath, 30, 33, 34, 35.
See also 3, 31, 36, 41, 52, 78.
Ventilation, 12, 17, 83, 97.
Cuffs to prevent scratching, 95.
Colds, 96.
Cup instead of bottle, 5, 56. See also 3.
In adult, 12-13, 50, 73-74, 86, 96.
Curds in stool, 52, 67.
In premature baby, 86.
Custard in nursing mother’s diet, 46.
Prevention, 12, 50, 73-74. See also 8 , 11.
Cuts and wounds, 98. S ee also 14.
See also 28, 29, 92.
Cyanotic attack, premature baby, 82.
Colic, 53-54, 78. S ee also 39, 55, 91, 92.
Color, see Skin.
Colostrum, 45, 86.
D
Communicable disease, 98-99. S ee also 30, 42S
43, 50, 55-56, 64, 67, 82, 86, 91, 92, 95, 96, a n d Daily schedule, 6-7.
Colds.
Premature baby, 88. S ee also 87.
Conference, well-baby, 9, 78.
See also 8 , 30, 40, 51, 68, 77.
Constipation:
Deficiency diseases, 11-12, 44. S ee also Beriberi,
In artificially-fed baby, 77.
Pellagra, Rickets, Scurvy, a n d Xerophthalmia.
In breast-fed aby, 52.
Deformity, 11, 21, 53, 94, 98. See also 42.
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104
I N F A N T CARE
Dementia in nursing mother, 56.
Development, 3-5. See also 1, Growth, Height,
a n d Weight.
Dextrin and malt sugar, 68. See also 77.
Diaper, 21—22.
Changing, 30, 31, 38, 94, 95.
Number needed, 20.
Premature baby, 81, 82, 85.
See also 17,19, 20, 27, 35, 41, 42, 51. 99, 100.
Diaper pail, 18, 22, 25.
Diaper rash, 27.
Diarrhea, 94. S ee also 11, 77, 91, 92, 93, 98.
Diet of baby, see Feeding.
Diet of nursing mother, 45-47. See also 11, 53,
55.
Digestive disturbances, 11.
In nursing mother, 47.
See also 47,49,54,55, 57,67, Colic, Diarrhea,
a n d Vomiting.
Diphtheria, 99. See also 8 , 13, 64, 92, 97, 98.
Discipline, see Habit formation.
Disease prevention, 11-14, 95, 96, 99.
In premature baby, 86.
See also 1, 8-10, 44, 50, 94, 99, Boiled milk,
Sterilization, a n d Water, drinking.
District of Columbia Health Department, 65-66.
Doctor, 8—14.
Advice on feeding, 42, 44, 45-56, 61-63, 66,
68 , 69, 78, 93. See also 74, 100.
Examination or treatm ent of mother, 12, 14,
48, 49, 99.
Premature baby, 82, 85, 87, 89, 90.
Prevention of disease, 11—14, 99. See also 2,
8-10,64..
Sick baby, 91-99.
Wet nurse, 50.
See also II, 2, 6-7, 24, 28, 29, 34, 43, 50, a n d
Inside front cover.
Double boiler, 58, 67, 75, 89.
Drafts, see Wind, protection from.
Drawers instead of diapers, 42.
Drawstrings dangerous, 14, 32.
Dresses, 24. See also 20, 21, 100.
Dressing table, 18, 19, 25-26.
Dressing the baby, see Clothes.
Dried fruit in nursing mother’s diet, 46.
Dried milk, 62. See also 46, 63, 70, 100.
Drinking water, see Water, drinking.
Drooling, 42.
Drowsiness as a sign of illness, 91,93. See also 52.
Drugs, see Medicine.
Dust:
In eyes, 29.
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Dust— Continued.
Sensitivity to, 97.
Dysentery, 98. See also 11.
E
Ears:
Abscess, 11, 28.
Cleansing, 29.
Earache, 91,96.
Ear infection in premature baby, 86.
See also 10.
Eating, see Feeding.
Eczema, 95.
Egg beater, 100.
Eggplant in nursing mother’s diet, 46.
Egg yolk in baby’s diet, 58—59, 77. See also 6 , 7,
11,12, 57,71-72, 93, 97.
Eggs in nursing mother’s diet, 46.
Electric appliances and safety, 15, 32, 84.
Electric fan, 17, 32, 83.
Electric heating, 17.
Premature baby’s bed, 83-85.
See also 32.
Elimination of body wastes, 8 , 9, 38, 44, 92. See
also 3-5, Bowel training, Bladder training, a n d
Stool.
Emetic, 97.
Emotional upset in nursing mother, 48.
Enema, 93. See also 42, 54, 92.
Epidemic, 64. See also Communicable disease.
Epilepsy in nursing mother, 56.
Eruption or rash, 27, 92, 95, 99.
Evaporated milk, 62. See also 46, 63, 70, 87, 89,
100.
Examination by doctor, 9-10. See also Doctor.
Exercise and play, 36-37, 38. See also 3-5, 6-7,
8 , 9, 17, 18, 24, 27, 32.
Exercise for nursing mother, 47, 48.
Expectant mother, 14, 99. See also 1, 12, 28,
56,81.
Expression of breast milk, 49, 86. See also 48,
51, 53, 56.
Eyes:
Cleansing, 29.
Diet and, 11-12.
Newborn baby, 14.
Redness or discharge, 92, 99. See also 14.
Shielding from light, 29, 30, 34, See also
Sleeping habits.
F
Face, 4, 91. See
Skin.
also 8 ,
27, 42-43, 92, 95,
and
I N F A N T CARE
Fan, electric, 17, 32, 83.
Farina, 58.
Farm care of milk, 64, 65.
Fat, body, 4, 44, 95. See also Body build a n d
Weight.
F at in diet, 12, 44. See also Butter, Cod-liver oil,
a n d Cream.
F at not to be used in cooking vegetables, 59.
Father, 36, 38. S ee also 1-2, 3-5, 12, a n d Inside
front cover.
Fatigue, 36.
In nursing mother, 47, 48.
See also Sleeping habits.
Feeding, 44-78.
Premature baby, 81. 82, 86-90.
Sick baby, 93, 94, 96.
S ee also 1-2, 3-5, 6-7, 8 , 9, 11-12,25,28, an d
Feeding habits.
Feeding habits, 40-41, 44, 51, 60-61, 77. See
also 3-5, 6-7, 30, 31, 38, 39, 70-72.
Feet:
Keeping warm, 20, 32, 33, 92.
Premature baby, 85.
Shoes and stockings, 23-24.
Soles peeling, 99.
See also 10, 21, 27, Standing, a n d Walking.
Fever, 28,91,92, 93, 94, 98,99.
Figs in nursing mother’s diet, 47.
Fingernails, 15. S ee also 95, 96.
Finger sucking, 43. See also 31, 41, 42.
Fire, 15. S ee also Burns.
Fish in nursing mother’s diet, 46.
Fish oil, see Cod-liver oil and other fish oils.
Flies and mosquitoes, 16, 98. See also 8, 18, 19,
32, 100.
Floor, 17. See also 13 a n d Creeping.
Fluid in nursing mother’s diet, 47, 48, 53.
Fluids, body, 93.
Premature baby, 87, 89. S ee also 83.
See also Water, drinking.
Flushing of face, 91.
Food, see Feeding.
Foreign bodies, swallowing, 97. S ee also 14, 37.
Foreskin, see Genital organs.
Formula for milk mixture, see Artificial feeding.
Fruit, contaminated, 98.
Fruit and fruit juices, 57, 59-60, 77.
In nursing mother’s diet, 46, 47.
For premature baby, 89-90.
For sick baby, 93, 94.
See also 6-7, 11, 12, 58, 70-72, 100.
Funnel, 100.
Furnishings of baby’s room, 18. See also 15.
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105
G
Gain, see Weight.
Gas in intestines, see Colic.
Gas poisoning, 15, 17.
Gate for stairway, 18.
Gauze, 23, 74, 81, 85, 100.
Genital organs, 29, 43.
Premature baby, 85.
S ee also 10, 27, 99.
Germs, see Boiled milk, Communicable disease,
a n d Sterilization.
Glands, 10. S ee also Goiter.
Gians, see Genital organs.
Goat’s milk, 12, 61-62, 64, 66.
Goiter, 12.
Gonorrhea, 99. See also 50.
Grapefruit in nursing mother’s diet, 46.
Grapefruit juice, 57, 94. See also Scurvy.
Great Lakes region and goiter, 12.
Green vegetables, see Vegetables.
Groin, 27.
Growth, 3-5, 44, 79-80. S ee also 28, 33-35, 94,
Height, a n d Weight.
Gums, 28, 94. S ee also 10, 96.
H
Habit formation, 38-43. See also 1-2, 3-5, 6-7,
8,27, Feeding habits, Sleeping habits, a n d
Toilet habits.
Hand expression of breast milk, 49. S ee also 48,
51,53, 56, 86.
Handling of premature baby undesirable, 82, 84,
85.
Hands:
Care, 15, 27, 96.
Keeping warm, 20, 32, 33, 92.
Learning to use, 3-5.
Peeling of palms, 99.
Undesirable habits, 43.
See also 36, 95, 96, 98.
Hands, clean, in disease prevention, 26, 64-65, 86,
99.
Head:
Holding up, 3-4, 81.
Measurement, 3, 4, 9.
Premature baby, 81, 82, 85.
Washing, 26-27.
S ee also 10, 19, 24, 96.
Health department, see Birth registration, Childhealth center, a n d District of Columbia Health
Department.
Health examination, 9, 10. See also 24.
Heart, 10.
Nursing mother, 56.
106
IN F AN T CARE
Heat rash or prickly heat, 95.
Heated bed, premature baby, 83-85. See also 81.
Heater, 15, 16—17, 83. S ee also 27, 32, 37, a n d
Temperature, room.
Heating pad not safe, 32, 84.
Height, 3—4. See also 1, 9, 10, 79-80, a n d
Growth.
Heredity, 2, 28. S ee also Body build.
Hiccoughs, 53.
Hoarseness, 92, 97, 99.
Hospital, 49, 97, 98.
Premature baby, 81-82, 83.
Hot-water bag or bottle, 32, 83-84, 96.
Hot weather:
Bath, 25.
Clothing, 17, 20, 23, 24, 95, 100.
Digestive disturbances, 11.
Drinking water, 51-52.
Electric fan, 17.
Premature baby, 83.
Prickly heat, 95.
Sleep, 19, 30, 32, 41.
Sunburn, 33, 35.
Weaning, 11, 55.
See also 6-7, 94, 98.
House, 16-19.
Humidity, 12, 17, 97.
Premature baby’s room, 83.
Hunger, 11, 51, 56, 76, 78, 93. S ee also Feeding
habits a n d Refusal of food.
Iodine for goiter, 12.
Iron in diet, 12, 44, 57.
Irritability, 11, 28, 36, 78, 91, 94.
Irritation of skin, see Chafing.
Itching, 95.
Kahn test, 14, 99.
Kale, see Vegetables.
Kerosene, precautions, 15.
Kicking, see Exercise and play.
Knitted suit, 24.
Knives, precautions, 14.
L
Lactic-acid milk, 63.
Lamp, sun, 34, 90.
Laryngitis, 97.
Laughing, 3, 4, 36.
Laxative food, 42.
Lead in paint unsafe, 15, 18.
Learning, 3-5.
Premature baby, 81.
See also 2 a n d Habit formation.
Leather for shoes, 24.
Legs:
Deformity, see Rickets.
I
Drawn up in colic, 53, 91.
Pain, 91,94.
Ice box, see Refrigeration.
Use, 3-5, 36.
Illness in baby, see Sick baby.
See also 10, 22, 27, 92, Creeping, Exercise
Illness in nursing mother, 13, 55-56.
and play, Standing, a n d Walking.
Immune globulin in prevention of measles, 13.
Lemon juice, 11, 57, 94.
Immunization, 13. S ee also 8 .
Lettuce, see Vegetables.
Impetigo, 95-96.
Light, shielding eyes from, 29, 30, 34. See also
Indigestion:
Sleeping habits.
In infant, see Digestive disturbances.
Lima beans, see Vegetables.
In nursing mother, 47.
Linoleum, 17.
Indoor sun bath, 34.
Infantile paralysis, see Communicable disease, Lips, spots on, 29, 96.
infectious disease, see Communicable disease.
Lungs, 10, 36, 94. See also Pneumonia a n d Tu
Infrared rays, 33.
berculosis.
Injection (or enema), 93. See also 42, 54, 92.
Lye, danger, 15.
Injection of fluid, premature baby, 87.
M
Inoculation, 8 , 13.
Insects, 16, 98. S ee also 8 , 18, 19, 32, 100.
Intestines, see Bowel training, Constipation, Maid or nurse, 8 .
Malaria, see Communicable disease.
Diarrhea, Dysentery, Stool, a n d Worms.
Malt sugar and dextrin, 68, 77.
Iodine, tincture of:
M alta fever, 64.
For cuts and wounds, 98.
Mask, in preventing colds, 74.
Precautions, 15.
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INFAN T CARE
Masturbation, 43.
Matches, precautions, 14, 15.
Mattress, 18-19. S ee also 14, 84, 100.
Measles, 98. S ee also 13, 92.
Measuring glass, 73-75, 100.
Measuring spoons, 73. See also 74.
Meat in nursing mother’s diet, 46.
Meconium, 52.
Medical supervision, see Doctor.
Medicine:
Not to be given except on doctor’s orders, 31,
42, 52, 54, 77, 92.
To be kept out of baby’s reach, 15.
Medicine dropper:
For feeding, 53, 86, 87, 89.
For putting drops into nose, 96.
For washing eyes, 29.
Meningitis, cerebrospinal, 95, 98.
Menstruation in nursing mother, 55,
Mental development, 3-5. See also 1, 2.
Milk in baby’s diet, see Breast feeding a n d Cow’s
milk.
Milk in nursing mother’s diet, 46.
Milk-borne disease, 64, 99. See also 65.
Milk bottle, 65, 66.
Milk mixture, see Artificial feeding.
Milk powder, see Dried milk.
Milk sugar, 68.
Milk teeth, 28.
Milking cows, 64-65.
Mineral oil:
For cleansing skin, 25, 27, 85-86, 95.
For constipation, 42, 77.
For earache, 96.
Not to be put into nose, 96.
Minerals in diet, 12, 44, 57.
Miscarriage, 14.
Mittens, 32,
Mixed feeding, 54-55. See also 76.
Moisture in air, 12, 97.
For premature baby, 83.
Mosquitoes and flies, 16, 98. See also 8 , 18, 19,
32, 100.
Mother, see Expectant mother a n d Nursing
mother.
Mouth, 29, 96.
Deformed, 53. See also 42.
Open during sleep, 96.
Premature baby, 81.
Thumb sucking, 43. See also 31, 41.
See also 10 a n d Teeth.
Movies, 30, 39.
Mucous membrane, 10, 96. See also Genital
organs, Mouth, Nose, a n d Throat.
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107
Mucus in mouth and throat of- premature baby, 81.
Mucus in stool, 91, 94.
Mumps, see Communicable disease.
Muscles, 3-5, 36-37.
Abdominal, 23.
Developed by kicking, 18, 24, 27, 36.
Premature baby, 81.
Rickets, 11, 94.
See also 44.
Mustard as emetic, 97.
N
Nap, see Sleeping habits.
Navel, 22-23, 26. See also Cord, premature
baby.
Neck, 10, 14, 32.
Needles, precautions, 15.
Netting, see Insects.
New foods, learning to eat, 60-61. See also 3-5,
40-41.
Night blindness, 12.
Nightcap, 32.
Night clothes, 24.
Premature baby, 85.
See also 6-7, 16, 20, 30-32.
Nipples, rubber, 73, 74-76, 86, 96. See also 25,
41,42, 100.
Nipples of nursing mother, 48-49.
Nitrate of silver, 14, 29, 99.
Noise, see Quiet.
Northern part of country, 33, 34. See also Cold
weather.
Nose:
Bloody discharge, 99.
Cleansing, 29.
Cold in, see Colds.
Stopped up, 53, 96.
See also 10 a n d Breathing.
Nurse, trained, 14, 18.
For premature baby, 82, 85.
Nursemaid, 8 , 99. See also Wet nurse.
Nursery toilet chair, 18, 41.
Nursing (breast feeding):
Difficult nursing, 96.
How to nurse, 50-51. See also 48.
See also Breast feeding.
Nursing bottle, 73-76. See also 25, 41, 100.
Nursing care for sick baby, 92-93.
Nursing mother:(
Diet, 45-47. See also 11, 53, 55.
Disease in, 13, 55-56.
Hygiene, 45-49. See also 11,12, 53-55, 94.
Menstruation, 55.
Pregnancy, 56.
INF AN T CARE
108
o
Pellagra, 11-12.
Penis, see Genital organs.
Pepper not to be used, 59.
Perspiration:
And drinking water, 52.
Excessive, 12, 20, 22, 25, 95.
In nursing mother, 47.
And shoes, 24.
Petroleum jelly, 91, 93. S ee also Mineral oil.
Petticoats or slips, 24. See also 20, 21 (illus.).
Pharmacopoeia, U. S., and vitamin D, 58, 63.
Phosphorus in diet, 44.
Physician, see Doctor.
Pictures, see Toys.
Pillow, 14, 19. See also 84.
Pills, accidental swallowing, 97. S ee also 15.
Pineapple juice, 57, 94.
Pins, precautions, 14,15,97. See also Safetypins.
Placental extract in prevention of measles, 13.
Play, 36-37, 38. See also 3-5, 6-7, 8 , 16, 17, 27.
31, 40, 50, a n d Toys.
Play pen, 36, 37. S ee also 14, 18, 19.
Play suit, 24.
Plumbing, 16.
Pneumonia, 98.
Nursing mother, 55.
Premature baby, 86 .
See also 15, 95, 96.
31.
Poisoning, 97.
Preventing, 15. See also 17, 18.
IPollen, sensitivity to, 97.
Porch, see Outdoor life.
Position:
Changing baby’s, 36, 37, 92.
For bottle feeding, 76.
For nursing, 50. See also 48.
Sick baby, 92.
Posture, 10.
Potatoes, 59, 77. S ee also 7, 46, 57 72t
Powder, dusting, 27, 29, 95.
Precautions, 15.
Sensitivity to, 97.
Powdered milk, see Dried milk.
Pregnancy:
Blood test in, 14, 99.
Reason for weaning baby, 56.
See also 1,12, 28.
Premature baby, 81-90. See also 34, 49, 94.
Prenatal care, 14, 99. See also 1,12, 28, 56.
Prenatal Care (U. S. Children’s Bureau Publica
tion 4), 1 a n d Inside back cover.
Prevention of accidents, 14-15. See also 18, 19,
27, 32, 37, a n d Burns.
Oatmeal, 58.
Oil, see Castor oil, Cod-liver oil, Mineral oil, Oil
for burns, Olive oil, a n d Vegetable fats or oils.
Oil for burns, 98.
Oilcloth, 19.
Oil heater, 17.
Olive oil, 25.
Ophthalmia neonatorum, 14, 99.
Orange juice, 57, 77, 94.
Nursing mother, 46.
Premature baby, 89-90.
Sick baby, 93.
S ee also 6-7, 11,58,70-72, 100.
Outdoor life, 33-35.
For baby with whooping cough, 98.
For nursing mother, 48.
For premature baby, 90.
S ee also 2, 6-7, 8 , 9, 12, 14, 16, 20, 30, 31-32.
Outhouse, 16.
Overfeeding:
Artificially-fed baby, 78.
Breast-fed baby, 53.
See also 31.
Oxygen, premature baby, 82.
P
Pacifier not to be used, 42-43, 96. S ee also
Pad:
Bed, 18, 19.
Diaper, 85, 99, 100.
Table, 19.
Pain:
Abdomen, 39, 53-54, 78, 91, 92.
Arms or legs, 91, 94.
Ear, 91,96.
Throat, 91.
Pain in nursing mother’s breasts, 48.
Painted articles, 15, 18, 37.
Paleness, 11, 12, 52, 94. See also Skin.
Pants, rubber, 22, 95.
Paper inside diaper, 21, 100.
Paper towels, 58.
Parsnips in nursing mother’s diet, 46.
Pasteurized milk, 65.
From breast-milk agency, 49-50, 86.
In nursing mother’s diet, 46.
See also 11, 12, 61,62, 63,64.
Patches in throat, see Diphtheria.
Patent or proprietary foods, 63.
Peaches, 60.
Peas, see Vegetables.
Peeling of palms and soles, 99.
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I NF A N T CARE
109
Prevention of disease, 11-14, 95, 96, 99.
Ringer‘s solution, 87.
In premature baby, 86.
Rocking, 36, 38, 41.
See also 1, 8—10, 44, 50, 94, Boiled milk, Rompers, 24.
Sterilization, a n d Water, drinking.
Room, 16-19, 37.
Prickly heat or heat rash, 95. t
Premature baby, 83.
Proprietary foods, 63.
Sick baby, 92, 97.
Protein in food, 44.
See also Sleeping habits
Prunes and prune juice, 57.
room.
In nursing mother’s diet, 47.
Roughage, 57.
S ee also 7, 42, 60, 77, 94.
Routine, see Habit formation.
Puerto Rico, sunlight, 33.
Rubber pants, 22, 95.
Punishment, see Habit formation.
Rubber sheeting, 19, 26, 100.
Pus in stool, 91.
Rugs and carpets, 13, 17.
Running ear, 11, 28.
Q
Quarantine, 98.
Quiet, 30-31.
Nursing mother, 53,
Sick baby, 92.
Traveling, 100.
See also 16, 36.
R
Racial traits, see Body build a n d Teeth.
Rack, bottle, 73^75.
Rash or eruption, 27, 92, 95, 99.
Raw milk, 63-64, 67, 98. See also Boiled milk
a n d Pasteurized milk.
Rayon clothes, see Clothes.
Recreation for nursing mother, 48. S ee also
54-55.
Rectum:
Enema, 93. S ee also 42, 54, 92.
Gas, 53-54.
Temperature by, 91. S ee also 82.
Worms, 96.
Refrigeration, 64, 65, 66, 74, 75. See also 18, 49,
50, 62, 73, 100.
Refusal of food, 40, 61, 78.
As sign of illness, 91.
During teething, 28.
See also 56.
Registration, birth, Inside front cover.
Regularity, see Habit formation.
Rest in illness, see Bed care in illness.
Rest for nursing mother, 47-48. See also 38, 45,
53, 54-55.
Restlessness, 31, 36, 91, 93, 94. S ee also Sleeping
habits.
Rice in nursing mother’s diet, 46.
Rickets, 94. S ee also 11,33-35, 44,57-58, 63, 76,
89, Cod-liver oil, a n d Sunlight.
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and
Temperature,
S
Safety, see Accidents.
Safetypins, 20, 21, 23, 25, 32.
Saliva, 29, 42-43.
Salt in cooking, 58, 59.
Salt solution, normal, 87.
Salt water as emetic, 97.
Sanitation, 16.
Scabies, 95, 96.
Scales, 18. See also Weighing baby.
Scalp, washing, 26-27.
Scar from bum, prevention, 98.
Scarlet fever, 64. S ee also 98.
Schedules, daily 6-7.
Premature baby, 88. S ee also 87.
See also 8 , 9, 30, 40,51,68, 77.
Schick test, 13, 97.
Scissors, precautions, 14.
Scolding, 39, 40, 60, 61.
Scratching:
In eczema, 95.
In impetigo, 96.
See also 15, 21, 31, 37, a n d Cuts and wounds.
Screening:
Against insects, 18, 32. S ee also 16 a n d
Insects.
Against wind, 12, 16-17, 18, 25, 83.
Scum on milk mixture, 75.
Scurvy, 94. S ee also 11, 44, 57, 76.
Second year of life, 5, 28, 30, 42, 58. S ee also
Child From One to Six, the.
Self-reliance, see Habit formation.
Sensitivity, see Asthma.
Septic sore throat, see Milk-borne disease.
Servant, 8 .
Sex organs, see Genital organs.
Shirts and bands, 22-23. S ee also 17, 20, 21
(illus.), 31, 32.
110
I N F A N T GARE
Spitting up:
Artificially-fed baby, 76, 78.
Breast-fed baby, 50, 53, 55. , See also 91, 93.
Spoon, learning to use, 5. S ee also 3.
Spoon, long-handled, 73, 74.
Spoons, measuring, 73. S ee also 74.
Spread, See Bed and bedclothes.
Squash, 59.
In nursing mother’s diet, 46.
Stairway, safety, 15, 18.
Standing, 3, 5, 23-24, 37.
See also Shoes a n d Stockings.
Starch for dusting powder, 95.
Starch not to be used in clothing, 21.
Starches and sugars in diet, 44, 57, 63. See also
Cereal, Potatoes, Sugar in drinking water, a n d
Sugar in milk mixture.
State board or department of health, 14 a n d
Inside" front cover. See also Child-health
center a n d District of Columbia Health De
partment.
Stearate of zinc, unsafe, 15.
Sterile bandages or gauze, 81, 98, 100.
Sterilization:
Clothes and bedding, 95, 99.
Milk, see Boiled milk.
Milk bottles and utensils, 49-50, 62, 65,
73-75, 86, 96, 100.
Nipple shield, 49.
Water, see Water, drinking.
See also 8, 96, 99.
Stillbirth, 14, 99.
Stockings, 23. See also 5, 20, 31.
Stomach, see Digestive disturbances.
Stomach tube, premature baby, 86.
Stool:
Soap:
Artificially-fed baby, 77.
For bathing baby, 25-27,95, 96. S ee also 29.
Breast-fed baby, 52.
For cleaning cut, 98.
Curds in, 52, 67.
For washing diapers, 22, 95.
During weaning, 55.
See also Enema a n d Soap stick.
Hard, see Constipation.
Soap stick, 42, 54, 93.
Pus, blood, or mucus in, 91, 94.
Soda, bicarbonate, 59, 95, 98.
Sick baby, 91, 92, 93, 94, 96, 97, 98.
Solid-alcohol stove, 100.
Worms, 96. See also 43.
Solid foods, learning to eat, 60-61. See also 4, 5,
See also 22, 27, 95, Bowel training, Colic,
28, 40-41, 58, 77, a n d Additional foods.
Diaper, Diarrhea, a n d Dysentery.
Soothing sirup not to be given, 31.
Southern part of country, 33. See also Hot Stool, disease spread by, 98.
Stopper for nursing bottle, 25, 73-75, 100.
weather.
Stove, see Heater.
Spasms, 95. S ee also 92, 94.
Strainer, 73, 100. See also 6, 57, 74, 75.
Speech, see Talking.
Strap, safety, 14, 18, 19.
Spells, see Convulsions and Tantrums.
String beans, see Vegetables.
Spinach, see Vegetables.
Shoes, 23-24.
Sick baby, 91—99. See also 12, 18, 28, 31, 41, 76,
a n d Prevention of disease.
Silk clothes, see Clothes.
Silver-nitrate solution, 14, 29,99.
Sitting up, 3-4, 23‘, 41.
Premature baby, 81.
Skim milk, 62, 67, 94.
For premature baby, 87.
See also 65.
Skin:
Bleeding, 94.
Chafing, 27, 95. S ee also 21, 22, 92.
Cut, 98.
Flushed, 91.
Light or dark, 34, 35.
Pale, 11, 12, 52,94.
Peeling, 99.
Premature baby, 81, 82, 85-86. See also 87.
Rash, 27, 92, 95, 99.
Sun baths, 33-35.
See also 3, 8 , 10, 44, a n d Bums.
Slapping, 40.
Sleeping bag, 32. See also 14, 19.
Sleeping habits, 30-32, 41.
Feeding, 44, 50, 52, 76, 77—78.
Nursing mother, 47, 48, 53.
Sick baby, 91.
See also 2, 3, 6-7, 8 , 9, 14, 36, 38, 43, 52, 96,
a n d Bed and bedclothes.
Slips or petticoats, 20, 21 (illus.), 24.
Smallpox, 8 , 13, 98.
Smothering, 14, 86. See also 50.
Sneezing, see Colds.
Snoring, 96.
Snuffles, 96, 99.
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I N F A N T CARE
Stripping breasts, 49.
Sucking, 3, 45, 53, 60.
Thumb, pacifier, and so forth, 31, 37,41,42,
43, 76.
Suction bulb, 81.
Sugar in drinking water, 45, 51, 67, 70.
Sugar in milk mixture, 68, 70-71, 73.
For premature baby, 87, 89.
See also 12, 44, 56, 62, 66-67, 74-75, 78, 100.
Summer, see Hot weather.
Sun bath, see Sunlight.
Sunburn, 33-35. See also 98.
Sunlight:
Artificial, 34.
Baby’s room, 16, 18.
Drying diapers, 22.
For nursing mother, 48.
Prevention of rickets, 33-35, 58, 83-90, 94.
S ee also 6-7, 8 , 11, 24.
Suppository, 93. See also 42, 54, 92.
Swallowing foreign bodies, 97. See also 14, 37.
Sweat, see Perspiration.
Sweater, 24. S ee also 20, 31-32, 100.
Syphilis, 99. S ee also 8 , 14, 50, 96.
Syringe, 93.
T
Table, dressing, 18, 19, 25-26.
Talcum powder, see Powder, dusting.
Talking, 3-5.
Tanning, see Sunlight.
Tantrums, 39.
Tapes on clothes, 20, 23, 85. S ee also 14, 32.
Tapes to hold toys, 36, 37.
Tea or coffee in nursing mother’s diet, 46, 47.
Tea treatment for burns, 98.
Teeth, 28.
Diet, 28, 44, 59, 77.
Rickets, 94.
S ee also 4, 5, 10, 95, Gums, a n d Mouth.
Temper, 39. See also 91.
Temperature:
Bath water, 26; premature baby, 85-86; sick
baby, 92.
Bed for premature baby, 83-85. See also 81.
Body, 91, 92, 93, 94, 98, 99; premature baby,
82, 83. S ee also 28.
Room, 12, 16-17, 25, 34; premature baby,
82, 83, 85, 90; sick baby, 92, 96, 97. See
also 20, 30-32.
Test, tuberculin (cows), 62, 63, 64.
Tests:
Anemia, 12.
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Tests— Continued.
Asthma, 97.
Diphtheria, 13, 97, 99.
Syphilis, 14, 99.
!
Tuberculosis, 99.
Tetany, 94, 95.
Thermometer:
Bath, 18, 26.
Clinical, 91.
Wall, 16, 18, 82.
See also 83, 85.
Thighs, 21, 43, 95. See also 13 a n d Legs.
Thirst, see Water, drinking.
IThroat:
Foreign body in, 97. See also 14.
Pain or swelling, 91.
Patches, 99.
Septic sore throat, 64.
See also 10, 81, 97, Adenoids, a n d Colds.
Thrush, 96. See also 29.
Thumb sucking, 43. See also 31, 41.
Toast or bread, 28, 59, 77.
In nursing mother’s diet, 46.
See also 7, 57, 72.
Toes, 23-24. See also 27 a n d Feet.
Toilet equipment, 18, 22, 41.
Toilet habits, 41-42. See also .3—5, 43, a n d
Constipation.
Tomato juice, 57, 77, 94. See also 6-7, 11, 70-72,
100.
Tomatoes in nursing mother’s diet, 46.
Tongue, 96. See also 10 a n d 29.
Tonsillitis, 96, 99.
Toothbrush, 28.
!Towels, 25-27, 58, 99. See also 84.
Toxoid, 13, 97.
Toys, 37.
Safety, 14, 15.
See also 3-5, 27, 43.
Training, see Habit formation.
Traveling with baby, 100. See also 22, 62.
Tray, bath, 25, 26.
For solid-alcohol stove, 100.
Tub, 25-27. See also 14, 43.
Tube feeding, premature baby, 86, 87, 89.
Tuberculosis, 12—13, 99.
Nursing mother, 56.
Tuberculin-tested cows, 62, 63, 64.
See also 8 , 10, 50.
¡Turnips in nursing mother’s diet, 46.
Twitching, 92.
Typhoid fever, 11, 64, 98.
Nursing mother, 56.
I N F A N T CARE
112
u
Water, drinking, 16, 44, 51—52, 68, 77.
Before mother’s milk comes, 45, 70.
Ultraviolet rays, 33, 34, 94.
Bottles and nipples, 73. S ee also 25, 100.
Underfeeding:
Cleansing mouth, 29, 96.
Artificially-fed baby, 77-78.
Constipation, 42.
Breast-fed baby, 52-53.
Nursing mother, 47, 48.
Undesirable habits, 42-43. S ee also 39-40.
Premature baby, 82, 87, 88, 89.
Undulant fever, see Milk-borne disease.
Refusal of food, 40, 61, 76.
United States Children’s Bureau, 1, 5, 42, 66,
Sick baby, 93. See also 92, 95, 96.
a n d Inside back cover.
Weaning, 55, 56.
Urine, 91, 92. S ee also 27, 43, a n d Bladder
See also 6-7, 38.
training.
Water in milk mixture, 69, 75, 78.
Utensils for preparing milk mixture, 1 2 - l b , 100.
Premature baby,J57, 88.
See also 56. 62, 66-67, 68 , 70-72.
V
Wax paper, 75, 100.
Vaccination against smallpox, 8 , 13.
Weaning, 55-56, 72. See also 4, 11, 49, 51, 54,
Vaccine, whooping cough, 13.
66, 89.
Vacuum bottle, 100.
Weighing baby, 9. See also 18, 51, 54, a n d
Vagina, see Genital organs.
Weight.
Vapor, 83, 97.
Weight, 10.
Vegetable fats or oils, 12.
Artificially-fed baby, 78-80. See also 67,
Vegetables, 59.
68, 69-72.
Minerals in, 12, 57, 59.
Breast-fed baby, 52. See also 51, 54, 55, 72.
In nursing mother’s diet, 46, 47.
Premature baby, 89. See a lso 81, 88.
Vitamins in, 11, 12, 57, 59, 94.
Sick baby, 11, 94, 98, 99.
See also 6 , 7, 61, 71-72, 77, 94, 100.
See also 1, 3, 4, 9, 10, 40.
Vegetables, contaminated, 98.
Weight-height-age tables, 79-80.
Ventilation, 17, 30-32.
Well, 16, 66. See also Water, drinking.
Nursing mother’s room, 48.
Well-baby conference, 9, 78.
Premature baby’s room, 83, 85.
Wet nurse, 49-50. See also 86 .
Sick baby’s room, 92, 97.
Wetting, see Bladder training.
See also 6-7, 12, 15, 41.
Whole-grain cereal, 46, 47, 57. See also 58.
Visitors, 41. See also 39, 40, 92.
Whooping cough, 98. See also 13.
Premature baby, 86.
Wind, protection from, 17, 19» 25, 29, 30, 32,
Vitamins:
33-35.
Vitamin A, 11-12,34, 44, 57.
Premature baby, 83.
Vitamin B, 11,44, 57.
See also 12.
Vitamin C, 11, 44, 57, 94.
Window board, 17. See also 12.
Vitamin D, 6-7, 11, 33-34, 44, 47, 57-58, 63, Windpipe, 97. .See also Throat.
89, 90, 94.
Winter, see Cold weather.
See also 63.
Woolen blanket and sleeping bag, 32.
Voice, hoarse, 92, 97, 99.
Woolen clothes, see Clothes.
Vomiting, 93.
Work by nursing mother, 47-48.
To get rid of poison, 97.
Worms, 96. See also 43.
See also 11,53, 76, 78, 91,92.
Wounds and cuts, 98.
W
Walking, 37. S ee also 3, 5, 23—24, 94.
Walls of baby’s room, 17.
Washcloth, 25-27. S ee also 30, 99.
Washing diapers, 22.
Wassermann test, 14, 99.
Water diluting fruit juice, 57.
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X
Xerophthalmia, 11-12.
X-ray of lungs, 8.
Z
Zinc stearate unsafe, 15.
Zwieback, see Toast or bread.
o
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