HEALTHY BABIES S.JOSEPHINE BAKER Columbia SBinitietsiitp intJ)eCit|)ofi^eUjpotfe College of ^})j)gicians; anb burgeons; ^^eferente Hihtavp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/healthybabiesvolOObake :^ >TJ O^ HEALTHY BABIES A Volume Devoted to the Health of the Expectant Mother and the care and welfare of the child BY S. JOSEPHINE BAKER, M. D., D. P. H. Director, Bureau of Child Hygiene, Depart- ment of Health, New York City. Consultant in Child Hygiene, United States Public Health Service. Former President American Child Hygiene Association. Lecturer on Child Hygiene at Teachers Col- lege, Columbia University, New York University and Bellevue Hospital Medi- cal College. Member American Medical Association. Fellow New York Academy of Medicine. THE FEDERAL PUBLISHING COMPANY MINNEAPOLIS. MINNESOTA 1920 Z^l— I 5 7-2- "2- Copyright 1920 by the Federal Publishing Co. Minneapolis Minn, II TO MY FATHER AND MY MOTHER THIS BOOK ON CARE OF MOTHER AND CHILD IS LOVINGLY AND GRATEFULLY DEDICATED III PREFACE The methods and advice given in this book on care of babies are, first of all, intended to be used in keeping babies well. The book is in no sense intended as a method of treating sick babies, nor should the advice that is given ever take the place of the individual care that can be offered by a doctor. The methods of keep- ing babies well are simple and easy, but the methods of curing babies after they are sick are difficult and often complicated. It has been proved over and over again that babies can be kept well with very little effort, and that any intelligent mother can learn all that is needful to assure good health in her baby. J There are certain minor forms of illness which can be corrected or cured simply by readjust- ment of the hygiene of the baby's life or perhaps by the use of some simple household remedies, and there is no reason why the mother should not know and apply the proper treatment in cases of this kind, but if actual illness occurs there should be no delay in obtaining the help of a qualified physician. Saving babies has proved to be one of the most interesting and satisfactory types of health work that has ever been carried out in this, or any other country. In every city or rural community where there has been any PRE FA CE systematic effort to reduce the baby death rate, the results have been prompt and satis- factory. During the past ten years in many of the large cities of this country the baby death rate has been cut in half. The saving of infant life during this period has been beyond all ex- pectation of what it had been thought could be accomplished by proper community action, and intelligent mother care. After all, these are the only two things that are necessary: first, the community must provide the neces- sary surroundings and equipment for the mother, and in many instances it must give her the instruction which will enable her to have an intelligent idea of the simple methods of baby care; second, the mother must use the knowledge which she has gained, and must make use of all the community helps and aids in seeing that her baby is cared for in a proper manner. The community can furnish decent housing, clean streets, clean water, pure milk, parks and playgrounds and oppor- tunities for wholesome living. The mother can use these in assuring a healthful and whole- some life not only to her baby, but to her other children. One of the most interesting facts that have been ascertained in our efforts to keep babies well is that the simple things are best. During the past few years there has been a great VI PRE FA CE reaction from the complicated and over-solicit- ous methods of baby care of the past. There is no question whatever that more children have been killed by overcare than by lack of care. There is a happy medium, too, between the rigid methods of ultra-scientific baby care, with its lack of human contact, and its stern, methodical routine, and the happy-go-lucky, careless, neglectful way of handling infants, the disastrous results of which have been evident in the past. This middle way, which is the sensible and successful one for keeping babies alive and well, has as its first principle the utmost simplicity, both in surroundings and methods. A great deal of common sense is needed in handling babies; regularity in feeding, atten- tion to proper methods of hygiene, proper adherence to the rules regarding the right kind of clothing, fresh air, exercise, sleep and quiet, all are essential, but they must not take the form of rigid routine, to be carried out to the exclusion of the baby's human needs. After all, no baby will live unless he has that intimate, human contact which, for want of a better name, we call "mothering." Every baby must be taken up in his mother's arms not only once, but several times a day. There is a time and a place for this, however, and over-handling and over-fussiness are just VII PRE FA CE as harmful as lack of any care. It is of the utmost importance, therefore, that in studying this book, and in applying its principles, the mother must never lose sight of the fact that the intimate relationship be- tween herself and her baby may be main- tained, yet every detail of proper baby care may be carried out at the same time. It has been found over and over again that babies who are perfectly well may be placed in properly equipped institutions where they are given all that modern science can devise in the way of the most approved methods of baby care, yet such babies will sicken and die if they are not taken up at frequent inter- vals and held, cared for, and really loved by some woman who has the mother instinct. It may readily be assumed that there is no need whatever for calling the mother's atten- tion to this essential relationship between her- self and her baby, and asking her not to neglect it. The only reason why this question has been referred to at all is because in the over-anxiety to give the babies the best of care, there has been a tendency to accentuate the more material things in the baby's life, and to neglect this human element which is of the utmost importance. A wise and intelligent mother is probably the highest representative of humanity. Her intuition and inclination VIII PRE FA CE accentuate her mother love. Her wisdom and intelHgence should teach her how to direct that love into the wisest and sanest channels. The best way to use this book is to read it through so that the general subject matter may be familiar. It is well to study the chapters on the routine care of the baby so that bathing, airing, clothing, ex- ercise, and all the other important details of the baby's life may be arranged in advance, and followed without interruption. In any book on health matters certain directions must of necessity be repeated many times with reference to different incidents, and some- times the same type of care will be discussed from various points of view. In order to learn all that the book contains on any given subject, the contents should be consulted. The glossary contains the technical words that have been used in the book, with their mean- ing. If there is the slightest doubt as to the exact meaning of any word, it should be looked up in the glossary. There have also been inserted in this book three sets of baby record forms. It is hoped that these may be not only of immediate value to the mother, but that they will form an important permanent record of the various phases of the baby's life. S. Josephine Baker. IX CONTENTS Chapter I. The Nursery Furniture and other furnishings. Ventilation. Temperature. Lighting. Toys. Baby carriages. Record book .. . Pages 1-10 Chapter II. Growth and Development Weight: scales. Height. Relation between size of head and chest. Muscular development: time that head and body should be held erect. Development of sight, hearing, speech. Teeth and their eruption. Teething and its disorders. Early care of the teeth. Development of the head. Hair, skin, breasts. Lifting the baby. Prevention of prominent ears. Training of bowels and bladder. Suppositories. Rectal injections. Bowel irrigations. Bad habits: pacifiers, thumb-sucking, nail-biting, masturbation Pages 11-Ifi Chapter III. Clothing List of clothing needed for the baby. How the clothes should be made. Difference between summer and winter clothing. Method of dressing the baby Pages 4i-50 Chapter IV. Bathing Equipment. Temperature of room. Temperature of water. Time of bath. Method of giving bath. Sponge bath. Tub bath. Care of the genital organs. Circumcision. Care of the diapers. Care of the eyes, nose, mouth, ears, navel. Warm and cool baths. Alcohol baths, bran baths, soda baths, mustard baths, salt baths Pages 61-62 Chapter V. Fresh Air, Sleep and Quiet, Exercise Value of fresh air. Airing of room. Temperature of sleeping room. Method of indoor airing. Outdoor airing. Sleeping outdoors. Sleep and quiet. How to put the baby to sleep. Amount of sleep. Sleeplessness: treatment. Prevention of nervousness. Exercise: methods; necessity for crying. Various types of cries; how to recognize them; how to deal with them Pages 63-80 Chapter VI. Feeding Breast feeding: when undesirable. Difficulty in nursing. Care of the nipples and breasts. Hygiene of the nursing mother. Nursing habits. Position of the baby while feeding. Signs of over-feeding. Milk plentiful, but poor in quality. Milk scanty but of good quality. Weaning. Substitute feeding. Composi- XI CONTENTS tion of human and cow's milk. Cow's milk: type of cows to be selected. Production of milk. Care of the milk after produc- tion: in the home. Types of milk sold. Refrigerators. Use of thermos bottles. Relative value of raw and pasteurized milk. Sterilized milk: how prepared; when advised; result of use. Pasteurized milk: how prepared, its value and methods of use. Modification of milk: principles. Methods of choosing proper formulae. Complete formulae for modifying cow's milk for infant feeding. Amount at each feeding. Intervals of feeding. Utensils needed in modifying milk. Method. Care of the bottles. Care of the nipples. Increasing or decreasing the amount of food or strength of formula. Use of other in- gredients in milk modification. Condensed milk and proprietary foods. Additional feeding under one year Pages 81-126 Chapter VII. Stomach and Bowel Disorders Cause, prevention and treatment of loss of appetite, regurgita- tion, vomiting. Stools: abnormal stools; diarrhoea: its preven- tion. Constipation. Colic and wind. Malnutrition and maras- mus Pages 127-14.1 Chapter VIII. Minor Illnesses and Ailments How to detect symptoms of illness. Method of taking tem- perature, pulse, respiration. Convulsions or spasms. Worms. Rickets. Scurvy. Sprue or thrush. Prickly heat. Earache. Hiccoughs. Skin diseases: eczema, intertrigo. Croup, acute catarrhal bronchitis Pages 14^-172 Chapter IX Food recipes Pages 173-179 Chapter X Nursery remedies Pages 180-184- TABLE OF MEASURES Page 185 GLOSSARY Pages 186-194 NOTES Baby's record of weight, height, first birthday, development, feeding, special events Pages 195-209 XII ILLUSTRATIONS Page Frontispiece Measuring the Baby 18 Baby Scales 19 Chart of Teeth 23 Method of Lifting the Baby 34 Method of Holding the Baby 35 Cardboard Cuff to Prevent Thumb-Sucking 38 Baby Clothes 50 Bathing the Baby 50 to 51 Bath Thermometer and Clinical Thermometer 66 Hess Home-Made Refrigerator 67 Utensils for Modifying Milk 114 Testing Nipple for Right Flow of Milk 115 Method of Syringing the Ear 131 Weight Chart 206 XIII HEALTHY BABIES CHAPTER I THE NURSERY Two laws of the nursery are simplicity and cleanliness. The room in which the baby is to live should not resemble a hospital ward with its unrelieved bareness and whiteness, neither should it be the opposite extreme — an over-furnished room with upholstered furni- ture and carpets. The right type of room is one in which everything may be washed, but it is not necessary to sacrifice beauty and harmony. A room with at least two windows and a southern exposure is best. If such a room is not available, the brightest, airiest, and quietest room in the house should be given over to the use of the baby. Painted walls are preferable. If paper is to be used, either that or the paint may be a soft gray-green in color, or a light buff or tan. The floors should be bare, preferably finished with shellac or an oil dressing which keeps the dust from rising. If the floor is not in suitable condition to be left bare, plain linoleum makes an excellent covering. Rugs should be small, easily handled, and of some washable material. Common cotton rugs are best. If only one set of shades is to be used on the windows, dark HE A L TH Y BABIES ones should be selected. Plain muslin cur- tains may be fastened directly to the sash, so that when the window is opened, the curtains will go up with it. Furniture and Other Furnishings While the baby should always sleep alone, during the early months of life it may be necessary for the mother or nurse to sleep in the same room. The furnishings of the nursery, therefore, may include a single, full length bed, in addition to the crib or bassinet. There is no real reason why the baby should not sleep in a crib from the time it is born, but if a crib is not available, a bassinet may be used for the first few weeks. Many types are sold, but there is nothing better than an ordinary clothes basket for this purpose. A large box may be used if a basket is ^ not available. The basket or box should be lined with thin padding, consisting of cotton batting between two layers of cloth or silk. ^ This lining is sewed or fastened around the inside of the basket, or the sides of the crib so that no direct draft will fall upon the baby. A felt or hair mattress is advised, and is to be placed in the bottom of the bassinet. The bed should be made up first with a rubJDer sheet spread over the mattress, next a thin cotton mattress pad and a cotton sheet. A covering THE NURSERY sheet and two light weight but warm blankets or a small down comfortable are advised. Pillows are not necessary. In addition to the crib or bassinet, the following nursery fittings will be found useful: Two low chairs, without arms. One may be a rocking chair. A chiffonier or closet for the baby's clothes. This may be built into the room or may be removable. A small bureau or chest of drawers. A low table about 36 x 24 inches, and not over two feet in height. A larger table may be used, if desired. The ordinary kitchen table cut down to the proper height answers the purpose well. Half the table should be used for toilet articles, and the other half for dressing the baby. Two shelves at convenient heights over the table. These should be open so that the articles placed on them may be easily reached, and so that they may be cleaned readily. A small rack for the baby's clothes. The best type is the ordinary low clothes horse. A three-fold screen. This should preferably be made of plain wood which may be painted white. A high clothes horse will do admirably for the purpose. The panels may be made of white muslin so that they may be washed, and they may be gathered on tapes at top and bottom, and fastened to the individual folds of the screen. A tin or rubber bathtub which may be placed under the table when not in use. A pair of scales. Two wash basins. Two pails with covers, for diapers. A small size chamber, made especially for babies' use. A round dish, with broad, flat edges, may be substituted. A wall thermometer which should be hung over the head of the baby's crib. A hot water bag, with flannel cover. HE A L TH Y BABIES A soft blanket, about four feet square. A rubber sheet, four feet square. Six well laundered, fairly old, soft towels. Four wash cloths. Two to be used for the face and two for the body. Those for the face may be woven, and those for the body knitted, or there may be different colored borders for the two sets, so that they may always be kept for the same use. A soap dish. A soft brush for the hair. On the shelf may be placed the few drugs and other small articles which may be needed from time to time. These will vary according to the doctor's directions for the individual baby, but the following will be found valuable in practically every household: Milk of magnesia Bicarbonate of soda Castor oil Zinc oxide ointment Boric acid powder Stearate of zinc powder Tube of white vaseline Toilet Articles Roll of absorbent cotton Talcum powder Castile soap Large safety pins, two dozen Bath thermometer Small safety pins, two dozen Medicine glass Ventilation Fresh air for the baby is essential in every room, both day and night, but care must be taken to see that there are no direct drafts. The bed should be placed where the light will not fall into the baby's eyes, and where there will be no draft. A screen may be used for this purpose. Some provision should be made for fresh air coming into the room both day and night. Probably the best method in cold weather is by the use of window boards, which consist of boards about six inches wide, an THE NURSERY inch thick and long enough to fit into the width of the window. The lower sash should be raised six inches, and the board inserted across the bottom. The air will then enter between the upper and lower sashes in suf- ficient quantity to keep the room w^ell ven- tilated. In warm weather, this is not sufficient. Then the windows must be kept wide open, and it is important to see that each window is screened carefully against flies and mosquitoes. Thorough airing of the nursery should take place both night and morning. During this time the baby may be taken into another room. Temperature The best type of heating for the nursery is the open fire. When this is not obtainable, and radiators or registers are used, at least one pan of water should be placed on the radiator or register, so that the air in the room will not become too dry. For the first two or three months of the baby's life the temperature in the nursery during the daytime should be from 66 to 68 degrees, and from 64 to 65 degrees at night. This day temperature is to be continued through the first year of life, but after the baby is three months old the night temperature should be reduced to 55 degrees, and after one year of age from 45 to 50 degrees is proper. HE A L TH Y BABIES The temperature should always be read on the thermometer which hangs at the head of the baby's crib. If the baby is kept com- fortably warm, has plenty of the proper type of bed clothing, no harm will be done if the night temperature goes below 65 degrees in the first three months or below 55 thereafter. Lighting During the first two or three weeks of life strong light must be avoided in the nursery. Dark shades are best to soften the light, al- though the room should not be completely darkened. Thereafter the ordinary lighting may be used for the baby's waking hours, with partial darkness during the sleeping time. Babies are peculiarly sensitive to light and sound, and for this reason the room selected for the nursery must be where the greatest amount of quiet may be obtained. Toys Very young babies do not need toys. When they are about three months of age, and begin to grasp objects, the simple rubber toys and those made of washable celluloid mixtures are best. These may be hung by a string to the side of the crib or baby carriage, but the string should not be long enough to allow the toys to reach the floor. Never hang toys from THE NURSERY the cover of a crib or carriage so that they dangle in front of the baby's eyes. This is an exceedingly bad custom, for it puts undue strain upon the eyes of the child. Young babies are in the habit of putting everything into their mouths. For this reason toys which cannot be washed are harmful. The toys that are used must be washed at least once a day, and oftener if they fall on the floor. Toys with bells, whistles or other small ornaments which may become loose, easily detached and possibly swallowed, should never be used by young children. When the baby is teething, a cutting ring is almost universally used. This may be of hard rubber, celluloid or ivory. There are also large, round, hard crackers which are sold for this purpose. The ring should al- ways be tied to the crib or carriage so that it cannot touch the floor, and when it becomes soiled should always be washed before being used again by the baby. Bahy Carriages The choice of a baby carriage is important. Comfort is often sacrificed for the sake of appearance, and here, as in every other phase of baby life, simplicity should be the rule. The carriage should first of all be light in weight and simple in construction, with rubber H EA L TH Y BABIES tires and good springs. The hood or top should be arranged so that it may be moved in two directions — forward and back. The fittings of the carriage when used for a very young baby, should be a flat, firm pillow or mattress, covered with rubber sheeting and a mattress pad. The upper cover should be warm, loose and light in weight, the whole fastened down with a strap which keeps both the baby and the covering secure without any undue pressure. The top should be adjusted so that there may be no direct wind blowing on the baby's head, and so that the sun will not shine into his eyes. The low go-cart has many conveniences. It is usually light in weight, easy to handle, and may be folded up, and put out of the way when not in use. On the other hand, it is not suitable for the very young baby as it forces the child to sit too upright, and also brings the baby so close to the ground that he cannot be adequately protected from the dust of the street. The simple high carriage is better until the baby is at least six months old. Record Book The keeping of a record book of the baby's life has many advantages. Its drawbacks are mainly that the setting down of information relative to the baby's growth, progress and THE NURSERY symptoms may tend to over-accentuate the importance of these items, and thus cause the mother unnecessary concern if the record does not show constant improvement. On the other hand such a record may not only be of great help to the physician, but may also be of definite value to the mother. Any blank book may be used for this pur- pose and each day's record, with the date, should be placed on a separate page. Certain items, such as weight, should be entered only once a week. The type of feeding may be put down on a certain date and thereafter left unrecorded unless a change is made. If med- icine is given at any time, or if illness occurs, brief data regarding this may be inserted. All changes in time of feeding or character of feeding should be noted. Separate pages may be kept for recording important facts in the baby's life. A weight chart similar to the one given in the back of this book should be inserted, and the baby's weekly weight recorded. Under the heading of "growth" record may be made of the baby's length at birth, height and chest measure- ments, the dates upon which he first held up his head, grasped for objects, sat upright, recognized father or mother, uttered the first word, began to creep, to stand alone, and other important items. This record often is of 10 HEALTHY BABIES great help to the physician, because of its relation to muscular and mental development. (See Record Sheets in back of this book.) CHAPTER II GROWTH AND DEVELOPMENT WEIGHT The average weight of a baby at the time of birth is from seven to seven and a half pounds. The birth weight is generally doubled at the end of six months, and trebled at the end of the first year. (See Weight Chart on page 206.) During the first few days of life there is a slight loss of weight which may amount to from four to eight ounces. As soon as feeding is established regularly a gain in weight should begin, and at the end of ten days to two weeks the amount lost should have been regained so that the baby weighs the same as at birth. During the first six months of life the gain in weight is more rapid than during the second six months. It will average from four to eight ounces a week while during the second six months the weekly gain is from two to four ounces. As the baby grows older, the gain each week tends to lessen somewhat, but in general, the following may be taken as a guide : 1st, 2nd, 3rd months, 6 to 7 ounces a week, 4th, 5th, 6th months, 4 to 5 ounces a week, 7th, 8th, 9th months, 3 to 4 ounces a week, 10th, 11th, 12th months, 2 to 3 ounces a week. 11 12 HEALTHY BABIES Bottle fed babies are less apt to gain during the first month. After that, the increase in weight is about the same as that of breast fed babies. The gain in weight of a baby is not always entirely regular. Sometimes the weight will be stationary for two or more weeks, yet the baby will remain perfectly well. In bottle fed babies, this is usually a sign that the per- centage of milk in the feeding formula should be increased. Stationary weight in breast fed babies may be an indication that supple- mentary feeding is needed. Gain in weight is less in warm weather. The weight may be stationary for two or three weeks in the sum- mer without any resulting harm, and during the hot weather no attempt should be made at extra feeding in order to increase the weight. Teething is also apt to delay regular weight increase, and in many babies there is a period dating from the seventh to the tenth months when weight may be stationary or increase very little. During the second year the gain, which averages about five or six pounds, is quite irregular. It is often interrupted by changes in the weather or changes in the type of feeding. Weighing The baby under six months of age should be weighed once each week. From six months GROWTH AND DEVELOPMENT 13 to a year once every two weeks, and from one to two years once every month. This weighing should take place at the same hour, on the same day each week, preferably just before the bath. It is not necessary to undress the baby for the weighing, provided the same number and kind of clothes are worn. The main point to be remembered is not how much the baby weighs, but whether the gain is regular, and of proper amount. Each baby is a law unto himself, as far as size is con- cerned, and there is no reason why a baby who weighed five pounds at birth and gained in proper proportion throughout the first year cannot be considered as healthy as the baby who weighed ten pounds at birth and gained in the same proportion. Scales The best type of scales are expensive. The kind used at the baby health stations and in hospitals are those with the bar and weight at one end and a flat platform on the other. On this platform is placed a flat pan with only two sides. (See illustration opposite page 1 9.) This is to prevent the baby's falling off the platform of the scale. The ordinary grocery scale is excellent for the purpose of weighing the baby. If the child is small enough he may be placed in the 14 HEALTHY BABIES ordinary scoop. As he grows older a larger scoop or basket may be substituted, care being taken to see that scale balances perfectly when it is empty. The basket scale with dial at- tachment, such as is sold in most baby fur- nishing stores, is good until the baby is about a year old, provided a reliable type of scale is purchased. The difficulty with them, however, is that all scales which have dials to indicate the weight fluctuate with the movement of the baby so that it is difficult to record the exact weight. The ordinary pocket scale which consists of a nickel holder with a hook on the end is not advised unless no other scale is available. It has the advantage, however, of being very cheap, costing usually from twenty-five to fifty cents. The baby should be placed in a napkin made in the form of a sling, with the four corners tied together. The hook of the scale is then placed in this knot and the baby's weight read on the indicator of the scale. Weight is the best indication we have of the progress of the baby. Long-continued station- ary weight or actual decrease in weight are usually signs that there is something wrong with the feeding or that the baby is ill. Usually this is a matter which requires ad- justment of the feeding. Boys have a tendency to be a little heavier than girls, but, in general, GROWTH AND DEVELOPMENT 15 not much difference is noticed during the first year. HEIGHT The average height of a new born baby is about twenty inches. During the first six months there is a gain of about five inches. During the second six months there is a gain of about three inches, so that at the end of one year the baby should measure about twenty-eight inches in length. During the second year the gain in height is from three to four inches. Height is not of much im- portance, because so many other factors have to be taken into consideration. Sometimes all the members of the family are small in stature. Sometimes the race to which the child belongs always shows small development. The point to be remembered is whether or not the child is keeping up its normal relation of weight to its height, rather than to pay too much attention to its height alone. RELATION BETV/EEN SIZE OF HEAD AND CHEST During the first few years of life the baby's head alvv^ays seems unduly large when com- pared with the rest of the body. This is a normal condition. At birth the average chest measurement is thirteen and a half inches while the head measures fourteen inches in 16 HEALTHYBABIES circumference. At one year the chest measure- ment is eighteen inches, and the circumference of the head, eighteen inches. At two years the chest measures nineteen inches, and the circumference of the head nineteen inches. MUSCULAR DEVELOPMENT The normal baby should be able to hold up his head without assistance at three to four months, and should be able to sit erect, with his back unsupported, between six and seven months. The first efforts to creep are made usually between the sixth and eighth months. Between the ninth and tenth months the baby tries to get on his feet, and from twelve to fourteen months should be able to walk alone. From fourteen to fifteen months he should run about without assistance. Attempts to walk should never be unduly urged, nor should any effort be made to allow the baby to hold up his head or sit or stand up before he is able to do so voluntarily. It must be remembered that during the early years of life the bones are soft, and must not be subjected to any strain. This is true par- ticularly of the bones of the legs which, in walk- ing, must bear the weight of the body. In- ability of a child to begin to walk at the end of a year may be an indication of some nutritional disorder, such as rickets, and if GROWTH AND DEVELOPMENT 17 efforts are made to force such a child to walk, the bones of the legs are likely to bend, and may become permanently deformed. The great majority of cases of "bow-legs" are caused by children suffering from rickets being allowed to walk at too early an age. The bones in early childhood contain a very small amount of calcium salts, so they are apt to be pliable, rather than brittle. Frac- tures of the bones in very young children are commonly called ''greenstick fractures," be- cause they resemble the kind of break that is made when one breaks a thin green stick. Frequently very little children appear to be bow-legged. This is probably true when they first stand on their feet. Careful observation will show that in the great majority of in- stances babies are not bow-legged at all. The flesh on the inner side of the thighs has a tendency to push the knees apart, and the baby will stand with the knees firmly planted at a distance from each other, so as to main- tain his balance. The condition of ''bow-legs" may be said to exist only when the knees are a considerable distance apart, although the ankles are in contact. Some children never creep. There are others who make every effort to push themselves around in this way. Creeping should not be urged. Teaching children to walk by the use 18 HEALTHY BABIES of contrivances is also to be condemned. The child should not be urged to stand, until he is ready to do so voluntarily. Not all babies progress alike in their mus- cular development. There are many things which may cause a child to be slightly back- ward in this respect. Thus, premature or delicate infants develop slowly. Severe or long illness, rickets, or cases where babies have had continued bowel or stomach disorders usually show retarded development. These children are not abnormal. They are simply slow. If they regain their health their tardi- ness in the matter of muscular development is usually made up in the second year. SIGHT It is probable that babies see nothing at the time of birth, although within a very few hours they seem to distinguish between light and darkness. However, objects are not recognized for from six to eight weeks. At three months the baby will usually focus his attention, and may recognize a few people, such as the mother or nurse. While the baby will grasp an article held up to him when he is three to four months old, he does not definitely reach out for toys and recognize them until he is six months of age. Proper Method of Measuring Baby cq GROWTH AND DEVELOPMENT 19 In early life the baby is particularly sensi- tive to light and should be kept in a semi- dark room for the first two weeks. When outdoors or in a bright light, the eyes should always be protected by holding the baby so that the light does not shine directly into them. Practically all babies have blue eyes at birth. This sometimes changes during the first few weeks to what is usually the permanent color. Many children are cross-eyed during the first few weeks of life, due to their inability to focus the eye muscles. This is merely a temporary condition, and tends to get well of itself. If the cross eyes persist beyond the third or fourth month, the advice of a physi- cian should be secured. While crying is com- mon in new born babies, tears are not. They do not appear until about the third month. HEARING Babies are deaf at birth. This is due to the mucus in the ear canal. The condition soon clears up, however, and thereafter the baby's hearing is abnormally acute. Sounds are recognized in a few days, but it is not until about two months of age that the baby is able to recognize where the sound comes from. This sensitiveness to sound is important, and indicates the need of quiet for babies. At 20 HEALTHYBABIES about the same time the baby learns to recog- nize his parents by sight he also recognizes their voices. SPEECH The average baby is able to say a few words at the end of one year. These are generally the most common words, such as "papa," "mamma," or there may be a definite recogni- tion of objects by giving them a name. From that time on development in speech varies a good deal in different infants. Some children learn to talk within a very short time, while others are much slower. Usually a child can form short sentences at the end of two years. If the baby is unable to talk at all when it is two years old, there are certain possibilities that must be suspected, either that the baby is a mute, a deaf mute, mentally backward or actually mentally defective. Occasionally, failure of speech is due to some physical defect in the vocal apparatus. In any event, if the child cannot speak at the end of two years, medical advice should be obtained. Closely allied to speech is the expression of pleasurable emotions. Babies will smile at a very early age, even when only a few days old, but they are not conscious of any pleasure. In fact, sometimes a little grimace or what seems to be a smile may be caused by indiges- GROWTH AND DEVELOPMENT 21 tion. The first smile of a baby which may be said to reflect any feeling of well being or happiness occurs at about four or five weeks, while the average baby laughs aloud between four and five months. TEETH The first teeth are twenty in number and appear at fairly regular intervals : Month, No. Teeth Location Ills. 5- 8 8-12 12-18 18-24 24-30 Lower central incisors Upper incisors Lower lateral incisors Front molars, upper and lower .... Canine teeth— upper jaw "eyeteeth" Canine teeth — lower jaw "stomach teeth" Back molars See A See B See C SeeD See E See E See F o 12; < 03 U O o o en 03 'o'o a> 0) 1) ^ ^ a Q O — — ^ — ^ ^ rt u u. u< -r a o d 2 o rt Ui li u 0) -< Ur Ui 0) 0) 0) o 0- o .2 <^'C C oJ o 64 6 <: o Q W W o o 5 tn N N N n3 N N N N N N N N N N 5 S o O OOOOOOOOOOOOO HlN •<*^t-'*oOO^toOOOOOO|| T— 1 T— iT-HCNCNrOfOrO'*'^^"^'^^ <^ u, tn >, OJ t* rt t^J>.t^t^t^O^OiOiOLO>OiOiOlO ^ <^ flj S B CD • a d a ^o ^ ^o o CO .ro rr.^ <=> - QJ vO 1 '^ •< -^ ^O _6 CnT^ M3 ■.-I vo'cn" H A _A_ A -\ /■ ^ Amount at Each Feeding N N N N N N N N N N N N N N o OOOOOOOOOOOOO i-(|e3 N N N N N N N* N N* ^i^ o OOOOOOOOOOOOO 12 lO vOOOooracOfOfOrorOfO'=:t^ <^ . "i m M JO ££ ,__c/5wt/53cnc«cntnmc«c/i|| biO , ';^^ X)X'---Q^XJ^43X!-D HiM iHIMCO — H , ^ ■— 1 ,-_. 1 . ^ .— 1 . , _i ,— , ,— . 1 ^*T'-i|iNO'^r t>-tJ4_i4_)+j+J4_i+_)4J+J4_>+j D ^ hfl D OJ-^ 90000000000 < ^ ^^6ssgeesgg6E -M '2T3'^'^^'^-C4:;j3^X-i:!Ji 05 C Vh C Ul+J-M-M-M-M-M-M-M-t-l tH C-000NO^-H(M T-l tH tH j:2 03 biO ■u +-> 3 (V biO 05 -M V4-I -M o 05 05 J3 ^ 3 -M tn O e u 0) oi 0) ho 1-1 rs 43 c« 4-> u OJ 1) c -l-> 03 <-»-i 03 ;3 6 +-> i-i 03 (J o 3 T) cx <-i-i CJ 3 Vh o be n +-> C n< l-l :3 ^ 05 01 n oj o3 c OJ QJ o ^ 0) 05 -l-l 4-> Oj 05 'n3 ^ 3 4=; >> (U >^ 6 o3 0) o 0) en 0) tn ID * c ;:^ o 112 FEEDING 113 and a half ounces of the mixture, at three months, four ounces, while a baby seven months will take eight ounces of milk, a baby eight months will take eight ounces, and a baby nine months will take the same amount. These amounts equal the capacity of the child's stomach at the ages given. A greater amount of food tends to dilate the stomach and cause symptoms of overfeeding. Intervals of Feeding From birth the baby should be fed at in- tervals of not less than three hours, with one night feeding. When he is three months old the night feeding should be omitted. At six months the interval of feeding should be lengthened to four hours. With robust infants the four-hour interval may be used from the beginning. Whenever it is possible to omit the night feeding at an earlier age than that given, that plan should be carried out. Fre- quently, babies can be made to sleep all night from the time they are born. They should never be awakened at night for a feeding, and the night feeding should be omitted as early in life as possible. In any event, it should never be continued after the third month. The interval of feeding and the amounts at each feeding recommended in the table have been found to lessen the liability to digestive 114 HEALTHY BABIES disturbance, to prevent regurgitation, vomit- ing, diarrhoea, colic and wind. Babies fed at these intervals are most restful, better nour- ished and have a finer development. Many of the digestive disturbances of the past may be traced directly to the practice of feeding babies too frequently and in too large amounts. Not only is the capacity of the baby's stomach limited, but investigations have shown that it takes from two and a half to three hours for a baby to digest milk. To give him additional milk before the amount already in his stom- ach has been digested is one of the easiest ways of promoting digestive disturbance and causing illness. Use of Water in Infant Feeding Every baby needs water to drink. When the three or four-hour feeding schedule is used, water should never be omitted. During the first week at least two teaspoonfuls should be given between feedings, and this amount should be increased gradually until the baby at six months is getting from two to four table- spoonfuls between feedings. Water should be given from a nursing bottle or from a spoon. Utensils Needed for Modifying Milk The following utensils are needed for modifying milk: (See illustrations on pages 114 and 115.) FEEDING 115 Eight four-ounce bottles. For the later months, eight-ounce bottles are necessary. They should have wide mouths so that they may be cleaned easily. Nipples — Rubber of good quality is advised. They should have no holes when purchased. Holes of proper size may be made with a No. 10 Cambric needle which has been heated and then plunged into the rubber. The hole should be of a size which will permit the milk to flow drop by drop when the bottle is held upside down. Any steady flow of milk shows that the nipple hole is too large. If the baby finishes contents of the bottle in less than twenty minutes, this also is an indication that the hole in the nipple is too large. Brush for cleaning bottles and nipples. Two-quart pitcher. Eight-ounce or sixteen-ounce glass graduate, for measuring. Double boiler. Saucepan. Strainer. Funnel for filling bottles. Dishpan for sterilizing bottles. Bottle rack. Teaspoon and tablespoon. Jar for holding nipples. Package of non-absorbent cotton. Method of Preparing Modified Milk All milk to be used for the day should be prepared each morning. A clean table should be available to work on. All utensils should be scalded in hot water, and the outside of the milk bottle washed with cold water before the cap is removed. If barley water, rice water or oatmeal water is to be used, it should be 116 HEALTHY BABIES prepared first. The cereal should be measured accurately and creamed in cold water to avoid lumps. It should then be added to the water in the double boiler, stirred constantly to avoid scorching, and boiled for thirty minutes. After the barley water has been prepared, the sugar needed for the day's feeding should be measured out and dissolved in a few table- spoonfuls of boiled water. This should be placed in the pitcher, the necessary amount of milk added, then the water or barley water, the whole stirred well together and the bottles filled, using the funnel. After filling, the top of each bottle should be plugged with a small piece of the non-absorbent cotton and all placed on the ice to be kept until needed. Feeding the Baby At the time of feeding, the bottle should be removed from the icebox and placed in a jar of warm water. The milk should be at body heat when used. This may be ascertained by letting a few drops fall on the wrist. The nipple should never be put in the mouth to test the temperature or the taste of the milk. A little of the milk mixture may be poured into a spoon and tasted to be sure it is sweet before it is given to the baby. As soon as the milk is at blood heat or body temperature, a clean nipple should be placed on the bottle, and the FEEDING 117 feeding given to the baby at once. Any milk that may be left in the bottle after feeding must be thrown away. Care of the Bottles Immediately after using, the bottle should be rinsed with cold water, then washed with hot water and placed upside down In the bottle rack until needed for filling on the fol- lowing morning. Before the bottles are filled again they should be scalded with hot water. Care of the Nipples As soon as they have been used, the nipples should be rinsed out with cold water and turned inside out so that no particles of milk may adhere to the inner surface. They should then be scrubbed thoroughly in warm soap- suds and water. It is not necessary to boil the nipples every day, although this should be done once a week. Rubber spoils rapidly and if ordinary precautions of cleanliness are ob- served this extreme heating at frequent in- tervals is not essential. In the intervals be- tween using, the nipples should be kept in a covered jar filled with a solution of borax, one teaspoonful to a glass of water, or table salt, one teaspoonful to a glass of water. Be- fore using, they should be rinsed with warm water. 118 HEALTHY BABIES When Amount of Food or Strength of Formula Should Be Increased or Decreased ■ The amount or strength of the formula may- be increased if the baby's digestive condition is good, that is, if there is no vomiting or diarrhoea, but if the child seems to be hungry after feeding, shows evidence of not being satisfied, and the weight either remains sta- tionary or decreases. There should be only the regular increase in the quantity and strength of the food if the child is gaining regularly, seems comfortable and sleeps well. The strength and quantity of the food should be decreased, that is, more water should be added or the formula for a younger child used, if the child shows a tendency to diarrhoea, vomiting, marked restlessness or evidence of over-feeding, such as regurgitation, colic, wind or other evidence of indigestion. Use of Other Ingredients in Milk Modification If the child is not gaining in weight, but there is no digestive disturbance such as vomiting or diarrhoea, or if marked constipa- tion is present, milk sugar or cane sugar may be left out of the formula and replaced by malt sugar (Mead's Dextri- Maltose) or one of the cereal proprietary foods such as Horlick's or FEEDING 119 Borden's malted milk or Mellen's food, in the quantity of two level tablespoonfuLs to each twenty ounces of the milk mixture. There are also two liquid forms of malt sugar, known as "malt zymose" and ''Loeflund's malt soup." When using these, the day's feedings should be prepared without sugar and two table- spoonfuls of either of the liquids mentioned should be added to the milk and barley water, and the whole brought to a boil. This should then be placed in the individual feeding bottles and cooled in the usual way. The amount of Loeflund's malt soup or malt zymose may be increased by one teaspoonful every day until there is some indication that the stools are loose, when the amount may be reduced by two or three teaspoonfuls at a time un- til the stools are normal in consistency and number of movements. The use of the pre- paration described above causes the stools to be of a brownish color. When indigestion is manifested by vomiting, colic or diarrhoea, skimmed milk should be substituted for the whole milk in the modification, and the greater part of any kind of sugar omitted. The malt sugar and foods mentioned above should never be used if there is vomiting or diarrhoea. 120 HEALTHYBABIES DRIED MILK Milk from which practically all of the water has been removed, leaving only the solid parts, has been put upon the market within the last few years under various trade names. Practically all of the brands are reliable. Some preparations consist of the solids of whole milk, including the cream; others have had the cream removed from the milk before the water has been evaporated. The usual process of preparing this milk is by spraying it upon hot revolving cylinders v/hich drive out all of the water at once. The powdered or dried milk is then placed in sterile containers and sealed. Powdered skim- med milk will keep almost indefinitely. The powdered whole milk will keep for several months but may become rancid. In order to use this milk for infant feeding it is usual to add one part of the milk powder to eight parts of water, in order to bring it back to the full strength of the ordinary fluid milk. It may then be modified in accordance with the directions given for fluid milk. Dried milk has many advantages. It is uniform in its composition, sterile, easily car- ried from place to place and does not require ice to keep it in hot weather. It may be con- sidered an excellent substitute for fluid milk FEEDING 121 when the latter is not available or if the purity of the milk supply is questioned. CONDENSED MILK AND PROPRIETARY FOODS Condensed Milk Condensed milk is prepared by bringing whole milk to a very high temperature in a vacuum, then adding sufficient sugar so that it will keep for a considerable period of time. Canned condensed milk will keep almost in- definitely. Evaporated Milk Evaporated milk is prepared in the same manner as condensed milk, except that the sugar is not added. The process of condensing or evaporating milk extracts some of the water, leaving the solids in the form of a thin paste. Use of Condensed Milk in Infant Feeding Where the purity of the milk supply cannot be assured and where it is difficult if not im- possible to sterilize or pasteurize it, as in traveling or in the case of temporary residence in various places, also when a child is suffering from a form of indigestion which causes colic and wind, condensed milk may be used for a time. Its prolonged use, however, is not ad- vised as the amount of sugar in condensed mi k is apt to increase the child's weight by 122 HEALTHYBABIES increasing the fat deposit in the body, while the muscular strength is not increased. Babies fed habitually on condensed milk are less apt to be resistant to disease than those fed on fresh, pasteurized or sterilized milk. How to Prepare Condensed Milk for Infant Feeding For a child three months old, one part of condensed milk to fifteen parts of water furnishes a good proportion. This may be prepared by pouring one teaspoonful of con- densed milk from the can and adding to it four ounces of water. The strength of this mixture may be increased gradually until the child at six months of age is taking a mixture in the proportion of a teaspoonful of the milk to two ounces of water. In preparing con- densed milk it must be remembered that the spoon should not be placed in the can, and the milk dipped out. The required amount should be poured from the can into a clean spoon and measured in that way. Use of Evaporated Milk Evaporated milk may be used in the same way and in the same proportion as condensed milk. As there is no sugar in the milk, some may be added in the proportion of one tea- spoonful of milk sugar to every six ounces of -# FEEDING 123 the mixture. As evaporated milk will not keep it must be used within twenty-four hours of the time the can is opened. Proprietary Foods Practically all the proprietary foods depend upon their cereal content. Certain of them have starch as an ingredient. Very young babies do not digest starch readily, therefore, in general, the proprietary foods should not be given to children until they are over three months of age. If the baby is not thriving on cows' milk mixture, and particularly if there is any indigestion with marked constipation, one of the cereal foods, such as Mellen's or Horlick's, may be added to the milk. These foods may be used also in place of the milk sugar or cane sugar in modifying cows' milk, particularly if there is any tendency to colic, wind or constipation in the infant. For babies over three months of age, various other infant foods such as Imperial Granum, Nestle's or Eskay's may also be used. It must be under- stood, however, that any of these prepared in- fant foods, unless they are made up with cows' milk, do not furnish in the right proportion the necessary constituents to keep the baby in good health. There are cases where the ordinary modifications of cows' milk do not seem to suit the infant's digestion. In such 124 HEALTHY BABIES instances it may be necessary to try not only one, but many of the various types of pro- prietary foods, but just so far as possible they must be made up with cows' milk. Plain, fresh, pasteurized or sterilized cows' milk, properly modified with water, barley water and milk sugar is the best substitute we have for breast feeding. However, if its use is not tolerated by the baby after repeated attempts to select a satisfactory formula, it will probably be necessary to try out the condensed or evapor- ated milk until the infant's digestion is in good condition, and then begin with one of the proprietary foods. No special one can be recommended above the others. All that have been mentioned are standard and reliable, and with the reservation given as to the age at which the child can take the special kinds of food, any one of them may be selected. ADDITIONAL FEEDING UNDER ONE YEAR Three to Four Months Barley water should be substituted for plain water in milk modifications. If there is a tend- ency for the baby to be constipated, oatmeal water may be used in place of the barley water. Two to Six Months Orange juice or the strained juice of canned tomatoes should be given to babies as early FEEDING 125 as two months, if pasteurized or sterilized milk is used. Breast fed babies need not have the orange juice until they are about six months old. It should be given in two teaspoonful amounts to start with, and gradually increased until at six months the baby is receiving at least a tablespoonful, and at nine months two tablespoonfuls. The juice of canned tomatoes may be substituted for the orange juice in any instance, and is equally as effective as orange juice in preventing scurvy in infants who are fed on pasteurized or sterilized milk. Six to Nine Months In bottle fed babies, beef, lamb or chicken broth may be given for one feeding of the day as early as six months. If the baby is doing well on the milk mixture, it is not advisable to change the diet, but if there are indications that the milk is not all that is necessary and the baby seems hungry and restless, one ounce (two tablespoonfuls) of the broth may be given once a day. Six Months If the baby is delicate it is advisable to begin with beef juice, one teaspoonful every other day for children as young as six months. All babies at nine months should have beef juice on alternate days. It can be given on a 126 HEALTHYBABIES little dry bread. Beginning with one tea- spoonful, it may be increased gradually until at one year the child is receiving from two to four teaspoonfuls on dry bread at a meal. The white of a coddled egg also may be given as early as six months, but should never be given on the same day as beef juice. Eight to Ten Months When the teeth come through on both upper and lower jaws, the baby should have a small piece of zwieback, once a day or a hard Hunt- ley & Palmer biscuit to chew on. Nine to Ten Months At this time, the baby, having been weaned, may have a teaspoonful of the mealy part of a baked or boiled potato with a little dish gravy or beef juice, a teaspoonful of scraped beef or two ounces of milk, vegetable or spin- ach soup. Soup, broth, beef juice or coddled egg should not be given on the same day. At this time, however, cereal gruels may be given once daily. When the child begins to take solid food, not more than a quart of milk a day need be given. Part of this may be in the form of junket. CHAPTER VII STOMACH AND BOWEL DISORDERS LOSS OF APPETITE In babies under one year of age loss of appetite usually is shown by refusal to take the bottle or breast feeding at the regular time. The cause is almost entirely due to some error in feeding; that is, the food is given at too frequent intervals, the milk mixture is too rich (there is too much cream in it) or, in older babies, loss of appetite may be due to the fact that the milk feedings have been con- tinued for too long a time and other articles of food are desirable. Other causes are chronic constipation, hot weather, lack of fresh air indoors and too little airing out-of-doors. Loss of appetite is apparent, also at the beginning of any acute illness. Treatment The method of dealing with loss of appetite is obvious. The interval between feedings should be lengthened, and generally, the strength of the milk mixture should be reduced. This is particularly necessary in hot weather, when water should be added to the feeding, and in addition the baby should receive plenty of water to drink between feedings. Lengthen- ing the feeding interval also is of the utmost 127 128 HE ALTHY B ABIES importance in hot weather, and no attempt should be made to increase the strength of the formula during the heated term. Attention must be paid to the condition of the bowels, and if constipation exists effort must be made to overcome it. The baby must be kept in the fresh air as much as possible, and the sleeping room must be well ventilated at night. If the loss of appetite is due to the onset of severe illness, other symptoms such as fever, irritability, restlessness, with possible vomit- ing and diarrhoea, will manifest themselves within a few hours and attention must be paid to the illness rather than to the symptom of loss of appetite. REGURGITATION Nearly all babies who have been overfed "overflow" or regurgitate their food immedi- ately after feeding. Sometimes this condition occurs when only a normal amount of food has been taken. Treatment In such instances attention must be paid to the condition of the clothing as this type of regurgitation occurs frequently as a result of an abdominal binder or a diaper which is fastened too tightly around the child's waist. For the type of regurgitation which is caused STOMACH AND BOWEL DISORDERS 129 by overfeeding, the remedy is to lengthen the interval of feeding, and if this does not bring about the desired result, water should be added after the breast feeding or the bottle formula should be diluted with water. If regurgitation occurs immediately after feeding, the child should be placed quietly in his crib and not handled. VOMITING If the vomiting occurs soon after feeding, it is probable that the child is receiving too large a quantity of milk, or that the hole in the nipple may be too large, and the food is swallowed too rapidly. Handling the baby immediately after feeding, feeding him at too frequent intervals, or tight clothing which con- stricts the abdomen are all causes of vomiting. Treatment The treatment consists in removing the cause. The quantity of milk may be reduced, the period of feeding should be shortened to fifteen minutes, care must be taken to see that the baby does not nurse too rapidly, the clothing should be readjusted and the interval between feedings lengthened. The baby should, of course, be placed quietly in his crib im- mediately after feeding, although in case any gas or wind is present, he may be held up over 130 HEALTHY BABIES the mother's shoulders and his back patted gently in order to stimulate the eructation of the gas. Vomiting some time after feeding usually is due to some change in the quality of the milk. It may be that there is too much fat, too much sugar, that the milk is stale or that the milk modification is too strong. Treatment In the case of the breast fed baby, the treat- ment is to lengthen the interval between feed- ings, and to give a smaller quantity of food. If the vomiting is persistent the baby may be fed wholly on barley water for three or four feedings, and returned to the breast for five or ten minutes for the next three or four feedings. Water should be given freely be- tween feedings and the feeding interval length- ened. For the bottle fed baby, the feeding interval should be lengthened, two teaspoon- fuls of lime water added to each feeding and a smaller quantity of milk used for the feeding. Less sugar should be added to the formula. If these measures do not stop the vomiting, the milk should be boiled and the sugar omit- ted entirely. Mild attacks of vomiting may be relieved by one quarter teaspoonful of bicarbonate of soda in one teaspoonful of I lurtesy Manhattan Maternity Hospital, N. Y. Method of Syringing the Ear STOMACH AND BOWEL DISORDERS 131 water or fifteen drops of rhubarb and soda mixture in a teaspoonful of water. STOOLS For the first few days of life the bowel movements are black and sticky, and occur from tw^o to four times a day. After the first week they become yellow, about the consist- ency of gruel. Later they are of a paler yellow, firmer and well formed. There may then be from three to four movements a day, if the baby is breast fed, or two to three if the baby is bottle fed. Occasionally babies have only one movement a day. If this is of good quality, no concern need be felt. Abnormal Stools If the bowel movements contain curds or lumps of mucus, it is an indication that the milk is not being digested properly. When the number of movements in a day exceeds four, and they are loose or watery in character, mixed with undigested food, sometimes green- ish in color, there evidently is some distinct trouble with the feeding, and proper attention must be paid to the matter at once. Stools that are frothy, rancid, green, liquid in char- acter and frequent in number, usually are due to an excess of sugar or fat in the feeding. The appearance of such stools may not be 132 HEALTHY BABIES accompanied by any constitutional symptoms. The baby may be restless, but usually there is no fever or any evidence of pain. There may be gas or colic. The baby's weight remains stationary or there may be a loss. Treatment The formula should be made with skimmed milk, with all sugar omitted. In hot weather the milk must be boiled. Water should be given freely between feedings, and the inter- vals between feedings lengthened- Restora- tion of the milk formula to its normal strength must be carried on gradually, the reduced formula being used for at least a week, unless the baby shows marked loss of weight in the meantime, when the amount of milk in the feedings may be increased or whole milk may be used in place of skimmed milk, but no sugar should be added until the bowels are entirely normal. DIARRHOEA With true diarrhoea there is a good deal of gas or wind passed by the bowels, and the baby usually has some fever, is very irritable and cries a great deal of the time. The ab- domen may be hard and tense, and there may be other evidence of pain and discomfort. Diarrhoea is very uncommon in breast fed STOMACH AND BOWEL DISORDERS 133 babies. When it occurs it may be due to diminished vitaHty as a result of very hot weather, or to overclothing. In bottle fed babies, however, diarrhoea is common, partic- ularly during the summer months. It may be due to overheating of the body, with too much clothing, or to irregular hours of feeding, or to too frequent feeding, too much sugar in the milk, or particularly to milk which is not entirely fresh or which has not been kept properly iced and covered. As diarrhoea in bottle fed infants may be a serious illness, active measures of treatment should be in- stituted at once. Treatment All milk feedings should be stopped im- mediately and the baby should be given a tablespoonful of castor oil. If the baby will not take castor oil or vomits it immediately after taking, give calomel in one-tenth grain doses every fifteen minutes until ten doses have been taken. For twenty-four hours there should be no food except barley water, rice water or albumen water, two ounces every two hours. Between feedings give plenty of cool, boiled water. During the illness the baby must stay in bed. If it is impossible to obtain the doctor's advice, and the child is very ill, the mother can give a colon irrigation. If 134 HEALTHY BABIES the baby has cold hands and feet, or if his legs and mucous membranes are blue, he should be given a mustard bath, then wrapped in a blanket with a hot water bag at his feet, and if necessary one on either side of the body. If the fever is very high, cool or tepid sponge baths should be given two or three times a day. Patent medicine should never be given to a baby except on the advice of a physician, nor should any preparations containing opium or alcohol be given. They are apt to do far more harm than good, and may be exceed- ingly dangerous in some cases. At the end of twenty-four hours, if the diarrhoea has lessened, nursing should begin again, but should not last more than five minutes and should be kept at four-hour intervals. For the bottle fed baby, the milk must be greatly diluted, a formula be- ing used that ordinarily is suited to a much younger child. The breast fed baby should have at least two ounces of water after the five-minute feeding. Frequent cool sponge baths and the very lightest of cloth- ing are essential. If the diarrhoea does not stop at the end of twenty-four hours, there should be no delay in getting the advice of a physician. STOMACH AND BOWEL DISORDERS 135 Prevention of Diarrhoea It is much easier to prevent diarrhoea in babies than it is to cure it. Particular care should be taken at the beginning of the hot weather to see that the milk supply is pure and that it is kept cool, clean and covered from the moment it reaches the home until it is fed to the baby. During the hot weather the milk should be pasteurized, and if there is any doubt at all about its purity or any difficulty in keeping it, the milk should be boiled. If there is any tendency to constipa- tion after boiled milk has been used, an in- creased amount of sugar may be added to the formula. Throughout the hot weather the baby's clothing should be very light and loose. Cool boiled water must be given between feedings and the feeding interval lengthened. It is best that no increase in the strength of the milk be made during the summer months, unless the child is actually losing weight. During the heated term it is unusual for in- fants to gain to any extent, but this does not indicate that they are not healthy. The baby must be kept outdoors as much as possible, must have cool sponge baths at least twice a day and must be kept free from all unnecessary handling and over-excitement. If diarrhoea does occur, it should be cared for as outlined above. 136 HEALTHYBABIES CONSTIPA TION Constipation in breast fed babies is very- rare. In bottle fed babies it usually is due to improper diet or to lack of muscular strength in the intestines. Treatment In the case of a breast fed baby it is neces- sary for the mother to increase the amount of fat in her diet. This may take the form of extra milk, cream, butter or olive oil in tea- spoonful doses three times a day. The baby may be given a teaspoonful of cream in a little water before each breast feeding or half a teaspoonful of olive oil after the morning, noon and evening feedings. In a bottle fed baby constipation may also be due to lack of sufficient fat in the feeding, although often it is due to insufficient water. If the baby is over six months old the constipation may in- dicate that he has been kept too long on a .milk diet, and needs additional food. Boiled milk, if long continued, also has a tendency to cause constipation. In such cases, orange juice should be given in the morning in table- spoonful doses at least one hour before the first feeding. Water must be given in suf- ficient quantity between feedings. If boiled milk is essential, an extra tablespoonful of STOMACH AND BOWEL DISORDERS 137 sugar should be added to the day's mixture. One teaspoonful of cream may be added to each feeding or a teaspoonful of olive oil may be given three times a day. Drugs should not be used, other than milk of magnesia which gives good results when one teaspoonful is added to the morning and night feedings. After the baby is three to four months old oatmeal water should be substituted for the barley water in making the formula, and at the end of ten months the child may be given the finely mashed pulp of some stewed prunes or a little baked apple each morning. It is important to establish regular habits, and the child should be taken to the stool at the same hour every morning. COLIC AND WIND Colic is one of the common disturbances of baby life. Usually it is caused by over-feeding, too rich milk, too frequent feeding, too much sugar in the milk, or irregularity in feeding. Some babies habitually gulp up quantities of wind from the stomach, and usually all that is necessary to start the eructation of the gas is to place the child gently over the mother's shoulder and pat him on the back. Sometimes, however, the symptoms are more severe. The baby may show signs of great distress, the face becoming blue and the muscles con- 138 HEALTHYBABIES tracted. The child draws up his feet and legs, the abdomen becomes hard and tense. The cry of colic is quite characteristic. Gen- erally it is sudden, sharp and strong, and to the trained ear always means that the baby is suffering pain. The immediate treatment is to place the baby across the mother's lap on his stomach and pat the back gently, or he may be held against the mother's shoulder and his back rubbed or patted in the same way. Placing the baby face downward, with the stomach directly over a hot water bag, some- times gives relief, care being taken to see that the bag is not too hot. Hot fomentations on the baby's abdomen also are helpful. The remedies which may be used consist of five drops of peppermint water in a teaspoonful of warm water, or a quarter teaspoonful of soda bicarbonate in a teaspoonful of hot water. Usually, after any of these remedies, there will be a sharp eructation of gas, and the child will begin to show relief. If the gas is in the bowels the abdomen may be massaged gently or rubbed, to start the wind. If this is not suf- ficient, a rectal injection of a pint of warm water w4th five drops of turpentine may be tried. This should be allowed to run into the rectum very gently, and when expelled usually will bring with it quantities of the gas. STOMACH AND BOWEL DISORDERS 139 Prevention of Colic and Wind- To prevent colic change must be made in the manner of feeding. Regular hours are es- sential. The interval between feedings must be lengthened. In breast fed babies two ounces of water should be given from a nursing bottle after each feeding. MALNUTRITION AND MARASMUS When the child has persistent malnutrition which is shown by inability to digest food, and by progressive loss in weight, or when the loss of body weight is so excessive that the child is actually emaciated, the condition is known as marasmus. This condition is far more common among babies in institutions than amiong those who are cared for at home. The general methods of hygienic care and right feeding are the best preventives, but prolonged malnutri- tion or marasmus may be the result of some special disease. While any baby in this condi- tion should be under the immediate care of a physician, a few suggestions may be given to the mother. Sometimes this condition of lack of nourish- ment is due to too strong milk mixtures in the artificially fed baby. Overfeeding also may be a cause. In this, as in every other matter concerning the baby, weight is the best indica- 140 HEALTHY BABIES tion of continued progress. When it remains stationary for any length of time, or continues to grow less, it is evident that the food is not agreeing with the baby. All other matters pertaining to improper baby hygiene are caus- ative factors. Because the causes are so many, no regular rules can be given as to treatment. If it is possible to obtain a wet nurse for the baby, this should be tried at once. Very weak dilutions of milk may have to be given for a time. If the weight is increasing slightly, do not increase the amount of food or force the feeding in order to increase the weight still more. Symptoms of vomiting and diarrhoea should be treated, but it must be remembered that these babies need more intelligent care than the normal baby. Fresh air is of the utmost importance and the baby should be kept outdoors as nearly as possible all of the twenty-four hours. Salt baths, gentle rubbing from head to feet with olive oil or cocoa butter, are excellent. This rubbing should always be toward the body; that is, beginning at the feet and making the movements up the legs, or beginning at the hands, and stroking up the arms. This should always be done very gently. Such babies should never be allowed to re- main very long in one position. Even while STOMACH AND BOWEL DISORDERS 141 they are sleeping, they should be moved. Mothers always should take up these ill- nourished babies several times a day, and walk around the room with them and hold them in their laps. While all these matters may help, and sometimes may effect a cure, the mother should never forget the importance of obtain- ing the best possible medical advice for her under-nourished baby. CHAPTER VIII MINOR ILLNESSES AND AILMENTS HOW TO DETECT SYMPTOMS OF ILLNESS The four main ways in which illness is shown are (1) appearance of the patient, (2) rise in temperature, (3) increase in pulse rate, and (4) increase in the respiratory rate. Observation While different diseases have different symp- toms, in general the first signs of illness in a child consist in slight flushing of the face, ir- ritability, restlessness, sleeplessness and lack of appetite. These signs are readily apparent. There are others which may be observed more readily when the baby is asleep. If he is well, the sleep will be quiet and peaceful. There should be no movement, restlessness or tossing about. In the normal baby, breathing is regular, easy and quiet, and he should always breathe through the nose, with the mouth closed. If he is well, the skin should feel cool and slightly moist. Hands and feet should always be warm, and the skin always should be a healthy pink color. Temperature The normal temperature of the body is 98.6 degrees Fahrenheit. Babies show more marked 142 MINOR ILLNESSES AND AILMENTS 143 changes in temperature than adults do. The cause of a high temperature in a baby may be very sHght, and the temperature may go up to 103 or 104 degrees for a Httle digestive disturbance, or an illness which need give no cause for concern. The only time when an increase in temperature is to be considered is when it persists longer than six hours. The temperature always is slightly higher at night than it is in the morning. Some children have a temperature which always is above normal and some, particularly those who are poorly nourished, have a temperature which is consistently below normal. Use of the Thermometer The ordinary clinical thermometer must receive proper care. It always should be washed in cold water immediately before and immediately after using. It never should be put in a warm place or washed with hot water. If this is done the bulb of mercury at the end of the thermometer will break. Usually it is necessary for a person to be in- structed in reading the thermometer, and every mother should obtain from her doctor or nurse the proper training in this regard. The baby's thermometer should be kept for his use alone. Before using, see that the indicator is at£a point below 97 degrees. If it is not, the ther- 144 HEALTHY BABIES mometer must be shaken very gently until the mercury goes down to that point. How to Take the Temperature The baby should be placed on his stomach on the mother's lap, or he may be held on his back, the ankles grasped and the legs held at right angles to his body. The bulb end of the thermometer is greased with vaseline, the fold between the buttocks gently separated, and the thermometer inserted into the rectum for about one inch. It should be kept in place for from one to two minutes, depending upon the type of thermometer used. It is well to accustom the baby to the taking of his tem- perature, even when he is not sick, so that, if sickness occurs, he will not be unduly fright- ened or worried when the thermometer is used. The normal body temperature taken with the thermometer in the mouth is 98.4. The rectal temperature is about one degree higher, but because babies have such wide variations of temperature in any event, a rectal temperature in an infant need not be considered subnormal unless it is below 97.6, and it need not be thought that the baby has a fever unless the rectal temperature goes above 100.6. The length of time the fever lasts is far more im- portant than the height it reaches. MINOR ILLNESSES AND AILMENTS 145 A word of warning should be given against placing too implicit reliance upon the use of a thermometer. Many mothers have worried unnecessarily regarding their children because of the habit of taking temperatures every day. It is not necessary, nor is it wise, to take the baby's temperature unless there is some indi- cation of illness. (See illustration opposite page 66.) Pulse All babies have a very rapid pulse. The number of beats in each minute decreases as the child grows older. Because the pulse is so rapid, it is difficult for anyone but a physi- cian or a trained nurse to determine whether the number of pulse beats per minute is more than normal. If the child has a fever, there is an increase in the pulse rate. The duration of these conditions only need be considered as of any particular importance. In certain dis- eases, particularly those which affect the brain, there is an unduly slow pulse rate. The same word of warning is attached to taking the pulse rate that has already been given with regard to taking the temperature. There rare- ly are any occasions when the mother need take the pulse, and certainly she should not do so unless marked symptoms of illness are present. 146 HEALTHYBABIES How to Take the Pulse The best way to feel the pulse is to place the forefinger of the right hand directly on the baby's right wrist, just at the base of the thumb. A little practice will show the spot where the beating of the artery can be felt most easily. While the normal pulse of a grown person is between seventy and eighty, the normal pulse of a baby at birth is between one hundred forty, and one hundred fifty. At one month this has decreased to between one hundred thirty, and one hundred forty, while at six months the pulse should not be higher than one hundred twenty. Usually it remains at about this rate during the remainder of the first year, while during the second year of life it should be between one hundred and one hundred ten. Respiration The frequency of a baby's respiration is not so important as its type. When the child is sick, it may be of importance to the doctor to have a record as to whether or not breathing has been irregular, noisy or difficult; also, in some instances it may be of value to know whether it has been rapid. In common with the pulse, the respiratory rate of infancy is much higher than that of later life. The ordinary respiratory rate in an MINOR ILLNESSES AND AILMENTS 147 adult is about eighteen per minute; that is, eighteen complete breaths are inhaled and ex- haled in sixty seconds. In a new born baby the rate of respiration is about forty per minute, which decreases to thirty at the end of the first year, and is still further reduced to twenty-six when the child is about two years old. CONVULSIONS OR SPASMS Convulsions may be the first indication of the onset of an acute illness, or they may occur in a child otherwise apparently healthy, who, after the convulsion is over, may seem to be as well as ever. Always there is a ten- dency for convulsions to be repeated, unless proper action is taken to prevent them, and the more often they are repeated, the more fixed becomes the habit. For this reason, every effort must be made to see not only that the convulsions are treated at once, but that proper care is instituted to prevent their oc- currence in future. Causes of Convulsions or Spasms The ordinary convulsion which occurs in a child otherwise in perfect health usually is cau- sed by some digestive disturbance, due to some error in diet. Other causes of convulsions are diseases like rickets, whooping cough or acute 148 HEALTHY BABIES illnesses of various kinds. In boys, tight fore- skin, which is an indication for circumcision, may cause convulsions by mechanical irrita- tion. Children who are poorly nourished may have repeated convulsions for no apparent reason. Spasms of this kind are practically unknown to occur as a result of worms or of teething. Symptoms In some instances the symptoms are slight. The baby's body will become stiff, the eyes fixed. If the baby is a runabout, he may be walking and stop suddenly staring into vac- ancy. The young baby will lie perfectly rigid and quiet. The duration of the spasm is very short and the child recovers almost immedi- ately, and seems as well as ever. More Severe Type In such instances the child's muscles begin to twitch, the whole body stiffens, the hands clinch, the eyes have a fixed and vacant look, the forehead usually perspires freely and is cold. The child becomes unconscious, with feeble breathing, and will remain in this con- dition for several minutes unless active meas- ures are taken to combat the spasm. MINOR ILLNESSES AND AILMENTS 149 Treatment If the child can be undressed at once, he should be placed in a mustard bath. Care must be taken to see that the water is not too warm. The best way to test it is to have the mother or attendant place her elbow into the water. If it feels warm but not hot, it will not burn the child. If a thermometer is avail- able, the water should be prepared at a tem- perature of 102 to 104 degrees. If there is not time to undress the child, the shoes arid stockings should be removed, the child placed flat on his back on the edge of the bed or table, and the feet allowed to hang into a mustard foot bath of the temperature mentioned above. Whether the full mustard bath or the mustard foot bath is given, a cloth wet with cold water or an icebag should be placed at the child's head. The bath should continue for from five to ten minutes. The feet or the body should be rubbed gently during this entire time. Then the child should be wrapped in a warm blanket, the icebag or iced cloth kept on his head and a hot water bag placed at his feet. As soon as it can be prepared an enema of warm soapsuds should be given in order to remove from the lower bowel any feces that may be there. A teaspoonful to a tablespoonful of castor oil should be given, 150 HEALTHYBABIES depending upon the age of the child, and he should be induced to sleep. Medical advice must be obtained for any child who has more than one convulsion. It is not safe to assume that he will outgrow them, nor is it safe simply to follow these methods of treatment that the mother may understand. After any convul- sion, great care must be taken in regard to the feeding. For several hours the child should have nothing but water to drink and no food of any kind. When feeding is resumed, it must be exceedingly light. In young babies, the milk should be reduced one-half in quality by adding an equal amount of water. Although convulsions occur very rarely in breast fed babies, if they do occur the baby should be nursed only half the usual time, and then be given water to drink. WORMS Thread worms are the only type which occur in babies under one year of age, and it is rare for any symptoms to accompany these worms. The tape worm and other varieties of in- testinal worms are not found until the child begins to eat solid food. The only way in which thread worms can be diagnosed is by finding them in the baby's stools. They occur as small, white threads, and if watched closely, MINOR ILLNESSES AND AILMENTS 151 may be seen to move. Occasionally the eggs of the worms are found. Treatment Irrigate the lower bowel with a solution of a tablespoonful of salt to a quart of water, or a solution of two tablespoonfuls of borax to a quart of water. This solution should be allow- ed to run in and out very slowly, and should reach as high into the bowel as possible. After this has been ejected completely, a solution of quassia should be injected slowly. This is made by adding one ounce of quassia chips to eight ounces of water, bringing it to a boil, and straining. The irrigation of the bowel and the injection of the quassia water should be repeated every day for three days. After that it may be done less frequently. The bowel movements must be examined every day to determine whether or not the worms are pres- ent. Particular care must be taken to examine the external genitals so that the baby may not become reinfected. It is not uncommon for the worms to remain hidden about the baby's genitals, and later to reach the rectum, setting up a reinfection. RICKETS This is a disease w^hich is due to some nu- tritional disorder. It is chronic in character. 152 HEALTHYBABIES The bones show the effects of rickets more clearly than any other part of the body. It is apt to manifest its symptoms after the baby is six months old, although the first symptoms may appear later, up to two and a half to three years old. Cause A certain amount of the undernourishment which leads to rickets is due to lack of prenatal care, because the mother's diet during her pregnant period has not supplied the child with the necessary materials for developing the bones in a normal manner. After the birth of the child, rickets may occur as a result of too prolonged use of the various proprietary foods, unless they are made up with plenty of fresh milk. Lack of fat or cream in the diet also frequently leads to the occurrence of rickets. Symptoms The symptoms of rickets are only fairly well defined in their early stage. At first all that may be noticed is that the child becomes increasing- ly restless and frequently there may be some pallor and anemia. Sleep is disturbed. The characteristic symptom is marked sweating of the head, particularly at night. It is not un- common to find the baby's pillow quite wet. As MINOR ILLNESSES AND AILMENTS 153 the disease progresses there are more marked bodily changes. The pot-belly abdomen is often the first symptom noticed. Here the abdomen becomes very large in proportion to the rest of the body and stands out promi- nently. Children with rickets always are late in showing the normal signs of development. Sitting up, creeping and walking will occur several months after the proper time. Denti- tion is apt to be very much delayed. If treat- ment is not started early, we have the per- manent results of rickets which are apt to be serious. As softening of the bones is char- acteristic of the disease, children who are allowed to walk too early are apt to become bow-legged. In any event the bones become enlarged and may be deformed. The head is over-size in proportion to the growth of the rest of the body, and the top of the head is apt to be flat. The wrist and ankle bones may show signs of enlargement. Frequently the chest is deformed, and on each rib in front appears a small, hard nodule of bone. As these nodules appear in about the same place on each rib, they can be felt on each rib and form what is known as the "rachitic rosary." Children who have rickets are subject to many symptoms of illness. They are apt to be constipated and to have various types of in- 154 HE A LTHY B A B I ES testinal trouble. Convulsions are not uncom- mon in rachitic children. Treatment As rickets is a nutritional disease, the way to treat it is to change the diet. If it has been caused by too prolonged use of propri- etary foods made without milk an absolute change in the manner of feeding must be made at once. Fresh milk always should be part of the dietary. If the milk must be pasteur- ized or boiled, orange juice, prune juice or the juice of canned tomatoes should be given, at least two teaspoonfuls of the juice each day. If there is a tendency to rickets, beef juice, the white of coddled eggs and vegetable broths may be added at the age of six months. Special attention must be paid to the bowel action of such children, and it is essential that they have a free movement once each day. Children with a predisposition to rickets or those who have already developed the disease should stay outdoors the greater part of the day. Sleeping outdoors is one of the best methods of treatment we know anything about. Medical treatment must be left to the physician, but it is permissible to use cod liver oil in doses of from one half to one tea- spoonful three times a day for children over nine months of age. MINOR ILLNESSES AND AILMENTS 155 SCURVY Scurvy is a nutritional disease, due to wrong feeding. It is most common in the latter part of the first year of life, when the baby's need of a changed diet is evident although milk feeding is still continued. However, it may occur during the second year, if the child is not being fed properly. Cause The most common cause of scurvy is too long continued use of one type of food so that the diet is not properly balanced. In infancy, therefore, it is essential to see that the child receives some fresh food. Frequently it hap- pens that the long-continued use of proprie- tary foods, boiled milk or pasteurized milk will lead to the occurrence of scurvy. Recent investigations have shown that there are certain vital food elements which are known as vitamines and which occur in var- ious types of fresh foods, including raw milk. They also occur in breast milk. It is pos- sible that pasteurizing or sterlizing the milk destroys them. Symptoms The most characteristic sign of scurvy is sore- ness and tenderness of the bones. This occurs more frequently in the child's legs and he will 156 HEALTHYBABIES cry out when handled. There may be some swelHng of the knees and ankles, and less com- monly, of the other joints of the body. This must not be mistaken for rheumatism, a disease which does not occur in children under one year of age. As the baby lies in bed, he seems un- willing to move and resents being handled or lifted. The gums frequently are swollen and may be congested, and of purplish color. They are apt to bleed and this bleeding sometimes occurs also from the nose and bowels. Fre- quently, in advanced cases, the child's legs will be covered with what seem to be black and blue spots. Treatment The treatment of this disease is indicated by what is given as the cause. The proper way to prevent scurvy is to see that, after three months of age, the baby receives every morn- ing two teaspoonfuls of orange juice, prune juice or the strained juice of canned tomatoes at least one hour before the first morning feed- ing. This is particularly necessary if the baby is being fed on proprietary foods or pasteurized milk. Care should be taken that weaning is not delayed too long. Whenever possible, fresh milk should be used. At least some proportion of it must be included in the dietary, even if the balance of the food is of another character. MINOR ILLNESSES AND AILMENTS 157 If the symptoms develop when the child is six months old or over, it is well to add to the diet a little of the mealy part of a baked potato, a teaspoonful of beef juice on a small piece of dry bread or two teaspoonfuls of apple sauce or the white of a coddled ^gg. These articles should be given alternately, on suc- ceeding days. This treatment of scurvy will result in marked improvement of the condition and usually will result in an entire cure within three weeks. SPRUE AND THRUSH A common complaint of infancy is known as sprue or thrush. The symptoms are tiny white threads or flakes which appear on the inner side of the lips or inside the cheeks The whole inside of the mouth and tongue may be covered. In such cases it may be necessary to wash out the baby's mouth, using a solution of borax or soda bicarbonate (baking soda), one teaspoonful to three ounces of water. This may be done twice a day. Absorbent cotton should be wound around the little finger of the mother, then dipped into the solution and applied to the affected surfaces with a gentle rotary motion of the finger. No force whatever should be used for the delicate mucous membrane is very easily injured. 158 HEALTHYBABIES PRICKLY HEAT Prickly heat consists of fine red pimples which may occur all over the body. They are noticeable especially where there has been ir- ritation or undue pressure from the under- clothing. They are due to inflammation of the pores, and are caused by excessive perspira- tion or the irritation from flannel undercloth- ing. To avoid prickly heat, the body should be kept cool and there should be frequent cool sponge baths during the hot weather. Muslin or linen always should be worn next to the skin. This is proper even in very young babies. Treatment For treatment, bran or soda baths are ad- vised. Sponge baths may be given with equal parts of vinegar and water. The skin never should be rubbed, but always patted dry, and after any kind of bath should be well dusted. For a baby with slight prickly heat a powder composed of one part boric acid to four parts powdered starch is advised. If the secretion is excessive or the itching is extreme, a powder made of one part zinc oxide to five parts starch or stearate of zinc powder will be found to have both healing and soothing qualities. MINOR ILLNESSES AND AILMENTS 159 EARACHE In very young babies symptoms of earache are apt to be obscure. Usually the first symp- tom is loss of appetite, followed by an in- crease in temperature, the fever going as high as 103 to 105 degrees. The baby is drowsy at first, later becoming extremely restless with much tossing about. Sometimes the child may be noticed attempting to move his hand up to the affected ear. Vomiting is not uncommon. The diagnosis of earache in a young infant is not easy, therefore it is necessary to deter- mine that no other condition exists which would cause the fever and apparent pain. If any indication exists that the pain is in the child's head, it is well to assume that the ear may possibly be involved and to proceed accordingly. Treatment Heat in some form is the best early treat- ment. The heat should be dry and continuous. The child's head should be allowed to lie against a hot water bag, care being taken to see that it is not hot enough to burn the baby's skin. Bags filled with salt may be heated in the oven and wrapped around with flannel. This furnishes a good method of applying heat. If the symptoms do not subside with this hot application, it is well to irrigate the ear with 160 HEALTHYBABIES a very warm solution of boric acid, a tea- spoonful to a pint of water, or a solution of salt and warm water, a teaspoonful to a pint. If the pain still persists after the irrigation, a doctor should be consulted at once, for it may be necessary to have an incision made in the ear drum. Occasionally the ear drum will rupture spontaneously, and after that there may be a flow of pus from the ear for several days. As long as this pus appears the irriga- tion should be carried on two or three times a day and the ear kept absolutely clean. As soon as the ear drum ruptures or is perforated, the symptoms of earache will subside and rarely return unless the drum heals too rapidly. Method of Irrigation There are two methods that may be used in irrigating the ear. First is by means of a fountain syringe at a height of two feet above the head of the child. He lies on his back, turned slightly towards the side of the ear that is affected. A shallow basin should be placed under the ear, and the nozzle of the fountain syringe held about one to two inches above the opening of the ear canal. The stream should be directed towards this opening, and the water should be allowed to flow in very gently, and to flow out of the ear freely at the same time. No force whatever should be used. One MINOR ILLNESSES AND AILMENTS 161 pint of the solution used in the ear is quite enough. The second method is by means of a small ear syringe, made like a soft rubber ball, drawn out to a point on one side. This may be squeezed and filled with the solution then squeezed gently to expel the contents in the baby's ear canal. Care must be taken to see that no pressure is directed inside the child's ear, and that the water flows out freely. After the irrigation has been completed the outside of the ear canal should be wiped out gently with absorbent cotton. (See illustration opposite page 131.) HICCOUGHS In babies, hiccoughs usually are caused by too rapid nursing either from the breast or from the bottle. Over-eating, with consequent indigestion and the formation of gas in the stomach, also will cause hiccoughs. Treatment The treatment of hiccoughs consists in pre- vention; that is, care of the diet to correct any tendency to over-eating. If the baby is bottle fed, attention must be paid to the nipple to see that the milk does not flow through in too free a manner. It should come through only a drop at a time. The baby must not be allowed to nurse too rapidly, and a full twenty 162 HEALTHYBABIES minutes is necessary for each feeding. For acute attacks of hiccoughs ten drops of rhu- barb and soda mixture in a teaspoonful of water or one-quarter teaspoonful of soda bi- carbonate to a teaspoonful of water usually will relieve the attack. If there is much gas formation in the stomach or intestines, a colon irrigation is advised. SKIN DISEASES ECZEMA Eczema in infancy is fairly common. It is more apt to occur in children who appear well nourished, and who are healthy looking and fat. It may occur either in breast fed or bottle fed babies, but is not common in poorly nour- ished children. The disease probably is due to both internal and external conditions. Over- feeding of milk which contains too much fat is responsible for many cases. Some children, however, have a certain susceptibility to eczema and it continues all through infancy, notwithstanding everything that is done to prevent or relieve it. The external causes are exposure to strong winds or cold outdoors. The first symptoms noticed are usually those of chapping of the face. It may occur also as a result of lack of cleanliness, when irritating discharges from the bowels or other bodily MINOR ILLNESSES AND AILMENTS 163 cavities are allowed to remain for any length of time. Irritation from rough clothing also has been known to cause eczematous conditions. Location of Eczema Usually eczema appears on the cheeks, fore- head and scalp, although it may occur on almost any part of the body. Upon the trunk or extremities it occurs usually in patches. When it appears on the scalp it is sometimes referred to as "milk crust," and is seen in the form of a yellow or grayish secretion, forming a crust which covers the entire head of the child. The first symptoms are those of red- ness and roughness of the skin. Later, the skin becomes moist, with much secretion. This dries and forms heavy crusts which be- come hard and unyielding. There is evidence that eczema causes intense itching. Treatment Attacks of eczema rarely last beyond the first year, although older children sometimes are affected. The treatment consists first in rearranging the hygiene of the baby's life, with particular reference to the diet. The food must be diluted and the interval of feeding lengthened. In breast fed infants, water should be given immediately after each feed- ing. In bottle fed infants, skimmed milk 164 HEALTHYBABIES should be used in place of whole milk so as to reduce the amount of fats. If no improve- ment is shown the amount of sugar also should be reduced. The child should be given plenty of water to drink. The local treatment varies slightly according to whether the eruption is on the body or on the scalp. Local Treatment for Eczema of the Scalp The affected area should be covered with olive oil which should be applied freely by means of muslin cloths dipped in it. These should cover the head of the baby, and should be kept in place by a soft cap. They should be changed twice a day, when the oil must be renewed. At the end of three or four days, the scalp should be washed with warm water and soap, and effort may then be made to remove the crusts very gently. If there is any bleed- ing the oil applications must be commenced again as no force must ever be used in remov- ing the crusts. After they have been removed, a soothing ointment should be applied. This may consist of a mixture of equal parts of lime water and sweet almond oil, or zinc oxide ointment. The ointment should be spread upon muslin and kept in close contact with the affected area. MINOR ILLNESSES AND AILMENTS 165 Local Treatment for Eczema of the Body The eruption should be covered with some mild ointment, such as zinc oxide. No water should be allowed to come into contact with the eczema and all cleansing must be done gently by means of soft cloths dipped in sweet oil. INTERTRIGO This is a term which is generally applied to an intense red eruption which occurs usually when two moist surfaces come into contact. Sometimes it is thought of as a form of eczema. It resembles severe chafing and sometimes the skin comes off over fairly large areas, and the surface is moist. There rarely is any formation of crusts. Intertrigo usually occurs between the thighs, about the anus, back of the ears, in the axilla, the folds of the neck, or in other places where the skin folds on itself, or comes into contact with any other part of the body. Cause Usually the cause is dependent upon some form of uncleanliness, that is, that the diapers are not changed frequently enough, that there has been excessive perspiration of the skin with bathing at too infrequent intervals, or it may be that the bowel discharges have been irritating. 166 HEALTHYBABIES Treatment The baby's body must be kept scrupulously clean, the diapers changed as soon as they have been soiled, and the parts of the body which come into contact with any other part must be kept dry and carefully dusted with a good talcum or boric acid powder. When in- tertrigo has appeared, the area should be washed carefully and covered with zinc oxide ointment or stearate of zinc powder. The baby should be given plenty of water to drink between meals, the milk should be diluted, and the interval of feeding lengthened. In addition, it is well to stop the use of sugar for a few days in the milk formula. How to Prevent Scratching in Skin Diseases Eczema and other itching skin diseases are made worse by scratching. The two methods which may be employed to prevent the child's irritating himself in this way, are by the use of aluminum mits and cardboard cuffs which are placed over the child's elbows. Both of these have been described in this book under the heading of ''Treatment for Thumb-Sucking and Nail Biting." CROUP Croup is an acute spasm of the larynx, ac-; companied by a harsh, brassy cough, noisy and MINOR ILLNESSES AND AILMENTS 167 difficult breathing and occasionally by signs of partial suffocation. It is not common in young babies, rarely appearing before six months of age. The vast majority of cases occur when the child is from three to six years of age. There seems to exist in some children a predisposition to croup, which may be a family trait. If there is one attack there are apt to be others. Sometimes the attacks occur three or four nights in succession. Again, there may be a long interval between them. Cause The immediate exciting cause of croup seems to be exposure to cold or some form of indigestion. Large adenoids and hypertro- phied tonsils often are predisposing causes. Onset During the day the child may exhibit some slight difficulty in breathing and older children may have a hoarse, rather hollow and barking cough. This becomes increasingly worse towards evening although the child may finally go to sleep. The attack itself generally comes on about midnight. The child awakens sud- denly, w4th great difficult}^ in breathing, loud, noisy inspirations with a characteristic sound which, once heard, is rarely forgotten. The child 168 HEALTHYBABIES appears to be in great distress. The mucous membrane may be blue and sometimes there seems to be imminent danger of suffocation. The pulse is rapid, occasionally there is slight fever, although the temperature rarely goes above 102. Sometimes the child is quite pros- trated, but it must be remembered that this disease is never fatal although it is always alarming. After the attack subsides the child usually falls into a refreshing sleep and seems quite well again the next day. There may be recurrent attacks of croup for two or three nights in succession, then they may stop for weeks or even months. Prevention A child with a tendency to croup should be kept in the open air as much as possible. If he can be accustomed to cold bathing, so much the better. In any event, the neck and chest should be sponged with cold water night and morning. If adenoids and enlarged tonsils are present, they should be removed. As di- gestive disturbances often cause croup, care must be taken to see that anything the baby or young child eats is readily digestible. In infants too rich milk or too frequent feeding may possibly be the cause, and feeding in- tervals should be lengthened and the milt MINOR ILLNESSES AND AILMENTS 169 diluted. For older children tonic treatment may be necessary. Treatment When an attack occurs the best remedy is syrup of ipecac. This may be given in doses of thirty drops every fifteen minutes for a baby from six months to a year old and one-half to one teaspoonful every ten to fifteen minutes for a child of two years. The dose should be repeated until vomiting occurs. If vomiting does not occur after two or three doses the child should be given a teaspoonful of white vaseline or two teaspoonfuls of goose grease. Hot flaxseed poultices or hot fomentations should be placed around the child's neck. If there is much difftculty in breathing, a croup kettle should be used. If a regular croup kettle is not available, an ordinary tea-kettle can be made to answer the desired purpose. It should be two-thirds full of water, which must be boiling vigorously when the kettle is taken from the stove. It should then be placed on a chair close to the bed and over the bed should be arranged a canopy. This may be done easily by raising an umbrella and then draping sheets over it so that the child is under a tent. The spout of the kettle is then inserted through an opening in the sheet and the child allowed to breathe the moist and steaming air. 170 HEALTHYBABIES Such treatment as this usually loosens up the cough and vomiting almost invariably relieves the spasm. If the attack recurs during the night, the treatment must be repeated. The next day the child should be kept quietly in bed, and it is advisable to give the syrup of ipecac in five-drop doses every two hours dur- ing the daytime in order to relax the spasm of the larynx. ACUTE CATARRHAL BRONCHITIS Acute catarrhal bronchitis is the ordinary type of cold which is common in infancy. This particular kind of cold occurs commonly dur- ing the first year and diminishes in frequency during the second year. It is particularly common in undernourished babies or those who have rickets. Adenoids and enlarged ton- sils also seem to be predisposing causes. Cause The immediate cause may be chilling of the body surface which usually comes from being overdressed, and then having the body sur- faces chilled while they are perspiring. Cold air alone rarely causes colds. Warm, vitiated and superheated air frequently does. Babies are much more apt to take cold if they are kept in a room with many other people, and are not given opportunities for being in the fresh air MINOR ILLNESSES AND AILMENTS 171 the greater part of the twenty-four hours. Colds of this type occur as secondary com- plications after measles and whooping cough, or some other infectious disease. Symptoms There usually is running of the nose, dif- ficulty in breathing owing to the stoppage of the nasal passages. The baby is apt to have a distressing cough which is rather harsh. Children under nine months of age rarely spit up any mucus. It is probable that the mucus comes up into the throat, and then is swallowed. This w^ill sometimes cause vomit- ing which may consist largely of mucus with a small amount of food. The respirations are apt to be increased in frequency and accom- panied by rattling sounds caused by the mucus in the lungs. There sometimes is a slight in- crease in temperature up to 100 or 102 degrees which may continue for two or three days. The baby is restless, shows loss of appetite, and occasionally there is fever and diarrhoea. Prevefition Babies who are kept in the open air most of the day, and who sleep in well-ventilated rooms seldom are affected with colds. As early as possible they should become accustomed to having cool sponge baths at least once a day, 172 HEALTHYBABIES with vigorous rubbing afterwards. This should be given, however, only when the skin becomes a good pink color after the bath, and the mucous membrane of the mouth and under the nails is a deep pink or red. Digestive dis- turbances must be avoided, the clothing should be light in weight and of proper warmth for the weather. Treatment Whenever the baby has a cold he should be kept in bed during the attack. It is absolutely essential that the room should be well-venti- lated, but it must not be cold. The tempera- ture should not be below sixty-eight degrees. Two or three times a day the baby should be taken out of the room while the latter is being aired. A dose of castor oil should be given at the onset of the cold, and thereafter the child should receive plenty of water to drink. If there is any tendency to indigestion the feeding interval should be lengthened. Breast fed babies should be given water after each feed- ing and bottle fed babies should have the milk diluted for a day or two. CHAPTER IX FOOD RECIPES Albumen Water The white of one fresh egg should be placed in a dish and separated lightly with a fork. Add half a pint of water and a pinch of salt. Shake and strain through fine muslin. Keep covered in a cold place. Rice Water Two heaping tablespoonfuls of rice should be soaked overnight. In the morning, add a quart of water and a pinch of salt. Boil for three hours, adding water from time to time to keep the quantity at one quart. Strain through a fine cloth and keep cold until used. Barley Water One tablespoonful of barley grains, one pint of water and a pinch of salt. Boil for three hours, adding w^ater from time to time to keep the quantity at one pint. Strain through a fine cloth and keep cold until used. If pre- pared barley flour or the patent barley is used, it should be made by taking a level tablespoon- ful of the flour and mixing it to a paste with a little cold water. This should be added to a pint of boiling w^ater and the whole boiled for thirty minutes, then strained and cooled. During the process of boiling, water should be 173 174 HEALTHYBABIES added from time to time to keep the quantity at one pint. A double boiler is preferable for preparing the barley water made from the flour. If an ordinary saucepan is used, the mixture must be stirred constantly to avoid scorching. Oatmeal Water One tablespoonful of oatmeal water added to one pint of water and a pinch of salt. Boil for three hours, adding water from time to time to keep the quantity at one pint. Strain through a cloth and keep cool until used. Cereal Gruels These may be made from rice, oatmeal or barley. If the grains are used take two table- spoonfuls and soak overnight. In the morn- ing, cook for three hours in a double boiler with sufficient water so that the product is of the consistency of thin gruel. Strain through a coarse strainer and serve with milk. Gruel may be made also from barley flour by using four level tablespoonfuls to a pint of water and boiling for thirty minutes. Whey Warm one pint of fresh milk to blood heat (tepid), add two teaspoonfuls of Fairchild's. essence of pepsin or liquid rennet. Stir quickly FOOD RECIPES 175 for a moment only. Let the mixture stand until it is chilled. At the end of an hour break up the mixture with a fork and strain through fine muslin. The liquid is whey and can be used for infant feeding for a short period of time in cases of diarrhoea or vomiting. Junket This is made in the same way as whey except that it should not be broken up. The jellied milk can be used for feeding children over eight or nine months of age. One or two teaspoonfuls of cane sugar may be added to the above recipe. For older children a little vanilla or nutmeg may be used for flavor. Beef Juice — Hot Method Take half a pound of upper round or sirloin steak. Warm slightly. Sear the surface by holding the meat on the broiler, close to the flame. Cut in fairly small squares and press out the juices in a meat press, lemon squeezer or potato ricer. Add a pinch of salt. Place the juice in a covered jar and keep cold. Before using, it may be warmed slightly by placing a small portion in a cup which is set into a pan or larger cup containing warm water. Beef juice should not be heated until it is more than blood warm. 176 HEALTHYBABIES Beef Juice — Cold Method Chop fine one-half pound of round steak. Put into a fruit jar, cover the meat with cold water and add a pinch of salt. Place the cover on the jar, and put the whole in the ice- box for six to eight hours, shaking occasion- ally. At the end of eight hours strain the meat and liquid through a fine cloth. This process takes longer and the juice is not quite so palatable for older children, but it is more economical, and the resultant beef juice is slightly more nutritious. It is preferable, therefore, to prepare the beef juice for young children in this way. It may be heated be- fore serving by placing it in a cup which is set into a dish of warm water. Scraped Beef Scrape a slice of round of beef with a dull knife until the pulp is obtained, but none of the fiber. This pulp should be made into a small cake, and kept cold until used. Be- fore using, a small portion should be spread out thinly on a saucer, a pinch of salt sprinkled over the top, the whole placed in the oven or on top of a teakettle for a min- ute or two until heated through and the juice is started. FOOD RECIPES 177 Coddled Egg Put an egg, without removing the shell, into a saucepan with boiling water. Take the pan from the fire at once, cover and leave it for seven minutes. The egg should then be taken out, and only the white used. The latter should be of the consistency of jelly. Chicken, Lamb and Beef Broth One pound of meat with the fat removed carefully should be cut into small pieces. Cover with one pint of cold water and add a pinch of salt. Simmer for two to three hours over a slow fire, adding sufBcient water from time to time to keep the amount at least one pint. Strain, let cool and remove the top layer of fat. The broth then may be reheated, and if necessary, diluted with a small amount of water. Milk Soup The water in which any green vegetables have been cooked should be saved, and added to hot milk in the proportion of one-half of each. If necessary, a small pinch of salt may be added and the mixture allowed to boil for five minutes. Vegetable Soup Half a pound of lean meat, one large carrot cut in cubes, two potatoes cut in cubes,J^soup 178 HEALTHYBABIES greens and a handful of spinach, chopped fine. One quart of water. Salt to taste. Simmer for three hours, until all vegetables are soft. Mash and put through a coarse strainer. Other veg- etables such as green peas or celery may be added or substituted in season. Spinach Soup The spinach should first be cooked well and left in its own liquid. Take one pint of milk, add to this one cupful of the water in which the spinach was cooked, then press half a cup- ful of spinach through a fine colander, mixing this with the milk. Add a pinch of salt, place the whole in a double boiler, and cook well for fifteen minutes. The soup may be varied a little by adding a tablespoonful of flour which has been mixed in cold milk and stirred grad- ually into the soup. This thickening, however, is advised only for older children. Prune Juice and Prune Pulp Cook prunes until they are very soft, adding enough sugar to have them slightly sweetened. The juice may be used in place of orange juice for young babies, while the cooked prunes may be placed in a fine sieve, and the pulp rubbed through. This prune pulp may be fecji to children over six months of age. FOOD RECIPES 179 Bran Biscuits Two and a half cups of bran, one and a half cups of white flour, one cup of sour milk, one- half teaspoonf ul of baking soda, one-eighth cup of butter, two tablespoonfuls of molasses. Bake in muffin rings with strong heat, as for bread. If desired, the muffins may be split and toasted just before serving. CHAPTER X NURSERY REMEDIES Castor Oil Dosage : Under three months, 1 teaspoonful. Three to six months, 2 teaspoonfuls. Six to twelve months, 1 tablespoonful. Calomel Dosage : Under three months, one-tenth grain tab- let every 15 minutes for 3 doses. Three to six months, one-tenth grain tab- let every 15 minutes for 6 doses. Six to nine months, one-tenth grain tab- let every 15 minutes for 9 doses. Nine to twelve months, one-tenth grain tablet every 15 minutes for 10 doses. The tablet may be crushed and dissolved in a teaspoonful of water. Milk of Magnesia Phillips' milk of magnesia probably is the best mild laxative to use for children under one year of age. It should be given in teaspoonful doses night and morning. In breast fed babies this dose may be given immediately after the morning and night nursings. In bottle fed babies the dose may be added to the morn-' ing and evening bottles of milk. 180 NURSERY REMEDIES 181 Rhubarb and Soda This mixture may be bought already pre- pared at any drug store. It is an excellent mild laxative for babies and children. Dosage Up to six months a half teaspoonful. From one to three years one teaspoonful. The dose should be given twice a day, after feeding. Syrup of Ipecac This is the best medicine we have for croup. For a baby under six months of age it should be given in fifteen-drop doses every ten to fifteen minutes until the child vomits. From six to twelve months the dose may be increased from a half to one teaspoonful, repeated at fifteen-minute to half-hour intervals. Not more than three teaspoonfuls should be given. Syrup of ipecac may be used also if the child has eaten anything that is indigestible, and where it is desirable to stimulate vomiting in order to empty the stomach of its contents. Here one dose usually is sufficient. If syrup of ipecac is not available, vomiting may be in- duced by placing one-quarter teaspoonful of mustard or a teaspoonful of salt in a glass of lukewarm water and forcing the child to drink it. 182 HEALTHYBABIES Boric Acid Solution Add one tablespoonful of boric acid powder to one pint of water. Boil in a clean dish for five minutes, adding water from time to time so that the total remains about one pint. Pour the solution into an absolutely clean bottle which has been scoured thoroughly with hot soapsuds and rinsed with boiling water. Keep the bottle corked tightly. Flaxseed Poultice For severe colds or croup a hot flaxseed poultice may be placed on the child's neck. It should not be allowed to remain after it has cooled, and as soon as it is removed the chest and neck should be rubbed well with alcohol or camphorated oil, and then covered with a piece of flannel. To make flaxseed poultices, take a pint of water and bring it to a brisk boil. Powdered flaxseed then should be sifted grad- ually into the water until a thick pasty mixture is the result. A large square of gauze or old linen is laid on a clean table and the flaxseed spread on this to a thickness of about an inch, covering an area large enough to cover the child's chest or to go around the neck. The edges of the gauze then should be folded over the poultice, making three or four layers ia the back while in the front there is simply the NURSERY REMEDIES 183 one fold of old linen or possibly two of gauze. The poultice should be applied as hot as it can be borne comfortably, care being taken that the skin is not burned. Carron Oil This probably is the best remedy we have for serious burns. It consists of equal parts of linseed oil and lime water. The mixture does not keep well and, particularly in warm weather, it is better to keep the ingredients separate and mix them as needed. It must be shaken well so that a thick emulsion is formed. This should be spread liberally over the burn- ed surface, and covered with clean gauze. Absorbent cotton is then placed over the surface so that all air will be excluded. Stearate of Zinc A greasy powder, to be used freely on any chafed surface or where it is desired to use a powder that will keep out moisture. It is ex- cellent in cases of severe chafing or prickly heat. Zinc Oxide Ointment This is a good remedy for burns, scratches, chafing or various forms of skin diseases, in- cluding eczema. It should be spread thickly on a piece of sterile gauze or old linen, and 184 HEALTHYBABIES then laid over the affected part. The dressing may be kept in place by fastening the gauze with two strips of adhesive plaster, projecting over the edge of the gauze and adhering to the skin. Dusting Powders for Delicate Skins (a) For the baby with slight prickly heat or rash, or where there is any redness of the skin, a powder made of one part boric acid powder to four parts powdered starch is ad- vised. (b) If the skin is excoriated or the chafing is extreme, a powder consisting of one part zinc oxide to five parts of starch will be found to have excellent healing properties. (c) Talcum powder: Equal parts of pure talcum and starch form an excellent dusting powder. Plain talcum may be used. It is important to see that it is not perfumed, and that it is of the finest quality obtainable. TABLE OF MEASURES Unless otherwise indicated, a tablespoonful and a teaspoonful measure should be level, not heaping. Liquid Measure 4 teaspoonfuls equal one tablespoonful. 2 tablespoonfuls equal one ounce. 1 tumblerful equals eight ounces or J^ pint. Dry Measure 4 teaspoonfuls equal one tablespoonful. 1 heaping tablespoonful of cane sugar equals one ounce. 3 level tablespoonfuls milk sugar equals one ounce. 1 dram equals one teaspoonful. 185 GLOSSARY Abdomen The belly. That part of the trunk of the human body between the chest and the legs. Abdominal Band A broad strip of flannel or other material placed around the body over the abdomen. Abnormal Diflferent from the normal or usual. Contrary to the natural condition. Abscess A collection of matter or pus in any part of the body as a result of inflammation. Adenoids Aloes Anemia Bacteria A mass of soft, glandular tissue, situated in the upper part of the pharynx or throat, just back of the posterior opening of the nostrils. When enlarged this growth blocks up the posterior nasal passage, and prevents breathing through the nose. All children have some adenoid tissue. It is only when it has grown to such an extent that it interferes with nasal breathing or pre- disposes to constant colds or ear disease that its removal by surgical means is desirable. A bitter drug. Taken internally as a laxative. Used externally because of its bitter taste and because it is not harmful, except when taken in large quantities. A deficiency in the haemoglobin or iron which normally is found in the corpuscles or cells of the blood. Germs. Bacteria are of many types, each usually associated with some special disease, such as bacteria of typhoid, the bacteria of diphtheria, etc. Many bacteria are entirely harmless and need be noticed only when they occur in larger numbers than 30,000|per cubic centimeter of milk. The bacteria which cause disease usually are* known as "toxic bacteria." 186 GILOS S A R y Band Bassinet Bladder See abdominal band. A basket, box or similar article, lined, and prepared for use as a bed for a newborn, or very young baby. The organ which holds the urine from the time it leaves the kidneys until it passes from the body. A thin sac in the front part of the pelvis, just in front of the uterus. Blood Heat Tepid. At the temperature of the body or blood, normally 98.4 degrees Fahrenheit. Body Temperature The normal body temperature is 98.4 degrees Fahren- heit. An abnormal body temperature is anything higher than the degree mentioned. Brassiere A breast binder, usually fitted in so that it adjusts itself around the breast, forming a natural support, without pressure. Sometimes it is made simply with darts, sometimes with thin flexible bones to give it a smooth and even shape. Breast Binder A band placed around the breast, either before or after confinement. Breast Pump An instrument for drawing milk out of the breast. Buttocks (Breech.) The fleshy part of the body, behind the hip joints, forming the big fleshy mass in the back where the upper part of the legs join the body. Breech See buttocks. 187 GLOS S A R Y Cathartic A medicine which acts upon the bowels in a manner to produce a free movement. The term laxative is used to denote a mild cathartic. A cathartic medicine is one which produces some form of purging, and which has a stronger effect than a laxative. Chafing Catheter A rubber tube, open at one end, and with one or more perforations at the other end. It is used by introducing the perforated end through the opening in the bladder for the purpose of drawing off the urine. Should never be used by anyone who has not been fully instructed in the method of its insertion. Irritation, redness and inflammation of the skin caused by friction of the parts or between the folds of the skin, etc. Circumcision Removal of all or part of the prepuce or foreskin of the penis or genital organ of a male child. Colon That part of the bowel or large intestine which termi- nates in the rectum. Colon Irrigation The injection of water or other fluid through the rectum into the colon, the water being allowed to flow in and out without obstruction. Constipation The state of the bowels where no movement of the feces takes place for a definite time. Constitutional Symptoms General symptoms, such as fever, increase in pulse and respiration; symptoms of general illness. Used in con- tradistinction to local symptoms which consists of signs of injury or illness in any one part of the body. Cutting Ring A ring of some hard substance, such as ivory or celluloid used by the baby in order to help in the cutting of the * teeth through the gums. 188 GLO SSA R Y Dentition The process of cutting teeth or the eruption of teeth through the gums. Ear Drum A membrane of the inner ear which receives sound impressions and from which the impression is trans- mitted to the brain. Eczema Element (Milk crust.) A skin eruption which may occur on any part of the body, but which is more common in the folds of the skin. When it occurs on the scalp it is sometimes known as "milk crust." Any one of the primary parts of a thing. The different substances from which anything is made up or com- posed. Elimination A throwing off or setting free. Enema A rectal injection, usually given for medicinal purposes. Is generally of plain or soapy water, and acts as a mechanical irritant to cause the bowel to move. Eructation The act of belching or casting off wind from the stomach. Faeces See feces. Feces Matter excreted from the bowels. Fecal Matter Same as feces. Fomentation A stupe. A cloth thoroughly wet with water or some medicated fluid. Hot fomentation. Cold fomentation. Fontanelle (Soft spot.) There are two fontanelles — the anterior and the posterior. They consist of soft spots in the head where the bones have not entirely united. Anterior Fontanelle Situated just above the forehead. Remains open for about eighteen months. At the end of that time the bones should be entirely joined together. Posterior Fontanelle Situated just above the back of the neck. Remains open about six weeks, at which time the bones should be entirely joined together. 189 GLOSS AR Y Foreskin The prepuce or fold of skin which extends over the glans or end of the penis, which is the male organ of the child. Formula — Formulae The prescribed method of preparing a combination of substances. In baby feeding this term usually refers to the mixture of the various ingredients to form the proper modification of milk for the individual infant. Gas Genital Term used to denote the production of fermentation in the stomach or bowels. Pertaining to the organs of generation or reproduction. Genital Region That part of the body which contains the genital organs, or that part of the body where the genital organs are situated. Germs See bacteria. Hygiene Science of preservation of health by means of attention to sanitary surroundings and personal habits. Incision A cut. Infection The communication of disease germs by any means. Infected Contaminated with infectious matter, as "the child is infected with scarlet fever." Infectious Contagious; easily communicated; capable of extension by infection. Inflammation A diseased state, generally localized in some one part of the body, characterized by pain, swelling and redness, with or without fever. Ingredients The elements which enter into the composition of any mixture. 190 GLOSS AR Y Injection See enema. Water or watery solution thrown into any cavity of the body, as a rectal injection, for the purpose of making bowels move. Also used as a term to denote the injection of fluid underneath the skin by means of a hypodermic syringe. Irrigation The washing out of a cavity by a stream of water or other fluid. Jaundice Yellowness of the skin, eyes and secretions due to the presence of bile pigment in the blood. Laxative A mild cathartic. See cathartic. Malnourished Undernourished. A condition of the body characterized by underweight, poorly developed muscles, pallor, anemia, bodily fatigue and lack of bodily resistance to disease. Undernourishment or malnutrition may be caused by the presence of physical defects, insanitary surroundings, lack of proper hygienic living conditions, over-excitement, wrong kind of food, irregular feeding or underfeeding. Massage Rubbing and manipulation of the body to strengthen the muscles or other tissues. Mastication The act of chewing food. Masturbation The causing of sexual excitement by friction of the genital organs by rubbing with the hand or the clothing. Milk Crust See eczema. Modification of Milk A term used to describe the mixture of various in- gredients, such as milk, water and sugar of milk to form a proper preparation for infant feeding. Modified Milk See modification. Mucus Liquid secreted by the mucous membranes. 191 GLOSS A R Y Mucous Membrane Lining of cavities which communicate with the external air, as the nose, mouth, etc. These membranes secrete a fluid called mucus. Nausea Navel Nipple Sickness at the stomach. A pit or scar in the center of the abdomen, left by the shrinking of the umbilical cord. The small protuberance in the center of each breast. Nipple Shield A contrivance of glass with rubber nipple in the center, the whole to be placed over the mother's nipple to protect it when it is sore. Nutrition The proper use of nourishment to build up the body, and make it healthy. Pacifier Penis A term used to describe a rubber nipple which usually is attached to a base of celluloid, and used by children between feedings in order to keep them quiet. Its use is harmful, because of the possibility of infection, on account of the uncleanliness of the pacifier and because the constant sucking leads to the formation of misshapen lips, irregular teeth, protruding upper jaw and adenoids and enlarged tonsils. The external genital organ of the male. Percentage Formula A formula for infant feeding made up of the various ingredients, such as milk, water, milk sugar, etc., in proportions based upon the percentage of fats, car- bohydrates, proteids and mineral substances which have been determined upon as the proper combination for the individual child. Pores Pulse Minute openings in the skin. Also refers to the openings of the sweat glands. The beating of the heart as felt through the wall of any' artery. Usually felt best in the front of the wrist, just at the base of the thumb. 192 GLOSS A R Y Pus Matter given off from an open sore. The cream-like fluid found in abscesses. Quassia A bitter drug, having slight medicinal value. Generally used because of its bitter taste. It is used in infancy on the thumbs and forefingers to discourage thumb- sucking and nail-biting. When diluted it is used as an injection for worms. Rachitis See rickets. Rectal Pertaining to the rectum. Rectum The lowest part of the bowel from which the feces pass out of the body. Respiration Breathing. Rickets A disease of childhood marked by tenderness and softening of the bones, resulting in curvature or de- formity of the bones. Rupture A hernia. The forcible tearing or breaking of a part. The protrusion of a loop of the intestine through an opening in the muscular wall of the abdomen. Saliva Spit. A clear fluid which is secreted by glands inside of the mouth. Scurvy A disease due mainly to the use of improper food. Secretion A substance separated from the blood and given off by some organ of the body. Soft Spot See fontanelle. Spasm A sudden, violent, involuntary contraction of a part or the whole of the body, due to muscular action. Spasmodic Having the nature of a spasm. 193 GLOSS A R Y Suppository A preparation of some substance which melts at the temperature of the body, usually introduced into the rectum for the purpose of stimulating the bowels to move. Sterile A condition showing the absence of harmful germs. Sterilized Made sterile. Stools Bowel movements. Feces. Temperature Degree of heat. The average temperature of the body in health is 98.4 degrees Fahrenheit. Top Milk The cream and that part of milk containing the fats which normally rises to the top when milk is left standing for any length of time. Umbilicus See navel. A pit or scar in the center of the abdomen left by the shrinking of the umbilical cord. Undernourished See malnourished. Urine Water secretion of the kidneys which flows from them into the bladder, and then is discharged from that organ to the outside of the body. Ventilation The supply of fresh air to any enclosed space, as a room. Vitiate Wind To lower the bodily vitality. To lower the standard of any substance, such as vitiated atmosphere, where there is not sufficient oxygen. The air in a^ room becomes vitiated through lack of proper ventilation. See gas. 194 NOTES 195 NOTES 196 NOTES 197 NOTES 198 NOTES 199 NOTES 200 NOTES 201 NOTES 202 NOTES 203 BABY'S RECORD Name Place of birth Date of birth _ Hour of birth Attending physician Attending nurse Birth registered Father's name.._._ Mother's name Christened on At By the Reverend Persons present 204 BABY'S WEIGHT At birth lbs oz. At one week lbs — oz. At two weeks lbs oz. At one month lbs oz. At two months lbs oz. At three months..^ lbs. oz. At four months.-- lbs oz. At five months lbs — oz. At six months lbs oz. At seven months lbs — oz. At eight months lbs oz. At nine months lbs oz. At ten months lbs oz. At eleven months lbs oz. At twelve months lbs oz. BABY'S HEIGHT At birth.-.- inches At three months inches At six months inches At nine months inches At twelve months inches BABY'S FIRST BIRTHDAY Baby is one year old today and is. inches tall, and weighs .....pounds. 205 \^ s r ■^ V ~ ~ "■ \^ :;; \ k - \^ S \ \^ ? V \^ ? > \^ ? ^ ¥ \ ^"\ V I ^\ T \ ? 1 ? [ \\ ^ \ \^ 5 \ - \^ S [ \^ S \ ^\^ S \ ^^ S ' ~^\ s s s s ^ - o ^\ s ^\ s i "\^ s s "\ s \ \^ ^ > \ " V \ R 1 \ ^ \ ^\ g I Z \ \ S V ■:: > ^\ s y ^-\ ic: ^ z \ 12 > ^ ^ s r \ ^\ o \ \^ o \ \^ ^ \ ^~\^ ■r \ ^\ ^ s ^\^ ri S ^"\ - / % i 3 o *? Ol 00 t^ to in t CO