The care and feeding of children; a catechism for the use of mothers and children's nurses

Front matter

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Preface To The Twelfth Edition

The constant use of the Catechism as a manual for mothers and nurses has shown the need of fuller treatment than was given in the earlier editions of several subjects, especially matters relating to older children. To meet this need, therefore, there has been introduced in the present edition a considerable amount of new material relative to growth, nutrition, diet and health education in later childhood.

The author 's aim has been not to alarm the mother by acquainting her with all the possible diseases and accidents which may befall her child, but to open her eyes to matters which are her direct and chief concern.

It is, therefore, the needs of the well child, not the sick one, which have been considered. The well child must, in most cases, be left to the care of the mother or nurse for whose guidance and assistance these pages are intended. For directions in matters of illness, however, no mother or nurse should de-

6 PREFACE TO THE TWELFTH EDITION

perid upon any manual, but upon the advice of a physician.

It is hoped that the mothers and nurses who have found the earlier editions helpful will find even greater assistance from the present volume.

New Yobk, 1923.

Contents

Bathing

Genital organs

Eyes .

Mouth

Skin .

Clothing

Napkins

Nursery

Airing

Weight, growth, and development

Dentition ....

PlOB

II Weaning from the breast .... 52

Artificial feeding .... 55

Selection and care of milk used for infant feeding - . 56

Modification of cow's milk . . .

Cream, 65; top milk, 66.

Food (or healthy infants ......

Formulas from whole milk, 71; formulas from

7-per-cent milk, 73.

Intervals of feeding ....

Schedule of quantities and intervals for first year Preparation of milk at home Directions for feeding .

General rules for guidance in feeding Regularity in feeding .

Weaning from the bottle Overfeeding ....

Common mistakes in infant feeding Changes in food required by special symptoms Loss of appetite ....

Vomiting

Gas, flatulence and colic Constipation Hot weather No gain in weight Indisposition, indigestion, etc.

Addition of other food

Use of fruit juices, 106; beef juice, 107; broths,

107; eggs, 107; toast and crackers, 108; vegetables,

108.

Substitutes for fresh milk Dried milk . . ...

Condensed milk . ...

Evaporated milk Goat's milk

Sterilized milk, Boiled milk, Pasteurized milk Modified milk from the milk laboratories Frozen milk

PAGE

CONTENTS

Buttermilk

Casein or Protein milk

Butter-flour-milk formula

Feeding during the second year .

Schedule for twelfth to fifteenth month

Schedule for fifteenth to twentieth month .

Schedule for twentieth to twenty-fourth month

Feeding during the third year

General rules in feeding

Food formulas ......

PAQB

III Older Children

Growth and nutrition .

. 141

Standard weight for height

. 143

Undernourished children

. 144

Average annual gain

. 144

Prevention of malnutrition

. 148

Training in health habits

. 149

Diet of older children .

. 153

Milk and milk products

Eggs

. 157

Meats and fish .

Vegetables .

. 159

Cereals

Broths and soups

. 163

Bread, crackers and cakes

Desserts

. 165

Fruits

Vitamins

. 169

Tea and coffee

. 170

Water ...

Combinations for the different meals School lunches Training to eat . .

Indigestion in older children

Acute indigestion, 176; chronic indigestion, 177.

PAOH

170 172 173 174 175

IV Miscellaneous

Treatment of constipation

Sleep

Causes of disturbed sleep

Exercise

Cry ...

Rupture

Lifting children .

Temperature

Nervousness

Playing with babies

The delicate child

Toys ....

Kissing . .

Convulsions

Foreign bodies swallowed

Foreign bodies in the ear

Foreign bodies in the nose

Colic ....

Earache

Croup

CONTENTS

Measles, 211; German measles, 212; Bcarlet 212; whooping cough, 213; chicken pox, diphtheria, 213; mumps, 214.

Treatment for commencing illness

Nursery training to help the doctor

Scurvy

Rickets

Anemia

Diarrhea

Bad habits

Vaccination

Care of the teeth

Adenoids

Enlarged tonsils .

Blowing the nose

Taking cold

Treatment of colds

Weight charts

PAGE

. 216

. 216

. 217 218

. 219

. 221

. 223

. 227

. 228

. 229

. 231

. 232

. 233

. 235

238, 239

. 243

PARTI THE CARE OF INFANTS i

BATHING

At what age may a child be given a full tub bath? Usually when ten days old ; it should not be given before the cord has come off.

How should the bath be given?

It should not be given sooner than one hour after feeding. The room should be warm ; if possible there should be an open fire. The head and face should first be washed and dried; then the body should be soaped and the infant placed in the tub with his body well supported by the hand of the nurse. The bath should be given quickly, and the body dried rapidly with a soft towel, but with very little rubbing.

At what temperature should the bath be given? For the first few weeks at 100° F. ; later, during 15 early infancy, at 98° F. ; after six months, at 95° F. ; during the second year, from 85° to 90° F.

With what should the oath be given?

Soft sponges are useful for bathing the body, limbs and scalp. There should be a separate wash-cloth for the face and another for the buttocks.

What are the objections to bath sponges?

When used frequently, they become very dirty and are liable to cause infection of the eyes, mouth, or genital organs.

Under what circumstances should the daily tub bath be omitted?

In the case of very feeble or delicate infants on account of the exposure and fatigue, and in all forms of acute illness except by direction of the physician. In eczema and many other forms of skin disease much harm is often done by bathing with soap and water, or even with water alone.

GENITAL ORGANS

How shoidd the genital organs of a female child be cleansed?

Best with fresh absorbent cotton and tepid water, or a solution of boric acid, one teaspoonful to eight ounces. This should be done carefully at least once a day. If any discharge is present, the boric-acid solution should invariably be used twice a day. Great care is necessary at all times to prevent infection which often arises from soiled napkins.

How should the genital organs of a male child he cleansed?

In infancy and early childhood the foreskin should be pushed completely back at least twice a week while the child is in his bath, and the parts thus exposed washed gently with absorbent cotton and water, afterwards drawn forward again.

If the foreskin is tightly adherent and cannot readily be pushed back, the physician's attention should be called to it. The nurse or mother should not attempt forcible stretching.

When is circumcision advisable?

Usually, when the foreskin is very long and so tight that it cannot be pushed back without force; always, when this condition is accompanied by evidences of local irritation or difficulty in passing water.

EYES

How should the eyes of a little baby be cleansed? With a piece of soft linen or absorbent cotton and a lukewarm solution of salt or boric acid — one-half teaspoonful to eight ounces of boiled water.

If pus appears in the eyes, what should be donef They should be cleansed every hour with a solution of boric acid (ten grains to one ounce of water). If the lids stick together, a little vaseline from a tube should be rubbed upon them at night. If the trouble is slight, this treatment will control it; if it is severe, a physician should be called immediately, as delay may result in loss of eyesight.

MOUTH

How is an infant's mouth to be cleansed?

An excellent method is by the use of a swab made by twisting a bit of absorbent cotton upon a wooden toothpick. With this the folds between the gums and lips and cheeks may be gently and carefully cleansed twice a day unless the mouth is sore. It is not necessary after every feeding. The finger of the nurse, often employed, is too large and liable to injure the delicate mucous membrane.

What is thrush?

It appears on the lips and inside the cheeks like little white threads or flakes. It is also called sprue.

In bad cases it may cover the tongue and the whole of the inside of the mouth.

How should a mouth be cleansed when there is thrush?

It should be washed carefully after every feeding or nursing with a solution of borax or bicarbonate of soda (baking soda), one even teaspoonful to three ounces of water, and four times a day the boric-acid solution mentioned on previous page should be used.

SKIN

How should the infant's skin be cared for to prevent chafing f

First, not too much nor too strong soap should be used; secondly, careful rinsing of the body; thirdly, no vigorous rubbing, either during or after the bath ; fourthly, protection of deep folds of skin — under the arms, in the groins, behind the ears, about the neck, etc. This is of special importance in very fat infants. The skin here should be thoroughly dried after bathing and a powder like borated talcum used, or, even better, the folds smeared with a little liquid albolene.

If the skin is very sensitive and chafing easily produced, what should be done?

No soap should be used, but bran or salt baths given instead.

How should a bran bath be prepared?

One pint of wheat bran should be placed in a bag of coarse muslin or cheese-cloth, and this put in the bath water. It should then be squeezed for five minutes, until the water resembles a thin porridge.

How should a salt bath be prepared? Half a teacupful of common salt or sea salt should be used to each two gallons of water.

How should the buttocks be cared for?

This is the most common place for chafing, as the parts are so frequently wet and soiled; hence the utmost pains should be taken that all napkins be removed as soon as they are wet or soiled, and the parts kept scrupulously clean and powdered or oiled.

If the parts have become chafed, what should be done?

Only bran and salt baths should be used, and in very severe cases even these may have to be omitted for a day or two. The parts may be cleansed with sweet oil and a little absorbent cotton, and the skin kept covered with a dusting powder of stearate of zinc or starch two parts, boric acid one part.

What is prickly heat, and how is it produced?

It consists of fine red pimples, and is usually caused by excessive perspiration and the irritation of woolen underclothing.

How should it be treated?

Lighter clothing should be used; muslin or linen should be put next to the skin ; the entire body should be sponged frequently with equal parts of vinegar and water, and plenty of the starch and boric-acid powder mentioned should be used.

CLOTHING

What are the most essential things in the clothing of infants?

That the chest should be covered with soft flannel, the limbs well protected but not confined, and the abdomen supported by a broad flannel band, which should be snug but not too tight. It is important that the clothing should fit the body. If it is too tight it interferes with the free movements of the chest in breathing, and by pressing upon the stomach sometimes causes the infant to vomit soon after swallowing his food. If the clothing is too loose it is soon thrown into deep folds or bunches, which cause much discomfort. No pins should be used, but, instead, all bands about the body should be basted. The petticoats should be supported by shoulder straps.

How should the infant he held during dressing and undressing ?

Nothing is more awkward than to attempt to dress a young baby in a sitting posture. He should lie upon the nurse's lap until quite old enough to sit alone, the clothing being drawn over his feet, not slipped over the head.

Of what use is ihe hand?

It protects the abdomen, but its most important use is to support the abdominal walls in very young infants, and in this way to prevent the occurrence of rupture. To be of any value the band should be wide, snugly applied, and pinned to the napkin below and the shirt above to keep it in place.

How long is this hand required?

The snug flannel band, not usually more than two or three months. In healthy infants with plenty of fat this may then be replaced by the knitted band, which may be worn up to eighteen months. The band is an important article of dress in the case of thin infants whose abdominal organs are not sufficiently protected by fat. With such, or with those prone to diarrhea, it

THE CARE OP INFANTS 23

is often advisable to continue the band until the third or fourth year.

What changes are to be made in the clothing of infants in the summer?

Only the thinnest gauze flannel undershirts should be worn, and changes in temperature should be met by changes in the outer garments. The greatest care should be taken that children are not kept too hot in the middle of the day, while extra wraps should be used morning and evening, especially at the seashore or in the mountains.

Should older children be allowed to go with their legs bare?

If strong and well there is no objection to this in warm weather. In cold weather, however, it is doubtful if any children are benefited by it, particularly in a changeable climate like that of New York. Many thin and delicate children are certainly harmed by such a practice.

What sort of underclothing should be worn during cold weather?

Never the heaviest weight, even in winter. Four grades are usually sold, the next to the heaviest being thick enough for any child.

Do little children require as heavy flannels as older people ?

Not as a rule. They usually live in a warm nursery ; their circulation is active ; and they always perspire easily during their play. When they go out of doors, the addition of coats and leggings renders thick flannels unnecessary.

Are not many little children clothed too thinly for the ordinary house f

Very few. The almost invariable mistake made in city homes is that of excessive clothing and too warm rooms. These two things are among the most frequent reasons for their taking cold so easily.

NAPKINS

How should napkins be taken care of?

They should be immediately removed from the nursery when soiled or wet. Soiled napkins should be kept in a receptacle with a tight cover, and washed as soon as possible.

Should napkins which have been only wet be used a second time without washing?

It is no doubt better to use only fresh napkins, but there is no serious objection to using them twice unless there is chafing of the skin. Clean napkins, changed as soon as -wet or soiled, are of much importance in keeping the skin healthy.

What are the important things to be observed in washing napkins?

Soiled napkins should not be allowed to dry, but should receive a rough washing at once; they should then be kept in soak in plain water until a convenient time for washing — at least once every day — when they should be washed in hot suds and boiled at least fifteen minutes. Afterward they should be very thoroughly rinsed or they may irritate the skin, and ironed without starch or bluing. They should never be used when damp.

NURSERY

What are the essentials in a good nursery?

The furnishings should be simple, and unnecessary hangings and upholstered furniture should be excluded. As large a room as possible should be selected — one that is well ventilated, and always one in which the sun shines at some part of the day, as it should be remembered that an average child spends here at least three fourths of his time during the first year. The nursery should have dark shades at the windows, but no extra curtains ; about the baby 's crib nothing but what can be washed should be allowed. The air should be kept as fresh and as pure as possible. There should be no drying of napkins or clothes, no cooking of food, and no gas burning at sight. A small wax nighHight answers every purpose.

How should a nursery be heated?

Best by an open fire; next to this by a Franklin stove. The ordinary hot-air furnace of cities has many objections, but it is not so bad as steam heat from a radiator in the room. A gas stove is even worse than this, and should never be used, except, perhaps, for a few minutes during the morning bath.

At what temperature should a nursery be kept during the day?

Best, 64° to 68° F., measured by a thermometer hanging three feet from the floor. The temperature should not be allowed to go above 70° F.

At what temperature during the night?

During the first two or three months, not below 65° F. After three months the temperature may go as low as 55° F. After the first year it may be 50° or even 45° F.

At what age may the window be left open at night?

Usually after the third month, except when the outside temperature is below freezing point.

How often should the nursery he aired?

At least twice a day — in the morning after the child's bath, and again in the evening before the child is put to bed for the night. This should be done thoroughly, and the child should be removed meanwhile to another apartment. It is well to air the nursery whenever the child is out of the room.

What symptoms are seen in a child who is kept in too hot a room?

He becomes pale, loses appetite, shows symptoms of indigestion, occasionally vomits, stops gaining, in weight', perspires very much, and takes cold easily because of this and also because of the great difference between the indoor and outdoor temperatures. His condition may be such as to lead one to suspect very serious illness.

AIRING

How early may airing indoors be commenced and how long may it be continued?

Airing in the room may be begun with a strong, healthy child, even in cold weather, when he is one month old, at first for only fifteen or twenty minutes at a time. This period may be gradually lengthened by ten or fifteen minutes each day until it is four or five hours. This airing may be continued in almost all kinds of weather.

7s there not great danger of a young baby's taking cold when aired in this manner?

Not if the period is at first short and the baby accustomed to it gradually. Instead of rendering the child liable to take cold, it is the best means of preventing colds.

How should such an airing be given?

The child should be dressed with bonnet and light coat as if for the street and placed in his crib or carriage which should stand a few feet from the window. All the windows are then thrown wide open, but the doors closed to prevent draughts.

At what age may a child go out of doors?

In summer, when one week old; in spring and fall, usually at two or three weeks. In winter it depends upon the climate ; in New York and New England on a protected piazza at two months ; in the street usually at about three mouths, but only on pleasant days, well protected from the wind. In large cities it is often better to place the infant for his airing, until five or six months old, on a roof or balcony or even by an open window in his carriage, to avoid the dust and wind of the street.

What are the best hours for airing out of doors f On hot summer days, better morning and late afternoon than midday ; in cold weather the best time for a young infant is between 10 a. m. and 3 p. m., although this depends somewhat upon the climate. In New York and along the Atlantic coast the early mornings are apt to be damp and the late afternoons raw and cloudy.

On what kind of days should a baby not go out?

In sharp winds, when the ground is covered with melting snow, and when it is extremely cold. A child under three months old should not usually go out if the thermometer is below freezing point; nor one under six months old if it is below 20° P.

Exceptions to all the above statements are to be made in the case of very small and especially delicate infants. Though they should have fresh air in abundance, they should be much more carefully protected against cold.

What are the most important things to be attended to when the child is out in his carriage?

To see that the wind never blows in his face, that his feet are properly covered and warm, and that the sun is never allowed to shine directly into his eyes when he is either asleep or awake.

Of what advantage to the child is going out? Fresh air is required to renew and purify the \ blood, and that is just as necessary for health and growth as proper food.

What are the effects produced in infants by fresh air?

The appetite is improved, the digestion is better, the cheeks become red, and all signs of health are seen.

7s there any advantage in having a child take his airing during the first five or six months in the nurse's arms?

None whatever. A child can be made much more comfortable in a baby carriage, and can be equally well protected against exposure by blankets and the carriage umbrella.

What are the objections to an infant's sleeping out of doors?

There are no real objections. It is not true that infants take cold more easily when asleep than awake, while it is almost invariably the case that those who sleep out of doors are stronger children and less prone to take cold than others.

What can be done for children who take cold upon the slightest provocation?

They should be kept in cool rooms, especially when asleep. They should not wear such heavy clothing that they are in a perspiration much of the time. After the morning bath the body, particularly the neck, shoulders and chest, should be sponged with cold water, temperature of 55° to 60° F. (see page 234). For young infants a slightly higher temperature may be used.

WEIGHT, GROWTH, AND DEVELOPMENT

Of what importance is the weight of the child?

Nothing else tells so accurately how well he is thriving.

During the first year a record of the weight is almost indispensable; throughout childhood it is of much interest and is the best guide to the physical condition. It will repay any mother or nurse to keep such a record.

How frequently should a child be weighed? Every week during the first six months, and at least once in two weeks during the last six months of the first year. After the first year a child should be weighed at least once a month.

How rapidly should an infant gain in weight during the first yearf

There is usually a loss during the first week of from four to eight ounces ; after this a healthy child should gain from four to eight ounces a week up to about the sixth month. From six to twelve months the gain is less, usually from two to four ounces a week.

Is it to be expected that bottle-fed infants will gain as rapidly as those who are nursed?

They seldom do so during the first month; after that time under favorable circumstances the gain is usually quite as regular, and during the latter half of the first year it is likely to be more continuous than in a nursing infant, because the latter usually loses weight at the time of weaning.

Why do they not gain so rapidly at first?

It takes a few weeks for the digestion to become accustomed to cow's milk, and until this is accomplished it is necessary to make the milk formula weak or the child's digestion will be upset.

TABLE SHOWING RATE OF GROWTH OP SMALL AND LARGE

TYPES OP HEALTHY BOYS

Birth Weight 7 to 9 pounds

One year Weight 20 to 23 pounds

Two years .... Weight 25 to 29% pounds

Three years . . . Weight 30 to 35 pounds

Four years. . .Weight 34 to 39% pounds

Five years . . . Weight 38 to 44 pounds

Note. All weights and measurements are without clothes.

The first column indicates the growth of small and the second of large children.

The weights for girls of different types are about one pound less than those of boys. Their measurements at the different ages are from one-fourth to one-half inch less than those of boys.

For a child of werage weight at birth (seven and a half pounds) what should be the weight at the different periods during the first year?

At three months it should be twelve to thirteen pounds; at six months, sixteen to seventeen pounds;

at nine months, eighteen to nineteen pounds. At five months an average healthy child has doubled his weight, and at twelve months he has nearly trebled his weight. (See Chart, page 238.)

Do all healthy infants gain steadily in weight during the first year?

As a rule they do; yet it is seldom the case that one gains every week for the entire year. With most infants there are from time to time periods of a few weeks in which no gain is made. These are more often seen from the seventh to the tenth month and frequently occur when the child is cutting teeth, sometimes during very hot weather.

7s it true that every infant who gains rapidly in weight is thriving normally?

Not invariably. Some who are fed upon condensed milk or prepared infant foods increase rapidly in weight but not in strength, nor in their development in other respects.

Is the weight of as much value in the second year as a guide to the child's condition?

After the first year, the gain in weight is seldom so regular; there are many interruptions, some depend on season, and others may occur without apparent cause.

At what age should the fontanel close?

The average is about eighteen months. It seldom closes earlier than thirteen or fourteen months. In healthy children it normally closes before two years.

At what age should a child hold up his head?

As a rule during the fourth month and sometimes earlier the head can be held erect when the body is supported.

When does an infant first laugh aloud? Usually in the fourth or fifth month.

When does he begin to reach for toys and handle them?

Usually from the fifth to the seventh month.

At what age should a child be able to sit and to stand alone?

At eight months a healthy child is usually able to sit erect and support the body. During the ninth and tenth months are usually seen the first attempts to bear the weight upon the feet, and at eleven or twelve months most children can stand by a chair.

When should a child walk alone?

The first attempts are generally seen in the twelfth or thirteenth month. At fifteen or sixteen months the average child is able to walk quite alone.

What conditions postpone these events?

Prematurity, a very delicate constitution, any severe or prolonged illness, and especially chronic disturbances of digestion making feeding difficult. A common cause of late sitting, standing, or walking is rickets.

Should a child be urged to walk?

Never; he is usually quite willing to do so as soon as his muscles and bones are strong enough. None of the contrivances for teaching children to walk are to be advised.

When do children begin to talk?

Generally at one year a child can say " papa " and " mamma " or other single words. At the end of the second year the average child is able to put. words together in short sentences.

V

If at two years the child makes no attempt to speak, what should be suspected?

Usually that the child is a deaf-mute or that he is mentally deficient, although this is occasionally seen in children who are in other respects quite normal.

DENTITION

How many teeth are there in the first set? Twenty.

What is the time of their appearance?

The two central lower teeth are usually the first to appear, and come from the fifth to the ninth month; next are the four upper central teeth, which come from the ■ eighth to the twelfth month. The other two lower central teeth and the four front double teeth come from the twelfth to the eighteenth month. Then follow the four canine teeth, the two upper ones being known as the ' ' eye teeth, ' ' and the two lower as the • ' stomach teeth ' ' ; they generally come between the eighteenth and the twenty-fourth month. The four back double teeth, which complete the first set, come between the twenty-fourth and thirtieth month.

At one year a child usually has six teeth.

At one and a half years, twelve teeth.

At two years, sixteen teeth.

At two and a half years, twenty teeth.

What are the causes of variation? The time of appearance of the teeth varies in different families; in some they come very early, in others much later. The teeth may come late as a result of prolonged illness and also from rickets.