The baby's first two years

Preface To Second Edition

Tuts second edition is offered to the new mothers in the hope that it may be of service to them in answering some of the many perplexing questions which are sure to arise during the baby’s first two years.

Part I has been carefully revised and certain portions, particularly Chapters V and VI, have been rewritten to bring them into conformity with present knowledge. Part II, written by Mrs. Greene, has not been changed.

RicHarD M. Smuitu, M.D.

February 12, 1924.

Preface To First Edition

Tus book is presented with no claim to any original material. It contains information which I have tried to state in a form easily available to those seeking advice on the care of a well baby. The book is divided into three parts. The first part, chapters I to X, is made up of definite rules for the care and feeding of infants up to two years of age; the second part, chapters XI to XIII, consists of general suggestions which may be modified to suit the individual baby; the third part contains recipes and charts.

Part II was written by Rosalind Huidekoper Greene. Mrs. Greene made many suggestions which have been incorporated in Parts I and III and also assisted greatly in} editing the book. Mr. Greene compiled the index. I wish to express to both of them my sincere thanks.

Ricuarp M. Smitu, M.D.

Boston, May 1, 1916.

Contents

PART I RULES FOR THE CARE AND FEEDING OF INFANTS ‘I. Preparations for the Baby : : Le ee II. Normal Development : : , Pe LL III. The Care of the Baby’s Body : : MEY IV. Breast-Feeding . , ; ; hie V. Bottle-Feeding : : : : aie VI. Diet to Two Years . : A : . 49 VII. Stools : , ; : ! at oy’ f VIII. Habits and Training : : : wri Oa IX. Clothes. : a t j 31, 69 X. Sickness. , ‘ : : oa PART II

SUGGESTIONS TO MOTHERS

XI. The New Mother . ; : : . 93 XII. How to travel with a Baby ; : +102 XIII. A Typical Day. ‘ : ‘ 0 BD, xii CONTENTS ee eee

Chapter I Preparations For The Baby The Nursery

Tue nursery should be sunny, spacious, and quiet. It is particularly important for the room to have sun. There should be as many windows as possible, even if it is necessary to have double glass in winter. A summer nursery should have a through draft. In winter the bed should be so placed that the wind will not blow directly on the baby. If one pane of double window is removed and muslin substituted, fresh air is admitted but there is no direct draft. Direct drafts may be prevented also by using screens or ventilators, or both. ;

The room should have an open fire. If the room is heated by a radiator or register, the open fire should still be used, but there should be some method of moistening the atmosphere. Pans of water sunk in the register or placed on the radiator are helpful. Oil stoves should be avoided, as they consume too much oxygen and are dangerous.

The room should be lighted by electric lights, if pos-

A THE BABY’S FIRST TWO YEARS (ern RR ert em Tem sible. If gas is used, great care should be taken not to leave it burning long in the room, as it exhausts the oxygen, or it may be blown out by a wind. If kerosene lamps are used, it must be remembered that they are easily upset. Wall-brackets are a safeguard against accidents. |

The walls of the room should have some smooth covering which can be washed. Walls painted some soft color and not glaring are the most satisfactory. The windows should have dark shades.

The floor should be smooth and easily washed. A hardwood floor is most satisfactory, or a floor covered with linoleum. Rugs should be of washable material. There should be no woolen draperies, no woolen or cotton matting, no upholstered furniture.

The room should be near a bathroom or connected with it. If the bathroom cannot conveniently be used for cooking, there should be next to the nursery a closet with outdoor light, running water, and with a place for a gas or alcohol stove. Neither cooking nor the heating of food should be done in the nursery itself. If a special room cannot be secured for this purpose, a table should be arranged in the hall or in an adjoining room.

In summer the nursery and the room used for cooking should be carefully screened against flies.

The temperature of the nursery in winter should be

PREPARATIONS FOR THE BABY 5 about 68° during the day. The temperature near the floor is much less than that higher up. This is important to remember, as the temperature should be taken at the same level as the place where the baby is. At night the temperature during the first months should be kept at from 60° to 65°, but as the baby grows older, it may go as low as 55°, or after the first year even as low as the outside air, provided it does not go below freezing. The temperature in summer should be kept as low as possible. A sleeping-porch or balcony is very useful, but, except in the city, is not necessary, as the baby can be put out of doors.

Furniture. The furniture for a well-equipped nursery should include the following: —

An iron or brass crib with sides at least fourteen inches above the mattress. Bassinettes are useful only for the first few weeks. A large sleeping-basket will serve for many months.

A bureau for keeping the baby’s clothes.

Two low chairs without arms; one of them may have rockers.

A low table to hold the baby’s bath things. On this table there should be a soapdish; a tumbler for boric acid solution, covered; a dish for holding absorbent cotton, covered; a washbowl. The washbowl may be divided into two parts and may fit into a specially provided stand, but this is not necessary. A small enamel bowl will serve every purpose.

A bathtub; a rubber tub and an enamel pail are most satisfactory, but a tin or enamel-ware one wil serve the purpose. Rubber tubs are made with a support to attach to the side of a big tub. These are convenient in some instances.

A screen — preferably a wooden frame with cotton filling which can be washed.

Small infant chamber with rubber air-cushion pad.

Small toilet chair.

A baby basket with compartments to contain the necessary toilet articles.

Scales. Do not buy spring scales; they are often inaccurate and are not satisfactory after the baby grows older. Get ordinary, standard balance scales, which weigh at least in half-ounces, and, better, in quarter-ounces. If these can be put on a separate small table and left undisturbed, it will be most cor venient and the scales will keep in order.

A baby pen. This should have a solid wooden platform about 16 inches above the floor on castors with a washable blanket on its floor. A pen three feet square is satisfactory. In a large nursery even a larger pen can be used.

Two enamel or galvanized pails with covers for soiled diapers.

Nd AGVA V

PREPARATIONS FOR THE BABY 7

A wall thermometer.

A screen for the fireplace.

Toilet articles. The following articles are needed toe the baby’s toilet: —

Three dozen large, strong, white safety pins.

Two dozen very small safety pins.

One box of sterile absorbent cotton.

Six tubes of lanoline.

One tube of white vaseline.

Three cakes of pure white castile soap.

Six boxes of unscented talcum powder.

One bath thermometer.

One pound of boric acid crystals, to be bought in sealed packages.

Eight ounces of pure olive oil or mineral oil.

Four wash-cloths. If these are made two each of different colors, the face and the body cloths may easily be kept separate. A good quality of all-wool flannel is softest for the baby’s face.

Two bath blankets, knitted-wool or cotton.

Six soft towels.

-A soft hairbrush.

Clothes. Each new baby should find ready for him the following articles: — One soft receiving blanket.

Six flannel wraps one yard square.

Four knitted blankets.

Two blankets for the crib.

Six sheets for the crib.

Two yards of the best grade of solid white rubber. sheeting for the crib.

Four dozen diapers. The diapers should be made of cotton or stockinet, not linen.

Four flannel binders.

Four high-neck and long-sleeved woolen, or silkand-wool, or cotton-and-wool knitted shirts.

Four knitted abdominal bands with shoulder straps. Neither shirts nor bands should be knitted with tough inner seams.

Four nightgowns; flannel, or canton flannel, or Arnold stockinet.

White slips.

Three flannel gertrudes.

Six horse-blanket pins for pinning the baby in his crib.

One two-quart hot-water bottle with woolen cover.

The doctor. Every mother needs advice about the care and feeding of her baby. The doctor is the person to give her this advice. She should decide what doctor she is going to have care for her baby and ask him to see the baby soon after he is born and while he is perfectly well. She should take her baby for examination at frequent intervals during his first two years. So long as the baby

PREPARATIONS FOR THE BABY 9 is nursing these visits may be two to four months apart, but when the baby is weaned, they should be as often as once a month for the first year, and once in three months the second year. It is often possible to prevent serious illness by frequent consultation about the apparently trivial affairs of the baby’s life.

Nursemaid. A mother can take entire care of her baby if she is willing to give up other things, but the baby should not be made a secondary consideration. If a nursemaid is to be employed, before she is engaged she should be sent to a doctor for a thorough physical examination with especial reference to the presence of tuberculosis, syphilis, gonorrhcea, deficient hearing, and decayed teeth. If the nurse understands that this is a routine procedure for all nursemaids she will not resent the examination unless there is something wrong.

If the nurse has had good training she will know how to do the ordinary things for the baby, but the mother should watch ner do them for the first time to be sure that she does them as the mother wants them done. Nurses with long experience in the care of infants have ideas about doing things which may be good; but the mother should retain her privilege of bringing up her own baby. The mother should insist on having everything done in accordance with the doctor’s directions, and the nurse must not be allowed to change the food or other routine except as the doctor prescribes.

Chapter II Normal Development

BaBIEs in general do certain things at certain ages but individuals differ greatly in their development. A mother should not be alarmed because her baby varies somewhat from the average. A child should not be urged to do tricks or be brought forward to show off his accomplishments. Let him do the new things when he is ready to do them; this is soon enough.

Weight. Most babies at birth weigh six and one half +o seven and one half pounds. Boys are usually slightly heavier than girls. Babies lose considerable weight during the first few days. This should cause no alarm. After the first week they gain about five to six ounces a week during the first year and somewhat less later. After the first nine or ten months they gain not so regularly as up to that time. At five to six months they usually have doubled the birth weight; at twelve months, trebled it. At two years they usually weigh twenty-five or twenty-six pounds.

Height. The average length of a newborn baby is twenty to twenty-one inches. In six months the aver-

NORMAL DEVELOPMENT 11 age gain is five inches; in twelve months, eight inches; and in two years, twelve inches.

Head. The baby’s head at birth shows two soft spots or fontanelles. The soft spot at the back of the head usually closes at about six weeks and the large spot in front at about eighteen months, often earlier.

Hair. The first hair which the baby has at birth usually comes out during the first weeks or months of his life and is replaced by new hair.

Mouth. Very little saliva is secreted at first, but the amount increases materially after the third or fourth month. The increased saliva runs out of the mouth because the baby has not learned to swallow it. This drooling has nothing to do with teething.

Eyes. The baby does not see very much at birth, although he seems to be able to distinguish between light and darkness. Probably he recognizes objects at the age of six or eight weeks and can definitely focus his attention at the age of three months. At this time he recognizes people. During the first few weeks of life a baby often appears cross-eyed at times, because of his inability to control the muscles. This disappears as he grows older. Nothing need be done for it. A baby does not shed tears usually until he is about three months old. Nearly all babies have dark blue eyes at birth. The color changes during the first few weeks to that which is to be permanent.

Hearing. The newborn baby probably does not hear at all. In a very short time he is able to recognize noises, but does not localize them until he is about two months of age.

Teething. Babies differ greatly as to the time at which the first tooth appears. Frequently there is a family tendency for late teething. In general, babies get teeth in about the following order: —

At 5- 8 months, the two lower middle incisors.

At 8-10 months, the four upper incisors.

At 10-11 months, the two lower later incisors.

At 12-15 months, the four anterior molars.

At 18-20 months, the four canines — the “eye” and “stomach” teeth.

At 24-30 months, the four posterior molars.

Skin. The baby’s skin at birth is bright pink which fades during the first week to a normal ruddy color. Frequently during the first few days of life the skin becomes slightly yellow; i.e., there is a little jaundice. This does not require treatment. Often the skin shows

NORMAL DEVELOPMENT 13 a fine red rash from overheating or from the irritation of the clothes. Sometimes the first skin peels off in small flecks leaving a soft normal skin beneath. The fine soft hair present on the body at birth soon disappears. A newborn infant does not perspire — this function appears usually within a few weeks.

Breasts. A baby’s breasts often begin to swell soon after birth, and are slightly reddened. They fill with milk, but if they are left alone the swelling gradually goes down and they return to normal size. If they are massaged or treated in any way they often become infected and require operation.

Bones. The bones at birth contain only a little calcium and therefore are very pliable. They become harder as the baby grows older. Nearly all young babies appear to be bowlegged, but the legs straighten as the baby grows older.

Actions. At four to five weeks of age a baby smiles.

At three to four months of age he usually grasps objects intelligently. |

At about four months of age he begins to hold up his head.

At six to eight months of age he usually creeps.

14 THE BABY’S FIRST TWO YEARS ALARA PUM Cera D MAES Rohe A At seven to eight months of age he usually sits up alone.

At fourteen months of age he begins to walk. At eleven to thirteen months of age he says words, but does not make formed sentences until two years of age.

Chapter III The Care Of The Baby’s Body

Bath. A normal, healthy baby should be bathed daily. Until the cord is off and the navel is dry, he should not be given a tub bath. The bath is usually most convenlently given at 8.30 a.m. if the baby is on three hcur feedings; at 9.30 a.m. if he is on four hour feedings. The face and hands should be sponged also at 5.30 p.m. In warm weather a complete sponge bath should be given in the afternoon and on very hot days in the middle of the day also. The temperature of the room in which the bath is given should never be below 70° Fahrenheit, but should not be much over this. If possible, the bath should be given before an open fire, but care should be taken that the rest of the room is not cold. The temperature of the water should be between 95° and 98° until the baby is six months old; after that it can be as low as 90°. The baby’s face should be washed first, then the body should be soaped thoroughly and dipped into the warm water. Powdered castile soap is useful for bathing. The baby should not stay in the water more than two or three minutes. He should be quickly dried by sopping, not by hard wiping. If the skin is sensitive and becomes easily irritated. a bran bath will be found beneficial. This is prepared by putting a handful of bran in a cheesecloth bag and soaking this in the water unti! the water is milky.

Eyes. The baby’s eyes should be protected from the light. They should be bathed each morning, at first with a two per cent boric acid solution; after two months with boiled water. A fresh piece of absorbent cotton should be used for each eye. Occasionally one eye has an excessive watery secretion which runs down on the cheek. This is due to a plugging of the canal which carries off the secretion. The canal in the majority of instances opens itself after a few weeks and no treatment is needed. If the eyes have a mattery secretion or if the eyelids are red or swollen, your physician should be notified at once, and the baby put under the care of an oculist. If proper treatment is not begun immediately the baby may become blind.

Mouth. The baby’s mouth should be left alone. If there is any milk in the mouth after nursing, a teaspoonful of sterile water may be given, which will wash it down. The teeth after they come should be cleaned daily with a soft brush.

Nose. The baby’s nose on the inside should be left alone, except for the cleaning which can be done easily

THE CARE OF THE BABY’S BODY 17 by a soft pledget of cotton. A stick should not be used to clean out the nostrils. If there is a slight secretion in the nose, one to two drops of liquid albolene put into each nostril with a medicine dropper will clear it out. Albolene may be used night and morning for this purpose.

Ears. The baby’s ears should be kept clean by daily washing of the outside with soap and water. No attempt should be made to clean the canal of the ear further than can be done with a piece of cotton put over the little finger. If a sharp instrument is put into the ear, the ear drum situated at the end of this canal may be injured and the wax may be pushed in and entirely block the canal.

When the baby is lying on his side, care should be taken that the ear is not bent forward under his head.

Scalp. The baby’s scalp should be washed at the time of the bath. For the first few months soap should not be applied more than two or three times a week. If there are scales present,— the so-called ‘‘cradle-cap,’”’ — pure olive oil or mineral oil should be applied at night and the scales removed in the morning. Care should be taken not to use force, as the condition is made worse by irritation.

Head. The baby’s head will become flattened on the under side if he is allowed to lie constantly in one position. He should be turned from one side to the other and on to his back.

Frequently he will rub off the hair from the back of his head. This is because he is kept too warm or because the sheet is very rough.

Skin. The baby’s skin should be soaped every day and then rinsed off with plain water. After the drying of the skin, talcum powder should be applied in all the folds. Care should be taken that an excess of powder is not used, as hard cakes of powder cause irritation. The skin of some babies will be kept in better condition if olive oil or lanoline is used in place of taleum powder.

Navel. The navel should be covered with a sterile pad and should not be wet until the cord comes off. After the cord is off and the navel dry, no treatment is required. If the navel is bulging, a pad of gauze may be placed over it, and the flannel band which the baby will be wearing applied tightly. If this does not keep the navel from bulging, a strip of adhesive plaster may be applied. The adhesive plaster should be about two inches wide and long enough to reach at least one inch on each side of the navel. It should be applied snugly and allowed to stay on until it becomes loose which is about a week or ten days. A fresh piece should be put

THE CARE OF THE BABY’S BODY 19 on until there is no bulging... Adhesive plaster should never be used if there is any moisture of the navel. Ether may be used to remove the plaster. Ether is useful also to cleanse the skin where the plaster has been applied.

Nails. The baby’s nails should be kept short enough so that he will not scratch himself. There is no objection to cutting the nails.

Buttocks. The buttocks should be cleaned after each movement by using either water or oil. Do not wipe the movements over the genitals; in female babies, it may cause trouble. If the buttocks are irritated by the movements, they should be washed with lime water and covered with lanoline. If this does not cure the condition a mixture of equal parts of zinc oxide ointment and castor oil should be used. The irritation may be caused by soap left in the diaper after washing. Be sure the diapers are thoroughly rinsed. Sometimes an ammoniacal diaper causes irritation. Boiling the diapers every day will usually prevent the formation of ammonia. The irritation often comes from a disturbance of digestion. Tell your doctor if it occurs in order that he may see that the food is correct.

Genitals. The genitals in girl babies do not require any special care except cleanliness. They should be washed twice a day with plain water. Care should be taken that all fecal matter is removed after each movement. In applying powder to the legs the labia should be held together to keep the powder from caking between them and causing irritation.

The foreskin in boy babies should be retracted once or twice a week and cleaned beneath. Get instructions from the doctor how to do this and how to recognize the appearance of adhesions. If there are any adhesions they should be broken up by the physician. The foreskin should then be retracted daily and vaseline applied until there is no tendency for adhesions to re-form.

Chapter IV Breast-feeding

Every mother should nurse her own baby. By refusing to give her baby the benefit of breast milk, a mother takes a risk for him which she has no right to assume. Breast milk is the best food for a baby. It is fresh, clean, and always at hand. It is the least expensive food which can be given. It prevents certain diseases and cures these diseases when they occur in babies who have not had breast milk. It increases the resistance of a well baby to disease, and it helps a sick baby to recover from all kinds of illness.

- The nursing mother. The mother who is nursing her baby should remember that, for the time being, nursing is her most important business in life and that all other things must be secondary to it. Remembering this she should, however, lead a normal life as nearly as possible. Her habits of exercise, her diet, and in fact everything about herself should be conducive to her best health. If she is used to being out of doors a great deal, she certainly will not feel well if she stays in the house all the time. Her diet should be such as she is accustomed to have. In addition to the usual three meals a day, she should have three lunches, one in the middle of the morning, one in the afternoon, and one at bedtime. The lunches should consist mostly of milk or gruel. She should take a large quantity of fluid in the day, but she should not force herself to the point of upsetting her own digestion. One quart of water and one quart of extra nourishing liquid daily is sufficient. She need not at the beginning avoid any article of diet. If she finds that a particular thing always disagrees with her baby, she had better not take it. The same thing may be quite permissible for another mother. Since certain drugs are excreted in the breast milk, she should not take any medicine while she is nursing except on the advice of a physician. She must remember, above all things, that her attitude of mind is intimately connected with the quality of her milk. She must keep a calm and even mind, for nothing upsets a baby more quickly than a nervous, irritable, or angry mother. She must realize that when she is disturbed the baby suffers much more than she does. The family and friends should realize this also and make a corresponding allowance. If she does lose her mental equilibrium, she should give the baby one teaspoonful of lime water mixed with one teaspoonful of boiled water before the next nursing.

Care of the mother’s nipples. The mother’s nipples should be washed with boric acid solution or sterile water before and after each nursing. If the mother has any discomfort at the time of nursing, the nipple should be inspected carefully to see if there are any cracks. A cracked nipple frequently leads to a sore breast which may result in an abscess. If a nipple is cracked, it should be washed with seventy per cent alcohol and painted with compound tincture of benzoin, applied with a camel’s-hair brush twice a day. The baby should be nursed with a nipple shield. The nipple shield should be washed and sterilized before each time it is used.

Composition of breast milk. Breast milk is composed of fat, sugar, protein, salts, and water. The average percentages are: fat, 4; sugar, 7; protein, 1.50; salts, 0.20; water, 87.30. There may be considerable variation in the ingredients and the milk still be suitable food. Breast milk on which a baby thrives is a satisfactory food for that baby. If the milk looks thin, this is no reason why it should not be used.

The percentage of fat, if low, may be increased sometimes by adding fat to the mother’s diet and by decreasing her exercise. These measures are not efficacious unless the mother is underfed and tired. The fat, if excessive, may be reduced by cutting down the amount of meat in the diet and by increasing the exercise to a point short of fatigue. The sugar cannot be modified to any appreciable degree. The protein, if high, may be lowered by increasing the exercise, not to fatigue, and by acquiring a calm mind.

The quantity of milk is increased by frequent nursing, i.e., the sucking stimulates the mammary glands to secrete, but the interval should not be less than three hours, except in rare instances. The milk is increased also by adding fluid to the diet. Incomplete emptying of the breasts results in decreasing the quantity of milk. Care should be taken that the baby empties the breast at each nursing.

INTERRUPTIONS TO BREAST-FEEDING

1. Mother’s illness. Tuberculosis is always a contraindication for nursing. Mental disease usually prevents nursing. Certain other chronic diseases may make nursing inadvisable. A short acute illness is no reason for giving up nursing. The question of whether or not breast-feeding shall be continued must be decided by the physician according to the circumstances in each instance.

2. Menstruation. Menstruation is not an indication for weaning. Sometimes, during the time the mother is unwell, the baby is slightly upset. When this is the case a teaspoonful of boiled water and a teaspoonful of lime water mixed should be given to the pe just before each nursing.

3. Pregnancy. Pregnancy is a positive reason for weaning.

4. The baby. A feeble or premature or very sick baby cannot nurse. Such a child should be fed on breast milk obtained by a breast pump from the mother or from a wet-nurse. Physical defects of the baby’s mouth, cleft palate or hair-lip, may make nursing impossible. Milk must then be given by a medicine dropper or spoon, or Breck feeder.

5. Unsuitable milk. It is frequently said that the mother’s milk does not agree with the baby. No baby should be weaned on this statement without careful investigation. The mother’s diet and mode of life should be considered and changes made in accordance with what is found to be at fault. The trouble is usually that the mother tries to do too many things beside nursing the baby. It is to be remembered that green or slimy or curdy movements in a breast-fed baby who is doing well are not a reason for weaning. If the baby spits up, it may be because he is handled too soon after feeding or the flannel binder may be too tight or he may have taken too much food. If the baby has gas, he may be taking the food too fast, or the mother may be doing too much or may have indigestion. If the baby is uncomfortable from the gas, he may be picked up, put over the shoulder, and gently patted on his back until the gas is expelled. Sometimes a hot-water bottle at the stomach will give relief.