Infancy and childhood; a popular book on the care of children

Front matter

1 1) 1 >!'!

Class.

Book.

Preface

In the writing of this book I have had constantly in mind the now recognized fact that, in order to accomplish anything in the way of preventive medicine, there must be an intelligent cooperation of the public.

Whatever progress is made in child-welfare will be largely along educational lines.

The future well-being of the average child which is normal at birth depends to a great extent upon the physical and moral care it receives. For the first years, which in many respects are the most important in the life of the individual, this care devolves largely upon the mother and nurse.

The old-time mysticism, which still to some extent surrounds medicine, must disappear and the public be taught what it may rightfully expect of itself and the physician.

It does not follow that the mother need have a technical knowledge of medicine. She should, however, have an intelligent idea of foods and their values and at least a knowledge of the fundamentals of hygiene.

vii viii PREFACE

She should have a sufficient knowledge of disease, especially the contagious forms, to understand their significance, the manner in which they are carried, and the means of prevention.

For example, she should know that a croup which persists for many hours, with progressive difficulty in breathing, may be a laryngeal diphtheria and that a physician should be summoned immediately, as the child's life may be in great danger.

She should know that a high fever, severe vomiting and diarrhea, or any other severe symptom, is never due to teething but to some other cause.

With the hope of aiding her to a better knowledge of such practical points as these, this book has been written.

W. R. R.

St. Paul, January 3, 191 5.

Introduction

The interest in child welfare during the past fewyears has been especially marked. Men and women in all walks of life have joined hands in advancement of the cause. Societies have been formed in almost every city in America and Europe for the prevention of infant mortality and for the general improvement of conditions relative to child life.

Why this world-wide interest, this great concern so lately awakened?

While the advancement of science has greatly diminished the mortality among adults, the infant death rate has remained practically at a standstill.

In the United States one infant out of every seven which come into the world dies before it has reached the end of the first year. When one considers that most of these infants are normal at birth the condition is all the more shocking.

The belief generally held that infant mortality is simply a matter of natural selection, that the fittest survive and that the race is thereby made stronger, is no longer tenable.

The fact is that many children although they survive the first year are much less " fit " as a result

ix x INTRODUCTION

of illness and defective feeding, and not a few of them succumb later or carry through life the effects of a bad early environment. What, then, is the cause of this appalling death rate in infants?

Ignorance and bad social conditions are responsible for the greater part of the preventable death rate in infants. Ignorance on the part of society in general and of parents in particular concerning the fundamental conditions underlying child life and development.

Many women are forced to do work which undermines their health and makes them unfit to give birth to healthy children.

The substitution of artificial for breast feeding is responsible for a large percentage of the deaths among infants. The breast-fed baby has six times as many chances of surviving the first year as the artificially fed infant.

Crowding into cities where the cost of living is so high that neither the mother nor the infant has the proper housing or food, is also responsible for many deaths.

Until recently the infant has been regarded as a miniature adult and was so treated even by the medical profession.

It is now known that the physiology of the infant is vastly different in many respects from that of the adult. In the infant we have to do with a sen-

INTRODUCTION xi

sitive, unstable and rapidly developing organism which must be supplied with the elements necessary to its growth, while in the adult it is only necessary to repair body waste. How can we prevent this unnecessary sacrifice of child life?

By educating fathers and mothers concerning their own care and the care of their children. By improving social conditions so that women employed will have proper sanitary conditions under which to live and work, a living wage and a proper knowledge of food and food values.

How can this be done?

Young women must be taught more at home and at school concerning the fundamentals which will fit them to be wives and mothers.

Proper legislation if enforced would do much to remedy some of the evil conditions.

Among the educated classes much may be taught through proper literature.

For immediate results we must depend to a great extent upon properly educated physicians, nurses and social workers, who will devote much of their time to spreading useful knowledge and to uprooting false ideas, whenever and wherever they may be found.

We are interested not only in saving the lives of infants but also in promoting their physical and moral welfare, so that they shall be the greatest possible benefit to society and to themselves.

CONTENTS INTRODUCTION

PAGE

History of the Progress in Child Welfare During the Past Few Years. Cause of Large Death Rate in

Infants. Education, etc ix

CHAPTER I The Skeleton i

The Skull 2

The Teeth 3

The Spine 4

Development of Soft Parts of the Body 5

The Heart and Circulation of the Blood 6

Respiration — Lungs and Chest Wall 7

Brain and Nervous System 8

Digestive Tract 9

The Stomach 10

The Intestines 11

CHAPTER II Average Weight at Birth 13

Gain in Weight and Length 13

Development of Boys and Girls During Puberty . . 14 Table Showing the Average Weight, Height, and Circumference of Head of Boys for the First Ten Years 17 Significance of Head Measurements, Movements, etc. . 20

Loss in Weight After Birth 20

The Normal Infant — Methods of Examination . . 21

Natural Movements of the Body 22

xiii xiv CONTENTS

PAGE

Rickets as Cause of Delayed Development .... 23 Development of the Special Senses — Seeing, Hearing,

Talking, etc 24

The Mental and Moral Development of the Child.

"Home Training" 26

Chapter III The Nurse

Qualifications, etc 37

CHAPTER IV Care of the Cord 39

Hernia (Rupture) 40

Bathing 42

Care of the Skin 43

Care of the Genital Organs 44

Care of the Eyes 45

Care of the Mouth 46

Clothing of Young Infants 47

The Nursery 52

Airing Out of Doors 54

Sleep 55

Temperature 56

Premature Infants 57

CHAPTER V Low Mortality of Breast Infants 60

Secretion of Milk 61

Discussion of Patent Foods in Comparison with Breast

Milk 62

Technique of Breast Feeding 63

Quantity of Milk Secreted, etc 64

Menstruation and Pregnancy in the Mother . . 67, 68

Fissured Nipples 68

CONTENTS xv

PAGE

Mixed Feeding 69

Weaning 70

The Wet Nurse 70

CHAPTER VI General Discussion of Milk and Artificial Foods . 72

Care of Milk in the Home 75

Composition of Cow's Milk as Compared with Mother's

Milk 78

Modification of Cow's Milk for Infants 79

Quantity of Food at a Meal 82

Different Milk Formulae 82

Fat, Sugar and Gruels 84

Substitutes for Fresh Milk 91

Proprietary Foods 91

Special Preparations of Milk 92

Peptonized Milk, etc 92

Bottles and Nipples 95

Sterilizers and Pasteurizers 97

Ice Box 98

CONTAGIOUS DISEASES

Tuberculosis 132

Diphtheria 134

Scarlet Fever 138

Measles 140

Smallpox 141

Chicken Pox 141

Mumps 142

Whooping Cough 142

Erysipelas 144

Gonorrhea 145

Syphilis k . . 146

Quarantine 147

Disinfection 148

CONTENTS xvii

PAGE

CHAPTER XIV MISCELLANEOUS Melena Neonatorum (Bleeding of the New Born) . . 150

Convulsions 151

Worms 152

Adenoids 155

Enlarged Tonsils 156

Enlarged Glands 157

Rheumatism and Chorea 158

Earache 159

Goiter 159

Cretinism 160

Rickets 161

Scurvy 162

Hives (Urticaria) 163

Milk Crusts (Eczema) 164

Thrush. Stomatitis 165

Summer Diarrhcea 166

Vaccination 168

Kissing 169

Habits 169

Thumb Sucking 169

Facial Movements 170

Bed Wetting 171

Masturbation 172

Proper Use of the Eyes 173

Errors of Refraction 174

Malnutrition 175

Delicate Children 176

Puberty 177

Clothing for Older Children 179

Toys 180

Foreign Bodies 181

Enlargement of Breasts in Infants 182

Care of Wounds 182

Milk for Traveling 183

Table of Caloric Values 185

Dietary 185

Index , m n . m 189

LIST OF ILLUSTRATIONS

"Wrapped in Warm Blankets and Out of Harm's Way"

Frontispiece

PAGE

Fairbanks Baby Scale 15

Fairbanks Scales 15

Weight Curve of the First Year 19

Outdoor Activities Which Keep Children Healthy ... 30 11 In the Country There Is Always Something to Interest

and Instruct the Child " 34

The Correct Treatment of Abdominal Hernia .... 40

The Skull of an Infant 42

"At Eleven to Twelve Months the Child Will Stand by

Taking Hold of Things " 42

Folding Bath-Tub 42

Handy Folding Table for Bathing and Dressing the Baby 50

A Knitted Hammock for the Baby 53

A Child Should Have Much Exercise in the Open Air,

Both Summer and Winter 54

Nursery Pen 56

" In An Open Shady Grass Plot Under the Trees " . . .56

Simple Incubator for Premature Infants 57

Breck Feeder 58

Breast Feeding — The Proper Position for Nursing the

the Baby 60

Breast Pump 65

Nipple Shield 69

LIST OF ILLUSTRATIONS

PAGE

A Modern Sanitary Cow Stable Contrasted With the Old

Style Disease-Breeding Conditions 74

Chapin Cream Dipper 80

Cream Dipper in Use 80

Pint Graduate 84

Nursing Bottle With Correct Nipple 96

The Arnold Steam Sterilizer and Pasteurizer .... 96

A Simple Home-Made Ice Box 97

Temporary or Milk Teeth 99

Permanent Teeth 101

Soft Rubber Syringes 108

Simple Vaporizer 128

A Simple Arrangement for Steaming Which can Be Fitted

to the Child's Bed 129

Simple Screened Bed for Outdoor Sleeping . . . .177

The body of the infant consists of : — i. The skeleton, or bony framework.

2. The soft parts, which are made up of ligaments, muscles, blood-vessels, nerves, digestive and urinary organs, etc.

3. A liquid portion, consisting of blood and lymph.

THE SKELETON

Cartilage. The skeleton of the infant, unlike that of the adult, contains a large amount of cartilage. This is relatively soft compared with bone, but later, by the process of multiplication of the bone cells and the deposition of lime salts, it is transformed into bone proper.

The skeleton, or bony framework, including the cartilage, serves a variety of purposes. It serves as a protection for the most vital and sensitive portions of the body — the brain, which is enclosed within a bony shell, the skull ; the spinal cord, which is enclosed within the spinal canal; and the lungs and heart, which are enclosed within the chest w T all.

The Chest Wall. The chest wall serves not only as a protection to the organs mentioned, but also, in connection with certain muscles, as an aid to breathing. The bones also serve as an attachment for the muscles which by their contraction, produce the power of motion.

Ligaments. The different bones in the infant are rather loosely held together by fibrous ligaments, so that there is a considerable amount of freedom of motion in all directions and there may be even some over-riding of the ends of the approximating bones.

Change in Shape of Head at Birth. This is particularly true of the bones of the skull, which during a difficult birth so overlap, that for a short time the shape of the head may be changed. The bony framework of the head can be roughly divided into two parts: the cranium, which contains the brain, and the bones of the face.

THE SKULL

The Jaws. In the infant the upper portion of the skull is much greater in proportion to the lower, than in the adult. This is a result of the undeveloped condition of the jaws.

The cranium is composed of thin curved plates of bone rather loosely held together.

Sutures. The spaces between the opposing edges of the different bones in the skull are called sutures.

Fontanels. The large, four-sided opening which exists at the upper, forward part of the skull, at the juncture of the two frontal and two parietal bones, is called the large fontanel, and the small triangular opening at the juncture of the two parietal bones with the occipital, is called the small fontanel. (See cut facing page 42.)

The Brain. The brain lies within the skull and its growth and development have undoubtedly much to do with the size and shape of the head.

Time of Closure of the Fontanels. The sutures, as well as the small fontanel, close normally at the end of the first year, while the large fontanel does not normally close until the end of the fifteenth to eighteenth month. Closing of the fontanels before the end of the first year may mean a limited brain development, a condition known as microcephalus. The nonclosure of the large fontanel after the eighteenth month, usually indicates the presence of rickets.

THE TEETH

At birth the teeth are well formed in the jaws and continue to grow so that, at the end of the sixth or eighth month after birth, the first teeth usually pierce the surface of the gums. The last ones appear normally about the thirtieth month.

The process of teething, therefore, contrary to what is generally believed by the laity, is practically continuous, extending from the sixth to the thirtieth month. (For " Teething " see page 99.)

THE SPINE

The spine or vertebral column consists of thirtythree segments or vertebrae placed one on top of the other, separated by cushions of connective tissue, the whole column being held together by ligaments.

The Vertebrae. These vertebrae consist largely of cartilage. The vertebrae form a bony canal which serves to protect the spinal cord from injury.

Spinal Nerves. Through small openings, or foramina, come the nerves which carry the impulses to and from the brain.

Curvature of the Spine. As the erect position of the spinal column can be maintained only by muscular contraction, and since in the young infant these muscles are undeveloped, the erect position of the body should never be enforced, as abnormal curvatures may result.

DEVELOPMENT OF SOFT PARTS OF THE BODY

The Skin. During the first few days after birth the skin of the new born infant is often intensely red. This redness gradually fades until, at the end of the second week, the skin assumes a pink color which from then on is characteristic of the normal breast infant.

The Hair. The fine hair which covers the body of the new born usually disappears after a few weeks, as does the copious growth of hair which often occurs on the head. This hair may persist for a considerable time and then fall out, to be replaced by another crop less profuse and frequently of a different color.

The skin of the new born baby is extremely tender and particularly susceptible to irritation either by undue friction or by irritating substances, such as impure soap or the discharges from the body, urine, stool and perspiration.

Color of Mucous Membrane. The tissue of the healthy breast infant is relatively richer in fat than that of older children.

The tissues of the healthy infant are characteristically firm and resilient. The first evidence of the disappearance of the fat from the body is shown by the flabby character which it assumes in comparison to the firm feeling of normal flesh.

The mucous membranes of the new born infant are also extremely red at birth but gradually become paler and assume after a couple of weeks the natural pink color.

THE HEART AND CIRCULATION OF THE BLOOD

Oxygenation of the Blood. The heart begins to beat and send blood through the vessels as early as the second month of foetal life. Since, however, the blood of the unborn child is dependent for its oxygen upon the placenta of the mother, its circulation is somewhat different from that of the child after birth. At birth, when the cord is severed, the child begins to breathe so that all blood must go through the lungs in order to get oxygen.

Heart Valves. Valves and vessels which were necessary before birth now become unnecessary and must permanently close before proper circulation is possible. If for any reason the free circulation through the lungs is interfered with, the blood will not receive sufficient oxygen and will become blue in color. Such a condition exists in the so-called "blue baby."

Frequency of Heart Beat. The frequency of the heartbeat during infancy is considerably greater than in older children and adults. At birth the heart beats 120 to 140 times per minute. At the end of the first year the frequency has been reduced to 1 00-110. From this time on the heartbeat gradually diminishes in frequency, until at six years it averages 80-90 per minute. These are averages and are to be taken only when the child is quiet and undisturbed.

RESPIRATION

The lungs are situated within the chest wall and, together with the heart and large blood vessels, practically fill that cavity. It is by means of the lungs that the blood comes in contact with the air, taking up oxygen and giving up the waste gases such as carbondioxide.

The act of breathing begins immediately after birth.

The frequency and rhythm of the respiration in infants is considerably different from that of older children and adults. The breathing is more frequent and irregular in character than in later years.

Chest and Abdominal Breathing. There is comparatively little movement of the chest wall in infants and most of the breathing is done by means of the diaphragm, that is, so-called abdominal breathing. Gradually as the infant grows older and as the chest muscles become more developed the chest breathing increases.

Character of Breathing. The rhythm of the breathing in infants is irregular. This irregularity is not infrequently the source of much concern to mothers, as it is particularly noticeable during sleep.

Frequency of Breathing. While the frequency of breathing in adults is 18-20 per minute, in infants during the first month it is as high as 30-40, and even in the second year it is 25-30 per minute.

Nose and Mouth Breathing. Air should normally enter the body through the nose. When an infant does not breathe through its nose, and the mouth remains open during sleep, it means some obstruction in the nasal passage, either in the nose itself, or behind the nose, usually in the form of adenoids, which condition is not infrequent even in the new-born infant.

THE BRAIN AND NERVOUS SYSTEM

Growth of Brain. At birth the brain and central nervous system are, at least to all appearance, well developed. As early as the eighth month after birth the brain of the infant is so well developed that, in comparison with the brain of the adult, no great difference can be detected. The growth of the brain during the first year is very rapid, in fact the growth during the first year equals, or exceeds, the growth during the entire remaining life of the individual.

Many of the bodily functions at birth are but poorly developed.

Of all animals the young infant is by far the most helpless, and for the first few years or so is entirely dependent.

Organs of Sense, The organs of sense during the first few weeks show very little development of function, although at an early age the infant is able to appreciate heat, cold and pain. Taste usually develops early; sweet things are taken better than sour or bitter.

Eye Movements. The eyes of the baby during the first few days, or even weeks, make all sorts of incoordinate movements and at times a positive squint is present. This, however, is but temporary and is due to the lack of muscular control. An infant acquires the ability to fix its eyes upon objects at about the third month.

Winking and Shedding Tears. Winking is seldom seen in the new-born baby, as is also the shedding of tears. After the first few weeks the winking of the eyelids becomes more frequent and tears begin to appear.

DIGESTIVE TRACT

The digestive tract begins at the mouth and ends at the anus.

io INFANCY AND CHILDHOOD

Sucking. The act of sucking is a complicated procedure and one which demands for its consummation the following organs: The jaws, the tongue, the cheeks and the roof of the mouth. If any of these parts are deficient in development the act is liable to be impaired.

Digestion of the milk begins in the mouth through the influence of the secretion from the salivary glands. The digestive action of these secretions is at first very feeble but increases considerably during the first three months.

Gastric Secretion. After passing through the mouth the food enters the esophagus and by muscular contraction is carried to the stomach, where it is acted upon by the secretions of that organ (gastric juice). The most active ferment in the infant stomach is the rennet, which results in the curdling of the proteid element of the milk. Pepsin and hydrochloric acid are present in the stomach of the new-born infant in small quantities. These secretions are undoubtedly rather inactive during the first weeks of life.

THE STOMACH

The form and position of the stomach of the infant is not unlike that of the adult, occupying rather an oblique position in the upper left side of the abdomen just below the heart under the diaphragm and extending from left to right.

STRUCTURE OF THE BODY n

The small end of the stomach is closed by a circular muscle known as the pylorus. This opens at intervals as a result of chemical and nervous influence combined, and the contents are forced through by rhythmic muscular contraction into the small intestine.

THE INTESTINES

Small Intestine. The intestinal canal is divided anatomically into two parts, the small and large intestine. The length of the intestinal canal is relatively longer than in the adult. In the infant the intestinal canal is approximately six times the length of the body, while in the adult it is only four and a half times as long.

Digestion in the Small Intestine. The milk is largely digested in the upper portion of the small intestine, through the influence of the secretions from the pancreas and the liver.

The Large Intestine and Its Functions. Very little digestion occurs in the large intestine, although it has some ferments capable of digestion. A great deal of the absorption of the liquid portion of the food, however, takes place in the colon (large bower).

Bacteria in the Intestinal Canal and Their Function. The whole intestinal tract at birth is free from any form of bacteria, but after twenty-four to thirty-six hours it contains millions of bacteria of many varieties, some of which undoubtedly have much to do in assisting in the digestion and assimilation of the food.

II

Average Weight at Birth. Although there is considerable variation in the size of individual infants at birth, the average for boys is about seven and a half pounds and for girls about seven pounds.

There is almost always some loss in weight directly following birth, which will be explained in chapter on Breast Feeding, page 61.

Gain in Weight. During the first three months the gain of a normal infant is from four to six ounces per week, or from one to one and one-half pounds per month. It is rather the exception that infants will maintain a gain of two pounds per month during the first three months.

Gain in Weight During the First Year. At six months the weight should be about double that at birth, which for the entire time is an average of a little over one pound per month. During the second half of the first year the gain in weight is not quite so rapid as during the first half.

At the end of the first year the weight should be approximately three times that at birth.

This tremendous gain in weight during the first year explains the large amount of food needed per pound of body weight during this period.

After the first year the gain in weight is not so rapid.

Gain in Weight During Second Year. During the second year the child should gain threefourths of a pound per month, or eight or nine pounds during the year.

Gain in Weight to Fifth Year. During the third year it should gain about four or five pounds, during the fourth about four pounds, and during the fifth, four and a half pounds, so that at five years the child should weigh forty or forty-two pounds.

The average weight of boys is one to one and a half pounds greater than girls at the same age.

Development of Boys and Girls During Puberty. At the time of puberty, which comes earlier in girls than in boys, the girls forge ahead of the boys. Later, however, the boys regain their superiority in weight and maintain it until maturity.

An approximately normal increase in weight of an infant is of vital importance. When an infant does not gain in weight for any length of time, there is always something wrong either with the feeding or with the child itself.

Fairbanks Baby Scale Weighing to 35 lbs.

Fairbanks Scales Weighing to 200 lbs.

Weighing. Infants should therefore be weighed regularly, at least weekly, during the first year, and at least once monthly during the second and third years.

The gain in weight is not the only thing in the development of an infant to be considered; in fact a too rapid increase in weight may be a detriment and usually means over- feeding.

Increase in Length During the First Year. The growth in length and a proper general development of the body are equally important with the increase in weight.

The average length of the male infant at birth is twenty inches and of the female nineteen and a half inches. During the first month the infant increases in length from one and a half to one and three- fourths inches, and during the second month slightly less. This increase gradually becomes less after the third month, and at the end of the first year the increase is about one-half inch per month. There is a gain in length of about eight inches during the first year, three and one-half during the second year, and three inches during the third year. From the third to the eleventh year the gain is about two and a half inches per year.

At the age of puberty there is a more rapid gain in height corresponding to the increased gain in weight.

Development During Puberty. During this period of rapid growth there is an unstable condition of the nervous system, the significance of which will be discussed under the chapter on " Puberty."

Table Showing the Average Weight, Height and Circumference of Head of Boys:

The weight of girls at birth is on the average about one-half pound less than boys. Their height is only slightly less:

at birth :

Weight 7J/2 pounds

Height 2oy 2 inches

Head 14 inches

one year:

Head 18 inches

two years:

Weight 2J pounds

Head 19 inches

three years:

Head 19J4 inches four years:

Head 19^ inches

five years:

Height 41 y 2 inches

Head 20J4 inches

six years:

seven years:

eight years:

Chest 24J4 inches

nine years:

ten years:

Weight 66 I /2 pounds

The weights for the first four years are without clothes. After that the weights include ordinaryhouse clothes. (After Holt.)

Some slight variation may occur from these

WEIGHT CHART.

Name - Date nf Birth.

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s h

MONTH OF AGE.

1 2 3 4 5 6 7 8 9 10 11 12

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6800-15

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Weight Curve of the First Year measurements without having any special significance. For instance, a child born of small parents will usually be smaller than one born of large parents and the weight and measurements will be correspondingly less. Any wide divergence from these averages means something abnormal. For example, if a baby which weighed seven pounds at birth should at three months weigh only eight pounds, one would be certain that there was something wrong; or if an infant at one year should have only the length of an infant of six months it would point strongly to " Cretinism " or some other abnormal condition.

Significance of Head Measurements. If the head should measure only fourteen inches at the end of the first year we should be suspicious as to the brain development, or if at one year it measured twenty inches instead of eighteen we would feel the probability of a Hydrocephalus being present.

Loss in Weight After Birth, During the first few days there is usually a loss in weight " which does not occur in other animals." The so-called physiological loss in body weight is proportionate to the size of the child ; the greater the weight the greater the loss. The loss continues from three to six days and then begins a gradual gain.