¡3/ 2/ / U-
Matron, Training School,
Victorian Baby Health Centres Association.
Children’s Hospital, Melbourne.
General Nursing, R.V.T.N.A.
Queen Victoria Hospital, Launceston.
Obstetrical Nursing, A.T.N.A.
Midwives’ Board of Victoria.
Mothercraft and Infant Welfare, Victorian Baby Health Centres Association.
Tressillian (New South Wales) Royal Society for the Welfare of Mothers and Babies.
State Registration (Victoria) for General, Obstetrical, and Infant Welfare Nursing.
Australian Army Nursing Service, Australian Imperial Forces,
Mrs. C. 0. White.
IT GIVES ME GREAT PLEASURE TO
THIS BOOK TO
Mrs. C. 0. WHITE,
HON. SECRETARY, VICTORIAN BABY HEALTH CENTRES ASSOCIATION FOR THE PAST TEN YEARS, WHOSE INDEFATIGABLE INTEREST AND ASSISTANCE, TO BOTH THE NURSING SISTERS AND MOTHERS HAVE EVER BEEN FORTHCOMING IN THE WORK OF “SAVING THE BABIES.”
ARTICLES PUBLISHED IN THE AGE DURING THE YEARS 19.25 AND 1926, BY KIND PERMISSION OF
MESSRS. DAVID SYME « CO. MELBOURNE.
“The Age” Office,
20th September, 192 6.
Dear Sister Purcell,—I wish to convey to you my appreciation of your papers on “Mothercraft.” •
Is there any other subject upon which you would like to contribute to our columns?
E. F. H. SCHULER, Ed.
First Published 1928. All Rights Reserved.
It is my earnest hope that the simple principles of Mothercraft laid down herein will prove useful to all those who have the care of young- children in rearing a sturdy race of little Australians.
Mothercraft is the largest part of all Infant and Child Welfare work, and one’s set of general rules for maintaining health can be adhered to at all times.
In regard to the method of infant feeding, however, it is one which I have proved successful, but it must be remembered that there are other methods which are just as successful, and in this matter it is the feeding which must be made to suit the child, never the child to suit the feeding, and the feeding of a sick child must ever be left in the hands of the doctor.
I take this opportunity of thanking those who have helped in the production of this book. Mr. Geoffrey Syme, for permission to publish “Age” articles, Dr. Bennie for many helpful suggestions, Dr. Tait for his interest and reading of the early copy, which has resulted in this work, Sister Burke for reading final proofs, and Dr. Younger for her introduction.
DR. ISABEL YOUNGER, M.B., Ch.B.
(Mrs. John Ross),
one of the founders, and pioneer medical woman of the infant welfare movement in Victoria. At present a Vice-President of the Victorian Baby Health Centres’ Association.
It is with great pleasure that I write the introduction to this little book on the Health of Mothers and Babies.
Of late years much time and thought has been given to this subject, and Miss Purcell has given in a simple manner much that will be helpful to all mothers, and especially to mothers with their first babies.
Miss Purcell is specially fitted for the task of writing on this subject, both because of her experience as Matron of the Victorian Baby Health Centres Training School, and because of her extra training at the Tressillian Mothercraft Home in Sydney. The chapters dealing with the expectant mother are most important.
There has been much saving of infant life since the opening of our first Baby Health Centre in Richmond eleven years ago. The importance of rearing healthy babies cannot be over-estimated. Babies born healthy and strong can fight disease more successfully than when born unfit. The expectant mother, by seeking advice, will reduce to a minimum those factors which result in babies being born so weak that they are unable to survive birth, or, if they survive, are so weak as to perish in the first month of life.
The Training School has trained 110 nurses for work in the Baby Health Centres and 48 Bush Nurses, and Miss Purcell’s experience has been wide and varied, so it is with confidence I wish this little book every success in its work of teaching mothers how best they can keep themselves and their babies healthy.
ISIE YOUNGER ROSS, M.B., Ch.B.
Miss Purcell.......................... 2
Baby’s Day Garments.................... 23
Baby’s Night Garments.................. 25
Improvised Bed...... 26
Nursing Sister—Bathing Baby.............. 33
Feed Baby Regularly.................... 36
Types of Milk Coolers.................... 54
Baby’s Playground ...................... 55
Exercise Dress for Hot Weather............ 56
Normal Weight Line Chart................ 58
Nursing Sister—Weighing Baby.............. 59
Fly Under Magnifying Glass................ 65
Baby’s Enemy........................ 68
Best Type of Bottle for Artificially Fed Babe .... 72
Demonstration Diet Table................ 94
To Fathers.......................... 12
The Expectant Mother.................... 14
Diet for the Expectant Mother.............. 11
Care of the Teeth........................ 19
Infant’s First Clothes.................... 21
Sleeping Suits and Baby’s Bed.............. 24
Outdoor Clothing..................... • 27
The Nursery.......................... 29
Requirements for Confinement.............. 31
Bathing Baby.......................... 32
The Breast Feeding of Infants .............. 35
Difficulties in Breast Feeding................ 37
Clothing of the Nursing Mother.............. 42
Baby Diet (10 to 12 months).............. 47
Care of Milk.......................... 52
Growth and Development (Part 1)............ 57
Growth and Development (Part 2)............ 60
Training the Child............... 62
Prevention of Summer Diarrhoea.............. 64
Prevention of Thrush...................... 67
Prevention of Constipation .................. 69
The Artificial Feeding of Infants............ 70
Fresh Milk............................ 79
Dried Milk............................ 84
Condensed Milk.......... 85
Patent Foods.......................... 86
The Premature Baby.................... 90
Management of Twins . ................... 95
Accidents to Children....................100
In this work for the welfare of women and children we sometimes lose sight of the fact that men-folk play an important part. To the cry of “Save the babies/’ we may add “Husbands, save your wives.” It is most pleasing to me, however, to see the interest the average young father takes in the welfare of his baby—in fact, it is quite remarkable, when one thinks of the somewhat detached father of days gone by! The joy a father has in his children to-day is striking. Over and over again fathers come to the centres with inquiries in regard to their babies. Perhaps mother cannot come, so the father may even bring baby for weighing!
I should like to ask every husband who sees this book to help his wife carry out the advice given; this just as much for her own sake as for that of the infant. The love the mother has for her child is the most perfect thing in human nature. The rearing of the baby is therefore largely left to her, but it is an arduous task, and she needs much encouragement. Who can give it better than her husband, although he may see comparatively little of his children in these early years? Man’s physical development fits him especially to maintain the struggle for existence —he is essentially strong, and therefore sometimes thoughtlessly selfish. Woman is weak and generous. In man is embodied the individual, in woman the race! Parents have duties to perform which are weighty and responsible. The infant must be taught how to live. If all this responsibility is left to the wife, as well as the feeding and care of the child, it proves too much and she becomes weary of the struggle, and who suffers ?—the husband. Remember always, a wife is not a burden and a trouble. She is a bearer of her husband’s burdens and a sharer of his troubles! A good wife is to a man, courage, hope and endurance. The husband expends his moral force in conflicts with the world, the wife hers in the daily round of household duties, which grow so monotonous at times—and with three or four small children whose lot is the harder? The ideal and true happiness is created only by the husband and wife sharing cares, and so helping one another in all things. Husbands, there is nothing so precious as the possession of a pure, fresh affection—nothing so devoted as a wife’s love. Therefore keep it. Help your wife in her physical weakness, in her hopeless and tired hours, give her one token of love, one kind, thoughtful word at the right moment, one gentle, helpful look to encourage her to go on. As far as it lies within your means, and your geographical position in our vast country, give her the comforts that go towards preventing the drudgery of housework in these servantless days. Do not let her carry heavy weights, or work hard enough to remain on her feet for fifteen hours a day when her babies are tiny, and so secure a healthy, happy home-life, and a family to be proud of. “The Australian Baby” is an absolute necessity, and we want him strong and wholesome.
In these days, with the Emipre’s war losses and our own vast unoccupied continent, everyone feels the importance of promoting the welfare of our mothers and their babies. Our best immigrant is the healthy infant, so we commence with the expectant mother.
Motherhood is the lot of woman, therefore pregnancy is a normal condition provided for by Nature. The majority of our young mothers today are so extremely ignorant of the subject that expectant motherhood is often a time of worry and anxiety.
Although a normal condition, for obvious reasons a doctor should be consulted as early in pregnancy as possible, to ascertain the physical condition and any abnormalities and to give advice. This is especially necessary in a first pregnancy. The neglect of seeing a doctor early has often meant the loss of either mother or baby later on, and even of both.
Having been examined by her doctor, the expectant mother should lead her usual normal life. Although a certain amount of care is necessary, she is not an invalid.
Exercise must be taken regularly. Walking is the best, whatever the weather, though not to the extent of being over tired.
Special exercises are sometimes ordered by the doctor. Usual house work is good, with windows wide open. The lifting of heavy weights, bending over and stretching up to high places, should be avoided; also violent exercises, such as tennis, riding, spring cleaning the house, especially during the first three and last three months.
Clothing should be as becoming as possible, light and warm, suitable to the season and individual comfort.
Avoid both becoming overheated and getting chilled. All weight must fall from the shoulders; present-day fashions are most appropriate. No tight elastic or other restricting bands should be worn round the waist, and, of course, no tight garters; the latter sometimes promote oedema and varicose veins. Shoes must have broad heels and fit comfortably.
That waste products from the pores of the skin may be got rid of, a bath should be taken daily (if this is not possible, an all-over sponge) and brisk friction with a rough towel afterwards. Do not have the bath too hot. It may be taken cold if this is the usual custom.
The diet should be well balanced, and taken at regular meal times only, as far as possible not giving way to special fancies. There must be no over-eating, as this puts an extra strain on the digestive and excretory organs.
Alcohol in excess should be avoided, also drugs, unless ordered by doctor.
Sufficient water should be taken daily to supply the tissues with fluid and to keep the kidneys well flushed.
An extra amount of sleep is necessary—windows open all night, of course—and when possible a nap after lunch. Always lie down for a short time inclined slightly towards the right side.
There should be an absence of fear, worry and anger in order to avoid upset of the nervous system. Regulation of the bowels is very necessary by attention to diet, especially the eating of fresh fruit. Liquid paraffin, cascara sagrada, or liquorice powder may be useful. Castor oil or other strong purgatives should not be taken.
If there is any persistent headache, a doctor must be consulted. This is most important, as it is one of the symptoms of a dangerous kidney condition.
Teeth must be kept in good order, as neuralgia and much ill-health are caused by decayed teeth.
During the last fortnight extra rest with feet up is advisable.
The nipples must be protected from all pressure, and they need particular attention during the latter months of pregnancy. Massage daily, between thumb and finger, with pure soap and water, and, after drying thoroughly, rub in a little lanoline. In this manipulation of the nipples the breasts themselves must not be interfered with.
If there is excessive “morning sickness,” swelling of the hands and feet, “loss of blood,” or “discharge” at any time throughout pregnancy the doctor should be consulted without delay.
Dates.—The easiest way to calculate the probable date of confinement is—count forward nine calendar months and add three days from the last day of the last menstrual period. The expectant mother (who has not had a child) should obtain details from her doctor in regard to the recognition of the onset of labour.
As already pointed out, the expectant mother must attend her doctor for examination as early in pregnancy as possible, and according to his verdict the diet is regulated. In regard to the normal expectant mother the following rules re diet hold good—the abnormal one is entirely in the hands of her doctor, and certain things which are set down here may be eliminated from her diet. Happily the normal ones are in the majority. If the expectant mother is not properly nourished she is less likely to produce a healthy child, or a good supply of breast milk.
Whilst she need not “eat for two,” she needs a wholesome, nourishing diet, consisting of the various necessary food elements, including mineral salts and vitamines, to say nothing of water in abundance. The majority of expectant mothers do not know the value of drinking water; six to eight glasses should be taken daily, the first one on rising. If there is morning sickness which is troublesome, a cup of tea and a biscuit should be taken before rising.
Meat, butter, eggs, fresh fruit and green vegetables, a fair amount of “starch,” as bread, and milk puddings, are necessary. On no account must food be fried or twice cooked. Meat and fish build up the body, butter and the starchy foods supply heat and energy. Vitamines are present in the fresh fruits and salads, and should be partaken of freely. Certain vitamines are also present in butter and some oils. Salts are provided in various foodstuffs, and also in table salt.
Three good meals a day are all that is necessary for the expectant mother. Of course, she may have a cup of afternoon tea and a glass of milk at bedtime, but no “snacks,” especially if there is any indigestion. Tea and coffee should be partaken of sparingly. Meals should be taken regularly at the same time every day.
During the latter months of pregnancy it is wise to take more white meats than red meats, and so less strain is put on the kidneys. During early months red meats are taken at least once daily. Cravings for certain articles of diet are sometimes very trying, especially when the indulgence of the cravings will cause harm.
THE “LYING-IN” PERIOD.
This is the term commonly applied in England to that time when the mother is recovering from the efforts of bearing her child, when all her organs are being restored to their natural state, and the supply of breast milk is being established. It takes nearly two months for the mother to become absolutely normal again physically, and whenever possible she should not resume her usual duties until the sixth week at the earliest. Two things are very necessary to the woman who wants to retain a good figure—extra rest and breast feeding the baby!
Baby should be put to the breast at regular intervals, as soon as the mother is rested after the birth (usually from three to four hours) only for a few minutes at first, and the time gradually lengthened. At first baby gets the colostrum, a fluid secreted before the milk is really established —this colostrum is very necessary for baby’s digestive organs. The “flow” of milk comes into the breasts towards the end of the second day.
Nipples must be washed before and after nursing with a little warm water and dried thoroughly. It is often necessary to rub in a little olive oil or camoline to make the skin soft and supple. The nurse should be engaged for at least a fortnight. A comforter must not be given to baby, as it is the cause of many ills—chiefly lack of self-control, which may have far-reaching effects.
CARE OF THE TEETH.
Baby’s first teeth start to form before birth; this is one important reason for the expectant mother to keep herself in good health. Her teeth should be well looked after and attended to by a dentist during pregnancy, if possible. The best time for this is during the middle three months.
The first tooth appears through the gums at various ages, but usually between the sixth and eighth month. The first teeth are called “milk teeth” and number twenty.
General Order of Appearance.
two bottom central incisors, four top central incisors, two bottom lateral incisors, four molars, two top, two bottom.
four canines (or eye teeth), four back molars.
Healthy breast-fed babies usually “cut” their teeth with very little trouble. There may be slight disturbances, such as restlessness^ loss of appetite, stationary weight, but this is usually a coincidence, as the actual “cutting” takes months and not a few days. Should any of these little ailments occur, keep baby quiet, give more boiled water, a warm bath at bedtime, a smooth bone (from which all the meat has been taken) or a bone ring to bite on, and rub gums with a little fresh lemon juice. On no account a-ive baby anything rough to bite on, as the gum may be torn before the tooth has grown through, and very sore gums caused through a germ entering the wounded surface. Bowels should be kept open regularly. On account of dribbling, a bib is worn,& which should be changed frequently, as a chill may result from a wet bib.
The milk teeth need care when they are through, as the “permanent” teeth can be affected through trouble with “milk teeth.” The child is taught to use a mouth wash early in life.
The second teeth are called permanent, and usually come through as follows:—
First group Second „ Third „ Fourth „ Fifth „ Sixth „ Seventh „ Eighth „
4 first molars.
4 central incisors. 4 lateral incisors.
4 first bicuspids.
4 second bicuspids. 4 canines.
4 second molars, wisdom teeth.
The child should be taken to a dentist for examination about every six months from the age of four or five years, if it is not necessary before.
The first sign of decay needs attention.
Sweets and biscuits should not be given at bedtime, as they adhere to the teeth throughout the night and cause decay.
Only a soft tooth brush should be used—rubber ones are good. These must be kept scrupulously clean or they may become germ carriers.
INFANTS’ FIRST CLOTHES.
Fashions have changed for babies as well as for their elders. It is hard to make people realise this sometimes. Once upon a time infants were draped in long garments of various materials, chiefly lace and frills. Now we have a more hygienic as well as a more becoming way of dressing them. As trailing gowns are a. thing of the past for mothers, so are long clothes for babies
Short skirts and shingled head for Mother, short clothes for Baby. Infants are at last allowed to kick their limbs and expand their lungs. As there are no long clothes, the expense and bother of “short-coating” is saved. The bandage (or binder) worn round the abdomen during the first few clays of life is discontinued as soon as it has served its purpose. It is quite unnecessary to have a flannel binder to take its place. Continued use of a binder prevents perfect development. I’m afraid the binder dies hard, though!
Several dozen yards of butter muslin, two dozen yards of flannelette or fine towelling, about 30 inches wide, is used for squares. These are sometimes put on folded in four and fastened with two safety pins, one on each side, instead of the three-cornered way, but the latter is more comfortable for baby. All other clothing is light, warm, porous, loosely fitting and suitable to the season. The color should be cream.
On no account must cotton garments be worn. Babies often lose weight if the clothing is not made of wool in winter. For day wear, the normal baby has first a soft woollen vest, which may be knitted with one ball of Toorine wool and No. 7 bone needles, or crocheted with one ounce and a half of 2-ply fingering, and a fine hook. Next comes a flannel petticoat just reaching to below the toes, fastening on the shoulders, and blanket stitch edging. Then the dress made of woollen delaine or nun’s veiling, slightly longer than the petticoat. In warm weather silk or radianta may be used. It is simply made, magyar style, with a soft crochet silk edge on neck and sleeves, feather-stitched hem, loop crocheted to run sash through, which must be tied loosely. Kimono jacket, made of same material as dress, and the same crochet edge to complete dressing. Booties in cold weather should be made with Andalusian wool and No. 10 knitting needles. They are not usually necessary in warm weather.
There is no need for modesties, but if worn in the cold weather, make with two ounces of four-ply fingering wool and No. 7 bone needles. When going out only, a bonnet made of two-ply wool, using a fine bone hook, is worn. For the hot weather a nice Irish crochet one can be made with Perle cotton (No. 8) fine steel hook.
For night wear, singlet and flannel nightgown. The latter reaches to just below the toes also, and is made from the same patterns as the little frock; crochet edge.
There should be three sets of clothes—
yards of 40-inch material makes three frocks and three jackets.
7f yards of 28-inch flannel makes three nightgowns and three petticoats;
And, if preferred to vests, three little shirts.
All garments are easy to cut out and make up, and patterns may be obtained from any Baby Health Centre, free of charge, giving full directions. The clothes are easily washed, no boiling,
blueing or starching, and very little ironing. They should not be washed in hot water.
The best shawl is made of 1|- yards flannel, 54 inches wide, which is obtained at all the leading drapers. Ask for flannel which has not yet been cut. There should be a four-inch hem, feather-stitched, and a favorite design in one corner. With this shawl there is no danger of baby pulling off little pieces of wool and swallowing them, as they so often do with knitted ones. In the hot weather radianta may be used for shawl. Another suitable material is cashmere.
If the skin is tender, it is best to have a little soft muslin shirt under the woollen vest.
Some flannel napkins are useful also, in case baby passes a lot of urine.
Rubber pants should never be worn; they are most unhealthy.
Baby’s Day Garments.
A child’s rest is often disturbed by uncomfortable clothing or bed. Until after he is eighteen months old, baby should wear a square, singlet and flannel nightgown, as before described. After that a little sleeping suit made of flannel is worn, patterns of which are obtainable at all welfare centres. The suit has long sleeves, and reaches to the ankles, and fastens at the back, and is finished with a little hand embroidery. In cold weather the little singlet may be worn underneath, but it is not really necessary at this stage. At the age of six years a silk or cotton sleeping suit may be worn in hot weather.
Baby’s mother must wear a warm dressing gown and slippers between bathroom and bedroom, and so avoid chills. Baby must always sleep alone. This enables the mother to get rest and baby to get more air, and prevents him becoming overheated or accidentally overlaid. His first bed may be a wicker cot on stand, a white enamelled iron bassinet, a wooden or canvas crib, half a large dress basket, a small clothes basket (or even a box with air holes put in), size about 30 inches by 15 inches. Later on he has his cot. There is no need for a thick lining, as it prevents the air from getting through. The best way to make the bed is envelope fashion. Place a lightweight, all-wool, single blanket over the little bed, allowing about a quarter of a yard to hang over the top, to keep draught from head. Hold top of bed and push blanket into shape. An ordinarysized firm pillow in slip is then placed on it for a mattress, and on top of this another pillow. This pillow must be made of kapok or chaff; the latter is better. Never use feathers, as they do not sup-
port the little body. On the second pillow place a small piece of blanket and then a piece of batiste (thin waterproof material), or another folded piece of blanket, or even three thicknesses of newspaper, and over this a folded square. It is not necessary to use a pillow, although sometimes a baby is more comfortable if he has a small, soft, very low pillow, also made of chaff. When baby is put into this bed a small sheet may be placed over him; this is not necessary, but may add to baby’s comfort. Then the two sides of the blanket are
Baby’s Night Garments.
brought up over the child, taking care not to have too much weight on the chest. The loose piece from the bottom of the bed is then brought up, and the ends tucked firmly under the mattress. This prevents the child from kicking the clothes off on a cold night. The piece of blanket at the top is tucked in tidily. These top layers of blanket may be arranged according to the season.
In hot weather—in fact, in all weathers—on account of flies, a mosquito net is placed over the crib, being kept in position by a curved bamboo frame, made by the handy father. If a half dress basket or box is used, place it on two chairs. These are placed with backs in opposite directions and tied together, so that the bed cannot be knocked off. A comfortably made bed for baby means more rest for mother and father, and better health for all three.
It is necessary to have a folding screen round two sides of baby’s cot. This is made with a wooden frame and washing covers, and top shade put on. Fadeless green is a good colour for the covers.
The advantage of the chaff mattress is that it can be emptied out and changed frequently, and it is quite inexpen-Improvised Bed. Sive.
Plenty of fresh air is necessary for baby’s health. This does not mean a daily outing, but a constant supply of fresh air and sunlight. Almost from birth, baby can be out of doors all day, providing the weather is suitable, and he is warmly clad. Windows must be wide open at night and when baby is indoors. Stale air in a room is just as bad for baby as stale foods. A perambulator should be light, have good springs, and be lined with a washing cotton material—never with leather, as it is too heating and prevents the air from coming through, and so the carriage becomes very stuffy. The hood should be lined with green material (also easy to wash), so that the glare will not be too strong for baby’s eyes when out in the sunshine. Have the hood movable so that it can be adjusted to protect the child. Those perambulators made with openings in the sides of the hood are healthy for baby. When placing the perambulator out of doors, choose a shady place in the garden or under a verandah and protect baby from, flies.
When baby is carried out it is only necessary to put on a little cashmere coat in addition to his other clothes, and to wrap him in his shawl. When driving or motoring, it is necessary to have an extra shawl. Do not give up baby’s perambulator too soon. It is an excellent thing for a comfortable outing for both baby and mother, or he may have a little “push” cart, to get into when tired of walking. After the age of two and a half years, baby may “toddle” out for his airing. Then he needs in winter, over his rompers, a little coat of thick, light, all-wool material. This is most charming in cream, of course, but where washing is difficult a mole or beaver colour is chosen, with fur edging in the same tone. For winter wear, hats for little girls are made with 1| ounce four-ply fingering- wool and a medium-sized bone crochet hook. For little boys, caps are made with 1^-ounce Ivorine wool and a fine bone crochet hook. For summer wear, little hats may be made of Perle cotton, No. 5, or knitting silk and medium sized crochet hooks, or the filet crochet hats made with No. 3 Perle cotton and medium-sized steel needle.
Baby’s mother should be warmly though lightly clad for outings, and her feet must be well protected with warm stockings and stout shoes.
As it is so necessary that a nursing mother should not be over-tired, a few simple ways of saving work when looking after baby, may be pointed out.
The mother who is worn out through lack of method in her care of baby, as well as with her ordinary work, is unable to rear that baby properly, is often a trial to her husband, and herself gets no joy out of life.
The room to be used most for baby must be bright and airy, getting as much sun as possible, and on a quiet side of the house. There should be a fireplace, and if possible a high safety fender. The floor should be stained and polished or covered with linoleum and a few mats. Curtains, walls, etc., to suit individual tastes. If the room is to be used solely for baby, then some special nursery decoration may be chosen. There should be a bath and stand, towel rail, jugs and a bucket with a lid, which may be kept in the bathroom when not in use. A low chair, apron made of flannel and lined with batiste or brown paper. An easy chair and footstool for use at feeding time. Table, cupboard, chest of drawers, and bed for baby.
The first thing to fit up is a little toilet tray. Any small tray may be used (about 24 in. x 12 in.), but an enamel one is best. Have three or four plain white hemstitched tray cloths; two are in use at a time, one on tray and one to cover from dust. The tray should contain a small bottle of pure olive oil, two little jars with salt and baking soda in case they are needed. A tiny bottle of rectified spirits, two screw-top glass jars (which have been washed and boiled by putting on the fire in cold water and bringing gradually to the boil). These
jars are filled, one with small pieces of absorbent wool and the other with cut pieces of clean old linen or well-washed butter muslin. There should also be an 8-oz. medicine bottle (also washed and boiled) full of cold boiled water, which must be renewed daily, soap dish, pure Castile soap, small basin with smooth rounded edges, one or two small enamel bowls, little flat dish for waste, and a measure glass.
Next comes baby’s basket. This is fiat, with sides about six inches high. Line with some soft white washing material. Have several little pockets and a pincushion of the same material, safety pins, two or three washers made of Turkish towelling and hand-worked round edges; hot water bag and cover, a wee hair brush for use as baby grows, three crepe bandages (27 inches long and 4 inches wide) for use in first week only, needle, white cotton and scissors, and inch tape to measure baby from time to time; book and pencil. Clean newspapers are useful in the nursery.
If choosing a color for the nursery walls, screens or floor covering, a soft green should be selected. This has a restful effect on baby’s eyesight, and is to be recommended in place of the pale pinks and blues usually seen.
The necessary articles to take to either public or private hospital for confinement depend largely on the individual hospital. The following list may prove useful, but I should advise every expectant mother to communicate with the sister-in-charge of whatever hospital she is going to in regard to this matter:—
Half a dozen white cotton nightgowns, bed-jacket and cap. Dressing gown and slippers, and usual toilet requisites. Clean old linen (this must be washed, boiled well, dried, put into a pillow slip and baked in the oven). Absorbent wool and safety pins.
For confinement in the home the nurse-incharge should be consulted, but the most necessary things are—
Single bed without castors.
Firm mattress with a board underneath (the same size as the mattress).
Blankets as usual.
Hot water bag or stone bottles and covers.
Waterproof sheet, or dozens of clean newspapers.
Six bed sheets.
Six pillow slips.
Three old sheets (to use as draw sheets).
Six nightgowns (cotton).
One pair long white cotton stockings. Roller towelling for binders if necessary.
Old linen (prepared as above).
Butter muslin and cotton wool, safety pins.
Three candles (in case electric light fails).
Hand basins and jugs.
Kerosene tin or other large vessel for boiling things.
Tray with screw top jars, two flat dishes.
Usual toilet requisites, etc.
Baby’s clothes, bed, and bath.
A bed pan should be hired if there is not one in the house.
Baby’s bath is always a matter of importance, and especially so in the hot weather. He should be given his bath daily, and allowed as much time as mother can spare to kick and play in it. The windows of the room should be closed and the bath placed out of the draught. In winter there should be a fire in the room.
Before commencing to bath baby everything to be used should be in readiness:—Bath, which should be long enough for baby to lie down; chair, for the mother’s comfort this should be low (a few inches cut off the legs of an ordinary chair serves the purpose) ; stand, on which to place bath, to raise it about four inches from the floor; apron, made of flannel, with a batiste lining (some thicknesses of brown paper also make a good lining) ; towels, two Turkish and a soft linen one for the face; washer, made of towelling or other cotton material, which can be boiled. Sponges are never used for baby, as they are too difficult to keep clean. A stand is required to place nursery tray on. And then there is the water, hot and cold; bucket or other vessel for soiled linen, and clothes in the order they are to be put on.
The cold water is always put into the bath first, thus avoiding accidents. The hot water is added until the temperature is about 08 deg. Fahr. If there is not a bath thermometer handy, water may be tested with the mother’s elbow to see that it is not too hot. As baby gets older he has his bath cooler.
To bath baby, the mother puts on the apron, takes baby up and places one towel over apron, sits down and lies baby on his back on her knee. He is undressed and covered with the other towel.
Nursing: Sister Bathing Baby.
The face is washed first with the clean washer, not using any soap. In washing the face the mother is careful to let the child see all the time, so that he is not frightened, washing first one side and then the other. The face is then dried with the soft towel and the head washed. This is done by lathering the soap on the hand and rubbing head well, and then holding over bath and washing soap off, not allowing any to get into baby’s eyes. The head must always be dried well, especially behind the little ears.
After head and face comes baby’s little body. The mother lathers the soap on her hand and rubs
baby well all over, while still on her knee, paying’ particular attention to all the crevices and soaping well between the fingers and toes. Then baby is lifted into the bath, particular care being taken in supporting the head and back with one hand, and holding feet between thumb and first two fingers of the other hand. When the infant rests on the bottom of the bath the water is splashed well over him and all soap washed off; he is turned forward and the back well washed. Baby is allowed to kick and play in his bath in the hot weather. He has some little floating toy when old enough, which he must not put into his mouth. The child is then lifted out and dried thoroughly, back first. In drying, he is not rubbed too much, just dabbed gently, special care being taken in drying under the arms, etc. Powder should never be used to dry baby, as it will cake and cause chafing. As soon as baby is dried, the damp towels are removed, singlet put on, and baby “held out.”
In dressing baby, the clothes are slipped on over the head without covering the face, and so he is not frightened. This is done quite easily by holding the garments so that a little frame is made of them for baby’s face. The best time for baby’s bath is just before a feeding, usually at 9 o’clock in the morning.
It is unnecessary for one to say that everything used for baby should be his own special property, and not be made use of by anyone else.
For those mothers with their first baby who are nervous of handling him on their knees, the “bed method” of bathing is good. The bath stands on a table near the bed, and mother stands up to bath the child (in same manner as above), and dries and dresses him on the bed. In this way she has more control over the child.
The most important thing in the infant’s life is to be naturally fed from the mother’s breast. Practically every mother can feed her baby if she really wishes to, and it is ever her duty to do so. To the woman who asked him what France most needed, the great Napoleon replied, “Mothers, madam; good wives and mothers,” and we can say the same of Australia to-day.
The first attribute of a good mother is the desire to feed her baby naturallv for at least nine months. Natural feeding is necessary for his mental, moral and physical health. The mother’s milk contains all the suitable substances necessary for baby’s normal development—proteins, fats, sugars, salts and vitamines. It is also free from germs. In order to have a good supply of milk it is necessary for the expectant mother to pay particular attention to her health for months before baby’s birth.
Baby must be put to the breast regularly at the same time every day, either three or four-hourly, as best suited to the individual baby. He is usually given fifteen minutes from one breast and five minutes from the other. One breast should be emptied at each feeding to keep the supply going.
It is altogether out of order, and causes indigestion and other gastric troubles for the mother to pick baby up for a drink every time he cries. At feeding time the mother must be seated comfortably on a low chair, and baby held in a comfortable position, and the flow of milk regulated to prevent baby from getting it too quickly. There is no objection to giving baby his drink whilst lying down.
After feeding, baby is sat up or put gently up over the shoulder to enable him to bring up any “wind” before being placed in his cot. Always lie
Feed the Baby Regularly.
baby on his side after feeding-. The nursing-mother needs to take the same care of her health as the expectant mother, and pay attention to the same details. The amount of exercise depends on her mode of life. The poor or working- mother needs extra rest; the leisured mother needs extra exercise, and the middle-class mother, who invariably does her own work in the house, also needs extra rest. “Early to bed and early to rise” is the rule for all, and an afternoon nap should be the order of the day. Every nursing mother needs at least an extra pint of fluid daily. There should be only three meals a day, avoiding rich or highly seasoned foods and anything that causes indigestion. A cup of hot milk on retiring may be necessary, or in cold weather a basin of gruel made with plain rough oatmeal. Fruit should be partaken of in the early morning. No strong aperients should be taken.
Every mother who is tempted to artificially feed her baby should seek skilled advice before doing so, and thus give him every opportunity of receiving his birthright—breast milk.
As already mentioned, every mother should be able to feed her baby naturally, provided she wishes to do so. But in some cases difficulties may be met with, and because the mother does not know how to overcome them baby is weaned during the early months of life.
There are difficulties on the part of the mother, and difficulties on the part of the infant. Let us first take those on the part of the mother. Chief among these is her mental attitude. She is afraid that she cannot feed her baby. She feels her milk is not satisfying him, etc., etc., and so she worries, and is nervous. Right in the beginning she needs someone to reassure her, and make her know that with care and attention and perseverance, she will be able to successfully feed her baby.
Cracks of the nipples, inverted nipples and inflammation of the breasts are difficulties that call for the immediate treatment of a doctor. These cracks are prevented by washing the nipples before and after feeding with a little boiled water and clean absorbent wool, and drying them thoroughly, and from time to time massaging gently with lanoline or olive oil. By having the inverted nipples attended during pregnancy this difficulty is overcome before the baby is born. Inflammation is prevented by putting baby to the breast regularly, at the same time every day.
Then we come to a deficient supply of milk. Here “test feedings” must be given, and so the amount of the deficiency found out. If we find that baby is not getting enough for his age and weight from the breast, a complementary feeding may be given. The quantity of this becomes less and less, as the breast milk increases—complementary means to “complete” the breast drink. To increase the supply baby is put to the breast at regular intervals. Ten minutes from each breast is the best routine here, afterwards breasts being emptied by manual expression.
The mother needs extra rest very often and regular pleasant exercise in the open air and plenty of sunshine. The breasts are bathed with hot and cold water alternately for ten minutes morning and evening, and special massage movements—shown by a Baby Health Centre Sister or instructions given by writing to the Victorian Baby Health Centre Training School, Melbourne.
The diet should include extra meat, eggs, and green vegetables. At least six glasses of water should be taken daily in addition to other fluid.
Another difficulty is an excessive supply. Often a baby is being overfed, and there is too great a gain in baby’s weight for a time, followed by a stationary period, and later still a loss of weight. Also the motions are large, and there is often vomiting. This difficulty may be overcome by lengthening the interval between feedings and correcting the mother’s diet, i.e., no milk or cocoa drinks in between meals—no “eats” except at regular meal-times.
Any departure from normal health and wellbeing, or any illness in the mother, may make breast feeding difficult, and any of these conditions call for medical aid.
Fear, or an excess of alcohol may cause difficulties in breast feeding.
Test weighing at feeding time is necessary in these cases of difficult feeding. The idea of “test feeding” is to show how much food baby gets at each nursing over a certain period. Several test feedings should be given, at different times of the day, over a period of not less than 24 hours whenever possible, and it is more desirable to extend them over a whole week. From time to time test feedings may be repeated in order to know whether all is going well.
For test feedings it is necessary to have a pair of well-balanced scales. The child is weighed in his clothes, and nothing is removed or changed until the test feeding is completely finished. Any mother writing to me for advice about a breastfed infant would greatly facilitate matters by giving a course of test feedings and sending the results. (In giving the course it is most essential to feed baby regularly.)
The following is the method for giving test feedings for 24 hours in a baby of three months: 6 a.m.: Weigh baby and put him to breast, and let him drink for 20 minutes, and then weigh again. Give 15 minutes from one breast and 5 from the other. The difference in weight shows the amount taken. The test feeding is repeated at 10 a.m., 2 p.m., 6 p.m., and 10 p.m., and the results charted as follows:—
Method of Setting Out Test Weighings.
Baby A............. 3 mths. old.
6.20 ............ 10 „ „ 2~ ozs.
Total in 24 hours 20i> ozs.
With this information the baby’s feeding can be thoroughly looked into, and regulated to suit the individual infant. The normal breast-fed baby usually goes on well, but in both ovei-fed and under-fed babies test feedings are most important, and the chief guide for correct treatment. Mothers in the larger towns have the opportunity of taking their babies to the centres for test feedings, but those mothers who are not able to do this may test feed their babies, and obtain advice when the results are submitted. It is especially necessary where breast milk appears to be failing to test feed baby before giving anything else. The mother must notice if the breast is quite empty after baby has finished, and if not draw off the remainder and measure it, and chart as follows:—Milk left in breast, i oz., or whatever it may be. Hands must be carefully washed before drawing milk off.
Having dealt with the difficulties on mother’s part, we now come to those on the part of the infant himself. When the child is first put to the breast he should grasp it, and take his food vigorously. Sometimes nervous and excitable infants are impatient if they do not get their drink at once, and they cry, which interferes with any further effort, and so we have our first difficulty with the infant. All that is necessary here is perseverance by the mother. She must make baby stop crying and take his drink, teach him early his first lesson of obedience, and let him know that he must do as mother wishes!
Next we come to deformities of the mouth, which are quite obvious and need early medical attention. Here the milk is drawn off and given to baby with a spoon, feeding him slowly.
Then we have thrush, which sometimes, if severe, interferes with sucking. Thrush is caused usually by a vigorous washing of the baby’s mouth during his early days. The mouth of a healthy child should never be touched, as the lining membrane is very delicate, and can be easily damaged. The use of a comforter is another common cause of thrush. In the case of a sore mouth it may be wise to draw off the milk and give to baby with a spoon or medicine dropper for a day or two.
Next we come to baby not gaining weight. Many mothers make the mistake of weaning their babies when this occurs, but baby should not be weaned. He should have skilled advice. There are many reasons for the baby not gaining, and the treatment depends on the cause in the individual baby. Some change in the details of the management is all that is necessary here, and advice as to these changes will be given at any baby health centre. The feeding may be too rapid, interval too short, the mother hot and flustered when baby is put to the breast, etc., and all these things can be easily remedied. Successful management in difficult breast feeding demands much patience on the part of doctor and nurse, but infinitely more on the part of the mother, and she should always be encouraged, helped and reassured by baby’s father and so piloted safely through a most trying time by love and sympathy. Weaning baby when difficulties arise shows a great want of resource, and should never be done without first consulting a doctor.
In spite of the comfortable fashions, one often sees the young nursing mother wearing clothes that are anything but suitable.
As breast milk can be affected so easily by any continued discomfort on the part of either mother or babe, it is very important that the clothes should allow of free movement in every way. The general principle to remember about the nursing mother’s clothes is that they should be light, warm, porous and loose. A woollen singlet should be worn in the cold weather, but, if it is the usual custom of the mother, silk or cotton ones amy be worn during the hot weather.
Chills should be guarded against. A chill to a nursing mother is always undesirable. The detail of the garments is most important, and as follows:—The combinations or singlet worn next to the skin should be open down the front; corsets should be cut low in front so that the upper rim altogether clears the breasts. In the early days of nursing some good support is sometimes required for the back and abdomen, and in cases where corsets are not worn a suitable well-shaped abdominal belt could be worn (patterns of such belts are easily obtainable), or a straight binder may be fitted comfortably into position with safety pins. Later on this is discarded. A slip bodice should be worn to support the breasts (without any pressure on the nipples), also opening in front. A very good breast binder is made of strong calico, cut in a Y-shape, with a long tail. Patterns of this are obtainable at all Baby Health Centres.
The tail is brought lightly across the front and fastened with two safety pins, and it just means unfastening these at each nursing time. The underslip and frock are best made to fasten under the arms, on both sides, with press hooks right from arms to below waist. This looks graceful, and has the advantage of allowing baby and mother both to be quite comfortable during the nursing, and to keep the breast covered from draughts, etc.
Nightgowns should also be made in this way, without the discomfort of press hooks, by fastening at either side with ribbons, as the 10 p.m. and 6 a.m. feedings are given in bed—no feeding between! All these garments can have openings stitched up after weaning time.
It is absolutely necessary for the woman who has slip and frock opening in front to keep the breasts covered with some light material during nursing to prevent a chill. Many women are careless about this.
It is altogether wrong, besides being rather unsightly, for the nursing mother to try to feed her baby clad in a slip or frock with openings for head and feet only. It is uncomfortable for both baby and herself.
For motoring, driving, etc., the nursing mother needs a light wrap over the shoulders, coming well down over both breasts in front—a great coat in the cold weather. If there is any overflow of milk in the intervals between feeding a requisite thickness of clean cotton wool is placed over the breasts. If the overflow is excessive, it may be necessary, when going out for any length of time, to place a piece of protective tissue between the wool and undergarments, to avoid soiling. The wool should be changed frequently, and not kept on when very damp.
The usual time for weaning is soon after the ninth month. If baby comes to the age of nine months during the hot weather he is often given the extra diet, but no cow’s milk, the breast milk being still kept for drinks until the weather is more suitable, even up to the age of twelve months, but he must have the various additions, which will be mentioned in Baby Diet.
About one pint of milk in the twenty-four hours is necessary for a baby at this age, and if we find from test feedings that the mother is able to supply this, and that it is not too much for her own strength, there is no reason for weaning during the ninth month, but it is necessary for the infant to have something else as well. The breast milk will only take the place of drinks, and not supply the variety of solid foods that are important from this time.
In regard to weaning, there are four very important things to be remembered:—(1) Consult your doctor before commencing to wean baby;
(2) never wean baby in the very hot weather;
(3) wean baby gradually, taking at least four weeks to complete the process; (4)' never wean baby before the ninth month, even though menstrual periods have begun. Nature has provided baby with a suitable food for the first months of his life.
Once upon a time the child was weaned suddenly by being taken away from his mother for several days by some relative or friend, and having a thoroughly miserable time, fed anyhow, and often becoming sick. The mother was worried and uncomfortable, and often got sore breasts, and so weaning was a dreaded time, but now things are much improved, and weaning takes place with more comfort to mother and bo by alike.
The following is the best method to follow:—
First Week.—6 a.m., breast feeding; 10 a.m., oatmeal or barley jelly, etc., 1 tablespoon, made with water, and one tablespoonful cow’s milk on it; rusk and butter (half-slice); milk, one part; water, three parts (gradually increase the milk and water to equal parts), 8 tablespoons, to which is added 1 teaspoonful of cane sugar. 2 p.m.: A little broth, 2 to 3 tablespoonfuls; breast feeding. 6 p.m.: Breast feeding; rusk with butter. 10 p.m.: Breast feeding.
Second Week.—6 a.m.: Breast feeding. 10 a.m.: As first week, slightly increasing amount. 2 p.m.: Broth with stale crumbs, 8 tablespoonfuls; milk and water, equal parts, 8 tablespoonfuls, to which is added 1 teaspoonful of sugar. 6 p.m.: Breast feeding, rusk with butter. 10 p.m.: Breast feeding.
Third Week.—6 a.m.: Breast feeding. 10 a.m.: Oat jelly, etc., 8 tablespoonfuls; toast and butter (make toast crisp and butter when cool), halfslice ; milk 2 parts, water 1 part, 8 tablespoonfuls, sugar added as above. 2 p.m.: As second week, increasing amount of bread crumbs. 6 p.m.: Toast with butter, half-slice or more if necessary; milk 2 parts, water 1 part, 12 tablespoonfuls, to which is added the usual amount of sugar. 10 p.m.: Breast feeding.
Fourth Week.—6 a.m.: Milk 2 parts, water 1 part, 16 tablespoonfuls, to which is added 2 level teaspoonfuls of sugar. 10 a.m.: As third week. 2 p.m.: As third week. 6 p.m.: As third week. 10 p.m.: Breast feeding.
Fifth Week.—Stop 10 p.m. breast feeding and give milk 2 parts, water 1 part (with sugar), 16 tablespoons; otherwise as fourth week. Plenty of boiled water, flavored with orange juice (or other fresh fruit juice), is given in between feedings.
Where there has been a large supply of milk the mother must give attention to her breasts. After breasts are empty during weaning period a tight binder is put on. If breasts are inclined to be uncomfortable, a little milk is gently drawn off, and binder tightened. Fluids must be cut down, milk drinks not taken at all. It is sometimes necessary to drink only black coffee, and very little of that. Meat, butter and eggs are cut down, and a fruit diet partaken of. If the breasts still become uncomfortable, saline aperients should be taken each morning. This encourages an escape of fluid from the body. Extra exercise must be taken, and the bath a little hotter in order to promote skin action.
The baby’s milk must be from a reliable source, and in hot weather boiled before use. The drink should be given with a spoon or in a cup; there is no need for baby to be subjected to the indignity of a bottle at this age. All utensils must be kept clean and covered from flies and dust.
If there is any upset in the beginning of a new week, baby may be kept an extra week on the same diet. This will prolong the weaning a little, but that does not matter, provided the child gets enough. It takes six weeks to wean some babies successfully, and others are weaned in two weeks.
The best times for feeding the child at this age are 6 a.m., 10 a.m., 2 p.m., 6 p.m., and 10 p.m. On no account should he be fed oftener than every four hours. No drastic alterations are made in the diet. He is just fed on his milk mixture and worked up to the baby diet, as we term it.
During the eleventh month the child needs one pint of milk in the 24 hours, as well as the more solid food. The following menu will be found satisfactory:—
6 a.m.: Milk 2 parts, water 1 part, 8 ozs.; sugar, 1 teaspoonful.
10 a.m.: Groats, maizena, etc. (oatmeal jelly in cold weather), 4 oz.; crisp toast (butter when cool), 4 slice; milk 2 parts, water 1 part, 4 ozs.; sugar 4 teaspoonful.
2 p.m.: Vegetable or mutton broth, with crumbs, 4 oz.; junket, milk jelly, or custard, 4 ozs.; with fresh fruit juice, baked apple or prunes, 6 teaspoonfuls.
6 p.m.: Rusks with butter, 2 ozs.; milk 2 parts, water 1 part, 4 ozs.; sugar 4 teaspoonful.
10 p.m.: Milk 2 parts, water 1 part, 8 ozs.; sugar, 1 teaspoonful.
If baby has been artificially fed, during these three months he must be broken off the bottle and taught to drink from a cup. In breaking baby off bottle a glass medicine measure is often found useful, as he can still see his drink in it, and it is small for the little lips. At least 15 ozs. of water should be partaken of daily, more if possible. This includes water added to milk mixtures. Meals must be given regularly at the same time every day; this is important. Drinks of water flavored with fresh fruit juice should be given between each meal. The above diet will give baby the right amount of carbohydrates, proteins and fats necessary to maintain health and strength. He will also get his vitamins and salts from it. This diet also supplies the requisite number of calories for the child at this age.
Sometimes baby’s rusk may be dipped into a little soft volk of egg. and so he gets into the habit of taking egg yolk; the amount is increased gradually until baby can take a whole yolk lightly boiled. This is not usually done until after the end of the first year. White of egg is not given until later. All vessels, spoons, etc., used for feeding baby must be kept perfectly clean and separate from other dishes.
Biscuits should never be given to a baby without a doctor’s order. They are far too starchy for the digestion of the normal infant, and so cause no end of trouble later on. They are recommended only by the doctor for some special reason. Far too many biscuits are given to babies and toddlers, and amongst other things have an injurious effect on the teeth. They are invariably given between meals, and so spoil the child s appetite.
Baby is sometimes ordered some special article of diet, and very often the mother is not sure of the correct way to prepare it. The following recipes of those things most commonly ordered will be found useful:—
Barley Water.—Ingredients: 2 tablespoonfuls of pearl barley, 1 pint of water. Method: Wash pearl barley thoroughly and put into clean saucepan ; cover with the cold water, bring to boil, and let it simmer for half an hour. Strain, cover and keep in jug in cool place. Must be freshly made each day, as it ferments.
Whey.—Ingredients: 1 pint of fresh milk, 1 junket tablet, 1 tablespoonful cold water. Method: Stand jug containing milk in saucepan of boiling water, and bring just to blood heat, then add junket tablet, which has been dissolved in the cold water. When the curd has become solid break with a fork and bring to boil, stirring all the time. Strain into a clean jug.
Sherry Whey.—Ingredients: i pint fresh milk, 1 wine glass sherry. Method: Put milk on stove in clean saucepan, and when actually boiling add sherry; simmer gently for ten minutes and strain into jug.
Albumen Water.—Ingredients: i pint of cold boiled water, the white of 1 egg. Method: Cut white of egg on plate with two knives for five minutes or until quite thin, add to water and pour from one jug to another gently for five minutes.
Raw Beef Juice.—Ingredients: i lb. of top side steak, pinch of salt. Method: Warm steak until a light brown (on griller), slash well with sharp knife; squeeze between two saucers or with a metal lemon squeezer, and strain into a clean vessel.
Bone Marrow.—Ingredients: One beef shank bone, vegetable marrow. Method: Seal both ends of bone with flour, bring to boil, and simmer for about three hours. Remove marrow from bone and serve with the vegetable, which has been boiled for about twenty minutes. Salt to taste.
Rusks.—The best way to prepare these is to cut pieces of bread (brown for preference) about one inch thick and five inches long; put into a warm oven and leave until a golden brown. Spread with fresh butter and give to baby ten minutes before a feeding. This will teach him to chew, and to digest some extra starch and butter fat.
Mutton Broth.—Get a shank, cover with cold water, bring to the boil and let simmer gently until meat falls off bone. Cool, skim fat off, salt to taste, and give the broth to baby immediately before his 2 p.m. feeding. Only give a few teaspoons at first, and in hot weather increase the amount very, very slowly, and be sure the broth is quite fresh. It must be made daily.
Vegetable Broth.—Pearl barley (or rice), 2 level tablespoons; carrot, 1 small; potato, 1 small; spinach, 4 leaves; salt, pinch; water, enough to cover. Bring all to boil and simmer for two hours (or until tender) ; strain through a sieve. The amount of broth when cooled should measure 6 tablespoons, and it is used with an equal quantity of fresh milk.
Oat Jelly.—Oatmeal, 1| level tablespoons; water, 10 ounces (20 tablespoons) ; salt, pinch. Cook in a double saucepan for three hours; when cooked rub twice through a wire strainer. This is given to the child with the required amount of fresh milk and sugar for his age.
Prune Pulp.—Prunes, 6; water, to cover. Wash prunes thoroughly, soak over night. Cook in double saucepan for one hour. Press through a sieve twice. This is given according to age, 1-6 teaspoons.
Groats.—Groats, 2 level tablespoons; milk, 10 tablespoons; water, 10 tablespoons. Cook in a double saucepan for 11 hours. This has a high food value and is useful in cold weather for the toddler. Quantities with fresh milk and sugar according to age.
Brains.—Brains, 1 set; salt, 1 pinch; water, to cover; milk, to cover and a little more; cornflour, 1 level teaspoon. Soak brains well in cold water and a pinch of salt. Strain water off, place in a saucepan and cover with cold water again; bring to boil and boil six minutes. Strain water off. Allow brains to get quite cold, then remove skins, break up with a fork, add milk to cover, and simmer for a few minutes. Add the teaspoon of cornflour mixed into a smooth paste with a little of the cold milk. Cook for a few minutes longer. This is given at mid-day after the age of fifteen months. Start with a small amount and gradually increase. Brains should not be given every day.
Oat Cake.—Flour, H breakfast cups; oatmeal, l-i- breakfast cups; baking soda, 1 teaspoon; cream tartar, 1 teaspoon; salt, 1 teaspoon; dripping, | breakfast cup; butter, 1, breakfast cup; sugar, 1 breakfast cup; egg, 1. Method: Mix butter, sugar and the beaten egg together. Rub diipping into the dry ingredients, add liquid. Roll thin and cut. Cook on an oatmeal dusted tray in a brisk oven. This oat cake is suitable for the school child, and is better in his lunch than the ordinary sweet cakes. In making any oatmeal preparation
_oat jelly, oat cake, household porridge, etc.—
plain, rough oatmeal should be used, and not the various flaked ones.
During the hot weather the question often arises as to the best way of keeping cow’s milk for the baby’s use. Milk should be from a mixed herd of cows which has been tested for tuberculosis.
Milk should be obtained as soon after milking as possible, preferably twice a day. If milk is brought to the house some hours before the housewife gets up it is most important that it is left on the cool, shady side of the house, in order that the early morning sun may not beat on it. Milk delivered in bottles should be left in the bottle until used, as the less handling it has the better. The cap is removed, and a piece of damp butter muslin, which has been previously boiled, put over the top. If milk is not delivered in bottles, use a plain, wide-mouthed vessel, free from ridges and crevices, that can easily be cleaned. An enamel billycan is always the most suitable thing. A tin billycan should not be used, as it does not keep the milk cool, and it is also finished with ridges, and therefore hard to keep clean. In fact, it is almost impossible for the average person to do so. An aluminium billycan is not satisfactory, either.
To clean the vessel after use rinse with cold water and salt to remove milk, then wash thoroughly with hot soapy water, dry with a clean tea towel, and then fill with water which is actually boiling; put cover on, and allow to stand until it is put out for milk. The water is just emptied out and the cover put on again. It is not rinsed or dried, as the boiling water scalds the vessel, and nothing else should touch the inside until the milk is put in. As soon after delivery as possible, the milk must be placed in the cooler. Germs double in number every twenty minutes in warm milk.
The best cooler is a small ice box, especially made for milk. These are obtainable for about 10/- each, and some of the milk vendors sell them on an instalment system, which makes them available for almost everyone. Sufficient ice for each day is supplied for about 2d.
An ordinary house ice chest is just as suitable, provided the milk is kept in the top, right on the ice, and not in the cupboard part of the ice chest.
Ice chests of any kind must be scrubbed daily.
Germs do not multiply in milk kept at ice chest temperature. Another cooler is made of an earthenware substance, and this needs thoroughly soaking before use, and must be kept wet.
A very good cooler may be made at home from a petrol tin, as follows:—
Cut the four sides out of the petrol or kerosene tin. Run a draw string through the long edge of a piece of Turkish towelling, 1^ yards long and -l yard wide, and hang it from the top of the tin. Put a basin (or a quarter of another tin) full of water on the top of the tin. Take some strips of towelling about two inches wide, and place one end of each strip in the basin, so that the water may run down from the basin on to the towelling, and keep it constantly wet. This cooler should be hung or stood outside in a shady place. It works on the principle of a Coolgardie safe.
An excellent cooler is made by filling a large baking dish with cold water, and standing the jug of milk in it, covered with two thicknesses of butter muslin, touching water all round. It is stood in a cool, draughty place.
An emergency cooler is made by standing the jug of milk in a soup plate full of water, with a piece of towelling over the top large enough to
touch the water all round. This may be stood outside in a shady spot, in front of the window, or in a fireplace. With due attention to the above, there should be no difficulty in keeping milk fresh in the hot weather.
Types of Milk Coolers.
Exercise plays a very important part in baby’s life. It is absolutely necessary for the development of his muscles. During the first few weeks all he gets is an occasional stretch. As he grows older, he enioys kicking his legs and throwing his little arms about after his bath. Exercise is also essential to his health. When he comes to the age of six or seven months it is a good idea to put him down on a clean rug on the floor and encourage him to use his muscles in every way. He must never be fatigued, though, and a very good rule to observe throughout his childhood is— a short period of exercise, followed by a long rest. He should take this exercise in the fresh air as far as possible. This develops both muscle and bone.
At about nine or ten months _ baby starts to crawl, and this is a splendid exercise, but he needs careful watching at this stage or he may crawl into danger. His rug should be put into a baby’s playground on the floor, out of draughts, and so making crawling safe. Baby must never crawl about floors, as he may pick up germs from dirty boots, etc. .
Walking- is attempted at about twelve months, but usually the child does not walk alone until fifteen months. If there is a tendency to bow legs, do not allow walking until a later date, otherwise encourage walking (not to the point of fatigue), and so strengthen muscles and bones. If there is any bending after walking has commenced, the child should be taken off his feet for a time, and a doctor consulted.
Crying, shouting and singing are all good exercises for the lungs.
Massage of the abdomen is an excellent exercise for children suffering from constipation.
As the child grows he gets his necessary exercise from the playing of outdoor games.' Skipping, in moderation, is a good exercise, especially if there is any tendency to flat foot. In order to get good breathing exercise, the child’s nasal passages must be kept perfectly clean, and as much fresh air as possible breathed both day and night. Walking with head erect and shoulders back and mouth shut is one of the best exercises for the g r o w i n g child.
Exercise Dress for Hot Weather.
Every mother should know something about the growth and development of the healthy normal baby. She should have this knowledge of the normal to enable her to recognise the abnormal, should she ever come across it. The new-born baby usually weighs about seven pounds, although he may be anything from six pounds to twelve pounds.
During the first few days after birth there is some loss of weight, often more than half a pound. This loss is due to certain natural changes, and is made up about the end of the second week, and then he gradually increases in weight, on an average one ounce a day, until he is six months old. After that the daily gain is a little less. A good rule to bear in mind is that the average baby doubles his birth weight at six months, and trebles it at twelve months. During the second year the child gains about seven pounds, and in the succeeding years about four pounds.
Every baby should be weighed at birth, and then about once a week, without his clothes, to see that all is going well, as a temporary disturbance either of the mind or body may arrest the gain in weight, and it would then be detected quite early and remedied.
If baby ceases to gain for some weeks or loses weight, medical advice should be sought.
A baby who gains too much is just as abnormal as one who does not gain enough. Cer-
tain errors in feeding, mostly over-feeding, cause an abnormal increase. In these babies a correction of diet is all that is usually necessary.
In regard to length, the child at birth usually measures about 20 inches. Incorrect feeding sometimes causes development in height to be slow in the young child.
In the normal infant the limbs are relatively short compared with the body, and the head and abdomen large compared with the chest. As the child grows, the limbs lengthen and the chest expands, and the head and abdomen become smaller in comparison.
The following figures of growth and development are only average, and in studying them parents should not worry if their children are not up to this standard in everything, providing they are healthy and happy.
Girls.—Birth, 61 lbs.; 20 inches.
6 months, 13 lbs.; 24 inches. Average gain, 7 oz. week.
1 year, 19 lbs. 8 oz.; 284 inches.
15 months, 21 lbs. 8 oz.; 291 inches.
18 months, 23 lbs. 8 oz.; 301 inches.
1 year 9 months, 24 lbs. 13 oz.; 311 inches.
2 years, 26 lbs.; 324 inches. Average weekly gain,
Boys.—Birth, 71 lb.; 20 inches.
6 months, 15 lbs.; 25 inches. Average gain, 8 oz. week.
1 year, 20 lbs.; 281 inches.
15 months, 22 lbs.; 30 inches.
18 months, 24 lbs.; 30! inches.
1 year 9 months, 25 lbs. 5 oz.; 32 inches.
2 years, 26 lbs. 8 oz.; 32! inches. Average weekly
gain, 3 oz.
During the next four years (from 2 to 6 years) the child usually gains 15-16 lb. and grows about 10 inches.
The child who is much under weight for his height, and does not pick up, is often undernourished, and needs very special care in feeding, clothing and general hygiene.
Baby’s Weekly Weighing at the Health Centre.
In the development of functions we take sight first. It must be remembered that very soon after birth the child is able to distinguish light from darkness, but it is a long time before he can really see things distinctly, although he may be attracted by a bright, shining object. At about four months he usually begins to recognise his mother. At six months he sees most things, but he is unable to judge of the distance of the objects. Colours, although noticed by their brightness in the first year, are not distinguished separately until the end of the second year.
Next comes hearing. Most babies are deaf for the first few days, and after that hear loud noises quite well. A baby usually turns to the direction of a noise. It is not usual for the infant to recognise his mother’s voice until he is nearly six months old. If a child does not respond to rattling noises at six months, an ear specialist should be consulted. Smell and taste are developed to a certain extent within the first few days- of life, but are not acute until the third year. Sensitiveness to touch and pain develops fairly early, and increases rapidly.
Voluntary movements of the infant depend on the degree of muscular development. He usually holds his head erect at four months; grasps articles firmly at five months or earlier ; is able to sit up at seven months, but may not sit up alone until he is nearly a year old; crawls at 9 months, attempts to stand after 10 months, but cannot usually do so until almost a year old. Walks at 15 months.
During the second year he learns with great rapidity to speak, and by the end of it can put sen-
tences together. Delay in speech calls for medical attention, although there are odd cases where the child does not commence to talk until he is two years old or more, when the intellect is normal. The reason for this is unknown. If the child stammers, attention should be given to the general health, and nervous excitement should be avoided, and the child encouraged to sing and shout.
The normal child is quite grown out of his baby talk before he reaches the age of six years. As children are most imitative, it is advisable for parents to speak correctly in their presence; if they fail to do so, one day they may get an unpleasant surprise. Baby should never be hurried into doing any of the above things—allow him to develop naturally. If he is a little slower than the normal do not worry, as every baby is a law unto himself. If he is inclined to be too forward, do not overtax his little brain by encouragement; keep him quiet for a time, or a strain may be put on his nervous system.
One of the most difficult tasks for the young mother is the training of her child. This training means the forming of his character. A little child’s brain is most sensitive to impressions, and the time to have good habits formed is early childhood. This is a tremendously important fact.
Baby’s physical life should be regulated from the beginning. As regards the moral training, it is most important that the child should keep his faith in father and mother. It is here that many young parents fail, and do not realise what they are doing until it is too late. Make baby realise that when “No” is said “No” is meant, and that no amount of whining or crying will change this. If parents alter their minds and baby is given way to, his quick little brain will at once notice the fact, and next time “No” is said he will endeavour to get round father or mother as before!
Children get into the habit of asking for many things, and the wisest thing for a parent to do is to think before granting or refusing a request; either give him what he wants, or refuse straight away, explaining as far as possible the reason for doing so. Once baby realises that parents mean what they say, he will behave sensibly, and will be “managed” instead of “managing.”
Obedience is the first law. Start from the time that baby first wakens in the night and asks for food, even if he is only two weeks old! Then go on, and when he is told to do something, see that he does it at once, with as little fuss as possible.
Never “nag” at a little one; it spoils his temper. To worry and annoy baby makes him obstinate, and there is trouble later on. One should never lose one’s temper with baby, although it may be difficult not to, but loss of temper and fairness do not go hand in hand, and a little child must never be treated unfairly. Unfairness in childhood often has far-reaching effects. A baby never forgets unfairness. Unfair treatment means loss of faith, which is one of the most precious things in the little life.
Parents must always keep their promise to a child. Parents are very wonderful beings to a young child, and they should live up to his ideal of them. If once the child hears father or mother tell an untruth, they cannot expect him to be truthful and straightforward. The child’s power of reasoning must not be under-estimated. It is not enough for a mother to love her child, she must respect him also.
It is natural for a child to romp and play, to be restless and want to talk, and he should not be called “naughty” for merely obeying the impulses of nature. Do not let baby be a nuisance, of course, but keep the word “naughty” for times when he is really so!
Baby’s little brain is very active, therefore it should not be overtaxed.
Before punishing a child always think, “Why is he behaving so badly; is it someone else’s fault?” A smal child of four said to me the other
day, “Miss D-was teasing me, and I threw the
gravel, and then I got a scolding from Mummie that Miss D--should have got.”
When training the child take into consideration his temperament. The gentle child is much easier to handle than the strong-willed one. The young mother must remember that her own character has a great influence on the child, and she must be sympathetic, just, patient, and perservering, although it is often difficult. The small child is most imitative, therefore those to whom the care of the child is entrusted must ever be on guard when the toddler is about.
As the child grows older teach him the rudiments of his religion, the meaning of the words honour, loyalty and courage, and give him the best education possible in his station. A child should be fitted for the work in the world to which he is best adapted.
I should like to say a word to mothers on the subject of summer diarrhoea in infants. It should really be called infectious diarrhoea. This form of diarrhoea is the cause of most of the loss of life in babies during the hot months all over the world, and is therefore a source of great distress to all baby welfare workers. It is still too prevalent in Australia, although there has been much improvement of late years. It is a preventable disease. Therefore, it is necessary that everyone should be able to assist in preventing its occurrence, or at least check the spread of it. It is only by some knowledge of the subject that this can be done. The chief thing is to realise that summer diarrhoea is a highly contagious disease.
For Prevention.—Firstly, keep your child away from any others suffering from the complaint. In the centres, infants suffering from this infective diarrhoea are not allowed to attend, but are visited by the Sister in their own homes. Secondly, feed your baby correctly. There is only one correct feeding, and that is the natural one.from the mother's breast. Babies who are fed naturally get a food that is properly balanced, the right degree of heat, and which is free from all germs. Breast-fed babies very rarely lose their lives with diarrhoea. Thirdly, if baby has to be fed artificially, the milk supply must be the best possible, from a tested herd, milked, sterilized, bottled and delivered under the best conditions. On being delivered to the home the milk must be handled as little as possible, kept very cool, correctly modified, and only given to baby when quite fresh. Fourthly, baby must never have a comforter, as it collects germs very easily, and the rubber is hard to sterilize. A comforter which has fallen on the floor, brushed against a coat or dress in
Fly Under Magnifying Glass.
A Dirty, Dangerous Creature.
train or tram, and put into baby’s clean little mouth, may cause diarrhoea, and may even cost the baby his life. I cannot speak too strongly on this subject, and I should like to appeal to every mother and ask her to let her baby do without a comforter, even though he is a little cross at first, and so save much of this summer trouble. Fifthly, keep baby covered with a mosquito net when sleeping, and so protect him from flies. All utensils used for an artificially fed baby must be kept covered from flies also. As everyone knows, the common house-fly is responsible for the spread of all sorts of disease—not only infantile diarrhoea. Sixthly, wash baby’s napkins carefully, first under a running tap wherever possible as soon as he has been changed, then put into a vessel with water and keep covered until boiling time. They should be boiled daily with a little pure soap, rinsed, dried out of doors and aired. Always wash hands after changing baby.
Next to prevention of any complaint comes early treatment, and so it is taken in time and much danger avoided. Let this be a rule throughout the hot weather:—If baby’s motions are frequent, stop all food for twelve hours, give an abundance of cold boiled water, and endeavour to find out the cause of the trouble. If there is no improvement at the end of this time seek medical aid. Of course, if baby is at all sick with these frequent motions see a doctor without delay. It is most important to give plenty of boiled water, as it acts as a wash out, and also supplies the tissues with fluid, which become wasted so quickly in an aeute summer diarrhoea. If at the end of twelve hours motions are back to normal, commence to get baby back on his food. A longer interval should be allowed, giving a very much weaker mixture and a shorter drink, and so gradually work up. Boiled water should still be given.
One sees thrush far too frequently amongst the babies attending the centres. It is a preventable disease, and in these days of scientific teaching of mothercraft should not be found.
It is known to be present by white spots appearing in the mouth, caused by the growth of a fungus.
The use of a comforter often causes thrush to commence, as it cannot be properly cleaned, and is too long for the baby’s mouth; it presses against the roof, and the delicate lining is injured, and so the thrush germ enters.
Bottle-fed babies are seen with thrush far oftener than breast-fed ones, and this is because of the faulty handling of the utensils used. The lack of good hygiene predisposes babies to thrush, lack of fresh air coming first. For this fungus to grow, the lining membrane of the mouth is not in a healthy condition, and where the mouth has been cleaned roughly and this lining injured the thrush grows rapidly. The mouth of the normal healthy baby should never be touched; it is altogether wrong to clean it, as Nature has provided certain secretions to take place which do this.
This unnecessary cleaning is usually done with a piece of rag or wool on the finger, which is obviously too big to go comfortably into any baby’s mouth, and so the delicate lining is bruised.
Never touch the healthy baby’s mouth. If you think it does not look clean, ask the advice of a health centre sister. The great thing to do is to prevent thrush, as mentioned above, by fresh air and sunshine, correct food, keeping one’s fingers out of baby’s mouth, by never allowing a comforter or “dummy.” In the breast-fed baby, by cleansing the nipples before and after nursing and in the bottle-fed baby by keeping bottle, mouthpieces, measures, mixing spoons, etc., perfectly clean.
If thrush, unfortunately, has occurred, take some clean absorbent wool, make it into a loose little roll, to fit into baby’s mouth, dip it in a solution made of baking soda (1 teaspoonful) in boiled water (1 pint), and gently dab the spots (do not rub them) three times daily; also dab gently, and very frequently during the day, with wool dipped in a solution of borax and glycerine, made up in the correct proportions by a chemist.
If absorbent wool is unobtainable, soft old linen, which has been well washed and boiled, may be used.
In severe cases of thrush a doctor is always consulted.
Always remember to dab the spots gently, as if they are rubbed off there is a very sore spot, which takes a long time to heal.
With due attention to the above simple details we should see very few babies with thrush.
The Cause of Many Ills.
Thrush is always a source of worry to the mother, and a cause of pain to the baby.
It is an “old wives’ tale” to say that every baby must get thrush sooner or later—he should not! The correctly-cared-for baby never does.
Remember, thrush is a preventable thing, and prevention is ever better than cure!
If baby leads a regular life, is correctly fed, and trained to use his bowels regularly, there should be no constipation. It is often caused by irregular habits, the use of aperients, oils, soap sticks, glycerine, enemas, etc. If baby is still constipated with correct food and careful training, give more boiled water. Up to ten ounces, or more, may be given daily.
The best way to train baby is for the mother to place a little basin between her knees after baby’s bath, and sit him on it, with back well supported. The basin should be large enough for baby to sit on comfortably. This “holding out” should be done at the same time every day, and so a regular habit is formed. Gentle massage of the abdomen with the tips of the fingers dipped in olive oil—up on the right side, across under the ribs, and down on the left side—is a good correction for constipation. Also the exercise of bending the knees up on the abdomen, six times for each leg, has excellent results for this purpose.
The daily “sun kick” is also most useful. This is best done between 8 a.m. and 9 a.m. in summer and between 12 and 1 p.m. in winter. Protect the eyes and head from the sun, uncover the legs and expose to sun for two minutes on first day; on second day undo napkin and expose legs and lower abdomen for two minutes; on third day for three minutes, and so on until there is five minutes’ exposure. Do not allow any burning. Never leave the child. The sun’s rays must be direct, and not through the glass of a window.
Sometimes it may be necessary to give liquid paraffin or milk of magnesia in small doses.
If constipation does not respond to these simple measures, a doctor should be consulted, as the cause may be more serious.
It is regrettable to think that any baby should be artificially fed in these days, when there are so many opportunities for the nursing mother to obtain help and advice from doctors and nurses in regard to BREAST FEEDING her baby. In cases where the child has to be separated from the mother, of course artificial feeding is necessary, and for those who have the care of an artificially fed infant the following is written:—
The successful artificial feeding of infants is one of the greatest problems met with in infant-welfare work.
Many things have to be taken into consideration, and I propose during the next few chapters dealing with each of them in turn.
The artificially fed baby never has such a good chance for health and strength as the breast-fed one, but with care and attention should do a great deal better than he usually does.
The first thing I wish to impress upon the mother is that she should never commence to feed her baby artificially without first seeking expert advice. It is through not doing this that so many of our babies get ill, or even die.
One hears of this food, or sees an advertisement for that one, and listens to the tales of “the next-door neighbour” about what she reared her seven on, and so an experiment is tried, and it is a very dangerous one, too, and may easily cost baby his life! So once again I say to every mother: Never give baby any food from the bottle without getting skilled advice. Advice should be obtained from one’s family doctor, or if there is not a doctor, from a baby-welfare centre in the district.
All baby foods prepared now have cow’s milk for their foundation, and each one is prepared by a special method. First, there are fresh milk, water, sugar and fat preparations, and secondly, the various dried milks, and the choice usually depends on the individual child. It is the duty of the mother only to give the preparation that is ordered.
It is always very unwise to make any drastic change in baby’s food without orders, and we are amazed to find so many mothers coming along to the centre with a sickly baby, saying, “Oh, doctor told me to give him boiled milk, but I felt it did not agree with him, so after two days I tried raw milk, but that did not suit him, and when, at the end of the week, my neighbour suggested dried milk, I tried that for a while, but this week we heard about evaporated milk, and his father said try that, but still he seems to have indigestion.” Poor baby! Remember, no changes without proper advice, especially in the summer. The second thing I wish to impress is to keep all baby’s bottles, measures, spoons, etc., perfectly clean and well protected from flies and dust.
A little steriliser (vessel in which to boil utensils) is made from half a petrol tin, with edges made smooth, and a handle put on. It is quite easy for the father to make.
In the prevention of sickness in the baby, the care of the feeding bottles plays a very important part, and a badly cared for bottle can be a source of grave danger. All bottles (it is well to have two or three on hand in case of breakages), screw-top jars (for mouthpieces), measures, jugs, spoons and bent meat skewer (for lifting purposes) are well washed with soap and hot water, rinsed thoroughly, put into the improvised steriliser, covered with cold water, put on fire or gas, brought to the boil, and allowed to boil for five minutes. Throw the mouthpieces in when the water is actually boiling. The bent part of the skewer is left hanging over side to act as a handle when lifting bottles, etc., out, as these utensils must not be lifted about by the mother’s hands after being boiled. After removing from the fire the screw-top jar is lifted out, and the mouthpieces also, which are put into the jar, kept dry and in a dark place to preserve the rubber.
Small tomato sauce or ginger ale bottles make excellent feeding bottles for baby, as they are quite smooth and have no neck in which food may get caught, and the ordinary small mouthpiece fits on them quite well. Medicine bottles are altogether out of order, also long mouthpieces. Another good feeding bottle is one shaped like a honey jar, with a large rubber top and small mouthpiece. (There are also other good feeding* bottles on the market which may be used.) This bottle is easily cleaned, and is really the most natural shape as far as the mouthpiece is concerned.
of Feeding Bottle.
The remainder of the things in the steriliser are left in the same water, covered with a clean tea towel, and kept in a cool place until used. As soon as baby finishes his feeding, mouthpiece, bottle and other utensils used in preparation of food are rinsed with water, rubbed with a little cooking salt, washed in the usual manner, and boiled again, and kept as above until the next feeding. Never use a mouthpiece or bottle for
baby which has not been boiled after the last feeding.
Baby should have a little saucepan for his special use, and there should always be a jug of cold boiled water on hand, which is kept well covered. This water is given to baby between feedings with a spoon. It is also necessary to have oranges or other fruit in season, so that baby may have fresh fruit juice each day. The subject of fresh fruit juice will be dealt with at length later. Milks, sugars, fats, etc., used for baby must be kept clean and cool, well protected from flies and dust.
If cow’s milk is used it should be kept on ice, especially in the summer. If there is no ice available it is kept in a cooler (already described in these pages), and brought to the boil before using.
In the winter, fresh, raw milk may be ordered, which should be obtained as soon after milking as possible. Correct medicine measures should be used in preparing baby’s food, as the household spoons vary so. These measures are quite inexpensive, and may be bought from the chemist. Spoons may also be obtained (free of charge) at the Baby Health Centres.
The next thing in regard to feeding baby is the manner of holding the bottle and the position of the child. The bottle must always be held in position by the person who is feeding the infant, never propped up and left. This is an important point, as baby may suck in air, and so experience a lot of pain after food, or a little may “go the wrong way,” and the child choke before help comes. I have been surprised to find, when “home visiting” mothers, how many of them put baby into his pram, or cot, prop up the bottle with a cushion or something, and leave it, and it is only by great good luck that there are not more serious accidents. The mouthpiece on the bottle must be small and shaped as much like the mother’s nipple as possible. The hole should only be big enough for the food to come through drop by drop, as baby will get indigestion if the food is taken too quickly. The part of the mouthpiece which goes into baby’s mouth should never be touched after boiling, as germs may be introduced if this is done.
The heat of the food is tested by the mother dropping a little on the inside of her forearm, and if it is just warm it is the right heat for baby. The food must never be given too hot. The child should be held during the feeding in the same position as though he were being fed at the breast, as one must make things as natural as possible for the artificially-fed babe. The food whilst feeding must come well up into the part of the bottle nearest baby’s mouth, so that no air can be sucked in, and in order to do this successfully the bottle must be tilted well up towards the end of the feeding. Baby’s bottle should have a small flannel cover slipped on, to keep it warm during the feeding. In holding the bottle, a finger should be kept under the chin, and a slight pull put on the bottle. This prevents sucking being too easy, and so causing a lack of development of jaws. Baby should not suck for longer than twenty minutes at a time. Any food left then is counted as a “leaving.” Continued sucking is too tiring for the child.
Demonstrations are given in all health centres in regard to the care of feeding bottles, the holding of the bottle, etc., and mothers who cannot follow the advice given here are invited to attend the nearest centre, where the sister will be only too pleased to give a practical demonstration. After feeding, the baby is held upright, with head at mother’s shoulder, or sat up on her knee, in order for him to get any “wind” up. There is usually a little, as the baby often opens his mouth so widely over the bottle that the air gets in. Having got rid of his “wind” in this manner, baby is put down on his right side, so that there is no undue pressure on the stomach, which is situated toward the left side of the abdomen. Later on he is turned on to his left side. Baby must never be put down on his back after feeding, as he may return a little of his food, which would run back into his windpipe, and so cause choking. Nor should baby be rocked or jolted about after his food. This may cause vomiting, which is always an undesirable thing to start.
The regularity of the infant’s feeding is one of the most important points. This applies both to the naturally and the artificially-fed infant. Baby must be fed regularly every three hours or four hours, as the case may be, at the same time every day.
No normal baby should be fed oftener than once every three hours, and this only when he is very young. As soon as possible, he is put on to four-hourly feedings. This is better for baby’s digestion, less strain on the mother of the breast-fed baby, and gives more time to the mother of the artificially-fed baby. The majority of well-cared-for babies get on to four-hourly feedings before the end of the third month. For the baby who is fed once every three hours the times suggested are: 6 a.m., 9 a.m. (after bath), 12 noon (before mother’s lunch), 3 p.m., 6 p.m. (just before mother’s dinner), and 10 p.m.; and for the one that is fed every four hours: 6 a.m., 10 a.m., 2 p.m., 6 p.m., and 10 p.m. These times depend, of course, on the routine of the mother’s life, and if it is more convenient for baby to start his day at 7 a.m. instead of 6 a.m., there is no reason why he should not do so, provided he starts at the same time every day. It is altogether wrong for a baby to have his first feeding at 6 a.m. one day,
7 a.m. the next, and 8 a.m. the following one, and is the cause of many digestive upsets. I should advise every mother to decide what time is mos, suitable for baby’s first feeding, and to take that time and keep it always. Baby is soon trained to regular feedings, and if he is a normal child there should be no difficulty in maintaining the habit.
Some mothers think that if baby is not getting enough food he should be given extra feedings. This is not the case. What he wants is more food at his regular feeding time.
No night feedings should be given to the normal baby. Enough food should be taken at the 10 p.m. feeding to last baby until 6 o’clock the next morning. One night feeding given will help to get baby into bad habits; therefore, it should not be started. This applies to the naturally fed baby also. The long rest at night is necessary for the baby’s digestive organs, and it is also necessary for the mother if she is going to keep well and look after her children properly.
Baby will get indigestion sooner or later if he is given night feedings, unless specially ordered, and the mother is likely to get a severe cold and perhaps illness if she gets out of bed on cold nights to prepare a feeding, and will probably become very “nervy” through lack of sleep. For the baby who has already been given night feedings there is trouble ahead, and it is something of a task for his mother to break him of the habit. This should be done as soon as possible, though. It will mean a few wakeful nights and many tears on baby’s part, but the sooner he is broken of the habit the better. For the mother who has to do this I would advise a full feeding (details for each individual baby may
be obtained from local health centre, or by writing“ to me and giving particulars of baby’s weight at birth, present weight, condition, etc.) at 10 p.m., and if he wakens and cries give boiled water for the first few nights (the amount given would be the same as the amount of food), and then gradually stop this also by giving less and less each night, and make him go off to sleep without anything. I usually find that most mothers (if they are sensible) can get their babies out of the habit of night feedings in about ten days or a fortnight. Regularity of feeding may be summed up thus: Correct amount of food at the same time every day, and no night feedings; and if baby has been fed irregularly, perseverance.
Having dealt with all the fundamentals in connection with artificial feeding, we come to quality and quantity.
Once again we look to Nature. She has provided baby with a food which is sterile (free from germs), which contains all the food constituents necessary for maintaining infant life, also certain vitamines necessary for the growth of the baby, and which is produced at a correct even temperature. Therefore, in preparing any artificial food, one tries to get as near the standard of breast milk as possible. The substances necessary in a food are;—(i) Protein, for growth and the repair of any wasted tissues; average breast milk contains 1.5 per cent, protein. (2) Carbohydrate, to supply heat and energy to the body; average breast milk contains 7 per cent, carbohydrate. (3) Fat necessary also for the heat supply of the body; average breast milk contains 3.5 per cent. (4) Salts, necessary for the proper formation of bone. (5) Vitamines, those food accessory factors without which the infant is liable to deficiency diseases. Whatever artificial food is given to baby, and that
depends on a variety of things, it must contain as nearly as possible protein, 1.5 per cent.; carbohydrate, 7 per cent.; fat, 3.5 per cent.; salts and vitamines; water.
This is what is termed a properly balanced diet. There are different kinds of proteins, carbohydrates, fats, salts and vitamines, and in the artificial feeding of infants we use those which resemble most the ones found in breast milk. The artificial food is rendered sterile by boiling, but it must be remembered that certain of the necessary vitamines are destroyed during the process, and must be supplied in the form of fresh fruit juices. Orange juice is the best of these, and every artificially-fed baby should be given diluted oranfe juice, commencing with a few drops each day, diluted with boiled water, and gradually working up until the child is getting six teaspoonfuls each day. The quantity to be given is estimated by the caloric requirements of the individual baby—that is, the amount required for the maintenance of bodily heat and energy, for normal growth and gain, and to keep up the resistance of the body to disease, etc. The baby of three months requires a greater number of calories than the one of six months, and so on. Later, a rough outline of how this is done will be given, but it is too complicated a thing to go into deeply, except for those who make a study of it; but every intelligent mother must have some idea of how a baby should be fed, and one can always do things better if one knows something of what is being done. There is a time-honoured saying of “If there is no mother and no foster-mother, take milk, water, sugar and cream, and make baby a foodbut in order to do this one must know how much of these things to take.
PART V. Fresh Milk.
As already mentioned, the choice of a food for an artificially-fed infant lies with the doctor, and depends on a great many things, but almost every food has cow’s milk for its foundation. First, we will take fresh cow’s milk, as that is usually given to the normal child. The proper use and modification of cow’s milk is the main thing, apart from the three C.’s—Clean, Cool, Covered.
The milk must come from a mixed herd, which has been tested for tuberculosis, and found free from these germs. One cow’s milk should never be used unless the cow has been tested and found free from germs. Next, milking must be done by clean, careful milkers, or by sterilised machines, all vessels used must be thoroughly clean, and the milk cooled and delivered as soon after milking as possible. It should be distributed by conscientious agents in the city and suburbs as early as possible in the morning.
On arrival in the home it must, as already pointed out, be kept clean, cool and covered, and apart from all other foods. Now comes the preparation for baby’s use. All vessels, measures, etc., should be well boiled, and only accurate measures used. House spoons are only used to stir. Cow’s milk contains proteins, carbohydrates and fats, salts, water and vitamines, but not in the same proportion as in the breast milk; therefore it is necessary to modify them to be as near to breast milk as possible. Average cow’s milk contains protein 3.5 per cent., carbohydrate 4.5 per cent., fat 4 per cent., salts and water.
Protein .. .. 1.5 per cent.
The protein and fats in cow’s milk are of a different kind from those present in human milk; but the carbohydrate, or lactose, is the same. The protein must be dealt with first (Nature has prepared it in cow’s milk for the growth of the calf). It is made more digestible by boiling usually, and also by adding-certain predigesting agents, but boiling is the simplest method, and also has the advantage of killing any dangerous germs. The fat is made digestible by giving a smaller percentage or by skimming the milk. This depends a great deal on the individual infant’s capacity for dealing with the fat. The carbohydrate being the same, but in a lesser amount, all that is necessary here is to add sugar.
Having boiled the milk to make the curd more digestible for the baby, we next proceed to make the balance right. This is done by adding an equal quantity of boiled water. It is now easily seen that the mixture contains protein 1.7 per cent., carbohydrate 2.2 per cent., and fat 2 per cent., and in comparing that with breast milk we find the protein (which is the most important point) is about right, the carbohydrate is much too low, and the fat slightly lower. Now we want to work the carbohydrate up to 7 per cent, and the fat up to at least 3 per cent; the former is done by adding 4.8 per cent, sugar and the latter by adding 1 per cent. fat. These ingredients must be added very gradually. It is best to use sugar of milk for a young baby; as the child grows older, cane sugar. If using cane sugar it is sometimes difficult for the infant to deal with 7 per cent, carbohydrate, and like the fat a little less must be given. A good rule to follow is one teaspoon of sugar of milk added to a two-ounce mixture, increases the carbohydrate by 5 per cent., and one teaspoon cane sugar added to three-ounce mixture increases the carbohydrate 5 per cent. In
adding fat 1 per cent., it is best to use a cod liver oil emulsion. The rule to follow is quarter-teaspoon of pure cod liver oil added to a three-ounce solution increases the fat 1 per cent. If a cod liver oil emulsion is used (containing- 50 per cent, oil), half a teaspoon is necessary. Our modified milk mixture now compares with the breast milk thus:
Modified Cows' Milk. Protein . . .. 1.7 per cent.
Having balanced our mixture correctly, we will deal with the caloric requirements of the average baby.
Now we come to the caloric requirements of the infant, that is, the number of calories (units of heat and energy) required to keep the child warm and energetic, and to make him grow. A baby under three months needs 50 calories per lb. body weight in the 24 hours, and so on, less and less, until the baby of 12 months is needing 42 calories per lb. body weight in the 24 hours. An under-nourished baby may need more at any age. Example:—
Weight of Baby. Age. Calories Necessary.
10 lbs......... 3 mths. .. 500
16 „ ........ 6 „ .. 752
These calories are produced from the various foodstuffs, and the following table of the commoner ones may be interesting:—
Cane Sugar ............
Malt „ ............
Milk „ ............
Cod Liver Oil..........
Cod Liver Oil Emulsion . . . .
Therefore a baby who takes half a pint (10 oz.) of milk, 10 oz. water, 1 oz. sugar and 1 oz. cod liver oil emulsion in the 24 hours gets 448 calories: 200 from milk, 116 from sugar, 132 from emulsion.
If it is found after correctly balancing the diet that the child is not receiving sufficient calories, the quantity of the mixture is increased and the composition (or quality) left the same. It must be increased slowly, though. Remember that all infant feeding must be carefully done, and all ingredients given in a very small quantity at first, and gradually worked up to the full strength. Thus a baby starting on cow’s milk should only have a proportion of milk one part, water three parts, for the first two or three days, and then milk one part, water two parts, and gradually up to equal parts. The normal baby, up to six months, should not be given a stronger milk and water mixture than equal parts, but occasionally it is necessary to work up to milk two parts, water one part. The individual baby must be always the guide in this matter. After six months, milk 2, water 1, is sometimes necessary, and at seven months crust and butter, vegetable broth, prune pulp, in small quantities, etc. At about nine months the child is worked up to milk 3 parts, water 1 part, and a modified baby diet. Once again let me impress upon mothers the importance of giving fresh, diluted fruit juice (preferably orange juice) to baby between each feeding, starting gradually and working up to six teaspoonfuls in the 24 hours, to supply the fresh element necessary to baby’s health, and which is destroyed or diminished in the preparation of artificial food. Then water must be given every day. It will now be seen that in using fresh cow’s milk for baby it is necessary to have good, fresh, clean milk, kept cool and covered, correct measuring spoons, clean bottles and other utensils, to be able to balance the diet by the addition of water, etc., to have an idea of the number of calories required to give fresh fruit juices and to let the baby himself be your guide. See that he is happy and contented, not suffering from “wind,” that his motions are normal (this is always an important guide), and that he is putting on a correct amount of weight each week. Weekly weighing is advisable for the artificially-fed infant.
Having dealt with the fresh cow’s milk and water mixture, with the addition of sugars and cod liver oil emulsions, which is the usual artificial feeding, we will now take some of the things which are added to a cow’s milk mixture to make it more digestible for the abnormal baby. First, let me say that these foods should never be given without expert advice, as quite the wrong one may be used.
Chief amongst these are the cereal waters used as diluents, such as barley and rice water; their slimy nature prevents the uniting or sticking together of the smaller curds, and so forming larger masses. Amongst the commoner things that take the place of sugar, and so supply the extra carbohydrate are Maltogen and Mellin’s Food. These are ordered, as some babies digest the malt preparations better than other sugars.
Butter or cream is sometimes used in place of cod liver oil emulsion. If cream is used it must be fresh, and have no flavouring or preservatives added. It is best obtained by setting some of the milk from same supply as that used for the feeding. It may be set from four to six hours, as ordered. It must be kept clean, cool and covered during this time.
Then we come to the alkalies used to modify the curd of cow’s milk, and so make it easier for the baby to digest. These are lime water, citrate of soda, and milk of magnesia. Lime water is usually ordered in the proportion of 1 oz. to 1 pint of mixture, and citrate of soda 1 grain to 1 oz. These alkalies must never be given without advice, as the boiling of the milk modifies the curd sufficiently for the average baby.
Next we have the peptonising powders and Benger’s Food, used as pre-digestives, and given to babies whose digestions are not up to standard. They should be discontinued as soon as their purpose is served, as the child’s digestive organs would become lazy and great trouble caused later if kept on too long. There is also the pre-coagulation of milk, which is brought about by the use of acids, e.g., buttermilk and rennin, which produces whey; and the Lactic Acid preparations only used under directions from a doctor.
There are other foods which are added to cow’s milk for various reasons, but they are too numerous to mention. In using any of the substances mentioned, accurate medicine measures must be used and not house spoons, as they are so much bigger than the correct measures.
Dried milks, condensed milks and patent foods all have their uses in the world of infant feeding, but they should not be used without expert advice. These foods are sometimes used according to directions on tin, but should be modified to suit the individual baby, taking, as before, breast milk as the standard.
First, we take dried milks. They are made from fresh milk, which in Australia is obtained from a good, clean farm, dried either by the cylinder or spray method. There is less contamination in the former. Dried milks are not sterile (that is, absolutely free from germs). The food can be infected during powdering and packing unless great care is taken under expert supervision. In using dried milks we must choose the one that is most digestible to the individual child. When an infant is fed on dried milk, it is absolutely necessary for him to have an adequate amount of fresh orange juice daily to make up for vitamines which may be destroyed in the process of manufacturing dried milks. Dried milks are used always in very hot climates, on sea voyages, where the fresh milk supply is not good, and in cases where the child who has to be artificially fed cannot digest the modified, fresh cow’s milk.
Next, let us consider condensed milks, of which there are two kinds, sweetened and unsweetened. The advantage of the unsweetened is that the amount of sugar can be controlled, and the disadvantages are that it does not keep well, and it is exposed to a higher temperature during manufacture than the sweetened. It is usually used in the proportion of milk one part, water three parts, and a requisite amount of sugar added. It is only used as a temporary food.
The sweetened condensed milk is rich in cane sugar. Owing to this, it cannot be modified to breast milk standard. It is only used where a diet rich in carbohydrate and poor in fat and protein is necessary. Its chief advantage is that it can be easily digested. Its disadvantages are: The child fed on condensed milk is subject to infections, as his resistance to disease is poor; it is not necessarily sterile, and germs multiply quickly if it is left standing diluted with warm or hot water. It is a food that is often favoured by mothers, but it does not make for sound nutrition. It is only used by doctors as a temporary measure in cases of some digestive upset, and baby should not be kept on it for too long. Fresh orange juice must be given daily. The correct amount of orange juice is two teaspoonfuls, three times a day. It must be started in small doses, and gradually worked up to the requisite quantity.
Now we come to patent foods, which are quite distinct from dried and condensed milks. They are only used for some special reason, and should always be ordered by a doctor. Chief amongst these are the malted milks, which are often given after a diarrhoea caused by excess of protein.
The patent foods are divided into three groups : (1) Foods without starch, but containing sugar, such as malted milk; (2) foods containing both starch and sugar, such as Nestle’s Milk Food; (3) foods exclusively starchy, such as Bowen’s Sago. Most of these are used in the proportion of one part of food to seven parts of water, or even weaker. None of these foods should be used after they have served their purpose, as all sorts of digestive troubles may be caused. When a baby is put on to a patent food by a doctor for some reason, the baby should be taken to the doctor again and orders for permanent feeding obtained. The correct grading from a patent food to fresh or dried milk is an important matter, and should always be done under supervision of either a doctor or a Baby Welfare Centre. It is too complicated a matter for the average person, and I do not propose to go into it here, and each individual baby has to be taken into consideration. This grading is done in the cold weather as far as possible.
Whether baby is being fed on breast milk or some artificial food, it is necessary that his general condition should be very carefully watched to see that he is progressing satisfactorily. He should be happy and contented, bright and energetic, sleep throughout the night (from 10 p.m. to 6 a.m.), and when he is very young for at least 12 out of the other 16 hours. Eyes must be bright and clear, skin clear and free from all blotches, and a healthy colour. His flesh must be firm and springy, no sagging of muscles. His head and abdomen (after the first few months) should measure less than his chest. He should gradually gain in length, until at the end of the first year he has grown about eight or nine inches. Of course, heredity plays a certain part in this, and where parents are short in stature baby may not grow quite so fast, although this is usually manifested later on. He should gain from 6 to 7 oz. each week during the first six months and a little less during the second six months. He should not suffer from “wind” to any extent, as any air swallowed should be brought up immediately after food. He should be fed four-hourly (or three-hourly), at the same time every day, and no night feedings, and only the correct amount given each time. His bowels should be open regularly once or twice daily, the motion of fair size, smooth, bright yellow (if breast fed) ; somewhat darker if artificially fed, and not offensive. If motions become frequent on any food, stop all food at once for 24 hours, give as much boiled water as possible, and if the condition does not improve attend the doctor. If motions contain blood and slime take baby immediately to a doctor, as treatment for this condition is necessary within, at the very outside, forty-eight hours, otherwise the diarrhoea may prove fatal. This form of diarrhoea is carried by flies, comforters, dirty food and unwashed hands. Breast feeding is the surest protection.
In concluding these chapters on the Artificial Feeding of Infants, I should like to say a little about vitamins, those accessory food factors without which baby would not thrive.
In breast milk, provided the mother has wholesome food, these vitamins are present in the right amount, so one has no worry about them, but in every artificial feeding they have to be supplied in some form or other. The growth impulse is inborn, and there are two factors as far as we know which allow it to go on—heredity, the internal factor, and the food supply, the external factor. Neither is independent of the other. Until recent years we have only thought of the five constituents of food—protein, carbohydrate, fat, salts and water—and have under-estimated, if not entirely neglected, the significance of other dietary constituents, and have very often only by accident got enough vitamins into the child’s food, hence the occurrence of stunted growth and malnutrition generally in some artificially fed children. It has been proved that if minute amounts of certain constituents are removed from natural foods, such foods then wholly fail to support nutrition, and grave symptoms arise. We are still ignorant of the precise chemical nature of all these vitamins, but in the last ten years of study their existence has been proved. There are four vitamins necessary to the well-being of the baby, which we will consider briefly in their order:—
1. Fat Soluble A.—The vitamin which makes baby grow. If this is absent, growth will cease; if diminished, the child is unable to resist infectious diseases, and is subject to certain eye troubles.
2. Vitamin B.—The vitamin which prevent neuritis and beri beri (common in the East).
3. Water Soluble C.—The vitamin which prevents scurvy, “Barcoo Rot,” etc.
4. Vitamin D.—The vitamin which prevents rickets.
There are no doubt other food accessory factors, but little is definitely known about them.
The following is a list of foodstuffs which contain the various vitamins:—
Fat Sol. A.—Milk, raw, dried and boiled, cream, egg yolk, cod liver oil, butter, fish oil, beef or mutton fat, wheat germ, liver, heart, cabbage (raw), lettuce.
Vitamin B.—Raw milk, dried milk and boiled milk (little), eggs, wheat germ, dried yeast, brains, nuts.
Water Sol. C.—Raw milk, cabbage (raw), lemon juice (raw), orange juice (raw). In a lesser degree, tomatoes, Swede juice, fresh raspberries, onion (raw).
Vitamin D.—Cod liver oil, Ostelin.
All these vitamins are easily destroyed. C. is destroyed or greatly reduced by drying and prolonged cooking. Preserving or any treatment with chemicals practically destroys all.
In the artificial feeding of infants it is necessary to give water sol. C. in the form of orange juice and fat sol. A. and D. in the form of cod liver oil emulsions, or Ostelin.
The care and management of the premature baby is an art in itself, but there is no reason why any mother with common sense, and her natural love and desire to do the best for her baby, should not learn this art. If cared for properly, the premature baby should be just as healthy and strong later on as the full-time baby.
A premature babe is one born before the normal time; therefore, his organs are not fully developed, and he must be treated accordingly.
There are four main points:
I. He must be kept warm, as he cannot maintain his own body temperature.
II. He must be handled as little as possible.
III. He must be given suitable food for his undeveloped digestion.
IV. He must be kept out of the reach of infection, as he is susceptible to anything of the kind.
From the minute he is born he needs special attention, and when a baby is expected prematurely he should be prepared for, and some person detailed to care for him.
Now let us study these four things in detail, and so be ready to care for any premature baby that may be placed in our care.
I. The maintenance of his body temperature. The first thing to do here is to see that there is a suitable room, which should be airy, but which keeps at about 70 deg. F. In winter it is necessary to have a fire burning day and night. Draughts must be avoided always.
Then the cot is prepared. A cot may be lined with brown paper, or an excellent “homemade incubator” can be made with two dress baskets, one a size larger than the other, and so get the effect of a double cot; these are on view at all Baby Health Centres, or a cardboard box may be used with air holes put in, and placed in the ordinary little bassinet. The outer basket is lined with a blanket, as shown in the envelope bed already described in these pages. The inner basket is placed inside this, and also lined with a soft all-wool blanket; a soft chaff mattress is placed in this, and then the hot water bottles are filled. If rubber bags cannot be obtained, stone bottles serve the purpose very well. The bottles must have flannel covers, so that there shall be no burning accident. One bottle is placed at the foot of the bed between the two blankets, and one at either side, also between the blankets; the bottle at the feet should be about 20 deg. hotter than the other two. When the bottles need filling, they should not all be removed from the cot at once, but filled in rotation. In this way an even temperature of the cot is maintained, which is most desirable. A dairy thermometer should be obtained, and the cot kept at about 95 deg. F., or whatever is necessary to keep the child at 99 deg. The thermometer is placed beside the baby in the cot. It is also important that the child does not get overheated. Soft absorbent wool should be ready, in which to wrap the child; it is a good idea to make a little jacket of the wool and cover it with butter muslin. This is made to fasten down the front and on the shoulders with tapes, and so there will be less movement of the child in dressing. Some soft bandages are also ready to bind the wool round the limbs, and a little bonnet may be made in the same manner as the jacket. Little Shetland wool garments could be worn in place of this, made to slip off easily.
As soon as the child is born, he is wrapped in a piece of absorbent wool and placed in the bed
which is ready for him. He should be left lying* quietly thus for several hours to recover from the effort of being born, and must be watched very closely, of course. His temperature is taken by the nurse every four hours in the rectum, and should register about 99 deg. F.
II. As the baby must be handled as little as
possible, he is not given a bath, but is oiled all over with warm olive oil. Before oiling, it is best to get everything ready on a table at the side of the cot. The oil is warmed by standing it in a bowl of hot water. For the first oiling it is necessary to use absorbent wool swabs, but the subsequent oiling, which usually takes place every second or third day until the child is able to take a bath, is done with the tips of the fingers, and so the immature skin is gently massaged and a certain amount of the oil absorbed. The child is not taken from his bed for oiling, but he should be gently turned from side to side about every four hours. A pad of absorbent wool is used in place of a napkin, and each time this is changed the little buttocks, groins, etc., must be carefully cleaned with warm olive oil. .
When the infant can maintain his own body temperature without the aid of the incubator, he may be given a warm bath each day. This is always done very carefully at first in order that there shall be no chilling or collapse. At this stage also the ordinary baby clothes may be worn.
III. The feeding is ever important, and the only hard and fast rule to be laid down is to get breast milk for the premature baby at any cost. If possible, colostrum (secretion from breast for the first two days after birth) should be procured. For the first 24 hours nothing is necessary but boiled water. This is slowly and carefully given with a medicine dropper, with a tiny piece of rubber tubing on the end. In nearly every case the mother will be able to nurse her child if properly cared for. If the baby is too weak to suck at first, the milk must be expressed by hand from the mother’s breast, and given in the same way as the water. To get the milk supply going properly it may be necessary for the nurse to give hot and cold water bathing to the breasts, and some special massage movements. If the child is strong enough to suck, the double cot must be carried to the mother’s bed, and she must lean over it, and not lift baby from the cot for the nursing. The mother must be made comfortable whilst this is going on. The interval depends on the amount the infant gets at each nursing, and for this every baby is a law unto himself. If the infant is unable to swallow properly, a doctor must be consulted. He will probably order feeding by means of a rubber tube, which is only done by a skilled person. If the mother’s milk is unobtainable, breast milk should be obtained from a foster-mother; this may need boiling or diluting with water to make it digestible enough. In rare cases it may be necessary to artificially feed the premature baby, and in such a case the doctor would order the feeding, which would probably be a whey modified mixture of fresh cow’s milk. Milk for this mixture is always boiled for about ten minutes to make the curd soft. Sometimes it is necessary to peptonise or Bengerise the milk. If fresh milk is not obtainable, it may be necessary to use a dried milk or even condensed milk preparation temporarily. The quantity of food (like the interval of feeding) depends entirely on the individual baby. It is necessary for all premature infants to have plenty of boiled water; at least 12 tablespoons in the 24 hours should be given.
IV. The risk of infection in the premature baby is great; therefore no one else should be in his
room, and only the person in attendance and his mother should be allowed near him. It is most undesirable that other children should run into the room, and no one with a cold, sore throat, rash, boils, etc., should go near the child. When he is able to maintain his body temperature as before mentioned, he may go out in the sun for a little time every day, and so gradually get into the regular habits and life of the ordinary babe.
If the mother regularly attends her doctor or ante-natal clinic, she is usually prepared for twins. Twins are sometimes born prematurely, and need the special care already pointed out in these pages.
Two babies mean more work for the mother; therefore she needs to follow the rule “at the same time every day” for feeding, bathing, sleeping, etc. If possible, it is nice for the babies each to have his own little bassinet, but when this cannot be managed they may be tucked into the same crib, provided they are both restful and well. If one is very restless, of if there is any sickness in one, he must be separated from the other immediately.
In order to establish regular habits, it is best to always bath, dress, feed, etc., the same one first, although he goes to alternate breasts for feeding. It is an excellent idea to feed both babies together, completely supported on pillows under the mother’s arms. It is very necessary for twins to be breast fed, and in order to ensure this the mother should not have too much to do (apart from caring for the twins) during the first three months after birth, as at this age they take twice as long to fix up as the single baby.
The mother of the twins needs extra fluid, and should endeavour to take at least twelve glasses of water daily, as well as her other drinks; the water may be flavoured in any way, if desired; fruit juices make good flavouring always. Meat, butter, eggs, fresh fruit and green vegetables should be partaken of freely. One hour’s rest with the feet up should be taken daily, and if possible ten hours in bed at night (10 p.m. to 8 a.m.), with windows wide open A walk in the fresh air is necessary each day, and there should be an absence of worry. If the mother of twins finds that she is worried or that her breast milk is failing, she should have medical advice or write to or attend a Baby Health Centre without delay, and obtain minute instructions in regard to the matter. Where milk appears to be failing, it is undesirable to only feed one baby on breast milk.and the other artificially; they should each be given an equal amount of breast milk, and if it is not sufficient, each one is given a complementary feeding until the supply increases in the manner already set out in these pages. After the third month, the normal healthy mother has recovered from the effect of having borne two children at once, and is more or less used to them, has got them into regular habits, has her breast milk well established, and therefore can begin her normal life again. The general rules of hygiene apply to the twins as well as to a single babe.
As they grow older there is the interest of their companionship, the dressing of them, etc., often of “not knowing one from the other,” that compensates for the extra trouble of their early months of life. .
I find that a number of mothers are inclined to attach very little importance to a rash, even one on baby’s face, whereas a rash on their own faces would send them post haste to the beauty parlour, the chemist or the doctor—in rare cases even to the skin specialist, although he is often the last one to be consulted! Baby’s rash is put down to a cold, teething, or some such thing.
Rashes should be prevented, and to prevent them we must look for the causes, which may be either external or internal. The first skin abnormalities noticed in the newly-born are birthmarks. They need medical advice.
There are certain serious rashes in the newborn, but these need medical attention.
The rash that is most common is strophulus, or, as it is called, “red gum,” and is usually caused by the wearing of too many clothes. It may also be caused by too-prolonged heat of any kind to baby’s body, as it causes an excessive action of the sweat glands and an inflammation occurs which blocks the tiny ducts, and waste material cannot be got rid of. “Red gum” is quite characteristic—scattered red spots, with a tiny yellow spot in the centre. It is prevented by attention to baby’s garments, as already pointed out, and to his bed and covering, and usually clears up in about six days.
Next comes the rash caused by irritation. This is seen in the baby who is badly attended in 1 eg aid to the changing and washing of squares. There is no chafing in the well-cared-for baby. Baby should be thoroughly washed and dried at each changing. Do not dry baby with powder, as it will “cake” and so cause irritation, and no soda or disinfectants should be used in the washing o squares. They should be boiled in water to which a little good soap has been added, rinsed in two waters (no blue), dried in the open air and sunshine, pressed and thoroughly aired. Air at the fire or radiator in winter and in the hot sun in summer. Another cause of such a rash is incorrect feeding. In preventing this, breast feeding is the first and last thing.
Then there are the vegetable parasites, which cause ringworms, etc. These are caused by the flannel garments not being washed regularly. Rashes caused by animal parasites, such as scabies, are indicated by their itchiness, and a doctor should be consulted. These rashes are contagious.
As baby grows older there is “cradle cap," caused by the incorrect washing of baby’s head, or the use of an irritating soap.
There is another rash called impetigo. It is caused in the first place by dirt and carelessness; then, as it is most contagious, it is spread to the clean child. In impetigo the skin is lifted up, and a crust forms, and it spreads over the body. Prevention lies in keeping your child away from those suffering from the complaint. .
As the child grows, there may be chilblains, an inflammation due to cold, which may be prevented by keeping up the child’s resistance, by seeing that he gets enough exercise, and by his wearing woollen socks and thick-soled shoes. If chilblains do occur, paint them with a little tincture of iodine.
Remember, the skin is not only a covering for the body, but also an important organ for getting rid of waste products.
If the child is at all sick with a rash or has a cold, remember it may be the onset of one of the infectious diseases, and the child should be put to bed, given only light nourishment, plenty of water to drink, and the doctor sent for at once. These things are never so dangerous if medical aid is sought early and treatment obtained, whereas delay may prove most disastrous.
if the toddler gets hives, his diet should be adjusted and some baking soda in the bath is often useful, or the child may be sponged with a solution made from baking soda, 1 teaspoonful; boiled water, 1 pint. Witch Hazel is also very soothing.
Accidents may happen even to the best of regulated babies, and very often the treatment given in the first few minutes, wjiilst awaiting the arrival of the doctor, is the means of saving the child much pain and unhappiness. Therefore, every mother should know the right thing to do in an emergency, and do it at once.
It is also rather important to know what should not be done.
Burns and scalds are first among the common accidents in toddlers. Should a child’s clothing catch fire, the flames should be smothered at once, using any coat or other covering that is handy. There should be no hesitation in doing this, and the child must never be carried elsewhere until all the flames are extinguished. Burns and scalds produce great shocks to the child. If a doctor is long in coming, a burnt or scalded child should be placed in a bath of warm water, to which has been added a handful of baking soda. The child should not be uncovered, but put into the bath with clothes on. The clothes may be cut away under the water. The soda in the water dulls the pain, and the even temperature of the water revives the child. When the child has quietened dowm he is lifted out carefully, the parts not burnt are dried, and to the burnt surfaces is applied a very clean oil dressing, if the doctor is not there to order otherwise. The oil or vaseline is spread on strips of very clean old linen, absorbent wool is placed over this, and the child is put into a warm bed, w-atched carefully, and kept very quiet.
Bruises are the next thing, and here all that is necessary is a plentiful supply of grease, and if there is pain a little eau de cologne may be used.
Then we have concussion, which is caused by a severe knock on the head. In this case the child is put to bed in a darkened room and kept very quiet, whilst awaiting the doctor. The child's bowels are kept well open, and light nourishment given if he is conscious.
Next come cuts; these are many and varied. The place is cleaned up well and a piece of clean linen applied and bandaged on. Tincture of iodine may also be used, evaporating lotions, and absolute rest.
Another fairly common thing in a child is a “green-stick fracture.” This is really a bending of the bones and not a complete break. It should not be treated until the arrival of the doctor. Falls from a perambulator are often responsible for these fractures; therefore, a harness safety strap is necessary the minute the infant begins to pull himself up.
Now we think of suffocation. This is caused by the mother overlaying the child while in bed with her, or by the child getting a shawl over his face. Suffocation can be avoided by the mother never allowing baby to sleep in her bed, and by covering him carefully. Choking is caused by the child swallowing a foreign body, which sticks in his throat. If this happens, the child must be held up by his feet, head downwards, and a sharp smack on the back given. In order to avoid poisoning, a child is never given toys covered with coloured paint, as he may suck them. Should a child suck matches or some such thing, medical aid must be sought without delay. A child bitten by a dog or scratched by a cat should have the wound at once bathed with some antiseptic lotion, and a clean linen dressing applied. A child bitten by a dog usually needs immediate attention from a doctor. In all accidents the mother should endeavour not to become frightened, and to bring all her common sense to bear in order to do the best she can for the child, and so save trouble later.
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