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The Care and Feeding of Children - A Catechism for the Use of Mothers and Children's Nurses
L. Emmett Holt
First digital edition 2017 by Gianluca Ruffini
PART I. THE CARE OF CHILDREN
Bathing Genital Organs Eyes Mouth Skin Clothing Napkins Nursery Airing Weight, Growth, and Development Dentition
PART II. INFANT FEEDING
Nursing WeaningArtificial Feeding Selection and Care of Milk Used for Infant Feeding Modification of Cow's Milk Food for Healthy Infants--The Early Months Food for Healthy Infants--The Later Months General Rules for Guidance in the Use of the Formulas Given Addition of Other Foods to Milk Overfeeding Loss of Appetite Changes in Food Required by Special Symptoms or Conditions Common Mistakes in Milk Modification and Infant Feeding Preparation of Cow's Milk at Home Directions for Feeding Infants Intervals of Feeding Regularity in Feeding Sterilized Milk Modified Milk of the Milk Laboratories Peptonized Milk Feeding During the Second Year Feeding During the Third Year
PART III. THE DIET OF OLDER CHILDREN
Milk and Cream Eggs Meats and Fish Vegetables Cereals Broths and Soups Bread,Crackers, and Cakes Desserts Fruits Indigestion in Older Children General Rules to be Observed in Feeding Food Formulas
PART IV. MISCELLANEOUS
Bowels Sleep Exercise Cry Lifting Children Temperature Nervousness Toys Kissing Convulsions Foreign Bodies Colic Earache Croup Contagious Diseases Scurvy Constipation Diarrhoea Bad Habits Vaccination Weight Charts
PART I. THE CARE OF CHILDREN
At what age may a child be given a full tub bath?
Usually when ten days old; it shouldnot be given before the cord has come off.
How should the bath be given?
It should not be given sooner than one hour after feeding. The room should be warm; if possible there should be an open fire. The head and face should first be washed and dried; thenthe body should be soaped and the infant placed in the tub with its body well supported by the hand of the nurse. The bath should be given quickly, and the body dried rapidly with a soft towel, but with very little rubbing.
At what temperature should thebath be given?
For the first few weeks at 100° F.; later, during early infancy, at 98° F.; after six months, at 95° F.; during the second year, from 85° to 90° F.
With what should the bath be given?
Soft sponges are useful for bathing the body, limbs and scalp. There should be a separate wash-cloth for the face and another for the buttocks.
What are the objections to bath sponges?
When used frequently, they become very dirty and are liable to cause infection of the eyes, mouth or genital organs.
Under whatcircumstances should the daily tub bath be omitted?
In the case of very feeble or delicate infants on account of the exposure and fatigue, and in all forms of acute illness except by direction of the physician. In eczema and many other forms of skin disease much harm is often done by bathing with soap and water, or even with water alone.
How should the genital organs of a female child be cleansed?
Best with fresh absorbent cotton and tepid water, or a solution of boric acid, two teaspoonfulsto the pint. This should be done carefully at least once a day. If any discharge is present, the boric-acid solution should invariably be used twice a day. Great care is necessary at all times to prevent infection which often arises from soiled napkins.
How should the genital organs of a male child be cleansed?
In infancy and early childhood the foreskin should be pushed back at least twice a week while the child is in his bath, and the parts thus exposed washed gently with absorbent cotton and water.
If the foreskin is tightly adherent and cannot readily be pushed back, the physician's attention should be called to it. The nurse or mother should not attempt forcible stretching.
When is circumcision advisable?
Usually, when the foreskin is very long and so tight that it cannot be pushed back without force; always, when this condition is accompanied by evidences of local irritation or difficulty in passing water.
How should the eyes of a little baby be cleansed?
With a piece of soft linen or absorbentcotton and a lukewarm solution of salt or boric acid,--one half of an even teaspoonful to one pint of water.
If pus appears in the eyes, what should be done?
They should be cleansed every hour with a solution of boric acid (ten grains to one ounce of water). If the lids stick together, a little vaseline from a tube should be rubbed upon them at night. If the trouble is slight, this treatment will control it; if it is severe, a physician should be called immediately, as delay may result in loss of eyesight.
How is an infant's mouth to be cleansed?
An excellent method is by the use of a swab made by twisting a bit of absorbent cotton upon a wooden toothpick. With this the folds between the gums and lips and cheeks may be gently and carefully cleansedtwice a day unless the mouth is sore. It is not necessary after every feeding. The finger of the nurse, often employed, is too large and liable to injure the delicate mucous membrane.
What is sprue?
It appears on the lips and inside the cheeks like littlewhite threads or flakes. It is also called thrush. In bad cases it may cover the tongue and the whole of the inside of the mouth.
How should a mouth be cleansed when there is sprue?
It should be washed carefully after every feeding or nursing with a solution of borax or bicarbonate of soda (baking soda), one even teaspoonful to three ounces of water, and four times a day the boric-acid solution mentioned should be used.
How should the infant's skin be cared for to prevent chafing?
First, not too much nor too strong soap should be used; secondly, careful rinsing of the body; thirdly, not too vigorous rubbing, either during or after the bath; fourthly, the use of dusting powder in all the folds of the skin, under the arms, behind the ears, about the neck, in the groin, etc. This is of the utmost importance in very fat infants.
If the skin is very sensitive and chafing easily produced, what should be done?
No soap should be used, but bran or salt baths given instead.
How should a bran bath be prepared?
One pint of wheat bran should be placed in a bag of coarse muslin or cheese-cloth, and this put in the bath water. It should then be squeezed for five minutes until the water resembles a thin porridge.
How should a salt bath be prepared?
A teacupful of common salt or sea salt should be used to each two gallons of water.
How should the buttocks be cared for?
This is the most common place for chafing, as the parts are so frequently wet and soiled; hence the utmost pains should be taken that all napkins be removed as soon as they are wet or soiled, and the parts kept scrupulously clean.
If the parts have become chafed, what should be done?
Only bran and salt baths should be used, and in very severe cases even these may have to be omitted for a day or two. The parts may be cleansed with sweet oil and a little absorbent cotton, and the skin kept covered with a dusting powder composed of starch two parts, boric acid one part.
What is prickly heat, and how is it produced?
It consists of fine red pimples, and is caused by excessive perspiration and the irritation of flannel underclothing.
How should it be treated?
Muslin or linen should be put next to the skin; the entire body should be sponged frequently with equal parts of vinegar and water, and plenty of the starchand boric-acid powder mentioned should be used.
What are the most essential things in the clothing of infants?
That the chest shall be covered with soft flannel, the limbs well protected but not confined, and the abdomen supported by a broad flannel band, which should be snug but not too tight. It is important that the clothing should fit the body. If it is too tight it interferes with the free movements of the chest in breathing, and by pressing upon the stomach sometimes causes the infant to vomit soon after swallowing its food. If the clothing is too loose it is soon thrown into deep folds or bunches, which cause much discomfort. No pins should be used, but, instead all bands about the body should be basted. The petticoats should be supported byshoulder straps.
How should the infant be held during dressing and undressing?
Nothing is more awkward than to attempt to dress a young baby in a sitting posture. It should lie upon the nurse's lap until quite old enough to sit alone, the clothing being drawn over the child's feet, not slipped over the head.
Of what use is the band?
It protects the abdomen, but its most important use is to support the abdominal walls in very young infants, and in this way to prevent the occurrence of rupture.
How long is this band required?
The snug flannel band, not usually more than four months. In healthy infants this may then be replaced by the knitted band, which may be worn up to eighteen months. The band is an important article of dress in the case of thin infants whose abdominal organs are not sufficiently protected by fat. With such, or with those prone to diarrhoea, it is often advisable to continue the band until the third year.
What changes are to be made in the clothing of infants in the summer?
Only the thinnest gauze flannel undershirts should be worn, and changes in temperature should be met by changes in the outer garments. The greatest care should be taken that children are not kept too hot in the middle of the day, while extra wraps should be used morningand evening, especially at the seashore or in the mountains.
Should older children be allowed to go with their legs bare?
If strong and well there is no objection to this in very hot weather. In cold weather, however, it is doubtful if any children are benefited by it, particularly in a changeable climate like that of New York. Many delicate children are certainly injured by such attempts at hardening.
What sort of underclothing should be worn during cold weather?
Never the heaviest weight, even in winter.Four grades are usually sold, the next to the heaviest being thick enough for any child.
Do little children require as heavy flannels as older people?
Not as a rule. They usually live in a warm nursery; their circulation is active; and they always perspireeasily during their play. When they go out of doors, the addition of coats and leggings renders thick flannels unnecessary.
Are not many little children clothed too thinly for the ordinary house?
Very few. The almost invariable mistake made in city homes is that of excessive clothing and too warm rooms. These two things are among the most frequent reasons for their taking cold so easily.
How should napkins be taken care of?
They should he immediately removed from the nursery when soiled or wet. Soiled napkins should be kept in a receptacle with a tight cover, and washed as soon as possible.
Should napkins which have been only wet be used a second time without washing?
It is no doubt better to use only fresh napkins, but there is no serious objection to using them twice unless there is chafing of the skin. Clean napkins, changed as soon as wet or soiled, are of much importance in keeping the skin healthy.
What are the important things to be observed in washing napkins?
Soiled napkins should not beallowed to dry, but should receive a rough washing at once; they should then be kept in soak in plain water until a convenient time for washing, at least once every day, when they should be washed in hot suds and boiled at least fifteen minutes. Afterward they should be very thoroughly rinsed or they may irritate the skin, and ironed without starch or blueing. They should never be used when clamp.
What are the essentials in a good nursery?
The furnishings should be very simple, and unnecessaryhangings and upholstered furniture should be excluded. As large a room as possible should be selected one that is well ventilated, and always one in which the sun shines at some part of the day, as it should be remembered that an average child spends hereat least three fourths of its time during the first year. The nursery should have dark shades at the windows, but no extra hangings or curtains; about the baby's crib nothing but what can be washed should be allowed. The air should be kept as fresh and aspure as possible. There should be no plumbing no drying of napkins or clothes, no cooking of food, and no gas burning at night. A small wax night-light answers every purpose.
How should a nursery be heated?
Best by an open fire; next to this by a Franklinstove. The ordinary hot-air furnace of cities has many objections, but it is not so bad as steam heat from a radiator in the room. A gas stove is even worse than this, and should never be used, except, perhaps, for a few minutes during the morning bath.
At what temperature should a nursery be kept during the day?
Best, 66° to 68° F., measured by a thermometer hanging three feet from the floor. Never should the temperature be allowed to go above 70° F.
At what temperature during the night?
During the firsttwo or three months, not below 65° F. After three months the temperature may go as low as 55° F. After the first year it may be 50° or even 45° F.
At what age may the window be left open at night?
Usually after the third month, except when the outside temperature is below freezing point.
How often should the nursery be aired?
At least twice a day in the morning after the child's bath, and again in the evening before the child is put to bed for the night. This should be done thoroughly, and the child shouldbe removed meanwhile to another apartment. It is well to air the nursery whenever the child is out of the room.
What symptoms are seen in a child who is kept in too hot a room?
It becomes pale, loses appetite, shows symptoms of indigestion, occasionally vomits, stops gaining in weight, perspires very much, and takes cold easily because of this and also because of the great difference between the indoor and outdoor temperatures. Its condition may be such as to lead one to suspect very serious illness.
How early may airing indoors he commenced and how long may it be continued?
Airing in the room may be begun, even in cold weather, when the child is one month old, at first for only fifteen minutes at a time. This period may be gradually lengthened byten or fifteen minutes each day until it is four or five hours. This airing may be continued in almost all kinds of weather.
Is there not great danger of a young baby's taking cold when aired in this manner?
Not if the period is at first short and the baby accustomed to it gradually. Instead of rendering the child liable to take cold, it is the best means of preventing colds.
How should such an airing be given?
The child should be dressed with bonnet and light coat as if for the street and placed in its crib or carriage which should stand a few feet from the window All the windows are then thrown wide open, but the doors closed to prevent draughts. Screens are unnecessary.
At what age may a child go out of doors?
In summer, when one week old; in spring andfall, usually at about one month; in winter, when about three months old, on pleasant days, being kept in, the sun and out of the wind.
What are the best hours for airing out of doors?
In summer and early autumn a child may be out almost any time betweenseven in the morning and sunset; in winter and early spring, a young child only between 10 or 11 A.M. and 3 P.M., although this depends somewhat upon the climate. In New York and along the Atlantic coast the early mornings are apt to be damp and the afternoons raw and cloudy.
On what kind of days should a baby not go out?
In sharp winds, when the ground is covered with melting snow, and when it is extremely cold. A child under four months old should not usually go out if the thermometer is below freezingpoint; nor one under eight months old if it is below 20° F.
What are the most important things to be attended to when the child is out in its carriage?
To see that the wind never blows in its face, that its feet are properly covered and warm, and that the sun is never allowed to shine directly into its eyes when the child is either asleep or awake.
Of what advantage to the child is going out?
Fresh air is required to renew and purify the blood, and this is just as necessary for health and growth as properfood.
What are the effects produced in infants by fresh air?
The appetite is improved, the digestion is better, the cheeks become red, and all signs of health are seen.
Is there any advantage in having a child take its airing during the first five or sixmonths in the nurse's arms?
None whatever. A child can be made much more comfortable in a baby carriage, and can be equally well protected against exposure by blankets and the carriage umbrella.
What are the objections to an infant's sleeping out of doors?
There are no real objections. It is not true that infants take cold more easily when asleep than awake, while it is almost invariably the case that those who sleep out of doors are stronger children and less prone to take cold than others.
What can bedone for children who take cold upon the slightest provocation?
They should be kept in cool rooms, especially when asleep They should not wear such heavy clothing that they are in a perspiration much of the time. Every morning the body, particularly the chest and back, should be sponged with cold water (50° to 60° F.).
How should this cold sponge bath be given?
The child should stand in a tub containing a little warm water, and a large bath sponge filled with cold water should be squeezed two or three times over the body. This should be followed by a vigorous rubbing with a towel until the skin is quite red. This may be used at three years, and often at two years. For infants a little higher temperature (65° to 70°) may be used.
WEIGHT, GROWTH, AND DEVELOPMENT
Of what importance is the weight of the child?
Nothing else tells so accurately how well it is thriving.
During the first year a record of the weight is almost indispensable; throughout childhood it is of much interest and is the best guide to the physical condition. It will well repay any mother or nurse to keep such a record.
How frequently should a child be weighed?
Every week during the first six months, and at least once in two weeks during the last six months of the first year. During the secondyear a child should be weighed at least once a month.