Management Of The Newly-born Child
( Originally Published Early 1900's )
Washing and Dressing—Feeding and Feeding-bottles—Aperients—Sleep—Warmth and Fresh Air - Separation of Navelstring—Swelling of the Breasts in the Newly-born—The "Thrush."
After making the mother comfortable, the next duty of the nurse is to attend to the washing of the child. This should be done, if possible, before the medical attendant leaves the house, in order that he may have an opportunity of examining the child thoroughly. For the washing, a foot-bath is required, or a basin at least one foot broad, one foot deep, and two feet long, so that the whole body, with the exception of the head, may be placed in the water for a minute or two. The nurse must also be provided with a piece of soft flannel,
some olive-oil, a piece of good, unirritating soap, and, for the dressing, in addition to the clothes, a needle and thread, some safety-pins, and a piece of linen rag six inches square, with a hole cut in its centre large enough to admit the navel-string. Sitting at a convenient distance from the fire, she then proeeeds to unfold the flannel wrapper and anoint the child's skin with warm olive-oil wherever it is covered with the white greasy material usually present. This having been done, the child is to be put into the water, the temperature of which should be about 90°, and the head supported on the left hand out of the water. After having rested there for about two minutes, it is to be taken on the lap and washed with soap and flannel, the eyes being carefully cleaned first, then the head, and afterwards the remainder of the body, great pains being take to cleanse the little wrinkles at the various joints. After gently drying the skin with a soft warm towel, it must be well powdered, and especially those parts near the joints- where chafing is most likely to occur; viz., under the knees and armpits, in the groins, and between the thighs. The piece of flannel used for the first washing should be burnt.
The skin having now been well washed, dried, and powdered, the square of old linen is to be held near the fire for a minute and slipped over the remains of the navel-string, which is to be folded in it and turned upwards upon the child's abdomen, where it is to be retained by means of the flannel binder until its separation, which usually takes place about the fourth or fifth day.
Up to the time of this separation, the child must be washed from head to foot on the nurse's lap, night and morning. Afterwards, when there is no longer any fear of injuring the navel, the child should be placed in the water for two minutes during the morning washing, the evening washing being done on the nurse's lap as before. Whenever a napkin is removed, the parts protected by it must be well cleansed by sponging with a little soap and water, and then thoroughly powdered, so as to prevent the skin becoming sore. This rule holds good even if the napkin has only been soiled with urine, though it is of course still more necessary when there has been also an action of the bowels.
It is part of a nurse's duty to wash and dress the child during the time she stays in the house, and she should, for this purpose, be provided with a large soft flannel apron, which must be carefully dried each time it is used.
The child's clothing should be warm without being heavy, and should fit loosely so as to allow the organs free play, and the blood to flow unhindered. The body-binder should be of flannel, as it is impossible to prevent its being soiled with the urine, and flannel, when wetted, does not chill the skin so much as other materials. None but patent safety-pins should be used _about a baby, and even for them it is better to substitute two or three stitches wherever it is possible.
The medical attendant must always be informed, when he makes his first after-visit, whether the infant has passed urine and whether the bowels have acted; also as to any marks or other peculiarities that may have been noticed. The state of the eyes, too, should be narrowly watched, and any unhealthy appearance or the least sign of discharge at once reported.
It is most undesirable to give a newly-born child butter and sugar, or other similar compound. For the first twelve hours at least, and indeed fora much longer time, the child will take no harm if left unfed. The proper course, however, is to apply it to the breast a few hours after birth-that is, as soon as the mother has recovered a little from the fatigue of labor. The breasts will probably not fill with milk for twenty-four or thirty-six hours, or even a little longer; but there is generally a little thick secretion of creamy fluid, called colostrum, much earlier than this, of which it is good for the mother to be relieved, and which acts as a gentle laxative upon the child. The early application of the child to the breast also helps to form the nipples, and renders the flow of milk easy from the first; it teaches the child how to suck, a lesson learnt Iess readily if it has previously been fed with a spoon; and, lastly, it provides it, in the majority of cases, with all the food it requires during the first day or two, and obviates the necessity of artificial feeding.
The child should be put to the breast with clock-like regularity. Until the flow is fairly established, the interval should be four hours; afterwards, for the first month, an hour and a half or two hours in the daytime and four hours in the night. In the daytime the child may be awakened at the feeding-hour; in the night he should on no account be disturbed out of his sleep. Many infants will sleep continuously for six hours in the night, and suffer no harm from the long fast.
If it is important that a child should be fed as often as is here stated, it is no less important that he should not be fed oftener. Young infants very soon learn habits of regularity, and, besides, their stomachs need rest between. their meals, just as in our own case, except that, of course, the intervals required are shorter. Many women put the child to the breast 'whenever it cries, forgetting that this is the only way in which it can express its sense of discomfort, from whatever cause arising, and that it is quite as likely to be crying because it is in pain, or because its napkin wants changing, as from hunger.
It is important from the first to apply the child to each breast in turn.
When the secretion of milk is long delayed, and it becomes consequently necessary to feed the infant, the proper food is good cow's milk, boiled, so as to prevent its being a carrier of infection, then mixed with about an equal quantity of water, and sweetened. Bread and .oatmeal gruel are not fit food for newly-born infants. They irritate the stomach and bowels and cause griping and flatulence. In short, during the first month of life no other food than the mother's milk or diluted cow's milk should be given, except under medical advice.
When the mother has not enough milk to satisfy the child, nursing maybe combined with hand-feeding, which is generally preferable to hand-feeding alone. The additional food should consist of good milk, boiled, diluted with an equal quantity of water and sweetened. After the first month the quantity of added water requires to be gradually lessened.
In case the mother cannot nurse her child, the next best way of feeding it is to obtain a good, healthy wet-nurse, whose child is not much older than the one she is to nurse. The medical attendant should always be consulted in regard to the health and suitability of a wet-nurse, before she is engaged.
It may be that a wet-nurse cannot be obtained, and then hand-feeding becomes necessary. For this purpose good milk (from one cow if possible), boiled, diluted, and sweetened, as already directed, is for the first few months all the food that is required. Arrowroot, cornstarch, and bread are all unsuitable at this tender age, and afford far less nourishment than milk.
Now and then a child is found with whom fresh milk does not agree, the curdy character of the stools showing that it is only partially digested. Should a change of dairy not suffice to set matters right, it will be desirable to try the concentrated Swiss milk, which, though greatly inferior to fresh milk, is the best of all-artificial substances. Failing success with this, a malted preparetion, known as Mellin's Food for Infants, may be tried, at any rate until the digestive powers become sufficiently improved to return to milk.
The custom of using feeding-bottles with India-rubber tubes has become exceedingly prevalent. These tubes are difficult to keep clean, and a mere drop or two of milk left adhering to the bottle or tube will often be sufficient to turn the next supply sour. Hence have arisen flatulence and indigestion, and much sickness and suffering. Another objection to the use of tubes is, that nurses are tempted to place children in the cot with the bottle of milk by their side and the tube in their mouth, a practice which is highly objectionable on several grounds. It does away with all regularity in feeding, and is very liable to cause the milk to be turned sour owing to the heat given off from the child's body. Feeding-bottles without tubes, and fitted with teats only, have the advantage of requiring to be held in the nurse's hand, and are on every account to be preferred. There should always be two, for alternate use, one being kept under water while the other is in actual use. Immediatetly after the child- has had a meal, the bottle must be thoroughly washed in warm water.
It is an unnecessary and injurious practice to administer castor-oil to the newly-born. The first milk (or colostrum) from the mother's breast generally relaxes the bowels sufficiently, and if not, no aperient should be administered except under the advice of the medical attendant.
Children should not sleep in the same bed with an adult, but should, from the first, be placed in their own separate cot. Attention to this rule would annually save many lives which are now sacrificed. The number returned every year as having been found dead in bed is astounding. Sometimes both mother and child fall asleep, while the child is at the breast, whereupon the child's face gets pressed so closely against the mother's body that both nose and mouth are covered, breathing becomes impossible, and the child is smothered; sometimes fatal asphyxia is produced by the child nestling down in the bed and going to sleep with its head completely covered by the bedclothes; and some-times, though of course very rarely, the cause of death in these cases is over-lying. These dangers are best avoided by letting the child sleep by itself.
During the first month or two a healthy child sleeps the greater part of both day and night.
Children should not be allowed to form the habit of being put to sleep on the nurse's lap, but should be placed in their cot awake, and soothed to sleep there. This is a lesson learnt without difficulty, if taught from the earliest days.
On no account should any kind of soothing medicine be given, except under medical advice.
Young babies require to be kept very warm, and yet need abundance of fresh air. Nursery windows should be opened very frequently, and the room kept pure and wholesome. After the first two or three weeks children should be carried in the arms out of doors every day in fine weather. In winter they should be well wrapped up, and in summer the head should be carefully protected from the rays of the sun,
When the navel-string is an unusually long time in separating, no force is to be used; all will go on properly if left to Nature. Separation having taken place, a small round piece of linen should be covered with a little vaseline or simple ointment, and applied to the navel. If the process be accompanied or followed by bleeding, the medical attendant should be informed without delay, as children occasionally die from this cause. Ile should also be told if, after the separation, the navel is found to project more than usual.
It is by no means an unfrequent occurrence for the breasts of newly-born children to become swollen and inflamed, and sometimes they are even found to contain a few drops of milk-like fluid. In either case the nurse must care-fully Avoid rubbing or squeezing them. The swelling will gradually disappear, and the fluid become absorbed under soothing treatment-as, for example, the ordinary water dressing; whereas rough manipulations, such as have just been mentioned, increase the inflammation, and are apt to result in the formation of abscess.
The appearance of a number of little white spots on the tongue, inside the lips and cheeks, and on the roof of the mouth, known in the nursery as "the thrush," is an almost certain sign that the child's food is in some way unsuit. able, and ought, therefore, invariably to be reported to the medical attendant-In the meantime the affected places should be painted several times a day with glycerine of borax, by means of a camel-hair brush.