Children - Physical Care
( Originally Published Early 1900's )
The following article has been prepared from a careful examination of most of the existing literature of the subject, both in this country and in Europe. It represents the last word on the subjects of which it treats. Among the volumes which have been used in this compilation and to which acknowledgments should be made are : Hutchison's great work, "Food and Dietetics"; Hess, "Principles and Practice of Infant Feeding"; Fischer, "Diseases of Infancy and Childhood"; and H. Lowenburg, "Infant Feeding." All these are standard authorities. But the greatest debt is to the assistance in materials furnished by Miss Lillian D. Wald, head nurse of the Henry Street Nurses' Settlement, New York, an institution of international fame and reputation whose great work in child saving is monumental. Jointly with these the author has consulted such works as the "Child, a Study in the Evolution of Man," by Dr. A. F. Chamberlain; "Child Training," by V. M. Hillyer; and "Handicaps of Childhood," by H. Addington Bruce. The schedules and formulas are those of the Henry Street Settlement, the Vanderbilt Clinic of New York City, and the Children's Bureau of Washington, D. C. On the entire article the valuable assistance of Dr. S. R. Burnap, associate dean of the College of Physicians and Surgeons of Columbia University, New York, is also acknowledged.
The care of the child from the moment of its birth is now known to be a matter of prime necessity, not merely because the child arrives as a stranger in a strange land, but because he has everything to learn and what at the moment is more important has no means of doing anything for himself.
"A child at birth," says Major J. W. Powell, "is destitute of things possessed in manhood, which distinguish him from the lower animals. Of all industries he is artless; of all institutions he is lawless ; of all languages he is speechless ; of all he is opinionless ; of all reasoning he is thoughtless." That is an exact description of the newborn babe. What he is to become, therefore, depends first of all upon this physical care and treatment which he receives. Here is the routine for the care of a newborn baby during its earliest months :
ROUTINE FOR BATH
Before Undressing the Baby.
a. Care of eyes:
The eyes are cleansed with a cotton pledget dipped in boric solution. The head is turned to one side, a dry pledget being placed at the outer edge to catch the solution and thus prevent its running into the ear.
The lids of the eyes are not pulled open. If the baby's eyes are shaded, it involuntarily opens them.
b. Care of the nose:
The nostrils are cleansed with small cotton swabs moistened in oil or vaseline.
c. Care of the ears :
The creases of the ears are cleansed with small cotton swabs (not toothpick swabs) moistened in oil or vaseline.
d: Care of mouth :
Cleansing of the mouth is not permissible, unless ordered by the physician.
While Undressing the Baby.
a. Rectal temperature.
b. The buttocks are cleansed with oil. (The mother is taught to follow this procedure twice daily and after stools.)
c. The foreskin is retracted, or labia separated, and parts thoroughly cleansed with oil.
d. The baby is weighed in shirt and band.
a. The baby's face is washed without soap, the head is soaped and rinsed well over the basin.
b. The baby's arms and legs are soaped and rinsed by sponging.
e. The creases are carefully oiled, the excess being wiped away with clean cotton.
d. Band is removed, protecting cord.
e. Trunk is soaped and rinsed by sponging.
f. If cord dressing is soiled, after washing hands, a dry sterile dressing is applied.
Dressing the Baby.
a. The straight band is necessary only as long as the cord is on. Then a knitted band is preferable.
b. The square diaper is used because there is no irritation to genitals and skin and no excess clothing forcibly separating the legs.
N. B.—Care of the Diaper : Soiled diapers should be brushed clean under the toilet flush, then washed at once, or put in covered pail of borax solution (1 tablespoon to a quart of water, fresh every day), rinsed daily through two waters and dried. All diapers should be boiled twice a week in soap solution and rinsed through three waters and dried in the sun if possible. Diapers are never blued; only ivory soap or some equally pure soap is used.
During the baby's bath, the bed is aired, in the sun if possible.
This routine indicates in detail which should receive the constant attention of the mother in the training of her baby. The first act being the bath, the bathing routine becomes one of great importance, as it remains throughout life. Then there are the eyes, the mouth, the skin, the various organs of the child to be carefully inspected and cleansed so that we have a clean and thoroughly groomed child.
The importance of caring for the eyes lies in the fact that the delicate tissues of the child are very susceptible to infection, and this must be guarded against most carefully. It has been found that many troubles come from want of care of the eyes in the newborn baby. They should be watched constantly, and if pus appears they should be cleansed and a solution of boric acid used. Always handle the eyes with extreme care.
The skin of a young child should likewise be a subject of very careful observation and care because, delicate as it is, it is likely to chafe and so become a source of trouble. In washing and otherwise cleansing the skin of the child, no harsh materials should be used. Note the instructions to the Henry St. nurses about the use of oil and the like and apply the principles there laid down in general wherever similar conditions prevail.
THE GENITAL ORGANS
As to the genital organs of the child, the main instruction to be observed is care and cleanliness with the possible use of boric acid solution. When unusual features present themselves, never use violence, as in pushing back the foreskin of a male child, but always use the delicate organs gently. Where some-thing very unusual presents itself, a physician should be consulted, but in a healthy baby care and especially cleanliness will solve most questions.
TEMPERATURE OF BATH
A full tub bath may be given to a child two weeks old and sometimes a day or two earlier, but generally not before the cord has come off. The temperature should begin at about 100 degrees Fahrenheit and be gradually reduced till it gets down at the end of a year to about 95, and perhaps ten degrees lower at the end of the second year. It seems to be the general opinion that sponges should not be used, because they may not get carefully cleansed after using or be properly aired or otherwise be kept sweet and wholesome ; but if they are used, they should be very soft and pliable, and care should be taken that the body should be dried quickly and without violent rubbing, which may injure the skin.
Many young mothers make the mistake of supposing that the child is to be kept warm by heavy clothing, but this is a mistake. The weight of the clothing does not insure warmth. Often it hinders circulation and aeration and does just the opposite. Light clothing, even in cold weather, should be worn next the body and additional warmth secured when necessary by additional outer clothing. In young children this rule holds equally well. Of course, perfectly healthy children may very well make most of their own rules, so long as thev are active and flourishing. The main thing to remember is that the clothing is for the body, not the body for the clothing. Excessive clothing in many homes is the rule. This tends to destroy freedom of motion and otherwise prevent the best development.
WEIGHT AND GRoWTH
Weight is generally considered the test of growth and development. There has been found to be a very well established average schedule of growth in weight and size, so that almost any mother can tell pretty well by reference to this table how her child is getting along. Of course it is not absolute, and allowances always must be made for prolonged sickness, for indigestion, or any other interruption of what should be the normal course of things. For this reason a record of the weight of a child should be kept, because, this will give the absolute fact which without it could never be established. It has the merit of being accurate, while simply saying "he looks all right" or "he acts all right" does not tell anything. Often troubles that come later develop in the loss of weight, or the failure to gain, which goes on imperceptibly unless a record of the weight is kept. Examination once in ten days or two weeks will give a fair insight into what is taking place in this regard. When the child is nursing, the progress is pretty regular if all goes well. When changes are made, to cow's milk, for example, enough time should be allowed to make the necessary change in the digestive organs. This is true of many changes. When for any reason a change is made in the diet or care of a child, always allow reasonable time for the change to work—don't expect it to produce a result over night. In all these matters use a little judgment and always remember that the subject is not one of mathematics—the results will vary with individual children ; and this must always be taken into consideration. The above table will give the general outline of what may reasonably be expected.
The subject of teeth carries its own deep significance to every-one, and the memory of the visits to the dentist with the attendant pains and discomforts should make us aware how carefully we should look to the culture and development of the teeth. There is one fact here which is very generally overlooked. When children are teething, there is a special burden laid upon them for which provision should be made, careful dieting and care that the losses attendant upon teething are made up daily in the food so that anaemia, which, oftener than we think, results during teething, may not occur. There are twenty teeth in the first set, and there should ordinarily be little trouble with most of them. They appear at regular intervals, beginning, possibly, in the fifth month, but there is no fixed rule; children differ greatly. But, in general, a year-old child should have six teeth ; at a year and a half he should have twelve; at two years he should have sixteen; and at two and a half he should have the whole twenty of the first set. But, as stated, the rule is a very flexible one, especially in the early appearance of the teeth. Here family inheritance may account for something and illness or careless feeding during dentition may account for others. The troubles of teething do not last long and are not dangerous, though uncomfortable, but the matter of careful feeding during this period is very important.
The subject of child nurture has assumed increasing importance as the matter has become the inquiry of scientists and investigators. The habits formed, the foods chosen, the inclinations developed, the regularity and the observation of digestive results, are all a part of the careful mother's business. No detail is too slight to be at least analyzed and weighed for what it may indicate. It must alwavs be remembered that the child cannot tell anything about itself except to give signs of pain or discomfort and the wellbeing of the child is therefore exclusively the business of the mother or nurse who attends it. Carelessness here is absolutely inexcusable and neglect is criminal. Because we have the ability to do anything we choose to do, it should be of paramount importance that we do the right thing at the right time.
There is a danger that should be noted at the outset. Children have no means of enforcing their needs. They can cry, of course, but a cry can go unheeded, especially if the child is off somewhere where it cannot be heard. Let nothing interfere with your exact observance of your plan. By all means have a plan and then stick to it. Often company appears at the child's feeding time, and because you want to be polite to your visitor, you keep delaying your duty to your child. Don't do it. Tell your visitor very plainly that you must be excused, and generally people will recognize the wisdom and justice of your excuse. Sometimes, however, it is not your visitor but you that is the cause of trouble. It is not unknown that young mothers, at pleasure parties, or in the midst of social diversions, have carelessly said to themselves, "Well, half an hour won't make much difference," or "He is so well that it will be all right," and then put off some duty in the matter of feeding so that usually the time has been extended until serious damage has been done. The break in regularity is itself a damage. Then, again, it is bad practice to have the ordinary conditions of feedings interrupted by the presence of other people, or by unusual events taking place in the room, and general disturbance of one kind and another. This should not be. Just keep before you that the peace and quiet of the little one is as valuable to him as it is to you, and don't intrude upon it needlessly. You and he are in the business of building up the digestive organs and the body with which he must travel through life. Every instant of care you give him in the formative stage of his existence saves him multitudes of troubles later on, and these, if they are permitted to accumulate, impair the efficiency of his body and may destroy his happiness in life. You have nothing but your own love and conscience to direct you in this matter, because there is no one to challenge your neglect or carelessness. The child cannot, and no one else would think of invading what is your special field. Not many mothers would willingly do anything injurious, or fail to do anything that is needful, but mothers are beset with many cares and because the home, the father, and perhaps friends and social duties are pressing, it is very easy, even for well meaning mothers, to become thoughtless almost without knowing it.