The Care and Feeding of Children

Skin

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 starch and boric-acid powder mentioned should be used.

Clothing

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 by shoulder 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 morning and 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 perspire easily 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.

Napkins

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 be allowed 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.

Nursery

What are the essentials in a good nursery?

The furnishings should be very simple, and unnecessary hangings 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 here at 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 as pure 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 Franklin stove. 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 first two 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 should be 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.

Airing

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 by ten 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 and fall, 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 between seven 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 freezing point; 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 proper food.

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 six months 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 be done 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 second year a child should be weighed at least once a month.

How rapidly should an infant gain in weight during the first year?

There is usually a loss during the first week of from four to eight ounces; after this a healthy child should gain from four to eight ounces a week up to about the sixth month. From six to twelve months the gain is less, usually from two to four ounces a week.

Is it to be expected that bottle-fed infants will gain as rapidly as those who are nursed?

They seldom do so during the first month; after that time under favourable circumstances the gain is usually quite as regular, and during the latter half of the first year it is likely to be more continuous than in a nursing infant, because the latter usually loses weight at the time of weaning.

Why do they not gain so rapidly at first?

It takes a few weeks for the stomach to become accustomed to cow’s milk, and until this is accomplished it is necessary to make the milk very weak or the child’s digestion will be upset.

For a child of average weight at birth (seven to seven and a half pounds) what should be the weight at the different periods during the first year?

At three months it should be twelve to thirteen pounds; at six months, fifteen to sixteen pounds; at nine months, seventeen to eighteen pounds; at one year, twenty to twenty-two pounds. At five months a healthy child will usually double its weight, and at twelve months it will nearly treble its weight.

Do all healthy infants gain steadily in weight during the first year?

As a rule they do; yet it is seldom the case that one gains every week for the entire year. With most infants there are from time to time periods of a few weeks in which no gain is made. These are more often seen from the seventh to the tenth month and frequently occur when the child is cutting teeth, sometimes during very hot weather.

Is it true that every infant who gains rapidly in weight is thriving normally?

Not invariably. Some who are fed upon prepared infant foods increase rapidly in weight but not in strength, nor in their development in other respects.

Is the weight of as much value in the second year as a guide to the child’s condition?

After the first year, the gain in weight is seldom continuous; there are many interruptions, some depend on season, and others often occur without apparent cause.

At what age should the fontanel close?

The average is about eighteen months. It seldom closes earlier than fourteen months, and it should not be open at two years.

At what age should a child hold up its head?

As a rule during the fourth month, and often during the third month, the head can be held erect when the body is supported.

When does an infant first laugh aloud?

Usually from the third to the fifth month.

When does it begin to reach for toys and handle them?

Usually from the fifth to the seventh month.

At what age should a child be able to sit and to stand alone?

At seven or eight months a healthy child is usually able to sit erect and support the body. During the ninth and tenth months are usually seen the first attempts to bear the weight upon the feet, and at eleven or twelve months most children can stand with assistance.

When should a child walk alone?

The first attempts are generally seen in the twelfth or thirteenth month. At fifteen or sixteen months the average child is able to run alone.

What conditions postpone these events?

Prematurity, a very delicate constitution, any severe or prolonged illness, and especially chronic disturbances of digestion making feeding difficult. A common cause of late sitting, standing, or walking is rickets.

Should a child be urged to walk?

Never; he is usually quite willing to do so as soon as his muscles and bones are strong enough. None of the contrivances for teaching children to walk are to be advised.

When do children begin to talk?

Generally at one year a child can say “papa” and “mamma” or other single words. At the end of the second year the average child is able to put words together in short sentences.

If at two years the child makes no attempt to speak, what should be suspected?

Either that the child is a deaf-mute or that it is mentally deficient, although this is occasionally seen in children who are only very backward.

Table showing the Average Weight, Height, and Circumference
of Head and Chest of Boys1

At birth	Weight	7½ pounds.
	Height	20½ inches.
	Chest	13½ inches.
	Head	14 inches.
One year	Weight	21 pounds.
	Height	29 inches.
	Chest	18 inches.
	Head	18 inches.
Two years	Weight	26½ pounds.
	Height	32½ inches.
	Chest	19 inches.
	Head	19 inches.
Three years	Weight	31 pounds.
	Height	35 inches.
	Chest	20 inches.
	Head	19½ inches.
Four years	Weight	35 pounds.
	Height	38 inches.
	Chest	20¾ inches.
	Head	19¾ inches.
Five years	Weight	41 pounds.
	Height	41½ inches.
	Chest	21½ inches.
	Head	20½ inches.
Six years	Weight	45 pounds.
	Height	44 inches.
	Chest	23 inches.
Seven years	Weight	49½ pounds.
	Height	46 inches.
	Chest	23½ inches.
Eight years	Weight	54½ pounds.
	Height	48 inches.
	Chest	24½ inches.
Nine years	Weight	60 pounds.
	Height	50 inches.
	Chest	25 inches.
Ten years	Weight	66½ pounds.
	Height	52 inches.
	Chest	26 inches.

The above weights are with ordinary house clothes.

Dentition

How many teeth are there in the first set?

Twenty.

What is the time of their appearance?

The two central lower teeth are usually the first to appear, and come from the fifth to the ninth month; next are the four upper central teeth, which come from the eighth to the twelfth month. The other two lower central teeth and the four front double teeth come from the twelfth to the eighteenth month. Then follow the four canine teeth, the two upper ones being known as the “eye teeth,” and the two lower as the “stomach teeth”; they generally come between the eighteenth and the twenty-fourth month. The four back double teeth, which complete the first set, come between the twenty-fourth and thirtieth month.

At one year a child usually has six teeth. At one and a half years, twelve teeth. At two years, sixteen teeth. At two and a half years, twenty teeth.

What are the causes of variation?

The time of appearance of the teeth varies in different families; in some they come very early, in others much later. The teeth may come late as a result of prolonged illness and also from rickets.

What symptoms are commonly seen with teething?

In healthy children there is very often fretfulness and poor sleep for two or three nights; there may be loss of appetite, so that only one half the usual amount of food is taken; there is salivation or drooling, and often slight fever; there may be some symptoms of indigestion, such as vomiting or the appearance of undigested food in the stools. In delicate children all these symptoms may be much more severe.

How long do these symptoms last?

Usually only three or four days; but there may be no gain in weight for two or three weeks.

What is the cause of most of the other symptoms attributed to teething?

Nearly all of them come from indigestion due to bad feeding.