The Care and Feeding of Children by L. Emmett Holt

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THE CARE AND FEEDING OF CHILDREN

A CATECHISM FOR THE USE OF MOTHERS
AND CHILDREN'S NURSES

By

L. EMMETT HOLT, M.D., LL.D.

PROFESSOR OF DISEASES OF CHILDREN IN THE COLLEGE OF
PHYSICIANS AND SURGEONS (COLUMBIA UNIVERSITY)

ATTENDING PHYSICIAN TO THE BABIES' HOSPITAL AND THE
FOUNDLING HOSPITAL, NEW YORK

Fourth Edition, Revised and Enlarged

NEW YORK AND LONDON
D. APPLETON AND COMPANY

1907

COPYRIGHT, 1894, 1897, 1903, 1906
By D. APPLETON AND COMPANY

[Transcriber's Note: The text scans did not include a Table of
Contents so the following has been added for the convenience of
the reader.]

CONTENTS

I. THE CARE OF CHILDREN

Bathing
Genital Organs
Eyes
Mouth
Skin
Clothing
Napkins
Nursery
Airing
Weight, Growth, and Development
Dentition

II. INFANT FEEDING

Nursing
Weaning
Artificial 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

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

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

THE CARE AND FEEDING OF CHILDREN

PART I

THE CARE OF CHILDREN

BATHING

_At what age may a child be given a full tub bath?_

Usually when ten days old; it should not 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; then the 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 the bath be given?_

For the first few weeks at 100 deg. F.; later, during early infancy, at
98 deg. F.; after six months, at 95 deg. F.; during the second year, from 85 deg.
to 90 deg. 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 what circumstances 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.

GENITAL ORGANS

_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 teaspoonfuls to 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.

EYES

_How should the eyes of a little baby be cleansed?_

With a piece of soft linen or absorbent cotton 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.

MOUTH

_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 cleansed
twice 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 little white 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.

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 deg. to 68 deg. F., measured by a thermometer hanging three feet from
the floor. Never should the temperature be allowed to go above 70 deg. F.

_At what temperature during the night?_

During the first two or three months, not below 65 deg. F. After three
months the temperature may go as low as 55 deg. F. After the first year it
may be 50 deg. or even 45 deg. 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 deg. 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 deg. to 60 deg. 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 deg. to 70 deg.) 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 Boys_[1]

At birth Weight 7-1/2 pounds.
Height 20-1/2 inches.
Chest 13-1/2 "
Head 14 "

One year Weight 21 pounds.
Height 29 inches.
Chest 18 "
Head 18 "

Two years Weight 26-1/2 pounds.
Height 32-1/2 inches.
Chest 19 "
Head 19 "

Three years Weight 31 pounds.
Height 35 inches.
Chest 20 "
Head 19-1/2 "

Four years Weight 35 pounds.
Height 38 inches.
Chest 20-3/4 "
Head 19-3/4 "

Five years Weight 41 pounds.
Height 41-1/2 inches.
Chest 21-1/2 "
Head 20-1/2 "

Six years Weight 45 pounds.
Height 44 inches.
Chest 23 "

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