COMMERCIAL BABY FOODS

3. From “Save The Babies” by Dr. L. Emmet Holt and Dr. H. K. L. Shaw. Copied by courtesy of The American Medical Association.

“The simplest plan is to use whole milk (from a shaken bottle) which is to be diluted according to the child’s age and digestion.

“Beginning on the third day, the average baby should be given 3 ounces of milk daily, diluted with seven ounces of water. To this should be added one tablespoonful of lime water and 2 level teaspoonfuls of sugar. This should be given in 7 feedings.

“At one week, the average child requires 5 ounces of milk daily, which should be diluted with 10 ounces of water. To this should be added 1½ even tablespoonfuls of sugar and one ounce of lime water. This should be given in 7 feedings.

“The milk should be increased by ½ ounce about every 4 days.

“The water should be increased by ½ ounce about every 8 days.

“At 3 months the average child requires 16 ounces of milk daily, which should be diluted with 16 ounces of water. To this should be added 3 tablespoonfuls of sugar and 2 ounces of lime water. This should be given in 6 feedings.

“The milk should be increased by ½ ounce about every 6 days.

“The water should be reduced by ½ ounce about every 2 weeks.

“At 6 months the average child requires 24 ounces of milk daily, which should be diluted with 12 ounces of water. To this should be added 2 ounces of lime water and 3 even tablespoonfuls of sugar. This should be given in 5 feedings.

“The amount of milk should be increased by ½ ounce every week.

“The milk should be increased only if the child is hungry and digesting his food well. It should not be increased unless he is hungry, nor if he is suffering from indigestion even though he seems hungry.

“At 9 months, the average child requires 30 ounces of milk daily, which should be diluted with 10 ounces of water. To this should be added 2 even tablespoonfuls of sugar and 2 ounces of lime water. This should be given in 5 feedings.

“The sugar added may be milk sugar or, if this cannot be obtained, cane (granulated) sugar or maltose (malt sugar).

“At first plain water should be used to dilute the milk.

“At 3 months, sometimes earlier, weak barley water may be used in the place of plain water; it is made with ½ level tablespoonful of barley flour to 16 ounces of water and cooked 20 minutes.

“At 6 months the barley flour may be increased to 1½ even tablespoonfuls, cooked in the 12 ounces of water.

“At 9 months, the barley flour may be increased to 3 level tablespoonfuls, cooked in the 10 ounces of water.

“A very large baby may require a little more milk than that allowed in these formulas. A small delicate baby will require less than the milk allowed in the formulas.”

These formulas may be tabulated as shown on p.177.

Mixed Feeding.Under some conditions the breast-fed baby is given also a certain amount of modified milk, and this combination of natural and artificial feeding is termed mixed or supplementary feeding.

A deficiency in the breast milk, ascertained by weighing the baby before and after each nursing, may be suppliedby following each nursing with a bottle feeding; or for some reason, one or two breast feedings, in the course of the day are sometimes replaced by entire bottle feedings. In any case the milk mixture to be used as supplementary feeding is prepared with exactly the same painstaking care as is the milk for entire artificial feeding.

If supplementary food is given because of an inadequate supply of breast milk, it is of great importance that the baby be put to the breast regularly, no matter how little food he obtains, for his suckling is the best possible means of stimulating the breasts to secrete more milk, and of equal importance is the fact that they will tend to dry up if the baby nurses less than about five times in twenty-four hours. Moreover, even a little breast milk is valuable to him and he should have the benefit of all there is to be had.

An entire bottle feeding is sometimes given to a baby who is nursing satisfactorily at the breast, in order to give his mother an opportunity to take longer outings than are possible between the regular nursings. And sometimes it is to the mother’s advantage, and therefore to the baby’s, to give him a bottle during the night and thus allow her to sleep undisturbed.

COMMERCIAL BABY FOODS

Since the baby’s nourishment is prescribed by the doctor, you have no reason to concern yourself with the various proprietary baby foods and canned and powdered milks that are so persuasively advertised to young mothers. And I earnestly hope that by the time you finish this little book, no one will be able to make you believe that any of these foods is likely to be satisfactory if used as a sole article of diet throughout the bottle-feeding period.

Unquestionably there are many times and circumstances when the temporary or supplementary use of a prepared infant food or canned or powdered milk is advantageous.

In some cases of intestinal disturbance a proprietary food may be a great boon, or while the mother is traveling and is unable to have freshly prepared milk formulas supplied to her along the way. These foods may be valuable, also, during the summer, while one stays at a hotel or boarding house where the freshness, cleanliness or purity of the milk are uncertain, or during a sudden shortage of fresh milk, as may occur during a strike or severe storm when transportation is interrupted. But you should not use a prepared infant food for any length of time without your doctor’s order.

If you are confronted with the necessity of choosing a prepared food, for temporary use, you may be guided by considering the general objects and principles of baby feeding and the character of the various foods at your disposal.

The proprietary foodsmay be divided into two general groups: one kind contains milk powder and is usually added to water, while the other consists largely of sugar and starch and is added to fresh milk before being given to the baby.

Canned milkis of two kinds; evaporated, which is unsweetened, and condensed, which is sweetened.Evaporated milkis whole milk from which part of the water has been removed, the milk then being canned and sterilized. The addition of water to evaporated milk restores it to the composition of whole milk in many respects, but it is still milk that has been heated.Condensed milkis evaporated milk to which cane sugar has been added to aid in its preservation. Since bacteria do not grow well in highly sweetened foods, it is not necessary to bring sweetened condensed milk to as high a temperature as the unsweetened product, to prevent subsequent bacterial decomposition. The high percentage of sugar in condensed milk quite obviously renders it unsuitable for continuous use as the sole article in a baby’s dietary.

Milk powders or dried milksare prepared by rapidly evaporating the water from whole milk, skimmed milk or partly skimmed milk, leaving the solid constituents in the form of a light, white powder. Milk powder readily dissolves in water, forming a “reconstructed milk” which closely resembles the fresh milk from which it was prepared. But it must not be forgotten that reconstructed milk has been heated. Many doctors consider whole milk powder the most satisfactory form of preserved milk which is available for baby food. Should it be used, however, the importance of keeping it tightly covered and in a cold place must be recognized, for the presence of fat renders it likely to become rancid if not kept cold.

Barley water, sometimes used to dilute whole milk, is made by mixing the barley flour to a smooth paste in cold water, adding boiling water and boiling for twenty minutesor cooking in a double boiler for an hour, straining and adding enough water to replace the amount lost in cooking. The proportions for different ages are as follows:

Three months, ½ level tablespoonful barley flour to 16 oz. water.Six months, 1½ level tablespoonfuls barley flour to 12 oz. water.Nine months, 3 level tablespoonfuls barley flour to 10 oz. water.

Three months, ½ level tablespoonful barley flour to 16 oz. water.

Six months, 1½ level tablespoonfuls barley flour to 12 oz. water.

Nine months, 3 level tablespoonfuls barley flour to 10 oz. water.

Potato Water.One tablespoonful of thoroughly boiled potato is mashed into one pint of the water in which the potato was boiled and carefully strained.

Spinach.Spinach is carefully washed, steamed for half an hour and mashed through a fine sieve. It is sometimes started at the sixth month; one teaspoonful daily, gradually increased to one or two tablespoonfuls daily.

Orange Juice.The orange should be dipped in boiling water and wiped on a clean towel before being cut and squeezed, to avoid possible infection of juice. It is usually given to babies, sometimes as young as one month old, who take heated milk. It is carefully strained and started gradually by giving one teaspoonful in water once or twice daily between feedings and increasing to ½ or 1 ounce by the sixth month and 1½ to 2 ounces by the end of the first year.

Infusion of Orange Peel.This is sometimes used instead of orange juice, and is made by boiling one ounce of finely grated orange peel in two ounces of water, adding a little sugar to counteract the bitter taste and adding enough sterile water to bring it up to two ounces.

Tomato Juice.Canned tomato strained through a fine sieve, is sometimes given to a baby a few weeks old, starting with one teaspoonful and gradually increasing to four to six ounces daily.

Whey.One quart of whole milk heated to 98° F. or 100° F. and one half ounce of liquid rennet or one junkettablet stirred into it and allowed to stand half an hour or until firm and solid, is poured into a cheesecloth bag and allowed to drain for about an hour without being squeezed.

Protein Milk.The curd from one quart of milk, which remains after the whey is drained, as directed above, is mashed through cheesecloth in a fine wire sieve, with a potato-masher or bowl of a spoon and the curd washed through with one pint of water. A pint of buttermilk is added and the mixture boiled while being stirred constantly. This is sometimes given in diarrhea.

Beef Juice.One pound of thick round steak, slightly broiled, is cut into small pieces and the juice expressed with a meat press or a lemon squeezer, the amount varying from 2 to 3 ounces. It may be diluted with an equal amount of warm water, or slightly warmed by being placed in a cup standing in hot water, and salted to taste.

Broths.One pound of lean meat, all fat and gristle removed, is allowed to one pint of water. The meat is cut finely and put on in cold water, heated slowly and allowed to simmer for three or four hours, when water is added to replace what was lost in cooking. It is strained, the fat removed and slightly salted.

Oatmeal Water.Two level tablespoonfuls of oatmeal in a pint of boiling water is cooked in a double boiler for two hours, strained and enough boiling water to replace the amount lost in cooking.

By the time you assume your baby’s care he will probably be having his daily bath in a tub. It may be given under a spray, however, or the doctor may prefer to have him sponged. The sponge bath may be given in yourlap or on a table covered with a pad, either method being satisfactory if the baby is kept warm and comfortable. But one inclines to the idea of having the baby bathed in the lap for he seems happier there; more comfortable and less frightened and we cannot be sure that these factors are unimportant to even a tiny baby.

The best time for the daily bath, during the first three or four months, is about an hour before the second feeding in the morning. After this age the full bath is sometimes given before the six o’clock feeding, in the evening, for a bath at this hour is soothing and restful and often helps toward giving the baby a good night.

Preparation for the bath should be made with its possible effects, both good and bad, in mind, for the baby may be helped or harmed according to the skill with which he is bathed. He must not be chilled during his bath, and fatigue and irritation must be avoided by giving it quickly and with the least possible handling and turning. These ends may be served by conveniently arranging all of the articles which will be needed, on a low table at the right hand side of your chair, before the baby is undressed.

There should be a pitcher of hot and one of cold water; a bath thermometer; two soft washcloths; soft towels; bath blankets; Castile, or some other mild soap; boracic acid solution; sterile cotton pledgets; large and small safety-pins, or large ones and a needle and thread if the band is to be sewed on; unscented talcum powder; sterile albolene or olive oil; soft hair brush and a complete outfit of clothing. The little garments should be arranged in the order in which they will be put on, the petticoat slipped inside the dress, and in cold weather, all hung before the fire or heater, to warm.

The temperature of the room should be about 72° F. and if it is possible to bathe the baby before an open fireor a heater, so much the better. In any case he must be protected from drafts and a sheet hung over the backs of two straight chairs will serve very well as a screen if no other is available.

The tub or basin should be about three-quarters full of water at 100° F. for the new baby; about 95° F. after the third month and gradually lowered to 85° F. or 90° F. for the baby a year old. The temperature of the water should not be guessed at, but tested with a thermometer, though in an emergency you may safely use water that feels comfortably warm to your elbow.

Lay a folded towel in the bottom of the tub, before beginning, as babies are often frightened by coming in contact with the hard surface.

It is a good plan to wear a waterproof apron, covered with one of flannel over which is laid a soft towel, until the bath is finished. The towel is then slipped out, leaving the dry, flannel apron to wrap about the baby. Wash your hands thoroughly with hot water and soap, before beginning; sit squarely, with your knees together, on a chair without arms; take the baby in your lap and undress him under a blanket. In order that the bath may be given deftly and quickly it is well to bathe the different parts in the same order every day, for practice makes perfect.

It is usually a routine to weigh the baby every morning, during the first two or three weeks and once or twice a week afterwards, though premature babies and those who are frail are sometimes weighed at longer intervals because of the inadvisability of disturbing them so often. The baby is undressed for his bath, wrapped in a blanket, and laid in the scoop or basket of a beam scale and a note made of the entire weight, for if he is placed in the scales without protection he is likely to be chilled and frightened. Theweight of the blanket is ascertained separately and deducted from the total thus giving the baby’s exact weight.

The eyes should be bathed first, with pledgets of sterile cotton dipped in warm boracic acid solution, each pledget being used but once. To prevent the solution from running from one eye into the other, the baby’s head is turned slightly to one side and the lower eye wiped gently from the nose outward. The lids may then be separated by placing one thumb below the brow and lifting it slightly, and the eye flushed with a gentle stream by squeezing a freshly soaked pledget just above it. The head is turned to the other side and the eye on that side bathed in like manner.

The mouth is swabbed outvery gentlywith boric-soaked cotton wrapped about the tip of the little finger, care being taken not to injure the delicate mucous lining. The nostrils are cleaned with little spirals of cotton dipped in mineral oil or olive oil.

The face is then washed with warm water, no soap, and patted dry. The scalp, neck and ears are washed with soap and water and thoroughly dried by patting and by wiping gently in the creases. The body should then be soaped with your hand, only one part being uncovered at a time in order to avoid chilling.

To place the baby in the tub, slip your left hand under his head in such a way that it will rest upon your wrist as your fingers spread out to support his shoulders. Your thumb naturally curves over and holds the upper part of the baby’s arm without pulling or straining it. Grasp his ankles with the right hand and lower the little body into the water, feet first, as shown in Fig.50. This gradual lowering of the baby into the water is worth while, for he is likely to be frightened if he is plunged in suddenly. If the baby’s arm and shoulder are firmly held and supported by your left hand, it is an easy matter to steady his entire body and keep his head out of the water while giving the bath with your right hand, as in Fig.51.

Fig. 50.—Method of holding baby and lowering him into his bath.

Fig. 51.—Method of comfortably supporting the baby’s head above the water while giving his bath.

The new baby is not usually kept in the tub for more than two or three minutes, but when he is three or four monthsold he may stay in for five minutes and still longer as he grows older.

Hot water should never be poured into the tub after the baby has been placed in his bath but cold water is often added, for a three or four months old baby, or the warm bath followed by a quick sponge with cold water. The little body is quickly patted dry, afterwards, and rubbed briskly with the palm of the hand; the legs and arms stroked toward the body; the back from the neck downward and the chest and abdomen with a circular motion. Babies who react well to cold baths are benefited by them, but those who do not, may be harmed. Such “toughening” methods, to be beneficial, therefore, must be adjusted very carefully to the individual baby and should be employed only in accordance with the doctor’s directions.

Thegenitalsshould be bathed and dried with care; inspected daily and any unusual appearance reported to the doctor. It is not uncommon for girl babies to have a slight bloody discharge from the vagina. Although this is unimportant and soon disappears, your doctor should be told of any discharge, however slight. The doctor often wishes to have the foreskin of boy babies retracted every morning at the time of the bath, by gently rubbing it back with gauze or cotton, taking pains that it is pulled forward to the original position after the part underneath has been thoroughly bathed with boracic acid solution. If retraction is impossible after several daily attempts, the baby is not infrequently circumcised.

The care of the baby’steethis a part of the bath and should begin when the first tooth appears. It should be wiped front and back with a piece of gauze or cotton dipped in boracic acid or soda solution or some other weak alkaline wash, to neutralize the acid secretions of the mouth as these favor decay. After the baby has five or six teeth,the use of a very soft brush with tooth paste is often advised, the teeth being brushed with a circular motion or from the gums toward their edges. The teeth should be wiped, or brushed, morning and evening and after feedings. The reason for such close care of the temporary teeth is that they serve as a mold or brace to hold the jaws in proper shape for the permanent teeth which appear later. If the “milk” or first teeth decay or crumble away before the jaws are developed to the point when the permanent teeth appear, these second teeth are likely to be crowded, crooked and uneven.

After all of these details have been attended to and the entire body, including creases and folds, has been patted quite dry, it may be dusted with an unscented talcum powder, but this powdering must not be resorted to as an aid in drying the skin. In order to prevent chafing, the buttocks and thighs should be wiped clean with oil, or bathed with warm water, no soap, patted dry and powdered or oiled each time that the diaper is changed.

Thecordhas dropped off, in all probability, by the time you begin to bathe your baby, and the navel so well healed that you need do nothing to it, but you may be interested to know what painstaking care the nurse has given to this important detail of the baby’s toilet. The form and method of cord dressings vary somewhat with different doctors but in practically all cases the dressings are sterile, to prevent infection, and porous in order that air may gain access to the cord and promote the drying process. The dressing itself may consist of dry, sterile gauze or gauze wet with alcohol wrapped about the cord, as shown in Fig.52; or it may consist of squares of sterile gauze or muslin with holes in the centers to fit around the cord, and dusted with some such powder as boric acid, bismuth or salicylic acid and starch. The dressed cord is laid flat on the abdomenand directed upward to prevent its being wet with urine; a gauze sponge is placed over the dressing and the flannel binder applied, being sewed on or held in place with safety-pins, as shown in Fig.53.

Fig. 52.—Cord dressed with dry sterile gauze. (From photograph taken at Johns Hopkins Hospital.)

Fig. 53.—Straight flannel binder applied over cord dressing.

The band is put on firmly and with even pressure, but not tightly. It is a mistake to think that a tight band strengthens the baby’s abdominal muscles, for it has quite the opposite tendency and in addition may give pain and even cause vomiting. The band is removed every morning at the time of the bath, or whenever it is soiled, but thecord dressing is not usually taken off unless it is soiled. When the cord finally drops off, the straight flannel binder is replaced by a knitted band with shoulder straps. This is usually worn for three or four months, particularly in cold weather, to provide a little extra warmth over the abdomen. Thin, delicate babies sometimes need this band for a year or more.

Fig. 54.—Putting on the diaper which has been folded straight through the middle.

After the band has been applied, the warmed shirt is put on and then the diaper. There are two methods of putting on the diaper.

One is to fold the square diagonally and bring the diagonal fold around the baby’s waist. One of the lower corners is drawn up between the thighs, the two corners from the sides brought over this, straight across the waistline and not carried down between the thighs. The fourth corner is brought up over these and all are pinned securely with a safety-pin, while two other safety-pins hold the margins of the diaper together above the knees. The other method is to fold the diaper straight through thecenter, forming a rectangle twice as long as it is wide; to lay the baby on it lengthwise, draw the lower half up between his thighs as shown in Fig.54, and pin it on each side at the waistline and above the knees. (See Fig.55.)

In either case the diaper must be put on smoothly and care taken to avoid forming a thick pad between the thighs as this will tend to curve the bones of legs, which, as you know, are still soft. Squares of soft, absorbent material, which may be burned, when soiled, placed inside the diapers will greatly facilitate the laundry work.

Fig. 55.—How the diaper in Fig.54looks after it has been put on.

The baby’s diaper should be changed whenever it is wet or soiled, for in addition to making him restless and fretful for the time being, the skin about the thighs and buttocks will grow red and chafed if he is allowed to wear wet diapers. Wet diapers should not be dried and used again but washed with mild soap, boiled and whenever possible, dried in the open air and sunshine. All of this makes it apparent that the regular use of waterproof protectors is to be condemned since a baby so protected may wear a wet diaper for some time before it is discovered. Under special circumstances such as a drive, ashort journey or visit the diaper may be covered by waterproof drawers but their habitual use will make the baby unhappy and uncomfortable and may even result in a serious condition of the skin.

Coming back to dressing the baby, after his bath, we find that after the band, shirt and diaper have been adjusted the petticoat and dress are put on with the fewest possible motions and the baby’s hair brushed upward from his neck and back from the forehead. He should be wrapped in a small blanket, fed and laid quietly in his crib to sleep. If his hands and feet are cold a hot water bottle at 125° F. with a flannel cover, may be placed beside him.

When the baby is made ready for the night he may have a sponge bath or simply have his face and hands sponged with warm water, according to the wishes of the doctor. The clothing which the baby has worn during the day should be entirely replaced. The day and night clothing may be worn more than once, if clean and if aired between times, but it is better not to have the baby wear the same set of clothes for twenty-four hours at a stretch. In cold weather a tape is often run through the hem of the stockinette or flannel nightgown in order that it may be drawn up, bag fashion, to keep the baby’s feet warm. During very warm weather the baby sleeps in a thin cotton slip.

Your baby’s clothes were made long since, of course, but a word about their use is worth while as they may be very influential in promoting the baby’s well-being. In order that his body may be kept at an even temperature the warmth of his clothing must always be adjusted to the needs of the moment. The general tendency is to dress thebaby too warmly and the usual result is that he perspires; is listless, pale, and fretful; sleeps badly; is susceptible to colds and other infections and has poor recuperative powers. His digestion is likely to be deranged and he may have prickly heat. On the other hand, if the baby is not dressed warmly enough his hands and feet will be cold and his lips blue; he will cry from discomfort and the general result may be lowered vitality and disturbed digestion. If the baby’s clothes are not comfortable, if they pull and drag or have tight bands, he will be fretful and restless, with disturbed sleep and upset digestion in consequence.

The little wardrobe will be entirely adequate, under ordinary conditions, if it consists of shirts, bands, diapers, flannel petticoats, dresses, nightgowns, flannel wrappers and sacques. As the petticoats and dresses are cut twenty-seven inches long, many doctors feel that they offer enough protection for the feet of the average baby to make stockings unnecessary until he is from four to six months old. The skirts are then shortened to ankle length and stockings added to the baby’s attire. Other doctors think it wiser to put knitted socks or part wool stockings on the new baby, particularly if he is born during cold weather.

When the baby begins to creep, he should wear soft soled shoes, part wool stockings in cold weather and thin cotton or silk ones during the summer, and firm but flexible soled shoes as soon as he tries to stand alone or to walk.

During the first month or two the baby scarcely needs special clothing for outdoor wear as he may be wrapped in one of the flannel squares with a casing run in one corner to form a hood, or he may be placed on a square diagonally and the upper corner folded about his head and held under the chin with a safety-pin. The corners on the sides are folded about his shoulders, the lower one broughtup over his feet and limbs and the additional blankets tucked in over all. But as the baby grows older and moves about in his carriage, he will need a cap and cloak or wrap with hood attached. In cold weather the cap should be knitted or wool lined and the cloak of soft woolen material or wool lined. In moderate weather the cap may be of one thickness of cotton or silk, or very light flannel, while on very warm days he will need no head covering at all.

To sum up: The baby’s clothes should be simple in design, hang from the shoulders, fit smoothly but loosely and have no constricting bands; they should be of soft, light, porous material; their warmth always adjusted to the immediate temperature so that the baby will be protected from being either chilled or overheated. And his clothing must always be clean and dry.

An abundance of fresh air is one of the baby’s greatest needs as it increases his resistance to disease and his recuperative powers, improves his appetite and aids digestion. In general, the more the baby is in the open air and the more fresh air he has while in the house, the better.

The two factors which must be considered in supplying the baby with fresh air are the condition and vigor of the baby himself and the immediate temperature and state of the weather. His age and the season of the year can be only partial guides because of the difference between individual babies of the same age and the variations in temperature, winds and moisture during any one season.

The air of the room which the baby occupies should be changing constantly in order that it may always be fresh, but the temperature should be equable and the baby protected from drafts. As the tendency here, as with thebaby’s clothes, is toward overheating, you will do well to remember that the young baby who lies covered up in his crib, may usually be kept in a colder room than is advisable for an older one who is creeping or walking about.

During cold weather the baby’s bed should not be directly in front of an open window and he should be protected from direct currents of cold air by a sheet hung over the head and side of his crib.

Two or three times daily, while the baby is out of the room, the windows should be opened wide to air the room thoroughly, one of these airings being just before the baby is put to bed for the night.

The doctor’s usual instructions concerning the temperature of the nursery are to keep it from 68° F. to 70° F. during the day and about 65° F. at night, during the first three months and lower it gradually to 64° F. during the day and about 55° F. at night as the baby grows older. It is customary to begin to open the nursery window at night when the baby is three or four months old, if he is well and the temperature is above freezing.

In planning to take the baby out of doors it is wiser, as a rule, to begin with the indoor airing when he is about a month old, except, of course, during the moderate or mild months of the year, when he is taken out at once. If the weather is cold, the baby may be protected with extra wraps and carried in the arms, into a room in which the windows are open and kept there for fifteen or twenty minutes. This indoor airing is increased by being gradually lengthened to two or three hours and by having the windows opened wider and wider. By the time he is two or three months old he is taken out of doors on clear, bright days, the best time being between ten and three o’clock, when the sun is high. If he is carried in the nurse’s arms at first the warmth of her body serves as a protection and helps toaccustom him to the out-of-door life, when he spends a good deal of his time out of doors in his carriage.

On windy, stormy days or when there is melting snow on the ground, the baby may be given his airing on a protected porch or in a room with the windows open. He is not usually taken out if the temperature is below freezing until the third or fourth month. After this time the average baby is taken out when the temperature is not lower than 20° F.

When the baby is dressed in his extra wraps he must be taken out of doors or the windows opened immediately, for otherwise he will become overheated and be in danger of chilling when taken into the colder air.

Warm hands and feet, a good color and the baby’s tendency to sleep most of the time while out of doors are evidences of his being adequately clothed for his airing, while the reverse is true if he is not warm enough.

A robust baby who has been gradually accustomed to being out of doors during the day will usually be much benefited by sleeping out at night. But he must be protected from winds and his clothing so arranged that he cannot be chilled. Knitted or flannel sleeping garments or sleeping bags (See Fig.20) are valuable and in addition, the blankets which cover the baby should be securely pinned to the mattress with safety-pins and tucked well under it at the sides and foot. The baby should wear a warm cap and the bed should be warmed before he is put into it. Or better still, he may be dressed for the night, put to bed in a warm room and the crib then moved out on the sleeping-porch.

An excellent device for protecting the baby’s arms and chest, and keeping him generally well covered, is the poncho (Fig.56) devised by Dr. Lucy Porter Sutton of Bellevue Hospital. The poncho is a rectangle made of flannel, outingflannel or an old blanket and cut large enough to tuck well under the head and sides of the mattress and extend below the baby’s feet. The baby’s head slips through an opening, which is almost a right-angled slit, equally distant from the sides of the poncho and about 20 inches from the top. The slit is firmly bound and provided with tapes to tie it together after the baby is put in. The poncho should be put on loosely enough to permit the baby to move about at will beneath it. After it is adjusted the bed is made up as usual with additional blankets.

Fig. 56.—The “Sutton Poncho” which keeps even a restless baby well covered. The insert shows how to make the slit for his head to pass through. The regular bedding is turned back in this picture. (From a photograph taken at Bellevue Hospital.)

Under all conditions the baby’s airings must be increasedgradually, both as regards lowering the temperature and lengthening the time, and always adjusted to the vigor and reaction of the individual baby. He must be warm, but not too warm; he must be protected from wind and dust, and his eyes shielded from glare and from flickering light, such as may be caused by a tree in a light breeze.

Although the baby should not be handled unnecessarily nor tossed about and played with by friends and relatives, it is important that his muscular development be promoted by regular and carefully planned exercise. It is usually considered best for the baby to lie quiet and undisturbed in his crib most of the time during the first three or four weeks. Dr. Griffith begins the baby’s exercise about that time by having the nurse or mother take him in her arms on a pillow and carry him about for a few moments several times daily. After a week or two of this form of exercise the baby is carried in the arms without a pillow but with his head and back carefully supported as the nurse is doing in Fig.57. The position of the baby’s body is changed by his being carried about in this way and the movement of the nurse or mother as she walks, causes a certain amount of motion of the baby’s muscles which constitutes a gentle exercise. The baby should be carried first on one arm and then on the other in order that both sides of his body may be equally exercised.

This semi-passive form of exercise by means of being carried about is regarded by many doctors as almost indispensable to the baby’s welfare. There is a possibility that lack of this form of “mothering” is one reason why babies in institutions sometimes fail to progress as they should. Certainly, it is inadvisable for the baby to be allowed to lie for very long in one position.

By the third or fourth month the baby sits up in his mother’s arms, as she carries him about, and he may be placed on the outside of his crib coverings for a little while every day, to kick and struggle at will. His skirts should be rolled up under his arms, or removed entirely, to leave his legs quite free, care being taken that the room is warm and that he has on stockings.

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