Happy is the mother and fortunate is the home that possesses the intelligent services of a trained attendant during the early days of the baby's career. A century or more ago skilled nurses were unheard of, and both mothers and babies seemed to thrive on the unskilled but faithful and sympathetic care given by the willing neighbor who "thought I'd just run over and help out." Who of us cannot remember the days when mother was "gone to a neighbor's" to give this same willing but unskilled care at the time of "confinement."

MODERN METHODS

And why are we so concerned today about asepsis, sterilization, etc., when a generation ago they were not? We used to live more slowly than we do now. Then it took the entire day to do the marketing for the week, now we take a receiver from the hook and a telephone wire transmits the verbal message. Our days are literally congested with events that were almost impossibilities a century ago. The ease and leisure of former days are unknown and unheard of today. The artificial way in which we live exerts more or less of a strain upon the present generation; the average woman's nervous system is keyed up to a high pitch; her general vital resistance is running at a low ebb; while child-bearing brings a certain added stress and strain that requires much planning to avoid and overcome.

For many days and ofttimes weeks the mother is unfit—physically unable—properly to care for her child, and so whether it be the trained assistant in constant attendance or the visiting nurse in her daily calls, or the kind, willing, but unskilled neighbor—each helper must acquaint herself, in varying degrees, with the physical, nervous, and mental needs of the child, as well as take into account and anticipate the numerous habits and wants of the new born babe, such as urination, bowel movement, pulse, respiration, temperature, etc.

THE HEAD

At birth, the head is remarkably large as compared to the rest of the body, for, surprising as it may seem, the distance from the crown to the chin is equal to the length of the baby's trunk; and, too, if birth has been prolonged this large head has also been pressed or squeezed somewhat out of shape. This state of affairs, however, need give no cause for either alarm or anxiety, for the head will shape itself to the beautiful rotundity of the normal baby's head within a few days.

The general shape of the baby's head, as seen from above is oval. Just back of the forehead is formed a diamond-shaped soft spot known as the anterior fontanelle which should measure a little more than one inch from side to side. On a line just posterior to this soft spot and to the back of the head, is found another soft spot somewhat smaller than the one in front. Gradual closure of these openings in the bones occurs, until at the end of six or eight months, the posterior fontanelle is entirely closed; while eighteen months are required for the closure of the anterior fontanelle.

These "soft spots" should not be depressed neither should they bulge. The head is usually covered with a growth of soft, silky hair which will soon drop out, to be replaced, however, by a crop of coarser hair in due season. The scalp should always be perfectly smooth. Any rash or crusts or accumulation of any kind on the scalp is due to uncleanliness and neglect, and should be carefully removed by the thorough application of vaseline followed by a soap wash. The vaseline should be applied daily until all signs of the accumulation are entirely removed. The eyes of all babies are generally varying tints of blue, but usually change to a lighter or darker hue by the seventh or eighth week. The whitish fur which often is seen on the baby's tongue is the result of a dry condition of the mouth which disappears as soon as the saliva becomes more abundant.

CHEST, ABDOMEN, AND LEGS

The baby's chest, as compared to the size of the head and abdomen, appears at a disadvantage, while the arms are comparatively short and the legs particularly so, since they measure about the same as the length of the trunk. They naturally "bow in" at birth so that the soles of the feet turn decidedly toward each other. All these apparent deformities, as a rule, right themselves without any help or attention whatsoever.

PULSE AND RESPIRATION

The pulse may be watched at the anterior fontanelle or soft spot on top of the head while the child quietly sleeps and should record, at varying ages, as follows:

The above table is correct for the inactive normal child. Muscular activity, such as crying and sucking, increases the pulse rate from 10 to 20 beats per minute.

The respiration of the baby often gives us no small amount of real concern at the first. The baby may be limp and breathless for some few moments at birth, and this condition calls for quick action on the part of the nurse and doctor.

The utmost care to avoid the "sucking in" of any liquid or blood during its birth must be exercised, for this often seriously interferes with the breathing. Sometimes this condition is not relieved until a soft rubber catheter is placed in the throat and the mucus is removed by quick suction. When you are reasonably sure that there is no more mucus in the throat, then sudden blowing into the baby's lungs (its lips closely in touch with the lips of the nurse or physician) often starts respiration. Slapping it on the back also helps, while the quick dip into first hot then cold water seldom fails to give relief.

A quiet-sleeping infant breathes as shown below at varying ages. An increase of six to ten breaths per minute may be allowed for the time it is awake or otherwise active.

THE WEIGHT

The normal weight of the average baby is seven to seven and one-half pounds. Its length may range anywhere from sixteen to twenty-two inches.

There is an initial loss of weight during the first few days; however, after the milk has been established the child should make a weekly gain of four to eight ounces until it is six months old, after which time the usual gain is from two to four ounces per week.

If the weight has been doubled at six months and the weight at one year is three times the birth weight, the child is said to have gained evenly and normally.

THE SKIN

At birth the skin of the baby is red and very soft owing to the presence of a coating of fine down. A blue-tinged skin may be occasioned by unnecessary exposure or it may be due to an opening in the middle partition of the heart which should close at birth. As soon as the baby is born, it should be placed on its right side while the cord is being tied, as this position facilitates closure of this embryonic heart opening. With the provision for a little additional heat the blue color should disappear, if it is not due to this heart condition. At the close of the first week the red color of the skin changes to a yellow tint due to the presence of a small amount of bile in the blood. This sort of jaundice is very common and is in no wise evidence of disease. The "down" falls off with the peeling of the skin which takes place during the second week; by the end of which time, the skin is smooth and assumes that delightful "baby" character so much admired.

THE CORD DRESSING

The cut end of the tied umbilical cord is swabbed and squeezed with a sterile sponge saturated with pure alcohol. It is then wrapped in a sterile dressing made as follows: Four or five thicknesses of sterile cheese cloth are cut into a four-inch square with a small hole cut in the center and one side cut to this center. This is slipped about the stump of the cord and wrapped around and about in such a manner as entirely to cover the stump of the cord. The wool binder is then applied and sewed on, thus avoiding both pressure and the prick of pins. If it remains dry this dressing is not disturbed until the seventh or eighth day, when the cord ordinarily drops off. Should it become moistened the dressing is removed and the second dressing is applied exactly like the first.

THE EYES

The closed eyes of the newly born child are generally covered with mucus which should be carefully wiped off with a piece of sterile cotton dipped in boracic acid solution, in a manner not to disturb the closed lid. A separate piece of cotton is used for each eye and the swabbing is done from the nose outward. The physician or nurse drops into each opened eye two drops of twenty per cent argyrol, the surplus medicine being carefully wiped off with a separate piece of cotton for each eye. The baby should now be placed in a darkened corner of the room, protected from the cold.

The eyes are washed daily by dropping saturated solution of boracic acid into each eye with a medicine dropper. Separate pieces of gauze or cotton are used for each eye.

THE FIRST OIL BATH

As soon as the cord and the eyes have received the proper attention and the mother has been made comfortable, the baby is given its initial bath of oil. This oil may be lard, olive oil, sweet oil, or liquid vaseline. The oil should be warmed and the baby should be well covered with a warm blanket and placed on a table which is covered with a thick pad or pillow. The temperature of the room should be at least eighty degrees Fahrenheit. Quickly, thoroughly, and carefully the entire body is swabbed with the warmed oil—the head, neck, behind the ears, under the arms, the groin, the folds of the elbow and knee—no part of the body is left untouched, save the cord with its dressing. This oil is then all gently rubbed off with an old soft linen towel.

THE FIRST CLOTHING

After the oil bath, the silk and wool shirt (size No. 2), the diaper and stockings are quickly put on to avoid the least danger of chilling. The band having been applied at the time of the dressing of the cord, our baby is now ready for the flannel skirt. This should hang from the shoulders by a yoke of material adapted to the season, cotton yoke without sleeves if a summer baby, and a woolen yoke with woolen sleeves if a winter baby. The outing-flannel night dress completes the outfit and should be the only style of dress worn for the first two weeks. Loosely wrapped in a warm shawl, the baby is about ready for its first nap, save for a drink of cooled, boiled water.

This cooled, boiled, unsweetened water should be given in increasing amounts every two hours until the child is two or three years of age. It is usually given the child in a nursing bottle. In this way it is taken comfortably, slowly, can be kept clean and warm, and should the babe be robbed of its natural food and transferred to the bottle as a substitute for mother's milk, it will already be acquainted with the bottle and thus one-half of a hard battle has already been fought and won.

BABY'S FIRST NAP

The baby's bed should be separate and apart from the mother's. It may be a well-padded box, a dresser drawer, a clothes basket, or a large market basket. A folded comfortable slipped in a pillow slip makes a good mattress. A most ideal bed may be made out of a clothes basket; the mattress or pad should come up to within two or three inches of the top, so the baby may breathe good fresh air and not the stale air that is always found in a deeply made bed. Into this individual bed the baby is placed as soon as it is dressed; and a good sleep of four to six hours usually follows.

Frequent observations of the cord dressing should be made as occasionally hemorrhage does take place, much to the detriment of the babe. If bleeding is at any time discovered the cord is retied just below the original tying. By the time baby has finished a six- or eight-hour nap the mother is wondrously refreshed and is ready to receive it to her breast.

PUTTING TO THE BREAST

During the first two days the baby draws from the breasts little more than a sweetened watery fluid known as the colostrum; but its intake is essential to the child in that it acts as a good laxative which causes the emptying of the alimentary tract of the dark, tarry appearing stools known as the meconium. On the third day this form of stool disappears and there follows a soft, yellow stool two or three times a day.

The child should be put to the breast regularly every four hours; two things being thus encouraged: an abundant supply of milk on the third day and the early shrinking of the uterus. More than once a mother has missed the blessed privilege of suckling her child because some thoughtless person told her "why trouble yourself with nursing the baby every four hours, there's nothing there, wait until the third day;" and so when the third day came, there was little more than a mere suggestion of a scanty flow of milk, which steadily grew less and less.

THE URINE

The urine of the very young child should be clear, free from odor and should not stain the diaper, nor should it irritate the skin of the babe. Often urination does not take place for several hours, sometimes not at all during the first twenty-four hours. If the infant does not show signs of distress, there is no cause for alarm; the urine should pass, however, within thirty hours. As a rule there are usually between ten and twenty wet diapers during each twenty-four hours. The following table shows about the amounts of urine at different ages:

GENITALS OF THE MALE CHILD

The foreskin of the male child is often long, tight, and adherent, and is often the direct cause of irritability, nervousness, crying, and too frequent urination. It should be closely examined by both physician and nurse and when the foreskin does not readily slip back over the acorn-like head of the organ, circumcision is advised early in the second week. This simple operation will start the child out on his career with at least one moral handicap removed and one desirable possibility established—that of being able to keep himself clean.

POST-OPERATIVE CARE OF CIRCUMCISION

The dressings that are loosely applied at the time of the operation should remain untouched (especially those next to the skin), unless otherwise directed by the physician, until the seventh or eighth day when the babe is placed in a warm soap bath, at which time the dressings all come off together. Clean sterile gauze is so placed as entirely to protect the inflamed skin from the diaper at all times before this bath, and these same dressings should be continued for at least another week. Sterile vaseline (from a tube) should be applied twice a day after the original dressings are removed in the bath at the end of the first week. There should be little or no bleeding following the operation, neither should the penis swell markedly; if either complication should occur, the physician should be promptly notified.

The girl baby is often neglected in respect to the proper care of the genitals. The lips of the vulva should be separated and thorough but careful cleaning should be the daily routine. The foreskin or covering of the clitoris should not be adherent; while the presence of mucus, pus, or blood in the vulva should be at once reported to the physician; in his absence, the application of twenty per cent argyrol should be made daily.

HANDLING THE BABY

Let us thoroughly come to understand the very first day the little one's life, that it was not sent to us because the family needed something to play with; it is not a ball to toss up, neither is it a variety show. It is a tiny individual, and your responsibilities as parents and caretakers are very great. The child was sent to be fed, clothed, kept warm, dry, and otherwise cared for by you, until such a time as it will become able to care for itself. Remember, what we sow, that shall we also reap. If we sow indulgence we shall reap anger, selfishness, irritability, "unbecomingness"—the spoiled child. At two or three days the baby learns that when it opens its mouth and emits a holler, someone immediately comes. If we do it on the second and third day, why should we object to run, bow, and indulge on the one hundredth and second day?

Handle the baby as little as possible. Turn occasionally from side to side, feed it, change it, keep it warm, and let it alone; crying is absolutely essential to the development of good strong lungs. A baby should cry vigorously several times each day. If the baby is to be handled, support the back carefully (Fig. 6).

THE EARLY BATHS

During the first week the baby is oiled daily over his entire body, with the exception that the cord dressing remains untouched. The face, hands, and buttocks are washed in warm water. After the third week the bathroom is thoroughly warmed and the small tub is filled with water at temperature of 100 F. The baby having been stripped and wrapped in a warm turkish towel, is placed on a table protected by a pillow, while the caretaker stands by and vaselines the creases of the neck, armpits, folds of the elbows, knees, thighs, wrists, and genitals; and then, with her own hands, she applies soap suds all over the body—every portion of which is more quickly and readily reached—than by the use of a wash cloth. And now, with the bath at 100 F., with a folded towel on the bottom of the small tub, the soapy child is placed into the water and after a thorough rinsing is lifted out again to a warm fresh towel on the table and the careful drying is quickly begun. After the bath all the folds and creases are given a light dusting with a good talcum.

During hot weather the bath should be given daily, soap being used twice a week. On the other days there should be the simple dipping of the child into the tub. During the cold weather the full bath is given but twice a week, while on the other days a sponge bath or an oil rub may be administered.

A weak, delicate child should not be exposed to the daily full bath, but rather the semi-weekly sponge bath and the daily oil rub should be administered. We have found the late afternoon hour to be better than the early morning hour for baby's bath. It requires too much vital resistance to react to an early morning bath, especially when the house is cool.

REGARDING SOAP

The use of soap is very much abused with young babies. I recall one mother who came into the office with her poor little baby which was constantly crying and fretting because of a greatly inflamed body—all a result of the too frequent use of soap. I said, "I am afraid you do not keep your baby clean." "O Doctor!" she replied, "I wash him with soap every time I change him; I am sure he is clean." And come to find out, the poor little fellow's tender skin had been subjected to soap several times a day. We ordered the use of all soap discontinued, vaseline and talcum powder to be used instead, and the child's skin got well in a very short time.

CARE OF THE UMBILICUS

Tight bands should not be placed about the babe. If the umbilicus protrudes, do not endeavor to hold it in by a tight band, but consult your physician about the use of a bit of folded cotton and adhesive plaster, and then allow the child the freedom of the knitted bands, with skirts suspended from yokes. The day of tight bands and pinning blankets with their additional and traditional windings is over. After the complete healing of the cord, the need for a snug binder to hold the dressings in place is over. Should the baby cry violently, the umbilicus should be protected in the manner described above—the fold of cotton and the adhesive plaster.

The diaper, stockings, shirt, skirt, and dress with an additional wrapper for cold days completes the outfit at this age.

BIRTH REGISTRATION

"One of the most important services to render the newborn baby is to have his birth promptly and properly registered."

In most states the attending physician or midwife is required by law to report the birth to the proper authority, who will see that the child's name, the date of his birth, and other particulars are made a matter of public record. Birth registration may be of the greatest importance when the child is older, and parents should make sure this duty is not neglected.

A public health official some time ago epitomized some of the uses of birth registration as follows: