Better babies and their care

Sound digestion in the family baby stands for many good things. It spells peace and comfort for the entire household; for good digestion means good health and good humor, therefore a baby whose presence does not disturb the family. It spells small doctor’s bills, because a sound digestion gives the baby power of resistance to throw off germs of disease and even to pass safely through exposure to contagion. It spells efficiency and intelligent care on the part of the mother, for, common belief to the contrary notwithstanding, the healthy baby is not a matter of accident but of care. The knowledge of how to give that care may be innate, inherited from a line of sensible, motherly women, or it may be acquired by education in the feeding and care of infants; but it is there.

That fact is proved by experiment among untrained mothers. A Philadelphia branch of the Congress of Mothers started an infant-saving campaign in a certain ward of that city. For a given time, they had meetings of mothers, with talks on the care and feeding of babies, week in and week out. Babies were weighed and measured, and, as they gained, the mothers were praised for the improvement in their children. In this one ward, where education for motherhood was taught persistently and intelligently, the death rate was reduced 44 per cent. on the year. No record was kept of the improved condition in mothers and homes. These are blessings which cannot be reduced to figures.

When the American woman knows as much about feeding babies and children under three years of age as she knows about mixing bread, polishing furniture, and embroidering doilies, our home economics and domestic relations will undergo a change for the better. Thousands of marriages have been wrecked by the ignorance of the mother in rearing her children, and the subsequent confusion and quarreling. A sickly baby loads the husband and father with harassing expenses. It brings the family bread-winner home to a disordered house and a tired, fretful wife. It keeps both husband and wife awake when they should be securing a good night’s rest to meet the next day’s duties. Result: in poor circles, the husband turns coward and deserts wife and child; higher up in the economic scale, the husband secures work in a distant city and the wife goes home to “her people.” In either case, the man often seeks, in more pleasant companionship, relief from the unsatisfactory conditions existing in his own home.

The wife considers the husband unreasonable and dishonorable. She declares that she has the heavier burden to bear, a sickly baby to tend day and night. What she does not realize is that the baby would not be sickly if the mother knew her job of motherhood as well as the father knows his trade of bread-winning. The law does not recognize indigestion in the family baby as a divorce cause, but any judge who has ever presided over what is known as a court of domestic relations will tell you that desertion, non-support, cruelty, and infidelity on the part of the husband can often be traced directly to the wailing of a baby or several babies, who would not wail if their mothers knew how to guard their digestion.

Mothers are not altogether to blame for their inability to prevent digestive ailments in their babies. Generally, their own mothers did not understand this wonderful science of infant feeding, nor warn them of the pitfalls which yawn before the young mother who has not studied it.

Even general practitioners have not placed great importance on the study of babies. They have had their hands full by doctoring grown-ups, who might have been healthy adults if properly started in life.

After ushering the child into the world and pronouncing it sound, the average family physician has turned the baby over to the parents; and under their care it has remained until it developed some acute malady, when the doctor has reappeared on the scene. The cure of the malady, not its prevention, has long been the office of the family physician. They do it better in China, where physicians are paid only so long as the health of the family is good.

The world has long proceeded on the theory that with the birth of the baby was born in the mother some heaven-sent knowledge of how to raise the baby. To be sure, she was taught to read and write and cook and sew, but there was no need to teach her how to feed her baby. By some mysterious process, God supplied that knowledge. That He did not is shown by the fact that twenty-five per cent. of the deaths in our country are of children under one year of age.

Another mistaken belief about babies has been that they are born “delicate” or “strong”; and, as they are born, so must they live—that is, if they live at all! The delicate baby has been regarded as a cross, to be carried with patience and resignation. Mother trotted and dosed it by day; Father walked the floor with it by night; and the neighbors pitied them both. The idea that the poor little tot was born with the right to acquire strength and health was not preached: the thought of calling in science to transform the delicate baby into a strong one is comparatively new.

Fortunately for the race, a few brave spirits in the medical profession decided to defy tradition and study babies as controllable human machines rather than as dispensations of a more or less kindly Providence. They found that babies born healthy and normal could be kept that way; that babies born puny and delicate could be made sturdy and strong; that even babies born with inherited defects, physical and mental, could be so treated that they would develop into useful, self-supporting citizens, where once they were consigned to that hideous human scrap-heap, the institutions for defective and feeble-minded children.

Only those of us who have followed the work of specialists in children’s diseases—pediatrists, as they are known in the medical profession—can appreciate what marvels have been worked in children born without the birthright of good health. Now these men are going farther. They stand behind the twentieth-century campaign for public education among women in the care and feeding of children. They have rent the veil of mystery which so long has surrounded medical learning; they have written books for mothers, couched not in dictionary-defying terms, but in simple English which the average mother can understand; they have given public talks to mothers on infant feeding; and now they are leading the movement for health conferences between parents, physicians, and health officers—city, county, and state—and for what are known as Better Babies Contests, where babies are brought by their parents for examination in physical and mental development.

All these signs indicate a new and popular appreciation of what is known as preventive medicine. The broad-minded physician practises preventive medicine. The progressive mother works with the progressive physician, and the baby profits by the combination. To-day there is little excuse for a colicky, crying, sickly baby in the family circle. Except in rare cases, when the baby’s poor condition does not improve under intelligent mother-care, modern medical science can effect a cure. What generally stands between the sick baby and its cure to-day is ignorance or tradition on the part of the parent, who clings to the belief that strong babies are born to live, that weak babies are born to die, and that the Creator has decreed it!

In reality the Creator should not be held responsible for the physical future of the child. Its normal development is practically in the hands of the mother. In the midst of this magnificent campaign for the intelligent care and feeding of infants, she has no right to remain ignorant. Lectures, conferences, and books are at her command; and what this simple preventive medicine teaches her to do for her child she is morally bound to perform.

And this brings us back to the original statement at the head of this chapter: Sound digestion in the family baby stands for many good things—more especially for the safety and comfort of the baby. So it is most important that the mother ask herself:

“What is the condition of my baby’s digestion?”

The baby whose digestion is in good order gains steadily in weight, has firm flesh, a clear skin, and good color. During the first few months of its life it sleeps two or three hours after nursing; and during the brief periods of wakefulness it is quiet, good-natured, and quite content to lie staring at nothing. It does not demand attention, rocking or walking. It has an excellent appetite, nursing with relish, often greedily. This does not mean whimpering or fretting for food. The baby that tugs nervously at the breast is not properly nourished.

The healthy baby may have what is known as regurgitation, which is best described as the overflow when the baby has taken more milk than its little stomach will hold. The milk, uncurdled, practically exactly as it was swallowed, rolls out of the baby’s mouth without any gagging or muscular contraction. This is especially apt to happen when there is an unusually strong flow of mother’s milk; or when the nipple hole is too large for the bottle-fed baby.

The healthy baby does not have colic or gas on the stomach.

A healthy baby may cry, especially just before it is fed, because crying is its only method of announcing that it is hungry. It may also cry while being bathed or dressed, because it resents being disturbed. Such crying in moderation is healthful, for it is about the only exercise the baby gets.

Perhaps the best indication that a baby’s digestion is in good condition is the state of the bowels. The mother should watch this closely. For the first three or four days the movements are black and sticky. There should be not less than two and not more than four in number. From black they are very apt to turn green, and remain so for a week or more, because the flow of mother’s milk is not yet established. As a rule, however, during the second week, the breast milk gains in quality, and the stools turn a light yellow and become more solid, about the consistency of mush. If the mother’s digestion and general health are good, the child will have from two to four movements a day.

Neglect to regulate the bowels is one of the most common causes of death among bottle-fed babies. The entire system is poisoned, for the waste matter is not carried off through the bowels. The inexperienced mother will be wise to have her physician watch the stools until the child’s health seems fairly well established. Hundreds of bottle-fed babies, who do not outlive the first month, might be saved if this rule were observed. When a physician is not at hand, the mother must watch the stools with a critical eye.

The bowels of the bottle-fed baby rarely move as often as those of the breast-fed infant; but the stool is larger, and of a lighter yellow, smooth, and of the consistency of a firm ointment or cold cream. If the child does not have at least one movement a day, the proportions used in the modified milk must be changed.

The digestion of the nursing baby may be disturbed by milk that is scanty and poor in quality, or by milk that is too rich and flows too fast. When the former condition exists the child does not gain, and it may even lose in weight; the flesh is soft and flabby, the skin pale; the child sleeps poorly and often brokenly or with sobs. When awake the baby looks dull and listless, or is fretful or irritable. It may also belch gas or, if the gas is retained, there will be colic and a distended abdomen. Sometimes the bowels are constipated, but more generally the movements are loose and the stools green in color and streaked with mucus. Also the movement is accompanied by pain sufficient to make the child cry.

When the supply of milk is scant, the baby will seem hungry and restless; again, three-quarters of an hour after nursing, the baby will seize the nipple greedily but, after a moment, drop it in apparent disgust and begin to cry.

Sometimes both the quality and the quantity of the milk can be built up by attention to the health and diet of the mother; but, as this process is necessarily slow, the baby in the meantime must be given occasional feedings of modified milk, as described in Chapter V. Then, if the flow of milk is not established or the child still turns from the breast, a complete weaning must follow.

If the indigestion is due to overfeeding, the child shows an abnormal gain in weight, is restless after nursing, vomits, suffers from wind and colic, is dull and sleeps a great deal but restlessly, not quietly, perspires heavily on head and neck, and passes so much urine that, despite frequent changing, the diapers are always wet.

For these conditions there may be either or both of two causes: milk that flows too quickly, and milk that is too rich. The first trouble is easily corrected by the mother compressing the base of the nipple between her first and second fingers while the child is nursing, thus checking the rapid flow of the milk. The second trouble is not so easily corrected, for it is caused by one of three things: (1) the mother is eating food that is too rich; (2) she is taking too little exercise; (3) she is giving way to mental excitement, hysterics, grief, or temper. If the condition is not mental, and the mother is taking sufficient exercise, then it is a question of modifying the mother’s milk.

This can be done, first, through the mother’s diet—simpler food, less meat, no alcohol; second, just before nursing, the baby may be given an ounce of boiled water in which one-fourth teaspoonful of malt sugar has been dissolved, using an ordinary nursing bottle with a plain nipple. The child will then nurse a shorter time and the water taken from the bottle will dilute the milk drawn from the breast. The first few ounces drawn from the breast are less rich than the last ones; so if the child does not drain the breast, he does not get the richest part of the milk. This experiment should not be tried, however, without consulting the family physician, who will have a sample of the mother’s milk drawn with a breast-pump and analyzed before prescribing the sweetened water.

The mother must bear in mind, however, that there is a distinct difference between chronic and acute illness from indigestion. When a baby, that has nursed contentedly and gained regularly in weight, suddenly refuses the breast, this is generally a sign of acute illness, requiring the immediate attention of a physician and prompt treatment. When the symptoms of indigestion are slight, but persistent and regular, and the baby shows general distaste for either breast or bottle, then it is merely some disturbance of digestion, malnutrition or mal-assimilation of food, which can be corrected by modifying the diet.

Neglect of acute indigestion may mean convulsions, intestinal inflammation or other ailment which will quickly prove fatal. Slight but chronic indigestion should be corrected because it disturbs and weakens the entire system, fills it with poison and makes the child liable to disease. The child who “takes cold easily” or “teethes hard” is generally the child whose digestion is out of order.

General disorder of the digestive system is indicated by one or more of these symptoms: Constipation, diarrhea, colic, and vomiting. Gastric or stomach trouble is indicated by vomiting or the belching of gas; intestinal trouble by colic, flatulence, diarrhea, and constipation.

The wise mother will learn to distinguish between the various forms of vomiting. Regurgitation, already described, is not a danger signal; if the milk, unchanged in consistency and color, runs easily from the baby’s mouth almost immediately after the child is taken from the breast or bottle, and then, as if relieved, the infant rolls over in comfortable slumber, there is no cause for anxiety. If, however, the vomiting happens just before the next nursing period, or even an hour after nursing, the diet should receive attention; especially if the milk is curdled or colored with bile.

Before changing the diet, however, other factors in the care of the baby should be considered:

Is it fed at regular intervals, as outlined in Chapter IV?

At the Better Babies Contests I have often been shocked at the replies given by mothers when the doctors inquired, “How often is your child fed?”

Here are some of the answers: “I don’t know.” “When he wakes up.” “Whenever he cries.” “When I have time to sit down.”

The child that is fed irregularly is very apt to vomit.

So is the child that is jostled, jogged, or rocked after nursing. Directly a baby is fed it should be laid down in its crib and the food given a chance to digest.

Tight clothing over the stomach and abdomen will cause vomiting; and, for that reason, belly-bands must not be pinned tightly.

If none of the above reasons is present, and the baby vomits habitually, the diet must be changed.

The third form of vomiting is acute and sudden. It may generally be regarded as a symptom of an acute illness, such as measles, pneumonia, scarlet fever. It is safest to send for a physician under such circumstances. He can decide whether the acute vomiting is due to something the mother or child has eaten, or whether other symptoms of a serious ailment are present. Under ordinary circumstances the mother should merely withhold food until the arrival of the doctor. If the doctor cannot be secured for some time, she may safely give the child calomel, one-tenth of one grain every half-hour until one-half of a grain has been taken. The calomel should be carried off by an enema of warm water and sweet-oil. This may prevent serious consequences until the doctor arrives.

Gas on the stomach, with distention and pain, is indicated by belching, sometimes accompanied by a sour, watery fluid. Relief can be given by adding half a grain of benzoate of soda to each ounce of food for the bottle baby; but it is far better for both nursing and bottle baby if the mother will either change her own diet or reduce the quality of the bottle milk. Dr. Holt recommends, for gastric indigestion, two ounces of lime water to each twenty ounces of food.

Colic and flatulence come from the distention of the bowel by gas, and are generally accompanied by constipation. As a rule, if the constipation is relieved, the colic will disappear.

The presence of gas in the intestines generally indicates that either the sugar or the starch in the food is not being properly digested. The mother must reduce the quantity of starch and sweets which she is eating, in order to modify the breast milk. For the bottle-fed baby starch may be omitted from the food, and malto should be used instead of cane sugar.

For constipation in bottle-fed babies, milk of magnesia, which can be purchased at any first-class drugstore, may be added to the modified milk, in the proportion of one-half to one teaspoonful to each twenty ounces of food. The proportion must be according to the age of the child and the stubbornness of the constipation.

Constipation may also come from weak milk; in this case top milk instead of plain milk should be used in preparing the food for the bottle-fed baby.

No baby should be given cathartics nor enemas, except in emergencies. Even castor-oil is not safe, because if constipation springs from the fact that the milk is already too rich in fat, the oil increases the trouble. Enemas given every day weaken the muscles of the lower bowel. Up to the time the baby is six months old the mother should give no cathartic except milk of magnesia. The bottle-fed baby is given some of this at each feeding. It may be given to the breast-fed baby in a little boiled and warmed water, just before nursing. If milk of magnesia and attention to the diet do not correct the trouble, then a physician should be called in.

After six months a child may have orange juice, or orange and pineapple juice, strained; also apples scraped very fine.

Massage or kneading the abdomen lightly sometimes brings relief; but this should never be done immediately after the baby is fed. An hour should be permitted to elapse; and it is still better to massage the abdomen just before feeding. However, massage without correcting the diet is not sufficient.

Constipation must be corrected during infancy, for there is no other evil of the human system that can bring upon men and women a greater number of ailments which make life one long story of aches and pains.

Diarrhea is a symptom of acute illness, and frequently ends in death. It is the most dangerous of all symptoms that babies develop. With all the agencies at work for infant welfare in large cities, during hot weather, more babies die of diarrhea than of all the contagious diseases, like measles, whooping-cough, diphtheria, scarlet and typhoid fever, put together. Even in the country, with its pure air and its better facilities for securing clean milk, babies die of diarrhea in shocking numbers.

This dreaded disease of infancy can generally be traced to two causes: improper food, and unclean milk.

One reason why it is more prevalent in summer than in winter is the fact that heat affects milk quickly and unfits it for the baby’s digestion. When the breast-fed baby has diarrhea, the mother must immediately look to her own diet. The mother of the bottle-fed baby must look to the source and care given to the cow’s milk fed to the baby.

In this respect the small-town mother and the farmer’s wife have the advantage over the city mother. They can secure milk from healthy cows, directly the milking is over, twice a day. They can strain it through cheese-cloth, cool it rapidly on ice, and allow no contaminating hand or utensil to touch it. The city mother must pin her faith to certified milk.

So much for the prevention of diarrhea. If, in spite of every precaution, it appears, food of any kind must be withdrawn. Even the breast-fed baby should fast for twelve hours. Cleanse the bowels with either castor-oil or calomel. Try castor-oil first: one teaspoonful for the baby three months old or less. From three months to a year old, the dose may be graduated from a teaspoonful to a tablespoonful. If the baby cannot retain the castor-oil, try calomel as prescribed for vomiting—one-tenth of one grain every half-hour until one-half grain has been taken—for the baby up to four months. After that, and up to one year, the quantity may be increased, one-tenth of one grain every half-hour until two grains have been taken. Boiled water may be given at intervals, but not in any quantity, especially if the diarrhea is accompanied by vomiting. If the diarrhea does not yield to this treatment within twenty-four hours, a physician should be called in.