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Infancy

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INFANCY, in medical practice, the first year of life. On being born the normal infant cries lustily, drawing air into its lungs. As soon as the umbilical cord which unites the child to the mother has ceased to beat, it is tied about 2in. from the child's navel and is divided above the ligature. The cord is wrapped in a sterilized gauze pad and the dressing is not removed until the seventh to the tenth day, when the umbilicus is healed.

The first event in a baby's life is its first bath. The room should be at a temperature of 70° F, and the bath water at zoo° F. The child should be well supported in the bath by the left hand of the nurse, and care taken to avoid wetting the gauze pad covering the cord. In some cases infants are covered with a white sub stance termed "vernix caseosa," which may be carefully removed by a little oil. Sponges tend to harbour bacteria, so absor bent cotton wool should take their place. After the first ten days F is the most suitable temperature for a bath. Night and morning, from the first, the mouth and nostrils should be cleansed with wet pledgets of cotton wool. When the baby has been well dried the skin may be dusted with pure starch powder to which a small quantity of boric acid has been added. The most im portant part of the toilet of a new-born infant is care of the eyes, which should be carefully cleansed with cotton wool dipped in warm water, and one drop of a 2% solution of nitrate of silver dropped into each eye. The clothes should consist exclusively of woollen undergarments, a soft flannel binder, which should be tied on, being placed next the skin, with a long-sleeved wool vest, and over this a loose garment of flannel coming below the feet and long enough to tuck up. Diapers should be made of soft absorbent material about 2ft. square and folded in a three cornered shape. An infant should always sleep in a bed or cot by itself. More than half the deaths from violence of children under one month are due to suffocation in bed with adults. A healthy infant should spend most of its time asleep, and should be laid into its cot immediately after feeding.

Physically, the first year is the most important one of the entire life cycle. Increase in height and weight and development of the organs of the body are greater than at any future similar period. The degree of health during the first year will determine, to a great extent, the health of the individual during later life. The main factor of proper infant care is nourishment, dependent upon the amount, character and regularity of feeding. Secondary fac tors of proper infant care are those which are concerned with the environmental conditions of life including fresh air, sunshine, sleep, cleanliness, bathing, exercise and the other measures of physical hygiene. The most definite evidence of health in infancy is an even continuous gain in weight in relation to height.

The normal infant at birth weighs about 7 lb. During the two or three days following birth a slight decrease in weight occurs, usually 5 to 6 oz. When nursing begins the child increases in weight up to the seventh day, when it will have regained its weight at birth. From the second to the fourth week after birth (accord ing to Camerer) an infant should gain I oz. daily or II to 2 lb.

monthly, from the fourth to the sixth month half to two-thirds of an ounce daily or i lb. monthly, from the sixth to the twelfth month . oz. daily or less than i lb. monthly. At the sixth month it should be twice the weight at birth. The average weight at the twelfth month is 20 to 21 lb. The increase of weight in artificially fed is less regular than in breast-fed babies.

Gain in weight is less in warm weather. Teething is apt to delay a regular gain in weight and from the seventh to the tenth month the weight may remain almost stationary or increase very little. The baby should be weighed once each week during the first six months and once every two weeks during the second six months. Weighing should take place at the same hour on the same day each week and with the same amount of clothing.

The average height at birth is about 19 in. If the weight of the baby is over or below seven lb., the height should be correspond ingly greater or less. The important points in determining health are : first, the relation between height and weight and, second, the rate of increase in height and weight. From birth to three months, the increase in height will be about three in. ; the same rate of increase should take place during the second three months and again during the following six months.

At birth, the circumference of the abdomen and of the chest should be the same ; in the average baby, about. I 3 2 in. The cir cumference of the head should be about 14 in. The chest and abdomen increase in size at the same rate and the head at a slightly less rate during the first year. At one year of age, the circumference of the head, chest and abdomen should be the same; about 18 in. for the average baby. Any disproportion to these measurements is evidence of malnutrition or some definite disease.

Food.—The ideal food for an infant is its mother's milk. Arti ficially-fed children are more liable to epidemic diseases. The child should be applied to the breast the first day to induce the flow of milk. The modern tendency is to feed it at 6 A.M., Io A.M., 2 P.M., 6 P.M. and 10 P.M., thus the mother gets a night's rest. Frequently, however, these intervals have to be shortened.

Artificial Feeding.

The simplest artificial food is cow's milk, diluted with boiled water and with the addition of a little cream and milk sugar. At first two parts of water should be added to one of milk and week by week the water should be diminished until at three months equal parts of milk and water and at six months three times as much milk as water are used. A teaspoonful of cream and a quarter of a teaspoonful of sugar of milk in each feed are appropriate amounts. Unless the source is unimpeachable the milk should be either sterilized by boiling or pasteurized, i.e., subjected to a form of heating which, while destroying pathogenic bacteria, does not alter the taste. The milk in a suitable apparatus is subjected to a temperature of 65° C (149° F) for half an hour and is then rapidly cooled to 20° C (68° F).

Various patent foods are on the market, some of which are satisfactory, but great care must be exercised in their selection as many are injurious. All infants artificially fed should be given fresh orange juice daily, beginning with a teaspoonful at the end of the first month, gradually increasing the amount to two table spoonfuls at the end of the fourth month and thereafter. Twice the amount of the juice of canned tomatoes (uncooked) and diluted with an equal amount of water may be used in place of the orange juice. These juices supply the needed vitamins which may be lacking in the pasteurized or boiled milk. (See VITAMINS; DIET.) As an additional aid to nutrition and to supply the vita mins that may be lacking in other foods, codliver oil may be given to babies more than one month old. The average dose is one-half teaspoonful at one month, one teaspoonful at two months, one and one-half teaspoonfuls at three months and two teaspoon fuls thereafter during the first year. This dose is given twice daily.

Additional foods may be given daily as follows : At four months, two tablespoonfuls of strained vegetable soup. At five months, three tablespoonfuls of the soup and one teaspoonful of vegetable pulp. At six months, one tablespoonful of strained cereal gruel, two ounces of vegetable soup and two teaspoonfuls vegetable pulp. At seven months, double the amount of cereal gruel and vegetable pulp, increase amount of vegetable soup by one ounce, add one third slice dried bread. At eight months, give above amount cereal gruel twice daily. At nine months, increase vegetable soup to four ounces and pulp to one tablespoonful, add one tablespoonful mixed coddled egg. At Io months, increase vegetable pulp to two table spoonfuls, coddled egg to two teaspoonfuls, dried bread to one half slice, cook beef bone in soup stock. At II months, increase amounts of all foods, add one teaspoonful mealy part of baked potato and same amount strained applesauce.

Method of Modifying Milk.

Wash all utensils in hot soap suds and rinse in boiling water. Boil bottles, nipples and corks for three minutes. Measure sugar and dissolve in small amount of water; pour into pitcher and add full amount of water; stir milk in bottle and add amount for day's formula. Stir mixture and pour right amount in each feeding bottle. Cork the bottles and place them on ice. Keep at a temperature at or slightly below 5o degrees, Fahrenheit, until used. At feeding time replace cork with nipple, hold bottle in pan of hot water until contents are warm. Test warmth of milk by dropping a small amount on arm just above wrist, the milk should feel warm but not hot.

Rules for Feeding I. Establish regular feeding habits and keep to them.

2. Feed by weight rather than age.

3. Wash bottles and nipples after each use; keep nipples in cov ered jar full of sterile water.

4. Give the baby water to drink from a bottle, cup or spoon between feedings.

5. Give the milk first at each feeding; then the additional foods.

6. Increase the additional foods gradually and in small amounts.

7. Decrease the amount of the milk formula at each feeding by the amount of other liquid given.

8. Give only one additional food at any one feeding.

9. Cook all cereals longer than the directions given on the package.

I o. Strong and healthy babies can take solid food at an earlier age than weak and delicate babies can.

I 1. Vegetables used in making soup are : carrots, turnips, spinach, chard, celery, asparagus, lettuce, beet greens, onions, string beans, cabbage and cauliflower (not more than three at any one time) ; all vegetables should be fresh.

1 2.

The formulae and other directions given for feeding apply to the average normal baby. If the baby is not gaining in weight or if any digestive disturbance develops, medical advice about the diet should be secured.

Normal Infant's Development.

A healthy infant should live out of doors during the daytime as much as possible, warmly clad, with a hot water bottle if necessary, protected from wind and rain and excessive sunlight. On the second day the eyes are sensitive to light, in the second month the infant notices colours, at the sixth month it knows its parents, and should be able to hold its head up. During the sixth month the baby usually begins to cut its temporary teeth. Attempts to stand are made about the tenth month, and walking begins about the fourteenth month. By this time the intelligence should be developed, memory is observed, and the child should be able to articulate a few small words. With the advent of walking and speech the period of infancy may be said to end.

months, amount, weight, milk, month, water and increase