Table showing the average height of a male child, at different ages:

At birth 20-1/2 in.

6 months 26 in.

1 year 29 in.

2 years 32-1/2 in.

3 years 35 in.

4 years 38 in.

5 years 41-1/2 in.

6 years 44 in.

7 years 46 in.

8 years 48 in.

9 years 50 in.

10 years 52 in.

THE RATE OF GROWTH OF A CHILD.--A child grows most rapidly during its first year--six to seven inches; from fourth to sixteenth, about two inches annually; thence to twentieth, one inch. Commonly, a child at two and a half years has attained half of its ultimate adult stature. The diseases of youth always accelerate growth.

PULSE RATE IN CHILDREN AND ADULTS.--Normal Pulse,--of new born, 130 to 140, per minute; first year, 105 to 115; second year, 106 to 115; third year, 95 to 105; fifth to twelfth year, 80 to 90; thirteenth to twenty-first year, 75 to 80; twenty-first to sixtieth year, 70 to 75; in old age, 75 to 85.

INFANT RECORDS.--A record should be kept by the mother of every child which would embrace exact data as to weight, diet, size, development of mental power, teeth, ailments, sickness, pains, etc., with dates and any information which would aid in recalling exact conditions. Such records are of the utmost value in a number of ways. They help in giving suggestions as to diet, general health, and mental qualities of the child in question, and they aid in furnishing what physicians call "past history," which past history has a very valuable significance in estimating the character and importance of sickness during later years.

Such a record is also of importance in comparing a child's development with what is regarded as standard development, and also with the growth and development of other children in or out of the family.

If a child should thus be found to fall seriously below the standard and yet not appear actually sick, a very thorough and routine investigation should be inst.i.tuted to discover if possible the cause. Some error might thus be detected which might seriously affect the child's future growth and well-being.

The date of the closing of the soft spot on the baby's head should be noted, and if it is still open, when it should be closed, it might mean that the child has a serious brain condition. The soft spot should close between the eighteenth and twenty-fourth months. The family physician should be notified if the soft spot is open later than the second year, as he may want to investigate the cause.

Should the child be unusually backward in walking, and when it does so should limp and feel pain in the knees, it should be examined for any symptom of hip joint disease, of which these are the earliest signs.

If the child complains of so-called "growing pains," keep in mind that these are rheumatic and may need attention. There are no such pains as actual "growing pains," that is, pains caused by the child growing.

CHAPTER XVII

BABY'S FEEDING HABITS

Overfeeding Baby--Intervals of Feeding--How Long Should a Baby Stay at the Breast--Vomiting Between Feedings--Regularity of Feeding--Why is Regularity of Feeding Important--"A Baby Never Vomits"--What is the Significance of So-called Vomiting After Feedings--Mothers Milk That is Unfit for Baby--Fresh Air for Baby--Air Baths for Baby.

OVERFEEDING BABY.--Every nursing mother should have printed and hung up, so she may read it every time she nurses her child, the following motto: "DON'T OVERFEED BABY." Few, if any, babies die of willful starvation: many die as a result of overfeeding. Mistaken kindness and lack of judgment are responsible for one-half of all the troubles of infancy.

Babies require much less than is constantly given them. The stomach of a baby at birth will not hold more than one ounce, which is two tablespoonfuls; and at two months it will not hold more than three tablespoonfuls; and at six months, six or seven tablespoonfuls. Read these quant.i.ties once again carefully and try to realize the significance of the smallness of them. A baby is just like a little pig; it will go on feeding as long as it is allowed. The baby does not reason; it has no judgment; it depends upon its mother's judgment. If the mother is false to the trust the baby overloads its stomach. A swollen, distended, overloaded stomach causes indigestion. A baby with indigestion is a colicky, fretty, sick baby. Overfeeding, therefore, is the beginning of lots of trouble to the mother, and needless pain and suffering and sickness to the baby. A simple matter, but it is one of the most difficult lessons nursing mothers have to learn.

Overfeeding is most apt to occur at night. Many mothers put the child to the nipple for its regular feeding and fall asleep; the child keeps on nursing at intervals until twice the proper quant.i.ty is taken; or she gives it the nipple or the bottle if it cries, without regard to whether it is the proper feeding time or not. The habit of overfeeding is very common in infants who are suffering from indigestion. They cry frequently, and are irritable most of the time; nothing seems to satisfy them but the nipple. Taking the warm milk into the stomach seems to allay the distress for the time being, so mothers get into the habit of quieting them in this way. The cry of the drinking man, whom we try to sober up, is: "Just one more drink and I'll quit." You give the drink and in a little while the demand is repeated. If the mother understood the seriousness of this practice of giving the child the nipple or bottle at irregular times, she would not do it.

Overfeeding an infant may lay the foundation for a lifelong ailment. The excess of food remains in the stomach or bowels undigested. If you remember that this ma.s.s of undigested matter is confined in a small s.p.a.ce which is both warm and damp, it will be easily understood that putrefaction is the inevitable outcome. As a result of this putrefaction there are produced certain ptomaines and leucomaines. These poisons are carried through the body, causing "auto-intoxication" which upsets and irritates the child's nervous system and may cause very serious consequences, as it frequently produces sudden death from apoplexy and "heart failure" in the adult. These children are always restless, fretful, continually uncomfortable, sleepless and colicky. They lose weight, the stomach becomes distended and a gastritis or inflammation of the stomach results.

Frequently a mother with such a fretful baby, seeing her child getting thinner and thinner, will think that it is not getting enough to eat, and will proceed to add to the trouble by giving the child more to eat.

Mothers must therefore learn not to overfeed their infants; not to imagine that a failure to gain weight means the need of more food (if the quality of the food being given is wrong, will increasing the quant.i.ty of bad food do any good?); not to feed irregularly, no matter how insistent the child may be.

INTERVALS OF FEEDING.--The physician will give instructions regarding the feeding of the newly born baby for the first few days. After the first few days and up to the beginning of the third month, it should be fed every two hours from 7 A. M. until 9 P. M., and twice during the night between 9 P. M. and 7 A. M., when the regular two-hours' interval again begins for the following day. The two night feedings should be about 1 and 4:30 A. M.

After the third month, and up to the sixth month, feed every three hours and once during the night. From the sixth month until weaned, every three and one-half or four hours, and not at all during the night.

While it has been pointed out that regularity of feeding is absolutely essential, the above schedule is not to be regarded as an absolute guide. It is a general guide,--approximately it will be found correct in a large majority of cases. Each baby is a rule unto itself. The quant.i.ty of the mother's milk will dictate the interval after the first month and for each month as the baby grows. If a mother with no milk to spare, is nursing a big, strong, husky baby, the three-hour interval during the day may have to be shortened to two and one-half hours. As a rule, however, these exceptions are better regulated by attention to the time the baby is given at each nursing to fill its stomach.

HOW LONG SHOULD A BABY STAY AT THE BREAST?--Babies differ as to their method of feeding; some of them seem to like to nurse a moment or two and then look around; others seem to regard nursing as a serious business, and resent any effort to take the nipple away until they have finished. A baby should be taught to nurse methodically; it should not be allowed to play the nipple. Let it fill its stomach and put it down as quickly as possible. A mother will very soon know just how long it takes the baby to fill its little stomach, and when she finds this out she should time it by the clock. When the supply of milk is sufficient, and the child is strong, and nurses freely, eight to twelve minutes are sufficient. After it is taken away from the breast it must be left quiet till the next feeding.

Other babies, according to the ability they evince to nurse, even when the milk runs freely, require a longer time,--from twelve to fifteen minutes. The rule, however, is never to allow them to nurse so long that when they are taken away the milk runs out of the mouth. If this occurs, cut down the length of time they are at the breast, and always time the length of feeding by the clock,--don't guess at it.

CHILDREN WHO "VOMIT" BETWEEN FEEDINGS.--When a child habitually brings up food between feedings it is usually a symptom of gastric indigestion.

In these cases it is advisable to add lime-water to each feeding, and to remove some of the fat in each feeding. If improvement does not follow remove more of the fat by removing some of the cream from the top of the bottle before shaking it.

Remove from the bottle four ounces of cream and shake before preparing the food from what is left. If the child improves after a few days remove only three ounces, then in a few days remove two ounces and later one ounce. After a time, sufficiently long to permit the stomach to become accustomed to the graded amounts of fat, the former diet of whole milk can be again resumed.

Never decrease the interval of feeding of a baby who is bringing up parts of its meal between feedings; it is frequently advisable to increase the interval. If a child is colicky and is bringing up lots of gas in addition to some food, one-half grain of benzoate of soda may be added to each ounce of food given and continued for a number of weeks if necessary. When the gas is located in the intestines and is not brought up, it must be made to pa.s.s downward. Attention to the bowels is of great importance in these cases and it may be necessary to peptonize the milk for some time. A reduction of the sugar and starch in the feeding frequently cures this condition. (See "Colic.")

There are children who continue to have symptoms of indigestion and who do not thrive despite various changes in the quant.i.ty and quality of the feedings. It may be necessary to obtain a wet nurse for them, as it is with "the delicate child." If a wet nurse cannot be obtained, or if the age will permit, a subst.i.tute may be tried. Borden's Eagle brand of condensed milk, canned, is probably the best subst.i.tute under these circ.u.mstances. Condensed milk should never be used as a continuous food; as a subst.i.tute, however, for a few weeks it is often invaluable. With an infant of three or four months it should be used at the beginning in the proportion of one ounce of the milk to sixteen ounces of plain boiled water or barley water. The proper quant.i.ty, whatever the child is taking (four or six ounces according to the age) at the time, can be taken from the sixteen ounces and fed to the child. As the symptoms improve the milk should be diluted less and less, 1 to 14, 1 to 10, and so on until the proper strength is reached. After the child has been on the condensed milk for a month it should be changed back to cow's milk, using of course a diluted formula until the child becomes accustomed to the change. Condensed milk, if used as a permanent food, will fatten babies, but their vitality is very deficient, the muscles flabby, and the resistance to disease exceedingly poor. They are apt to develop rickets and sometimes scurvy.

REGULARITY OF FEEDING.--One of the very first, and one of the most important factors in contributing to the good health and the comfort of a baby is absolute regularity in feeding. A regular interval of feeding is particularly essential during the first month of a baby's life.

Despite the explicit way in which young mothers are instructed in this respect, it is one of the disappointing incidents of the practice of medicine to observe how many of these mothers fail to heed the advice.

We have personally tried to find an explanation for this astonishing carelessness, and have come to the conclusion that it is not due to intentional forgetfulness, but rather to an inexplicable failure to appreciate that the physician means exactly what he says.

If, for example, specific instructions are given to feed, or nurse, the child every two hours (and by "specific instructions" it is meant, that the physician takes time to explain in detail the instructions he gives--that the instructions are not incidental to the call, but part of the call;--that the advice is given not as a choice of what is desirable, but as an absolute rule to follow; and carefully explains why it is imperative to do as he says; and is satisfied the mother understands what he means) it would seem that there could be no possible reason why the directions should not be faithfully carried out. Yet such is not the case in many instances, and the excuses given by mothers for failure are so trivial and annoying that they show a failure to appreciate that they are dealing with a serious problem--a problem affecting human life. They fail to understand that fatal consequences may follow their negligence. They treat the baby problem exactly as they would a household incident, and as they do not consider it important whether the breakfast dishes are washed at 9 A. M. or at twelve noon, neither do they consider it important whether the baby is fed at 9 A. M.

or an hour later. When mothers learn that the attention they must give their babies is essentially different from the attention they give ordinary household duties, the problem of raising children with success and comfort will be greatly simplified.

If the instructions are to feed the baby at certain intervals, do so at all hazards. To offer the foolish excuse that the baby was asleep when feeding time came, is no excuse at all; as a matter of fact the baby should be asleep at each feeding time, if it is healthy. Wake it and feed it, for, as will be shown later, it is the constant regularity that counts. It will be more difficult to inst.i.tute regular feeding intervals during the first month, because a healthy baby is very difficult to wake up, even to be fed, during the first few weeks of life. It is absolutely essential, however, that it should be wakened: otherwise the tendency to overfill the stomach at the next feeding will lead to indigestion and colic.

WHY IS REGULARITY OF FEEDING IMPORTANT?--Because a baby's stomach holds a very small quant.i.ty, and experience has taught us that a baby will thrive better on small quant.i.ties given frequently, rather than large quant.i.ties at longer intervals. The smaller the baby, the smaller the quant.i.ty to begin with. Some babies weigh from five to seven pounds at birth, while others weigh from nine to twelve pounds. It would be unreasonable to expect a very small baby to be able to hold and digest as much as a very large baby. Considerable common sense and the exercise of some judgment is therefore necessary on the part of the uninstructed mother, as to just the right quant.i.ty to give. Fortunately, a little experience will enable the observant mother quickly to solve this important problem. Nature promptly furnishes the symptoms which will correctly guide her. Before considering the significance of these symptoms let us appreciate certain facts common to all babies, and we will more easily interpret the meaning of the special symptoms the baby will furnish.

First of all the baby never vomits. The ejection of food, therefore, is dependent upon a condition, not a disease. If milk runs out of its mouth immediately, or within a few moments, after a feeding, the explanation is that it was fed too much; it does not vomit, the stomach simply overflows. It is exactly like trying to put more milk into a cup after it is full,--it will not hold more, it overflows.

The significance of this symptom, therefore, is that the quant.i.ty of the feeding is wrong (it is not the baby's stomach that is at fault,--it is the mother's judgment). Reduce the quant.i.ty of each feeding and you will quickly cure it. If the milk does not overflow soon after a feeding, the baby will appear satisfied and will go to sleep, and will sleep until it is time for the next feeding. It may not do this, however. In half an hour, or a little longer, after the feeding, it wakes, it begins to fret and cry, and very soon it suddenly belches gas and ejects a mouthful of milk, after which it will rest quietly for a few moments, when it will begin fretting all over again. It may keep up this performance for an hour, or until the next feeding, and if so it is exhausted and unfit to carry on the digestive process. It is in these cases where most mothers make serious mistakes. This is the beginning of real trouble, and the family physician is the only one qualified to give advice under such circ.u.mstances. Remember the warning given regarding heeding the advice of every busybody just at this time. Your baby's health is at stake; maybe its life depends upon what you choose to do.

WHAT IS THE SIGNIFICANCE OF "VOMITING" AFTER FEEDINGS IN BABIES?--Let us examine the difference between the milk which overflowed immediately after the feeding and the milk which the baby ejects one-half hour or so later, and which is now being considered.

The first milk looks like ordinary milk (breast milk), or if the baby is being fed from the bottle, it looks just like the mixture in the bottle.

It not only looks like what it took, but it smells just like it. Now examine the other; we find it looks like curdled milk, it is lumpy, and we immediately can tell that it is sour, because it smells sour and looks sour.

The explanation of the first overflow (immediately after the feeding) was the too great quant.i.ty; the explanation of the second overflow (one-half hour or so after the feeding), is the wrong quality of milk.

The quant.i.ty was right because none overflowed right after the feeding, but the quality was wrong. Again, it is not the baby's stomach that is at fault,--it is the quality of the milk.

How do we know this? Because of what takes place in the baby's stomach during the one-half hour between the feeding and the time of the overflow of the sour milk. The quant.i.ty being right, why should the baby have any trouble if the quality is correct? It should not. Therefore by changing the quality (not the quant.i.ty as in the former case) we cure the trouble, thus proving the quality of the milk to be at fault.

What took place in the baby's stomach in the intervening half hour? The quality being wrong, the little stomach could not digest the mixture quick enough. Fermentation set in, gas was evolved, and as the stomach was full before the gas was manufactured (and as more and more gas is manufactured when food ferments), the stomach overflowed and out of the baby's mouth comes gas, and sour, fermenting, curdled milk. This process goes on until fermentation stops, or until the little stomach has just enough left to fill it and no more. But think what this is,--a sour ma.s.s of rotting, indigestible, curdled milk,--and that is what this baby is expected to live and thrive on.

Some babies seem to have trouble from the very first day of life. Either they will not retain the food, or the food fails to agree with them. If the baby is put upon artificial food at once, these troubles are, of course, not unexpected (because the right artificial food may not be first chosen for the particular baby), but it is not always the artificially fed baby that gives us trouble, and it is sometimes difficult to find the cause for such trouble in a baby who has had nothing but its mother's milk since it was born.