_Pneumonia._ Keeping the arms and chest well protected by a long-sleeved coat of warm texture, should help in preventing this serious complication. Pneumonia complicating labor is usually the result of carelessness and exposure.

PART II

THE BABY

PART II

THE BABY

CHAPTER XII

BABY'S EARLY DAYS

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 a.s.sistant 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 antic.i.p.ate 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 coa.r.s.er hair in due season. The scalp should always be perfectly smooth. Any rash or crusts or acc.u.mulation 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 acc.u.mulation 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:

At birth 130 to 150 First month 120 to 140 One to six months about 130 Six months to one year about 120 One to two years 110 to 120 Two to four years 90 to 110

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.

At birth and for the first two or three weeks 30 to 50 During the rest of the first year 25 to 35 One to two years about 28 Two to four years about 25

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 part.i.tion 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 a.s.sumes 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 p.r.i.c.k 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