Nursery Guide 
For Mothers 
and Nurses 
% 
Louis W* Saner* M>Ai| MJI, 
IKuiimtedi 
€X ¥, Mmby Co,-— Publishers — St. NURSERY GUIDE NURSERY GUIDE 
FOR 
MOTHERS AND NURSES 
BY 
LOUIS W. SAUER, M.A., M.I). 
• r 
Senior Attending Pediatrician, Evanston Hospital; formerly At- 
tending Physician Chicago Infant Welfare, and Assistant 
Attending Physician Children’s Memorial Hospital, 
Chicago 
ILLUSTEATED 
STT L'DTTIS 
C. Y. MOSBY COMPANY 
1923 Copyright, 1923, By C. Y. Mosby Company 
(All rights reserved) 
Printed in U. S. A. 
Press of 
C. V. Mosby Company 
St. Louis PREFACE 
Tlie care, nourishment, and ills of infants are so dif- 
ferent from those of children and adults that they de- 
serve special consideration. The person in charge of an in- 
fant has unparalleled responsibility, for to her is entrusted 
the progeny of our race. Through providing proper care 
and nourishment, the ills of infancy are greatly reduced. 
Food, more than any of the other factors of selection, 
determines which child shall live. Babies fed food other 
than mother’s milk as a rule are greatly handicapped in 
the struggle for existence. 
Although epoch-making discoveries have been made in 
the science of infant feeding during the past two decades, 
a high infant mortality rate continues. Through the ef- 
forts of scientific investigators, physicians, departments of 
health, nurses, and mothers, a decrease in the infant 
death rate is evident, but much still remains to be done. 
This brief nursery guide is intended to aid those to whom 
are entrusted the care and feeding of infants. 
Louis W. Sauer. 
Evanston, Illinois, 1923. 
7 CONTENTS 
CHAPTER I 
PAGE 
General Care and Development 13 
Prenatal Care, 14; Instructions During Pregnancy, 14; 
General Care, 15; Minor Ailments of the Newly Born, 16; 
Clothing, 19; Bowels, 23; Bath, 24; Air, 27; Sleep, 28; 
Out of Doors, 29; Physical Development of the Infant, 30; 
Outline of the Daily Routine, 36; Behavior, 37. 
CHAPTER II 
The Nursing Infant 44 
Breast Troubles, 44; Nursing Technic, 49; Technic of 
Manual Expression, 49; Nursing Routine, 52; Routine Life 
of the Nursing Mother, 59; Weaning, 61; Nutritional Dis- 
turbances of the Breast-Fed Infant, 63. 
CHAPTER III 
The Premature Infant 67 
Maintaining Uniform Warmth, 68; Proper Food, 70; 
Avoiding Infections, 74; Adopting an Infant, 76. 
CHAPTER IV 
Artificial Feeding 77 
Cow’s Milk, 77; Preparation of the Infant’s Food, 88; 
Recipes, 95; Artificial Food, 98; Mixed Feeding (Breast 
and Bottle), 100; Rules for Infant Feeding, 102; Calories 
and Tolerance, 103; Food Tolerance, 105; Feeding During 
the Second Year, 110; Diet from 12 to 18 Months, 110; 
Diet from 18 Months to 3 Years, 112; The Undernourished 
Older Infant, 114. 
9 10 
CONTENTS 
CHAPTER V 
PAGE 
Nutritional Disturbances of the Artificially Fed Infant 116 
Weight Disturbance, 118; Dyspepsia, 119; Atrophy 
(Marasmus), 120; Alimentary Intoxication, 120; Rickets, 
121; Scurvy, 122. 
CHAPTER VI 
Some Common Ailments 124 
Lowering Resistance, 124; The Common Cold, 125; Cough, 
127; Croup, 127; Bronchitis, 128; Pneumonia, 128; 
Adenoids, 129; Diseased Tonsils, 129; Middle Ear Disease, 
129; Mastoid, 130; Glands, 130; Genito-Urinary System, 
130; Kidney and Bladder Infections, 130; Rupture, Hydro- 
cele, 131; Circumcision, 131; Vaginitis, 132; Nervous 
System, 132; The Nervous Baby, 132; Bad Habits, 132; 
Bed Wetting, 133; Convulsions, 133; The Skin, 134; Chaf- 
ing, 134; Prickly Heat, 134; Hives, 135; Eczema, 135; 
Cradle-cap, 136; Contagious Diseases, 136; Quarantine, 
136; Quarantine in the Home, 137; Scarlet Fever, 139; 
Measles, 139; Prevention of Measles, 140; Diphtheria, 140; 
Prevention of Diphtheria, 142; Whooping Cough, 142; 
Chicken-pox, Mumps and German Measles, 143; Vaccination, 
143. 
CHAPTER YII 
Care of the Sick Infant 147 
The Trained Nurse, 147; Signs and Symptoms, 147; 
Examining' the Patient, 148; Thermometer and Fever, 148; 
Rectal Temperature, 148; Hydrotherapy, 149; The Tepid 
Sponge Bath, 149; Mustard Bath, 149; Cold Douche, 150; 
Hot Pack, 150; Tepid Pack, 150; Mustard Pack, 151; 
Turpentine Stupe, 151; Stomach Washing and Tube Feed- 
ing, 152; Lavage, 152; Gavage, 153; Colonic Flushing and 
Rectal Feeding, 154; Enema, 154; Collection of Specimens, 
156; Blood Examination, 157; Worms, 157; Accidents, 158; 
Foreign Bodies, 160; Poisons and Antidotes, 162. 
Appendix 165 FIG. PAGE 
1. Proper way of nursing while lying down 50 
2. Proper way of nursing while seated 51 
3. Year old infant 57 
4. Overweight nine-month-old infant 58 
5. Crib for premature infant 69 
6. Face mask 75 
7. Utensils needed in milk modification 89 
8. Proper way of giving a feeding 91 
9. Improper way of giving a feeding 92 
10. Stomach lavage 153 
11. Giving an enema 155 
12. Weight charts 170 
LIST OF ILLUSTRATIONS 
11 NURSERY GUIDE 
CHAPTER I 
GENERAL CARE AND DEVELOPMENT 
Although the general health of the parents 
is not so intimately related to the ills of in- 
fancy as to those of later life, three diseases 
deserve mention. 
1. Tuberculosis is not inherited, but ac- 
quired some time before or after birth. The 
infant, in contaminated surroundings, in- 
hales the germs or takes them in the food. 
Parents with active tuberculosis must not 
expose their offspring. Infants born of such 
mothers should be taken out of surroundings 
that endanger their health. Over seventy 
per cent of all children past the fourteenth 
year give a positive tuberculin test—proof 
that a tuberculous infection exists or has 
existed. The earlier the infection occurs, 
the more likely will it be severe. 
2. Syphilis. Where successive miscarriages 
occur without an apparent cause, a Was- 
sermann blood examination is essential. 
Modern methods of treating this serious dis- 
13 14 
NURSERY GUIDE 
ease practically cure cases that have not 
been too long neglected, so that normal chil- 
dren can result. Infants born with this 
taint should be treated early. 
3. Gonorrhea. This highly contagious dis- 
ease is the most frequent cause of blindness 
in the newly born. Because of the rapidity 
of its spread, the eyes of the babe need very 
careful watching. A vaginal discharge of 
mother or child should always be examined 
microscopically to exclude this contagious 
disease. (See Vaginitis, page 132.) 
Date of 
Confinement 
By reckoning back three calendar months 
from the beginning of the last menstrual 
period and then adding seven days, the ap- 
proximate date of confinement can be de- 
termined. For example, if the date of the 
beginning of the last menstruation was July 
first, the confinement may be expected about 
the eighth of the following April. 
Prenatal Care 
Instructions During Pregnancy 
1. Outdoor exercise should be encouraged, 
but fatigue must be avoided. Golf is per- 
missible, but tennis, skating, horseback rid- 
ing, swimming, and motoring over rough 
roads are hazardous. An afternoon nap 
should be taken daily. GENERAL CARE AND DEVELOPMENT 
15 
2. The diet should consist of plain, not 
highly seasoned food; milk and cocoa are 
much better than tea or coffee. The diet 
should be more or less restricted during the 
last month. 
3'. The pelvic measurements should be 
made by the physician at least two months 
before the first delivery. 
4. An 8 oz. bottle of urine should be sent 
to the physician on the first of every month, 
and during the last two months at least 
every two weeks. The bowels should not 
be allowed to become constipated. 
5. If the confinement is to take place 
at home, all supplies should be on hand 
at least six weeks before the expected 
date. This outfit should include: several 
pounds of sterile cotton, 25 yards of sterile 
gauze, 4 rolls of cotton batting, 2 yards of 
heavy muslin for abdominal binders, a dozen 
diapers or old towels, several old sheets, a 
quart of grain alcohol, vaseline, tape, douche 
pan, basins, pitchers, rubber sheeting, foun- 
tain syringe, drinking tubes, medicine drop- 
pers, and several dozen large safety pins. 
General Care 
The responsibility of birth registration in 
the archives of the state rests with the ob- 
stetrician. In case of doubt, inquiry may be 
Birth 
Registration 16 
NURSERY GUIDE 
directed to the bureau of birth registration 
of the department of health at the state 
capital. 
The modern maternity hospital offers ideal 
conditions for confinement. 
After the cord has been cut a sterile dress- 
ing is applied, % per cent silver nitrate solu- 
tion or 10 per cent argyrol solution is 
dropped into the eyes by the attendant, and 
the infant, wrapped in a few diapers and 
blanket, is taken to the nursery where he 
gets his first bath. This usually consists of 
oil. In fact, the oil bath is usually con- 
tinued daily until the cord is off and the 
navel healed. The temperature of the bath 
room should be 85° to 90° F. 
The infant’s rectal temperature should be 
taken daily before the bath for the first 
two weeks. (See Taking Temperature, page 
148.) Boiled, warm water is given every 
four hours, beginning four hours after birth, 
until the baby is twenty-four hours old, 
when feeding at the breast begins. After 
this, water may be given several times a day. 
Oil Bath 
Minor Ailments of the Newly Born 
Pus in the eyes, soreness of the navel, or 
rise in temperature must be reported to the 
physician. Jaundice of the newly born is GENERAL, CARE AND DEVELOPMENT 
17 
usually transient. Pustules or vesicles 
(blisters) are obstinate when they occur, 
and need immediate attention. Swollen 
breasts of the newly born should be let 
alone, as manipulation may cause infection. 
Swellings about the scalp usually disappear 
in the course of days or weeks. Faint birth- 
marks about the eyes, forehead, or nape of 
the neck usually disappear during the first 
year. The dark red or purple ones, on the 
other hand, are more permanent, getting 
larger as the child grows older. They may 
often be caused to disappear if treated be- 
fore the end of the first year. 
Nursery assistance has disadvantages as 
well as advantages. A person applying for 
the position of nursemaid should prefer- 
ably have had experience, and should be 
willing to bring a recent certificate of health 
from her physician. Her uniforms should 
be clean and washable; her room should ad- 
join the nursery; she must take instructions 
from the mother. 
The nursery should be isolated, light, and 
easily ventilated. It is preferable to have 
the walls painted some light color; there 
should be no pictures or unnecessary cur- 
tains. If there are any rugs, they should 
be cleaned frequently. Sunlight should 
Nursemaid 
N ursery 18 
NURSERY GUIDE 
enter the room several hours each day. 
Dark shades are indispensable, as there 
should be no bright light in the nursery 
while the baby sleeps. Electric bulbs which 
can be dimmed are convenient. It is usually 
impossible to give the baby sufficient privacy 
in a room occupied by other members of the 
family. 
Cribs are indispensable for premature in- 
fants, and other babies may be kept in 
them until they begin to sit up. 
The bed should be plain enameled iron, 
brass, or wood, with woven iron springs. 
One side of the bed should be sliding. A 
four-inch, loose hair mattress is placed on 
the wire springs, then a rubber sheet, a 
draw-sheet, and a plain sheet. Pillows 
are seldom necessary. If the room tem- 
perature gets below 65° P. it is safest to 
cover the infant with a sheet, then a thin 
quilted pad or woolen blanket, and over 
this another sheet. A double set of bedding 
permits one set to be aired while the other 
is in use. It is advisable to turn the mat- 
tress from day to day. If during cold 
weather hot water bottles or electric heat- 
ing pads are used for prematurely born in- 
fants, care should be exercised to avoid 
Crib 
Bed GENEKAL CARE AND DEVELOPMENT 
19 
burns. The water in hot water bottles 
should never be above 110° F. 
A nursery medicine chest is convenient. 
It should contain ground mustard, powdered 
boric acid, mineral oil, castor oil, milk of 
magnesia, peroxide of hydrogen, adhesive 
plaster, cotton, bandages, spoons, medicine 
glass, tweezers, and scissors. Poisons such 
as bichloride of mercury, lysol, tincture of 
iodine, and carbolic acid should never be 
kept in the nursery. These should be locked 
in a special poison chest in another room out 
of reach of children. The mother should 
have sole access to them, and supervise their 
administration and disposal. 
Medicine 
Chest 
Clothing 
A well-equipped wardrobe varies some- 
what according to the season. It should 
contain: 
3 to 6 half-wool, double-breasted under- 
shirts (second size) ; 
3 to 6 cotton or silk undershirts or bands 
(for hot weather use only); 
6 outing flannel or stockinette nightgowns 
(with drawstrings) ; 
6 white cotton slips; 
3 flannel, 3 cotton or linen petticoats; 
3 or more pairs of while silk or cotton 
hose; 
Wardrobe 20 
NURSERY GUIDE 
2 or more dozen canton flannel napkins 
(20 x 40 inches) ; 
4 dozen bird’s eye cotton napkins (same 
size) ; 
Also 2 jackets, 1 cloak, 1 cap, 1 veil, mit- 
tens, and 2 crib blankets. 
(Complete outfits can be obtained at de- 
partment stores.) 
Most young babies are overclothed. As 
infants perspire and become restless when 
overclothed, excess of clothing must be 
avoided, even during cool weather. Infants 
cannot regulate their body temperature as 
well as older children. The coldest days 
out of doors are often the hottest in the 
nursery. Clothes should be loose and sus- 
pended from the shoulders. If the napkin 
is pinned too tightly, the feet are apt to be 
cold from lack of proper circulation. Young 
infants should be dressed with care, and 
turned as little as possible while being 
dressed. 
If the temperature of the nursery gets be- 
low 50° F. at any time during the twenty- 
four hours, it is advisable to use the double- 
breasted undershirt. Should the room tem- 
perature get down to freezing, or should the 
baby get an airing during cool weather, the 
band, petticoat and stockings may also be 
Excess 
Clothing 
Indoor 
Clothing 
In Winter GENERAL CARE AND DEVELOPMENT 
21 
used, and the sleeves of the gown should 
be pulled down over the hands. Feet and 
hands should never feel cold. The night- 
gown can be worn during the day as well 
as at night—at least for the first few months. 
Sleeping bags may be used for older infants. 
They should so include the body that ex- 
posure and the danger of suffocation are 
entirely eliminated. 
The clothing worn should be in accord 
with the temperature to which the child is 
exposed. In the late spring and early 
autumn it is sometimes necessary to add or 
remove garments and covers several times 
a day. During the heat of a summer day, 
the infant is best off with only a diaper 
and band, and on hot nights a thin, loose 
cotton slip may be added. Excess of cloth- 
ing and covers must be avoided at all times. 
Electric fans should not blow directly on 
the baby, but should keep the air in motion 
and thereby improve ventilation. 
After the undershirt has been put on, the 
napkin is adjusted. Care must be taken 
that it is smooth and free from wrinkles. 
It is not advisable to put a small folded 
diaper inside the triangularly folded one. 
Soft pads may be pinned to the inside of 
Indoor 
Clothing 
In Summer 
Napkin 
(Diaper) 22 
NURSERY GUIDE 
the dress or nightgown, whereby the linen 
is protected. 
The normal infant urinates between 
twenty and thirty times in twenty-four 
hours, the more frequently the more he is 
awake. During the day the napkin should 
be changed whenever it is wet or soiled; 
at night, when the baby is taken up to be 
fed. The urine should be pale and free from 
odor. The so-called ammoniacal diaper— 
the kind that chafes the infant—is not in- 
frequently the result of poor hygiene. It 
is now known that a germ, found in insuffi- 
ciently boiled napkins, decomposes the urine 
shortly after it is passed, and that the 
strong odor is the result of such decomposi- 
tion. If the infant becomes chafed, the nap- 
kin should be left off for several hours each 
day. All used napkins should be boiled for 
fifteen minutes and dried in the sun when 
the weather permits. Soda, lye, and wash- 
ing powders should not be used. Rubber or 
waterproof diapers worn over the regular 
napkin may do more harm than good. They 
keep the clothing clean, but often cause the 
buttocks to become chafed. They are suit- 
able only for temporary use when out of 
doors. Paper napkins of the proper tex- 
ture and permeability are practical while 
traveling. GENERAL CARE AND DEVELOPMENT 
23 
Rompers are practical when the child has 
reached the run-about age, and has fairly 
good bladder control. Socks may be worn 
during warm weather, but must be discon- 
tinued when it begins to get cold; a mother 
may be exposing her child to unnecessary 
dangers in the hope of “hardening” him. 
Stockings are much safer than socks. The 
first pair of shoes should be soft-soled and 
may be worn when the infant begins to 
stand. When the child begins to walk, the 
sole must be somewhat thicker. Well fit- 
ting lace-shoes give more ankle support than 
do button-shoes. Shoes should be suffi- 
ciently large and broad. Overshoes and leg- 
gings should be worn on cold as well as 
on damp days by infants old enough to walk. 
Other 
Clothing 
The healthy, breast-fed infant usually has 
one to three orange-colored stools in twenty- 
four hours. If he is given too much food 
or kept too warm, there may be four to six 
a day, which may contain white curds and 
mucus, or may be green and foamy. Some 
breast-fed infants who are thriving may 
have infrequent bowel movements (one nor- 
mal stool every two or three days). Moth- 
ers often worry needlessly about this. These 
Bowels 
Bowels 24 
NURSERY GUIDE 
healthy infants are utilizing the food so 
completely that the amount of waste is min- 
imal; this is not constipation. The consis- 
tency of the stools rather than the fre- 
quency, determines constipation. In case of 
constipation, a soap, glycerin, or gluten sup- 
pository may be used, and if without result 
may be repeated in twelve hours. In very 
obstinate cases a few ounces of sweetened 
oatmeal water may be fed several times 
a day. Enemas* often make constipation 
worse. The buttocks should be cleansed 
with soap and water after each bowel move- 
ment. 
When the child can sit alone, the com- 
mode should be used daily before the bath. 
Regularity should be taught early. If neces- 
sary, a suppository may be resorted to. In 
the course of a few weeks most infants ac- 
quire the habit of a daily evacuation of the 
bowel before the bath. 
Commode 
Bath 
The full tub bath may be given as soon 
as the navel has entirely healed. The best 
time to bathe the young infant is in the 
morning before the second meal, that is, 
between nine and ten o’clock. Infants past 
eighteen months should be bathed before GENERAL CARE AND DEVELOPMENT 
25 
the evening meal. The room should be 
warm, but overheating and drafts must be 
avoided. An electric heater, a small gas 
or oil stove may be necessary. The tem- 
perature of the bath water should be that 
of the body and is best determined just 
before the child is placed in it. As bath 
thermometers often get out of order, dip- 
ping the elbow into the water will test the 
temperature with sufficient accuracy. The 
bath should be about 95° F. until the begin- 
ning of the sixth month; from then until 
one year, 90° F.; during the second year 
about 85° F. Delicate children are some- 
times better off with only one or two baths 
a week. An infant with a cold, cough, or 
skin disease should not be bathed without 
the physician’s consent. 
After everything necessary for the bath 
is at hand, the infant is undressed and cov- 
ered with a towel. After the face has been 
washed with plain water, the genitals, ex- 
tremities, trunk, and scalp are lathered with 
a soft cloth. The child is then placed in the 
tub, the neck and shoulders resting on the 
palm of the mother’s hand. After rinsing 
he is placed on the dressing table or lap 
and gently dried with a soft towel. Stear- 
ate of zinc or corn starch may be dusted in 26 
NURSERY GUIDE 
the armpits, folds of the neck, about the 
groins and buttocks. After the infant has 
been dressed, the ears are dried and the nos- 
trils cleansed with cotton applicators (cot- 
ton wrapped about the end of a tooth pick). 
The scalp is then thoroughly dried, and the 
hair brushed or combed. 
The sex organs in girls as well as boys 
should be well lathered, at least once each 
day. In the latter the foreskin should, if 
possible, be drawn back at least once a week 
and the white particles (smegma) removed 
with an applicator. Circumcision is some- 
times necessary when the foreskin is too 
long or very adherent. 
As the child grows older the time spent in 
the tub may be prolonged to five or ten 
minutes. During hot weather this is advis- 
able. When he can stand, one should begin 
to increase his resistance by sprinkling a 
cupful of cold water down the spine, just 
before he is taken from the tub. After a few 
weeks a cupful of cold water may also be 
sprinkled over the chest, and as he gets 
older, the temperature of the room and the 
bath may be gradually lowered. Immedi- 
ately after the cold douche, he should be 
wrapped in towels and dried, a little friction 
being used to stimulate the circulation. 
Genital 
Organs 
“Hardening” GENERAL CARE AND DEVELOPMENT 
27 
Early autumn is the best time to begin 
“hardening.” 
Sun baths on warm days are very bene- 
ficial. The coat of tan should be acquired 
very gradually, as the skin is very sensitive. 
The head and eyes should be protected, 
all clothing should be removed for the ten 
to twenty minutes that the infant is ex- 
posed to the direct rays of the sun. This is 
considered one of the best methods of pre- 
venting rickets. 
The hardening process advocated by some, 
whereby the infant sleeps all night in a very 
cold room or on an open porch, has lost 
many adherents. If ice forms (32° F.) on 
the top of a glass of water near the crib the 
air is too cold for the baby. “Fresh” air 
does not necessarily imply very cold air. 
Enclosed sleeping porches may be used at 
night if drafts can be avoided. 
Breathing bad air even for a few hours is 
harmful. The condition of the air in the 
nursery in the morning indicates the amount 
of ventilation that has taken place during 
the night. The air of the nursery should 
never be offensive. 
Opportune times to give the nursery thor- 
ough airings are in the morning before the 
Air 
Sun Baths 
Cold Rooms 
Bad Air 
Ventilation 28 
NURSERY GUIDE 
child gets his bath and in the afternoon 
while he is out of doors. During the win- 
ter the windows should be opened a little 
from above and below. Night air is as 
wholesome as day air. Ventilators are very 
practical. The crib should be in a comer of 
the room where there is no draft; a screen 
placed in front of a window or around the 
crib will keep the draft off. 
The air of heated rooms is usually very 
dry, and provision should be made to in- 
crease the amount of water vapor. The use 
of humidifiers for steam or hot water heat 
is advisable. A pan of water on the radi- 
ator does not produce sufficient moisture. 
Moisture 
Sleep 
The young infant should sleep quite 
soundly the greater part of the day and 
night. If he is not awake at the feeding 
hour, he should be wakened, for regularity 
in this respect is of paramount importance. 
He should be held over the arm or shoulder 
after each meal to allow air in the stomach 
to escape, and then he should be put to bed. 
Rocking or singing him to sleep must be 
avoided. If he is fretful before, during, or 
after feeding, the cause should be deter- 
mined. The fretfulness is often due to Over- GENERAL CARE AND DEVELOPMENT 
29 
feeding, overclothing, soiled diaper, or cold 
hands or feet. Soothing syrups, paregoric, 
etc., are harmful and must never be used to 
induce sleep. 
From the second to the sixth month he 
should sleep at least sixteen hours of the 
twenty-four, this number decreasing as he 
gets older. The morning nap may be short- 
ened after the first year, but the afternoon 
nap should be continued until after the 
fourth year. An infant should not be al- 
lowed to fall asleep while taking food. If 
he dozes off after nursing ten minutes, he 
should be placed in the crib and not be given 
food until the next feeding time. 
The baby carriage should be substantial, 
convenient, well-springed, rubber-tired, and 
have an adjustable top with storm and sum- 
mer hoods. The hair mattress should be 
covered with a down pillow, rubber sheet, 
plain sheet, and blanket. An extra pillow 
may be used for the head. On cool days the 
baby, dressed in cap and coat, is placed in 
the carriage and covered with several 
woolen blankets, the amount of cover used 
depending upon the severity of the weather. 
Infants should not be fed while out of 
doors. 
Out of Doors 
Baby’s 
Carriage 30 
NURSERY GUIDE 
Out of 
Doors 
Thriving infants may be out of doors 
for a few hours on non-windy, sunny 
days after the third week, providing the 
weather is not very cold. Babies born in 
late autumn, winter, or early spring, should 
be gradually accustomed to cold air before 
being taken out of doors. This is done by 
dressing them in out-of-door clothes, and 
opening the windows of the nursery, but 
drafts must be avoided. Such an airing 
should gradually be increased to an hour. 
If a veil is used, it should be washed daily. 
When the child is dressed for out-of-doors, 
the windows must be open or he must be 
taken outdoors immediately, in order to 
avoid catching cold. 
When the 'child walks fairly well, a cart 
may be used in place of the carriage. It 
should be well constructed, and have a back 
rest. Restraining straps may be necessary 
to keep the child from falling out. 
Cart 
Physical Development of the Infant 
The body of the infant is not that of an 
adult in miniature. While the head is larger 
in proportion, the face is smaller. The fon- 
tanelle (soft spot), usually rather large at 
birth, grows smaller toward the end of the 
first year, and should be closed by the eight- GENERAL CARE AND DEVELOPMENT 
31 
eenth month. The hair present at birth is 
replaced during the first few weeks by a 
lighter crop, which usually grows somewhat 
darker. Tears and perspiration are seldom 
noticed during the first few months. The 
healthy infant usually holds his head up at 
three to four months, sits alone at six to 
seven, creeps at eight to ten, stands at 
twelve, and walks at fourteen months. The 
height of newly born boys averages about 
twenty inches, that of girls about nineteen 
inches. The rate of growth decreases with 
age. During the first year it is about six 
inches, during the second about three inches. 
(See table, page 168.) The pulse of the 
young infant beats about a hundred and 
twenty times a minute; after the first year 
it is appreciably slower. The respirations 
of the newly born are also more rapid (forty 
to thirty per minute). 
The initial loss in weight (normally about 
eight to ten ounces) which takes place dur- 
ing the first few days after birth should be 
regained by the tenth day. The average 
infant doubles his weight during the fifth 
month and trebles it at the end of the first 
year. During the second year the infant 
usually gains about six pounds. (See table, 
•page 169.) 
Height 
Weight 32 
NURSERY GUIDE 
Teething 
Customs are handed down from genera- 
tion to generation, dating back hundreds of 
years. So deeply rooted are some false no- 
tions that they are overthrown with great 
difficulty. This applies especially to some 
of the ideas about teething. Teething is a 
normal process, and, as such, should not 
cause more pain or trouble than the growing 
of hair and nails. The development of the 
teeth begins months before the baby is born 
and their appearance is merely an incident 
in their development. Nevertheless, teeth- 
ing is, at times, still blamed for many ills. 
It has thus in times past been blamed for 
cough, diarrhea, nasal discharge, earache, 
swollen glands, fever, rashes, and convul- 
sions. The result of this parental ignorance 
is that the infant must, under such circum- 
stances, endure pain until Nature corrects 
the underlying condition or until the child 
gets so much worse that a physician is 
called. By such delay, an infection in the 
ear, bladder, or glands may become severe. 
The infants of today are fortunate that the 
lancing of teeth has become obsolete. 
It is true that pain and fretfulness fre- 
quently manifested during the teething 
period are more pronounced in bottle-fed 
babies, but these symptoms are usually due 
Teething 
Pains GENERAL CARE AND DEVELOPMENT 
33 
to nutritional disturbances. When so-called 
“teething pains” are present, the quantity 
and quality of the food deserve investiga- 
tion. If there is fever, a careful physical 
examination of the infant, including throat, 
chest, and ears, or an examination of the 
urine may reveal the cause of the trouble. 
Relief is usually rapid when a diagnosis is 
made and the proper treatment instituted. 
Swollen gums may possibly be somewhat 
tender; rubbing with a cold, wet spoon will 
then bring relief. Lancing of gums seldom 
aids an advancing tooth, and may become 
the source of an infection. “Pacifiers” of 
all kinds are harmful and dangerous. Ivory 
teething-rings and the ordinary spoon are 
very satisfactory for teething infants to 
bite on. 
The deciduous (“milk” or “baby”) 
teeth should appear in pairs. Three to ten 
weeks is the usual interval between pairs. 
The first pair usually appear before the 
eighth month, at twelve months there should 
be three to four pairs, at eighteen months 
six to eight pairs, at two years eight pairs, 
and at two and a half years ten pairs. A 
delay or marked irregularity may be due to 
previous illness, improper feeding, rickets, 
or other nutritional disturbance. Artifi- 
Pacifiers 34 
NURSERY GUIDE 
cially fed infants are often given phosphor- 
ized cod liver oil for weeks or months to aid 
tooth and bone development. The diagram 
illustrates the sequence in which the teeth 
usually appear: 
hfgcb ; bcgfh 
hegda : adgeh 
Explanation of the diagram: 
aa—lower central incisors (first to appear) 
bb-—upper central incisors 
ce—upper lateral incisors 
dd—lower lateral incisors 
ee—first lower molars 
ff—first upper molars 
gg—upper canines (“eye” teeth) 
gg—lower canines (“stomach” teeth) 
hh—second molars 
When the infant has about twelve teeth, 
one should begin to care for them. An ap- 
plicator dipped into a solution of baking 
soda (1 teaspoonful of soda to eight 
ounces of water) should be brushed over 
and between the teeth twice a day. After 
the second year a child’s tooth brush should 
be used. The bacteria of the mouth act on 
food particles that are not dislodged. Acids 
are thus formed which attack defective teeth 
and cause tooth decay and bad breath. The 
quality of the teeth is influenced by hered- GENERAL CARE AND DEVELOPMENT 
35 
ity, by acute and chronic diseases, and by 
diet. Proper care of the “baby” teeth has 
a beneficial effect on the permanent ones. 
During the first few months the daily 
shampoo is part of the bath, but later, one 
shampoo a week is usually sufficient. If the 
hair is dry and brittle, it should be washed 
only once in two weeks, after which a little 
castor oil or vaseline may be rubbed into 
the scalp. When the child gets older the 
hair should be thoroughly brushed several 
times a day. 
The toe and finger nails should be cleansed 
with a flat tooth pick shortly after the bath. 
They may be shortened once a week with 
paper file or scissors. 
The bath, crying, and kicking of the feet 
are the first means of exercise. Changing 
the child’s position in the crib after each 
meal aids the head and body to develop 
symmetrically. It is a good plan to place 
him on the back in the morning, on one side 
after the bath, on the other in the afternoon, 
and on the abdomen at night. Kicking with 
the feet should be encouraged by uncovering 
the legs for an hour or more each day. 
When he begins to creep he should be placed 
in a “pen” or baby-yard for an hour each 
day. Standing and walking are thus mastered 
Hair 
Kails 
Exercise 
Iiaby-yard 36 
NURSERY GUIDE 
more quickly. As the coldest air of a room 
is nearest the floor, it is wise to place the 
‘‘pen” in that part of the room where there 
is the least draft. 
Infants need not learn to creep. In fact, 
those who creep very well often walk rather 
late. Creeping has two other disadvantages 
—the child is more exposed to drafts and is 
likely to pick up things from the floor. 
Bowlegs, knock-knees, deformed pelvis, 
or curvature of the spine are not likely to 
occur if the child has been properly fed 
during infancy. Walking will be attempted 
as soon as the bones and muscles are strong 
enough. Heavy babies, infants who have 
been ill, and those who have had feeding dis- 
turbances or rickets are usually late in walk- 
ing. They should not be urged; if the diet 
is correct, walking will be attempted as soon 
as the infant has developed sufficient 
strength. The baby tender or “walker” 
should be used only when the physician 
orders it. 
Drafts 
Creeping 
Walking 
Outline of the Daily Routine 
(For infants under six months) 
6 to 7 A. M. First nursing or feeding. 
9 A. M. Bath. 
10 A. m. Second nursing or feeding. 
11 to 1 Out of doors when the weather permits. GENERAL CARE AND DEVELOPMENT 
37 
2 p. M. Third nursing or feeding. 
3 to 5 p. M. Out of doors when the weather permits. 
5 to 6 p. M. Recreation or exercise hour. 
6 p. m. Fourth nursing or feeding. 
10 P. M. Fifth nursing or feeding. 
Infants under ten pounds may have a feed- 
ing during the night. 
By following a daily routine the baby 
soon awakens at meal times, has a bowel 
movement before his bath, awakens in the 
late afternoon for his recreation hour, and 
sleeps peacefully at night. As the child 
grows older the recreation hour may be 
utilized to teach him to sit, stand, walk, 
and talk. 
Training 
Behavior 
Fretfulness, disturbed sleep, sleeplessness, 
and crying are frequently due to errors in 
nursing or feeding. The interval between 
feedings may be too short, the food of im- 
proper strength or amount. Underfed in- 
fants usually behave better than those who 
get too much food. The feeding interval 
recommended by the physician must be ob- 
served; the food must never be strength- 
ened or increased without his knowledge. 
Fretfulness when the bottle is taken away 
does not always imply hunger. 
Crying and whining—expressions of dis- 38 
NURSERY GUIDE 
content or pain—are significant to the 
trained ear. 
The fretful cry signifies discomfort. One 
may find the napkin soiled, the hands or 
feet cold, the covers too plentiful, the gar- 
ments wrinkled, the room too light or noisy, 
the air impure or too warm and dry, or that 
the child desires a change in posture. When 
the cause is removed the cry ceases. 
If the abdomen is distended or the bowel 
movements frequent, the cry is probably due 
to colic. It is often accompanied by draw- 
ing up of the legs. It may be temporarily 
relieved by the expulsion of gas or stool. 
On being offered food or water the child 
may quiet down temporarily. It is impor- 
tant that this cry be recognized early; it is 
a safety-note which Nature has instituted. 
If this cry is not heeded and the feeding rec- 
tified, dyspepsia may soon develop; or, if 
the weather is hot and the food is strength- 
ened instead of weakened, one of the more 
severe types of nutritional disturbance may 
develop. The dangers for the bottle-fed in- 
fant are naturally much greater than for 
the breast-fed. 
The cry of pain due to earache, etc., is 
different; in older infants it may be more 
like a whine. Tt is not quieted by attention, 
The Fretful 
Cry 
The Colic 
Cry 
The Pain Cry GENERAL CARE AND DEVELOPMENT 
39 
food, or water. There is often a rise in tem- 
perature. The underlying cause can usu- 
ally be diagnosed by the physician and 
proper treatment may bring early relief. 
The hunger cry may occur before or after 
nursing or feeding. It merely signifies that 
the digestion and appetite are normal. If 
the amount of food is insufficient, the weight 
does not increase as it should. The stools 
may be infrequent or constipated. The child 
may act famished until he gets his food. He 
may begin to cry when he has finished eat- 
ing. Infants very much underfed may be 
exceptionally good. 
The cry of thirst is frequently overlooked. 
When the weather is hot, the room warm, or 
if the little one has a fever, the cry may be 
due to thirst. Giving a few ounces of warm, 
boiled water then quiets him. It should not 
be given within an hour before or after a 
meal, nor should sugar be added. 
The earlier that the cry of temper, the 
outburst of disappointment, is mastered, the 
better. Giving the child his way may quiet 
him, but this yielding makes control more 
difficult. Most irate tempers are not in- 
herited, but developed. This cry is strong, 
the face becomes flushed, the arms and 
legs are held stiff or are moved freely. 
The Hunger 
Cry 
The Cry of 
Thirst 
The Cry of 
Temper or 
Anger 40 
NURSERY GUIDE 
As the child gets older lie may hold his 
breath. This cry is soon recognized; in fact, 
one usually knows what the child wants. 
The most effective remedy is to let him “cry 
it out.” A few futile attempts will teach him 
who is master. The more he has been hu- 
mored, the more difficult will be the task; 
and the earlier one begins to teach him con- 
trol of temper, the better. 
Spoiling the child often begins during the 
first months of infancy. Many children, es- 
pecially the first born or the only child, get 
what they want every time they want it. 
Such an infant, much to his detriment, soon 
masters all he surveys. Fond grandparents 
are not infrequent offenders. Fondling, ca- 
ressing, and rocking should be reduced to 
a minimum. This caution does not mean 
that the infant should never be taken up or 
held; in fact, a certain amount of maternal 
devotion is necessary, and the recreation 
hour is intended for this. Infants soon be- 
come nervous, however, through incessant 
caressing and rocking. When the child is 
fed, he should receive only the necessary 
attention (changing of napkin, etc.), then 
be placed to bed, tucked in, the light turned 
out, and the door closed. Rocking soon 
spoils an infant. A few hours of crying each 
Spoiling: the 
Child GENERAL CARE AND DEVELOPMENT 
41 
day is healthful exercise, and is indulged in 
more or less by all normal infants. There 
may he something wrong with the infant 
who never cries. 
Teasing has a bad effect on conduct and 
disposition. Older children must play 
gently with the baby, and playmates who 
tease must be avoided. Playmates of the 
proper age and temperament usually have 
a strong influence on the mental develop- 
ment of the child. 
The child should learn to respect not only 
his parents, but also his nurse and other 
people. This result must be achieved by 
more or less discipline. It must be remem- 
bered, too, that anger or rage on the part 
of his elders has a bad effect on the plastic 
mind of the young. A child should be 
taught to do as he is told, and his faults 
must be corrected early. Though sternness 
may be necessary, threats seldom accomplish 
much. A mother who threatens her child 
soon loses his confidence, and naturally her 
control over him begins to wane. If a child 
does not mind, the fault usually rests with 
his early training. 
The privilege of hissing the baby must be 
limited to the healthy adult members of the 
family. The person who picks up or fon- 
Teasing 
Punishing 
Threats 
Kissing 42 
NURSERY GUIDE 
dies tlie infant should first wash her hands 
and face. The feet and forehead are the 
safest places to kiss an infant. As soon as 
the child is old enough, he should be taught 
to turn his head or run away when visitors 
attempt to kiss him. The mother and nurse 
should protect him from such affliction. A 
nurse should never kiss her charge. Any- 
body with even the slightest cold must be 
excluded from the nursery where hats and 
coats should never be worn. 
As infants are in the habit of putting 
everything in their mouths, toys must be 
large, smooth, and washable, as well as in- 
destructible. 
The infant needs quietude and rest dur- 
ing the first two years, for his brain is 
developing very rapidly. At birth he can 
scarcely see a bright light nor does he focus 
on objects until months later. He discov- 
ers his hands when he is about three months 
old, and smiles, chuckles, and “coos” 
shortly after that. At six months he recog- 
nizes mother and nurse, and then learns to 
grasp objects and hold them. Sitting, stand- 
ing, and walking require mental develop- 
ment as well as muscular activity. The first 
words that all understand are often uttered 
before the first birthday, although his 
Toys 
Talking GENERAL CARE AND DEVELOPMENT 
43 
mother understands his language long be- 
fore that time. Many normal children do 
not enunciate distinctly under the second 
year. Time should be spent daily in teach- 
ing a few simple words. 
If a child does not talk at two years, the 
physician should be consulted. Some in- 
fants carry on conversations long before 
that age. 
Correction of lisping, stammering, and in- 
distinct enunciation should be attempted as 
soon as detected. The child should be 
taught to watch the lips of the mother or 
nurse as she slowly says the word in ques- 
tion, and be encouraged to repeat it. This 
must be done again and again each day un- 
til the words are properly spoken. Patience 
in this respect is usually rewarded. Stam- 
mering usually develops after infancy and 
may need special training. 
Retarded 
Speech 
Lisping 
Stammering CHAPTER II 
THE NURSING INFANT 
Prenatal 
Care of 
Jireasts 
Physicians usually recommend routine 
care of the nipples before, as well as after, 
delivery in the hope that trouble during 
nursing will be minimized. Substances like 
diluted alcohol, glycerin, and tannic acid 
harden the nipple, while others like cocoa 
butter, lanolin, borated and benzoinated 
vaseline keep the nipples soft. 
Before and after each nursing, a saturated 
solution of boric acid should be applied to 
the nipples with a large sterile applicator. 
After nursings, sterile cocoa butter, borated 
or benzoinated vaseline, lanolin or alboline 
may be applied. A piece of sterile gauze is 
then placed over the area before the binder 
is pinned. 
Care of 
Nipples 
Breast Troubles 
Hard “lumps” in the breast are usually 
due to insufficient emptying. If the infant 
does not empty the breasts, manual expres- 
sion or the breast pump must be resorted to. 
Lack of attention to this warning is often 
followed by an early decrease in the milk 
supply. 
44 THE NURSING INFANT 
45 
Soreness of the nipple is often due to too 
frequent nursing or to maceration of the 
nipple as a result of leaving the baby at the 
breast too long. Twenty minutes is the 
maximum nursing period; at times, six to 
ten minutes may be long enough. Through 
an early discontinuance of the night nurs- 
ing (when the baby weighs ten pounds), 
the nipples are less likely to become sore. 
Sterile benzoinated vaseline (5 per cent), or 
compound tincture of benzoin may be ap- 
plied to sore nipples after each nursing. 
Lead nipple shields worn between nursings 
are considered useful. 
The “fissured” or “cracked” nipple is 
most common during the first few months 
of nursing. Fissured nipples are very pain- 
ful to the mother while the child nurses. 
Further, the infant may swallow escaping 
blood with the milk, and when this is vom- 
ited, it causes much alarm. Pus-producing 
bacteria of the skin may enter the breast 
through a fissure and cause a deep-seated 
infection, producing inflammation or abscess 
of the breast (mastitis). Weighing the in- 
fant before and after nursings when a nip- 
ple shield is used usually shows that very 
little milk is obtained this way. By its con- 
tinued use a milk-supply is endangered, as 46 
NURSERY GUIDE 
the breasts receive insufficient stimulation. 
Pain may be relieved by emptying the breast 
several times a day. If the flow is started 
with difficulty, a breast-pump may be of 
aid. If the breast becomes inflamed and the 
mother has fever, she should remain in bed 
and use warm boric acid solution dressings 
frequently changed. When an abscess needs 
opening, the physician should decide 
Avhether nursing from that breast should be 
discontinued. The infant should nurse from 
the other breast at regular intervals. Milk 
expressed from an infected breast may be 
pasteurized and fed. Temporary comple- 
mental feedings may be necessary. Hands 
must always be washed before touching the 
breasts, and the breast-pump, shield, etc., 
should be sterilized by boiling before each 
use. 
If a breast is not emptied three or more 
times each day (by the infant, manual ex- 
pression, or pump), the production of milk 
soon decreases. This condition holds true 
with an overabundant supply as well as in 
cases of prematurity, weakness, or illness of 
the infant. 
When the supply does not increase in spite 
of regularity in nursing and subsequent 
manual expression, and if the infant’s 
Maintaining 
the Supply 
An 
Insufficient 
Supply THE NURSING INFANT 
47 
weight fails to increase, the supply is insuf- 
ficient. 
The old adage, “strong enough for the 
birth, is strong enough to nurse,” has two 
exceptions—active tuberculosis of the 
mother, and intercurrent pregnancy. In- 
verted nipples, deformity, and acute diseases 
are usually accompanied by a rapid decrease 
in supply; one should, however, continue to 
use whatever milk is available. “Flat” nip- 
ples usually “come out” sufficiently if a 
pump is used each time before the child 
nurses. 
A nervous mother may have varying quan- 
tities of milk. This condition is probably 
dependent upon irregularities in diet, fluid 
intake, nursing period, and sleep. A lack 
of routine will endanger the best milk sup- 
ply. A temporary reduction in the amount 
of milk, the result of anger, fright, distress, 
sorrow, Avorry and pain is due to a break in 
routine. Occasionally, though the breasts 
fill, the infant fails to get the milk, as the 
“purse-string” muscle about the exit of the 
nipple does not relax when the infant 
nurses. The application of warm, wet tow- 
els will probably aid in overcoming the ten- 
sion. The average child, however, easily 
overcomes the resistance encountered at the 
Contra- 
Indications 
to Nursing 
Conditions 
Which 
Influence the 
Supply 48 
NURSERY GUIDE 
beginning of a nursing. Occasionally the 
muscle at the exit of the nipple is so relaxed 
that the milk drips continually. This drip- 
ping does not imply an overabundance. 
Thick absorbent pads should then be worn 
as otherwise the nipple may fissure or be- 
come sore. 
Menstruation may cause a temporary de- 
crease in the milk supply, and the infant 
may manifest his dissatisfaction in various 
ways. The supply is usually back to nor- 
mal, however, within a week. 
By an analysis of the breast milk is usu- 
ally meant a determination of the percent- 
age of fat. Such an examination has, as a 
rule, very little value, and may be misleading. 
The quality and quantity of milk are lit- 
tle influenced by diet or tonics; none of the 
advertised nostrums are more effective than 
warm milk, weak tea, or water. On the 
other hand, if the mother is weak or anemic, 
anything done to improve her general con- 
dition may be reflected in an increase in milk 
production. The sucking of the healthy in- 
fant is the best stimulus for the milk supply. 
Completely emptying each breast three 
times a day will usually maintain a supply. 
Weeks may pass before the proper rela- 
tion between supply and demand is estab- 
Menstruation 
and Nursing 
Stimulation 
of Supply 
Supply ami 
Demand THE NURSING INFANT 
49 
lished. A supply that is at first insufficient 
may become too abundant, and if the proper 
measures under such conditions are not re- 
sorted to, this excessive supply may soon 
wane or entirely disappear. Discomfort due 
to overproduction must be relieved. If the 
breasts produce more than the child should 
have, the milk should be expressed daily and 
discarded. Failure to empty an overfilled 
breast greatly endangers the supply. 
Nursing Technic 
The mother should lie on the side to be 
nursed with the infant facing her. The one 
arm holds the child close to the breast, the 
other keeps the breast away from the in- 
fant’s nose. (See Pig. 1.) 
With the mother’s legs crossed or her 
foot supported on a stool, the nursling’s 
head rests on her elevated knee. The one 
arm presses the babe to the breast, the other 
keeps the breast from the nose. (See 
Fig. 2.) 
N ursing 
While 
Lying Down 
Nursing 
While Seated 
Technic of Manual Expression 
Completely emptying the breast regularly 
three times a day serves to augment or re- 
store the supply. If the infant is too weak 
or too young to empty the breast, if the sup- 
ply is too abundant, or if the milk is waning, 50 
NURSERY GUIDE 
either manual expression or pumping must 
be resorted to. The increase in the milk 
supply of wet-nurses exemplifies what man- 
ual expression will do. Patience is a pre- 
requisite. The technic is as follows: 
]. After the ball of the thumb and index 
Fig. 1.—Proper way of nursing while lying down. 
finger of one hand have been placed on op- 
posite sides of the nipple just outside of the 
pigmented area, they are pressed firmly 
against the breast. 
2. Maintaining this pressure, the thumb 
and finger are brought toward each other 
back of the base of the nipple. 
3. The thumb and finger are then pulled THE NURSING INFANT 
51 
forward slightly, whereby the milk is forced 
out. 
A repetition of these three movements 
Fig. 2.—Proper way of nursing while seated. 
many times after each nursing frequently 
increases the production of breast milk grad- 
ually and continuously. 52 
NURSERY GUIDE 
Nursing Routine 
At the time of nursing, the napkin is 
changed, the nipple is cleansed with boric 
acid solution, and the child is nursed the 
required length of time. lie is then held 
over the arm or shoulder until the air in the 
stomach is belched. The napkin may again 
need changing, after which the infant is put 
to bed, and should not be picked up for sev- 
eral hours. The breasts then receive the 
necessary care. Weak and newly born ba- 
bies may need constant coaxing while at the 
breast. As already pointed out, the thor- 
ough emptying of each breast is most essen- 
tial in maintaining and increasing the sup- 
ply of milk. 
No rule applies to the frequency of infant 
feedings, for we are dealing with individu- 
als, no two of whom are alike. The argument 
for a long interval between the feedings is 
that it gives the digestive organs a rest. 
Although the frequency of nursings is still 
a topic of discussion, some advocating the 
short interval, others the long, the follow- 
ing plan has approved itself generally: 
5 to 6 nursings in 24 hours if above 8 lbs. 
6 nursings in 24 hours if between 7 and 8 lbs. 
7 nursings in 24 hours if between 5 and 7 lbs. 
7 or 8 nursings in 24 hours if below 5 lbs. 
Frequency THE NURSING INFANT 
53 
A thriving nursling over eight pounds in 
weight will usually go through the night 
unfed (from ten p.m. to six a.m.) without 
much resentment. The longer one puts off 
going through the night without a nursing, 
the more difficult it becomes. 
Premature, delicate, and vomiting infants 
must be nursed according to the physician’s 
order. 
Infants of the average weight thrive best 
on the four hour interval. This is usually 
most convenient at six a.m., ten a.m., two 
p.m., six p.m., and ten p.m., (two a.m.) Nurs- 
ings according to the three hour interval 
may come at six a.m., nine a.m., noon, three 
p.m., six p.m., etc. 
An infant should nurse until he gets the 
proper amount for his age and weight. 
Some must stay at the breast twenty min- 
utes ; others get all they need in one-half or 
one-third that time. An infant nurses by 
instinct. He usually nurses rapidly at first, 
swallowing with each sucking movement; in 
fact, when the milk comes very freely he 
often swallows in rapid succession for some 
minutes without sucking. 
The only way to determine how much an 
infant gets is to weigh him on accurate 
scales before and after each nursing. The 
Nursing 
Hours 
Duration 
Quantity 54 
NURSERY GUIDE 
increase in weight is the amount of milk in 
ounces that has been consumed. The clothes 
need not be removed for this simple and 
accurate test. The well-being of an infant is 
dependent upon the quantity of food di- 
gested and assimilated, not upon the amount 
fed. The quantity consumed increases 
slowly during the first ten to twelve weeks, 
and then continues fairly constant at be- 
tween twenty-six and thirty ounces a day 
until the infant is weaned at nine months. 
The average infant usually takes six to ten 
ounces a day during the first two weeks; 
thereafter the quantity gradually increases. 
The well infant should get in twenty-four 
hours about two times as many ounces of 
breast milk as his weight in pounds; for 
example, an infant weighing eight pounds 
needs about sixteen ounces of breast milk in 
twenty-four hours (about three ounces five 
times a day). As the amount of milk may 
vary during the day, a twenty-four hour 
record must sometimes be kept. (See Chart, 
page 166.) 
The quantity of milk in one breast is usu- 
ally sufficient for a nursing. If the infant is 
nursed from one breast at one feeding and 
from the other breast at the next feeding, 
the nipples are less likely to cause trouble. 
Rotation THE NURSING INFANT 
55 
Nursing at both breasts each time also en- 
dangers the supply, as the partly emptied 
breasts fail to get sufficient stimulation. If 
an infant prefers one breast, he should be 
put to the other just as frequently. 
Both breasts, however, may be given at a 
nursing under the following conditions: 
1. To temporarily relieve congestion or 
overproduction. 
2. To stimulate a very scant supply. 
3. To decrease the supply during weaning. 
4. To avoid the richest milk in case of 
eczema. 
Two infants of the same age and weight 
may have stomachs of varying capacity; ac- 
cordingly some infants can take twice as 
much as others without regurgitating. This 
greater capacity may be due to the fact that 
the “valve” between stomach and intes- 
tine in the former relaxes much more easily 
than in the latter, and thus allows fluids to 
pass into the intestine. An infant who re- 
gurgitates (spits up) after nursing prob- 
ably gets more than his stomach can hold. 
The average newly born should be able to 
take one to two ounces at a nursing, 
three ounces at one month, six to seven 
Both 
Breasts 
Stomach 
Capacity 56 
NURSERY GUID* 
To determine the amount of breast-milk an infant obtains, weigh the clothed baby 
before and after nursings and record the difference and the length of time at the breast 
in the proper columns. 
Date Date Date ~ Date Date 
Amt. Duration Amt. Duration Amt. Duration Amt. Duration Amt. Duration 
Nursing Chart THE NURSING INFANT 
57 
ounces at six months, eight ounces at a year, 
and twelve ounces at two years. 
The newly born should be given water 
frequently each day until the milk supply is 
well established. After this, water must be 
Water 
Fig. 3.—Year-old infant. 
given only a few times a day, as quenching 
his thirst might interfere with breast stim- 
ulation. After the third month, especially 
during warm weather, it is advisable to give 
an ounce or more of boiled water (unsweet- 
ened) several times a day, about an hour 58 
NURSERY GUIDE 
before nursing. Giving water from the bot- 
tle facilitates bottle feeding and weaning. 
The birth weight should be regained 
Signs of 
Successful 
N ursing 
Fig. 4.—Overweight nine months old infant, 
by the end of the second week. The 
weight should increase about five to eight 
ounces a week during the first few months, 
and thereafter about a pound a month. (See THE NURSING INFANT 
59 
Appendix, page 168.) An infant weighing 
seven pounds at birth usually doubles his 
weight during the fifth month, and trebles 
it by the end of the first year. (Fig. 3.) 
The nursing mother should live, as far as 
possible, as she has been accustomed to. Her 
clothing must be comfortable; corsets that 
hamper the breast should not be worn, 
though the breasts may be supported by a 
well-fitting binder. Fatigue, worry, sudden 
joy, fright, must be avoided. Skating, ten- 
nis, swimming, and horseback-riding should 
not be indulged in. 
The main dietary restriction is to avoid 
overeating. If certain foods cause digestive 
disturbance, loss of appetite, or constipa- 
tion, they should be avoided. Salads, spices, 
etc., are not necessarily harmful. Constipa- 
tion may be aggravated by cocoa or choco- 
late. If an increase in weight is desired, 
gruels (cooked in milk), eggnogs, warm 
milk, etc., may be served with each meal, 
and a glass of milk may be taken during the 
morning, afternoon, and evening. If milk 
is unpalatable, it can be disguised by the 
addition of a little coffee, postum or malted 
milk. 
Routine Life of the Nursing Mother 60 
NURSERY GUIDE 
The nursing mother should sleep at least 
eight hours at night and take a nap during 
the day. She should he out of doors at least 
a few hours daily. 
If the bowels fail to move each day, meas- 
ures must be instituted at once to assist in 
establishing regularity. Coarse cereals, 
bran bread, fruit, and vegetables should be 
eaten at least twice a day. Drinking two 
glasses of cold water half an hour before 
breakfast is sometimes very effective. 
If constipation persists, in spite of dietary 
measures, then the so-called “fruit laxa- 
tive” may be used. Half a pound of washed 
prunes with the stones removed, and half a 
pound each of figs and seeded dates are mixed 
and put through a meat grinder; to the mix- 
ture an ounce or two of powdered senna 
leaves are added, and the whole is then 
kneaded. A tablespoonful or less is eaten 
at night. When the proper dose is estab- 
lished, squares or balls of it may be rolled 
in sugar, and thus made more palatable. 
If these measures are without avail, the 
physician should be consulted before resort- 
ing to purgative medicines. Enemas, used 
regularly, may prove harmful, as the nat- 
ural muscular activity of the intestinal wall 
is thus decreased. 
Anti- 
Constipation 
Treatment THE NURSING INFANT 
61 
For various reasons it may become neces- 
sary to suddenly stop the secretion of breast 
milk. This is best accomplished as follows: 
1. Do not empty the breasts—no matter 
how full and tense they become. 
2. Reduce the intake of fluids for at least 
a week. 
3'. Adjust a tightly fitting binder from 
day to day. 
4. If necessary, take a saline laxative 
(sodium phosphate) once or twice a day. 
In this way, the breasts increase very 
much in size for thirty-six to forty-eight 
hours, becoming more or less tense and pain- 
ful. After a few days the pain decreases, 
and the breasts slowly decrease in size with 
a disappearance of the milk. 
Stopping 
Breast 
Secretion 
Weaning 
If an infant is kept on the breast more 
than nine months, he usually grows pale, his 
muscles become soft, and he fails to increase 
in weight. It is therefore advisable to wean 
infants about the ninth month. In spite of 
an abundance of milk at this time, it is 
better for the child to begin to get other 
food, preferably cereals (cooked in milk and 
water), vegetable puree, and fruit juices. 62 
NURSERY GUIDE 
One must proceed gradually, however, to 
wean the child, and never attempt this 
hazardous step in nutrition without confer- 
ring with the physician. The season of the 
year or other circumstances may sometimes 
make its postponement advisable. It is 
safer, for instance, to nurse until autumn 
than to wean during the summer. If the 
little one has been getting a little water in 
the bottle daily, or has been given one ar- 
tificial feeding since the fifth month, diffi- 
culty is seldom experienced. 
Infants exclusively breast-fed for nine 
months or longer are usually weaned from 
the breast with more or less difficulty. For 
such children, it may become necessary to 
discontinue the breasts rather abruptly. 
When this is done, some refuse to take any 
food or water from the bottle, cup, or spoon 
for days. Such a child should neither see 
nor hear the mother while weaning is being 
attempted. Gavage feedings may become 
necessary in obstinate cases. Water, sweet- 
ened with a little sugar and given by spoon, 
is usually the first thing taken voluntarily. 
Weak milk mixtures or expressed breast 
milk may be offered from spoon or cup 
until there is no more opposition. 
When a mother becomes ill, it may be THE NURSING INFANT 
63 
necessary to substitute the bottle for the 
breast without delay. If the infant weighs 
less than ten pounds, properly prepared pro- 
tein milk is undoubtedly the best substitute, 
whereas larger infants usually do well on 
weak milk mixtures which may be grad- 
ually strengthened and increased. A slight 
loss in weight for the first few weeks is 
without significance, provided the food 
agrees with the child. 
Nutritional Disturbances of the Breast-Fed 
Infant 
Everyone realizes that breast milk is the 
ideal food, and that it is more prudent to 
keep a well baby well than it is to try to 
cure a sick one. The most frequent nutri- 
tional disturbances of breast-fed infants are 
the result of: 
1. Overfeeding. 
2. Underfeeding. 
3. Intercurrent disease, causing a lowered 
tolerance for food. 
The earliest and most frequent complaint 
is colic. This is usually due to overfeeding, 
irregular nursing hours, nursing too fre- 
quently or too long. Some mothers and 
nurses still favor “twenty minute nursings” 
instead of weighing the child before and 
Overfeeding 
and Colic 64 
NURSERY GUIDE 
after and determining how much he gets. 
One child may get an ounce in twenty min- 
utes, another may get six or more ounces. 
The scales should determine whether one is 
dealing with over- or under-feeding. In the 
consumption of more food than can be taken 
care of, fermentation with gas production 
takes place. This causes more or less dis- 
tention and abdominal pain, commonly 
called “colic.” Regurgitation, vomiting, 
passing an excess of gas, and the colic cry 
are Nature’s way of calling our attention 
to overfeeding. Possibly five instead of six 
or more nursings, or shortening the time 
to five or ten minutes will relieve the 
trouble. This condition is most common 
during the first three months. 
If the mother or nurse fails to heed the 
above warnings, the condition may slowly 
improve as the child grows older and 
stronger, or it may get distinctly worse. 
Sometimes, the person in charge feels cer- 
tain that the child is “suffering from hun- 
ger,” or that “the mother’s milk disagrees,” 
and a bottle of artificial food (often im- 
properly prepared) is given. In other cases 
the crying babe is given sugar water, is 
allowed to nurse longer or more frequently, 
or a hot water bottle and more covers are 
Dyspepsia or 
Indigestion 65 
THE NURSING INFANT 
added. Any of these measures and many 
more (laxatives, soothing syrups, paregoric, 
rocking, enemas) usually make matters 
worse, and in a few days the little one may 
have dyspepsia or indigestion. This is char- 
acterized by diarrhea (four to eight green 
stools with mucus and curds), gas which is 
frequently expelled, and vomiting. Infants 
who exhibit these symptoms usually do bet- 
ter by being given only barley water (with- 
out sugar) for twelve hours. After this, 
the breast may be given every four hours, 
preferably only five nursings in twenty-four 
hours. The duration of a nursing must be 
very closely watched—the child should be 
weighed before and after each nursing. A 
colonic flushing may temporarily relieve ab- 
dominal pain and distention and must oc- 
casionally be resorted to. As many infants 
who have suffered from indigestion have 
been spoiled by being humored, crying is 
usually the last symptom to disappear. 
The first indication of underfeeding is a 
failure to gain sufficiently. The infant is 
usually good, often sleeping very well at 
night. When nursing, the child either works 
more or less greedily for twenty minutes 
or longer or, if somewhat older, he will 
nurse rather greedily for a few minutes, 
Under- 
feeding 66 
NURSERY GUIDE 
then stop and cry, and possibly repeat this 
procedure, and finally refuse to nurse. If 
a stream of milk cannot be produced by 
manual expression and the breast is soft, the 
little one is probably underfed. There is 
no vomiting, the temperature may be sub- 
normal, and the fontanelle depressed. The 
bowels move infrequently, the stool some- 
times being green with very little substance 
(hunger stool). By weighing before and 
after a twenty minute nursing, the actual 
amount taken can be determined. When ar- 
tificial food is prescribed for such an in- 
fant, the age, weight, and time of year are 
factors that must receive attention. 
Infants with fever should be given less 
food. When the temperature is above 102° 
P. the duration of nursing should be short- 
ened and water should be given more fre- 
quently. The breasts should be emptied sev- 
eral times a day until the fever subsides. 
Intercurreiit 
Diseases CHAPTER III 
THE PREMATURE INFANT 
Statistics show that of one hundred births, 
three infants die before the end of the sec- 
ond week, and that premature birth is re- 
sponsible for over half of these deaths. Still- 
births (not counted as deaths) are one and 
a half times as frequent as deaths from all 
causes during the first two weeks. Measures 
such as those outlined under Prenatal Care 
serve to prevent prematurity and still-births. 
A premature infant is one born before the 
allotted time (i.e., before two hundred and 
eight days after conception). An infant 
with a birth-weight less than two and a half 
pounds seldom does well; one from two and 
a half to four pounds may live and grow 
normally if proper measures are instituted 
early, and one above four pounds usually 
thrives if the child receives proper care and 
breast milk. Nothing should be left undone 
to make a premature infant thrive. The 
three essentials in the case of the premature 
infant are: maintenance of uniform warmth, 
proper food, and avoiding infections. 
67 68 
NURSERY GUIDE 
Maintaining Uniform Warmth 
The room in which a premature child is 
born should have a temperature of 75° to 
80° F. The infant should be covered with 
a warmed blanket and placed into a blanket- 
lined basket containing hot water bottles 
as soon as possible after birth. An initial 
chilling of the body must be avoided. 
Skilled nursing care is essential and, not 
infrequently, hospital care is necessary dur- 
ing the first few weeks or months. 
The most satisfactory garment for pre- 
mature and delicate infants is the “pre- 
mature jacket.” This consists of two 
twenty-inch squares of cotton or wool cov- 
ered with cheesecloth. One or more layers 
of cotton may be basted to the cloth. The 
infant is placed between the cotton squares 
and the latter are pinned so that only the 
head is exposed. As the child gains strength 
the thickness of the cotton is gradually re- 
duced and when the weight reaches five 
pounds ordinary clothing is usually suffi- 
cient protection to maintain a normal body 
temperature. The “premature jacket” 
should be changed only three times a 
week. A small piece of cotton or cheese- 
cloth takes the place of a napkin. A 
satisfactory crib can be made of a large 
Clothing: THE PREMATURE INFANT 
69 
basket. A large, soft pillow is better than 
a mattress and three hot-water bottles main- 
tain a more constant temperature than do 
electric heating pads or incubators. After 
the child is placed in the crib a light wool 
Fig. 5.—Crib for premature infant 
blanket thrown over the basket should leave 
sufficient space for ventilation. A ther- 
mometer under the cover gives a fair esti- 
mate of the crib temperature. Room-, crib- 
and body-temperature readings should be 
charted two to four times in twenty-four 70 
NURSERY GUIDE 
hours. The room-temperature should be 
about 75° F., the crib-temperature about 
85° F. and the body-temperature between 
97° and 100° F. The temperature of the 
water in the hot-water bottles should not 
be above 110° F. and one bag should be 
changed at a time as often as necessary. 
The room should not be large and the air 
should be kept moist by means of a humidi- 
fier or a pan of boiling water. 
Premature infants should be handled very 
little and as carefully as possible. The child 
should be slowly turned from side to side 
many times during the day, but the posture 
should always be such that the respirations 
are not embarrassed. Heavy covers should 
never handicap respirations. Constant 
watch during the first few days is necessary 
so that oxygen can be administered if the 
lips or finger tips turn blue. An oil bath 
every two or three days and weighing once 
or twice a week are sufficient during the 
first few weeks. Changing the soiled cotton 
should not require handling of the delicate 
infant. 
Handling: 
Proper Food 
Breast milk should be given early as the 
weight loss is otherwise appreciable and THE PREMATURE INFANT 
71 
very slowly regained. Infants under four 
pounds should be given diluted breast milk 
the first few days. As the mothers of pre- 
mature infants seldom have breast milk be- 
fore the end of the first week, it should be 
gotten from another source (maternity hos- 
pital, infant welfare station, friend or wet- 
nurse). Such milk should be pasteurized 
or boiled. Infants weighing more than four 
pounds usually nurse well and may usually 
be put to the breasts after the first few days. 
The smaller the infant the more difficult 
the feeding technic. Infants under four 
pounds seldom nurse well and very few are 
strong enough to take the bottle. Such in- 
fants usually do well on tube feeding (see 
Gavage, page 153) until they gain sufficient 
strength to take the breast or bottle. The 
Breck feeder is a novel device which re- 
lieves the infant of much work. It is a 
graduated glass tube like a large medicine 
dropper with a rubber bulb at one end and 
a small nipple at the other. Pressing on 
the bulb forces the milk out of the nipple, 
whereby the infant is relieved of much ef- 
fort. Feeding by dropper or spoon is sel- 
dom satisfactory, as the child is likely to 
vomit the food. If the infant does not 
empty the breasts they should be drained 
Feeding 
Technic 72 
NURSERY GUJDI 
Date 
Day 
Weight 
Room 
Temp. 
A. M. P. M. 
Crib 
Temp. 
A. M. P. M. 
Rectal Temp. 
A. M. P. M. 
Bowels 
Amt. of Food 
Taken in 24 
hours. 
1 
2 
3 
4 
5 
6 
7 
(An accurate daily record should be kept for the first few weeks) 
Premature Chart (For 1 Week) THE PREMATURE INFANT 
73 
regularly several times a clay by manual ex- 
pression or a breast pump. A supply may in 
this way be increased or maintained for 
weeks or months—until the child is strong 
enough to empty the breasts. 
The amount and strength of the food is 
determined by the size of the infant. By 
the end of the first week a feeding usually 
consists of an ounce of undiluted breast 
milk. The smaller the child, the shorter the 
feeding interval, but more than seven or 
eight feedings in twenty-four hours are sel- 
dom necessary. The physician should be 
informed if food is refused or regurgitated. 
Vomiting, gas, diarrhea and colic are usu- 
ally signs of overfeeding, overheating or 
improper technic. 
If the mother’s milk supply is insufficient 
and if breast milk from another source is 
not constantly available, a wet-nurse may 
be indispensable. The “want ad” column 
of the daily paper usually brings a number 
of applicants. The physician examines the 
candidates and their infants. Breast milk 
from a wet-nurse should be pasteurized at 
least until the result of the Wassermann 
blood-test is known. As it is essential that 
the supply be maintained, the wet-nurse’s 
baby should empty each breast several times 
Wet Nursing 74 
NURSERY GUIDE 
a day. Her baby should sleep in the nursery 
and should be cared for by her. If he fails 
to thrive, complemental or supplemental 
food should be given. The wet-nurse should 
be kept occupied with light housework, sew- 
ing and mending, but she should have ample 
time for rest. Her food should be plain and 
substantial. She should drink sufficient 
water and two quarts of milk daily. 
If a premature infant fails to gain or if 
the milk supply decreases, the cause should 
be determined early. Both babies should be 
weighed before and after nursings. A pre- 
mature infant may have other congenital 
handicaps which often make progress 
tedious. When an infant attains a weight 
of eight pounds, breast milk is usually no 
longer necessary. 
Infants weighing less than four pounds 
seldom do well on artificial food. The best 
substitutes for breast milk are protein milk, 
powdered milk and condensed milk properly 
prepared and carefully fed. 
Artificial 
Food 
At no time is a cold more to be dreaded 
than in a premature infant. Any infection, 
but especially a cold, may seriously handi- 
cap the child’s progress. Only the mother, 
Avoiding Infections THE PREMATURE INFANT 
75 
nurse, and physician should come in con- 
tact with the infant until the weight reaches 
eight pounds. Aseptic nursing technic must 
be observed until the infant is at least sev- 
eral months old. No one with a cold, or 
any other infection, should be allowed in the 
nursery. A nursing mother with a cold 
Fig. 6.—Face mask. 
should wear a face-mask, and should not 
cough, sneeze, or talk while near the baby. 
(See Fig. 6.) Children should never enter 
the nursery, nor should they ever come 
within a yard of a premature baby. As pre- 
mature and delicate infants are very easily 
infected, prevention is of paramount impor- 
tance. 76 
NURSERY GUIDE 
Adopting an Infant 
Before adopting an infant, one should find 
out as much as possible about the parentage. 
The Wassermann blood-test, tuberculin test, 
nasal culture, vaginal and eye smears should 
be negative. The feeding of an adopted in- 
fant should be under the physician’s care. 
Underweight infants usually thrive if prop- 
erly fed and cared for. CHAPTER IV 
ARTIFICIAL FEEDING 
Cow’s Milk 
The best substitute for breast milk is pure, 
fresh cow’s milk, modified to suit the re- 
quirements of the individual infant. The 
supply should preferably come from a mixed 
herd of healthy cows. Jersey and Guernsey 
milks are not very desirable for young in- 
fants on account of the high fat content. 
If the milk comes from one cow, it should 
preferably be from a Holstein. 
Milk has been responsible for more dis- 
ease and deaths than all other foods com- 
bined. In 1910 ten per cent of Chicago 
market milk and butter contained tubercle 
bacilli. The introduction of pasteurized 
and certified milk since that time has greatly 
improved matters. 
Milk may be dangerous because: 
1. Bacteria grow very rapidly in it. 
2. It “spoils” when not kept cold. 
3. The consumer cannot discriminate 
“good” from “bad” milk. 
4. It is often used “raw.” 
77 78 
NURSERY GUIDE 
These dangers can be avoided to a cer- 
tain extent by: 
1. Supervision of dairies and inspection 
of the milk supply by state and municipality. 
2. Compelling dairies to pasteurize and 
refrigerate all milk entering cities. 
3. Certifying milk which is obtained 
under exceptional dairy conditions. 
4. Proper care of the milk as soon as it 
reaches the home. 
Unpasteurized milk, used by residents of 
small towns, rural districts and summer re- 
sorts, should be strained, boiled for ten min- 
utes and cooled rapidly (as soon as it is ob- 
tained). A visit to the dairy from which 
the infant’s milk supply comes may not be 
amiss. The stables should have plenty of 
air and light, and must be well-floored. 
There should be no excess of dust, manure, 
or bad odor. The cows, especially their ud- 
ders, should be clean, and the latter should 
be wiped with a clean, damp cloth before 
each milking. The milker should be healthy, 
his hands should be clean, and the pails and 
bottles should be sterilized before each milk- 
ing. The more dirt and dust that enter the 
milk, the more bacteria will it contain; the 
warmer the weather, the more rapidly will ARTIFICIAL FEEDING 
79 
they multiply; and the longer the milk is 
kept before being pasteurized or boiled and 
cooled, the more likely will it be unwhole- 
some. 
Although the unsanitary dairy of a decade 
ago is rapidly disappearing, and most milk 
entering cities is either pasteurized or cer- 
tified, great care must be exercised by the 
consumer to keep it from becoming unfit for 
use. Milk relatively pure when it leaves the 
dairy may, in the course of twenty-four 
hours, become swarming with bacteria. The 
bacterial count reflects the care which has 
been exercised in the milking and market- 
ing. A count of 10,000 or less per c.c. (1 c.c. 
equals 15 drops) is ideal. Milk showing a 
count of 100,000 or more should not be used 
for infants. Bacteria belong to one of two 
classes: 1, the pathogenic (disease produc- 
ing) such as streptococci, bacilli of typhoid 
fever, diphtheria, and tuberculosis; 2, non- 
pathogenic (more or less harmless), occur- 
ring in dust and on the udder. If the bac- 
teria in the milk are not destroyed, either 
type of germ may menace health. The 
poisonous substances produced by the non- 
pathogenic bacteria can render milk un- 
wholesome. 
Tnfants are easily upset by “spoiled” 
Sour MilU 80 
NURSERY GUIDE 
milk. Sour milk contains acid-producing 
bacilli which are not necessarily harmful. 
While certain changes take place in frozen 
milk it may be used if quickly melted, boiled 
for ten minutes, and kept cold until used. 
In the course of the last decade, many 
American municipalities have set up stand- 
ards for a pure milk supply. Certified milk 
should have a very low bacterial count 
(10,000 or less per c.c.), must be free from 
preservatives, should not be over twenty- 
four hours old, and must come from cows 
that are free from tuberculosis (tuberculin 
tested). The stables, milking, and vending 
must withstand a rigid examination. The 
milk is placed in sterilized bottles and kept 
at a temperature below 50° F. until deliv- 
ered. These precautions make certified 
milk high-priced. Certified Holstein milk 
is the ideal milk for young infants. The 
main objections to certified milk are that 
it often contains too much cream, and that 
there is no guarantee that the milker and 
cows are free from contagious disease. Ap- 
parently healthy cows may develop tuber- 
culous udder disease during the interval be- 
tween veterinary inspections. For these 
reasons there is a certain amount of risk 
even in raw certified milk. The numerous 
Frozen Milk 
Certified 
Milk ARTIFICIAL FEEDING 
81 
outbreaks of scarlet fever and streptococcic 
sore throat among infants and children fed 
raw certified milk show that even certified 
milk should be boiled or pasteurized to be 
rendered safe for the infant. 
A small group of physicians still recom- 
mend raw milk on account of the vitamins. 
These accessory food substances are as 
necessary for growth and life as are protein, 
fat, carbohydrate, water and salts. One 
vitamin present in milk is called “water 
soluble B,” another, occurring in cream, 
butter, cod-liver oil and egg yolk, is known 
as “fat soluble A.” We know that boiling 
fresh milk does not completely destroy these 
substances. If raw milk is prescribed, cer- 
tified milk should be used. 
Heating milk to 150° to 160° F. and main- 
taining that temperature for thirty minutes 
destroys all germs except spores and ren- 
ders the milk safe. It must be cooled 
quickly and kept cool until used. Most milk 
entering our cities is thus pasteurized. 
When the infant’s food is prepared, the milk 
should be boiled or again pasteurized, cooled 
rapidly and kept on ice in sterilized feed- 
ing bottles. 
Boiling cow’s milk in a single boiler for 
ten minutes not only destroys the germs, 
Raw Milk 
Pasteurized 
Milk 
Boiled Milk 82 
NURSERY GUIDE 
but makes it more digestible and less laxa- 
tive. Diarrhea, the bane of artificial feed- 
ing, occurs much less frequently with boiled 
than with raw milk. The constipating ac- 
tion, as well as the danger of scurvy, can 
be counteracted by the daily administration 
of a little diluted orange juice. This may be 
begun about the fourth month. By the use 
of a double boiler the boiling point is not 
quite reached, but maintaining this high 
temperature for ten to twenty minutes and 
then cooling rapidly destroys all harmful 
bacteria. 
Boiling milk for fifteen to thirty minutes 
destroys all the germs (including spores). 
In this process, the flavor is markedly 
changed, the protein is rendered somewhat 
less digestible, and orange juice must be 
given daily to prevent scurvy, as much of 
the vitamin of the milk is thus destroyed. 
Fat-free or skimmed milk is frequently 
used when an infant fails to digest whole 
milk. As commercial skimmed milk is a 
by-product of the modern butter industry, 
it is safer to let whole milk stand until the 
cream collects, and then pour or dip off all 
the cream. 
There are on the market several reliable 
brands of milk in powder form. The milk 
Sterilized 
Milk 
Skimmed 
Milk 
Dry Milk ARTIFICIAL FEEDING 
83 
used in their manufacture should be from 
healthy cows, obtained under sanitary con- 
ditions, and dried within twelve hours after 
milking. A quick drying process whereby 
the milk is not heated above the boiling 
point (212° F.) kills the germs while most 
of the vitamin content is preserved. Half 
or all of the cream is removed before dry- 
ing to keep it from becoming rancid. Dry 
milk should be mixed with hot, boiled water, 
and strained. It must be freshly prepared 
once or twice each day. It is very useful 
in traveling or where pure, fresh milk can- 
not be obtained. 
Most of the infants with severe nutritional 
disturbances coming to the attention of the 
specialist have had a proprietary “food” 
of one brand or another. Not infrequently 
a number of such “infant foods” have been 
tried in vain. The mother or nurse usually 
maintains that the directions on the pack- 
age were followed. After the child’s diges- 
tion has thus become very much impaired, 
careful supervision for weeks or months is 
often necessary to restore the child’s health. 
Many of these infants get rickets. While 
most of the best known “infant foods” are 
not harmful, the ironclad formulae, the short 
interval, and the use of unboiled milk make 
Proprietary 
Infant 
Foods 84 
NURSERY GUIDE 
this method of feeding extremely hazardous. 
The fact that vast sums of money are spent 
each year in advertising is ample proof that 
none of the patent “infant foods” is a 
panacea. The secret of successful infant 
feeding is to adapt the food to the individ- 
ual infant, not to attempt to adapt the in- 
fant to ironclad feeding directions. 
Condensed milk has a very limited field 
of usefulness in infant feeding. If properly 
diluted it may be used for a short period 
when the infant needs a food very high in 
sugar and low in other constituents. Be- 
cause of its extremely high sugar con- 
tent (from 35 to 55 per cent), it is 
impossible to make a dilution approximate 
the proportions of fat, protein, and sugar 
as they exist in breast milk. On account of 
its cheapness, palatability, and ease of prep- 
aration, condensed milk still enjoys a cer- 
tain degree of popularity which it does not 
deserve. The few children who apparently 
thrive on it would, most likely, do well on 
any food. An infant kept on it for months 
is usually greatly handicapped. 
Unsweetened, evaporated milk is of value 
on long journeys, especially during warm 
weather, when fresh milk and milk powder 
cannot be procured. It is about twice as 
Condensed 
Milk 
Evaporated 
Milk ARTIFICIAL FEEDING 
85 
strong as ordinary milk, and must be used 
within twenty-four hours after the can is 
opened. When it is given for a long time, 
starches and sugars should be added, and 
orange juice must be given daily. 
To make buttermilk, boil a quart of 
skimmed milk five to ten minutes, allow to 
cool to 100° F., and add the buttermilk cul- 
ture. This may be in the form of four 
ounces of “ripe” buttermilk or a solution of 
lactic acid bacilli (purchased from the drug 
store). “Buttermilk” tablets are seldom 
satisfactory. After mixing, it is allowed to 
stand in a warm place for six or more hours. 
It is then mixed with an egg-beater or small 
churn, passed through a fine sieve, and kept 
on ice. Four ounces of this will serve to 
inoculate another quart of milk, whereby one 
culture may serve for weeks. Buttermilk 
must be warmed very carefully to prevent 
curdling. 
To prepare protein (casein-, albumin-, or 
Eiweiss-) milk, add one tablespoonful of es- 
sence of pepsin to a quart of raw whole 
milk. Allow to stand in a warm place 
(double boiler) for an hour, and then drain 
the curds in a sterile muslin or cheesecloth 
bag for an hour or longer (in the ice chest). 
Then rub through a fine colander or sieve 
Buttermilk or 
Baetic Acid 
Milk 
Protein 
Milk 86 
NURSERY GUIDE 
(36 wires to the inch) four or five times, 
using a pint of buttermilk in the process. 
After the addition of cooled, boiled water 
to bring the volume up to a quart, the whole 
is brought to a boil, during which time it 
must be vigorously stirred or beaten. The 
finished product should be kept in the ice 
chest. Dextri-maltose or another sugar 
should be added. When this milk is being 
warmed for a feeding, caution is necessary, 
as the milk curdles if heated above 100° F. 
The difficulties encountered in the prepara- 
tion of this valuable food are manifold. 
Though it is invaluable for prematures and 
young infants deprived of breast milk, its 
main field of usefulness is in nutritional dis- 
turbances. Protein milk can now be had in 
powder form.# The powder as well as the 
mixture must be kept in a cool place. 
In the preparation of peptonized milk, 
unless otherwise specified, the milk is boiled 
for five minutes, and allowed to cool to 
100° F. before the junket, pepsin, chymo- 
gen or peptogenic milk powder is added; 
it is then kept in a warm place (double 
Peptonized 
Milk 
*Protein Milk—Merrell Soule Co., Syracuse, N. Y., and 
leading cities. 
Albumin Milk—Pouis Hoos, 5232 Kenmore Ave., Chi- 
cago. 
Caseo—Meade Johnson & Co., Evansville, Ind. ARTIFICIAL FEEDING 
87 
boiler) until it thickens. It is then mixed, 
passed through a sieve, and kept cold until 
used. It must be warmed carefully to avoid 
curdling. 
To prepare malt soup, three ounces of 
malt soup extract are boiled in ten ounces of 
milk. In another saucepan two to four 
tablespoonfuls of wheat flour are thoroughly 
boiled in twenty ounces of water (with con- 
stant stirring) for ten to fifteen minutes. 
The two are then mixed, and after the whole 
has boiled about three minutes longer, it 
is diluted with water to total a quart. The 
proportions of milk, water, and flour vary 
according to the age and strength of the 
child. There are now on the market satis- 
factory malt soup “stock” powders. Malt 
soup is of value in feeding constipated in- 
fants with stationary weight. 
To prepare whey, boil a quart of milk for 
five minutes, allow to cool to 100° F., add 
two teaspoonfuls of essence of pepsin or a 
dissolved junket tablet, and allow to stand 
until firm. Cut the curd, but avoid stirring, 
warm gently for a few minutes, and then 
carefully strain through a boiled, double 
cheesecloth. The whey contains most of the 
sugar, salts, and water of the milk. If milk 
or cream is to be added, the whey should be 
Malt Soup 
Whey 88 
NURSERY GUIDE 
heated to 160° F. to inactivate the pepsin 
or rennet. 
Add one and one-half teaspoonfuls of es- 
sence of pepsin to a quart of half-skimmed 
milk which has been boiled for five minutes 
and cooled to 100° F. A temperature of 
about 105° F. is maintained for half an hour. 
The thickened milk is then suspended in a 
sterile muslin bag until all the whey has 
drained off. The curds are passed through a 
fine sieve three or four times, then transferred 
to a sterile muslin bag and suspended in a 
large pan of water. The water is changed 
several times so that the curds are thoroughly 
washed, after which six and one-half ounces 
of the whey are added to the washed curds. 
To this mixture is added enough plain water 
or barley water to bring the volume up to 
a quart. After the required amount of 
dextri-maltose No. 2 has been added, the 
mixture is again rubbed through a fine sieve. 
As eczema soup curdles easily, it must be 
carefully warmed. It should be used only 
when ordered by the physician. 
Kczema 
Soup 
Preparation of the Infant’s Food 
Utensils 
The utensils necessary for the preparation 
of the daily food supply should be used for 
this purpose only and should have a special ARTIFICIAL FEEDING 
89 
place in the kitchen. There are necessary: 
six or more nursing bottles (round, gradu- 
ated, with wide mouth and short neck), 
an equal number of rubber stoppers and 
nipples (preferably the black, reversible 
kind), two wire baskets for the bottles (one 
for the ice chest, the other for the used 
Fig. 7.—Utensils needed in milk modification. 
bottles), a sixteen-ounce graduate, a funnel 
(to fit the bottles), a two-quart double 
boiler, a quart pitcher, a large, deep sauce- 
pan (for boiling the bottles, nipples, and 
utensils), a dairy thermometer, tablespoon, 
knife, and nipple and bottle brushes. 
The bottles, filled with water, are scoured 
with soap and hot water by means of the 
Sterilizing 
Utensils 90 
NURSERY GUIDE 
bottle-brush. After all adherent particles 
have been removed, the bottles are rinsed 
until clean, then filled and placed in the 
deep sauce-pan, which is half-filled with 
water. The nipples and stoppers are then 
scoured, rinsed, and placed in the pan, as 
are also the graduate, funnel, spoon, and 
knife. After the water has boiled for ten 
to fifteen minutes, it is poured off, and the 
hot contents of the pan are allowed to drain 
by being placed on a clean towel. The dry 
nipples are then transferred by the aid of 
the spoon to a clean tumbler. 
The prescribed ingredients are mixed as 
directed and, unless otherwise specified, are 
boiled in a sauce-pan or covered double 
boiler the required length of time. When 
somewhat cool the required amount is 
poured into the proper number of bottles 
which are then sealed with the sterile stop- 
pers or cotton. The bottles are then cooled 
rapidly and placed in the ice chest. After 
a little practice the food can usually be pre- 
pared within an hour, but care should never 
be sacrificed for speed. After the food has 
been prepared, the utensils are scoured, 
rinsed with hot water, and put in their place. 
The hands should be washed before the 
bottle is taken from the ice-chest. The nip- 
Preparing 
the 
Food 
Giving- tlie 
Bottle ARTIFICIAL FEEDING 
91 
pie is put on without touching the upper 
part of the bottle or nipple. The food is 
then warmed by means of an electric bottle 
warmer or sauce-pan of warm water. The 
temperature of the food is best determined 
Fig. 8.—Pnoper way of giving a feeding. 
by allowing a few drops to fall on the inner 
side of the wrist. It should feel warm, not 
hot. The hole in the nipple is tested by in- 
verting the bottle and gently shaking down- 
ward, when the milk should drop out readily 
—not stream out. If the hole is too small it 92 
NURSERY GUIDE 
may be enlarged with a hot needle; if too 
large, the nipple must be discarded. A feed- 
ing should never require less than ten nor 
more than twenty minutes. Should the hole 
become “plugged” during a feeding, the bot- 
Fig. 9.—Improper way of giving a feeding. 
tie should be held upright in one hand and 
forcibly brought downward against the 
palm of the other. If the curd is not thus 
dislodged, another nipple should be used. 
The bottle must be properly held during the 
entire feeding. (Figs. 8 and 0.) Any food ARTIFICIAL FEEDING 
93 
left in the bottle at the end of twenty min- 
utes should be discarded and the bottle 
filled with hot water. 
While the main ingredient of an infant’s 
food is usually milk (whole or skimmed 
milk, buttermilk, protein milk, peptonized, 
powdered, or goat’s milk), other ingredients 
such as sugar, flour, or cereal are added. 
If sugar, flour, or cereal is prescribed by 
weight, an inexpensive letter-scale may be 
used. If the measuring is done by spoon, 
the same spoon should be used from day to 
day. 
Two after-dinner coffeespoonfuls equal a 
teaspoonful; three teaspoonfuls equal a 
tablespoonful; two tablespoonfuls equal a 
liquid ounce. 
The Table on page 94 gives the number of 
level tablespoonfuls to the ounce, also the 
weight of a teaspoonful and tablespoonful of 
various supplies. 
The three sugars used most frequently are 
dextri-maltose, granulated (cane) sugar and 
milk sugar (lactose). A sugar is added to 
the milk mixture to increase its food value. 
Occasionally a proprietary “food” is used. 
Granulated sugar is usually too sweet, and 
milk sugar may be too laxative, especially 
during hot weather. 
Ingredients 
Measures 
Sugars 94 
NURSERY GUIDE 
NO. OF LEVEL TABLE- 
SPOONFULS TO THE 
OUNCE 
1 LEVEL TEASPOONFUL 
WEIGHS ABOUT 
1 LEVEL TABLESPOON- 
FUL WEIGHS ABOUT 
3 
Dextri-Maltose 
YlO 
ounce 
Vs 
ounce 
8 
Dry Milk 
Ys2 
l < 
Ys 
( l 
3 
Milk Sugar 
YlO 
( 6 
% 
( ( 
2 
Granulated Sugar 
y8 
( ( 
% 
t 6 
3% 
Protein Milk Powder 
Yu 
6 ( 
Vs 
( ( 
4 
Wheat or Barley Plour 
Vio 
( ( 
Ys 
C ( 
4 
Kolled Oats 
Vl2 
“ (scant) 
y4 
i i 
2 
Eice or Pearl Barley 
y6 
< 6 
% 
“ (scant) 
3 
Farina 
Vio 
i 6 
y3 
i i ARTIFICIAL FEEDING 
95 
The flours of barley, rice, and wheat are 
seldom used before the second month. Par- 
tially dextrinized “patent” barley flour and 
rice flour are most easily digestible. Wheat 
flour, properly prepared may be useful in 
mild cases of diarrhea. Corn starch is sel- 
dom used before the second year. Soy-bean, 
rich in vegetable proteins, is occasionally 
used in the treatment of intestinal disorders. 
Cereals (farina, oats, corn meal, etc.), must 
be thoroughly cooked to be rendered digest- 
ible. Farina is the favorite gruel. It has a 
high nutritive value and contains mineral 
salts which are valuable in bone and tooth 
development. Cereals form an important 
part of the diet during the second half of 
the first and the first half of the second year. 
Flours, 
Starches 
and Cereals 
Beef-juice is best prepared as follows: 
sear small pieces of lean round steak in a 
hot pan and run through a meat grinder 
that has been immersed in hot water. The 
ground meat is then put into a wet, boiled 
cheesecloth bag and the remaining juice ex- 
pressed. After the expressed juice has been 
chilled, the fat should be removed and a 
little salt added. It may be poured over 
toast, zwieback, or mashed baked potato. 
Recipes 
Beef-Juice 96 
NURSERY GUIDE 
Two to four tablespoonfuls of beef-juice is 
usually sufficient. It is valuable for pale 
infants. 
To prepare broth, half a pound of lean 
beef, mutton, or chicken, and a pint or more 
of water are cooked for two hours (water 
being added from time to time). After 
cooling, the fat is skimmed off and sufficient 
water added to make a pint. It is then 
strained. As broth has very little food- 
value, it should be thickened with cereal, 
bread crumbs, or potato. Like beef-juice 
and green vegetables, it furnishes elements 
valuable for growth. 
Cereals must be thoroughly cooked in a 
covered, double boiler; water, milk and 
water, or milk are used in their preparation. 
A little sugar and salt are usually added to 
make them more palatable. 
To prepare cereal water, a level table- 
spoonful of barley, rolled oats, or rice is 
added to a pint of water and boiled an hour 
in a covered double boiler, strained, and 
enough boiled -water added to make a pint. 
Patent barley flour is boiled only thirty min- 
utes. Barley water is frequently used in 
place of other food for twelve or twenty-four 
hours in severe case of diarrhea, vomiting, 
or colic. Oatmeal water is frequently given 
Broths 
Cereals 
Cereal 
Waters ARTIFICIAL FEEDING 
97 
to breast-fed infants who have infrequent 
bowel movements. 
To prepare custard, a level teaspoonful of 
sugar and an egg are beaten in a cup and 
sufficient milk is added to fill the cup. It 
is covered with a saucer, placed in a sauce- 
pan of boiling water for ten minutes, then 
cooled and placed on ice until served. 
To make flour ball, four cupfuls of wheat 
flour are tied in a double cheesecloth or 
muslin bag, placed in two quarts of water, 
and boiled for six hours, water being added 
from time to time. The water is then thor- 
oughly drained off. After several hours 
the cloth is removed, and the chalk-like 
center is broken into pieces and gently 
baked in an oven for two hours. This is 
then grated, sifted, and put in dry mason 
jars. Prepared flour ball may be obtained 
under the names of “Cereo” and “Old Hol- 
land Pood.” It is very nutritious, easily 
digestible, and is of particular value as a 
temporary diet for older infants who refuse 
to eat ordinary food. 
To prepare junket, a teaspoonful of es- 
sence of pepsin or a junket-tablet that has 
been previously dissolved in a spoonful of 
water is added to a half pint of luke-warm 
milk. After being mixed, it is kept warm 
Custard 
Flour Ball 
Junket 98 
NURSERY GUIDE 
(double boiler) until firm, then put on ice 
until served. If plain junket is used, a drop 
of vanilla may be added. 
To prepare tea for infants a quart of boil- 
ing water is added to a scant after-dinner 
coffeespoonful of tea leaves. This is al- 
lowed to steep until the water has a pale 
yellow tint, when it is strained. A saccharin 
tablet may be added. Some physicians use 
weak tea in place of barley water for twelve 
or twenty-four hours in cases of severe diar- 
rhea, vomiting, or colic. 
Tea 
Artificial Food 
The artificially fed infant usually thrives 
when the food given him is accurately ad- 
justed to his individual requirements. The 
path with the least pitfalls is to have the 
physician make a complete physical exami- 
nation of the child when the gain is less 
than four ounces a week. Several stools 
and a specimen of urine should he submitted. 
After a diet is prescribed a record should 
be kept of his progress. This includes the 
daily or weekly weight, the number and 
consistency of the stools and the amount of 
food refused or vomited. The progress 
should be reported to the physician at def- 
inite intervals so that the necessary changes, ARTIFICIAL FEEDING 
99 
increases, and additions to the diet can be 
made as they become necessary. Individ- 
ualization is the secret of successful infant 
feeding. Every infant fed artificially needs 
and deserves individual attention. Advice 
of relatives, neighbors, and unscrupulous 
patent “infant food” concerns may produce 
permanent injury and should never be 
heeded. The day of generalized tables for 
infant feeding, and the era of complicated 
formulas, are things of the past. It is pru- 
dent to consult the physician as soon as 
the infant fails to thrive on the breast. 
The artificial food usually consists of a cer- 
tain amount of pure cow’s milk, water, and 
sugar. Later on a flour or cereal is usually 
added. 
Human Milk and Cow’s Milk Compared 
CONSTITUENTS 
BREAST MILK 
COW’s MILK 
Fat 
4. % 
4. % 
Sugar 
7. % 
4.5% 
Protein 
1.5% 
3.5% 
Salts 
0.2% 
0.7% 
Water 
87.3% 
87.3% 
This analysis shows that human milk con- 
tains about twice as much sugar, half as 
much protein, and a fourth as much of salts 
as does cow’s milk. Attempts have been 
made so to modify cow’s milk as to make it 100 
NURSERY GUIDE 
contain these ingredients as they occur in 
human milk. Such modification is intri- 
cate, to say the least. 
Infants under ten pounds usually thrive 
on protein milk containing 3' per cent or 
more of dextri-maltose. If cow’s milk mix- 
tures are given, they must be weak at first 
and strengthened as the child grows older. 
A half milk, half barley water mixture con- 
taining a sugar is usually satisfactory until 
the third or fourth month, when the propor- 
tion of milk is gradually increased. During 
the sixth or seventh month, one or two 
cereal feedings are usually given, and a 
small amount of vegetable is frequently ad- 
ded. Infants past four months should be 
given orange juice daily when the bowels 
are not loose. In case of constipation after 
the eighth month, a few ounces of unsweet- 
ened prune juice may be given daily. 
Mixed Feeding (Breast and Bottle) 
Mixed feeding, properly conducted, does 
not endanger the breast milk supply, even 
when the child gets relatively little from the 
breast. The occasions where it is resorted 
to are: 
1. If the breast milk supply is insufficient. 
2. If the duties of the mother take her ARTIFICIAL FEEDING 
101 
away from her child for many hours of 
the day. 
The two methods available are: 
1. To give the artificial food in the bot- 
tles immediately after one or more nurs- 
ings (Complemental Feeding). 
2. To give one or more bottles in place of 
the breast (Supplemental Feeding). 
Complemental feeding is the ideal method 
if artificial food must be used. By weigh- 
ing the infant before and after each nursing 
for a day or two, the necessary amount of 
complemental food is determined. 
If the infant fails to gain on complemental 
feedings, then supplemental feeding is usu- 
ally resorted to. If two or more bottles are 
substituted for nursings, both breasts should 
be emptied at the other feeding periods. 
The breast supply is usually endangered 
when supplemental feeding is resorted to. 
Mothers are usually willing to nurse their 
infants indefinitely if one bottle is given 
about the fifth month. The best time of day 
to give this bottle is at two or six p.m. If 
the food is properly prepared (sufficiently 
weak) and both breasts are given at the 
next nursing (at six or ten p.m.), the sup- 
ply is seldom impaired before the child is 
Methods 
Complemental 
Feeding 
Supplemental 
Feeding 102 
NURSERY GUIDE 
ready to be weaned. Giving a bottle at five 
months makes subsequent weaning rela- 
tively easy. 
The age at which mixed feeding is begun, 
the condition of the infant, and the time of 
year are factors that receive the physician’s 
attention when artificial food is prescribed. 
The child should not be able to get the arti- 
ficial food too easily nor should the food be 
too sweet, as the child may develop a prefer- 
ence for the artificial food and take the 
breast very reluctantly. 
Rules for Infant Feeding 
The following rules will guide the mother 
or nurse in avoiding and detecting gross 
errors. 
1. Artificial feeding must never he begun 
before it is necessary, but when necessary, 
valuable time should no± be lost. 
2. The physician’s orders must always be 
adhered to. 
3. The infant must be fed regularly, being 
awakened for his food, if necessary. 
4. The food must be warm, and the bottle 
must be held during the feeding, -which 
should never require more than twenty 
minutes. 103 
ARTIFICIAL FEEDING 
5. After gas has been allowed to escape 
by holding the child over the shoulder, he 
should be put into the crib and left there 
for at least several hours. 
6. Used nipples must be turned inside out, 
cleansed, boiled, and kept in a clean, dry 
tumbler. 
7. The used bottle should be immediately 
rinsed and filled with hot water. 
8. Overclothed infants perspire and get 
colic or catch cold very easily. 
9. Colic, diarrhea, or fever require a de- 
crease of food and the physician’s advice. 
Calories and Tolerance 
The average infant of a certain age and 
weight, requires, theoretically, a definite 
amount of food daily to maintain the body 
functions and to gain properly. Sugars and 
fat serve as fuel and are burned, whereby 
body heat and energy are liberated; the 
proteins on the other hand, serve for 
growth and repair. The amount of inher- 
ent heat or energy of all foods is known; 
the unit of measure is called a calorie. Each 
ounce of food represents a definite number 
of calories; for instance, an ounce of human 
milk or cow’s milk contains twenty-one 
calories, an ounce of any of the sugars about 
Calories 104 
NURSERY GUIDE 
a hundred and twenty, and an ounce of 
flour, starch, or cereal, about a hundred. 
Painstaking observations have shown that 
to thrive, the average newly born needs for 
each pound of his weight about forty-five 
calories in twenty-four hours; older infants 
usually require forty calories; whereas the 
minimum to maintain life is about thirty 
calories per pound in twenty-four hours. 
Infants much underweight may need sixty 
or more calories for each pound of weight. 
A specific example may serve to illustrate 
the method pursued in calculating an in- 
fant’s food requirements. An average ten 
pound infant requires about four hundred 
and fifty calories each day. As an ounce of 
breast milk contains twenty-one calories, he 
will need about twenty-one ounces of breast- 
milk in twenty-four hours. This amount 
would be consumed in five feedings of four 
ounces each. This is the equivalent of two 
ounces of breast milk for each pound of 
weight in twenty-four hours. If the infant 
is artificially fed, fifteen ounces of cow’s 
milk, fourteen ounces of water, and about 
three level tablespoonfuls of dextri-maltose 
are theoretically the optimum proportions. 
About one and a half ounces of cow’s milk 
for each pound of weight serves as a guide ARTIFICIAL FEEDING 
105 
in determining the necessary amount of 
cow’s milk. The quantity of additional car- 
bohydrate is usually estimated at three or 
more per cent. The number of calories per 
pound in twenty-four hours on such a for- 
mula is estimated as follows: 
Milk — fifteen (ounces) times twenty-one 
(calories) — 315 calories 
Water — 0 
Dextri-Maltose — 3 level tablespoonfuls 
= 120 calories 
divided by ten (pounds) equals forty- 
three and a half calories per pound in 
twenty four hours. 
Food Tolerance 
Healthy infants usually have a wide food 
tolerance (capacity for food); that is to say, 
the quality and the quantity of food given in 
twenty-four hours may vary within rela- 
tively wide limits without causing nutri- 
tional disturbances. An infant who has 
been underfed for a long period of time or 
who has been ill often has a decrease in food 
tolerance. Gross errors in feeding cause 
diarrhea, vomiting, and other serious dis- 
orders because they overstep the food toler- 
ance of the individual. A fever caused by 
an earache, bladder infection, tonsillitis, etc., 
or an extremely hot day, too much clothing 
or too many covers, may cause a decrease in 106 
NURSERY GUIDE 
food tolerance. An “overstepped” toler- 
ance is very slowly restored; in fact, skill 
and patience are necessary to avoid a fur- 
ther decline. Increasing artificial food 
rapidly, especially during hot weather, is 
hazardous. 
The healthy infant is happy and content. 
He should take all of the food, sleep com- 
fortably, and gain consistently a little more 
than a pound a month. There should not be 
much if any regurgitation, and the bowels 
should not move more than twice a day. If 
the bones and teeth develop as they should 
and the weight reaches fourteen pounds at 
five months and twenty pounds at a year, 
the feeding has most likely been successful. 
Nervousness and overanxiety of mother or 
nurse will handicap even a normal infant. 
Harm may result if the little things are not 
done accurately. Using “rounded” spoon- 
fuls of food, adding a “good measure” of 
milk, or adding a pinch of sugar to the 
drinking water are common errors which 
may have grave consequences. A gain of 
eight ounces or more a week for an infant 
past four months whose weight is not very 
much below par is not desirable. Overfeed- 
ing, even with properly prepared food, often 
leads to serious intestinal derangements. 
Successful 
Artificial 
Feeding 
Errors in 
Feeding ARTIFICIAL FEEDING 
107 
On the other hand, insufficient quantities of 
a proper food may cause an insufficient gain 
or stationary weight. 
The great increase in infant ills and 
deaths during hot weather is not solely de- 
pendent upon the quality of the milk. Pood 
is only one of a number of factors which act 
on the infant organism at this time of the 
year. Heat regulation of the body deserves 
close attention. Clothing should keep the 
body only comfortably warm. The quality 
and quantity of clothing must be adapted 
to climate, season, and room-temperature. 
It must be borne in mind that wool and silk 
inhibit heat loss through radiation and con- 
duction much more than do cotton and linen. 
Excessive clothing on hot days or in hot rooms 
disturbs the heat regulation of the body and 
may cause serious disturbances in the body 
functions, especially those of the digestive 
tract. The adult adjusts his clothing to the 
feeling of comfort, while the infant, in whom 
the question of heat regulation is much more 
grave, must rely upon the judgment or whim 
of the caretaker. Sleeplessness, fretfulness, 
colic, and diarrhea are often the result of 
excessive heat or too much clothing. Many 
of the ills of summer can be avoided by 
proper diet, clothing, and care. On hot days 
Hot Weather 
Care 108 
NURSERY GUIDE 
the amount of food must be reduced, and 
plain boiled water should be given several 
times daily. Clothing should be thin and 
loose, the room should be kept cool by 
proper ventilation; frequent baths may be 
necessary, and the food must be boiled and 
kept on ice. Any intestinal upset should 
be reported to the physician. 
Traveling with an infant under a year is, 
occasionally, a necessary evil. Artificially 
fed infants, especially those who have had 
any nutritional disturbances, are extremely 
poor travelers. A change of abode is per- 
missible, however, if the infant is to be 
taken to a cooler climate during July, Au- 
gust, and September, provided the accom- 
modations and milk supply are irreproach- 
able. A frequent cause of trouble is giving 
milk which is richer in cream than that to 
which the infant is accustomed. Before 
leaving home the depth of the cream ring 
of a quart bottle of milk should be measured 
and the milk from which the infant’s food 
is to be prepared should not show more. In 
case of doubt, most of the cream should be 
removed and then gradually added from day 
to day. Young, artificially fed infants usu- 
ally thrive best at home. If the mother 
needs a rest or change, it is often advisable 
Vacation and 
Travel ARTIFICIAL FEEDING 
109 
to leave the baby at home with a reliable, 
trained infant’s nurse, while the mother re- 
cuperates at the seashore, mountains, lake, 
or in the country. 
Should circumstances necessitate a jour- 
ney with an artificially fed infant, a twenty- 
four or thirty-six hour supply of food should 
be taken along. The sterilized, tightly 
corked and labeled bottles must be kept 
cold; they may be given to the dining-car 
porter to be placed in the refrigerator. 
Small portable ice-boxes are cumbersome 
and need frequent filling with ice. They 
are, however, indispensable on some occa- 
sions. If pure milk is not available en route 
or at the place visited, dry milk or evap- 
orated milk should be • taken along. Such 
milk should be properly diluted with boiled 
water as needed. Thermos bottles are quite 
satisfactory for keeping drinking water 
warm and for keeping food cold. They must 
be thoroughly cleansed before use. 
Infants should never be unnecessarily ex- 
posed to disease. One child with beginning 
whooping cough or measles may start an 
epidemic. Baby ‘‘shows,” birthday parties, 
and picnics are frequently followed by out- 
breaks'of such diseases. 
Baby Shows 
Parties, 
Picnics 110 
NURSERY GUIDE 
Feeding’ During the Second Year 
Most year-old infants are able to digest 
boiled whole milk. The infant of twelve 
months usually eats cereal, vegetable, and 
fruit juices without any trouble. The ce- 
reals may be cooked in water or milk. In- 
fants seldom relish broths and exceptional 
skill and patience are often necessary 
to feed them. Broths may be thickened 
with well cooked vegetable, cereal, potato, 
or bread crumbs. The average infant sel- 
dom gains more than six pounds during the 
second year. 
Diet from 12 to 18 Months 
6 to 7:30 a.m. 
Eight to ten ounces whole milk; one-half 
slice of toast, or a piece of zwieback. 
9 a.m. 
One to two ounces of orange juice in an 
equal amount of water may be given, if the 
bowel movements are not loose. 
10 a,m. 
(1) Six to eight ounces of beef, mutton, 
or chicken broth containing one and a half 
tablespoonfuls of farina, rice, pearl barley, 
or a grated potato (See Recipes). ARTIFICIAL FEEDING 
111 
Or 
One to two ounces of beef juice (See Rec- 
ipes) with two to three tablespoonfuls of 
mashed baked potato (to which a little salt 
and pasteurized butter have been added). 
(2) Spinach, carrots, green beans, or peas. 
Any one of these vegetables can be given in 
amounts up to three tablespoonfuls. (Vege- 
tables must be well cooked in very little 
water and passed through a sieve.) 
(5) A piece of buttered toast or zwieback 
and four ounces of milk. 
2 p.m. 
Feeding same as 6 a.m. 
6 p.m. 
(1) Cereals: two to three tablespoonfuls 
of farina, barley flour, arrowroot, tapioca, 
cornstarch; if constipated, Wheatena, Ral- 
ston, or Pettijohn. (Cereals should be 
cooked for at least an hour in a covered dou- 
ble boiler in 8 to 10 ounces of milk, and a 
level teaspoonful of sugar and a pinch of 
salt.) 
(2) Apple sauce, baked apple, or prune 
pulp. Two to four tablespoonfuls of any 
one of these can be given, to be discontinued 
if bowel movements are loose. 112 
NURSERY GUIDE 
All milk should be boiled; all food must 
be minced or finely divided. The milk may 
be given from a bottle, other food from a 
spoon. The child should never eat between 
meals, nor should he go to bed later than 
six or seven o’clock. 
Diet from 18 Months to 3 Years 
Breakfast 
7-8 a.m. 
1. One egg (coddled or soft boiled), or a 
bowl of cereal (two level tablespoonfuls of 
farina, rice flour, barley flour, oatmeal, corn- 
meal, Wheatena, or Pettijohn cooked at 
least an hour in one-half cup of milk and 
one-half cup of water). 
2. One (later two) slices of bacon (not 
too crisp) may be given three or four times 
a week. 
3'. Zwieback, toast, or stale bread, graham 
or soda crackers (spread with a small 
amount of pasteurized butter). 
4. A cup of boiled milk or very weak 
cocoa. 
1. Six ounces of beef, mutton, or chicken 
broth thickened with cereal or toast crumbs 
may be given several times a week. 
2. White meat of chicken, broiled lamb 
chop, or minced beef-ball. About two table- 
spoonfuls of meat may be given. 
Noon Meal 
12-1 o’clock ARTIFICIAL FEEDING 
113 
3. Baked potato (seasoned with a little 
salt and butter) ; or two tablespoonfuls of 
well boiled rice or macaroni. 
4. Vegetables: well cooked spinach, peas, 
green beans, carrots, asparagus tips, stewed 
celery, squash, beets, or cauliflower. (Vege- 
tables are to be minced and may be sea- 
soned with a little salt and butter.) 
5. Dessert: gelatin, bread pudding, corn 
starch, tapioca, custard, or junket. (See 
Recipes.) Milk need not be given at this 
meal. 
1. Bowl of cereal (farina, rice, barley, oat- 
meal, cornmeal, Wheatena, or Pettijohn, 
cooked for at least an hour), or 8 ounces of 
a creamed soup (pea, tomato, potato, etc., 
cooked with milk, flour, butter, and salt). 
2. Zwieback, toast, or stale bread (spread 
with a small amount of pasteurized butter 
and honey), and a cup of boiled milk or 
very weak cocoa. 
3. Finely divided stewed fruit: apple 
sauce, prune pulp, peaches, pears, or apri- 
cots. 
The eighteen months old infant should be 
given only three meals a day. The various 
foods must be cautiously increased as age 
advances. He should be taught to eat 
slowly and to masticate his food. Eating 
Supper 
0-7 p.m. 
Second 
Summer 114 
NURSERY GUIDE 
between meals should not be tolerated. 
‘‘Prepared” breakfast foods, pies, nuts, ber- 
ries, bananas, candy, and sweets such as 
cake and ice-cream should not be given. 
Egg, meat and dessert should at first be 
given only three times a week. Milk and 
drinking water should be boiled. Well 
cooked creamed vegetable soups are very 
nutritious. The only fruit of the day should 
be given with the evening meal. If these 
precautions are observed, the second sum- 
mer need not be feared. 
The Undernourished Older Infant 
If a child of twelve, eighteen, twenty-four 
months, or older, is ten or more per cent 
below weight for his height and age, the 
parents should have the physician ascertain 
the cause. Infants much underweight sel- 
dom gain if fed the routine diet, and 
special diets are often necessary. When 
the underlying cause has been discov- 
ered, it is the task of mother and nurse 
to cooperate with the physician. Errors 
in diet (improper foods), errors in feed- 
ing (letting the child decide which food he 
wishes to eat), insufficient rest (no naps, up 
too early and late), adenoids, tonsils, eon- ARTIFICIAL FEEDING 
115 
stipation, and other factors frequently hand- 
icap the development of young children. 
A careful record of the quality and quan- 
tity of food eaten, and a daily estimate of 
the calories consumed is a valuable aid 
in determining whether a child eats proper 
and sufficient food for growth. The average 
child requires about 40 calories per pound 
per day; the underweight appreciably more. 
The following table gives the amounts of 
various foods necessary to make a hundred 
calories: 
100 Calories Are Contained in: 
Apple Sauce 3 tablespoonfuls 
Bread 1 full slice 
Broth (thick) 5 ounces 
Butter 1 tablespoonful 
Buttermilk 10 ounces 
Crackers 
Graham 4 
Oyster 20 
Soda 4 
Cream 2 ounces 
Dextri-Maltose 3 tablespoonfuls 
Egg 1 large 
Farina 2 tablespoonfuls 
Meat 1 chop 
Milk (whole) 5 ounces 
Milk (skimmed) 9 ounces 
Olive Oil 1 tablespoonful 
Orange 1 large 
Potato 1 average 
Puddings 2 tablespoonfuls 
Soup (creamed) 4 ounces 
Sugar 1% tablespoonfuls 
Zwieback 3 CHAPTER V 
NUTRITIONAL DISTURBANCES OF THE 
ARTIFICIALLY FED INFANT 
Improper feeding of the artificially fed 
infant is the cause of many ills. The 
mother who can provide excellent care for 
her offspring and who conscientiously fol- 
lows the advice of her physician may usually 
be spared most of these troubles. Even un- 
der ideal circumstances, however, the haz- 
ards for the artificially fed are greater than 
for the child on the mother’s breast. 
The delicate digestive apparatus of most 
infants can usually take care of artificial 
food if it is properly prepared and cau- 
tiously fed. Disturbances are nearly inva- 
riably due to improper food, unwholesome 
food, or faulty feeding technic. The quality 
and quantity of the food and the feeding in- 
tervals are the three factors which deserve 
most careful attention. The earliest symp- 
toms of nutritional disturbance are usually 
mild. If they are recognized and the cause 
removed, the more serious conditions seldom 
develop. Vomiting, colic, and diarrhea, fre- 
quent manifestations of alimentary disturb- 
116 NUTRITIONAL DISTURBANCES 
117 
anee, may be preceded by fretfulness, rest- 
lessness, and crying. 
Abdominal pain caused by air in the 
stomach or gas in the intestine is often the 
result of fermentation of food. It is brought 
about by overfeeding, improper food, or 
faulty feeding technic. Enemas and sup- 
positories may give temporary relief, but the 
cause must be removed in order to bring 
about a permanent cure. 
Regurgitation or “spitting up” a small 
amount of food shortly after a meal may 
signify that air was swallowed before or 
during the feeding. If the infant is prop- 
erly held over the arm or shoulder imme- 
diately after the feeding the air is readily 
expelled. Too rapid feeding, improper han- 
dling, or overfeeding may also cause regur- 
gitation. Recurrent vomiting must be rem- 
edied by removing the cause. Forceful 
(projectile) vomiting, when accompanied by 
an insufficient gain or a loss in weight, may 
be a symptom of a serious disease of the 
stomach and usually needs expert advice 
early. In some instances surgical measures 
may be necessary to save the child’s life. 
This disease also occurs in breast fed 
infants. 
The artificially fed infant should not have 
Colic 
Regurgitation 
and Vomiting 
Pyloric 
Obstruction 
Diarrhea 118 
NURSERY GUIDE 
more than two stools a day. When there 
are more than four in twenty-four hours, 
the cause must be sought, as artificially fed 
infants seldom gain properly when the bow- 
els move frequently. Overfeeding, keeping 
the baby too warm, or an intercurrent dis- 
ease (tonsillitis, common cold, bladder in- 
flammation, etc.) may be the underlying 
cause. The amount and the strength of the 
food should be reduced at the onset of diar- 
rhea. In severe cases, barley water or weak 
tea should be given for twelve or twenty- 
four hours. The physician should be noti- 
fied at once so that proper measures may be 
instituted. Diarrhea seldom lasts more than 
a week if proper measures are taken early. 
The return to the normal diet must be grad- 
ual so that a recurrence will be avoided. 
It is wise to give only a teaspoonful of 
the milk mixture the first time an infant is 
given artificial food, as occasionally infants 
react very peculiarly to cow’s milk (fever, 
vomiting, diarrhea). If no such reactions 
occur within a few hours, the prescribed 
quantity may be given without concern. 
Reaction to 
Cow’s Milk 
This rather mild nutritional disorder is 
not uncommon. The weight, after fluctuating 
Weight Disturbance 119 
NUTRITIONAL DISTURBANCES 
for some weeks, becomes more or less sta- 
tionary. As time goes on, the growth be- 
comes impaired. Infants thus affected are 
often receiving a mixture of cow’s milk, rel- 
atively rich in cream. They are more or 
less restless, pale, flabby, and thin, but not 
very much emaciated. The stools are usu- 
ally gray and formed. The condition re- 
sponds rapidly to proper treatment. 
This is due to intestinal fermentation, 
frequently the result of overfeeding with 
one or more food constituents. The infants 
suffer from diarrhea, colic, and vomiting. 
The stools, usually more than three a day* 
are more or less green and foamy and con- 
tain mucus and curds. As their tolerance 
for food is low and increases slowly, these 
infants usually do well if given barley water 
or weak tea for twelve or twenty-four 
hours, followed by weak milk mixtures 
which are strengthened from time to time. 
Breast milk or protein milk usually gives 
good results in obstinate cases. Intelligent 
increase of the food is necessary not only to 
avoid a recurrence, but also to avoid under- 
feeding. Laxatives and enemas should be 
used only when the physician orders them. 
Dyspepsia 120 
NURSERY GUIDE 
This chronic state of malnutrition called 
atrophy is due to a severe impairment of 
digestion. The extremely emaciated infant 
fails to assimilate food properly. The 
weight loss may be slow during the first few 
weeks. The skin appears somewhat gray, 
the lips rather pink. The child seldom cries, 
often sleeps well, and has a good appetite. 
The stools may be quite normal in appear- 
ance and frequency, or there may be periods 
of diarrhea and constipation. The infant 
fails to gain, the temperature is often sub- 
normal, and bronchopneumonia in winter 
or “summer complaint’’ during the hot 
weather are serious complications. The 
sooner these infants receive proper treat- 
ment, the better are their chances for recov- 
ery. Breast milk is usually necessary. 
Intelligent nursing care (see Prematurity, 
page 67) is necessary to exclude infection, 
subnormal temperature, overheating, and 
collapse. The younger the child the more 
serious the outlook. 
Atrophy (Marasmus) 
(Summer Complaint, Cholera Infantum) 
This very serious condition has an acute 
onset with fever, diarrhea, vomiting, deep 
Alimentary Intoxication 121 
NUTRITIONAL DISTURBANCES 
breathing, and more or less listlessness. It 
occurs most frequently in summer, in arti- 
ficially fed infants of the tenement and rural 
districts. It may be preceded by one of the 
above described disturbances of nutrition 
or may be induced by excessive heat or pos- 
sibly contaminated food. In the more severe 
cases the eyes are sunken and half open and 
have a characteristic stare. The great loss 
of fluids through the bowels and vomiting 
makes it imperative that the extremely sick 
infant receive immediate attention of the 
proper kind. The child should be trans- 
ferred to a hospital where measures may be 
instituted to replenish the water loss. La- 
vage, rectal feedings, and other measures are 
usually necessary to save the child’s life. 
Discretion in diet must be exercised for 
years after the child has recovered. 
This disorder of nutrition, characterized 
by a disturbance in mineral metabolism, 
manifests itself to a great extent in the 
bone-development of infants. The changes 
become most apparent at those parts where 
the long bones groAV—at the wrists, ankles, 
and ribs below the nipples. The fontanelle 
is usually late in closing and the teeth often 
Rickets 122 
NURSERY GUIDE 
appear late and singly instead of in pairs. 
The infant perspires easily and walks late. 
Although the condition exists in all possible 
degrees, it is seldom serious. It occasion- 
ally leaves its traces by distorted contour of 
trunk, legs (* ‘bow-legs” and “knock- 
knee”), or pelvis (the latter in girls may 
add to difficulty in labor during childbirth 
later in life). Fractures of bones occur with 
surprising ease and frequency. Few dis- 
eases show such marked improvement as 
does rickets when proper treatment and diet 
are adhered to. Phosphorized cod liver oil, 
green vegetables, fresh air, and sunlight not 
only cure rickets, but also prevent it. 
Recurrent convulsions during infancy or 
early childhood are usually due to tetany, 
a condition possibly allied to rickets. 
A spasm of the larynx causing a crowing 
sound is a serious type of convulsion; the 
child nearly suffocates and gets pale until 
the spasm relaxes. The first thing to do in 
case of convulsion is to send for the physi- 
cian. In the meantime the child may be 
given a warm bath or mustard pack. (See 
Convulsions, page 133.) 
Tetany 
Iiaryngospasm 
Scurvy 
Scurvy 
Scurvy is less frequent than rickets and 
quite different in its manifestations. It oc- NUTRITIONAL DISTURBANCES 
123 
curs most frequently during the first two 
years of life, especially after the sixth 
month. It is more frequently encountered 
among babies fed exclusively on boiled milk 
or cooked cereals. The first symptom most 
frequently noticed by the mother is that 
the child cries when picked up, or when his 
legs are grasped rather firmly. Dark blue 
hemorrhages in the gums are usually found. 
Orange juice must be given daily; also green 
vegetables and a mixed diet if the infant 
is past eight months. CHAPTER VI 
SOME COMMON AILMENTS 
Tlie healthy infant is usually happy and 
content, being companionable and seldom 
out of sorts. When awake, he is always ac- 
tive, kicking his feet and tirelessly waving 
his hands. As soon as he is not well, his dis- 
position changes: he is no longer playful, 
becomes fretful, his smile vanishes, and he 
usually refuses to take all his food. The 
mother often knows that things are not as 
they should be some time before the seat of 
the trouble is discovered. When the smile 
returns one can feel quite certain that things 
are on the mend, even though the physical 
condition of the young invalid is still far 
from normal. His disposition keeps pace 
with his improvement, and when his appe- 
tite is completely restored he is usually quite 
well again. 
The nose and throat may harbor germs 
which are relatively harmless as long as the 
individual’s resistance is normal. Healthy 
breast fed babies who are well cared for 
seldom get sick. When the protective sub- 
stances in the blood fail to act or are not 
sufficiently replenished, germs gain a foot- 
liOwering 
Resistance 
124 SOME COMMON AILMENTS 
125 
hold and an infection gets started. Resist- 
ance in infants is lowered chiefly in the fol- 
lowing ways: 
1. Breathing dry, overheated room air. 
2. Chilling by being dressed too lightly 
or by exposure to drafts. 
3. Sudden changes in temperature, espe- 
cially when perspiring. 
4. Insufficient sleep. 
5. Improper food and care. 
6. Constipation or diarrhea. 
7. Insufficient fresh air and exercise. 
8. Intercurrent disease (rickets, adenoids, 
diseased tonsils, etc.) 
The common cold is the most prevalent 
illness, because it is the most contagious. It 
is, without doubt, the most important of the 
acute infections during infancy, for from it 
a dozen or more serious respiratory condi- 
tions may develop. It is an inflammation of 
the mucous lining of the nose and throat. 
Sneezing or a congestion of the air passages 
may be the first symptom. This may be 
followed by a profuse, watery nasal dis- 
charge which later on becomes thick and 
yellow, resembling pus. A so-called “cold” 
may also be the first sign of measles, whoop- 
ing cough, or diphtheria in infants. The 
The Common 
Cold 126 
NURSERY GUIDE 
younger the child, the more likely will com- 
plications arise. 
Colds are “caught” in one of the follow- 
ing ways: 
1. Direct contact (kissing, fondling). 
2. By being within a yard of a person 
with a cold (when he talks, sneezes or 
coughs). 
3. Indirect contact (using the same hand- 
kerchief, towel, or cup that somebody with 
a cold has used). 
The child should be put to bed and kept 
there until the temperature has been nor- 
mal for at least two days. The room should 
have an even temperature during this time 
—preferably about 68° to 72° F. If the 
temperature gets above 75° F. the air be- 
comes too dry and acts harmfully by drying 
the mucous membrane of the nose and 
throat; if below 50° or 60° F., it will often 
aggravate a cough. The physician should 
be consulted. The rules for isolation should 
be enforced if only one of two or more chil- 
dren contracts a cold. The diet should be 
reduced, the amount of water increased. 
If an adult with a cold must take care of 
an infant, a face mask (four layers of gauze) 
should be worn over the nose and mouth. 
(See Fig. 6.) If possible, a person with a 
Treatment 
tor Colds SOME COMMON AILMENTS 
127 
cold should refrain from coming near an 
infant, as serious complications may develop 
when an infant contracts a cold. 
A cough is a reflex action due to an irri- 
tation in the throat. The throat or pharynx 
may be the seat of an infection or inflamma- 
tion, or the cough may result from nasal se- 
cretions flowing into the throat. Coughs are 
usually aggravated when the child lies on 
his back. A compress to the neck, local and 
internal medication may be necessary. In 
case a cough lasts longer than ten days and 
comes on in attacks, one should think of 
whooping cough. A blood count may aid in 
early diagnosis. 
There are two kinds of croup. The one 
is harmless, the other is a form of diphthe- 
ria. The physician should be summoned 
early so that cultures or other measures may 
be taken. The harmless type is here de- 
scribed. There may be a slight nasal dis- 
charge or hoarseness toward evening. After 
a few hours of sleep the infant awakes with 
a barking cough. About midnight the 
cough gets worse; the cry is hoarse; there is 
shortness of breath, inspirations are diffi- 
cult and noisy. The attack usually lasts 
an hour or more, after which the child may 
go to sleep. The next day the cough and 
Cough 
Croup 128 
NURSERY GUIDE 
hoarseness are usually slight, but that 
night the attack may recur. An at- 
tack is usually more alarming than dan- 
gerous. During the spell, hot compresses to 
the throat, changed every fifteen minutes, 
may give relief; one grain of antipyrin may 
be given in warm orange juice every few 
hours. Steam inhalations, taking the child 
to the bath room (where hot water is kept 
flowTing) may be of service. Simple, inex- 
pensive “croup kettles” can be had at most 
druggists. Vomiting need not be resorted 
to unless the attack is very severe. For 
this, ipecac is sometimes used. 
When the mucous membrane lining the 
bronchial tubes is the seat of inflammation, 
we speak of bronchitis. Wheezing in the 
chest is more or less audible. Bronchitis 
may be preceded by croup. The physician 
should be called. Counter-irritation of the 
chest such as mustard-packs, camphorated 
oil inunctions and internal medication usu- 
ally bring relief within a week. 
There are two types of pneumonia: bron- 
chopneumonia and lobar pneumonia. 
The former is more common in infants 
who have been ill with measles, whooping- 
cough, or other diseases which decrease re- 
sistance. The irregular fever often lasts 
Bronchitis 
Pneumonia 129 
SOME COMMON AILMENTS 
weeks. It is one of the most serious con- 
ditions of infancy. 
Lobar pneumonia usually begins quite 
suddenly with a high fever, cough, and 
“grunting” respiration. The fever is more 
or less high until the crisis, which usually 
occurs between the third and the eighth 
day. The child appears very ill. 
Pneumonia requires intelligent nursing 
care. The fever is usually counteracted 
with packs, sponging, and the frequent ad- 
ministration of water. 
Frequent complications of the common 
cold and other respiratory ailments are the 
involvement of the naso-pharynx, tonsils, 
and middle ear. Recurrent colds often pro- 
duce adenoids which, when once established, 
become the source of repeated colds. Ton- 
sils which have become the seat of chronic 
infection, harbor germs which may, in time, 
cause valvular heart disease, rheumatism, 
St. Vitus’ dance, and other serious disease. 
Middle ear disease is a relatively common 
source of high fever in infants. The pain 
may be severe. If the infection causes the 
drum-membrane of the middle ear to bulge, 
the abscess usually ruptures of its own ac- 
cord or may require puncture by the physi- 
cian, so that the pus may escape from the 
Adenoids 
Diseased 
Tonsils 
Middle Ear 
Disease 130 
NURSERY GUIDE 
middle ear. The treatment for discharging 
ears is variable. Borated vaseline applied 
to the outer ear and cheek when the dis- 
charge is profuse may prevent soreness of 
the skin. Diseased tonsils and adenoids 
often need surgical removal. When the in- 
fection of the middle ear spreads to the 
porous bone behind the ear (mastoid) sur- 
gical measures are usually necessary. 
The glands of the neck may become 
acutely or chronically enlarged in acute or 
chronic conditions of the throat and require 
a physician’s attention. Chronically en- 
larged glands of the neck are sometimes 
tubercular. 
Mastoid 
Glands 
Genito-Urinary System 
Kidney and 
ISladder 
Infections 
One of the most common and obstinate 
conditions occurring in infancy is inflam- 
mation of the bladder or kidney. The only 
way this condition can be diagnosed is by 
a microscopic examination of a fresh speci- 
men of urine. When an infant has a fever, 
diarrhea, or stationary weight, or if the 
child is pale, a specimen of urine should be 
submitted to the physician at the time the 
child is examined. Urine analyses are as 
important in infants as in older patients. 
(See Chapter VII for methods of collecting SOME COMMON AILMENTS 
131 
specimens.) In some of the severe eases the 
temperature is extremely high. Medical 
treatment must often be continued for 
weeks or months—until the urine is free 
from pus. Recurrences are rather frequent. 
A sudden cold, high fever, constriction or 
swelling of the penis may cause infrequent 
urination or urine retention. The infant 
should be given copious quantities of water 
sweetened with saccharin and a warm wet 
towel should cover the lower part of the ab- 
domen and genitals. Drugs or catheteriza- 
tion are seldom necessary. 
When an infant is a few days, weeks, or 
months old, there may appear an unusual 
swelling in the navel or genital region. If 
it gets larger when the child coughs or cries, 
it is probably a rupture (hernia). A pro- 
truding navel should be properly strapped 
with adhesive plaster for months. A hydro- 
cele, a collection of fluid in the scrotum, is 
seldom cause for alarm and usually disap- 
pears spontaneously in the course of months 
or years. “Hidden” or undescended testi- 
cles seldom need attention during infancy. 
Boys are usually circumcised as soon as 
the birth weight is regained, that is, some 
time after the tenth day. At this age an 
anesthetic is unnecessary and healing is usu- 
Rupture 
Hydrocele 
Circumcision 132 
NURSERY GUIDE 
ally rapid. When older infants with tight 
or long foreskin require circumcision, it 
should not be done in summer or winter. 
A profuse vaginal discharge deserves the 
immediate attention of the physician. If 
due to gonorrhea, it is highly contagious and 
needs prompt isolation and persistent treat- 
ment. 
Vaginitis 
The Nervous 
Baby 
Some infants are more or less nervous. 
They are restless, their sleep is not sound, 
they cry easily, and lie awake for hours be- 
fore going to sleep. Nervousness may be 
inherited from a parent or grandparent, but 
it usually is the result of improper feeding, 
lack of routine, or rickets. Some of the 
more common nervous manifestations en- 
countered in infants are here considered 
briefly. 
The first “bad habit” to be acquired is 
usually thumb-sucking. If the habit is not 
broken early, the teeth may not grow in 
straight or infections about the nail may 
occur from time to time. The sleeve should 
be tied so that the hands are included; later 
on, a mitten or adhesive plaster may prove 
effective. Pinning the sleeve to the mat- 
tress may also be resorted to. Night terrors, 
in which the child awakes crying hysteri- 
Nervous System 
Had Habits SOME COMMON AILMENTS 
133 
cally, are seldom encountered during infancy. 
If they occur, the child should not be pun- 
ished, but assured that nothing is wrong. 
While many children of two years go 
through the night without wetting the bed, 
those who do not need further discipline in 
this respect. The evening meal should con- 
tain very little fluid and very little or no 
water should be given during the night. 
They should be taken up about 10 p.m. and 
on awakening in the morning. The stool and 
urine should be examined. “Masturbation” 
may occur very early. It is usually accom- 
plished by thigh friction or rubbing against 
the covers or pillow. When it is discovered 
the physician should be told about it. The 
condition is somewhat more common among 
girls than boys. Close watch and restraint 
when going to sleep are usually necessary 
for weeks or months. If these measures are 
without avail, circumcision may prove effec- 
tive. 
Convulsions in the newly born may be due 
to hemorrhage within the skull. In older 
infants these attacks may be associated with 
gastrointestinal disturbance, or may pre- 
cede an acute illness such as meningitis, 
measles, pneumonia, or tonsillitis. If con- 
vulsions recur, the child is usually suffering 
from tetany. The physician should be called 
lied Wetting 
Convulsions 134 
NURSERY GUIDE 
at once. Before he arrives the child may be 
given an enema and cold cloths should be 
applied to the head. He may be put in a 
warm mustard pack for twenty minutes, 
after which the skin should be red. 
The Skin 
The upper layer of skin of the newly born 
normally peels off some time during the first 
two weeks. The skin of infants is extremely 
sensitive and needs careful daily attention. 
Chafing, the result of local irritation of 
the skin, is so frequently encountered be- 
cause so many factors may cause it. The 
most usual are: insufficient boiling of nap- 
kins, rubber napkins, irritating stools, in- 
frequent changing, improper cleansing of 
buttocks, intestinal disturbances, urinary 
infection, too much cream in the food and 
overfeeding. Using a mild soap and water, 
followed by the liberal application of zinc 
oxide ointment or Lassar’s paste several times 
a day, usually effects a cure if the cause is 
removed. All clothing and bedding which 
has a strong odor should be boiled in a cov- 
ered pail of water for fifteen minutes. 
Prickly heat, the result of overheating, 
may occur in wunter or summer. It is usu- 
ally due to wool or too much clothing. Re- 
Chafing 
Prickly Heat SOME COMMON AILMENTS 
135 
moving the cause, sponging with soda water 
(one tablespoonful of baking soda to a pint 
of water), and then using stearate of zinc 
dusting powder freely will cause the irrita- 
tion to disappear. 
Hives can usually be attributed to an in- 
testinal “upset.” The patches or wheals 
are more or less elevated, smooth, flat, pale 
or red. They come and go rather suddenly, 
increase rapidly, and itch. A baking soda 
enema (one tablespoonful of soda to a quart 
of warm water), a small dose of milk of 
magnesia once or twice a day, and a reduc- 
tion in diet usually help. In case of severe 
itching, -wet dressings of baking soda solu- 
tion (one tablespoonful to a pint of water) 
bring relief. Eggs, strawberries, antitox- 
ins, etc., may cause this condition in sus- 
ceptible individuals. 
Eczema is the most frequent and most 
obstinate inflammation of the skin occurring 
during infancy. It is encountered among 
breast-fed as well as bottle-fed babies. 
Though a predisposition to this condition 
exists, there are a number of external and 
internal factors that influence it. Under the 
former may be mentioned: strong soaps, 
woolen clothing, hot or cold weather, and 
lack of care resulting in skin infection. Un- 
Hives 
Eczema 136 
NURSERY GUIDE 
der internal factors, constipation, digestive 
disturbances, improper diet, and overfeeding 
are the most frequent. Soap and water are 
usually harmful; olive oil, mineral oil, oint- 
ments, and lotions are used. The results ob- 
tained may depend upon the patience and 
care with which the treatment is carried out. 
Cradle-cap may be the first sign of eczema. 
It consists of yellowish scales in the region 
of the fontanelle. By the application of 
vaseline twice a day and the use of a fine 
baby-comb, the crusts can usually be re- 
moved. The attention of the physician 
should be called to this early symptom. By 
the elimination of the factor which is induc- 
ing the disease, the more advanced stages of 
eczema may be avoided. 
Cradle-cap 
Contagious Diseases 
Quarantine 
It is the duty of every one to assist in the 
enforcement of quarantine in any case of 
disease that spreads by contact, particularly 
such diseases as scarlet fever, smallpox, in- 
fantile paralysis, epidemic meningitis, diph- 
theria, measles, whooping-cough, chicken- 
pox and mumps. Any household afflicted 
with such a disease renders a valuable serv- 
ice to the community by co-operating with 
the health authorities. Epidemics often 137 
SOME COMMON AILMENTS 
arise by allowing a “mild” case to mingle 
with healthy children. A “suspicious” case 
should be kept isolated until the authorities 
make a diagnosis. 
The best isolation and care for the first 
five diseases mentioned above are obtained 
in a contagious disease hospital. When the 
patient is taken care of in the home, the 
following brief outline may be of some 
assistance. 
The quarantined rooms should be well iso- 
lated from the rest of the house. A room or 
two on the top floor is ideal if heat, flowing 
water, and bath room facilities exist. The 
nurses are quarantined with the patient, and 
should sleep in a room adjoining that of the 
patient. Scarlet fever cases should prefer- 
ably be nursed by a person who has had the 
disease. Food, clothing, and supplies for the 
quarantined should be left at their door. 
Soiled linen and used dishes should be 
disinfected by immersion in lysol water or 
bichloride of mercury solution overnight, 
after which they should be placed in a pail 
which is kept outside the door. The nurse 
and all who came in contact with the child 
before he w'as quarantined should gargle 
and use a nasal spray. The nurse should 
wear washable clothes, a face mask, and a 
Quarantine in 
the Home 138 
NURSERY GUIDE 
close-fitting cap. The physician leaves his 
coat outside the sickroom and puts on a long 
well-fitting gown, cap, and mask before en- 
tering. These and a basin of disinfecting 
solution should be placed just outside the 
door. The parents are obliged to provide 
safety for the nurse and physician. It is the 
duty of the latter to insist that the rules of 
quarantine are enforced. When the quar- 
antine is raised, the patient should have at 
least two “discharge” baths—the entire 
body being thoroughly cleansed with anti- 
septic soap and water and then sponged 
with a solution of lysol or bichloride of mer- 
cury. Every particle of clothing should be 
changed, and after the second bath the child 
is taken from the room. The nurse then dis- 
infects everything washable, and possibly 
prepares the room for fumigation. Mat- 
tresses, pillows, etc., are sterilized by some 
health departments. Where such facilities 
for sterilization do not exist, the bedding, 
if valuable, should be sponged with bichlo- 
ride of mercury solution and then exposed 
to the sun and fresh air for days. The nurse 
must change her clothing and disinfect her 
hair, face, and hands. Fumigation is not as 
effective as was formerly believed. Wash- 
ing the walls, floors and furniture with SOME COMMON AILMENTS 
139 
antiseptic solutions is probably more effec- 
tive. 
A child with vomiting, headache, sore 
throat, and fever should be isolated until 
the physician has made a diagnosis. The 
distinctive rash usually appears first on the 
neck and chest, and then spreads over the 
trunk and extremities. By early isolation, 
spread of scarlet fever can be prevented. 
Mild cases are often atypical and are diag- 
nosed with great difficulty. All cases must 
be kept in strict quarantine for at least five 
weeks. If desquamation (peeling) or dis- 
charges from ear, nose, or glands are pres- 
ent at the end of this time, longer quaran- 
tine must be maintained. In uncomplicated 
cases the temperature is usually normal 
within a week. As subsequent kidney com- 
plications may arise, a specimen of urine 
should be sent to the physician from time 
to time for several months. Diphtheria is 
occasionally a complication. One attack of 
scarlet fever usually confers immunity. 
Infants under five months seldom contract 
measles. It is highly contagious in the early 
stage, even days before the rash appears. 
The first symptoms may be those of a cold; 
later the eyes become inflamed and the nasal 
discharge becomes more profuse. The child 
Scarlet Fever 
Measles 140 
NURSERY GUIDE 
shuns the light, the cough gets more hoarse, 
and the fever increases until the rash is at 
its height. A diagnosis can often be made 
several days before the rash appears, as the 
small white spots which appear on the mu- 
cous lining of the cheeks (“Koplik spots”), 
are characteristic of the disease. The rash 
usually appears first on the face and neck 
and then spreads over the trunk and ex- 
tremities. Measles patients should be kept 
warm, their eyes and nose need careful at- 
tention, and strong light should be avoided. 
The quarantine lasts about two weeks. As 
measles may prove to be serious during the 
first few years of life, everything should be 
done to prevent young children from con- 
tracting it. 
By injecting into a young child within 
four days after exposure 5 c.c. or more of 
blood serum from a child who has com- 
pletely recovered, the disease can be pre- 
vented. When children between five months 
and three years have been exposed, they 
should, whenever possible, receive this pro- 
phylactic treatment sufficiently early. 
The incubation period of diphtheria may 
be hours, days, or weeks. The germ is car- 
ried from person to person or by clothing, 
toys, and food. While the most common site 
Prevention 
of Measles 
Diphtheria SOME COMMON AILMENTS 
141 
of diphtheria is the tonsil, infants may have 
the disease in the nose (nasal diphtheria) 
or larynx (membranous croup). The poison 
(toxin) produced by this deadly germ acts 
quickly and makes the disease extremely 
serious. Cultures taken of any suspicious 
nasal discharge or patch in the throat aid 
in early diagnosis. As soon as a diagnosis 
is made, the patient should receive an am- 
ple dose of antitoxin and be placed in quar- 
antine until the cultures are free from the 
germ. Cultures should be taken of all per- 
sons who have come in contact with the 
patient, and they should not mingle with 
others until the culture-report shows them to 
be free from the germ. Some people are 
“carriers” of this bacillus. Should it be 
found in culture without visible signs of the 
disease, a Schick test will aid in determining 
whether the individual has enough natural 
antitoxin or whether an injection of anti- 
toxin is necessary. If a person has at any 
time in the past received antitoxin, or is 
subject to asthma, great care must be exer- 
cised in the administration of antitoxin. Al- 
though early diagnosis, antitoxin, and intu- 
bation have greatly reduced the mortality 
due to this treacherous disease, the death 
rate is still high. 142 
NURSERY GUIDE 
Prevention of 
Diphtheria 
Diphtheria is now a preventable disease. 
The Schick test detects susceptibles, and 
three toxin-antitoxin injections (given two 
weeks apart) confer immunity. It is advis- 
able to have a Schick test made five months 
after the last toxin-antitoxin injection to 
prove the existence of immunity. Investiga- 
tion has shown that the children of the well- 
to-do are very much more susceptible to 
diphtheria than are those living in the 
crowded parts of cities. 
Whooping-cough is often a serious disease 
in infants. One attack usually confers im- 
munity. The most frequent and serious 
complication is bronchopneumonia. As the 
germ is short-lived outside the human body, 
the patient himself is the main source of 
infection. The contagious period begins 
during the first stage of the disease. The 
second stage is called the spasmodic, on ac- 
count of the characteristic paroxysms of 
cough which often end with a “whoop.” 
The third period is the decline, during which 
the coughing spells become less frequent 
and less severe. The average duration of 
the disease is about nine weeks. By the aid 
of blood counts, a diagnosis can often be 
made days before the first whoop. It is at 
present customary to give hypodermic injec- 
Whooping- 
Cough SOME COMMON AILMENTS 
143 
tions of whooping-cough vaccine. The ear- 
lier these injections are given, the more 
benefit seems to be derived from them. It 
is difficult to determine whether the disease 
can be prevented by the administration of 
vaccine before symptoms arise. Patients 
should be kept warm during cold weather 
—the temperature of the room ranging from 
55° to 68° F., and the air should be kept 
moist. When frequent vomiting occurs, the 
quantity of food should be reduced and the 
number of feedings increased. Thick cereal 
feedings may prove serviceable. 
Chicken-pox, mumps and German measles 
are usually mild and complications seldom 
occur. Isolation must be observed. 
Vaccination with cowpox against small- 
pox has been practiced in all civilized coun- 
tries for over a century. It is one of the 
greatest achievements of medicine. Every- 
one should be vaccinated at least three 
times: in infancy, at puberty, and at 
twenty. When smallpox is prevalent in a 
community, all who have not been success- 
fully vaccinated within five years should 
have it done. 
The first spring or autumn after the child 
is four months old is the ideal time for the 
first vaccination, provided he is well and 
Chicken-pox, 
Mumps and 
German 
Measles 
Vaccination 144 
NURSERY GUIDE 
free from skin disease. Boys are usually 
vaccinated on the left arm, girls on the left 
leg some distance above or below the knee. 
As no inherited immunity exists, an unsuc- 
cessful attempt should he repeated, if neces- 
sary, a number of times. 
After the vaccination is dry, it is covered 
with a sterile dressing which is held in place 
with adhesive plaster, which may he re- 
moved the following day. The wound heals 
and the small blister which appears after a 
few days increases in size. A red area ap- 
pears about the blister and the temperature 
may go above 103° F. The blister then dries 
and a firm, dark brown or black crust re- 
mains for a week or more. When this drops 
off, a discolored scar remains which becomes 
pale and somewhat porous. The glands in 
the arm pit or groin usually enlarge and be- 
come tender when the process is at its height 
(about'the 7th to 10th day). 
When the blister forms, the area should 
be covered with stearate of zinc dusting 
powder and a sterile gauze dressing applied 
daily. This is held in place by two narrow 
strips of adhesive. Vaccination “shields” 
do not permit sufficient drying. No water 
should touch the area until after the scab 
has fallen off. If the contents of the blister SOME COMMON AILMENTS 
145 
Table op Incubation* and Isolation Pepjods 
ISOLATION 
disease 
INCUBATION 
(varies according to 
local health rules) 
Chicken-pox 
14 to 21 days 
2 or more weeks 
Diphtheria 
2 to 7 days 
Until cultures are negative 
German Measles 
14 to 21 days 
1 to 2 weeks 
Infantile Paralysis 
2 to 14 days 
4 to 8 weeks 
Measles 
• 10 to 14 days 
2 weeks 
Mumps 
14 to 2.1 days 
2 weeks 
Scarlet Fever 
2 to 5 days 
4 or more weeks 
Whooping-Cough 
7 to 21 days 
6 or more weeks 
*I-nternal between 
exposure and first symptom. 146 
NURSERY GUIDE 
ooze, great care must be exercised to avoid 
infection. Scratching must be avoided, as 
infection may thus be produced, or the vac- 
cine may be spread to other parts of the 
body. CHAPTER VII 
CARE OF THE SICK INFANT 
The Trained Nurse 
The trained nurse who has graduated 
from a modern children’s hospital is often 
indispensable in case of severe illness or an 
obstinate condition that requires careful 
nursing. Her experience and skill give the 
patient, to a certain extent, many of the ad- 
vantages of hospital care. Many measures 
are resorted to in saving infant and child 
life, and the registered trained nurse is usu- 
ally well equipped to take her share of re- 
sponsibility. 
Signs and Symptoms 
The mother and nurse can aid the physi- 
cian by recording the patient’s condition 
between visits. The following observations 
are of value: rectal temperature, taken 
twice a day if nearly normal, four times a 
day if fever; respirations, best observed 
while asleep ; disposition, normal, fretful, or 
drowsy; sleep, sound or restless; appetite; 
frequency of bowels and urination; nature 
of the cry, cough or pain; vomiting; belch- 
147 148 
NURSERY GUIDE 
ing of gas; and the condition of the skin, 
lips, and eyes. 
Whenever an infant becomes ill it is of 
the greatest importance to find out as soon 
as possible whether one or more things are 
wrong. For the physician to make a thor- 
ough examination, it is important that the 
light be good and the room warm. The in- 
fant should be completely undressed so that 
the physician can examine the skin, lungs, 
heart, abdomen, legs, arms, spine, and gen- 
itals. An extension or drop-light is a great 
convenience for the ear, nose, and throat 
examination. A bowel movement and a 
specimen of urine are essential. The latter 
should be kept in a cool place in a clean, 
small, well-corked and labeled bottle. 
Examining 
the Patient 
Rectal 
Temperature 
Tlie only reliable way to determine an 
infant’s temperature is to take it with a 
rectal thermometer. After the mercury has 
been shaken down into the bulb a little vas- 
eline is applied to the bulb end, about an 
inch of which is then inserted into the rec- 
tum and held there for several minutes. 
After the temperature has been read, the 
thermometer is cleansed with cotton and 
alcohol. The normal rectal temperature is 
Thermometer and Fever CARE OF THE SICK INFANT 
149 
98° to 99.5° F. A rectal temperature of 
100° to 101° F. is subfebrile; 101° to 103° F. 
is mild fever, above 103° F. is high fever. 
When a high fever has persisted for some 
time and suddenly drops to normal and does 
not go up again, we speak of crisis (as in 
lobar pneumonia); when the decrease is 
gradual, it is known as lysis (as in typhoid 
fever), when a febrile temperature goes to 
normal for several days and then goes up 
again, it is called an intermittent fever (as 
in pyelitis.) 
Hydrotherapy 
Water has been used in the cure of dis- 
ease since the time of the ancient Greeks 
and Romans. Water, internally and exter- 
nally, is a most potent agent in the treat- 
ment of children’s diseases. 
The tepid sponge bath aids in reducing a 
high body temperature. The child should 
be undressed in a warm room (70° F. or 
above), covered with a sheet or blanket, and 
slowly sponged with tepid water for five to 
fifteen minutes. The evaporation of the 
water from the surface of the body reduces 
the temperature. 
The mustard bath is used for collapse, 
subnormal temperature, and convulsions. 
Four or more tablespoonfuls of ground mus- 
The Tepid 
Sponge Bath 
Mustard 
Bath 150 
NURSERY GUIDE 
tard are mixed with a little hot water and 
added to about four gallons of warm water 
(temperature 105° F.). The child is left in 
the bath about five minutes, during which 
time the extremities and trunk should be 
vigorously rubbed. The child is then 
wrapped in a warm blanket and placed in 
the crib. 
The cold douche is resorted to in respira- 
tory failure. While the child is in a warm 
bath, a pint of cold water is poured over 
the head and chest. 
The hot pack is used at the onset of a 
cold. After the child has been placed in a 
warm bath (105° F.) for three minutes, he 
is rolled in a warm blanket and allowed to 
perspire for one hour, a cold compress being 
applied to the forehead. At the end of this 
time, he is sponged with tepid water and 
rubbed with alcohol. 
The tepid pack is valuable when the tem- 
perature stays above 103.5° F. A small 
sheet which has been dipped in tepid water 
(75° F.) is wrung out, and the child is 
wrapped in it from the armpits to the hips 
or feet and covered lightly with a blanket. 
If the temperature is still high at the end 
of four hours, the pack should be renewed. 
Cold Douche 
Hot Pack 
Tepid Pack CARE OP THE SICK INFANT 
151 
The mustard pack is of value at the onset 
of bronchitis. Two or three rounded table- 
spoonfuls of ground mustard are mixed with 
ten ounces of hot water. A medium-sized 
towel is dipped in and wrung out. The chest 
and back are anointed with oil or vaseline, 
and the mustard towel is put around the 
trunk, from the armpits to the hips, and the 
child is then wrapped in a warm blanket. 
After fifteen minutes, he is given a warm 
bath, the temperature of the water being 
brought up to 105° F. He is then wrapped 
in a warm, dry blanket and allowed to re- 
main quiet for half an hour, at the end of 
which time he is sponged with tepid water 
and rubbed with alcohol or camphorated oil. 
The skin should redden, but not blister. 
The turpentine stupe is sometimes used in 
case of colic. A towel which has been 
dipped in warm turpentine water (one tea- 
spoonful to the pint) is placed over the 
anointed abdomen and left there for fifteen 
to thirty minutes. 
Mustard 
Pack 
Turpentine 
Stupe 
NOTE: Artificial Respiration: The room temperature 
should not be below 65° F. The clothing is removed; the 
extended arms are slowly brought above the head and then 
firmly pressed against the chest to expel the air from the 
lungs. These movements should be synchronous with res- 
pirations (about 20 times per minute). The body should 
be kept warm, and the limbs should be rubbed in the direc- 
tion of the heart in order to aid circulation. 152 
NURSERY GUIDE 
Lavage 
Washing out the stomach is known as gas- 
tric lavage. A small funnel is attached 
either directly or by means of a small piece 
of rubber tubing with a glass connection 
(“window”) to a rubber catheter (No. 14 
French) ten to sixteen inches long, marked 
in inches. If the catheter is not graduated, 
4, 5, and 6 inches should be marked on it 
with ink or silver nitrate solution. 
Two persons are necessary for the pro- 
cedure. The arms are included in a tightly 
wrapped blanket, the head is held rather 
firmly, and the moistened catheter is slowly 
introduced. It is passed four to six inches 
from the gum line, according to the size of 
the infant. Holding the catheter firmly in 
place with one hand and lowering the fun- 
nel with the other, the stomach contents 
may be syphoned off. When no more flows 
off, then 2 to 4 ounces of normal salt or 
baking-soda solution is poured into the ele- 
vated funnel. The latter is again lowered 
until all the fluid flows out. By pouring 
the solution from a graduate and collecting 
the washings in another graduate, overfill- 
ing the stomach can be avoided. Lavage 
Stomach Washing and Tube Feeding CARE OF THE SICK INFANT 
153 
should be repeated until the water returns 
clear. (Fig. 10.) 
Gavage feeding is often resorted to in the 
early feeding of premature infants. The in- 
troduction of the catheter is as by lavage, 
but it is not necessary to pass the tube be- 
Gavage 
Fig. 10.—Stomach lavage. 
yond three or four inches, as vomiting is less 
likely to occur if the tube does not enter 
the stomach. 
The amount of food given by gavage 
should be recorded. If an infant is very 
weak, care should be observed that the tube 
is not passed down the windpipe. 154 
NURSERY GUIDE 
Colonic Flushing and Rectal Feeding 
Colonic 
Flushing 
Colonic flushings are helpful for high fe- 
ver or when the abdomen is distended with 
gas. A rubber catheter (No. 20 French) is 
attached to the small hard rubber tip of a 
fountain syringe outfit and a pint or more 
of plain or soapy water, salt or baking-soda 
solution is slowly injected into the rectum. 
The catheter should be well lubricated and 
slowly introduced for a distance of four to 
six inches. To bring down a high body tem- 
perature, the enema should be between 90° 
and 95° F.; otherwise it should be about 
100° F. (Fig. 11.) 
An appreciable amount of fluid, food and 
medicine can be absorbed by the lower in- 
testine. This route is used in cases of ob- 
stinate vomiting, convulsions, collapse, hem- 
orrhage, etc. The apparatus consists of a 
small funnel attached to a No. 14 French 
catheter. One to four ounces are poured 
into the funnel after the lubricated catheter 
has been introduced about six inches into 
the rectum. After the removal of the cathe- 
ter the buttocks are held together with a 
strip of adhesive. Such feeding or medica- 
tion is usually repeated several times a day. 
In older infants the dow drop method is 
sometimes used. The outfit for this consists 
Enema 
Rectal 
Feeding CARE OF THE SICK INFANT 
155 
of an enema can, rubber tubing, glass con- 
nection (“ window”), catheter (No. 14 
French), and a thumb screw or clothespin 
so that the flow can be reduced to about ten 
drops per minute. The rate must be care- 
fully regulated before the catheter is 
inserted. 
A solution much in use for rectal feeding 
is known as Ringer’s solution. It is made 
as follows: 
Sodium chloride (salt)—2 level teaspoonfuls 
Potassium chloride — 7 grains 
Calcium chloride — 4 grains 
Boiled water — one quart 
Fig. 11.—Giving an enema. 156 
NURSERY GUIDE 
Collection of Specimens 
Chemistry and the microscope have revo- 
lutionized the diagnosis of disease. Many 
diagnoses are today verified by laboratory 
tests and findings. Urine specimens should 
be obtained after the vagina or penis has 
been carefully cleansed with soap and water. 
The receptacle and bottle must be clean, and 
specimens should be kept in a cool place 
until the physician arrives. An infant’s 
urinal, bird-seed dish, or small wide-mouth 
bottle placed in the proper position inside 
the napkin facilitates the collection of a 
specimen. Enough can sometimes be ob- 
tained from a pledget of cotton placed at 
the urinary orifice. A rubber sheet spread 
beneath the infant after the napkin has been 
removed will permit urine to collect in a 
pool which can be scooped up with a spoon. 
Giving water to drink and applying a warm 
or cold wet cloth over the lower part of the 
abdomen may induce urination. 
Nose, throat, and ear cultures are incu- 
bated at 98° F. for twelve hours before ex- 
amination. Eye and vaginal smears are 
made on clean glass slides; sputum speci- 
mens should be collected in clean wide- 
mouth bottles. Stools to be. examined for CARE OF THE SICK INFANT 
157 
invisible traces of blood, starch, fat, or worm 
eggs should be placed in small, tightly 
closed, labeled jars. 
Blood Examination 
The normal white blood count of infants 
may vary between 6,000 and 8,000 per cubic 
millimeter. It is increased in some diseases 
(whooping-cough, pneumonia, etc.) and de- 
creased in others (measles, influenza, mala- 
ria, and typhoid fever). Hemoglobin deter- 
minations are made to detect anemia. 
Worms 
Intestinal worms are rarely found in in- 
fants. Symptoms usually attributed to 
worms may be due to errors in diet, indiges- 
tion, or nervousness, and usually continue in 
spite of “worm” medication, if the error is 
not corrected. A small, white thread-like 
worm is the most common variety found in 
infants’ stools. These worms are sometimes 
seen between the folds of the vagina, where 
they may cause itching. Worms which are 
passed should be sent to the physician for 
identification so that the proper treatment 
may be begun. Not infrequently, suspected 
worms prove to be shreds of orange, paper, 
or thread. 158 
NURSERY GUIDE 
Accidents often occur when medical aid 
cannot be obtained quickly. A first-aid kit 
should contain: sterile cotton, gauze and 
bandages, adhesive plaster, carron oil, per- 
oxide of hydrogen, boric acid, alum and 
small quantities of tincture of iodine and 
lysol. 
If a bump begins to swell, it should be 
pressed with a cold spoon and then a smooth 
piece of ice or a cold compress should be 
applied to minimize swelling and discolora- 
tion. 
First degree burns are so mild that a 
blister does not form. Sterile vaseline and 
a bandage usually suffice. In second degree 
burns the blister should be opened with a 
sterilized needle and after all the destroyed 
skin is carefully removed, carron oil emul- 
sion (equal parts of linseed oil and lime 
water) or sterile vaseline should be applied 
very freely on sterile gauze and a bandage 
applied. Extensive second and all third de- 
gree burns must be seen by the physician. 
They leave more or less permanent scars. 
Burns due to firewmrks necessitate the in- 
jection of anti-tetanic serum to prevent 
lockjaw. 
If the skin is lacerated or bleeds, the 
Accidents 
Bumps and 
Bruises 
Burns 
Cuts CARE OF THE SICK INFANT 
159 
wound should be washed with peroxide of 
hydrogen or lysol solution (one teaspoonful 
to one pint of boiled water), gently dried, 
and a sterile dressing or adhesive strap ap- 
plied. If a cut is very deep and blood spurts 
out, a tight bandage should be applied to 
prevent loss of blood until the physician 
arrives. Stitches may be necessary to facil- 
itate healing and decrease scar formation. 
If an infant rolls off a bed, falls out of a 
high chair, or has any other severe fall, he 
should be placed in a horizontal position, the 
clothing loosened, and when crying ceases 
he should be kept quiet for some time. If 
vomiting occurs or if he cries when an arm 
or leg is moved or when he sits up, he should 
be seen by the physician. An x-ray picture 
may be necessary to detect a fracture or 
dislocation. 
Concussion of the brain is accompanied 
by a complete or partial loss of conscious- 
ness. In concussion, a cold compress to the 
head should be frequently changed, and if 
the feet are cold, heat applied. The child 
should be kept quiet until the physician 
arrives. 
If a child inhales stearate of zinc or tal- 
cum powder, wipe out the mouth as thor- 
oughly as possible, keep child quiet, and 
Falls 
Concussion of 
the IJrain 
Inhaling 
Powders 160 
NURSERY GUIDE 
send for physician. Smelling salts may be 
of value. Artificial respirations or oxygen 
are rarely necessary. 
Foreign Bodies 
In the Eye 
By holding the lids apart, one can usually 
remove particles of dust from the eye with 
the corner of a clean handkerchief. If this 
is unsuccessful, the physician should be 
called. Rubbing must be avoided, as the 
object becomes more firmly imbedded and 
the inflammation more intense. A wet dress- 
ing of boric acid solution may bring relief 
until the physician arrives. 
Orange seeds, buttons, safety pins, paper, 
pebbles, and other objects may be lodged so 
firmly that great caution must be exercised 
to prevent pushing the object farther in. 
If the object cannot be easily removed with 
tweezers, the child should be taken to the 
physician without delay. If old enough, the 
child should blow his nose strongly while 
the empty nostril is compressed. 
Coins, buttons, pins, etc., are not infre- 
quently swallowed. If there is difficulty in 
breathing, the child should be held with 
the head down and quite forcibly slapped 
between the shoulder blades. Should this 
fail to dislodge the object, the child should 
In the Ear 
and Nose 
Swallowing: 
Objects CARE OF THE SICK INFANT 
161 
be gagged by pressing at the base of the 
tongue with a spoon handle. If there is no 
difficulty in breathing or swallowing, the 
object has probably reached the stomach 
and there is usually no need for immediate 
alarm. Young children should be given the 
usual food. Older children should be given 
bread crumbs, potato or cereal. An x-ray 
is of value if symptoms arise. Swallowing 
an open safety pin sometimes necessitates 
operation. Laxatives and emetics should 
never be given, and all stools should be very 
carefully examined during the next few 
days until the swallowed object appears. 
Some foreign bodies require five or six days 
to pass through the intestinal canal. 
Bones of young children break rather 
easily. The x-ray reveals many fractures 
(“ green stick” fractures) which might 
otherwise not be recognized. 
Nosebleed may be due to an ulcer in the 
nose. The bleeding can usually be quickly 
stopped by inserting a pledget of cotton 
which has been dipped in a solution of alum. 
The child should be kept quiet in an up- 
right position, and the bleeding nostril com- 
pressed until a clot forms (about ten 
minutes). 
Medicines taken promiscuously may act as 
Fractures 
(Broken 
Bones) 
Nosebleed 
Poisons 162 
NURSERY GUIDI 
poisons. (See Poisons and Antidotes, page 
163.) 
If a sliver enters the flesh it should be 
completely removed as soon as possible with 
tweezers or a sterilized needle, after which 
a wet dressing (one teaspoonful of lysol to 
a pint of boiled water) should be applied 
for twenty-four hours. 
In the case of a sprain or a dislocation, the 
affected joint swells and is painful when the 
child is picked up, undressed, or attempts to 
walk. Medical aid should be sought early. 
Splinters 
Sprains and 
Dislocations 
Poisons and Antidotes 
In case of accidental poisoning, one should 
do as follows: 
1. Send for the physician at once, telling 
him wThat was taken. 
2. When the poison is not an acid or 
strong caustic, vomiting should he induced. 
This may be accomplished by pressing down 
the tongue with a finger or spoon, by giving 
a teaspoonful or more of ground mustard in 
water, or by giving Syrup of Ipecac in large 
doses. 
3. The poison should be neutralized as 
soon as possible. 
4. Give 5 to 10 drops of Aromatic Spirits 
of Ammonia in a tablespoonful of water as 
a stimulant in case of threatened collapse. CARE OF THE INFANT SICK 
163 
Poison 
Antidote 
Acids (acetic, hydro- 
chloric, sulphuric, 
nitric) 
Baking soda, milk of magnesia, soap 
and water, then olive or sweet oil 
(no emetic). 
carbolic, lysol, etc. 
Epsom salts, soap and water (no 
emetic); externally for burns 
50% alcohol. 
oxalic 
Emetic, then lime water, chalk, or 
tooth powder and water. 
Aconite 
Emetic, stimulation. 
Alcohol (brandy, whisky, 
etc.) 
Emetic, cold douche, coffee enema; 
apply external heat, friction. 
Alkalies (Ammonia, caus 
tie) 
Vinegar, lemonade, then olive oil or 
sweet oil (no emetic). 
Ammonia (see Alkalies) 
Arsenic (Fowler’s Solu- 
tion, Paris Green, 
Rat Poison, Depila- 
tories) 
Emetic, milk or white of eggs, then 
emetic; give arsenic antidote as 
soon as possible (fresh mixture 
of tincture of iron and calcined 
magnesia); laxatives. 
Atropine (see Bella- 
donna) 
Belladonna (Atropine) 
Emetic, coffee, cold to head, stimula- 
tion. 
Bichloride of Mercury 
(see Mercury) 
Carbolic (see Acid) 
Caustic (see Alkali) 
Corrosive Sublimate (see 
Mercury) 
Cough Syrups (see 
Opium) 
Gas (illuminating, coal 
fumes) 
Fresh air, artificial respiration, stimu- 
lation, strong coffee by mouth or 
high enema; warm bath with cold 
douche. 164 
NURSERY GUIDE 
Hydrochloric Acid (see 
Acid) 
Iodine 
Starch or flour mixed with water or 
milk, then emetic; stimulation. 
Laudanum (see Opium) 
Lye (see Alkali) 
Matches (see Phosphorus) 
Mercury (Bichloride of 
Mercury, Corrosive 
Sublimate) 
Emetic, then white of egg, milk or 
one teaspoonful tannic acid in a 
cup of water. 
Morphine (see Opium) 
Nitric Acid (see Acid) 
Nux Vomica 
Emetic, then tannic acid solution (one 
teaspoonful to cup); ten grains 
bromide of soda. 
Opium (cough syrups, 
laudanum, morphine, 
paregoric, soothing 
syrup, etc.) 
Emetic, strong coffee, keep awake for 
twelve to twenty-four hours, cold 
douche, artificial respirations. 
Oxalic Acid (see Acid) 
Paregoric (see Opium) 
Paris Green (see Ar- 
senic) 
Phosphorus (Matches, 
Rat and Roach 
Pastes) 
Emetic, white of egg, magnesia in 
large doses; no milk or oil. 
Rough on Rats (see Ar- 
senic) 
Silver Nitrate (Lunar 
Caustic) 
Emetic, one teaspoonful of salt to one 
cup of water, then emetic; milk 
or white of egg. 
Stearate of Zinc 
Emetic, then milk or white of egg, 
followed by an emetic. 
Sulphuric Acid (see Acid) 
Tobacco 
Emetic, milk, heat and friction of 
extremities, stimulation. APPENDIX 166 
NURSERY GUIDE 
Name 
Date of Birth 
weight 
GAIN on 
FOOD HEALTH 
AGE LBS. OZ. 
LOSS IN OZ. 
REMARKS 
At birth 
1st day 
2 
3 
4 
5 
6 
7 
2nd week 
3rd “ 
4 
5 
6 
7 
8th (2 mo.) 
9 
10 
11 
12 
13 (3 mo.) 
14 
15 
16 
17 (4 mo.) 
18 
19 
20 
21 
22 (5 mo.) APPENDIX 
167 
Name 
Date op Birth 
weight 
GAIN OR 
POOD HEALTH 
AGE LBS. OZ. 
LOSS IN OZ. 
REMARKS 
23 
24 
25 
26 (6 mo.) 
27th week 
28 
29 
30 (7 mo.) 
31 
32 
33 
34 (8 mo.) 
35 
30 
37 
38 
39 
40 (9 mo.) 
41 
42 
43 
44 (10 mo.) 
45 
46 
47 
48 (11 mo.) 
49 
50 
51 
52 (1 yr.) 168 
NURSERY GUIDE 
(The figures after one 
year are based on the Table of the 
of Labor.) 
Children’s 
Bureau, 
II. S. Dept. 
AGE 
AVERAGE 
AVERAGE 
HEIGHT IN 
HEIGHT 
WEIGHT 
WEIGHT 
YEARS 
MONTHS 
DATE 
INCHES 
LBS. 
oz. 
Birth 
20 
7 
1 
1 
20% 
8 
4 
2 
21 
10 
8 
3 
22 
12 
4 
4 
23 
13 
8 
5 
24 
15 
6 
25 
16 
7 
25% 
17 
8 
26 
18 
9 
26% 
19 
10 
27 
19 
8 
11 
27% 
20 
Table of Approximate Weight and Height APPENDIX 
169 
1 year 
28 
20 
8 
14 
29% 
21 
10 
16 
30% 
22 
10 
18 
31 
23 
6 
20 
32 
24 
2 
22 
32% 
25 
4 
2 years 
33 
26 
6 
2% “ 
34% 
27 
12 
234 “ 
35 
29 
3 years 
36 
30 
8 
3% “ 
37% 
32 
3% “ 
38% 
33 
4 years 
39 
33 
12 
5 “ 
41% 
41 
6 “ 
43 
45 
7 “ 
45% 
49 
8 “ 
47% 
54 
9 
49% 
59 
10 “ 
52 
65 WEIGHT CHART OF_ 
BORN 
AGE IN MONTHS. 
WEIGHT IN POUNDS 
AGE IN WEEKS. 
170 WEIGHT CHART OF 
BORN 
AGE IN MONTHS. 
WEIGHT IN POUNDS 
AGE IN WEEKS. 
171 172 
NURSERY GUIDE 
Eventful Dates: 
Sat up alone 
First tooth 
Stood alone 
Walked alone 
First Words 
First Sentence 173 
APPENDIX 
MEMORANDUM 174 
NURSERY GUIDE 
MEMORANDUM APPENDIX 
175 
MEMORANDUM 176 
NURSERY GUIDE 
MEMORANDUM INDEX 
A 
Abscess of breast, 45 
of ear, 129 
Accessory food factors, 81 
Accidents, simple remedies 
for: 
burns, 158 
inhaling substances, 159 
swallowing foreign bodies, 
160 
swallowing poisons, 162 
Adenoids, 129 
Adopting an infant, 76 
Aiding the physician, 147 
Air in stomach, 28 
moistened, 28 
Airing, 30 
nursery, 27 
Albumin milk, 85 
Alimentary intoxication, 120 
Anger, 39 
Anemia, 157 
Antidotes for poisons, 162 
Antitoxin, 141 
Appetite, 97, 114 
Applicator, 26 
Artificial feeding, 77 
amount at a feeding, 105 
constituents of, 93 
Artificial feeding—Cont’d. 
for normal infant, 101 
for premature infants, 74 
preparation of, 90 
standards of, 106 
Artificial respiration, 151 
Atrophy, 120 
Average infant (sec Normal 
infant) 
B 
Baby foods (see Infant 
foods) 
shows, 109 
Baby’s basket, 19 
bed, 18 
carriage, 29 
cart, 30 
crib, 18 
pen, 36 
wardrobe, 19 
yard, 36 
Backward infant, 114 
Bacon, 112 
Bacteria, in disease, 124 
in milk, 77, 79 
Bad air, 27 
Baked potato, 110 
Banana, 114 
Band, 19, 20 
177 178 
INDEX 
Barley, 110 
Hour, 95 
water 96, 119 
Bath, directions for giving, 
24 
hour for, 23 
not to be given, 25 
preparation for, 25 
temperature of, 25 
tepid sponge, 149 
mustard, 149 
Bed, 18 
Bed-wetting, 133 
Beef, broth, 110 
juice, 95, 111 
Berries, 114 
Binder, abdominal, 19 
for breasts, 61 
Birth, marks, 17 
registration, 15 
weight, 31 
Bladder infection, 130 
Blankets, 29 
Bleeding, of nose, 161 
of wound, 158 
Blindness, 14 
Blisters, 17 
Blood count, 157 
examination, 157 
in stools, 120 
Body, development of the, 
30 
Boiled milk (see Cow’s 
milk) 
Boiled water, 57 
Bones, broken, 122, 161 
soft, 121 
Borie acid solution, 44 
Bottle feeding, 91 
Bottles, nursing, 89 
Bowels, infant’s, 23 
mother’s, regulation of, 60 
Bowrel trouble (see Diar- 
rhea) 
Bow-legs, 122 
Bread crumbs, 110 
Breast, abscess, 45 
care of, 44 
engorged, 44 
manual expression of, 49 
of infant, 17 
pump, 45 
sore, 45 
suppurating, 45 
when weaning, 61 
Breast-feeding (see Nurs- 
ing) 
advantages of, 124 
contraindications, 47 
duration of each, 53 
interval of, 53 
number of, 52 
position for, 50, 51 
supplementing, 100 
weaning from, 59 
Breast-milk, amount at a 
feeding, 53 
composition of, 99 INDEX 
179 
Breast-milk—Cont’d. 
deficiency in, 46 
factors influencing the, 
47 
flow of, 48 
for premature infants, 
70 
in dyspepsia, 119 
production of, 48 
too much, 63 
weaning from, 59 
Breath-holding, 40 
Breathing, 31 
Breck-feeder, 71 
Bronchitis, 128 
Bronchopneumonia, 128 
Broths, 96 
Bumps, 158 
Burns, 158 
Butter, 19, 158 
pasteurized, 111 
Buttermilk (see Cow’s milk) 
C 
Cake, 114 
Calories, 103, 115 
Candy, 114 
Cane sugar, 93 
Care of buttocks, 22 
ears, 26 
eyes, 16 
genitals, 26 
hair, 35 
mouth, 34 
Care of—Cont’d. 
nails, 35 
navel, 16 
nose, 26 
scalp, 26 
skin, 17 
teeth, 35 
Carrots, 110 
Cart, 30 
Catching cold, 28 
Cathartics, 60, 65 
Catheter feeding (see Ga- 
vage) 
Cereals, 96, 111, 113 
preparation of, 96 
when begun, 61 
Certified milk (see Cow’s 
milk) 
Chafing, 22 
Chicken pox, 143 
Childbirth, 122 
Chocolate, 59 
Cholera infantum, 120 
Circumcision, 26, 131 
Clothing, for newly born, 
19 
indoor, 20 
outdoor, 21 
summer, 21 
winter, 20 
Cocoa, 59 
Cod liver oil, 122 
Colds, 120 
Cold weather, 20, 27 180 
INDEX 
Colic, 63, 117 
Collapse, 121, 154 
Commode, 24 
Complemental feeding, 101 
Concussion of brain, 159 
Condensed milk (see Cow’s 
milk) 
Constipation, causes of, 59 
diet in, 24, 60 
mother’s, 60 
so-called, 23 
true, 24 
Consumption (see Tubercu- 
losis) 
Contagious disease, rules in, 
136 
Contraindications to nurs- 
ing, 47 
Convulsions, 133 
Cough, 127 
Cow’s milk, analysis of, 99 
bacteria in, 77, 79 
boiled, 81 
buttermilk, 85 
care of in home, 77 
certified, 80 
characteristics of, 77 
choice of, 80 
condensed, 84 
dry, 82 
evaporated, 84 
formula, 105 
for nursing mother, 59 
frozen, 80 
Cow’s milk—Cont’d. 
modification of, 88 
pasteurization of, 81 
peptonized, 86 
raw, 81 
skimmed, 82 
sour, 79 
sterilization of, 78, 82 
supply, 79 
Crackers, 112 
“Cradle Cap,” 135 
Cream, 77, 108 
Creeping, 35 
Crib, 18 
Croup, catarrhal, 127 
diphtheritic, 14.1 
-kettle, 128 
Cry, 38 
Custard, 97 
Cuts, 158 
D 
Daily routine, 36 
Date of confinement, 14 
Decayed teeth, 34 
Delayed talking, 43 
teething, 121 
Delicate infants, 114 
Dentition (see Teeth and 
Teething) 
Desserts, 113 
Development, 30 
Dextri maltose, 93 
Diapers, 21 INDEX 
181 
Diarrhea, 117 
from overfeeding, 116 
in breast-fed infants, 63 
in hot weather, 120 
with fever, 118 
Diet, after eighteen months, 
112 
during fever, 118 
during hot weather, 107, 
113 
for constipation, 60 
for newly born, 57 
for nursing mothers, 60 
for wet-nurses, 73 
from twelve to eighteen 
months, 110 
of sick infants, 61, 114, 
118 
in diarrhea, 119 
Digestive capacity, 105 
Diphtheria, 140 
Discipline, 37, 40 
Disease, resistance to, 124 
contagious, 136 
Disinfection, 138 
Disposition, 124 
Drafts, 36 
Dry milk (see Cow’s milk) 
Dust, 78 
Dysentery, 120 
Dyspepsia, 64, 119 
E 
Ear, abscess of, 129 
cleaning the, 26 
Ear—Cont’d. 
foreign bodies in, 160 
washing of, 26 
Eating, forced, 52, 62, 114 
Eczema, 135 
soup, 88 
Eggs, 112 
Emergency outfit, 15, 158 
Emetics, 162 
Enema, 155 
Errors, in artificial feeding, 
106 
in breast feeding, 63 
Eruption of skin, 136 
of teeth (see Teething) 
Eventful dates, 172 
Examination, of ears, 148 
of infant, 148 
of throat, 148 
of urine, 130 
Exercise, 35 
Expectant mother, rules for, 
14 
Expression of breast milk, 
50 
Eyes, care of, 16 
foreign body in, 160 
F 
Face mask, 75 
Falls, 159 
Fat babies, 63 
Fermentation of food, 106 
Fever, 148 
scarlet, 139 182 
INDEX 
Fever—Cont’d. 
baths in, 149 
feeding in, 118 
hydrotherapy in, 149 
treatment of, 150 
Finger sucking, 132 
First aid, 158 
Flour ball, 97 
Flours, 95 
Fontanelle, 30, 121 
Flushing, of bowels, 154 
Food, caloric value of, 103, 
115 
for traveling, 108 
forcing of, 52, 62, 106 
habits, 114 
tolerance, 105 
Forcing food, 52, 62 
Foreign bodies, in ear, 160 
in eye, 160 
in nose, 160 
in throat, 160 
swallowed, 160 
Foreskin, 26 
Formulas {see Feeding) 
Fractures, 122, 161 
Fresh air, 28 
Fretful infants, 28, 38 
Fruit juices, 111, 113 
Fumigation, 138 
G 
Gain, in height and weight, 
168-169 
Gas, in bowels, 38 
in stomach, 38 
Gavage feeding (tube feed- 
ing), 153 
Genital organs, 26 
German measles, 143 
Glands, enlarged, 130 
Gonorrhea, 14 
Granulated sugar, 93 
Green stools, 119 
Grippe (see Influenza) 
Gruels {see Cereals) 
Gums, 33 
II 
Habits, bad, 132 
Hair, 31, 35 
Handling the infant, 70 
Happiness of the infant, 124 
Hardening, 26 
Heat rash, 134 
Height, table of, 168, 169 
Hemorrhage {see Cuts and 
Nose-bleed) 
Heredity, 13 
Hernia, 131 
Hives, 135 
Hoarse cry, 127 
Hot bath {see Bath) 
water bottle, 18, 69 
weather cautions, 21, 107 
Humidifiers, 28 
Hunger, 65, 114 
stools {see Stools) 
Hydrocele, 131 183 
INDEX 
I 
Ice chest (portable), 109 
Ice cream, 114 
Incubation period of dis- 
ease, 145 
Indigestion, 64 
Infant feeding, 88, 98 
“foods,” 83 
Infantile paralysis, 136 
Inhaling stearate of zinc, 
159 
Injection (see Enema and 
Flushing) 
Intervals of feeding, 53 
of nursing, 52 
Intoxication, alimentary, 120 
J 
Jaundice, 16 
Junket, 97 
K 
Kidney infection, 130 
Kissing, 41 
Knock-knee, 122 
L 
Labor, calculating date of, 
14 
Lancing of gums, 32 
Laryngosjmsm, 122 
Lavage (stomach washing), 
152 
Laxatives, 119 
M 
Malnutrition, 120 
Malt soup, 87 
Manual expression of breast, 
49 
Mastoiditis, 130 
Masturbation, 133 
Maternity hospital, 16 
Mattress (see Baby’s bed) 
Measles, 139 
Measures, 93 
Meat, 112 
Medicine chest, 19 
Menstruation, milk supply 
during, 48 
Mental development, 42 
Milk {see Breast milk or 
Cow’s milk) 
in infant’s breast, 17 
sugar, 93 
Mixed feeding, 102 
Moisture, 28 
Mucus in stools, 65 
Mumps, 143 
Mustard, bath, 149 
pack, 151 
water (as emetic), 162 
N 
Nails, 35 
Nap, 29 
Napkin, 21 
Navel, 16 184 
INDEX 
Newly born, 16 
Nervous infant, 37, 132 
mother, 132 
Nipple, care of, 90 
care of mother’s, 44 
fissure of mother’s, 45 
hole in, 91 
inverted, 47 
shield, 45 
soreness of mother’s, 45 
Normal infant, artificial 
feeding of, 77 
mental development of, 
37, 42 
physical development 
of, 30 
Nose bleeding, 161 
cleansing the, 26 
foreign body in, 160 
Nurse, trained, 147 
wet, 73 
Nursemaid, 17 
Nursery, 17 
Nursing, care of sick in- 
fants, 147 
contraindications to, 47 
errors in, 38, 64 
fundamental principles of, 
49 
intervals, 52 
mother, diet for, 59 
exercise for, 59 
illness of, 48 
rules, 52 
Nursing—Cont ’cl. 
sick infants, 66, 120 
successful, 58 
Nutritional disturbances, in 
artificially fed, 116 
in breast fed, 63 
Nuts, 114 
0 
Oatmeal, 112 
water, 24, 96 
Observing the infant, 147 
Oil bath, 16 
Orange juice, 82, 100, 123 
Out-of-doors, 29 
Overfeeding, 63, 106 
Overstepping the food tol- 
erance, 105 
P 
Pack, hot, 150 
mustard, 151 
tepid, 150 
Pacifier, 33 
Pain cry, 38 
Paper napkins, 22 
Pasteurization (see Cow’s 
milk) 
Pale infants, 61, 119, 157 
Patent foods (see Infant 
foods) 
Penis, 131 
Peptonized milk (see Cow’s 
milk) INDEX 
185 
Perspiring infants, 122 
Pie, 114 
Pillow, 29 
Pneumonia, 128 
Play-mates, 41 
things, 42 
Playing with the baby, 37- 
40 
Poisons and antidotes, 162 
Poor appetite, 96 
in infant, 52 
in nursing mother, 59 
Potato, baked, 111 
Powdered milk (see Cow’s 
milk) 
Pregnancy, influencing the 
breast milk, 47 
Premature infant, 67 
amount of food at a meal, 
72 
breast milk for the, 73 
care of the, 68 
other food for the, 74 
wet-nurse for the, 73 
Prepared breakfast foods, 
114 
Prickly heat, 134 
Proprietary iufant foods, 83 
Protein milk, 85, 100 
Prune juice, 100, 111 
Pulse of infants, 31 
Punishment, 41 
Purees, 61 
Q 
Quarantine, 145 
R 
Rashes, 137 
Reaction to milk, 118 
Recipes, 95 
Record of feeding, 166 
of health, 173 
of nursings, 56 
of sick infant, 174 
of weight, 166, 170 
Rectal feeding, 154 
temperature, 148 
Registration of birth, 15 
Return to breasts, 119, 120 
Regularity in daily routine, 
37 
Regurgitation, 117 
Resistance to disease, 124 
Restlessness, 28, 32 
Rice, 110 
Ringer’s solution, 155 
Rickets, 83, 121 
Rocking, 28, 40 
Rompers, 23 
Rotation of breasts, 54 
Routine, daily, 36 
life of the nursing mother, 
59 
Rubber diapers, 22 
Rugs, 17 
Rules for feeding, 102 
for nursing, 49 
Rupture, 131 186 
INDEX 
S 
Saccharin tablets, 98 
Scales, for weighing infants, 
53 
for weighing foods, 93 
Scalp, 136 
Scarlet fever, 139 
Schedule for a day, 52 
Schick test, 141 
Scurvy, 122 
Second summer, 114 
Shield for nipple, 45 
Shoes, 23 
Sits alone, 31 
Size of stomach, 55 
Skimmed milk (see Milk) 
Skin, care of, 134 
chafed, 134 
Sleep, 28 
Smallpox, 143 • 
Smegma, 26 
Soap, 135 
stick (see Suppository) 
Socks, 23 
Sore buttocks, 22, 134 
Soup, 96 
Soy bean, 95 
Spasms (see Convulsions) 
Spoiling the baby, 40 
Sprains, 162 
Standing, 31 
Sterilization of milk (see 
Cow’s milk) 
Stockings, 23 
Stomach, size of, 55 
washing out of, 152 
Stools, abnormal, 65, 118 
blood in constipated, 24 
blood in diarrheal, 120 
curds in, 65 
formed, 119 
frequent, 117 
frothy, 23 
green, 23 
hard, 24 
hunger, 66 
irritating, 23 
Successful feeding, 106 
nursing, 58 
Sugar of milk, 93 
Sugars, kinds of, 93 
Summer complaint, 120 
precautions, 21 
Sunbaths, 27 
Supplemental feeding, 101 
Supplies for accident, 158 
Suppository, gluten, 24 
glycerin, 24 
soap, 24 
Swallowing foreign bodies 
160 
Sweating, 31, 107 
Sweets, 114 
Swollen glands, 130 
Symptoms, 124 
Syphilis, 13 INDEX 
187 
T 
Table, of feeding, 166 
of height, 168 
of poisons and antidotes, 
162 
of weight, 168 
Talking, 42 
Tea, 98 
Tears, 31 
Teasing, 41 
Teeth, appearance, 34 
care of, 34 
Teething, error in diagnosis, 
32 
fallacies, 132 
late, 33 
Temperature, of the bath, 25 
of the food, 91 
of the infant, 148 
of the nursery, 27 
Test, tuberculin, 13 
Testicle, undescended, 131 
Tetany, 122 
Thermometer, 148 
Thermos bottle, 109 
Thirst, at night, 39 
in fever, 39 
in summer, 39 
Throat, foreign body in, 160 
Toast, 110 
Tolerance of food, 105 
Tonsils, enlarged, 129 
Tonsillitis, 129 
Toys, 42 
Trained nurse, 147 
Training, 37, 41 
the bladder, 24, 37 
the bowels, 24 
Travel, 83, 108 
Tuberculosis, of cow, 77 
of mother, 13 
test for, 13 
Turpentine stupe, 151 
U 
Underfeeding, of premature, 
71 
on artificial food, 114 
on the breast, 65 
Urine, collection of, 156 
“strong,” 22 
Utensils for preparing food, 
89 
V 
Vacation, 108 
Vaccination, 143 
Vaginitis, 132 
Vegetables, 100, 110, 113 
Veil, 20 
Ventilation, 28 
Visitors, 40 
Vitamines, 81 
Vomiting, 65, 117 
W 
Wakefulness, 37 
Walking, 36 188 
INDEX 
Wassermann test, 13, 73 
Water, 16, 24, 57, 108 
Weaning, 61 
Weighing the infant, 53 
Weight, average gain in, 
168, 169 
charts, 170 
disturbance, 118 
excessive, 58 
loss in, 31 
Weight—Cont’d. 
record of, 170 
Wet-nurse, 73 
Wetting the bed, 133 
Whey, 87 
Whooping cough, 142 
Worms, 157 
Z 
Zwieback, 110