UBRARY 6 CALIFORNIA STATE BOARD OF HEALTH 'M 27 IS33 SAVE THE BABIES BY L. EMMETT HOLT, M.D., LL.D. Professor of Diseases of Children in the College of Physicians and Sur- geons (Columbia University), New York; Attending Physician to the Babies' Hospital AND HENRY L. K. SHAW, M.C. Clinical Professor of Diseases of Children in Albany Medical College (Union University), Albany, N. Y.; Attending Physician to St. Margaret's ;*:**7 Hospital for Infants; Director of the Division of Child Hygiene, New York State Department of Health ISSUED BY THE CALIFORNIA STATE BOARD OF HEALTH FOR FREE DISTRIBUTION Other Copies may be Obtained by Applying to the Secretary of the Board, Sacramento, California SAVE THE BABIES This Pamphlet was Prepared by L. EMMETT HOLT, M.D., LL.D. Professor of Diseases of Children in the College of Physicians an4 Surgeons (Columbia University), New York; Attending Physician to the Babies' Hospital AND HENRY L. K. SHAW, M.D. Clinical Professor of Diseases of Children in Albany Medical College (Union University), Albany, N. Y. ; Attending Physician to St. Margaret's Hospital for Infants; Director of the Division of Child Hygiene, New York State Department of Health AMERICAN MEDICAL ASSOCIATION FIVE HUNDRED AND THIRTY-FIVE NORTH DEARBORN STREET CHICAGO BIOLOGY LIBRARY G COPYRIGHT, 1915 BY THE AMERICAN MEDICAL ASSOCIATION #74" I. BEFORE THE BABY COMES Motherhood should cause no fear of trouble. Giving birth to a baby is natural and normal. As soon as you know a baby is coming, engage the best doctor you can afford and place yourself under his care/ If you had one miscarriage, another may be pre- vented by proper treatment. If you cannot afford a doctor, apply to a hospital or dispensary where experienced doctors and nurses will advise and care for you. A nervous, overworked, underfed woman cannot expect to have a strong, vigorous healthy child. The expectant mother requires an extra amount of sleep, and a day-time rest for an hour or two is desir- able. She should keep the windows open while she sleeps. Much climbing of stairs and the use of the sewing machine should be avoided during the later months of pregnancy. Hard household or factory work during the later months of preganacy tend to bring on miscarriages, or to make the child small and delicate. When labor is threatened before the proper time, the expectant mother should go to bed at once and remain perfectly quiet until the danger is over. Walks in the open air should be taken during the entire course of pregnancy. Exercise in the fresh air and housework with the windows open are better than medicine. Violent exercise in any form should be avoided. Daily bathing is necessary for the best health of the mother. At least one satisfactory movement of the bowels should take place every day ; if there is any difficulty 851036 about this, the doctor should be consulted, for it is important. It is necessary to drink plenty of water so that the kidneys will act freely. Loose, comfortable clothing is essential to the com- fort of the mother and the welfare of the child. Skirts and dresses should hang from the shoulders ; but no tight bands about waist or chest. Breasts and nipples should be kept clean and softened with a little vaseline each day; this will make the act of nursing one of pleasure and satisfaction instead of one of pain and discomfort. Expectant mothers must have plenty of simple nourishing food ; the baby must not be starved before it is born. Tea and crackers will not make milk and strength. Also, highly seasoned, rich and fried foods should be avoided. Overeating surely taxes the organs which care for waste materials and may cause serious illness. DIET FOR MOTHERS The following diet is recommended during preg- nancy and nursing. All kinds of soups. All kinds of fresh fish, boiled and broiled. Meats once a day beef, mutton, lamb, veal, ham, bacon, chicken or turkey. Eggs freely, one or two each day. All cooked cereals with milk and cream and sugar. All stale breads, avoiding fresh bread and rich cake. All green vegetables peas, string-beans, aspar- agus, cauliflower, onions, spinach, white and sweet potato, celery, lettuce and other plain salads with oil. Desserts of plain custard or pudding, ice cream; no pastry. Fruits should be freely taken-; all ripe raw fruits and cooked fruits. Drinks milk, buttermilk, cocoa and plenty of water, one or two quarts daily ; tea and coffee spar- ingly and not strong, once a day. No beer or other alcoholic drinks. II. WHAT TO PREPARE NECESSARY THINGS FOR THE BABY . Three-quarter yard thin, light-weight flannel. Two light-weight woolen blankets. Three cotton and wool undershirts. Three flannel skirts. Three outing flannel gowns. Four cotton slips. One and one-half dozen diapers, 18 inches. One and one-half dozen diapers, 22 inches. One box boric acid. One box talcum powder. One piece Castile soap. One-quarter pound sterile gauze. One-quarter pound sterile absorbent cotton. Two dozen safety pins, large and small. One set of scales. NECESSARY THINGS FOR THE MOTHER Three nightgowns. One and one-half yards square oil cloth or rubber sheeting. Two pounds absorbent cotton. Two pounds sterilized gauze or equivalent in old clean linen. , III. THE NEW-BORN BABY There should be a warm, soft blanket to receive him. The body should be oiled, not bathed. The eyes should be carefully cleansed with a satu- rated solution of boric acid, and into each eye the doctor or nurse should put two or three drops of a 2 per cent, solution of nitrate of silver to prevent sore eyes and possibly blindness. He should be placed in a quiet, darkened room, properly protected against the cold but not sur- rounded with too many hot water bags or bottles. NURSING He should not be put to the breast for five or six hours. During the. first twenty-four hours the baby should not nurse more than four times, but both breasts each time. If he cries much, he should have boiled water, but not any kind of tea, nor sugar and water. Beginning with the third day, when the milk usually comes, he should nurse regularly every three hours, alternating the breasts, or taking both breasts each time according to his appetite and the amount of milk secreted. He should not remain at the breast more than twenty minutes in all. Nursing times should be regular by the clock; regular feeding means regular sleep and these things make the care of the baby much easier. In the beginning it is well to waken the baby at nursing time ; soon he forms the habit of waking him- self at the regular interval. In case the milk is delayed longer than the third day, the baby should be fed at three-hour intervals, but he should be regularly put to the breast first in order to stimulate the flow of milk. IV. REASONS WHY YOU SHOULD NURSE YOUR BABY Breast milk is always ready and is never sour. Breast milk does not have to be prepared or mea- sured. It- is Nature's method and was intended for your baby. It will make your baby strong and healthy. It is absolutely free from germs and dirt. It protects your baby from many infants' diseases. It is safer for the baby. Ten bottle-fed babies die to one fed on the breast. It is the only perfect food for the baby. It contains the proper elements of food in the right proportion for the growing child. Breast-fed babies seldom have bowel trouble, which is so fatal in bottle-fed babies, especially during hot weather. Your baby will have the best chance of living if it is breast fed. V. ADVICE TO NURSING MOTHERS Keep yourself well. As long as you are well, your baby will probably be well. Don't get discouraged if you have but little milk at first. Feed the baby a little from the bottle after nursing when necessary; but do not give up nursing. Be patient and try again. Eat plain, nutritious food. Avoid salads, pickles and spicy foods. Drink plenty of water and milk. Avoid tea, coffee and alcoholic beverages. Nurse the baby regularly. Feed him by the clock and not longer than twenty minutes at one time. Until he is four months old, nurse every three hours up to 1-0 p. m. and only .once during the night; seven nursings in twenty-four hours. After he is four months old, omit all night nursings ; give but six nursings in twenty-four hours. When six months old, nurse every four hours (usually giving both breasts each time) ; only five nursings in twenty-four hours. When the baby cries between feedings, give him cooled, boiled water without anything in it. Do not wean or give any other feeding without con- sulting a doctor. VI. WEANING FROM THE BREAST If a mother becomes pregnant, or has any serious or severe acute illness, the baby should be weaned. Under other circumstances, if the baby is thriving, the nursing should be continued for nine or ten months without other food. Weaning should be done gradually, if possible, by giving the baby at first one, and later two or more feedings from the cup or bottle in place of a nursing. The number of feedings should be gradually increased until the baby is taken entirely from the breast at eleven or twelve months. If the baby is weaned before eight months he should be taught to take the bottle ; if at ten or eleven months old, it is better to teach him to drink or feed from a spoon. If possible, weaning during the summer months should be avoided. VII. ARTIFICIAL OR BOTTLE-FEEDING There is no perfect substitute for breast milk. Clean fresh cow's milk properly modified is the best substitute available. Patent foods should be avoided ; they are not fresh ; they are expensive, and the babies fed on them are more liable to be sick than those fed on cow's milk. CARE OF "THE MILK Buy only clean milk, from a clean milkman and keep it clean in your home. Buy for the baby the freshest milk you can get, but not the richest milk. If possible^ only milk delivered in bottles should be used. Dipped milk is never clean and never quite safe; dirt and flies are likely to get into it. If such milk is used, it should always be kept covered. When received, the milk should be put immediately on ice and kept there. Warm milk readily spoils and spoiled milk will make the baby sick. One should never leave an open pitcher out of doors for the milkman to pour milk into. One should never allow milk to stand about the house in open vessels nor on the steps in the sun. Not only the bottles and dishes used, but the hands of the mother should be very clean before preparing the milk. New rubber nipples should be boiled. All nipples after using should be carefully washed in soap and water and kept covered in a glass containing boric acid or baking soda and water. They should be rinsed before using. Bottles should be rinsed when emptied and then kept filled with water. Before preparing the food for 11 the day they should be thoroughly washed with hot suds and placed for ten minutes in boiling water. During the summer the milk should always be boiled or pasteurized. Boiling milk kills the germs and makes the milk safer. In preparing the milk for the baby it is easier to fix the entire supply for the day at one time. The proper quantity for each feeding is put in a separate bottle. The milk may be pasteurized by placing these bot- tles in a deep saucepan filled with cold water and left on the stove until the water boils. Then remove from the stove to a table and allow the bottles of milk to stand in the hot water for twenty minutes. Then cool by placing them in cold water, afterwards putting them on ice. Rapid cooling is of great impor- tance. When milk is boiled, this should be done in the separate feeding bottles after it is prepared. A HOME-MADE ICE BOX This may be made as follows : Get from your grocer a deep box about 18 inches square and put 3 inches of sawdust in the bottom. Place two pails in this box, one, a smaller pail, inside the other, and fill the space between the outer pail and the box with sawdust. The nursing bottles filled with milk are placed in the inner pail. This pail is then filled with cracked ice which surrounds the bottles. The inner pail should have a tin cover. Nail several thicknesses of newspaper on the under surface of the cover of the box. This ice-box should be kept covered and in a shady, cool place. The water from melted ice should be poured off and the ice renewed at least once each day. PREPARATION OF THE FOOD The simplest plan is to use whole milk (from a shaken bottle) which is to be diluted according to the child's age and digestion. Beginning on the third day, the average baby should be given 3 ounces of milk daily, diluted with 7 ounces 12 of water. To this should be added one tablespoonful of lime water and two level teaspoonfuls of sugar. This should be given in seven feedings. At one week, the average child requires 5 ounces of milk daily, which should be diluted with 10 ounces of water. To this should be added one and a half even tablespoon fuls of sugar and 1 ounce of lime water. This should be given in seven feedings. The milk should be increased by y 2 . ounce about every four days. The water should be increased by y 2 ounce about every eight days. At three months, the average child requires 16 ounces of milk daily, which should be diluted with 16 ounces of water. To this should be added three tablespoonfuls of sugar and 2 ounces of lime water. This should be given in six feedings. The milk should be increased by y 2 ounce about every six days. The water should be reduced by y 2 ounce about every two weeks. At six months, the average child requires 24 ounces of milk daily, which should be diluted with 12 ounces of water. To this should be added 2 ounces of lime water and 3 even tablespoons ful of sugar. This should be given in five feedings. The amount of milk should be increased by y 2 ounce every week. The milk should be increased only if the child is hungry and digesting his food well. It should not be increased unless he is hungry, nor if he is suffering from indigestion even though he seems hungry. At nine months, the average child requires 30 ounces of milk daily, which should be diluted with 10 ounces of water. To this should be added two even table- spoonfuls of sugar and 2 ounces of lime water. This should be given in five feedings. The sugar added may be milk sugar or if this cannot be obtained cane (granulated) sugar or maltose (malt sugar). 13 At first plain water should be used to dilute the milk. At three months, sometimes earlier, a weak barley water may be used in the place of plain water; it is made y 2 level tablespoonful of barley flour to 16 ounces of water and cooked for twenty minutes. At six months, the barley flour may be increased to 1% even tablespoonfuls, cooked in the 12 ounces of water. At nine months, the barley flour may be increased to 3 level tablespoonfuls, cooked in the 8 ounces of water. A very large baby may require a little more milk than that allowed in these formulas. A small or delicate baby will require less than the milk allowed in the formulas. RULES FOR FEEDING Rules for bottle feeding must be carefully observed ; regularity is very important. From the outset the baby should not be fed oftener than every three hours up to 10 p. m. and one feeding later during the night; only seven feedings in the twenty-four hours. After four months no night feeding after 10 p. m. should be given ; only six feedings in the twenty-four hours. After six months the time between feedings should be made four hours and only five meals given in the twenty-four hours. The bottle should always be held while the child is taking his food. After feeding, the child should be placed upright and patted to allow him to bring up the gas, generally air which he has swallowed. He should then be placed in his crib, but not rocked. A child should never be played with after feeding. He should not be allowed to suck on an empty bottle. He should not be allowed to sleep with the nipple in his mouth. 14 If a child does not take all his feeeding, what is left should be thrown away ; never warmed over again for a later feeding. Unless a child has loose bowels he should be given from one to three tablespoonfuls of strained fruit juice once a day after he is seven or eight months old. After he is nine months old, he may be given squeezed beef juice, beef tea or plain mutton or chicken broth, once a day. When he is ten months old, he may have part of a soft egg, a small piece of crisp toast or zwieback or a crust of bread to chew, immediately after his feeding. Other solid foods should not be given during the first year. At twelve months, he may take his milk undiluted and strained cereal may be given twice a day. VIII. FROM THE BOTTLE TO TABLE FOOD During the second year, the child should have four meals a day; hours: 6 a. m., 10 a. m., 2 p. m., 6 p. m. Nothing but water should be allowed between his meals. At twelve months, the baby should be weaned from the bottle and taught to drink milk from a cup. He may then have cereals twice a day which should be thoroughly cooked and for the first two or three months they should be strained. He should have four cups of milk daily. When fifteen months old, he may have at first a teaspoonful, later one tablespoonful of rare scraped beef, mutton or chicken. When eighteen months old he may have one-half of a mealy baked potato daily. When two years old, he may have most of the fresh green vegetables when thoroughly cooked and finely mashed. Tea, coffee, cider, wine, beer, soda-water and candy should never be given to a young child. The juice of fresh fruits may be given after twelve months. Cooked fruit, such as baked apple or applesauce, should be given once a day after a child is eighteen months old; it should at first be strained. Stale, raw fruits are especially dangerous in the city and in the summer. IX. DIET TWO TO THREE YEARS Breakfast 7:30 A. M. The juice of one sweet orange or the pulp of four or five stewed prunes, or applesauce. Either a well-cooked cereal: corn meal, Petti John, oatmeal, cracked wheat, wheatena, all well salted and not more than one-half teaspoonful of sugar, and milk added ; or soft boiled or poached egg with stale bread or crisp toast. Glass of warmed milk. 10:30 A. M. Glass of warmed milk. Dinner 1:30 to 2 P. M. One-half cup of broth or soup, which may be chicken, beef or mutton, thickened with barley or rice. Chop, rare roast beef, rare steak, or chicken or broiled fish. Boiled or baked potato. Asparagus tips, carrots, string beans, peas, spinach. All vegetables should be very thoroughly cooked and mashed. Dessert: baked apple, plain bread or rice pudding, corn starch, custard, junket, or stewed prunes with skins removed.' Supper 5:30 P. M. Well-cooked cereal, or bread and milk, or bread and butter and cocoa, and stewed fruit, applesauce. Glass of warmed milk. No food between meals. Water several times a day. X. THINGS WHICH ARE BAD FOR ALL BABIES Pacifiers. Thumb sucking. Soothing syrups. Patent medicines. Whisky or gin for supposed colic. Dirty playthings, dirty nipples, dirty bottles, dirty floors. Waterproof diapers except for temporary use. Moving picture shows. Violent rocking, bouncing and rollicking play at any time. Play of every sort after feeding. Kissing the baby on his mouth either by the family or by strangers. Testing the temperature of the baby's milk by taking the nipple in the mouth. Sucking on empty bottles. Sleeping on the mother's breast while nursing. Sleeping in bed with the mother. Spitting on handkerchief to remove dirt from baby's face. Sneezing and coughing in the baby's face. Allowing a person with a cough or cold to hold the baby. Allowing any person with tuberculosis to take care of the baby. The baby is not a toy or a plaything, but a great responsibility its health, growth and happiness depend largely on you. XL THE SUMMER CARE OF BABIES THE BREAST-FED BABIES Breast milk is the best milk for the summer. Breast-fed babies seldom have severe diarrhea. If they vomit or have acute indigestion it is usually because they are fed too much or too often, or because the mother is so sick or tired out that her milk is poor. In very hot weather the baby should nurse less often. Give him the breast only every four hours, but give cooled boiled water freely between the nursings. THE BOTTLE-FED BABIES They are much more likely to get diarrhea. If they have diarrhea it is much more often severe. The milk must be clean and be kept cold. It should be boiled or pasteurized. The bottles and rubber nipples should be boiled daily and kept very clean. In very hot weather the baby needs less food but more to drink. His milk should therefore be diluted with boiled water and cooled boiled water given freely between feedings. SUMMER DIARRHEA It is easier to prevent diarrhea than to cure it. The important means of preventing severe diarrhea are: 1. Boil all milk in summer. 2. Dilute the baby's food in very hot spells. 3. Stop the food at once if an acute diarrhea begins. If the movements become loose and only two or three a day, do not neglect it because the baby happens to be teething ; it may mean the beginning of a serious illness, Dilute the food with an equal amount of boiled water and give less than the usual amount at a feeding. 19 If the movements are more frequent and there is vomiting or fever, stop all food at once and give only boiled water, and call a doctor. After twelve hours without food, barley water, made one tablespoon ful to one pint, may be given. Proper treatment at the beginning of a diarrheal attack is worth more than many days' treatment later. GENERAL CARE The clothing in hot weather should be light and on very hot days only the shirt, band and napkin worn. Bathe the baby morning and evening and on hot days also in the middle of the day. Keep the skin clean and well powdered. Napkins when soiled should be placed at once in water and washed as soon as possible. The baby needs fresh air quite as much as fresh food. Keep him out of doors as much as possible. Avoid the sun on hot days. In very hot weather take him out early in the morn- ing and in the late afternoon and early evening. It is often cooler in the house, with shutters closed, in the middle of the day. Take the baby to the park, to the beach and to the country whenever you can. AVOID INFECTION Keep the room free from soiled clothes and rubbish. Do not let the baby play with cats or dogs. Cats and dogs carry diseases to babies. Do not let the baby crawl around on a dirty floor or dusty carpet. Place him on a clean sheet or blanket. Keep playthings and pacifiers out of his mouth. Flies carry disease to babies. Screen the baby's room. Keep flies away from the baby and his food at all times. Cover the crib or carriage with netting to keep out the flies and mosquitoes. THIS BOOK IS DUE ON THE LAST DATE STAMPED BELOW AN INITIAL FINE OF 25 CENTS WILL BE ASSESSED FOR FAILURE TO RETURN THIS BOOK ON THE DATE DUE. THE PENALTY WILL INCREASE TO SO CENTS ON THE FOURTH DAY AND TQ $LOO O*J JWE SEVENTH vER lwft