CHAPTER II
GENERAL DIRECTIONS FOR THE MANAGEMENT OF INFANTS
BEFORE commencing a description of the most common diseases of infants and children, we think it necessary to offer some general instructions on the management of early infancy, touching on points which may appear to be of only minor importance, but which have a most important bearing on the prevention of infantile disease and mortality.
4. The Newly-Born Infant.
As an illustration of helpless weakness, nothing can exceed that which an infant presents at birth. The little thing requires aid of every kind, and if abandoned it soon perishes.
If an infant be born before the doctor’s arrival, it should receive the attentions pointed out in the section on “Labour” in The Lady’s Manual (Secale57). If the child is healthy and strong, it will cry vigorously; for the transition from a condition of unconscious repose, in a bland fluid, at a temperature of 98oC Fahr., to the contact of rough cloths, and a comparatively cold temperature, cannot be agreeable. The act of crying helps to fill the lungs with air, and thus the functions of breathing and pulmonary circulation become established.
The First Wash.
As soon as breathing has fairly commenced, and the navel-string been tied, the infant should be enveloped in soft warmed flannel, and, everything being ready beforehand, immediately washed, and as quickly as possible. Immediately, for the skin requires cleansing from the tenacious fluid which adheres to it at birth, in order that healthy transpiration may be established. A newborn child is often allowed to remain a long time before it is washed, and even then it is not always washed quickly and skilfully, so that it shivers, and its skin become blue before it is placed by its mother’s side.
Before commencing the process of washing, the eyelids should be carefully wiped with a piece of moist soft linen, then the rest of the body should be cleansed by means of a fine sponge, with warm water and a little soap, and carefully dried with a soft warmed towel. If the unctuous matter be considerable or very adhesive, a little fresh lard rubbed upon the skin previously to the application of the soap and water will render its entire removal an easy operation. As soon as the cleansing is completed, a little violet powder – finely powdered, scented starch – may be dusted lightly on the surface, especially in the creases of the joints.
Dressing the Navel
This is to be done by folding a piece of soft linen into four or six thicknesses, about six inches by three, and cutting a hole through the centre for the remnant of the cord, winding around it a strip of soft linen; then one half of the folded linen should be doubled over the other half, so that the portion of cord lies between the folds, and directed upwards towards the chest; the whole is to be kept in apposition by a band, about four inches wide, passed gently around the child’s abdomen, and worn till the remnant of the cord comes away, which is usually within six days. All the linen thus used should be rendered surgically clean scorching before a fire. The raw surface left after separation must be protected with scorched linen until completely healed over some seven days later. If any signs of inflammation or suppuration show themselves, bathe with weak lysol (an eggspoonful to a pint of warm water) and give Hepar Sulph. internally.
The infant must never sleep in the mother;s bed, but in a cradle or cot by her side, and every care must be taken to keep it warm.
Milk in the Breasts the First Day.
It is affirmed by some nurses that until the third day after labour the breasts contain no milk, and that a substitute- gruel or some other farinaceous preparation – is necessary. In the great majority of cases, milk or a kind of milk sufficient for all the requirements of the infant, is present on the first day, and the only thing necessary to be done is to apply the child’s mouth to the nipple. Should there be no milk at the moment, the suction of the infant, which is the natural mammary stimulant, will hasten the secretion; while the suction promotes the necessary uterine contractions which are favourable to the mother and also lessens the chance of what is called “milk fever.” The infant should be put to the breast every four hours during the first day, and somewhat oftener on subsequent days until the milk comes freely. If the child cannot get enough and is unhappy in consequence, it should have sweetened water several times a day, best given after unsuccessful attempts upon the mother. No other food should be given. When the flow of milk has been fairly established, the child should be put to the breast every three hours, the breasts being used alternately. If during the first two or three days of life the infant’s temperature rises to over 101o and then there is no unhealthy appearance of the cord or other evidence of illness, the child is suffering from hunger and must be fed (see Section II).
Also see Ruptured Navel Chapter.
5. Still-born Infants.
Children are sometimes born apparently dead, and if means are not quickly adopted, this conditions may pass into one of real and permanent death. But so long as the heart continues to beat, even but feebly, there is a probability that well-directed efforts will be successful in exciting breathing.
CAUSES. Constitutional feebleness, so that the effort necessary to commence breathing cannot be made; obstructed circulation during labour by pressure or twisting of the navel-string; too long continued compression of the head; tenacious mucus in the mouth and throat, preventing the entrance of air, etc.
TREATMENT.- The navel-string should be at once divided. Obstructive mucus should be carefully wiped away from the mouth and throat, and the general surface exposed to cold air; an attempt should then be made to excite the function of breathing by blowing in the infant’s face, sprinkling cold water with some little force on the face or chest, or alternately cold and hot, and by giving several smart blows with the hand, or with the corner of a towel wetted with cold water, on the buttocks, back, and chest. The back and limbs should be well rubbed, while the face is freely exposed to the air.
The following is another capital method of exciting breathing;- Close the infant’s nostrils by the finger and thumb, press the windpipe gently backwards, and then blow into the mouth, so as to drive the air into the lungs; afterwards press the ribs together, so that the lungs may expel the air. The process should take place about fifteen times in one minute, and if preserved in, is most likely to be successful in a short time. Meanwhile the body should lie on a flat surface, and be well rubbed with warm flannels, and the head not suffered during these efforts to fall on the chest.
If these means are not successful, the infant should be plunged into a warm bath, 98o Fahr., or what is agreeable to the back of the hand. If the sudden plunge does not excite breathing, it will be no use keeping the infant in the bath beyond a minute or two, and Dr. Marshal Hall’s ready method may then be tried as follows:-
“Place the infant on its face; turn the body gently, but completely, on the side and a little beyond, and then on the face, alternately; repeating these measures deliberately, efficiently, and perseveringly, fifteen times in the minute only.”
A few physical facts with regard to the normal infant should be borne in mind. The anterior fontanelle on the head should close between eighteen months and two years. A depressed state of the fontanelle is an indication of a feeble state of health. A child should begin to hold up its head at three or four months, and to walk from twelve to eighteen months and three years, and the permanent set start at six years. Babies should be weighed regularly, as this is the most important test of progress. Dr. Hutchison has pointed out the multiples of seven to be noted in regard to the normal child’s weight : at birth 7 lbs, at four months 14 lbs., at twelve months 21 lbs., at six years 42 lbs., and at twelve years 84 lbs.
6. Washing and Bathing.
Cleanliness is of great importance to the healthy growth of children. An infant in health should have a tepid bath twice in twenty-four hours – morning and evening. The best method is to dip the baby into a bath of tepid water, while the head is supported by the hand and arm of the nurse, and then have the whole surface of the skin rapidly rubbed with a soft soaped sponge or piece of flannel; next again immerse the body in the bath, and then quickly and thoroughly dry with a fine warm towel. During warm weather, tepid bathing should not the continued beyond one or two months, after which it should gradually give place to cold. Feeble infants may required tepid bathing somewhat longer. For children born in the winter, the lukewarm bath may be continued till the return of warm weather, when the change to cold should be made. Except as above stated, warm bathing is to be emphatically condemned. The use of cold water, on the other hand, affords a great protection to children against excessive sensibility to atmospheric changes. But no child should have a cold bath oftener that once a day.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."