Infancy

Infancy, in medical practice, the nursing age, or the period during which the child is at the breast. As a matter of convenience it is usual to include in it children up to the age of one year. The care of an infant begins with the preparations necessary for its birth and the endeavour to ensure that taking place under the best possible sanitary conditions. On being born the normal infant cries lustily, drawing air into its lungs. As soon as the umbilical cord which unites the child to the mother has ceased to pulsate, it is tied about 2 in. from the child’s navel and is divided above the ligature. The cord is wrapped in a sterilized gauze pad and the dressing is not removed until the seventh to the tenth day, when the umbilicus is healed.

The baby is now a separate entity, and the first event in its life is the first bath. The room ready to receive a new-born infant should be kept at a temperature of 70° F. The temperature of the first bath should be 100° F. The child should be well supported in the bath by the left hand of the nurse, and care should be taken to avoid wetting the gauze pad covering the cord. In some cases infants are covered with a white substance termed “vernix caseosa,” which may be carefully removed by a little olive oil. Sponges should never be used, as they tend to harbour bacteria. A soft pad of muslin or gauze which can be boiled should take its place. After the first ten days 94° F. is the most suitable temperature for a bath. When the baby has been well dried the skin may be dusted with pure starch powder to which a small quantity of boric acid has been added. The most important part of the toilet of a new-born infant is the care of the eyes, which should be carefully cleansed with gauze dipped in warm water and one drop of a 2% solution of nitrate of silver dropped into each eye. The clothes of a newly born child should consist exclusively of woollen undergarments, a soft flannel binder, which should be tied on, being placed next the skin, with a long-sleeved woven wool vest and over this a loose garment of flannel coming below the feet and long enough to tuck up. Diapers should be made of soft absorbent material such as well-washed linen and should be about two yards square and folded in a three-cornered shape. An infant should always sleep in a bed or cot by itself. In 1907, of 749 deaths from violence in England and Wales of children under one month, 445 were due to suffocation in bed with adults. A healthy infant should spend most of its time asleep and should be laid into its cot immediately after feeding.

The normal infant at birth weighs about 7 ℔. During the two or three days following birth a slight decrease in weight occurs, usually 5 to 6 oz. When nursing begins the child increases in weight up to the seventh day, when the infant will have regained its weight at birth. From the second to the fourth week after birth (according to Camerer) an infant should gain 1 oz. daily or 1½ to 2 ℔ monthly, from the fourth to the sixth month ½ to 2⁄3 of an oz. daily or 1 ℔ monthly, from the sixth to the twelfth month ½ oz. daily or less than 1 ℔ monthly. At the sixth month it should be twice the weight at birth. The average weight at the twelfth month is 20 to 21 ℔. The increase of weight in artificially fed is less regular than in breast-fed babies.

Food.—There is but one proper food for an infant, and that is its mother’s milk, unless when in exceptional circumstances the mother is not allowed to nurse her child. Artificially fed children are much more liable to epidemic diseases. The child should be applied to the breast the first day to induce the flow of milk. The first week the child should be fed at intervals of two hours, the second week eight to nine times, and the fourth week eight times at intervals of two and a half hours. At two months the child is being suckled six times daily at intervals of three hours, the last feed being at 11 P.M. Where a mother cannot nurse a child the child must be artificially fed. Cow’s milk must be largely diluted to suit the new-born infant. Armstrong gives the following table of dilution:—

1st week,	milk	1	tablespoonful,	water	2 tablespoonfuls
at 3 months	”	3½	tablespoonfuls,	”	3     ”	added with sugar.
at 6 months,	”	9	”	”	3     ”
at 9 months,	”	12	”	”	3     ”

Koplik has drawn out a table of the amounts to be given as follows:—

1st day	3	feeds of	10 cc	total	1 oz.	in 24 hours
2nd day	8	”	20 cc	”	5½	”
3rd day	8	”	30 cc (1 oz.)	”	8	”
7th day	9	”	50 cc	”	13½	”
4th week	8	”	60 cc (2 oz.)	”	16	”
3 months	7	”	4 oz.	”	28	”
6 months	6	”	7 oz.	”	42	”
9 months	6	”	8½ oz.	”	50	”

In cities it is advisable that milk should be either sterilized by boiling or pasteurized, i.e. subjected to a form of heating which, while destroying pathogenic bacteria, does not alter the taste. The milk in a suitable apparatus is subjected to a temperature of 65° C. (149° F.) for half an hour and is then rapidly cooled to 20° C. (68° F.). Children fed on pasteurized milk should be given a teaspoonful of fresh orange juice daily to supply the missing acid and salts.

Artificial feeding is given by means of a bottle. In France all bottles with rubber tubes have been made illegal. They are a fruitful source of infection, as it is impossible to keep them clean. The best bottle is the boat-shaped one, with a wide mouth at one end, to which is attached a rubber teat, while the other end has a screw stopper. This is readily cleansed and a stream of water can be made to flow through it. All bottle teats should be boiled at least once a day for ten minutes with soda and kept in a glass-covered jar until required. A feed should be given at the temperature of 100° F.

At the ninth month a cereal may be added to the food. Before that the infant is unable to digest starchy foods. Much starch tends to constipation, and it is rarely wise to give starchy preparations in a proportion of more than 3% to children under a year old. A child who is carefully fed in a cleanly manner should not have diarrhoea, and its appearance indicates carelessness somewhere. The English registrar-general’s returns for 1906 show that in the seventy-six largest towns in England and Wales 14,306 deaths of infants under one year from diarrhoea took place in July, August and September alone. These deaths are largely preventable; when Dr Budin of Paris established his “Consultations de Nourissons” the infant mortality of Paris amounted to 178 per 1000, but at the consultation the rate was 46 per 1000. At Varengeville-sur-mer a consultation for nurslings was instituted under Dr Poupalt of Dieppe in 1904. During the seven previous years the infant mortality had averaged 145 per 1000. In 1904-1905 not one infant at the consultation died, though it was a summer of extreme heat, and in 1898 when similar heat had prevailed the infant mortality was 285 per 1000. The deaths of infants under one year in England and Wales, taken from the registrar-general’s returns for 1907, amounted to 117.62 per 1000 births, an alarming sacrifice of life. France has been turning her attention to the establishment of infant consultations on the lines of Dr Budin’s, and similar dispensaries under the designation “Gouttes de lait” have been widely established in that country; gratifying results in the fall in infant mortality have followed. At the Fécamp dispensary the mortality from diarrhoea has fallen to 2.8, while that in neighbouring towns is from 50 to 76 per 1000 (Sir A. Simpson). It has been left to private enterprise in England to deal with this problem. The St Pancras “School for Mothers” was established in 1907 in north-west London. Though started by private persons it was in 1909 worked in connexion with the Health Department of the Borough Council, but was supported by charitable subscriptions and by a small contribution from the student mothers. There are classes for mothers on the care of their health during pregnancy, infant feeding, home nursing, cooking and needlework. Poor mothers unable to contribute get free dinners for three months previous to the birth of their child and for nine months after if the child is breast-fed. Two doctors are in attendance, and mothers are encouraged to bring their children fortnightly to be weighed, and receive advice. The average attendance is ninety. A baby is said to have “graduated” when it is a year old. An interesting development in connexion with the scheme is a class for fathers at which the medical officer of health for the district lectures on the duties of fatherhood. Similar schools for mothers are now established in Fulham and Stepney. Weighing centres have been established at Dundee, Sheffield, Nottingham, Birmingham, Aberdeen, Bolton, Belfast, and Newcastle-on-Tyne. An infants’ milk depôt has been established at Finsbury, and effort is being made to establish milk laboratories where separate nursing portions of sterile milk could be supplied to poor mothers. The Walker-Gordon milk laboratories in the United States are a step in this direction.

The average length of a child at birth is 19½ in. and during the first year the average increase is 77⁄8 in. A new-born infant is deaf (Koplik). This is supposed to be due to the blocking of the eustachian tubes with mucus. On the fourth day there is some evidence of hearing, and at the fifth week noises in the room disturb it. A healthy infant may be taken out of doors when a fortnight old in summer, after which it should have a daily outing, the eyes being protected from the direct rays of the sun. On the second day the eyes are sensitive to light, in the second month the infant notices colours, at the sixth month it knows its parents, and should be able to hold its head up. At the sixth month the baby begins to cut its temporary teeth. After their appearance they should be cleaned once a day by a piece of gauze moistened in boric acid solution. Attempts to stand are made about the tenth month, and walking begins about the fourteenth month. By this time the intelligence should be developed and memory is observed. A child a year old should be able to articulate a few small words. With the advent of walking and speech the period of infancy may be said to end.

---