Vitamins benefits for your baby

Vitamins are organic chemicals that the foods we eat contain in minute amounts and that our bodies must have if we are to remain healthy. Deficiencies of the various vitamins are associated with certain specific disorders. Most people are aware that every child from birth on requires vitamins in his diet, but not everyone realizes that in the consumption of vitamins it is possible to overdo a good thing. although even in our overvitaminized society we rarely sec any toxic effects of overdosage. The vitamins to consider are A, D. C, and the B group.

Since the B vitamins are well represented in the foods (including human and cow’s milk) given to babies in the United States, we mention them only in passing. The child’s diet may, however, be short on A, D, or C. and parents should have a little information about them. (There are other vitamins besides those we have mentioned, but they are widely enough distributed in the diet so that no conscious decision about them is necessary. We will confine our discussion to the three which are sometimes missing from the diets of children.)
Vitamin A is found in milk, butter, cheese, egg yolk, cartis, squash. sweet potatoes. and animal fats. Fish liven—cod, halibut, tuna—contain large quantities and are the most COMMA% commercial source Human milk contains vitamin A, usually in adequate quantities if the mother herself has a normal diet. Cow’s milk varies with the season, depending on the available forage, but in general contains adequate amounts for infants. Vitamin C appears in almost all fresh fruits and vegetables. but especially in citrus fruits, tomatoes, berries, and leafy green vegetables. Overcooking tends to destroy the vitamins, but modern canning and freezing methods help to preserve them.

Cow’s milk lb an unreliable source of vitamin C and supplementation is required. Human milk contains adequate amounts if the mother receives sixty milligrams daily in her diet. Vitamin D is Found in fish oils and (in lesser quantities) m eggs. it is manufactured by chemicals in human and animal skin under the action of sunlight. However, vitamin I) is passed poorly into human or cow’s milk and therefore as a general practice in this country it is added. both to cow’s milk and to commercially prepared milk. Vitamin A is important to vision.

A deficiency of A muses night blindness and other disorders of the eye. Vitamin 13 is essential to normal growth of bones. The bone changes known as rickets, not seen as often nowadays as formerly, result from a deficiency of vitamin D. Vitamin C. whose chemical name is ascorbic acid, is essential to the healthy development of the small blood vessels and other bodily U111(7- tures. Easy bruising. bleeding gums. hemorrhages around the bones arc symptoms of deficiency of vitamin C.

The medical name for this condition is scurvy. A couple of centuries ago the British Navy began requiring its sailors to drink lime juice to prevent scurvy. and Englishmen ever since have been known as “limeys.” Many symptoms beyond those noted are commonly attributed to vitamin deficiencies. Among them are poor appetite, stunted growth. whining, and frequent colds. It is true that these symptoms are often seen among severely malnourished children, but the deprivations of these children usually go beyond vitamin deficiencies. in owl affluent society we do not recognize any direct relationship between these symptoms and lack of vitamins.

Though parents often pour vitamins into children exhibiting the symptoms, the children rarely respond. The parents are right to be concerned about the problems, but they should look in another direction for the solutions.

bottle feeding Preparation

Thanks to the commercial preparations. there is a marked reduction in the amount of tedious work a mother has to endure in order to feed her infant by bottle. Until the development of these excellent preparations, the daily task of sterilizing and preparing formula was a time-consuming chore for a woman already hard pressed to keep up with a demanding schedule. The economy-minded may protest that making one’s own formula in the kitchen saves money. but the woman who has tried both ways will probably conclude that the saving in dollars is not worth the extra trouble.

On the other hand, some parents with real financial constraints may choose the cheaper method with the full realization that their infant will be properly nourished. The preparation of formulas requires a small amount of equipment, some of which can be adapted to other uses when the baby is weaned. Nursing bottles come in two sizes, four ounce and eight ounce.

Since the baby will begin with the small ones and grow into the larger size, you will need about eight of each. Any bottles you buy should be of heat-resistant, unbreakable glass or clear plastic, smooth inside and with a graduated scale in ounces plainly marked on the outside. You will need the scale to measure haw much formula you are pouring. If early in the game you have occasion to buy a six-pack of commercial formula. you will be that much ahead, because those bottles can be used again for formula of your own preparation.

You will need caps. collars,…and nipples for the bottles. All these components can be bought separately. Make sure that you have at least a dozen nipples on hand. Extra collars with the little disks that convert
them into caps are always handy. You will want a bristle brush fur scrubbing the bottles and a pair of metal tongs for handling them. You will find use for a heat-resistant glass measuring cup, a measuring spoon, glass funnel, can opener. standard tablespoon, strainer, and a glass jar with a tightly fitting screw top to keep sterilized nipples and collars uncontaminated. The sterilizer. of course, is the main piece of equipment.

This contraption need be nothing more complicated than a deep kettle  with a lid and rack for the bottles. Sterilizers come in a variety of styles (more accurately. in a range of prices) , and you can suit your own taste and pocketbook. When the baby is weaned, you can add the sterilizer to your collection of kitchen pots and pans. Even the bottle rack will be worth keeping—you can use it for steaming asparagus.

The old ideas about sterilizing the formula and the utensils have undergone some modification in recent years. When bottle feeding was first attracting attention, infections among the newborn constinned a serious health problem. Since those days we have developed effective inoculations and medicines against some of the most dreaded infections, and we have greatly improved the sanitation of our water supplies. Under conditions of ordinary cleanliness, the majority of American babies probably could get by today without any sterilization of their bottles or formulas. but there is no point in subjecting them to needless risk.

Unless your own doctor advises otherwise, you should sterilize at least for the baby’s first two months. The procedures for sterilizing are really quite simple. When the baby has finished a bottle. rinse it and the collar and nipple under the faucet. If you are not going to wash the bottle immediately, leave it filled with water until you do. For washing use either scrap or a dishwashing detergent. Scrub the inside of the bottle and the screw threads of the collar thoroughly with the bristle brush.

The brush will be more effective for digging into nooks and crannies if it has a hook on the bristle end. Wash the nipples by forcing soapy water through them. Bold the nipple between your first two fingers, fill it with soapy water, and then press down with your thumb. The water will shoot out in a fine stream. Use the same trick with clear water to rinse. Ile thorough about rinsing bottles. nipples, and collars. With the bottles. nipples. and collars washed clean, you have a choice of two methods for the sterilization proper. You can boil the utensils and the formula separately or (the simpler way) fill the bottles with the mixed  and boiled.

The First Few Days After delivery of a baby

whether or not nursing is planned. the female breasts (with exceptions) secrete a milky fluid called colostrum. Colostrum appears usually after the sixteenth week of gestation. This fluid is thicker and yellower than later milk and somewhat different chemically, but both colostrum and the later milk come from the mammary gland and are valuable for nourishment of the baby.

The biological changes that lead to secretion of milk are not known totally or exactly, but a decline in the levels of progesterone and estrogen  appears to accompany a rise in the level of a pituitary hormone called frrolaciin or luteotropin, known as the lactogenic hormone from its influence on milk production. Prolamin activity is high in the blood of lactating women, and in certain complicated experiments prolactin has been shown to produce secretion and breast engorgement artificially.

The true milk appears from twenty-four to ninety-six hours after delivery. “coming in” so suddenly that many women are confident they could tell the exact moment. Others who have been breast-feeding from birth are not so sure. however, and it may be that the sensation of “coming in” is no more than a feeling that the breasts are too full. The letdown reflex is the psychosomatic mechanism involved in expelling the milk that has been secreted in the mammary glands.

This milk is stored in the alveoli, tiny sacs in the breast surrounded by special cells that contract as muscles do. The full process of milk expulsion can be described as follows: sucking stimulates nerves in the breast. and the impulses are carried to the pituitary gland at the base of the brain.in commercial preparation as Pitocin). The oxytocin reaches the breast by way of the bloodstream and acts on the contractile cells. These cells squeeze the milk out of the alveoli into large ducts leading to the nipple. The baby’s sucking. of course, then empties the ducts. The letdown phase of this total process refers to the expulsion of the milk from the alveoli. Other signs of die letdown reflex are strong contractions in the uterus.

The oxytocin in the bloodstream acts on the uterine muscles as well as the tiny muscles in the breast. These uterine contractions, while sometimes painful at first, are a sign that the mother is letting down her milk and that breast feeding is working well. After several days the action of the oxytocin will have served its purpose. The utenis will have clamped down and become small. Thereafter there will be no uterine cramps or afterpains. The letdown reflex is easily inhibited.

When a mother is frightened or upset, she does not let down her milk as well. The milk is in the breast, but the baby cannot get it easily. In one experiment, inhibited mothers, after nursing their babies and being pumped by machine, received oxytocin by injection to set off the letdown reflex artificially. Mothers who had not had enough milk for their babies finally produced. and it was found that almost half their milk had not been avail-able to the baby or the milking machine.

Fortunately. oxytocin can now be given by nasal spray instead of needle. Some doctors prescribe it to help mothers let down their milk when hospital routines disturb them or. later, when something at home upsets them. A tingling in the breast follows the squirt of spray and then milk begins to flow. Newton and Newton have listed four symptoms of letdown:
I. The mother feels cramps or lower abdominal pain while nursing. (Oxytocin causes uterine contractions.)

2. Milk drips from the breast not being sucked. (Cell contractions stimulated by oxytocin are forcing milk from the alveoli.)

3. The breasts drip at expectation or sight of the baby. (The reflex has been established at previous feedings.)

4. Nipple pain ceases after the baby has sucked for a few seconds. (Sucking causes back pressure on .the empty ducts: letdown fills the vacuum with milk, relieving the pressure and pain.) mothers.

Among mothers whose interest in breastfeeding is wavering from the start, the distractions of the usual hospital surroundings may be enough to inhibit the letdown reflex. In pregnancy the breasts become larger in preparation for breastfeeding, and the nipples grow darker. Nature has provided for the nipples to keep themselves partially sterile. Sweat mixed with the oily secretions of the skin has an antibacterial action, and the nipple has the largest sweat glands of all.

Further. newly secreted human milk is reported to have an antibacterial action. Thus, the nipples are ready for sucking whenever the baby needs comfort or food. Although a few drops of fluid hom the breast often appear in the latter days of pregnancy, the big boost in secretion comes at birth. The breasts begin to fill up. How long it takes fur the milk supply to be ample for the baby depends on how much stickling is permitted during the first few days, as well as on individual factors.

An experienced nursing mother who can have her baby in the room with her from birth and who suckles him for hours a day may find the baby gaining weight by the second day, especially if he is very vigorous and alert. But in the usual situation even with rooming-in, milk may not begin to appear in quantity until the third or fourth day. This delay is nothing to worry about. Babies are expected to lose some weight the first few days and most arc a bit poky in the beginning, especially if they have received analgesic drugs transplacentally prior to birth. About the time the milk collies in. the breast may become firm, full, and tender.

This is normal. In extreme cases, fortunately rare, there may be fever and aching all over the body. as well as localized pain in the breast. These are symptoms of extreme engorgement, a condition not common when the breasts have been kept empty by frequent, vigorous nursing periods. Even with extreme engorgement. most of the discomfort goes away after a day or two. Wet packs of towels wrung out in hot tap water seem to help when placed on the sore breasts. A bra that gives good support is helpful.

THE DIET OF INFANTS

Infants’ diets are now receiving some long overdue attention. Interest stems from two major public health concerns. coronary artery disease and obesity. Until recently, most interest in these two hazards to health has focused on adults, since older members of our society are the ones who actually suffer most. However. evidence is accumulating that these disorders begin far earlier in life, perhaps in infancy. Recent studies of the blood of newborns from families with a disorder of fat metabo. lism leading to high blood fat levels has shown elevation of blood fat at birth.

Although there is no proof yet that this blood funding is predictive of later disease or that reducing the blood fat by special diets or drugs will help, the likelihood of these relationships is quite great. If important clues such as these are linked to the strong suspicion that the average American diet, particularly regarding its heavy use of animal fats, contributes significantly to the development of atherosclerosis, it is understandable that interest is being directed to the diet of infants.

Already, certain changes in infant feeding are occurring in keeping with this line of thinking. even though there is no conclusive evidence yet to prove their value. For example, there is a growing tendency to use low fat milk for older infants and children. More and more dairies are producing special milks with reduced fat content and added protein. These changes may be premature, however. Recent experimental work in rats has suggested that it may be desirable to expose baby rats to the animal fat of their own mother’s milk. Exposure to this fat during infancy may “accustom” rats to using these fats effectively so that they are not deposited as readily in arteries.

The blood cholesterol levels of human infants who are breastfed arc higher than those of infants fed commercial formulas with polyunsaturated fats. The long-range mean-ing of this observation is not known. Is this helpful or harmful? At present, we cannot answer this question. Accordingly, we cannot
Obesity
Babies of today are undoubtedly larger and heavier as a group than those of thirty or forty years ago. It is reasonable to suspect a connection between this development and our national problem of obesity. An interesting experiment recently conducted in rats suggests an explanation for how obesity in infancy may set up a lifelong pattern. Infant rats in this experiment were fed average diets and then compared with other rats overfed to the point of obesity. When the rats were sacrificed and their fat analyzed, it was found that the ones overfed in infancy had more fat-containing cells. And the cells were bigger.

Rats made obese as adults, on the other hand. increased only the size, not the number of fat cells. The number of fat cells present at the end of infancy persisted throughout life, regardless of diet. Thus, the rats made obese by over-feeding as infants had more fat cells as adults. It appears that appetite is related to number of fat cells. If the number of fat cells increases, appetite may permanently increase. This increase in fat cells may be the way the food thermostat is raised by overfeeding in infancy. If the same situation applies to humans, it may explain in part at least why infants who become obese because of too many calories in their diet tend to remain so, why dieting to lose weight is often so difficult, and why a premium should be placed upon preventing obesity in infants when this is possible.

Why some babies are fat and others are thin is an intriguing question to which a satisfactory answer is not yet available. Paradoxically, thin babies consume more calories than obese ones under normal circumstances. The apparent explanation is that thin infants are very active and “burn up” energy, while chubby ones tend to be quieter, converting more of their caloric intake to fat. The basic appetite thermostat of a baby appears to he largely determined by his heredity. The number of calories that a baby is offered unquestionably plays a part, but probably more so for some infants than others. Variation in number of calories taken depends on the richness, calorically speaking, of the diet and the emphasis placed on food by parents.

WHAT IS BOTTLE FEEDING

The Formula
Cow’s milk differs from human milk in having a higher concentration of protein and salts. The kinds of protein and the salts are somewhat different too. The calorie content (that is, the number of calories per
ounce) is about the same. Both milks contain adequate amounts of vitamin A but are deficient in vitamin D and may be lacking in vitamin C. Neither human milk nor cow’s milk has enough iron. A continuing deficiency of iron through infancy can bring on anemia. If we gave the newborn undiluted cow’s milk, the higher concentrations of salts and protein would put a heavier load on his kidneys than he would get from human milk.

In ordinary circumstances a healthy baby could carry this load, but some unusual stress might change the picture. By lowering the level of the bodily fluids. diarrhea, vomiting, or profuse sweating (all frequent accompaniments of illness) could increase the concentration of salts and protein. An undesirable accumulation of salt and protein waste products in the bloodstream would result. It is to prepare for such contingencies in non-breast-fed infants that we modify cow’s milk before we give it to infants. Mainly, we want to reduce the concentrations of protein and salts in early infancy (three to four months) .

Such a modification is known as a formula. You can think of the formula your doctor will prescribe as a recipe for modifying cow’s milk to a better approximation of human breast milk. There are three basic types, the first two of which you can make in your own kitchen. The first uses canned evaporated milk, which is cow’s milk boiled to remove a certain amount of water. In the process, the protein is altered to produce a softer, better tolerated curd. The second uses fresh whole (usually homogenized) milk straight out of the dairy bottle. In both formulas water is added to reduce the concentrations of salts and protein.

This dilution also cuts the calorie concentration, and it becomes necessary then to restore the proportion by adding sugar of some kind. The final result with either the evaporated milk or the whole milk is a product much closer to human milk than to the cow’s milk with which we started. The third principal formula, also based on cow’s milk, differs from the others in being the product of a commercial factory.

The protein. fat, and salts of cow’s milk are altered to make it more like human breast milk. Vegetable fats arc substituted for the animal fats of the cow . Vitamins and usually iron are added. The final preparation is packaged for sale as a canned liquid concentrate or powder to which water must be added, or as an already diluted, bottled formula all ready for the baby. Like beer, the bottle formula is offered in convenient, tidy six-packs, one more illustration of how the merchandiser’s long arm reaches into our lives. There are three major brands of the commercial formulas.

your doctor will have his own recommendation to make, there does not appear to be any significant difference among them. Indeed, in respect to nutrition, science has not been able to demonstrate any significant difference between these formulas and human breast milk. The average baby will thrive on any of them.. This does not mean, however, that your own doctor will automatically prescribe a commercial formula for your baby. He may have his own reasons to prefer something else, or he may find that a particular baby does not tolerate standard formulas and needs something special.

BREAST OR BOTTLE MILK

One decision you will have to make in motherhood is whether or not to breast-feed. Until this century the majority,of mothers had little choice but to follow nature’s method of nourishing babies. Now, thanks to formula (the magic word!), the situation is quite different. The woman of today has a choice between breast-feeding or bottle feeding or a combination of both. Studies have shown that the percentage of women who breast-feed varies from region to region and according to socioeconomic class.

Over the last few decades, however, in Europe as well as America, there has been one consistent trend that has overridden the local variations. A drastic reduction in breast-feeding is reported everywhere. In just ten years, for example, the tate for the entire United States dropped by a half. A similar rate of decline has been reported in British and French regional surveys. While no final count one way or the other exists. there is reason to guess that in our western society the formula bottle may now be nourishing almost as many infants as the breast does. Yes, of course. some will say, and why not? If great-great-grandmother could have gone down the street for a six-pack of reliable canned baby formula, the switch from breastfeeding would have occurred long since.

From as far back as we have records, at least from the time of the ancient Greeks. there has been a search for an adequate substitute for a mother’s own milk. To avoid breast-feeding, women in favored social positions have hired (or bought) wet nurses to feed their babies. The wet nurse, a lactating woman with milk to spare, was a familiar figure in ancient Athens and Rome, in the London and Paris of the seventeenth and eighteenth centuries, in our own Colonial America Her frequent appearances in the novels of Charles Dickens are a reflection of how numerous her kind must have been a hundred years ago.

Fashionable women were not the only employers of wet nurses. Mothers without milk and the guardians of infants whose mothers died in childbirth also turned to the wet nurse for help. Over the centuries, other substitutes, besides the wet nurse’s milk. were tried but with much less success. The milk of goats and cows, mixtures of honey or sugar and water, various cereals ground and stirred with fluids into pap, foods pre chewed by mothers or grandmothers—all these and more have nourished orphans, the infants of mothers without milk, or hungry babies in times of famine.

In ancient Rome a research project was subsidized by the government to develop a satisfactory substitute for mother’s milk, and the efforts of many individual physicians were applied to the problem from those days until our own time. One or two British. physicians of the last century made international reputations with the formulas they concocted for babies. Nevertheless, in spite of centuries of experimenting, development of
the satisfactory substitute for mother’s milk had to wait (or our own era. Advanced techniques in chemical analysis were required.

Respect for scientific methods had to be encouraged. When these conditions finally came about, science was able to produce an adequate formula for feeding babies. For the first time, there was a food other than mother’s milk that could be given to the average normal baby in full confidence that it would not endanger his lite. Certainly, formula feeding has fitted in well with the times. The wet nurse has disappeared from our scene. but the baby-sitter is very much in evidence.

Knowing that someone else is there to give baby his bottle, the new mother can in good conscience leave the home for longer periods of time. She may take up her social life again or even go back to her job. Baby will get his bottle just the same. He no longer requires her physical presence. Formula feeding also has had appeal in the age of technology because it seems so scientific. We have been able to prescribe not only the kinds and amounts of nutrients in the bottle but also the times of feeding. Nevertheless, it is still impossible to duplicate fresh breast milk. The current formulas come very close, but there remains a significant difference.

For instance, breast milk contains enzymes and antibodies riot found in heat-treated cow’s milk. To many parents and doctors, however, these shortcomings in the accepted formula mixtures seem less important than the positive side of the ledger. With formula the nutrients known to be of crucial importance—protein, carbohydrate. fat, certain vitamins—can be given to the baby in regulated amounts. In our technological age we insist upon measuring, weighing, sampling, charting, and wherever possible, substituting machines for human effort. Canned baby formula satisfies most of these specifications.

In thinking about our century’s startling change in the feeding of babies, there are two possible avenues of approach. One can ask why so many mothers have given up breast-feeding for bottle feeding, or one can ask why. when bottle feeding has proved satisfactory, so many mothers still persist in breast-feeding. The second approach seems to promise more interesting answers, and it is the one Newton and Newton’ have followed in their study of lactation as a phenomenon of human behavior. They find lactation sensitive to a variety of psychological influences that can be separated roughly into three classes. The first is the nursing mother’s emotions and attitudes as an individual. The second is her emotions and attitudes as a member of a social group.

ALL ABOUT IMMUNIZATION SYSTEM

In the first three months of life the only immunization shots the infant ordinarily receives are the OPT, which protects him against diphtheria, pertussis (whooping cough), and tetanus, and the Trivalent OPV against poliomyelitis (infantile paralysis) On the immunization schedule recommended by the Child and Family Health Division of the Children’s Hospital Medical Center. he will receive the DPT and Trivalent OPV twice more in his first year and boosters at eighteen months and again before entering school. Thereafter boosters should be given at intervals for the rest of his life. Any immunization is a deliberate stimulation of the body’s defenses against a specific harmful germ. We know that many diseases occur only once in any one person’s life.

From this fact. observed over many years and among millions upon millions of. people. the scientists who first developed vaccines concluded that when a person recovers from certain diseases he thereafter is immune to them. The basic idea of immunization is to set up these conditions artificially and safely, just as if the child (or adult, for that matter) were being infected by the harmful germ but without having to undergo the illness. The ideal immunization would stimulate the immunity without causing any symptom of sickness.

Most of the vaccines we use do come close to this ideal but never quite achieve it. There are some vaccines with undesirable side effects. but. except for the very rare patient. these side effects are not nearly as serious as the disease that the vaccine has been developed to prevent. The body responds to the vaccine much as it would to any foreign body: that is, it produces antibodies directed specifically against that foreign body. The antibodies react with or unite with the foreign substance (toxin, bacteria, or virus in this case) and inactivate either the germ or the germ’s toxic product. By “tagging” the substance and sealing it off, the antibodies render it less harmful and mark it for removal from the system.

And having once been produced to rescue the body from invasion by this specific foreign body, the antibodies thereafter remain on call, so to speak, to respond immediately to any new invasion by the same enemy. In other words, the body has organized a specific defense against a specific germ—it has become immune. Many vaccines, besides stimulating the production of antibodies, also stimulate changes in the immunity of the individual cells of the body. A type of allergy develops such that mere contact with a microbe or its toxic product elicits a reaction capable of destroying the invader. The vaccines for immunization are of two types, killed and live. Killed vaccines consist of concentrates of dead germs, which may be either bacteria or viruses. or of their toxic products. Certain bacteria produce chemical poisons that do the actual damage: these poisons are the toxins. The whooping cough vaccine, for instance, is made of the killed germs of the disease, whereas the diphtheria and tetanus vaccines are made of toxic products, not the bacteria themselves. The toxin is modified to stimulate immunity without causing the harmful effects of the unmodified toxin. In this condition it is called a toxoid.

Live vaccines consist of living viruses. These are harmless close relatives of the harmful viruses that cause full-blown disease. Because a dose relationship exists between the two viruses, the body responds to both in the same way: exposed to either, it becomes immune. The difference is that whereas the harmful virus would cause a serious illness, the vaccine virus produces only a mild local reaction, sometimes with fever. Smallpox is a severe. disfiguring, even fatal disease. Small-pox vaccine (although no longer given routinely) , in contrast, causes a single soon-healed sore, perhaps with low fever and mild discomfort. Yet both stimulate similar immunity.

This is the crucial point. Another important difference is that vaccine viruses. in general, are not transmitted from person to person as disease viruses are. For successful immunization it is not enough merely to stimulate production of antibody—a certain amount of the antibody must be produced. This amount is called the protective level. More than a single injection of certain vaccines (notably DPT) is required to stimulate development of the protective level of immunity. For others (notably the measles vaccine) one shot is enough. It seems likely that some vaccines (measles and mumps. for example) confer immunity for life. With others the immunity gradually wean off until it drops below the protective level.

Then a booster injection is required to stimulate antibody production back up to the protective level. Immunization against tetanus and diphtheria requires regular boosters throughout the person’s lifetime. Smallpox vaccination also had to be repeated when it was routinely given. The following immunization schedule or a close variation thereof is standard for children in the United States. The DPT, which is the only immunization that comes within the age limits set for this book, is given to infants by injection into the thigh.

Children cry on being punctured, but most of them experience no ill effect from the shot. A small minority exhibit slight irritability and may have mild fever twelve or twenty-four hours after the inoculation. Occasionally there will be redness and some swelling at the site of the inoculation. These symptoms usually subside in a day or two. They should be reported to the doctor at the next checkup. He may lower the dose for the subsequent shots. Because whooping cough is mainly a disease of quite young children, boosters for this immunization are not given after the age of five. We have gone into this subject at some length because immunization, which should be started in the infant’s second or third month, is a lifetime undertaking

All about baby skin care

SKIN CARE
The newborn’s skin tends to be dry and scaly. Since he has just come from spending nine months in a brine solution, this condition is not to be wondered at. But even if it should receive no special care beyond sponge bathing. this rough skin under natural conditions will soon become as smooth as . . . well, as smooth as a baby’s bottom, to use a popular comparison. With one preventive exception aimed at diaper rash (of which most babies sooner or later have at least a touch), the newborn’s epidermis can get along very well without special unguents, lotions, powders, or oils.

This is not to say that infants do not enjoy being laved with oils and sprinkled with powder. only that oils and powders are not medical necessities. In fact, caking a baby with oil and powder may bring on or aggravate heat rash instead of preventing it or soothing it. Until the cord falls off and the navel heals (that is, for the first couple of weeks) washing is usually confined to sponge bathing, with soap used only on the baby’s bottom. A mild soap or cleansing lotion is satisfactory. Stronger soaps may be irritating and for normal skin they are not necessary. Cradle cap, which looks like crusted, scaly skin, is not dried skin at all but dried oil from numerous tiny glands on the scalp.

It is very common in infancy. The recommended treatment is vigorous massage, combing. and brushing. not soap and water. If the cradle cap does not clear up in a few weeks under this treatment, consult your doctor. In the absence of cradle cap your initial washings of the scalp will be done with just warm water and a soft cloth. Later, say at three weeks, you can use soap on the scalp once or twice a week. Any of cute baby

BREATHING
The noisy breathing of small babies frequently alarms parents. The infant’s respiration in sleep may be loud enough to awaken a person in the same room. If he is thrashing about, he may pant like a fifty-year-old office worker running for a bus. At times he may sound as if he were in the throes of asthma. f-lc may sneeze often and vigorously. The parent frightened by thew noises overlooks the fact that the nasal passages of a small baby are very narrow. A mere speck of dust can trigger a sneeze. Sucking in the necessary volume of air through the small openings sets up noise. The loudness of the baby’s breathing is usually quite normal. The asthmatic sound, which is extremely disquieting to a parent with a history of asthma, is usually heard after the infant has been feeding.

This particular noise comes from the temporary lack of firm cartilage in the yoke hos: and will be heard until the airway matures, perhaps as late as a year of age. Some doctors call it the “floppy epiglottis sy• drone.” The best analogy to explain this wheezing like sound is that longtime favorite at New Year’s Eve celebrations, the rolled-up paper pipe you blow on. The epiglottis is a thin structure. somewhat like a valve, that covers the opening to the larynx to keep out food or fluid. Fully developed, it is fans with cartilage, but in some quite normal habits it rolls up and flaps like the paper pipe, making a similar noise. Feeding, bubbling, drooling, or a cold may accentuate this syndrome, but they do not cause it. Noisy breathing does not signify asthma or ill health, nor does it represent an inherited condition. It will pass.

baby Early Care

THE BABY’S EYES
WHEN WILL my baby see? This is one of the most frequent questions the pediatrician hears. Newborns react to light, following it with their eyes. and in the second month babies notice, or seem to notice, movement of objects. But these are probably not the answers parents really are seeking. What they want to know is, when will he see me and all the love I want to give him? This dawning of love, the perceptible change from helpless infant to human baby, has to wait for maturation of the visual system.

The baby must develop binocular vision, the process of fusing the separate images from two eyes into a single image, and acquire the ability to focus according to the distance between the object and his eyes. Only when he begins to see you, in the adult’s sense of seeing, will you be able to count on the look of recognition and the pleased smile of greeting. Your baby will then become a person and begin to develop a real personality. Apart from the clinical fact that his eyes follow a spot of light. we have no way of knowing what the newborn or very young infant actually sees, but once he has learned to focus, the change in his relationship with his parents is quite remarkable. This process takes time, perhaps as short as three months or as long as six or more.

Though she has carried her child within her for nine months, a mother may find herself unable to relate fully to the baby or even to make his acquaintance. She should nor feel guilty or frustrated. The infant must respond before the parent can feel satisfied that her mes-sages are getting across to him, and this response comes in full only when baby and mother can look into each other’s eyes knowing, some-how, that the other is seeing too. This period of early development may be even harder for fathers. Though he may help his wife by feeding, changing, and dressing the baby from time to time, the young father probably has to push himself a bit to produce a continual overflow of warm affection for a creature that does no more than eat, eliminate, sleep. and cry. All this will change at the first smile of recognition. In a way, it may be somewhat of a blessing that the baby does not “see” for the first several months.

This is the period of often agonized trial and error, of experimentation with sleeping schedules, formulas, and so forth. The baby is totally oblivious to our harried, even on occasion hostile. looks. His powers of perception, if we can call them that, are concentrated in his mouth. We have a period of grace in which to adapt to this new responsibility. The eyes of the newborn sometimes show certain mild. temporary symptoms which can be of concern to parents:
1. From so to 5o percent of newborns exhibit a tiny spot of bleeding on the white of the eye. This will disappear in two to three weeks and has no significance.

2. Medication required by law to prevent infection (primarily gonorrheal infection) may cause considerable swelling around the eyes, sometimes enough to hide them entirely, and also a temporary dis-charge. which disappears by the fifth day. The silver nitrate of the medication causes the discharge.

3. A temporary plugging of a tear duct at the corner of the eye may cause an intermittent discharge. Your donor will tell you how to deal with this condition, but usually no special attention is called for. Nevertheless. it is always a good idea to inform your doctor of any eye discharge. however minor.

4. While he is learning to focus, your baby may give the appearance of being cross•eyed. His lack of muscular coordination and control, together with the configuration of his features are responsible. Up to the age of five months this occasional crossing of the eyes has no sig. naviance.

In spite of all the crying he will do. your baby is not likely to produce tears before his fourth or fifth week of life; and since the majority of babies are born with “blue eyes.” it may be months before you can be sure whether he will have mother’s brown eyes or father’s blue eyes .
THE HEAD
Some distortion of the shape of the baby’s head at birth is not at all unusual. In delivery the skull accommodates to the passage through the birth canal, and often the head emerges looking more like a football than a sphere. This distortion (or molding) is not cause for alarm. In from one to three weeks the head will regain its normal shape. Curiously, though mothers are said to talk a good bit among them-selves about distortions of the head. it is a subject they rarely bring up in their conversations with doctors.

They do show concern about the fontanel and about the localized collections of blood that may form at the time of birth between the skull and scalp. These blood clots, known as cephalohematomas, are common and quite harmless. The clots may linger for three to four months but always disappear. They go away in the course of an intermediate process of hardening (or calcification), which may produce a bony lump standing out in prominent silhouette against the natural contour of the skull. In three to four months the lump blends in with the normal skull. It should be emphasized that neither the distortion of head shape nor the collections of blood come about through anything either the mother or doctor has done.

Nor do they in any way affect the infant’s brain. You should not regard them as “damage.” They have no significance for the infant’s future. The fontanel (see page aro) may remain open for a year. The time varies considerably from baby to baby. This soft spot is a source of worry to many parents, who think the head is vulnerable to injury until the skull is completely closed. Some parents are almost afraid to shampoo the baby’s hair.

Those fears are groundless. The “soft’ spot is in fact an extremely tough fibrous covering. The fontanel will be an area of special interest to your doctor if your baby should become ill, particularly when there is high fever. In the presence of infection the doctor will want to know whether the fontanel seems “full” or “tense.” You have no need to worry about the doctor’s routine interest in the fontanel at periodic examinations, but by all means ask if your concern has not been completely quieted. The newborn’s earlobes may be slightly folded down at birth, a minor and inconsequential deviation that comes from the position of the fetus in the womb. You can expect that by one or two months of age they will have returned to normal.

 

All About Baby’s Doctor

WHILE it is certainly true that untold millions of infants have grown to healthy manhood and womanhood without being seen by doctors except in sickness, nevertheless, the only way to be absolutely sure that your baby is thriving in his early years is to have him checked regularly. For these checks you can take the baby to a public well-baby clinic or to a physician of your own choosing, either a family doctor or a pediatrician. Pediatricians are doctors who have undergone specialized training in the care of children.

The usual practice is to take the baby for a check once a month in the early months and then at intervals of three months through the second year. At these regular visits the baby will be weighed and measured and thoroughly inspected for all the signs that indicate normal development. He will receive a series of inoculations according to a schedule based on worldwide experience in the protection of children from communicable diseases.

In a small minority of cases the examination will reveal some abnormality, either of development or disease. The doctor will prescribe treatment or make recommendations regarding further investigation of the condition. Both he and the nurse will answer the mother’s questions, not just about medical matters, but about all the day-to-day problems of caring for an infant. One great benefit from these regular visits is the security they can give to a young mother. When the doctor pronounces the infant to be in good health, he is at the same time relieving those groundless anxieties that trouble so many inexperienced parents. If the mother will ask questions, the regular visit can also be a source of education for her.
She should never be hesitant for fear of sounding ignorant or stupid. The doctor and his nurse will have heard almost all of the questions before and nine times out of ten will be understanding and sympathetic in their answers. Finding a doctor to look after the baby may take some time but it should not be difficult. There is no problem, of course, if the family doctor attended the mother through pregnancy and delivery—he prob-ably will undertake supervision of the baby’s health too.

Or the mother’s obstetrician can recommend a pediatrician. The names of pediatricians can also be obtained at hospitals, from the local medical society, or from a medical school if there happens to be one in the community. In prepaid health care plans such as Kaiser. parents have the choice among the physicians on the staff. Information about well-baby clinics or child health centers can be obtained at the hospital where the baby was delivered, from city or county health departments. or from the Visiting Nurse Association. The various social service agencies listed in telephone directories would either have information on such matters or would be able to refer you to a responsible source.

A person living in a remote rural area could write to the state health department for information about visiting nurses, baby clinics, and health centers of various kinds. Nowadays it is not unusual for an obstetrician to suggest that his pregnant patient pay a prenatal visit to the pediatrician or general practitioner she has in mind for her baby. This is not yet a general practice or perhaps even a common one, but in some sections of the United States more and more parents are taking advantage of the idea. Some weeks before the expected arrival of the baby, they telephone the pediatrician to introduce themselves and ask whether he will be able to take on the care of the baby, beginning while the mother and child are still at the hospital.

If the pediatrician is one who encourages this approach, he will probably suggest a get-acquainted visit at his office. He will want to see not just the mother alone, but both parents. Considering how important this professional relationship will be, it is unfortunate if not enough thought is given to the selection of a pediatrician. If the parents are newcomers in a town or city or even in a big city neighborhood, they often have little or no information to go on The new another may still be groggy from the delivery room when she is called upon to make the decision. Obviously, it would be better for all concerned if the parents could have a little time to study the decision, free of pressure, and in a relatively relaxed condition.