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A better bed can be arranged by using a small clothes basket or, still better, a box well padded inside and outside by quilting, into which is fitted a removable platform about 4 inches above the padded floor of the basket. A thin, flat hair pillow or several layers of wool blanketing should be used as a mattress to cover the platform. Beneath the platform, on the floor of the basket, three warm-water bottles are placed, which must be refilled whenever necessary to keep the temperature in the bed between 80° and 90° F. It is best to refill one bottle at a time, so as not to cool the bed too much. An opening should be cut in the side of the basket below the platform so that the warm-water bottles can be removed for refilling without disturbing the baby. (See illustration, p. 53.) The bottles beneath the platform should be at 115° to 125° F. If warm-water bottles are placed beside the baby in the bed, they should never be warmer than 115° F.

If the baby's bed is too hot, his temperature will rise above normal.

BATHING

With very small and weak babies it is frequently advisable not to give a bath for two or three days. It may, however, be necessary for the doctor ourse to use the warm bath to stimulate the baby when he does not breathe well. If the complete daily bath can not be undertaken without danger of chilling the baby, it should be dispensed with or a partial bath may be given daily-washing the. face, buttocks, and genitals only-without removing the baby from the heated bed and without exposing the rest of the body.

The baths should consist of a rapid sponging with oil or with water at 105° F. in a room 75° to 80° F., one part of the body only being exposed at a time to prevent chilling.

PROTECTING THE BABY FROM INFECTIONS

Premature babies have very little resistance to disease. They are particularly subject to infections, especially colds. A cold is serious in a premature baby because it is very likely to develop into pneumonia, which may prove fatal. Every person who cares for a premature baby or comes in contact with him in any way must be careful to wash the hands before touching the baby lest some infection be carried to him. No one who has even a slight cold or other infectious illness should be allowed to care for a premature baby. No visitor should ever be permitted in the room where a premature baby is kept. These rules can not be kept too strictly. Colds, pneumonia, and ear infections are common causes of death in premature babies.

FEEDING THE BABY

HUMAN MILK

The feeding of a premature baby is a most serious problem. Mother's milk is the best food for him. Until the mother's milk is established, every effort should be made to get at least a few ounces of milk daily from some other mother nursing her own child or from a breast-milk agency, or to obtain a regular wet nurse. Any milk except that of the premature baby's own mother should

be boiled for one minute.

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The premature baby may be too weak to nurse or to draw milk from a bottle, and in that case the mother's milk should be expressed by hand or by a breast pump 1 and fed to the baby slowly by means of a medicine dropper or stomach tube. Feeding with a stomach tube (so-called catheter feeding.") should be undertaken only by a trained person. If a medicine dropper is used, it is well to slip a short piece of soft-rubber tubing over the end to prevent injury to the baby's mouth. Occasionally a strong premature baby may be able to nurse or to take breast milk from a bottle.

As it may be some weeks before the baby is able to draw even small amounts of milk from the breast, it will be necessary for the mother to empty her breasts at regular intervals, not only to obtain milk for the baby during the early weeks of life, but to keep up the milk flow until the baby is strong enough to nurse.

If breast milk can not be obtained, artificial feeding will become necessary. The doctor will order the formula.

Care should be taken that the baby is not overtired during feeding.

NUMBER AND AMOUNT OF FEEDINGS

It is best to withhold food for 12 hours the first day of the baby's life. During the second 12 hours the baby may receive three feedings. Expression of milk from the mother's breasts should be begun at the

1 The breasts may be emptied by hand, by an electric breast pump, or by a hydraulic breast pump. Breast pumps may be rented or purchased through the physician. The ordinary suction breast pump is of little value. Emptying the breast by hand should be done as follows: Scrub hands and nails with soap and warm water for one full minute, using a brush. Dry the hands on a clean towel. Wash the nipple with cotton dipped in boiled water. Have a sterilized glass and bottle ready to receive the milk. If the glass you are using has no lip, you should also have a sterilized funnel ready. Place the balls of the thumb and forefinger on opposite sides of the breast 11⁄2 inches from the nipple. This is usually at the edge of the pigmented area. Press deeply and firmly into the breast until the resistance of the ribs is felt. Then bring the thumb and fingers tightly together well behind the base of the nipple. When the fingers and thumb are pressed deeply into the breast, keep them there and repeat the " together" motion 60 to 100 times per minute. Speed is important and is attained after some practice. The fingers should not slip forward on the breast lest the skin be irritated. It is not necessary to touch the nipple. If the stripping of the breasts is done in this way, it will cause no discomfort. If the milk expressed is not to be used at once, it should be kept on ice in a sterilized stoppered bottle.

end of 12 hours, and the colostrum-and the milk when it comesshould be given to the baby. From then on he should be fed regularly day and night. Small babies fed with a medicine dropper should receive their food at 2-hour intervals during the day and 3-hour intervals during the night (10 feedings in 24 hours). Larger babies, whether fed with a dropper or from a bottle, may be fed from the start at 3-hour or even 4-hour intervals.

The baby needs daily a total amount of fluid (milk and water) equal to about one-fifth to one-sixth of his body weight in pounds. For instance, if the baby weighs 3 pounds, he will need daily one-fifth of 3 pounds, or three-fifths of a pound of fluid. As 1 pound is equal to 16 ounces, three-fifths of a pound will be equal to about 92 ounces. The 3-pound baby's full requirement of fluid therefore during 24 hours will be 911⁄2 ounces.

Such quantities, although needed, can not be given to the premature baby during the first days of life. The amount given daily will at first be small and the increases gradual. In fact, it is fortunate if the baby can take one-eighth of his body weight in total fluid (2 ounces for each pound of body weight) by the fourth day.

The quantity of milk given in 24 hours at first will be half an ounce to an ounce of milk for each pound of body weight. This will be divided into 10 feedings; each feeding will therefore be very small-1 to 3 teaspoonfuls of breast milk. The total amount of milk given in 24 hours may be increased daily by one-eighth to one-fourth ounce for each pound of body weight, until usually by the tenth day the total amount of milk taken in 24 hours will be 2 to 3 ounces per pound of body weight. The rapidity with which the amounts can be increased will vary with the size and development of the individual baby.

DRINKING WATER

During the period when the baby is receiving very small feedings of breast milk, special care must be taken to give him small quantities (2 to 4 teaspoonfuls) of boiled water between feedings. He will need this to bring his total intake of fluid up to even the lowest requirement-2 ounces for each pound of body weight. As he takes more milk he will require less water, but it is well to offer water to him between feedings even when he is strong enough to take an adequate amount of fluid at his feedings.

THE BABY'S WEIGHT

Although occasionally premature babies will hold their birth weight, most of them will lose weight and should not be expected to regain their birth weight until the second or, what is more likely,

the end of the third week. In very small premature babies an average daily gain of one-third to one-half ounce, with a doubling of birth weight in 75 to 100 days, may be considered satisfactory.

ADDITIONAL FOODS

Premature babies are likely to develop rickets, and therefore it is important that treatment in the form of pure cod-liver oil, tested for the antirachitic vitamin D, should be begun at the end of the first week of life. Begin with one-fourth teaspoonful of cod-liver oil twice a day and after two or three weeks increase this amount to one-half teaspoonful twice a day. At the end of six weeks this amount may be again increased to 1 teaspoonful twice a day, and in the third month to 11⁄2 teaspoonfuls twice a day.

Orange juice-one-half teaspoonful in water once a day-should be begun when the baby is 2 weeks old and the amount increased gradually so that at 2 months the baby receives one-half tablespoonful twice a day and at 3 months 1 tablespoonful.

Other foods should be added to the baby's diet as he grows older, as they are to the diet of the normal baby.

SUN BATHS

Sun baths can not be given to small premature babies until they are strong enough to have part of their clothing removed and lie in the sun without chilling. In summer, when the sun is very warm, premature babies may be given sun baths at an earlier age than in winter. Because sun baths can not be given to premature babies when they are very young, special effort must be made to see that the full amount of cod-liver oil, tested for vitamin D, is given with great regularity. In hospitals artificial sun baths of ultra-violet light may be advised by the doctor.

THE BABY'S LATER DEVELOPMENT

As he grows older a premature baby should become more and more like a small edition of a healthy full-term baby. Though small, he should have good color in his cheeks, his muscles should be firm, and he should gradually become more and more active and alert. He may be slower in learning to do some things, like holding up his head or sitting up; but if he gets the right kind of food and plenty of sunlight, he will usually catch up to the full-term baby of the same age by the time he is 2 or 3 years old.

SELECTED BOOKS OF INTEREST TO MOTHERS 1

Baby's Daily Time Cards. U. S. Children's Bureau Chart No. 14. (Revised February, 1930.)

The Baby in the House of Health. American Child Health Association, New York, 1926. 48 pp. 10 cents.

Breast Feeding. U. S. Children's Bureau Folder No. 8.

Child Management, by D. A. Thom, M. D. U. S. Children's Bureau Publication No. 143. Washington, 1928. 47 pp. (New edition in preparation.)

A Doctor's Letters to Expectant Parents, by Frank Howard Richardson, M. D. Children, the Parents' Magazine, and W. W. Norton & Co., New York, 1929. 118 pp. $1.75.

The Expectant Mother; care of her health, by Robert L. De Normandie, M. D. (Edited by the National Health Council.) Funk & Wagnalls Co., New York,

1924. 57 pp. 30 cents.

The Expectant Mother in the House of Health. American Child Health Association, New York, 1926. 23 pp. 10 cents.

Everyday Problems of the Everyday Child, by D. A. Thom, M. D. D. Appleton & Co., New York, 1927. 349 pp. $2.50.

Feeding the Family, by Mary Swartz Rose. Macmillan Co., New York, 1929. 459 pp. $2.40.

Getting Ready to Be a Mother, by Carolyn Conant Van Blarcom, R. N. Macmillan Co., New York, 1922. 237 pp. $1.50.

Infant Care. U. S. Children's Bureau Publication No. 8.

127 pp.

Washington, 1929.

The Infant and Young Child; its care and feeding from birth until school age, by John Lovett Morse, A. M., M. D., E. T. Wyman, M. D., and L. W. Hill, M. D. (Revised.) W. B. Saunders Co., Philadelphia, 1929. 299 pp. $2. Keeping the Well Baby Well. U. S. Children's Bureau Folder No. 9. (Revised 1930.)

A Practical Psychology of Babyhood, by Jessie Chase Fenton. Houghton Mifflin Co., Boston, 1925. 348 pp. $3.50.

The Prospective Mother, by J. Morris Slemons. (Revised.) D. Appleton & Co., New York, 1921. 343 pp. $2.

Simplifying Motherhood, by Frank Howard Richardson, M. D. G. P. Putnam's
Sons, New York, 1925. 263 pp. $1.75.

Sunlight for Babies. U. S. Children's Bureau Folder No. 5.
What Builds Babies. U. S. Children's Bureau Folder No. 4.
Why Drink Milk? U. S. Children's Bureau Folder No. 3.
Why Sleep? U. S. Children's Bureau Folder No. 11.

Your Child's Teeth. U. S. Children's Bureau Folder No. 12.

1 Single copies of Children's Bureau publications may be obtained free by writing to the bureau at Washington, D. C.

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