Taking Care of the Developing Infant

The chief requirement of a developing infant is its getting enough to sleep, play and exercise. For a month and a half it should be allowed to sleep as much it wants to, during the day as well as during the night. Of course, there is no harm if it wakes up at the time of feeding, bathing, changing clothes or nappies etc. and plays for a few minutes.

 

Baby’s Normal Requirement to Sleep

1. Fed on adequate nutrients a healthy baby remains asleep for long periods and does not cry or trouble the mother in any way.
2. It doesn’t need to be rocked in a cradle or a swing. It is only when something is troubling it, physically or mentally, that it needs to be rocked or swung or held in the lap. About after six weeks, there is a gradual decrease in the periods it spends in hibernation or sleep. Although the sleep requirement caries from the individual (baby) to individual and due to the environmental factors, the period required by normal babies for sleep is given in the table below :

Age in months	Total periods of sleep needed in every 24 hours
1 month	22 hours
2 months	21.5 hours
3 months	21 hours
4 months	20 hours
5 to 6 months	19 hours
7 to 12 months	18 hours

As explained the above table gives the requirement of sleep for a normal child.

3. However, a child could be just normal but due to lack of nutrition if may not have the sound sleep. If the child is not in normal health, it may sleep for shorter periods than indicated in the above table, but in such a cause no definite indication of its requirements of sleep can be given.
4. Often the hunger pangs in an undernourished child would wake it up. The sleep requirements of babies between the sixth and the twelfth months vary rather drastically. There could be many factors that may be responsible for this: physical health, environment, beliefs of the parents regarding the requirements of sleep, etc. Children up to the age of eight or nine years should get ten to twelve hours of sleep at night.
5. If the child does not get sufficient sleep, or if it does not get sufficiently sound sleep, its health may be impaired. In fact, the child needs sleep even more than it needs food. Moreover, it is not enough that the child sleeps for ten hours; its sleep must be peaceful, deep and uninterrupted.
6. The environment should, therefore, be quiet, not too warm and not too cold, and sufficiently protected from interruption. During sleep, the rates of breathing and heart-beats are lower. As a result, the nerves and the brain are at rest. In the body of the sleeping child, the work of restoring the tissues is going on. Thus sleep is beneficial for the health of the child.
7. If the child wakes up smiling, in a cheerful mood, it can be inferred that it has had sufficient sleep, and to that extent, it has gained in physical and mental health. If it wakes up crying, it has not had sufficient sleep.
8. Never wake up a child unless there is a reason for doing so. And exhibiting your child to guests, or such other trivial reasons do not justify disturbing its sleep. In fact, waking up a sleeping child is justified only when it is to be fed.

 

Play

1. The baby does not show any tendency to play for the first three months or so, nor does it need the exercise involved in playing during this period. It gets all the exercise it needs in the act of feeding.
2. After three months, it begins to indulge in random movements of its arms and legs. It derives a certain pleasure from these movements and makes various gurgling sounds to express this pleasure.
3. At the age of four to five months, it can hold its head steady. At about this age it is attracted towards simple brightly colored toys.
4. When the baby becomes capable of sitting, which happens at the age of six months or so, it plays with things near at hand, including its own fingers, thumbs, and toes. It likes to put rattles, toys, dolls, etc., into its mouth, sucking or licking them. Sometimes it starts throwing things around. If you bring the things back to the baby, it will throw them again. It derives great pleasure from such activity.
5. As the child grows older, its tastes in play and playthings change. A one-year-old child will play tirelessly with the sari of its mother or piece of cloth.
6. At the age of a year and a half, the child prefers toys in the shapes of animals and birds, and cycles, motor cars or even boxes. Tearing paper into pieces, folding and unfolding paper again and again, and such other activities give it the pleasure and also help the development of its faculties.
7. A two-year-old child enjoys playing with chalk, pens, pencils and the like, drawing wriggles on the floor or the walls and rubbing them out. The parents may be inclined to view such activity as meaningless and harmful, but all this has been proved to be valuable from the point of view of the mental and intellectual developments of the child.
8. A certain tendency to break and dismember various toys and other things develops in a child about this time.

 

Exercise

1. The new-born baby is exercising many of its muscles in the very act of feeding at the breast. Crying in itself is a very important exercise for the lungs and the diaphragm and plays a very important part in the development of the baby’s musculature. You have just to watch a baby feeding or crying to confirm these facts. In fact, it can be said that the baby sometimes seems to cry just for the exercise the act involves. If therefore the baby seems to be crying naturally without any real cause of discomfort, you should not be in a hurry to stop its crying.
2. Every tendency and activity of a child is natural and instinctive and rather than trying to stop such activity without thinking, it would be advisable to direct or modify such activity after careful consideration. Our knowledge of the general principals and other information regarding the methods and manner of bringing up a child cannot be applied indiscriminately and uniformly to all children. For instance, a child that is normal in its health and in other ways may not cry or may do so very infrequently. In such a case if the mother tries by various means to make it cry in the belief that ‘crying strengthens the lungs’ she would, in fact, be harming the child.
3. In babies case, play and exercise cannot really be distinguished. Play exercise a variety of muscles, and the baby may enjoy exercising its muscles. In point of fact, every kind of activity in playing involves the movement of the muscles of the arm, legs and other parts of the body. Hence for a child, even a play is actually a form of exercise.
4. As the child grows and develops, there is a gradual accumulation of energy in the body of the child. When the energy accumulates in abundance it demands an outlet and the child naturally turns to play. As the child-psychologists believe play is the catharsis of the surplus energies of the child.
5. In child’s growth judicious blend of sleep, play and exercise make as great a contributions proper nutrition and other facts may do. It was not for nothing that Shakespeare said: “Sleep is the chief nourisher for the life’s feast.”
6. Lack of sleep, play or exercise can ruin all the ideal dietary effects on the child’s body no matter what you feed him. These four vital factors: proper food, adequate sleep, exercise, and play make a lot of difference in the children’s health as their body is more receptive and rather untrained.

 

The Stages in the Development of the Child

Like any other being’s development, the child’s development has district stages. The stages have been demarcated and defined on the basis of the development of various bodily characteristics and the associated behavioral changes. Eminent psychoanalysts have classified these in the following categories from birth to adulthood.

1. Infancy: from birth to the age of one month.
2. Babyhood: from the age of one month to one year.
3. Childhood: covering the period generally from birth (correctly speaking from the age of one year) to the age of five years.
4. Adolescence: from the sixth to the twelfth year.
5. Teenage: from the thirteenth to the eighteenth year. In this chapter only the first phase, up to the age of one year, will be considered.

Every parent has a special affection for his or her own offspring, and in addition to parental love, every parent takes a certain pride in the child. This love and affection often prevent parents from taking an objective view of the physical and mental development of the child. On the other hand, there are parents who are always dissatisfied with the progress of their child. All you hear from them about their child is, ‘my child is not growing well’, ‘it is not robust enough’, ‘recently it seems to have lost weight’, etc. Such parents keep dosing the children with tonics and medicines and then worry about the fact that despite all this care and treatment, the child is not gaining in height and weight as would normally be expected according to its age.

It is advisable for all parents to keep watch over the physical and mental development of their children. Although they should compare their child’s growth with others, they need not get unduly perturbed seeing their child’s less growth rate. The development of all children is not necessarily parallel. Some babies learn to walk earlier than others while some others learn to speak much earlier than others. This is normal depending upon the individual growth of faculties. There can not be any fixed rules or a common yardstick to evaluate the development of a child. However, common parameters can still be fixed which are shown in the table given below. If your child has faster development in mental faculties than physical, it should not cause any alarm. The table gives the general parameters of a child’s growth.

The table below gives an idea of the normal level of attainment of a child at various stage. A comparison with the parameters mentioned in the table would give a rough idea to the parents whether their child is ahead or lagging behind in various mental or physical abilities and activities.

Many a time the physical parameters are given wrong preference over the mental parameters. Mental development is no less important than physical development, and just as nutritious food is required for promoting physical development, a loving, warm, secure environment is necessary for proper development of mental faculties. The development of a child deprived of maternal love remains incomplete, and when it grows up, it cannot give wholehearted love to anyone, nor can it trust anyone. However, love by itself is not enough in bringing up a child. Love should be accompanied by discipline, regularity and an insistence on the development of good habits. Excessive indulgence and excessively strict discipline are both equally harmful to the all-round development of the child. It is necessary to let the child develop freely and naturally. It must be recognized that a child is also a person, and it should have adequate opportunities of expressing its likes and dislikes, interests and preferences, fancies and feelings. Parents should take an interest in its daily activities but should be careful not to impose their own ideas and ideals on the child. It is only in ‘democratic’ atmosphere that originality can develop, and parents are duty-bound to allow sufficient scope for such development. It is also desirable that the child should have an opportunity to mix freely in society. The child should be induced to take an interest in all types of activities. Its dormant faculties should be awakened, so that it can develop its personality and gain self-confidence as an individual in its own right.

As hinted earlier never compare your child with others without reason. Do not expect more from it than its natural capacity and capability warrant. Before criticising the child, try to gauge its strengths and weaknesses. Unnecessary criticism leads to the development of an inferiority complex in the child; it will become shy and repressed and may develop anti-social tendencies. It may suffer from some sort of mental disorder in later life as a consequence.

 

Stage in the Physical-Mental Development of the Child

1	2	3	4	5	6
Age	Weight (kg)	Height (cm)	Circumference of head (cm)	Chest measurement (cm)	Indications of mental development in terms of what the child can do
At birth	2.5 to 3	48 to 50	32 to 34	31 to 33	Starts at sudden noises, (This will indicate whether the baby can hear normally).
3 months	5	52 to 55	36 to 38	35 to 37	The baby can keep its head steady, fixes its eyes at sources of light and other things, makes various sounds, laughs when played with, recognizes the fact and the touch of the mother.
6 months	6.5	60 to 65	38 to 40	37 to 39	Turns to lie on its belly, sits without support, can grasp things, recognizes faces.
9 months	8	65 to 68	41 to 42	39 to 41	Can stand with support, can identify items of food. Simple words like mama, baba, recognises members of the family, is aware of natural calls, has learnt to relieve itself (to urinate and defecate) only in specified places rather than just anywhere.
1 year	9 to 10	70 to 72	42 to 45	42 to 45	Can walk without support, can pick things up with thumb and forefinger, can draw lines with chalk, can speak simple words like mama, baba, recognises members of the family, is aware of natural calls, as learnt to relieve itself (to urinate and defecate) only in specified places rather than just anywhere.
2 years	12	80 to 85	45 to 47	47 to 48	Climbs stairs, runs, turns (and tears) pages of books, draws squiggly lines, speaks sentences of two or three words, can identify parts of the body, has complete control over eliminatory functions (urination and defecation), attempts to put on clothes by itself, etc.
3 years	14.5	85 to 90	46 to 48		Runs, jumps, kicks, grasps pencils properly while writing or drawing, speaks whole sentences, recites short poems, does not wet the bed, plays with other children, rides a tricycle.
5 years	18	100 to 105	50 to 52		Can play games that require hopping on one leg, can read, draw, recite, and shows interest in going to school.

Show your appreciation of its achievements, praise it when praise is due, but remember that excessive and undeserved praise will promote a ‘superiority complex’, which will in all probability make the child vain and impudent. If the child commits mistakes, draw its attention to the mistake and give it sound advice, but do not mete out any punishment for its mistakes. And never, never inflict corporal punishment.

 

Standards of Development

The following detailed description would give a better insight into your child’s growth, whether the process of development of the baby is taking place at the normal rate or in a normal way:

1. Weight: In our country, the average weight of a normal baby at the time of its birth is 2.8 kg. Any child weighing between 2.5 kg to 3.5 kg would be considered normal. Within three days from birth, the baby normal loses about 10 percent of its weight (250 to 300 grams) but regains the lost weight in the following ten days. Subsequently, the growth becomes more regular, and the child gains 20 to 30 grams a day if given the normal supply of nutrition. Thus at the end of the first month, its weight should have increased by about 500 grams.
   
2. Height: The height (sometimes referred to as the length) of the baby is about 50 to 52 centimeters at birth. A healthy and well-nourished child, in the absence of any deficiencies of development, grows by about 1.5 centimeters by the end of the first month, so that the one-month-old baby is about 52 to 54 centimeters in height. This increase in height continues more or less uniformly till the age of to 10 years. Around the 11th to the 14th year, the increase in height becomes even more rapid. The periods of these spurts in height are different for boys and girls.
   
3. Size (circumference) of the head: Generally the circumference of the head is taken as an approximate measure of the state and development of the brain. At birth, this is about 33 to 35 centimeters and grows by about 1.3 centimeters in one month. There is a gradual increase in subsequent periods.
4. Chest measurement: Surprisingly, the chest of the new-born baby measure one or two centimeters less in circumference than the head! With the passage of time, it increases till it equals and then exceeds the circumference of the head.
5. Development of tissues and limbs: The increase in efficiency of the movements of the limbs of the baby, and of the function of the eyes, nose, tongue, etc., are naturally viewed as evidence of development. The sense of the child has already been developed by the time of its birth, and so the child shows sensitiveness to various changes in the environment and responds appropriately. It can see, hear and move its limbs in response to stimuli like sudden noises and movements. An eight-day-old baby would be more responsive to sounds other than human voice, but by the time it is one month old, it begins to respond more to human voices than to other sounds.

As the muscles develop, the baby progresses from random movements to co-ordinated movements, turning on its side, overturning to lie on its belly, and even beginning to change its position. A five to six months old child can keep its body steady. In a normal state of health, it should be able to sit without support when it is about six or seven months old. It can stand up at the age of eight or ten months, and may even take a few faltering steps. At this time it makes attempts at communication with various sounds. By the time it is one year old, the child can articulate certain simple words like ma, pa, go, give, etc. It is sensitive now too hot, cold, rough and smooth surfaces and shows appropriate responses like avoiding or enjoying them.

 

Normal Development Tests

Following tests will be helpful in judging whether your child is normally developing or not. Slight variations don’t matter but if there be major variations suggesting some deficiency the doctor should be consulted.

1. A one-month-old child moves its head, arms, and legs very frequently.
2. If a child is laid on its belly, it can turn its head sideways.
3. Within a few days after birth, and certainly, at the end of the first month, the child shows a response to the sounds of a rattle or a bell.
4. From a very early age, a baby tends to fix its eyes on a brightly colored object. At the age of one month, it can follow the movements of an object with its eyes.
5. The baby makes various sounds from a very early age.
6. The crying of the baby gradually becomes purposeful and indicates specific discomforts such as hunger, thirst, wet nappies, a feeling of heat or cold, etc.
7. There is almost a daily increase in the baby’s interest in the human face and figure as opposed to inanimate objects.
8. A crying baby normally becomes quiet on being picked up.
9. The baby shows its pleasure at the sight of its mother by smiling and gurgling.
10. It cries at the sight of an unfamiliar face or object, or even a frightening picture.

Some of the important factors that affect the growth and development of a baby are its innate abilities, hereditary characteristics, geographical location, environment, educational level of the mother, the manner of bringing it up, and the amount of affection and sympathy it receives.

Some other indications marking the development of the baby:

1. The baby learns to keep its head steady on its neck by the age of about four months.
2. It can sit without support at the age of six months, but this may take a month less or a month more.
3. It can stand without support at the age of nine months.
4. By the tenth to the twelfth month, it should be able to walk with a little support.
5. At the age of twelve to fourteen months, it can walk independently.
6. The baby can speak simple words of one or two syllables like ma, pa, ta, mama, dada, etc., at the time it is one year old.
7. It picks up more words by the age of fifteen months and begins to speak sentences of three words by the age of two years. If it fails to start talking by the eighteenth month, it is likely that there is some defect in the ears, the tongue or the larynx. It would be advisable to consult a doctor in such a case.
8. A three-month-old baby can grasp and handle things. Gradually it begins to play with toys, especially brightly colored ones. As it grows older, around the age of a year or a year and a half, it begins to investigate all unfamiliar things by touching, grasping, throwing and sucking them. At this time, parents would be well advised to keep out of the reach of the child everything that they would not like the child to play with.
9. As the child grows older, its interest widen and it wishes to sojourn out of the house. Understanding parents should, therefore, spare some time to take the child out from time to time.
10. The process of teething begins around the age of six months. The first set of teeth is known as ‘milk teeth’. Special care has to be taken by the parents at the time of teething.

 

The eruption of various teeth roughly follows the time-table given below:

1. Normally the first teeth to appear are two lower incisors, between the sixth and eighth month.
2. Between the eighth and ninth month, the four upper incisors erupt.
3. Between the eighth and the tenth month appear two remaining incisors.
4. Then start erupting four molars on the right and left in the upper and lower jaws between 12th and 16th months.
5. Then follow the four canines between the 16th and 20th months.
6. The last (saving the wisdom tooth!) to appear are the four more molars, one on each side of the upper and lower jaws, between 24th to the 30th months.

It must be again stressed that the time duration of this teeth-appearance cannot be precise and a few weeks’ difference should not cause any alarm.

Besides watching your child grow happily and healthily, you must try to make your child follow a regular routine. Maintenance of the regular hours for various activities of the child helps a lot in his acquiring a homogeneous and undisturbed personality. First, you must try to follow what your child does comfortably on its own without any cajoling and coaxing. Then you must chalk out a regular routine for the child according to the following broad guidelines.

 

Daily Routine

1. In the morning when the baby wakes up to give it a loving look and a smile, and pick it up with affection.
2. Stroke its head to console and pacify it.
3. Change its clothes, as usual during long periods of sleep the bay is sure to have wetted them.
4. Wipe the face and the body of the baby with the clean cloth wrung out in warm water.
5. Feed it whether with breast milk or a substitute, in an unhurried and peaceful manner.
6. A child is always fresh and cheerful in the morning. The mother should add to its cheer by her affectionate behavior.
7. Some babies wake up unusually early or late in the morning. This should be accepted as natural.

 

Bathing the baby

Time & Method: The best time to bathe the baby is between 8.00 and 10.00 in the morning. This can be considered convenient for the mother too. But the baby should never be bathed just after feeding, and preferably never within half an hour before or after a feed. The bath water should be comfortably warm. All parts of the body including the genitals must be cleaned thoroughly, but care should be taken not to harm the tender skin of the body. A soft cloth such as khaddar should be used for drying the skin, which should be done with a light hand. Mild soaps such as Pears’ glycerine soap or Johnson’s baby soap should be used. If preferred, especially in winter, the skin can be lightly massaged with oil. Coconut oil or castor oil can be rubbed gently in the hair. Drops of oil should never be put into the nostrils, as oil may cause pneumonia. The eyelids should be cleaned with wet cotton. The nose too can be similarly cleaned out with cotton twisted into the form of a wick. Care must be taken to see that no water is allowed to enter the ears during bathing. A straw or a matchstick covered with a cotton bud can be used to clean the ears, and another one dipped in oil should then be used to apply a thin layer of oil to the ear hole.

In case you are using a soap to bathe the body, take care that no soap enters the eyes. All the soap must be meticulously washed off from the skin. If the baby is very young, a tub would not be convenient for bathing it. The baby can be laid on the soft cloth spread on a smooth wooden seat. When the baby is old enough to sit, it can be seated on the floor or in a tub. It can be allowed to splash water about if it desires to do so.

After thoroughly drying the skin of the baby with a clean soft towel, unless it is intended to apply oil to the skin, especially in summer, talcum powder should be applied to the whole body. The baby should then be dressed in dry, clean, soft and lose fitting clothes. It is likely that this prolonged process of bathing, drying, and dressing may tire out the baby. It would, therefore, be advisable to feed it after the bath.

 

The regularity of habits of elimination

Normally every child ingests food and water in sufficient quantities to satisfy its bodily needs. After performing its intended functions, all this matter has to be eliminated, chiefly in the form of urine and feces (stools). Water that has been taken into the body helps in the process of digestion and assimilation and afterward goes to the kidneys. Here the impurities present in this water (as a result of the above processes) are extracted from the blood in the bladder normally remain closed. In the case of a baby, the sphincter muscles controlling this outlet allow it to open many times during the day and the night, releasing urine. Thus the bladder is emptied before it is overfilled. In the same way all the remnants of food that have remained undigested travel through the intestines and ultimately get expelled through the anal opening. This process of elimination too is not continuous but takes place intermittently.

Regular habits of elimination should be inculcated in every child right from its babyhood. The baby must learn these three things regarding the elimination of liquid wastes:

• The baby must learn to keep the outlet of the bladder closed till a fair amount of urine has accumulated in it.
• It should become aware of the need for emptying the bladder when the bladder is filled.
• It should learn to release the urine voluntarily at the proper time and the proper place.

As the child grows older, the acquisition of the first one of the habits listed above becomes progressively easier, but that of the second one is more difficult. And till the second one is acquired, the acquisition of the third habit cannot even begin. Naturally enough, sleep makes the control of the above processes even more difficult.

Most of the babies can keep from urinating for four to six hours even when asleep. After the baby has slept for such a period, the mother should pick it up, take it to the bathroom, and position it for urinating, so that it can sleep for four to six hours more without wetting the bed. If care is taken by the mother to do this every five hours during the daytime too, the baby will form a habit of urinating at regular intervals.

If you keep on placing the baby on the tub every day at a specific time, just after the first feed in the morning, it will begin to form the regular habit of emptying the bowel and the bladder. Seat the baby in the tub and support its head and back. If the child does not urinate or defecate (have a bowel motion) in ten or fifteen minutes, there is no point in keeping it in the tub for a longer time. But following this procedure twice a day in the morning and evening will ultimately help it to form regular habits in this regard. Attempts at the formation of these habits should normally start at the age of six months, but there should be no haste or impatience. It is because of lack of this regimen that many babies fail to develop regular habits of elimination even up to the age of two years and continue to wet their beds.

Many children don’t gain control over the bladder for a comparatively long time. These children invariably wet their beds in their sleep during the night, and often even during the day. They create a problem for their mothers. But the mother should understand clearly that bed-wetting is not rare. One child in seven continues to wet its bed even at the age of seven, and one child out of ten may continue to do so until it is nine or ten years old.

This is owing to a number of physical and psychological reasons. One reason may be the very small size of the urinary bladder. Or the rate of formation of urine may be abnormally high. Or the child may not have acquired control of the sphincter muscles. In many cases, such babies are heavy sleepers, and so are not aware of the urge to urinate. There is also the possibility of defects in the bladder or the urinary tract, that interfere with the control of the process. Some of these reasons are trivial, but others are serious. So instead of simply worrying about the problem, the mother should consult a doctor. If certain children, adolescents and sometimes even youths exhibit the tendency of wetting their beds, it is probable that in addition to physical reasons, there are psychological reasons as well-fears, disappointments, frustrations, feelings of insecurity, etc.

 

Sleeping Habits

The new-born children have a tendency to sleep most of the times, even for 20 to 22 hours a day. Weak and premature babies sleep even more. As the baby grows older, the hours it spends in sleeping generally decrease. A six months old baby normally sleeps for 18 hours out of 24, but a one-year-old baby sleeps for only about 14 to 16 hours in a day.

Having observed the baby’s requirement for sleep, the mother should make up a timetable, keeping in view her own convenience, and that of the baby as well. For instance, if she is required to work in the kitchen from eight to ten in the morning, she should form the habit of waking up the child at about six in the morning. She may allow the baby to play in the bed for some time, feed it, see to its elimination processes, bathe it and then put it to bed again. The baby will then naturally sleep for three to four hours. Unless it becomes necessary for some reason, do not let the baby get into the habit of being rocked to sleep in a cradle or a swing. If all its needs are attended to, the environment is favorable, and there is no noise pollution either or minimized as much as possible, the baby will be able to maintain a regular routine of sleep automatically.

Also important is watching what clothes the baby is wearing when you are putting him to sleep. They must be loose, warm or cotton-made suiting to the weather. Also make sure of protecting the baby by using various mosquito-repellants, nets or the like.
Besides these precautions also take care to take out your baby for fresh air. It is not proper to confine the baby all the twenty-four hours of the baby to the stagnant and stale atmosphere of the house. At a convenient time in the morning or evening, the baby should be carried out into the open air for half an hour or so, using a pram (perambulator) if possible. Besides getting fresh air the baby would get the opportunity of observing new places, new surroundings. Such changes unobtrusively contribute to making the child cheerful. Make sure that your such outings should be in the open park or uncrowded places. Especially in big town, such places are difficult to find. You have to make a very careful choice. No use taking your baby to the roads having blaring horns and blasting traffic. In such cases taking your child on your lap and strolling leisurely in your lawn would be a better choice.