From Big Medical Encyclopedia

BABY — the child from the moment of the birth until the end of the first year of life. During this time there pass two periods of life of the child — the period of a neonatality (see. Newborn ) and chest period (chest age).

Anatomo-fiziologichesky features

In processes of a metabolism at babies an essential role is played by desmoenzymes which activity changes with age. All types of a metabolism at babies differ in nek-ry features (see. the Metabolism and energy, at children ).

The child gradually adapts to conditions of the environment. The inevitable accidental contact with various infections leads to development of specific antibodies (see), providing to the child some acquired immunity (see) and a sensitization of its organism to various bacteritic factors; along with it at the child the initial oroimmunity received vnutriutrobno from mother gradually weakens.

Morfol, incompleteness of a structure of c. N of page, the originality of its functional features (tendency to diffuse reactions) and a hyperpermeability of a blood-brain barrier for an infection and toxins explain tendency to spasms, to a meningism and true meningoentsefalitichesky processes. The combination of insufficiency of actively acquired immune properties, decrease in oroimmunity and a sensitization to various factors with morfol, features of fabrics and bodies of children of early age creates at them predisposition to various pyogenic and other infections accepting quite often heavy current. Tendency to diffusion reactions and inability to an otgranicheniye patol, processes only by certain body or one fabric is characteristic of children of chest age; so, local process often accepts at them a rapid current with massive generalization. Skin and a mucous membrane of respiratory and digestive ways are the most frequent entrance infection atriums.

At the age of 4 — 5 months babies can be infected with causative agents of children's diseases (measles, a rubella, chicken pox, etc.). The current is usually heavy.

Inborn syphilis gives characteristic a wedge, manifestations (see. Syphilis, inborn ).

Already at chest age at some children hereditary burdenings and so-called anomalies of the constitution — exudative and limf, diathesis clearly come to light (see. Exudative and catarral diathesis , Status thymicolymphaticus ).

Need of the child of the first year of life for food with rather high caloric content with relative functional insufficiency went. - kish. a path promotes emergence at it acute and hron, frustration of food and digestion (see. Gastroenteritis , Dyspepsia ).

Intensive growth of a skeleton, the increased vulnerability of processes of digestion and a metabolism create at predisposition to to rickets (see), spasmophilias (see). Lability of the hemopoietic device even at insignificant errors in food and leaving can be led to anemia (see. Anemia, at children ).

For the intensive, but gradually decreasing increase of indicators physical Is characteristic. development, and also relative (in comparison with more senior children and adults) functional inferiority of some systems, especially in the first months of life. At children of the first year of life thermolability is sharply expressed. Body temperature at them, as a rule, on 0,3 — 0,4 ° above, than at adults.

Dynamics of growth and weight

the Weight of the child intensively increases during the whole first year of life, but monthly increases in weight gradually decrease (see. Body weight ), length of a body also considerably increases, especially in the first half a year (see. Growth ).

Indicators physical. development Is given in the table.

Average values of physical development of children of the first year of life (according to A. F. To a tour)

At assessment physical. development it is necessary to consider not only objective data of various measurements, but also the subjective data based on the general survey, clarification of features of its psychomotor development taking into account conditions of the environment and education.

Skin. The thin corneous coat, consists of 2 — 3 rows loosely coupled among themselves and constantly exfoliated cells. The basal layer is developed well, it is always possible to prove vigorous division in it epithelial cells. The basal membrane is underdeveloped, very gentle also a rykhla, plentifully a vaskulyarizirovana.

Sebaceous glands function well. Function of sweat glands within the first 3 — 4 months is a little reduced.

The hypodermic fatty layer, well-marked at healthy newborns, intensively accrues within the first 6 months, hl. obr. on a face, more slowly — on a stomach. The hypodermic fatty tissue at contains more firm fat to - t (palmitic and stearin) and less olein.

Musculoskeletal system Differs in a number of features.

Muscles Are developed rather poorly; the weight of muscles at children of the first weeks of life makes apprx. 23% of body weight whereas at adults — apprx. 42%.

Within the first months of life at children the hypertension of muscles especially clearly expressed from sgibatel of extremities is noted fiziol; the hypertension of muscles of upper extremities disappears by 2 — 2V2 months of life, and the lower extremities — by 3 — 4 months.

Bones contain less dense substances more water, than at adults. The periosteum thick is also less strongly tied with a bone.

Normally developing child in a certain sequence has ossification centers and fontanels are closed. Side fontanels at the full-term children at the birth are closed; the small fontanel is open approximately at 25% of newborns and is closed during the first quarter of the first year of life; the big fontanel at the birth is open and is closed by the end of the first year, not later than 1,5 years.

Sagittal, coronal and lambdoid seams begin to be formed by 3 — 4 months; their pliability remains much longer.

The backbone has no bends, a thorax barrel-shaped, edges cartilaginous, are attached to a backbone horizontally. At breath the thorax extends a little.

Respiratory system. Number of respiratory movements in 1 min. at children aged up to 3 months — 40 — 45, from 4 to 6 months — 35 — 40 and from 7 to 12 months — 30 — 35. 2,5 — 3 pulse blows, and by the end of the first year — 3 — 4 blows on average are the share of one respiratory movement at newborns. Functional capacity of a respiratory organs at G. is characterized by the following main indicators: the volume of each respiratory movement at the newborn — 20 ml, at the monthly child it raises approximately to 25 ml, by the end of the year reaches 80 ml. The minute volume of breath quickly increases with age: at the newborn it is equal to 700 — 800 ml, at the age of 1 month — apprx. 1400 ml and by the end of the first year — apprx. 2600 ml.

At newborns diaphragmal respiration prevails, at children of chest age so-called grudobryushny breath with dominance phrenic comes to light (see. Breath ); excursions of a thorax are poorly expressed in its upper parts and are much stronger — in lower. With transition of the child from constant horizontal position in vertical also the type of breath changes; at this age (the end of the first — the beginning of the second year of life) the combination of diaphragmal and chest respiration is characteristic, and in one cases one prevails, in others — another.

Warmly - vascular system. From the moment of the birth of the child placental blood circulation stops, lungs finish and filled with blood, germinal circulatory ways — venous (arantsiyev) and arterial (botall) channels, an oval opening and the remains of umbilical vessels — are closed. Extra uterine blood circulation is established.

Within the first months of life at children the relative weight of heart decreases and at the age of 5 — 6 months becomes minimum, corresponding to about 0,4% of body weight.

The minute volume of heart at the newborn apprx. 330 ml, by the end of the first year of life reaches about 1200 ml. The minute volume of heart is proportional to the need of an organism for oxygen; expected 1 kg of weight, it in two with lipshy is more than time, than at adults.

Pulse at much more often than at adults: at the birth — apprx. 120 — 140 blows in 1 min., in 6 months — 130 — 135 and by the end of the year — 120 — 125.

The ABP increases with age: in the first months maximal pressure is 74 mm of mercury., by the end of the year apprx. 90, minimum respectively 51 and 63.

Idiosyncrasies of an ECG — the right type, accelerate conduction of impulses from auricles to ventricles and the shortened duration of the ventricular QRS complex. With age the ECG gradually approaches an ECG of the adult. Bigger, in comparison with adults, the amount of blood and higher intensity of power processes impose big requirements for the work performed by it to children's heart. Rather big heart, rather wide cordial openings and vessels facilitate blood circulation.

Alimentary system. Shall receive milk of mother. On the basis of a congenital instinctive sucking reflex the child after the birth has various uslovnoreflektorny bonds influencing processes of secretion of digestive juices and a metabolism.

The oral cavity Is rather small. Language big. Sialadens emit not enough saliva. Morfol, features of an oral cavity, lips and cheeks — Roben's fold — Mazhito, sucking rollers of Lushki — Pfaundlera, cross folds — rollers on a hard palate and fatty lumps of a cheek (Bish's lumps) facilitate to it the act of suction, providing the best sealing of an oral cavity in a phase of aspiration and more intensive squeezing of a nipple. Department of saliva occurs reflex under the influence of various irritants, submitting generally to the same patterns, as at the adult. The amount of saliva considerably increases at the age of 3,5 — 6 months. Saliva contains enzyme ptyalin, amylolytic and a glycogen to a maltose; pH of saliva fluctuates from 6 to 7,8.

At the age of 6 — 8 months at the child the lower medial cutters, then upper — in the beginning medial, then lateral are cut through; also the lower lateral cutters are by the end of the year cut through. By the beginning of the second year of life at the child usually happens 8 milk teeth (see).

The gullet at children is rather longer, than at adults: at newborns — apprx. 10 cm, by the end of the year — apprx. 12 cm.

The stomach at also has a number of features. At children of early age the greater cul-de-sac is poorly developed; at it makes about 1/4 lengths of a stomach whereas at the adult 1/3. Capacity of a stomach at the newborn is equal on average 30 — 35 ml; further it increases, reaching by 3 months 100 ml, and by a year — 250 ml. Motility of a stomach and secretion of its glands at babies generally submits to the same fiziol, to patterns, as at adults. As the activator of secretion at the earliest age unconditional reflex irritants have the greatest value; influence of conditioned excitators is found a bit later. In a stomach of children even of the earliest age it is possible to find pepsin, cathepsine, chymosin and a lipase. The quantity free and connected salt to - you increases with age; the total titratsionny acid (Mikhaelis's method) at children of the first weeks of life does not exceed 3 — 6 ml 0,1 N. The game, by the end of the year reaches 15 — 20 ml. Free salt to - that respectively makes 0,8 and 10 ml, pH of gastric contents fluctuates from 5,8 to 3,8.

During the feeding by women's milk healthy babies allocate a gastric juice with the smallest acidity and activity of enzymes, however quite sufficient for digestion of milk. During the feeding by cow's milk juice with bigger acidity and with more considerable content of all main enzymes separates. There is the known parallelism between activity of enzymes of a stomach, intestines and blood.

Liver of rather big sizes. Bile is poor bilious to-tami, cholesterol, lecithin and salts, but is rich with water, mucin, pigments, and in the period of a neonatality — and urea. Contains in bile more taurocholic to - you whereas adults have more glycocholic.

Intestines have the following features. Erepsin, a lipase, amylase, maltase, lactase, invertase and enterokinase which activity increases with age are found in children of the earliest age in intestinal juice.

The amount of juice of a pancreas and activity of its enzymes — trypsin (trypsinogen), amylase, maltase and a lipase — increase with age and depend on a state and character of food.

Duodenal juice on an empty stomach has almost neutral reaction — pH 6,8 — 7,2. At receipt in a duodenum of acid gastric contents reaction of duodenal juice deviates on a nek-swarm time in the acid party, and pH reaches it 3,5 — 5,0; in the middle of pancreatic digestion reaction becomes neutral or even alkaline again. Activity of enzymes of duodenal juice within the first year of life increases. Activity of trypsin at babies fluctuates from 512 to 1024 conventional units, activity of amylase does not exceed 500 units, and activity of a lipase is equal to 20 — 30 pieces.

In processes of digestion of food an undoubted role is played by pristenochny digestion (see. Digestion ), still a little studied at children of chest age.

Fermentation in intestines both at natural, and at artificial feeding to a nek-swarm of degree supplements zymolysis of food; rotting in intestines of healthy children of the first months of life is absent.

At children during the feeding only by breast milk reducing processes are not expressed and therefore bilirubin is not reduced in urobilin, cholesterol — in coprosterol etc.

In normal contents of intestines at healthy, left the period of a neonatality, at natural feeding bacteritic flora is presented very restrictedly: the anaerobic stick — you prevails. bifidus, you. acidophilus, Bact. coli, Bact. lactis aerogenes, etc. At the artificial and mixed feeding Bact prevail. coli, you. acidophilus, you. bifidus and enterococci which are almost in equal quantities. The child who is on artificial feeding on a picture of an indestinal flora as if is in a condition of a constant subinfection. At the children raised by the decanted women's milk, bacteritic flora of intestines to a greater or lesser extent differs from flora of intestines of the child receiving milk directly from a breast of mother that depends on degree of impurity of the decanted milk.

Bacteria, strengthening hydrolysis of proteins, subjecting carbohydrates to fermentation, saponifying fats and dissolving cellulose, can promote digestion of food. They take part in synthesis of vitamins, especially groups B and K.

Prodolzhitelnost of passing at food gruel on intestines can fluctuate over a wide range: at newborn from 4 to 18 hours, at more senior babies is about days; at artificial feeding is extended and can reach the 48th hour.

Intensity of absorption at children of chest age much more, than at the senior children. At in a stomach also water solutions, in a large intestine of hl are intensively soaked up. obr. water, and all other products generally in a small bowel.

Excrements healthy, nursed, have golden-yellow coloring, acid reaction and a sourish smell, contain more water and to - t and have a consistence of mustard. At artificial feeding of an excrement of light yellow color, sometimes with a grayish and clay shade, often there is an unpleasant putrefactive smell, reaction approaches neutral. Fecal masses contains less water and to - t, has more dense zamazkoobrazny consistence, and is sometimes issued.

Koprogramma healthy Is various depending on the food received by it (see. Kal ). During the feeding by breast milk against the background of a detritis only single crystals fat to - t come across; with transition on dokorm mixes with mucous broths single grains of starch, and occur at the children receiving meat, single muscle fibers.

Absolutely healthy children of the first year have lives, especially in the first months, microscopic examination the calla finds a small amount of leukocytes.

The number of bowel emptyings at healthy fluctuates in quite wide limits: on the first week of life the chair happens 4 — 5 times a day, a bit later 2 — 3 times, by the end of the 1st year — 1 — 2 time. At artificial feeding the number of defecations in most cases are less per day.

Defecation at babies happens reflex, without participation of the strong-willed moment. The healthy correctly brought up child shall be accustomed to any defecation since the end of the first year of life.

Kidneys. Essential age fiziol, feature of function of kidneys — very insignificant minute diuresis at newborns in the first days of life and its bystry increase in the next days. Kidneys of children of the first weeks of life have no sufficient ability to concentrate urine that, apparently, is connected with inferiority of renal tubules (see. Kidneys, age functional features ). The diuresis at children of the first months of life at healthy nutrition and in usual conditions of the environment for them makes not less than 2 ml on 1 m 2 body surfaces in 1 min. whereas at the adult this size equals 0,6 ml.

Endocrine system. Within the first year of life of the child there are certain changes and in endocrine system: at the age of 4 — 5 months amplifies and in the next months inkretny influence of a thyroid gland continues to accrue, functions of a hypophysis and a thymus come to light. Due to the establishment of correlation between closed glands the standard metabolism reaching quite often a maximum by the end of the first year of life amplifies.

Blood. The main body of a hemopoiesis at — marrow (see), but at the newborn also an extramedullary hemopoiesis is also rather expressed. Blood Is characterized by the lowered hemoglobin content and red blood cells and dominance of lymphocytes in a leukocytic formula (see. Blood, features of blood at children ).

Central nervous system. The lowered excitability and easy exhaustion of a cerebral cortex is characteristic of children of early age; at action of unconditional irritants they have a generalization of nervous processes.

Emergence and consolidation of the first conditioned reflexes from various exteroceptors happens in various terms to a certain sequence (see. Conditioned reflex ). Most early at children vestibular and acoustical conditioned reflexes, a little later — visual, kozhnotaktilny and proprioceptive are developed; flavoring and olfactory conditioned reflexes arise, apparently, in intervals between emergence of reflexes within acoustical and visual analyzers.

At the end of the first — the beginning of the second month of life at children steady conditioned reflexes concerning almost all analyzers are developed. After others — in the middle or at the end of the 2nd month of life — the visual conditioned reflex forms. With age at the child interactions between bark and subcrustal educations, and also relationship of an organism with the environment become quickly enough complicated and differentiated. All this indicates bystry functional maturing at children of a cerebral cortex. Development of century of N of depends on influence of environmental factors.

Coordination between hearing and sight is established very much early. The adult reacts to sounds approximately with the same speed, as well as.

The weight of evidence suggests that even newborn children have ability to distinguish noise, knocks and the howling sounds from musical tones. For 2 months of life the child differentiates qualitatively various sounds.

Sense of taste is rather well developed even at newborns. For 3 months of life the healthy child already rather well distinguishes the main flavoring irritants (sweet, salty, acid, bitter).

Children of the first months of life react to the strong smells irritating with hl. obr. terminations of a trifacial. Rather constant and accurate differentiation of several smells is possible only for 4 months of life.

The tactile and temperature feeling at Is expressed well. Painful sensitivity is a little lowered.

Psychomotor development

Fig. 1. Development of the baby depending on age (on months).

Psychomotor development (development of motor activity at Is shown in the figure 1). At the newborn yawning, sucking and deglutitory reflexes are well-marked. It is also possible to cause a reflex from an Achilles tendon, knee, tussive, etc. From the first days of life the reflexes disappearing further are found: hobotkovy (protrusion of lips at effleurage of a cheek about a corner of a mouth), a positive Babinski's reflex (a dorsiflexion of a thumb and bottom other fingers of foot at irritation of skin of an inner surface of foot), a reflex of a skhvatyvaniye of Moro (the symmetric covering movement by hands at pat on buttocks, at blow to a little table, on Krom lies the child), a tonic reflex of hands of Robinson (a skhvatyvaniye and a strong continence of a subject at a touch to them to an inner surface of a palm). The positive Kernig's sign (impossibility of full extension of a leg in a knee joint when it is bent in coxofemoral) and a positive phenomenon of crawling (at situation on a stomach the child reflex makes a start legs from the palm put to soles) is always noted. Pupillary and corneal reflexes are positive. The movements of eyes are insufficiently coordinate; are often observed fiziol. squint and nystagmus. During 1 week of life the child has short-term muscle tensions of a neck. Duration of a dream is 20 hours a day.

At the age of 1 month the nystagmus disappears, the movements of eyes become coordinate, the child fixes eyes bright objects. The sharp sound causes start and a blinking; acoustical concentration is planned. The child begins to make some uncertain sounds; it has a smile, shout gets an emotional shade. The child are successful attempts to hold the head at vertical position of a body for several seconds. Lying on a stomach he tries to raise the head. Stretches. Rests legs when he is supported under mice. The Kernig's sign, a phenomenon of crawling and a tonic reflex of hands — are positive. A dream — apprx. 20 hours a day.

At the age of 2 months ability to visual and acoustical concentration clearly comes to light: the child looks after moving objects better, turns the head on a human voice, stops suction when show it a bright subject. The child lying on a stomach well raises the head and raises a breast; holds 1 — 1,5 min. the head, being in vertical position; supported under mice, long costs, but turns in legs. The symptom of crawling and a tonic reflex of hands disappear; the Kernig's sign often remains still positive. Emotional reactions become more various: the child smiles in response to a smile, a tormosheniye etc.; babbles (murmurs) more definitely. The child begins to hold objects all hand, and, thus, motor reactions gain nek-ry expediency.

At the age of 3 months the child visually concentrates and 5 — 6 min. watch a subject, being in vertical position. The child accurately catches the direction of a sound, turns the head towards a sound. The chaotic search observed earlier a mouth of a maternal breast is replaced by opening of a mouth at approach to a breast, at the sight of a small bottle or spoons (conditioned reflex). Lying on a stomach the child raises a trunk, leaning on elbows and forearms, sits with support for a basin, turns from a back sideways, freely holds the head. The movements of hands become free and reasonable: he pulls a subject in a mouth, feels a diaper, reaches for toys etc. At some children already also the Kernig's sign disappears by this time. The child begins to recognize mother, laughs in good mood and shout shows displeasure if it is left one or stack in a bed when he does not want to sleep. Guleniye becomes more various. Musical sounds cause positive emotions in the child.

At the age of 4 months, lying on a stomach, the child well watches moving objects; feels a maternal breast; reacts to the unfamiliar person. The hypertension of muscles of the lower extremities disappears fiziol. The movements become more differentiated and free: rising on hands, the child leans only on palms, turns from a back on a stomach, does «bridge», is enough, irons and holds objects. Guleniye becomes longer, melodious and guttural sounds appear. Shows displeasure a whimper.

At the age of 5 months the child perfectly knows mother, unequally reacts to various faces, does not take others breast, surely is enough objects and drags them in a mouth. It fits well, holding something hands, however the backbone is easily mobile in this connection the sharp kyphosis comes to light. Supported under mice, the child costs directly, without turning in legs, does attempts to be exempted from the diaper thrown the person. Holds in each hand in one subject not less than 20 — 30 sec.

At the age of 6 months the child turns over from a stomach on a back, sits without support, tries to grabble, rises to the feet at pulling up on hands; supported for a breast, does the first attempts to cross. Is enough objects with one hand, swings a rattle, lifts the toy which dropped out of hands, throws off a diaper from a face. Emotional manifestations are more various. Does the first attempts to say syllables — «oh», «ма» etc.

At the age of 7 months the child reaches for the image in a mirror, itself lifts and pulls the small bottle which dropped out during the feeding in a mouth rises by all fours, creeps, independently sits, kneels, clinging hands to a grid of a bed; supported under mice, well crosses. The movements become more reasonable. Many movements have quite emotional shade: the child lasts from hands on hands, gives hands of mother and the acquaintance etc. There is a repetition of syllables like «babab», «mamam» etc.

At the age of 8 months the child smiles to the reflection in a mirror, looks for a look a subject necessary to it, expresses with a mimicry surprise and interest at the sight of new objects etc. He already independently sits down and from a sitting position lays down; rises, clinging to a barrier. Costs, supported by one hand; supported by both hands and clinging to a back of a bed, does attempts to go. Tries to clap.

At the age of 9 months the child looks for the subject hidden under a diaper or fallen to a floor; does attempts to stand without support and to go behind a chair. Well goes, supported by both hands, sits down from vertical position, kneels. For the child at this age there are available some elementary movements: he collects small objects, gets cubes from a box, monitors falling of the thrown objects, clicks language, trying to draw attention of the adult, etc.

At the age of 10 months the child costs, rises without support, well goes behind a chair and does attempts to go with support only by one hand; imitates the movements of adults: opens and closes doors, takes small objects two fingers, does not give the toy which is taken away from him etc.

the Child calls separate, but always the same words various objects, napr, a cow — «му», a dog — «ав» etc., pronounces the simplest words — «mother», «woman», fulfills simple requirements, understands prohibition.

At the age of 11 — 12 months the child imposes one subject on another, tries to take off a stocking, squats without support, lifting a subject, bends down without squat, well goes, supported by one hand (11 months), takes the first steps without support (12 months). The child knows names of many objects, specifies parts of a body, carries out a large number of requirements, pronounces separate words etc. Duration of a dream decreases gradually and makes by 12 months 14 — 16 hours a day.

Hygiene of the baby

Correct physical. both psychomotor development and the normal resilience of its organism to negative impacts of the environment (in particular, to accidental infections) are possible only at correct physical. (food, the mode, physical culture) and pedagogical education in combination with rational leaving in the conditions of strict observance of rules of hygiene.

Children's chambers in institutions and the nursery in a family shall * be light, dry, with windows if it is possible, turned on Yu., Yu.-V. or Yu.-Z. A cubic capacity of air on each child — apprx. 20 — 30 m3. Temperature in the room 18 — 20 °, for children of the first months of life — 21 — 22 °. The room should be aired well, it is the best of all through a transom. It is necessary carefully to accustom children to sleep at an open window leaf or a window, seasonally, protecting them at the same time from a stream of a cold air.

Daily walk — an indispensable condition of the correct care of the child. Out of the room children well fall asleep and sleep peacefully. The child shall be warmly dressed (in the winter better to use warm sleeping bags). In 1,52 — 2 months air and hydrotherapeutic procedures for a hardening of children are shown (see. Hardening ); from the same age children should appoint massage (see. Massage , at children) and gymnastics (see. Gymnastics , for children of early and preschool age).

For it is the best of all to have a bed iron with the going-down sidewalls, height apprx. 60 cm. The mattress from a horsehair or a sea grass should be covered with an oilcloth, atop a cut to put a bed-sheet. The pillow is not obligatory, children well sleep also without it; if to use a pillow, then it shall be flat and is filled by a horsehair. It is necessary to use woolen or flannelette, in the summer in the winter — a fabric blanket with a blanket cover.

Fig. 2. Swaddling of the baby (consecutive stages): 1 — the child in a baby's undershirt lies on a diaper (the diaper curtailed by a corner), under a diaper consistently — a thin diaper, a warm diaper, a blanket; 2 and 3 — the end of a diaper is stretched between legs and will turn; 4 — the child is wrapped in a thin diaper to armpits (the end it is sprained under legs); 5 — the child is wrapped in a warm diaper (the end is sprained under legs); 6 — the child is wrapped in a blanket (the end it is sprained on legs and corners are filled from below).
Fig. 3. Some elements of care of the child: 1 — washing of an eye a cotton plug; 2 — a toilet of a nose a wadded wick; 3 — a toilet of an ear a wadded wick.
Fig. 4. Rubdown of the child after a podmyvaniye.

The clothes of the child in the first months of life consist of a baby's undershirt, a jacket, romper suit and diapers. Swaddling shall be free and not constrain movements of legs of the child (fig. 2). The swaddled child is put in a bed. At daily washing it is necessary to have for one child of 8 — 12 baby's undershirts and a romper suit, 6 jackets, 24 diapers, 24 thin diapers, 12 flannel diapers, 2 thin blankets and one warm (see. Linen, children's ).

Needs careful care of skin. In the morning his face is washed warm (25 — 28 °) with water. Each eye is washed out from an outside corner to internal a separate lump of the sterilized cotton wool (fig. 3, 1) moistened with boiled water or 2% solution boric to - you. The auricle and outside acoustical pass are cleaned the wadded wick moistened with boiled water (fig. 3, 3). The nose of the child is cleaned the same wick (fig. 3, 2) moistened with sterile liquid or vegetable oil. Then to the child wash with soap of a hand; the grown nails carefully cut scissors. It is impossible to wipe a mouth neither to, nor after feeding since even careful and gentle wiping easily injures a mucous membrane. Frequent change of the washed diapers, a podmyvaniye after defecation and an urination and a daily bathtub are necessary. After a podmyvaniye of the child carefully drain easy applying of a diaper (fig. 4), grease folds on his body with sterile vaseline, children's cream, vegetable oil or powder a thin coat of powder (talc with zinc); it is not necessary to apply organic powders.

Mother, the nurse and other persons who are looking after for shall observe purity of clothes, hands etc. Existence at them of a furunculosis, pempigus and other pustulous diseases of skin demands temporary discharge them from care of the child.

Along with correct a gigabyte. leaving and physical. education it is necessary to pay much attention and to the pedagogical education which is systematically carried out from first months of life of the child. It is necessary to support a positive emotional mood of the child, to timely develop at it motive abilities and the speech. In hours of wakefulness the child shall receive motive, acoustical, visual impressions which, however, shall not lead to his excessive exhaustion.

See also Feeding of children .

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A. F. Typ.