Infant Home

INFANT HOME (for nursing infants), a closed-type institution of the Mother and Child Protection organization. Infant Homes are intended for the upbringing of foundlings, as well as those nursing infants which, due to illness or the death of the mother, are deprived of proper care and feeding. Infant Homes, as they exist today in the USSR, did not exist before the revolution. The purpose of the old orphanages (see) was merely to provide for foundling children. Institutions of the type of our Infant Homes also exist in Germany and Austria. Previously, these institutions in our country and in the West were 'houses of death,' and only in the last 20 years has it been possible to successfully raise nursing infants in closed institutions. In 1894, Heubner became the head of the Berlin Children's Clinic. His merit lies primarily in the frank recognition of the horrifying infant mortality in closed institutions and in the study of its causes. Heubner was the first to state that the accumulation of nursing infants inevitably leads to high mortality; that the danger for infants of this age increases as they are accumulated and disappears upon separation; hence the principle of organizing an Infant Home so that the entire house is divided into groups, sharply isolated from one another. The high percentage of mortality in Infant Homes depends both on the severe condition in which the children arrive and on the diseases they acquire within the institution itself. The physical condition of the children in an Infant Home is characterized by the following features. The majority are sick children, and their weight compared to that of normally developed children of the same age is significantly lower. Upon admission to the institution, the majority fall under the influence of a whole series of negative factors acting on them—primarily of an infectious nature (intestinal infection and influenza). Most children in the first days of admission have dyspeptic stools and lose weight, which is apparently explained by the period of adaptation of the child to the new environment. Meyer explains this by the fact that the child in the new environment—in the institution—receives per os such bacteria as it did not have in its intestine until now. Other authors also observe that diarrhea followed by nutritional disturbance occurs significantly more often in closed institutions than in nursing infants in private homes. The greatest evil in the infant departments is influenza, which is a specifically severe disease in an Infant Home and gives the maximum of complications and mortality. In second place are gastrointestinal diseases. The principles underlying the organization of an Infant Home are the same as those for organizing hospitals for nursing infants: appropriate premises, qualified medical personnel, division of children into groups, application of meticulous hygiene, properly organized care and feeding. Each group of 10-12 children should have a room with a separate entrance, consisting of 2-3 rooms communicating with each other. It is desirable that at least one of these rooms can be isolated through an exit door into the corridor. A group of children aged 8-12 months should additionally have a playroom and a room for toilet training. The cubic capacity of the premises should be 27 m³, minimum 13-18 m³ per child and 1 staff member. An Infant Home must have a large garden. The children's rooms should face southwest or southeast. Approximate number of rooms for an Infant Home for 100 people: 8 sharply isolated groups; a separate room for an isolation ward with a separate exit to the outside (the isolation ward must be partitioned); a quarantine distribution room for newly arriving children, where children are held in terms of infection for up to 3 weeks (this must be a room separated from the general house). Each group must have a bathroom with several bathtubs. In addition, the following must be available: 1) a reception room and a room for examining a newly arrived child, isolated from all children's rooms; 2) a doctor's office; 3) a pharmacy for preparing and dispensing medicines, care items, and other medical equipment by groups; 4) a laboratory; in large Infant Homes it is desirable to have an X-ray room and a room for treatment with mountain sun; 5) a milk kitchen; 6) an office room, isolated from the children's rooms; 7) a room for duty personnel; 8) a room for feeding, calculated at 12 m² per wet nurse; 9) a dining room for wet nurses and staff; 10) a kitchen for wet nurses and living staff; 11) a room for wet nurses' activities (sewing, reading); 12) a bathroom and toilet for wet nurses; 13) a food store; 14) two linen rooms: a dispensing one and a reserve one; 15) a laundry with a dryer and ironing room. A cellar-freezer, sheds for storing firewood, coal, and all yard and household equipment are also necessary. The staff of an Infant Home (doctor, head of household, instructor sister, janitor) must live there, for which appropriate premises are necessary. The staff of the institution consists of a specialist doctor—pediatrician, well acquainted with early childhood (1 doctor per 30 children), an instructor sister, sisters who have also received special training in the care of young children, and technical personnel. The maximum number of children with whom a sister can cope to satisfy the minimum requirements in terms of necessary care, under which the children's development should not suffer, is 12 people. A separate shift of sisters is required for the isolation ward (for sick children and for quarantine) regardless of the number of children. The questions of feeding play a colossal role. The correct methodology of feeding nursing infants in an Infant Home is linked to the fact that the institution should always have a certain minimum of breast milk; that when transitioning to mixed and artificial feeding, the child receives mixtures sufficient in calories, which it can most easily assimilate, and finally that from 3-4 months the child receives a sufficient amount of vitamins. The supply of an Infant Home with good cow's milk with a properly organized farm is of very great importance. Under all these conditions, the development of children in an Infant Home can be no worse than with individual care. If hospitalism (see) occurs, it depends on the lack of prepared doctors, a small staff of sisters and their qualifications, and deficiencies in equipment. The path to further limiting the harmful influence of Infant Homes must consist in preventing respiratory diseases and improving the methods and technique of feeding.