BABIES AND THEIR CARE
The principles of hygiene are fundamentally the same for young and old.
The applications, however, differ at different ages. From the time when
physical growth and development are complete until changes due to old
age appear, an individual commonly has greater resistance than at other
ages, and is able in consequence to endure unfavorable conditions of
life with more success.
Babies, on the other hand, are exceedingly sensitive to their
environment. Surroundings that are even slightly unfavorable are likely
to make babies sick. In order to remain healthy, they must have exactly
the right kind of food, in the right quantities and at the right times;
their sleep, exercise, and clothing must be carefully regulated; they
must be protected from careless handling, from nervous strain, and above
all, from the many kinds of infection to which they are peculiarly
susceptible. The life of a baby fortunately can be controlled almost
completely; when properly regulated it offers, therefore, an unequalled
opportunity to see how hygienic principles work out in actual practice.
The primitive mother's instinct to nourish and protect and succor her
helpless child was the original form of nursing. Instinct alone,
unfortunately, has never accomplished much in preserving health. The
human race has now had an experience in the care of infants that extends
over thousands of years. Yet today we are still, on the whole, less
successful in keeping babies alive than we are in raising domestic
animals; we still allow society to continue, like a modern Herod, in its
ruthless career of slaughtering the innocents.
About 14 babies out of every 100 born in the registration area[1] of the
United States die before reaching the age of one year, while in some of
our industrial cities as many as 25 out of every 100 born die before
they are a year old. Most of these deaths are preventable. Thus, in a
few American cities, the death rates have been so reduced that fewer
than 10 babies out of every 100 die before completing the first year;
while in Dunedin, New Zealand, as a result of the work of the Society
for the Health of Women and Children, the infant death rate has been so
reduced that in 1912 only about 4 out of every 100 babies died before
they were a year old.
While ignorant mothers, who may or may not be uneducated women, and
contaminated milk, are as a matter of fact, chiefly responsible for our
high infant death rates, yet as we have already seen, every factor in
the environment has its effect upon a baby. This fact has led Sir Arthur
Newsholme, an eminent English authority, to say:
"Infant Mortality is the most sensitive index we possess of
social welfare. If babies were well born and well cared
for, their mortality would be negligible. The infant death
rate measures the intelligence, health, and right living of
fathers and mothers, the standards of morals and sanitation
of communities and governments, the efficiency of
physicians, nurses, health officers, and educators."
Care of the child should begin at the earliest possible moment: that is,
nearly nine months before he is born. Care before birth, for want of a
better name, is called prenatal care of the mother. Every woman who
thinks that she is pregnant should put herself at once under the care of
a competent physician, so that he can make the necessary examinations as
early as possible. If she follows his advice in regard to hygiene and
proper regulation of her life, she may be free from anxiety, and may
justly expect that her delivery will be a safe and normal process.
A demonstration of the value of prenatal care was recently made by the
Boston District Nursing Association. During the year 1915 prenatal care
was given to 751 expectant mothers in 5 wards of the city; each woman
attended a pregnancy clinic, where she was under the care of an
experienced obstetrician, and was visited at intervals by a nurse who
kept careful watch of her general condition and gave necessary advice
and encouragement. In consequence the death rate among the babies whose
mothers had prenatal care was only half as great, through the whole
first year of life, as the death rate of babies in the same wards whose
mothers had not had prenatal care. Moreover, the rate of still-births
was only half as great as the rate among the general population of
Boston. If prenatal care can save so many lives, surely it ought to be
available for every pregnant woman in the land, including even that
generally neglected class of people who are neither very rich nor very
poor.
Each baby's birth should be recorded by the registrar of births, and
parents should make sure that registration has been attended to in the
city or town where they live. In some states birth registration is
already obligatory, but in any case it is required by the child's own
interest. For instance, in later life it may be necessary for him to
prove the date and place of birth in order to establish, among other
things, his right to vote and to inherit property, and to settle the
question of his liability to military service. Moreover, complete and
accurate birth registration is needed by every community because it is
essential to such reforms as reducing infant mortality and abolishing
child labor.
GROWTH AND DEVELOPMENT
Statements in regard to growth and development are based on observations
of many children. It should be remembered that the following figures
represent averages only, and that healthy children may vary from them
considerably without giving cause for alarm.
AVERAGE SIZE.--The average weight of a baby at birth is from 7 to 7½
lbs. and the average length is about 20 inches, but it is not unusual
for a child to weigh anywhere from 5 to 10 pounds at birth and to
measure from 16 to 22 inches in length. During the first week of life a
baby loses slightly in weight. After the first week a healthy baby
should gain from 4 to 8 ounces a week until he is six months old; after
that time the weekly gain is less. The weight at birth will usually
double during the first five months, and treble during the first year.
Consequently, a baby weighing 7 pounds at birth may be expected to weigh
14 pounds when five months old, and 21 pounds when a year old. Weight is
one of the most important indications of a baby's condition. He should
be weighed every week during the first 6 months, once in two weeks
during the second 6 months, and once a month throughout the 2nd year.
MUSCULAR DEVELOPMENT.--A baby at birth is helpless, and during the first
few months he has little muscular control. During the third month he
ordinarily begins to lift his head, and he can usually hold it up
without support by the time he is 3 months old; when 7 to 8 months old
he sits erect and begins to play with toys. From this time a baby makes
rapid progress; he attempts to stand on his feet, begins to creep, and
by the time he is 14 months old he is usually able to stand alone, or
even to walk a few steps. He is usually running about without difficulty
when fifteen or sixteen months old.
Babies should never be urged to walk or to bear their weight on their
feet. If healthy they are generally eager to go about unaided, and like
to investigate their surroundings without assistance. If walking is
unusually delayed, a physician should be consulted.
DEVELOPMENT OF SPECIAL SENSES.--A new-born baby is unable to
distinguish objects, but the eyes are sensitive to light and need
careful protection. Hearing, although undeveloped at birth, soon becomes
acute; consequently the child should stay in a quiet room. When six or
eight weeks old he notices objects, and at three months old he welcomes
his mother when he is hungry. A month or two later he begins to
distinguish between familiar and unfamiliar faces, and to show approval
or disapproval.
DEVELOPMENT OF SPEECH.--A baby six or seven months old begins
consciously to utter sounds, and usually can say a few unconnected words
by the time he is a year old. The average child, however, does not begin
to form sentences of more than two or three words until he is about two
years old.
DEVELOPMENT OF TEETH.--The so-called milk teeth are twenty in number;
they are followed by thirty-two permanent teeth. The two lower front
teeth (central incisors) generally appear when a child is from five to
nine months old, and in from one to three months later the four upper
front teeth (upper incisors) appear. All the first or milk teeth should
have come through by the time a child is two and a half years old, but
wide variations occur both in the time and order of appearance and
should occasion no uneasiness if the child seems well. Unusual
conditions of any sort should be referred to the physician; it is a
great mistake to attribute all illness at this time to teething.
The first of the permanent teeth appear when a child is about six years
old. Mothers sometimes mistake the first permanent molars for temporary
teeth, a mistake that frequently leads to neglect and even extraction of
highly important teeth. All but the last four molars, sometimes called
wisdom teeth, should be through by the time a child is fifteen. The
wisdom teeth may not appear before the 20th or even the 25th year.
NORMAL EXCRETIONS.--A new-born baby should have one or two bowel
movements during the first twenty-four hours; the first bowel movements
are sticky and almost black in color. After the baby begins to nurse,
three to four movements a day are not unusual, and throughout infancy
and childhood as well as adult life there should be one or two
evacuations of the bowels daily. The character of the stools is more
important than the number. While the baby is taking milk only, the
movements should be soft, yellow in color, and nearly odorless. Change
in frequency of the movements, or appearance of undigested food or curds
of milk in the stool, should be carefully noted and if continued,
reported to a physician; they may be the first signs of serious
digestive trouble.
The urine of an infant should be odorless and colorless. It should be
voided at least once during the first twenty-four hours, and much more
frequently after the baby begins to nurse. Marked diminution in the
amount of urine should be reported to a doctor.
Efforts should be made early to develop habits of regularity in the
evacuation of the bladder and bowels. If taken up regularly most
children learn to use a chamber for bowel movements by the time they are
three months old. Normal children, if properly trained, usually have no
bladder discharge during the night after they are 18 months old, and
they learn even earlier to indicate a desire to urinate during the day
time.
CLOTHING.--The amount and weight of a baby's clothing should depend upon
the season; but garments worn next to the skin, except the diaper,
should be wholly or partly of wool, the lightest weight in summer and
heavier weight in winter. During the first few weeks a baby's abdomen
should be supported by a flannel binder about six inches wide, applied
snugly but not tightly enough to restrict either the abdomen or chest
walls. It may be replaced later by a loosely fitting knitted band worn
for warmth only. Such a band is especially necessary if there is
tendency to diarrhœa, but in no case should it be discarded before
the 18th month. All garments except the diaper and first flannel binder
should hang from the shoulders, and should fit loosely but well.
Clothing for babies should be of soft materials and should be simply
made. Even the first clothes should not be very long. The weight of very
long clothing is an unnecessary burden, and prevents free movements of
the legs. At night an entire change of clothing should be made, and a
nightgown of warmer material substituted for the petticoat and slip.
Most children are dressed too warmly indoors, but in low temperatures
they need to be well protected.
Diapers should be soft and absorbent. It may be necessary to wash new
diapers several times before using in order to make them soft enough.
Care should be taken not to apply them too tightly, or in such a way as
to cause pressure on the genitals. They should be changed during the day
whenever wet or soiled, and at night when the baby is taken up to be
fed. Proper care of diapers is highly important, however laborious. They
should be well washed, boiled, and thoroughly dried before they are used
a second time. Diapers that have been wet but not soiled should not be
dried and used again before being washed. Much work can be saved if
pads of loosely woven absorbent material are used inside the diaper to
receive discharges. The pads can be burned, but even if washed the labor
is less than washing full sized diapers. Like all other infant's
garments, diapers should be washed with pure white soap and without
starch. Waterproof material used to cover the diaper is almost sure to
irritate the baby's skin, and is consequently harmful.
SLEEP.--During his first few weeks a normal baby sleeps about
nine-tenths of the time, and should be left undisturbed except for
necessary care. He should sleep in a crib, bassinet or basket protected
from light and drafts; in no circumstances should a baby sleep in the
bed with his mother or any other person. Pillows are unnecessary for
babies, and indeed for older children, but if used they should be thin
and firm.
The amount of sleep necessary gradually diminishes, but during all the
years of growth a child needs more sleep than an adult. The amount of
sleep required daily is approximately as follows:
First month 18 to 20 hours
Second to sixth month 16 to 18 hours
Sixth month to one year 14 to 15 hours
One to two years 13 to 14 hours
Two to four years 11 to 12 hours
After this time a child should sleep at least ten hours out of the
twenty-four. During the first year a nap in the middle of the forenoon
and another in the afternoon are desirable. A child who is inclined to
sleep so long that his nap interferes with his night's sleep, should be
waked from his nap, but at the same hour every day. When a child is a
year old, one nap during the day is often sufficient, if he is doing
well, but the habit of taking a nap at some time during the day should
be continued through the fifth year if possible, or even later.
Babies should not be rocked or otherwise coaxed to go to sleep; they
should be made comfortable and then left alone. They learn to go to
sleep by themselves as soon as they are convinced that sleep is expected
of them, and that no unfounded objections on their part will be
regarded. Continued inability to sleep normally usually indicates
discomfort or poor general condition, and should be taken up with the
doctor. Pacifiers and thumb-sucking should not be allowed, since they
lead to changes in the shape of the jaw with resulting imperfect
adjustment of the teeth. Soothing syrup and like medicines should never
be given to a baby; death or permanent injury has resulted from their
use. It is impossible to emphasize too strongly the danger of giving
them even a single time.
FRESH AIR.--All that has been said about the importance of fresh air
for adults applies with even greater force to infants and children.
During his first month especially a baby is susceptible to draughts;
nevertheless, the room should be well ventilated and its temperature
kept between 68° and 70° F. during the day, and at about 65° F. at
night. Even in cold weather the room should be well aired two or three
times a day; the baby should be removed to another room while the
windows are open. After the baby is three or four months old the windows
may be left open at night provided the outside temperature does not fall
below freezing. A healthy baby two or three weeks old may be taken
out-of-doors for a short time in mild weather; when he is three months
old he may be taken out-of-doors even in winter on bright sunny days.
The time spent out-of-doors should be gradually increased until the baby
stays out the greater part of the day; but he should not be exposed to
storms, wind, flying dust, dampness, extremes of temperature, or
insects. The eyes should not be covered by veils, but they should be
shielded from the direct rays of the sun at all times.
DIET.--A baby, in order to thrive, must have suitable food, given at
regular intervals. During the first few months of life no other food
can take the place of mother's milk. Breast-fed babies are more robust
than bottle-fed babies; more than this, they are less likely to contract
infectious diseases or to suffer from digestive disorders. The number of
bottle-fed babies who die every year is three times as great as the
number of breast-fed babies who die. Many mothers do not understand the
risk involved in weaning small babies; and so every year many little
lives are lost, and lost needlessly. When poverty forces nursing mothers
to wean their babies and seek work outside their homes, one can only say
that a society which tolerates such a waste of infant life is indeed
regardless of its own welfare.
Special conditions, of course, may make it undesirable for a mother to
nurse her baby. No one but the physician is competent to decide this;
not even neighbors, grandmothers, other members of the family, or the
mother herself. Where artificial feeding must be used, it should be
carefully adapted to the individual child, and in consequence it must be
prescribed by the doctor. Patent foods, notwithstanding the claims on
their printed labels, should be used only under his advice.
INTERVALS OF FEEDING.--Little milk is secreted during the first two days
after the birth of a child. The baby should, nevertheless, be put to
the breast as soon as he has had his first bath, if the mother is
sufficiently rested. Always before and after nursing the mother's
nipples should be washed in water that has been boiled. Nursing should
be repeated at intervals of six hours during the first two days.
The following schedule for the feeding of healthy babies is given by
Holt in "Care and Feeding of Infants." (1917.)
SCHEDULE FOR HEALTHY INFANTS FOR THE FIRST YEAR
------------------+--------+----------+----------+-----------+--------
| | | | |
|Interval| Night | No. of | Quantity |Quantity
Age |between | feedings,| feedings,| for one | for 24
|meals by| 6 p.m. | in 24 | feeding | hours
| day | to | hours | |
| | 6 a.m. | | |
------------------+--------+----------+----------+-----------+--------
| Hours | | | Ounces | Ounces
2d to 7th day | 3 | 2 | 7 | 1-2 | 1-14
2d and 3d weeks | 3 | 2 | 7 | 2-3½ | 14-24
4th to 6th week | 3 | 2 | 7 | 3-4 | 21-28
7th week to 3 mos.| 3 | 2 | 7 | 3½-5 | 25-35
3 to 5 months | 3 | 1 | 6 | 4½-6 | 27-36
5 to 7 months | 3 | 1 | 6 | 5½-6½ | 33-39
7 to 12 months | 4 | 1 | 5 | 7-8½ | 35-43
------------------+--------+----------+----------+-----------+--------
During the period when seven feedings are given in 24 hours the
following hours will be found convenient: 6 a.m., 9 a.m., 12 m., 3 p.m.,
6 p.m., 10 p.m. and 2 a.m. The 2 a.m. feeding is the one omitted when
the number of feedings is reduced from seven to six. Food should be
given on exact schedule time; the baby if asleep should be waked for
any meal except the one due at 2 a.m.
WATER.--Pure boiled water should be given regularly even to a young
baby. He is often satisfied with a little warm water if he is fretful
between the hours of nursing. Water may be given from a cup, a spoon, or
a bottle; it is desirable, however, for the baby to learn to drink from
a cup before the period of weaning begins.
WEANING.--Ordinarily, a baby should be fed from the breast until he is
seven months old, either exclusively or with the exception after the
second month of one bottle-feeding in twenty-four hours. This exception
will do the baby no harm and may be a great relief to his mother.
Partial breast-feeding should continue if possible through the ninth
month, but every baby should be entirely weaned by the time he is one
year old. It may be necessary, if either the baby or the mother is not
thriving, to change the food before the ninth month; but it is desirable
not to make the change in hot weather. Healthy babies, it should be
remembered, increase in weight constantly, and steady gain in weight is
the best indication that a baby's food is suitable.
NURSING BOTTLES AND NIPPLES.--Nursing bottles should be of heavy glass,
cylindrical in shape, without angles or corners to make cleaning
difficult. The number of bottles provided should be two or three more
than the number of feedings given in 24 hours.
Short black rubber nipples which slip over the neck of the bottles
should be selected. They should be of such a shape that they can easily
be turned inside out; a nipple turner costs little, and is well worth
the price. Nipples should be discarded when they become soft or when the
opening grows so large that the milk runs in a stream rather than drop
by drop.
As soon as the baby has finished his meal, the bottle should be removed
from his mouth, rinsed in clear hot water, and left standing filled with
cold water until a convenient time for boiling all the bottles to be
used during the next 24 hours. Sufficient time must be allowed for the
bottles to cool thoroughly between the time when they are boiled and the
time when they are refilled. When it is time to boil the bottles they
should be placed in an agate or other suitable kettle, covered with
water, and boiled vigorously for three minutes. A cloth placed in the
bottom of the kettle will help to prevent the bottles from breaking.
After the bottles have been removed from the boiling water, they should
be stoppered at once, either with rubber stoppers or plugs of sterile
cotton. The stoppers, if used, should be boiled with the bottles;
sterile cotton may be purchased by the package.
An easy and satisfactory method to care for rubber nipples is the
following: Provide as many nipples as the number of feedings given in 24
hours, and another, if desired, to be used in case of accident; provide
also two cups of ordinary white enamel, each one large enough to hold
all the nipples at once. One cup should have a cover; the other should
not. To avoid mistakes it is well to have the cups different in shape.
As soon as each feeding is finished the nipple should be thoroughly
cleansed under running water by scrubbing it inside and out with a
nipple brush. The nipple thus cleansed is placed in the cup without a
cover. When all the nipples have been used, cleansed, and collected in
the uncovered cup, they are transferred into the other cup; water is
added, the cup is covered and its contents are boiled for three minutes.
The nipples remain covered in the boiled water until needed; they are
removed one by one for the successive feedings. Care must be used in
removing a nipple to take it by the rim, not to touch other nipples
during the process and not to dip the fingers into the water. The best
way is to remove them by means of a glass rod, which is boiled with the
nipples and kept with them in the cup when not in use. There are
several advantages of this method of caring for nipples: it is easy; it
reduces to a minimum the necessary handling of the nipples after
boiling; and it reduces the probability of using the wrong nipple, since
boiled nipples are always in one kind of receptacle and used nipples in
another. It also prevents the too common practice of continuing to keep
nipples in a supposedly antiseptic solution long after the solution has
become badly soiled.
TABLES of diet for children over one year of age may be found in the
Appendix, page 322.
BATHING.--Usually the cord has separated and the navel has entirely
healed by the time a baby is 10 days old. After this time a daily tub
bath should be given; it should be given not less than one hour after
feeding. The temperature of the room should be from 70-72°, measured by
a thermometer placed in the part of the room where the bath is to take
place. In order to avoid chilling or tiring the baby the bath should be
given quickly, without confusion or interruption; success can be
achieved by using even a moderate amount of foresight. Before undressing
the baby everything to be used should be collected and placed within
easy reach,--clean clothing, soft towels, 2 wash cloths, pure white
soap, powder, absorbent cotton, etc. The bath tub should last of all be
filled with water, and its temperature tested by means of a bath
thermometer. The temperature of the water should be from 98° to 100°.
After the baby is three months old slightly cooler water should be
splashed over his chest, back, neck, and arms just after he is removed
from the tub, and as he grows older the temperature of his cool splash
can be reduced. Children who become accustomed to cool water in this way
take kindly to their cold showers later.
The baby's face should be washed first and dried carefully, while his
body is still covered. Next the head should be washed; a little soap
should be used, but it must on no account enter the eyes. Next the
entire body should be soaped with the hand; and then the baby should be
placed gently in the bath, his head and shoulders supported by the
attendant's left hand and forearm. Care should be taken to rinse off all
the soap. The baby should not stay in the tub more than 2 or 3 minutes;
after he has been removed from the tub he should be wrapped at once in a
soft bath towel. He should be dried gently but thoroughly by patting
with soft, warm towels rather than by rubbing. Folds of the skin should
be dried with special care. A little powder may be applied, but a baby
who is kept both clean and dry will not need much powder, if any. The
baby should next be quickly dressed, with as little turning and moving
as possible. Clothing should be drawn on over the feet instead of over
the head, and the petticoat should be placed inside the slip so that the
two garments may go on simultaneously.
EYES.--Secretion accumulating in the corners of a baby's eyes should be
removed by means of a bit of absorbent cotton moistened in boiled water.
The secretion should be wiped away gently; a different piece of cotton
should be used for each eye, and a piece that has been used should not
be put back into the water. Further than this, eyes in a normal
condition do not need cleansing.
Every person who handles a baby should be very sure that her hands are
clean; she should be doubly sure before she touches his eyes, since a
baby's eyes are peculiarly susceptible to infection from any source.
More than a quarter of all totally blind persons in the United States
became blind by infection of the eyes at birth. Blindness of the new
born can be prevented in practically all cases if the doctor uses a
preparation of silver in the baby's eyes immediately after birth. This
treatment is effective and entirely safe.
If at any time the eyelids look red or swollen, or if a drop of matter
appears between the lids, the physician should be summoned at once.
Total blindness may result if treatment is delayed even a few hours.
MOUTH.--The mouth should be rinsed after feeding by giving the baby a
teaspoonful of boiled water. Until the teeth come it does not require
other cleansing, and attempts to clean it may injure the delicate
membranes that line it. Indeed, except in an emergency, fingers should
not be inserted into a baby's mouth. The teeth when they appear should
be cleaned by means of a soft tooth-brush.
NOSTRILS.--The nostrils need no cleaning other than removal of mucus
that can easily be reached by means of a piece of cotton. If a little
vaseline is placed in the nostrils on a small piece of absorbent cotton
in the early morning, collections of mucus will usually be softened so
that they can be removed easily at bath time.
GENITAL ORGANS.--The genital organs of girl babies should be gently
washed twice a day, using absorbent cotton, and tepid water. Treatment
other than cleanliness is ordinarily unnecessary. Vaseline may be
applied if the genitals are slightly reddened; any discharge or abnormal
appearance should be reported to the doctor. In the case of boy babies
the foreskin should be gently drawn back twice a week after immersion in
the tub; after the parts have been gently washed with absorbent cotton,
it should be drawn forward again. No force should be employed in
retracting the foreskin; the physician should be consulted if it cannot
be retracted easily.
THE DEVELOPMENT OF HABITS.--During his first few months crying is a
child's only means of expression, and he quickly learns to make
effective use of his limited opportunities. It is important for the
mother to distinguish between crying caused by pain, illness, or hunger,
and crying caused by temper. These cries are more or less distinctive,
but no one can be sure in every case just what a crying baby is
attempting to express.
A cry caused by hunger is fretful and often interrupted by sucking the
thumb; it ceases when the child is fed. A cry caused by indigestion is
similar; the child is relieved for a short time by feeding, but soon
begins to cry again. If he has acute pain, such as earache, the cry is
sharp, repeated at frequent intervals and accompanied by other symptoms
of distress, such as restlessness, contraction of the features, and
drawing up the legs. In serious illness the cry is usually feeble,
fairly constant except when the child is asleep, and exaggerated by
slight causes.
A limited amount of crying is useful exercise for a baby, and should not
distress his mother unduly. Moreover, crying may be merely the
expression of a wish to be taken up, to be played with, carried about or
otherwise amused, to be given a pacifier, or to be indulged in other bad
habits. If not indulged in these ways he may cry from temper. The cry of
temper is loud and violent, accompanied by vigorous kicking or by
holding the body rigid. Proper treatment of the baby may prevent many
months of discomfort, and spare him the formation of his first bad
habit. All other possible causes for crying should be eliminated. If the
child continues to cry when he is warm and dry and comfortable, "It
should simply be allowed to cry it out. This often requires an hour and
in extreme cases two or three hours. A second struggle will seldom last
more than ten or fifteen minutes and a third will rarely be necessary"
(Holt). Gas may form in the child's stomach during prolonged crying. It
is consequently permissible to take him up after 15 minutes, and hold
him erect; he generally expels gas at once, and immediately experiences
relief. As soon as he is relieved, he should go back to his crib.
EXERCISE.--Exercise is essential to the development of the body, but
during the first few weeks warmth and quiet are so important that a baby
should not be disturbed except for necessary care. His position,
however, should be changed occasionally; if he lies on the same side
constantly the soft bones of the head may become misshapen from
pressure. As the baby grows older he needs more exercise, and he may be
given an opportunity for it by removing his outer clothing and placing
him on a bed in a warm room for a short time each day. Unnecessary
handling is not good for a baby at any age.
After he becomes more active, he may play on a mattress or thick blanket
placed on the floor. The blanket should be covered with a washable pad
or rubber cloth and clean sheet, and the whole should be surrounded by a
fence at least two feet high. In such an enclosure a baby may safely be
left to play if protected from draughts and cold. Elevated pens that can
be folded when not in use are more convenient but more expensive than
the home-made arrangement. As soon as a child begins to run about he
takes ample exercise, and he may even need to be guarded from too great
fatigue, especially toward bedtime. Games and play should be adapted to
the age of the child and sufficiently varied to exercise all portions of
the body; but they should not be too violent nor too prolonged. Some
supervision of children's play is necessary, but they should be given as
much freedom as possible and allowed to develop their own initiative.
PLAY AND TOYS.--The desire for play does not develop until a child is
about six months old. At this age toys that can be washed, such as those
of hard or soft rubber, should be selected. A baby instinctively carries
everything to his mouth,--first his thumb, then playthings, and later
whatever he may find, no matter how unsuitable. For his safety and
protection this habit should be overcome as soon as possible, and he
must learn to put nothing in his mouth except food and drink. Relatives
are nearly always tempted to give too many and too fragile toys; they
merely teach a child to be destructive and constantly to expect
something new. Toys are the first possessions of which a child is
conscious, and through them many desirable qualities may be developed:
neatness and order, gentleness and a feeling of protection toward the
helpless doll or Teddy bear, and unselfishness in sharing special
treasures with playmates. Later the child may be given pets and made
responsible for their care; but animals should not be subjected to
unintentional cruelties from small children.
EXERCISES
1. What two factors are chiefly responsible for the deaths of babies
under a year old? What other factors contribute? In your city or town
what is the number of deaths per 1000 births of babies under one year
old?
2. Why is birth registration important to an individual? to a
community? Is it required by law in your city?
3. What is the average weight of babies at birth? Describe the rate at
which they should gain.
4. At what age may a normal child be expected to sit erect? to stand? to
walk? to speak? When should his first teeth appear? his permanent teeth?
5. Describe normal bowel movements of a baby.
6. How should a young baby be dressed?
7. Describe a baby's bath and toilet.
8. Describe the surroundings that are suitable for a baby.
9. What is the best food for a healthy baby? Why?
10. Describe in detail a good daily program for a healthy baby four
months old.
11. What habits are desirable for a baby to form, and how may he be
trained so that he will form them?
12. Name all the indications that would tell you when a baby was not
thriving, and in each case tell what you would do about it.
FOR FURTHER READING
The Care and Feeding of Children--Holt.
The Care and Feeding of the Baby--Truby King.
The Baby's First Two Years--R. M. Smith.
The Care and Feeding of Children--J. L. Morse.
Preventive Medicine and Hygiene--Rosenau, Section III, Chapter II.
Pamphlets:
Prenatal Care, Mrs. Max West.
Infant Care, Mrs. Max West.
Child Care, Mrs. Max West. Published by the Children's Bureau,
United States Department of Labor, Washington, D. C. (Free on
request.)
The Care of the Baby--Supplement No. 10 to the Public Health Reports,
1913, Government Printing Office, Washington, D. C.
Your Baby: How to Keep It Well--New York State Department of Health,
Albany.
Publications of the American Association for the Study and Prevention of
Infant Mortality--1211 Cathedral Street, Baltimore, Md. (Free on
request.)
Publications of the National Committee for the Prevention of
Blindness--130 East 22d Street, New York City. (Free on request.)
FOOTNOTES:
[1] An area including about two-thirds of the population of the United
States.