The daily care of the normal, well eye has been already described, and while it need not be reiterated, we may say, in passing, that if the eyelid be at all inclined to be sticky or adherent, never use force, but instead, gently swab with boracic acid. As a preventive of this condition, a little vaseline from the tube may be rubbed on the edges of the lids at night.

In the toilet of the ears, never attempt to introduce anything beyond the external ear, which may be carefully cleansed with a soft cloth. It is often found necessary to apply oil to the creases behind the ears before the daily bath. There should be no irritation, redness, or roughness present, all such conditions being readily prevented by the use of oil or vaseline before the bath.

With the sharp point removed, make a cotton applicator out of a toothpick, and gently (with no force, whatever) introduce vaseline or oil into the nose. This should be a part of baby's daily toilet. Any stoppage of mucus or snuffiness in the nose should be reported at once to baby's physician. Young babies often have adenoids.

CARE OF THE MOUTH

Leave the well mouth alone until the teeth appear, and then keep the teeth very clean (allowing no particles of milk to accumulate at their bases) with a soft bit of cotton and gentle rubbing. When a child attains the age of two, he should have his own toothbrush; previous to this time all food particles should be removed from between the teeth with waxed silk floss. All decay should be promptly attended to by a competent dentist.

Thrush and ulcers are often caused, not prevented, by the frequent wiping out of baby's tender mouth. The treatment of thrush and other mouth infections will be considered in a later chapter, "The Common Disorders of Infancy."

THE CARE OF THE GENITAL ORGANS

Before the bath, the baby girl's genitals are carefully swabbed between all the folds with boracic acid solution. The foreskin of the boy baby should be pushed well back and washed gently with water. If the foreskin of the male child be long, tight, or adherent, circumcision is advised. See our chapter, "Teaching Truth."

The genitals of both the boy and girl should be kept scrupulously clean every day, with as little handling as possible, and, upon the appearance of the least swelling, discharge, or even redness, the physician's attention should be at once called to it. In a later chapter, the subject of irregularities of sex habits will be taken up.

CARE OF THE BUTTOCKS

Often, because of irritating bowel movements, the buttocks become reddened, chafed, and sometimes raw in places. Some poor little babies are sometimes roughly rubbed—scoured on the buttocks—much like the kitchen sink, many times a day, and it is not surprising that they become reddened, chafed, and very much inflamed.

The buttocks require a gentle swabbing and thoroughgoing "patting dry" after each soiling or wetting of the diaper, but no soap is required in this region but once a day, and even then it should be used sparingly.

When the buttocks are inflamed, after a good cleansing with water and a thorough drying, vaseline or zinc ointment should be applied on a piece of sterile cotton, and this application should be repeated after each changing of the diaper. Wet diapers should be removed at once, for the acidity of the urine causes more chafing. A dusting powder composed of starch two parts, and boracic acid one part, may be dusted on after a cleansing with oil.

Great care should be exercised in the thorough daily rinsing of the diapers as well as in the tri-weekly boil in the laundry. White soap only should be used in their cleansings; no washing sodas or other powders should be used.

OTHER SPECIAL CARE

Under the arms and in the creases of the neck the skin sometimes becomes irritated because of neglect. To prevent such chafing the following program should be carefully carried out:

1. Not too much soap—and no strong soap. 2. Careful rinsing of the skin area. 3. Avoid harsh rubbing, but thoroughly dry. 4. The use of talcum powder in all folds of the skin.

With a fine camel's hair brush the hair should receive its brushing after the cleansing of the scalp. Combs are for just one purpose and that is to part the hair. The brush should be used to do all the smoothing.

While the frequent trimming of the hair has no marked effect upon its growth, yet the comfort the little girls enjoy, especially during the warm-weather months, should not be denied them.

And certainly the boy should become a boy when he puts on trousers and not be made the laughing stock of his mirthful companions just because his "beautiful long curls are much admired by the mother and his aunts."

The finger nails should be trimmed round with the scissors, while all hangnails are properly cared for every day. Toe nails should be cut straight across and the corners never rounded off. Many ingrowing nails may be thus avoided.



CHAPTER XXI

BABY'S CLOTHING

The Eden story suggests that in the beginning of our racial experience artificial clothing was unnecessary; but after a time, in that selfsame garden, proper clothing became an important problem and has remained so ever since. Everybody seems to agree, however, that baby's clothing in particular should at least be comfortable. It may give the child great discomfort because it may be too warm, or it may not be warm enough, or it may be too tight, and so, in the discussion of baby's clothing in this chapter, we are going to keep in mind these two things—comfort and heat.

GENERAL SUGGESTIONS

The choice of material demands some thought and attention. As a rule, baby's clothing materials should be light in weight, good moisture absorbers, and at the same time able to retain the body heat. Most layettes have the common fault of being prematurely outgrown; and so it is well to allow for ample growth in making baby's first clothes. Since the principal object of clothing is to insure a uniform body temperature, it is important that the mother be constantly on her guard to keep the baby cool enough in the summer and warm enough in the winter.

The mothers of various races and nations have their own ideas concerning the clothing of their babies. One mother will wrap her baby in cotton, which is held in place by means of a roller bandage, and as you visit this home during the first week of baby's life, you will be handed a little mummy-shaped creature—straight as a little poker—all wrapped up in cotton and a roller bandage. The surprising feature is that the baby does not seem to complain.

In another district of the city we find the baby dressed in starched clothes, ribbon sashes, bright ribbon bows on its arms and around its neck. At first glance you wonder if the little child is not many years older and is about to make a visit to a county fair, but on inquiry we find that he has only been prepared for the event of circumcision on the eighth day.

And if you go into the forest of primeval days you will find another mother bandaging her baby to a board, head and all, and he seems to live and thrive in his little woven nest strapped on the back of his Indian mother.

Other babies in the warmer portions of the earth have almost less than nothing on, and are left to be swung by the breezes in little baskets tied to the boughs of trees; being taken up only when it is time to feed.

BABY'S LAYETTE

In preparing an outfit for the newcomer it is wise to provide for the necessities only, because of the fact that since the baby grows very fast the layette will soon have to be discarded; it is always possible to get more clothing after the baby is here and started on his little career. We offer the following list of essentials for the new born baby:

Slips 8 to 10 Skirts (flannel) 3 Shirts 3 Light-weight wool wrappers 2 Abdominal bands 3 to 5 Diapers (first size) 2 doz. Diapers (third size) 2 doz. Stockings, pairs 3 Booties, pairs 3 Nightgowns 7 Handling blankets 2 Silkaline puffs 2 Baby blankets, pair 1 Hair or cotton mattress 1 Basinet 1

BANDS AND SHIRTS

The binder should be made of an unhemmed strip of flannel six inches wide and twenty inches long, so that it goes around the abdomen once with a small overlap. This binder should be sewed on instead of being pinned, and serves the purpose of holding the dressings of the cord in place. It is usually worn from four to six weeks, when it is replaced by a silk and wool barrel-shaped band with shoulder straps and tabs at the bottom, both front and back, to which may be pinned the diaper. This band is worn through the first three or four years to protect the abdomen from drafts and chilling, thus guarding against those intestinal disturbances which are caused by sudden weather changes.

There is great danger of having the bellyband too tight, and, in the early weeks, it is often the cause of great discomfort—often interfering with the normal expansion of the stomach at meal time.

No matter what the season, the new-born baby should be clothed in a light-weight silk and wool shirt, preferably the second size. After the first month, if the weather is exceedingly warm, this woolen shirt may be displaced by a thin silk or lisle shirt. In buying the second-size shirts always secure the stretchers at the same time, for in the laundering they soon shrink so that they are very uncomfortable for the young babe.

DIAPERS

There are a number of materials on the market from which comfortable diapers may be made for the baby. The cotton stockinet (ready-made shaped diaper) is excellent, fitting smoothly at the waist, while it is large and baggy at the seat, thus permitting not only a comfortable feeling but the free use of the hips, without the bulkiness of the ordinary diaper.

The large square of cheesecloth is easily laundered, and if an inside pad is used makes a very acceptable diaper.

The stork diapers are made of materials resembling turkish toweling and are used to some extent. This diaper should not be confused with the stork rubber diaper which will be spoken of later.

Birdseye cotton is popular and extensively used. It absorbs quickly, and is much lighter in weight than linen. The first- and third-size widths should be purchased as a part of the layette, and the number of diapers needed depends upon the opportunities to wash them out, for diapers are never used but once without washing; they should always be quickly rinsed and dried in the sunshine if possible. So if there are good laundry privileges, and daily washing is possible, the mother can get along with fewer diapers, but no less than four dozen should be provided.

The diaper pad will be found convenient and serviceable in the early days when the skin of the child is so very tender. This pad should be pieces of clean old linen or small pads of absorbent cotton.

CHANGING THE DIAPER

During the mother's waking hours, the diaper should be changed as soon as it is soiled or wet. If the child cries during the night it should be changed immediately, but the mother should not feel called upon to lay awake nights merely to change the baby's napkin when it is soiled. If she places a pad underneath the baby, which will absorb the urine quickly, he often does not awaken or become chilled. The pad should be sufficiently thick to ensure that the nightgown does not get wet.

RUBBER DIAPERS

Rubber sheeting diapers of any description should never be used. Avoid all patent diapers with a covering or an inner lining of rubber, for, like the rubber diaper, they not only irritate the child but also retain moisture and heat, which produce such irritation and itching that the subsequent "habit-scratching" often lays the foundation for future bad practices. It is far better for the mother to carry about with her, whenever it is necessary to take the baby away from home, a rubber pad which she puts on her lap underneath the little fellow, thus affording ample protection to herself without in the least harming the baby.

STOCKINGS AND BOOTIES

During the winter months merino stockings are required, while during the summer months a thin wool or silk stocking is sufficient; on the extremely hot days thin cotton hose may be worn. During infancy, the stockings should be fastened to the diaper with safety pins, while on the second-year child, hose supporters attached to the waist are found very convenient.

A friend told me the other day of a mother who told her the following story: "Do you know, I don't have any trouble any more about my baby keeping up his socks for I have fixed it so they won't come off any more. Every time I looked at his feet he had kicked off his socks and they were no good to him at all, so I took little chunks of brown laundry soap, moistened them and rubbed his legs, as well as the inside of his socks and I never, never have any more trouble with them coming off."

It does not seem possible in this enlightened age that a mother could be so ignorant as to keep the socks up with brown soap, but the friend assured me it was a true story, and while it may shock some of my readers as it did me, I must add, in passing to another subject, that the use of round garters on little babies and young children is just about as shocking.

During the fall, winter, and spring, booties are worn on top of the stockings. These booties should be crocheted or knitted out of the heavy Germantown yarn, and there should be enough of them so that the child may have a clean pair on every day.

SKIRTS AND PETTICOATS

The flannel petticoat is made with yokes instead of bands, and during the fall, winter, and spring these yokes are made of flannel like the skirt and should have long sleeves of the same material. The yokes should be made large enough so that they may be used during the entire first year (the plait in the front can easily be taken out when the baby is six months old so that it may be used much longer than if the yoke is made without a plait). For the hot summer months, the yokes should be a thin cotton material without sleeves; and, if the baby is housed in an over-heated apartment, this fact should be borne in mind and the winter skirt should be made accordingly. We have found, however, that the baby who is amply protected and uniformly dressed, does not require the outer bundlings that the poorly dressed child requires. Part wool and cotton materials are very comfortable in the overheated city apartments. White skirts are not necessary for small babies. They only add extra weight and it is always foolish to put anything on a small baby simply for looks.

NIGHTGOWNS, WRAPPERS, AND SLIPS

The nightgowns should be made of soft cotton flannel or stockinet. The latter is really the better, and can be purchased in sizes up to two years; it is absorbent, easily laundered, and may be conveniently drawn up at the bottom by means of a drawstring.

At least seven nightgowns are needed. A fresh nightgown should be used each day and each night during the first four or five weeks of baby's life; while as he gets older (two or three years), the night drawers with feet in them are used to advantage.

The wrappers are usually made of challis, nun's veiling, cashmere, or other light woolen materials which can be readily washed. They are very serviceable to wear over the baby's thin slips and on cool nights they may be used over the nightdress. They should be simply made, containing no heavy seams, and at the neck there should be the simplest kind of a soft band that will in no way produce friction or in any other way irritate the baby's skin.

Slips are usually made of some very soft material such as nainsook, batiste, pearline, or sheer lawn cloth. Twenty-seven inches is the length that will be found both comfortable and convenient. All laces, ruffles, and heavy bands which will scratch or irritate should be avoided as eczema is often caused by such mistakes.

SLEEPING BAG

The sleeping bag is of inestimable value, affording extra and secure covering for the child, and peace of mind for the mother. In the early weeks it should be made of light flannel, but as the child gets older the sleeping blanket is made according to illustration (See Fig. 5) by merely folding a blanket in such a manner that the child cannot possibly uncover himself. The mother can sleep undisturbed, knowing that the baby is always safely protected by at least one warm blanket cover.

COMMON FAULTS WITH MOST LAYETTES

As a usual thing the first clothes are made too small. The sleeves are too short as well as too small around. There is nothing more uncomfortable than a tight sleeve. Everyone of our readers knows that, and we recall one poor little fellow who kept up a fretful cry until we took the scissors and cut the tightly stretched sleeve up to and including the arm hole. He then relaxed and went to sleep. Sleeves should be made two inches longer than they are needed at first, and it is a very simple matter to pin them up or turn them back at the wrist. They should be loose and roomy.

The yokes of the dresses usually are too tight before the slips are discarded. Heavy seams and raw seams irritate and often make ugly impressions on the baby's skin.

Usually the first layette is profusely embroidered, and, while it is beautiful to look at, the mother feels when she sees it outgrown so quickly that a lot of vital energy was wasted on garments that mattered so little as long as baby was comfortable. Baby is dear and sweet enough without the fuss and furbelows of such elaborate garments.

Heavy materials are sometimes used where lighter ones would serve better.

ERRORS IN CLOTHING

A soiled garment should never be put back on the baby. Dirt draws flies, and flies are breeders of disease. Sour-smelling garments should be changed at once. They are likely to make the baby sick and interfere with his appetite if left on indefinitely. The care of the diaper has already been mentioned.

The main symptom of too much clothing is sweating, and when the baby sweats something must come off. If he has perspired so much that his clothes are moist, the clothing should be changed and the skin well dried with talcum powder. The feet and hands should be kept warm, but the little head should always be kept cool. When the baby is crying and getting his daily exercise, remove some of the covering, loosen his diaper, and let him kick and wave his arms in perfect freedom.

When the baby's feet and hands are cool he is not warm enough. Cotton underskirts cannot be used in the dead of winter on little babies. They do not hold the body heat as woolen garments do. The baby's feet should always be warm and this is particularly necessary in poorly nourished children. The outer wrapper of woolen material should be added to such baby's clothing. It is a safe rule to follow that if baby's hands are warm and he is not sweating, he is "just about right."

SHORT CLOTHES

At the age from four to six months, baby's clothes are shortened. This should not take place at the beginning of winter if it can be avoided. If the first layette has consisted of only the necessary garments, they are nearly worn out by the time the short clothes are due; of those that do remain, the sleeves should be lengthened, the arm holes enlarged, and all the little waists let out. Creeping garments and bibs are now added to baby's outfit, as well as leggings and other necessities for outdoor wear. Remember that all garments must be loose—then baby is happy.

About the same number of garments are found necessary for the short clothes as were required at first; except that a large number of creeping rompers should be added. These creeping rompers should not be made of dark materials that do not show the soil. We desire the dirt to be seen that we may keep the baby clean, and if the creeping romper is made of a firm, white material it may be boiled in the laundry, thus affording ample and thorough cleansing.

We attributed a sick spell of one baby to the dark-blue calico creeping romper which he wore day in and day out because it "did not show" the soil. White ones are much to be preferred, not only for looks but chiefly for sanitary reasons.

CAPS AND WRAPS

The cap should be made of a material that will protect from drafts and cold air, but not of such heavy materials as will cause too much sweating. There are a number of outside wraps that can be purchased ready-made and which are comfortable, convenient, and warm. They should be long enough not only to cover the baby's feet well, but to pin up over the feet, thus giving good protection from winds and drafts.

During the summer months nainsook caps or other thin materials are to be preferred to the heavy crocheted caps that are sometimes worn by babies. No starch should be used in the caps or strings, and there should be no ruffles to scratch the delicate skin of the baby. In all these outer garments, as well as the under garments, the irritation of the skin must be constantly borne in mind, as eczema is often produced in this manner.

THE FIRST SHOES

The first shoe that is usually worn during the creeping days is a soft kid shoe without hard soles. It is important that this soft shoe be worn to protect the child's foot from chilling drafts while creeping about.

As the baby nears one year of age the hard-sole shoe is secured which must be wide, plenty long and comfortable in every respect, and without heels. Rubbers and overshoes may be worn on damp and cold days. Moccasins and slippers do not give sufficient support to the ankles, so, when the baby begins to walk, the shoes should be high and of sufficient support to the tender ankles.

PLAY SUITS

As the baby grows up into the child, the tiny clothes are laid aside and the boy is given substantial garments that in no way remind him of girls' clothing. A child's feelings should be respected in this manner, and while it often adds joy to the mother's heart to see her boy "a baby still," remember that he is not only chagrined but is nervously upset by these "sissy clothes."

A child three or four years of age should still wear the woolen binder supported from the shoulders, over which is the union suit, stockings, and the buttoned waist from which hang the hose supporters. The most comfortable and easily laundered garment we know of for the small lad is the "romper," which should be made of washable materials that may be readily boiled. For cool days a Buster Brown coat of the same material, with patent-leather belt, may be slipped on over this washable romper—which completes the boyish outfit.

We recall the pleasant days with our own little fellow when he was between the ages of two and one-half and five years. We were often compelled to be away from home—on the train, in the hotel—and when traveling we used a black, smooth silk material which was made up into rompers with low neck and short sleeves. There were three such rompers, and two Buster Brown coats with wide, black, patent-leather belts which completed the traveling outfit. During the warm days on the train the coat was folded carefully and laid aside. In the early morning and in the cool of the evening the coat was put on, and he always looked neat and clean. At night, before undressing him, the entire front of the romper was cleansed with a soapy washcloth, rinsed, and rubbed dry with a towel, and, after carefully spreading to avoid wrinkles, it was hung over the foot of the bed. The coats were sponged or pressed once or twice a week, and this simple outfit served its purpose so well that it was repeated three different summers.

The little girl as she leaves her babyhood days should be put into garments that do not necessitate the constant admonition, "Keep your dress down, dear." We like to see knickerbockers, the exact color of the dress, made for every outfit, in which the little girl may kick, lie down, jump, dance, climb—do anything she pleases—unmindful of the fact that her "dress is not down." The same undergarments are used for the little girl as were mentioned for the little boy.

WINTER GARMENTS

Always bear in mind the over-heating of the child with heavy garments indoors, and the danger of skin chilling and drafts on going out to play in this over-heated condition. Let the children dress comfortably cool in the house, and as they go out to play add rubber boots or leggings and rubbers, sweaters, caps with ear laps or the stockinet cap. Allow them the utmost freedom in clothes, and always encourage romping in the cool frosty air.

CLOTHING RULES

Do not overload the baby with clothing. Dress according to the temperature of the day and not the season of the year. Avoid starched garments. Avoid tight bellybands or old-fashioned pinning blankets. Change all clothes night and morning. Use woolen shirts and bands. See that hands and feet are always warm. Protect the abdomen night and day with the band. Use the sleeping bag on cold nights. Baby should sleep in loose stockings at night. Avoid chilling the child. Use hot water bags if necessary.



CHAPTER XXII

FRESH AIR, OUTINGS, AND SLEEP

Fresh air is just as important and necessary for the baby as for the adult. Neither baby, youth, nor adult can receive the full benefit of his food—in fact it can not be burned up without the oxygen—without an abundance of fresh air. During the early weeks of life, the air baby breathes must be warm; nevertheless, it must be warmed fresh air, for baby requires fresh air just as much as he needs pure food.

INDOOR AIRING

The delicate child often requires more fresh air than does the normal baby. Both appetite and sleep are improved by fresh air. The digestion is better, the cheeks become pink, and all the signs of health are seen in the child who is privileged to breathe fresh air.

During the early days, say after the third week, baby should be well wrapped up with blanket and hood, tucked snugly in his basinet or carriage, while the windows are opened wide and the little fellow is permitted to enjoy a good airing. Even in the winter months the windows may be raised in this way for a few minutes each day. These "airings" may be for ten minutes at first, and, as the child grows older, they may be gradually increased to four or five hours daily. The carriage or basket should stand near the window, but not in a direct draft.

OUTDOOR LIFE

In summer, a baby one week old may be taken out of doors for a few minutes each day; in the spring and fall, when baby is one month old, it may go out for an airing; while, during the winter months, the airing had better be taken indoors until he is about two months old, and even at that age he should go out only on pleasant days and should always be well protected from the wind.

A young baby may enjoy the fresh air in his carriage or crib on the porch, on the roof under suitable awnings, in the yard, under the trees, and even on the fire escape. In fact, at proper age and in season, he may spend most of his time out of doors in the fresh air, if he has proper protection from the sun, wind, and insects.

BEST HOURS FOR AIRING

During the balmy days of summer and early autumn, baby may spend most of the time outdoors between seven in the morning and sunset. During the cooler days of winter and the cool and windy days of spring, the best hours for the airing are to be found between eleven in the morning and three in the afternoon.

At six weeks, perhaps an hour a day in the fresh air is sufficient; while at six months, four to six hours a day are a necessity, and from then on—the more the better.

Now we realize that the mother of the farm household does not always have as much time to take the baby out for his airings as many of our city mothers; but we suggest to this busy mother that the baby be rolled out on the porch or in the yard, within her sight and hearing, and allowed to enjoy the fresh air while the mother continues her work.

It is virtually a crime to try to keep baby in the kitchen, hour after hour, while the busy mother is engaged at her tasks. A hammock, a crib on casters, or a carriage, is just the coziest place in the world for baby—out on the porch.

THE COUNTRY BABY

The average city baby really gets more fresh air than ninety per cent of the country babies. Our city apartments are usually steam heated, and our windows are open in the winter nearly as much as in the summer. The country home is often only partially heated by two or three stoves. The windows are closed in summer to keep out the dust, heat, and flies, in the winter to shut out the cold, and so the baby who lives in such a home has little chance to get fresh air.

The city mother is constantly talked to about the benefits of fresh air. The daily paper brings its health column to her, her pastor talks of it on Sunday, and—best of all—the older children come home from school and reiterate the doctrine of fresh air that is constantly being preached to them at school.

Screen the windows, rural mother, and oil the roads in front of your residence, and then keep your windows open. Remember that baby's health is of more value than the meadow lot or even a fortune later on in life. Plan for a new heating plant, if necessary, so that the home can be both warmed and ventilated during the winter.

WHEN NOT TO TAKE BABY OUT

If a sheltered corner of the porch is within the reach of the mother, we can hardly think of a time when the baby cannot be taken out. It may rain, the wind may blow, it may snow or even hail, but baby lies in his snug little bed with a hot water bottle or a warmed soapstone at his feet. As long as the finger tips are warm, we may know he is warm all over, and a long nap is thus enjoyed in the cool fresh air. When the sheltered corner of the porch is lacking, we wish to caution the mother concerning the following weather conditions:

1. When the weather is excessively hot, take him out only in the early morning and late in the afternoon.

2. In extremely cold, below zero, weather, let his airing be indoors.

3. Sharp and cold winds may do much mischief to baby's ears, as well as blow much mischief-making dust into his nose and eyes. In the case of dust or sand storms, baby remains in the house.

4. All little people enjoy the rain, and only when the raincoat, rubbers, and umbrella are missing should they be robbed of the "rainy-day fun". In the case of baby's outing on rainy days, ample roof protection is the only factor to be considered; if it is adequate, then take him out; if it is lacking, let the airing be done indoors.

WINTER OUTINGS

The very young baby is taken out for a fifteen-minute airing during the noon hour when he is two months old; before this time he receives his airing indoors. The interval is gradually lengthened until most of the time between eleven and three is spent out of doors. The reddened cheeks, the increased appetite, all tell the story of the invigorating benefits of cool, fresh air. Most babies dislike heavy veils, and they may be avoided by a fold of the blanket arranged as a protection shield from the wind.

The wind shield, procurable wherever baby carriages are sold, should be a part of the outdoor equipment, as it greatly helps in the protection of the baby.

The wind should never blow in his face; neither should he lie, unprotected, asleep or awake to gaze up into the sunshine or the sky—or even at a white lining of the hood of his carriage. The lining should be a shade of green, preferably dark green. And while it may be necessary during the summer to suspend a netting over the carriage to protect from flies, mosquitoes, etc., it should never lie on his face.

OPEN WINDOWS

Many of our readers recall with sadness of heart a little hunchback child or a life-long invalid confined to a bed or wheel chair because some careless but well-meaning caretaker or mother left an open window unguarded; and—in an unlooked for moment—baby crawled too near, leaned out too far, and fell to the ground. The little fellow was picked up crippled for life; and so while it is very essential to baby's health to have open windows, admitting fresh air, they should be amply guarded. Screens afford protection if well fastened, and in their absence a slat three inches wide and one inch thick may be securely fastened across the opening, thus preventing all such tragedies with their life-long regrets.

SLEEP

If any of our readers have seen a new-born baby immediately after he has been washed, dressed, and comfortably warmed, they have observed that he usually goes to sleep at once, and that he generally sleeps from four to six hours. Babies, especially new-born babies, need just four things: warmth, food, water, and sleep.

And while the babies sleep they are not to be disturbed by the fond mother's caresses and cuddling—feeling of the tiny hands, smoothing out the soft cheek, or stroking his silky hair—for all such mothers are truly sowing for future trouble. Let baby absolutely alone while sleeping, and let this rule be maintained even if some important guest must be disappointed. If such cannot wait till baby wakens, then he must be content with the mental picture drawn from the mother's vivid description of baby—his first smile, his first tooth, his first recognition of the light, etc. The wise mother cat never disturbs her sleeping kittens.

SLEEP REQUIREMENTS

Sleeping, eating, and growing occupy the whole time of young babies. Until they are two months old they need from eighteen to twenty hours sleep out of each twenty-four; and not less than sixteen hours up to the end of the first year.

At six months, baby should sleep right through the night from six in the evening until six in the morning, with a ten o'clock feed, which should be given quietly, in a darkened room, the babe being immediately returned to his bed.

At two or three years of age, twelve to fourteen hours of sleep is required; while at four to five years, eleven to twelve hours are needed; when they attain the age of thirteen years they should still have ten hours of unbroken sleep each night.

As a general rule, children should sleep alone; even in the case of two brothers or two sisters, separate beds are far better than a double bed for both hygienic and moral reasons.

Baby should have a separate bed. The temptation to nurse him on the least provocation, as well as the danger of overlying, are reasons enough for such an arrangement.

PUTTING BABY TO SLEEP

At five-thirty in the afternoon, baby should be undressed, rubbed or bathed, made perfectly comfortable, and fed; then, my mother reader, he should be laid down in his little bed and allowed to go to sleep, without any coaxing, singing, rocking, or even holding his hand. Babies will do this very thing and continue to do it if you never begin to rock, jolt, bounce, or sing to them; and, mind you, if you do sing to them or rock them, or even sit near without doing anything but "just hold their tiny hands," there will come a time when you greatly desire to do something else—you have many urgent duties awaiting you—and baby not being old enough to understand the circumstances, begins to wail out his feeling of neglect and abuse. It is nothing short of wicked thus to spoil a child.

We have seen so many beautiful babies go to sleep by themselves without any patting, dangling, or rocking, that we encourage and urge every mother to begin right, for if the little one never knows anything about rocking and pattings he will never miss them; and even if the baby is spoiled through extra attention which sickness often makes necessary, then at the first observance of the tendency on the part of the child to insist on the rocking, or the presence of a light in the sleeping-room, or the craving for a pacifier, we most strongly urge the mothers to stick to the heroic work of "letting him cry it out."

The notion that the household must move about on tiptoes is not only unnecessary but perfectly ridiculous. From the very hour of his birth, let the child become accustomed to the ordinary noises of the home, and if this plan is early started he will prove a blessing and a ray of sunshine to the family and not an autocrat to whom all must bow and bend the knee.

BEDTIME AND SLEEPING POSITION

Bedtime is regulated somewhat by the hour of rising in the morning. Usually, up to two years, baby is put to bed from five to six P. M. Regularity is urged in maintaining the bedtime hour.

The seven o'clock bedtime hour is later established and continued until the young child attains school age, when retiring at the curfew hour of eight o'clock gives our boy or girl from ten to eleven hours of sleep, which is essential to proper growth, calm nerves, and an unruffled temper.

The first few days finds our little fellow sleeping nine-tenths of his time. Let him lie on his right side, for this favors the complete closure of the fetal heart valve, the foramen ovale.

Whether baby lies on his stomach, his side, or with the hands over his head is of little or no consequence. His position should be changed first from one side to the other until he is old enough to turn himself.

WAKING UP AT NIGHT

Before baby is three months old, he should receive nourishment during the night at nine and twelve, and again at six in the morning. After four or five months a healthy child should not be fed between the hours of ten P. M. and six A. M. At this age, many children sleep right through from six P. M. to six A. M. without food.

After five months, if a healthy baby awakens between ten P. M. and six A. M. warm water may be given from a bottle; he soon forgets about this and the night's sleep becomes unbroken. There are many other reasons than the need of food that cause the wakefulness of the child; and since the baby should, after a few months, sleep undisturbed and peacefully, if he is wakeful and restless—crying out in a peevish whine—and then quiets down for a few moments only to cry out again, you may suspect one of a half-dozen different things. Let us, therefore, summarize the things which may disturb baby's sleep:

1. Lack of Fresh Air. Babies cannot sleep peacefully in a hot, stuffy room, or in a room filled with the fumes of an oil lamp turned low. A crying fretful baby often quiets down as if by magic, providing he is not hungry and the diaper is dry, when taken into a cool room with fresh air. After the first two months the temperature of the sleeping room should be fairly cool and fresh.

2. Clothes and Bedding. The night clothes may be irritating and causing perspiration, while the bedding may be wrapped too snugly about the child. If baby's neck is warm and moist, you may know that he is too warm. If the diaper is wet it should be changed at once. One of the worst habits a baby can possibly get into is to become so accustomed to a wet diaper that it does not annoy him. In cold weather he is changed under the bed clothing without exposure or chilling. It may be the bedding is cold and, if so, it should be warmed up by the use of the photophore previously described, or by means of the flannel-covered hot water bottle.

3. The Food. Too little, too much, or the wrong kind of food, will disturb baby's sleep. Indigestion is very easily produced in babies who are improperly fed. For instance, the mother's milk may be lacking in nourishment and baby may really be hungry; or, as in the case of a bottle-fed baby, it is usually due to over feeding. Many mothers we have known who sleep with their babies or who sleep very near them, nurse them every time they wake up or murmur, and this soon becomes one of the biggest causes of disturbed sleep.

4. Spoiling. A lighted nursery or bedroom, rocking to sleep, jolting the carriage over a door sill or up and down, the habit of picking baby up the moment he cries, late rompings—any and all of these may disturb sleep, as well as unsettle the tender nervous system of the child, thus laying the foundation for future nervousness, neurasthenia, and possibly hysteria. This is particularly true in the case of the children who have nervous parents.

5. Reflex Causes. Wakefulness is sometimes due to reflex nervous causes such as the need for circumcision, or the presence of adenoids, enlarged tonsils or worms. Does baby have to breathe through his mouth? Then you may suspect adenoids or other conditions which should be removed.

6. Chronic Disorders. The presence of scurvy or syphilis causes the child to cry out sharply as if in acute pain, while in older children tuberculosis of the spine or hip is attended by a sharp, painful crying out during sleep. Malnutrition or anemia are also conditions which greatly disturb sleep.

7. Soothing Syrups. Untold trouble, both physical and nervous, is bound to follow the giving of soothing syrups. These medicines soothe by knocking the nerves senseless and never by removing the cause. They contain morphin, opium, cocain, heroin, and other drugs which deaden pain, and are most dangerous to give baby.

DAILY NAPS

The morning nap from the sixth month on should be from two to three hours long, out on the porch, well protected; while the afternoon nap may be from one to one and a half hours long with an interval of two or three hours before bedtime. The child should be wakened at regular intervals for feedings during the day—every three hours until he is six months old, and then every four hours. These naps should be taken in a cool place—on the porch, on the roof, in the yard, under a tree, or on the protected fire escape.

If the nap is to be taken indoors, then lower the windows from the top and darken the room. All children should take daily naps until they are five or six years old.



CHAPTER XXIII

BABY HYGIENE

Possibly if all our babies could grow up in a mild, warm climate, out of doors, where they were cared for by mothers who had nothing else to do but enjoy nature in a garden, their babies unhampered by clothes and other conventionalities inflicted upon us by our present standards of living—well, if that were our environment, probably this chapter on baby hygiene would not need to be written. But realizing that variable climatic conditions, the indoor life, and the necessary bundling up with clothes, all tend to increase the ever-present danger of infection from thickly settled peoples and their domestic pets—these facts, together with the further fact that modern social conditions make it necessary for some mothers to toil long hours—all these influences, I say, considered separately or combined, make it imperative for us to give thoroughgoing consideration to the essentials of baby hygiene. The subjects of fresh air, sleep, bathing, etc., have been duly discussed in previous chapters.

WATER DRINKING

As soon as the newborn baby has been washed and dressed, before he is put to sleep, he is given two teaspoons of warm, boiled water in a sterile bottle with a clean nipple. This is repeated every two hours when he is awake, until he is old enough to ask for water himself. This water should contain no sugar, or anything else—just clean, boiled water. It is better to give this water from a bottle; for in case of enforced weaning, this practice of taking his water from a bottle, will have made him acquainted with that method of feeding.

URINATION

The baby may pass very little urine during the first day or two of his life, but if the warm, boiled water is administered regularly, the urine will soon become more abundant.

As the child nears two years of age, if put to bed at six P. M. he should be taken up at ten or eleven to urinate.

In older children, bed wetting is often corrected by serving the last meal not later than four P. M. and not allowing any liquids after that hour.

The physician should be consulted in all instances where the habit of bed wetting extends beyond three years. The subject will be treated more fully in a later chapter.

EXERCISE

A baby pen, lifted up from the floor, well protected at the sides, and covered with mosquito bar—if exposed to flies or mosquitoes—affords splendid opportunity for exercise. Here the little fellow may lay on a well-padded mattress and kick, move his arms, and otherwise roll about to his own satisfaction. It should not be in the direct sunshine, but rather in a protected, somewhat shady place, yet where the air is pure and fresh.

Much exercise is obtained from the daily cry. Here, the arms, legs, hands and feet, as well as the body, are all exercised until the baby is pink. A good rebound of blood is flowing through the well-warmed skin, while the baby is greatly benefited by such daily exercise.

Later on, "creeping" is urged, but not forced. With regard to standing—he will pull himself up on his feet just as soon as nature qualifies him, and so he needs no urging or coaxing in this matter. Older children should be encouraged in active romping, games, etc., rather than to spend the entire day in the more sedentary amusements, puzzle pictures, etc.

It is a most abnormal situation when a three-, or four-year-old child is content to sit quietly all day. There is usually something seriously wrong with a child who never soils his rompers, who never makes a noise, and who does not seem to enjoy normal play and fun.

Let the little folks early learn that the home is theirs to enjoy and that their little friends are welcome; and thus you may be spared such a reproof as one little lad of four unknowingly gave his mamma. His little friend was approaching the stairs of the play room, when the thoughtless mother carelessly and impatiently remarked: "Oh, are you going to bring Ned upstairs? you'll make so much noise." The little host met his friend at the top with the words: "They don't want boys in the house, we'd better go outdoors." The mother "woke up" and arranged a little "party" upstairs for the two husky, healthy—and noisy—boys.

During the creeping days remember that the floor is the coolest part of the room, and in the absence of the creeping pen, which is "built up" two feet above the floor, extra clothing should be put upon the child while on the floor. During the damp days of early spring and the cool days of late fall, as well as on the bleak days of winter, baby is better off if he is kept off the floor. It is a fine plan to put a number of table boards on top of the springs of the baby's bed; in this way a sort of pen is produced which is high above the cold floor and the baby is content to spend much of his time in this little pen, happy with his playthings.

KISSING THE BABY

We most strongly protest against the haphazard, promiscuous kissing of babies. Many forms of disease, such as tuberculosis, syphilis, diphtheria, influenza, common colds, etc., may be carried to the child in this way.

The baby, notwithstanding his attractiveness, his beauty, and his grace, should not be overfondled. Kissing the hand is not much better than the mouth, for the hand quickly finds its way to the mouth. If it be necessary to kiss a baby, then let the kissing be done on the back of the neck or on top of his head, but never on the face or hand.

SUCKLING HABITS

There came into the office one day a woman forty or more years of age, whose mouth was markedly disfigured, and on my inquiring as to the probable cause she said: "Doctor, it is the result of sucking my thumb when I was a mere child, too young to know better, and every time I look into the glass, which I assure you is only when I am compelled to, I curse my parents for not breaking me of that habit." The indulgent parents were hated and despised for neglecting their duty, because of the disfigurement which resulted from this unrestrained habit of early childhood.

Thumb sucking, finger sucking, or pacifier sucking, are all filthy habits, and should be early discouraged. To aid in overcoming the habit of sucking the thumb or biting the fingernails, the ends of the fingers and edges of the nails may be painted with a solution of aloes or quinine. In extreme cases, a splint may be placed on the anterior bend of the elbow, thus preventing the possibility of raising the hand to the mouth.

The "sugar teat" of our mother's generation has passed, as has also the "mumbling" of food for the young child; we no longer give the babies concentrated sugar, nor do we "chew" our children's food at the table.

Extreme cases of chalk or dirt eating have been noted; such tendencies are decidedly abnormal, and require medical attention.

KEEP BABY WARM

Much colic and fretfulness may be avoided if baby is kept warm. The finger tips are a good thermometer, for if they are warm the feet usually are. "Bundling" is unnecessary, but careful attention should be paid to keeping the feet and hands warm without making the child sweat; that is an art, and all mothers should attain it. An extra flannel wrapper and a pair of heavy wool booties in the winter are good warmth producers. Cotton flannel petticoats should be replaced by warm woolen ones, and when the baby begins to get about on his hands and knees a pair of loosely fitting wool tights, made from discarded woolen underwear are of inestimable comfort and value. In the effort to avoid draughts and body chilling, ever bear in mind baby's need of fresh air and the dangers of sweating, for the sudden cooling of a sweating child is a forerunner of pneumonia, cold catching, diarrhoea, and other troubles.

BABY'S TEMPERATURE

During early infancy, baby's temperature sometimes varies greatly; for instance, a rectal temperature may register 97.5 or 100.5 F. while the child may be in perfectly good health.

The baby's temperature should be taken at the rectum—which should normally register 99.5 F. This temperature, as stated above, may register 100.5 F., with no other symptoms of illness. In taking rectal temperature the thermometer should remain in place two minutes.

The groin is the next best place to take the temperature; here the thermometer should remain five minutes, and the registry is usually a degree lower than that of the rectum.

The baby's temperature usually is a good guide to the severity of any illness. In case the temperature runs above 101 F. the physician should always be notified and his orders carefully followed. Slight causes often produce a high temperature of 103 to 105 F. for a short time; but such a temperature of long duration means serious trouble and demands expert advice and attention. Abnormal temperature will be more fully considered in that section of this work entitled "Common Disorders of Infancy."

BABY BOUNCING

The common custom of bouncing or trotting baby on the knee is a harmful one. The young and growing nervous system of the child is decidedly injured by this constant jolting and jiggling, to say nothing of the "spoiling" effects of this practice. There is a vast difference between the sensitive nervous system of the infant, with its liability to shock and disturbances, and that of the settled and developed nervous system of an adult. The strength of the mother or nurse is so great that the jarring not only often causes indigestion and vomiting in the infant, but sometimes also lays the foundation for "wrecked nerves" in later life.

The tossing of baby in the air comes in for the same condemnation. Baby is not "our plaything," and must not be bounced and tossed about like a rubber ball.

CARRIAGES AND GO-CARTS

The first carriage should be roomy and comfortable. The bed should be thirty-three inches long and fourteen inches wide, and should be twenty-eight or thirty inches from the floor. The wheels should be rubber tired. The cover should be a good sized hood containing a dark lining, and provided with a wind shield. This dark lining creates a neutral shade for the eyes and protects them from the glare of the sun and the bright skies.

The bed of the carriage should be soft and warm; and, with the size before mentioned, there is ample room for the "tucking in" with warm blankets, which are first spread out on the bed and then the baby placed into the blanket, after which it is brought up and over him.

The folding go-cart and the small carrying-basket are to be used only in an emergency. They are convenient in traveling or shopping for the mother who has no maid or caretaker with whom to leave the baby; but they are not satisfactory pleasure vehicles, neither should the baby be left to sit fastened in one of these carts for any great length of time.

The mattress of the carriage should be of hair, while needed warmth may be secured by the use of a thick, light-weight woolen blanket, placed under the child and brought up and around him.

A top covering for the carriage must have washing or dry cleaning qualities. A crocheted afghan, a washable embroidered cover, or a firm silk puff, are good covers. The one thing to be remembered is that everything about the carriage soils readily, and if this thought enters into the selection of fabrics, you will not be disappointed when cleaning time comes.

The carriage pillow should be of down, except in the very hot months, when hair is preferable. Simple, easily laundered slips may be made from two men's-size handkerchiefs.

BOW LEGS

Particularly in boys and men, bow legs are not only awkward but are a noticeable deformity; even the little folks notice them and often remark about it, as did one child who sat profoundly eyeing a very important visitor who stood before the cheerfully lighted grate warming himself. The little fellow suddenly exclaimed, "Oh, Mister, look out! You're warping." Such a painful experience might have been saved this distinguished gentleman had his mother or caretaker not urged his standing too soon; and at the same time had fed him on the proper food, so as to avoid "rickets." The ossification or hardening of the bones of the legs continues all through childhood and is often interfered with by improper feeding during the first two years of life. Urging the little people to stand too early is to be discouraged. Nature prepares them for it when the right time comes; which time varies—thin children standing and walking usually much earlier than heavy children.

LIFTING THE BABY

A very young baby should be lifted from his bed by grasping the clothing below the feet with the right hand, while the left hand slips underneath the back and with spreading fingers supports the neck and head. It is then raised upon the left arm. During the early months the entire spine must be supported in this manner (See Fig. 6). In grasping a baby under the arms or about the waist, undue pressure is made upon the abdomen and chest. Serious injury often follows the careless lifting of the older child by his wrists or hands. The throwing or whirling of the older children by the arms is strongly condemned. Dislocations have followed such careless so-called fun.

PREVENTION OF FALLS

In the selection of the high chair, care should be given to the possibility of overturning. Fortunately, baby's bones are only partially ossified, else he would sustain many fractures in the frequent falls and bumps. When we pause to consider the thoughtless manner in which many babies are left on beds and in unguarded chairs, it is not strange that they fall so often.

Open windows must be carefully protected by well-fastened screens or by slats of wood. Beds afford a good place for a romp or play, but high-backed chairs should be placed at the side to prevent a fall. A strap across the waist should be fastened to the sides of the carriage to prevent falling out. Everything possible should be done to prevent falls. Outdoor hammocks are exceedingly dangerous for the baby. Never leave a child in one unguarded. A little caution, a large amount of common sense—the "good use of brains"—will prevent scars and other lifelong deformities.

THE BABY'S BREASTS

Never allow anyone to manipulate or "break down" a swollen breast in a girl or boy baby during the first week or two. This swelling occurs often and should not be interfered with. A hot compress of boracic acid solution may be applied, after which a piece of sterile gauze should be placed over the swollen part and held on by a muslin bandage. Secure medical attention if the swelling does not go down in a day or two.

VISITING

Unless absolutely necessary, babies should not be taken on trains and street cars; nor should they take long journeys into the country to attend "reunions." Infections accompany crowds, and baby is far better off at home, in the quiet of his natural surroundings, than he is in the dust, closeness, and bustle of illy ventilated cars, streets, shops, movies, or even at church. Many an infant has been sacrificed by a train journey to "show him off" to the fond grandparents; scores of babies acquire whooping cough at the movies; and many a baby has nearly lost his life by catching measles, scarlet fever, or diphtheria at church; while the only thing accomplished by the church experiment was the spoiling of the entire service by its fretful, tired cry—the infant's only means of protest.

THE RUNABOUT BABY

"Runabouts" are the little folks between the age of one and three years, and they require good care, good feeding, and warm and comfortable dressing.

In general, they need the same fresh air, daily outings, and daily naps of the younger child. Their hands need washing oftener, and their clothing, which is usually a play romper, should be either of white or fast colors that it may be most thoroughly boiled, thus getting a good disinfection. Their eyes, nose, and ears, as well as the genital organs, all require the most rigid daily cleanliness.

The "bugbear" second summer need not be feared by the mother who takes particular care to see that:

1. The drinking water is boiled or distilled. 2. The orange is not overripe. 3. The banana is not underripe or overripe and is not eaten in chunks. 4. The milk is fresh and pasteurized. 5. The baby does not eat candy, ice cream, or other forbidden foods. 6. The baby's bowels move daily. 7. He does not remain dirty. 8. He naps daily. 9. He is protected from dust, flies, flees, and mosquitoes. 10. He does not go visiting, to church, shops, or "movies."

The second summer is no harder than the first, as good clean water, easily digested foods, and good general hygiene are all a baby needs at this time. A large army of little folks grow up in spite of the little care they get and the place in which they live. Did they not possess good vital resistance, sound nerves, and good digestion, the children of the "slums" and of the "ghetto" would quickly succumb to their unhygienic surroundings.

TOYS

In selecting toys for the infant, it must be borne in mind that they will be put to the mouth, and hence they should not be:

1. Toys with sharp points. 2. Small enough to swallow, or to push into the nose. 3. Covered with hair or wool. 4. Glass that is easily broken. 5 Painted toys. 6. Toys that may be taken apart and the small parts swallowed. 7. Paper books that may be chewed or torn.

Bear in mind that babies are easily amused with such simple toys as:

1. A half-dozen clothes pins. 2. An aluminum pan and a spoon. 3. Rubber toys (easily washed). 4. Celluloid dolls, ducks, and other floating toys. 5. Blocks. 6. A large rubber ball.

The older children have wonderfully good times out of doors with a spade, a cart, and the sandpile. Boys most thoroughly enjoy a track with its engine and cars, switches, etc. They build sham fortifications, truly works of art, with their blocks, while the girls are happiest with dolls and household sets. However, occasionally we meet a mother who has a girl who is really a boy in her tastes for toys, and so we say to that mother: give the little girl the desire of her heart; if it's a train instead of a doll, or a toy gun instead of a doll's trunk, well and good, let her have them. What we want are free and easy, natural, children. They are much more likely to have good nerves, clean thoughts, sound digestion, and equalized circulation.



CHAPTER XXIV

GROWTH AND DEVELOPMENT

The newborn baby comes into the world in an absolutely helpless condition and completely unconscious of his surroundings. He unconsciously performs certain acts, such as opening his eyes, crying, urination, movement of the bowels, and even nursing of the breast; but there is probably no distinct voluntary action connected with any of these acts. All of his senses at birth are practically dormant, but as the days and weeks go by, they begin to awaken.

SPECIAL SENSES

The baby cries, but the tears do not actually flow over the lids until he is three or four months old, and while the baby may fix his eyes upon objects and distinguish light from darkness, he will not wink nor blink when the finger is brought close to the eye. Vision is probably not complete until the beginning of the third month.

Infants are said to be deaf for the first twenty-four to forty-eight hours after birth, and some authorities hold that they are deaf for several days.

Taste is early developed, as a newborn baby will often repeatedly show a desire to taste sweet things, while if sour or bitter things are put to the tongue, it shows its displeasure.

HAIR AND SCALP

The newborn baby usually comes into the world with a good head of hair, but the end of the first or second week witnesses the falling out of much of this hair, and falling may continue for even another week or two. The hair is often worn off on the back of the head because of constant friction upon the pillow.

Children differ greatly in the growth of hair. Some of them come into the world with heavy hair, and others lose it quickly and remain nearly bald-headed until after the first year.

As the second hair grows in, it is usually lighter than it was at birth and lighter than it will be later in life, as the hair has a tendency to grow darker as the years go by.

The scalp should receive the care already mentioned. As the hair comes in it should be shampooed once in two weeks and brushed often, making it healthy and vigorous.

MISSHAPEN HEADS

It is wise to turn the baby first on one side and then on the other and not allow him to sleep night after night on one side of his head. The newborn head may be misshapen by laying the child constantly on one side, and the ear may be misshapen if it is allowed to curl under or become pressed forward. Markedly protruding ears may be partially corrected by having the child wear a well-ventilated cap made for the purpose.

THE SALIVA

Many mothers think that the presence of drooling or the excessive flow of saliva is associated with teeth cutting. While it may be associated with the teeth, this is not usually the case; it is more probably due to the beginning of a new function of secretion. The newborn baby has only enough saliva to furnish moisture for the mouth, and not until the age of four or five months does saliva really flow, and since the teeth appear a bit later we often confuse the institution of a new secretion with the oncoming teeth.

SENSATIONS AND RECOGNITION

The young baby manifests a number of sensations early in its career. Hunger and satisfaction as well as comfort and discomfort seem to be recognized by the little fellow. He early learns that the approach of someone when he cries usually means that he is to be taken up, and he usually ceases crying as soon as he is taken up. He early manifests a sense of comfort when he is cuddled; there also is early present a manifestation of the desire to sleep, and the satisfying pleasure of a drink of water.

At the age of three months he has recognized many things such as the light or a bright object. He distinctly recognizes his mother and often smiles at her approach. He recognizes his hands at four months, and now begins to recognize other members of the household aside from his mother. Even as early as one month, he may smile at his mother. At two months of age he will often smile at other members of the family. He laughs out loud or chuckles during the fourth or fifth month. But, on the whole, he must be considered as just a little animal whose greatest needs are to have his appetite and thirst satisfied, his little body clothed, and his little nerves put to rest—to sleep.

SITTING ALONE

At four months the normal baby will hold up his head; and if he is supported at the back with a pillow, he will sit erectly—holding his head up—at six months; while at eight months or not later than nine, the normal child should sit alone on the floor with no support. Later in the ninth month he often manifests a desire to bear his weight upon his feet. Care is here urged that the mother protect the little fellow at this time and not allow him to rest his weight upon his feet but a moment or two at a time.

He will reach for a ball suspended from the top of his carriage or bed as early as the fifth month. About this time he discovers his toes while in his bath. He will handle a rattle at six or seven months, and shows delight in such toys.

DENTITION

In both the upper and lower jawbones of the newborn infant there are hidden away in snug little cavities two sets of tiny teeth; the first set, or milk teeth, and the second set, or permanent teeth. These rudimentary teeth grow as the baby grows and push their way up or down from the jawbones until they finally make their appearance through the gums. The milk teeth appear in a definite way and in five definite groups.

There should be no physical disturbance at the appearance of the teeth, which is a physiological process, and it is to be deplored that all of the ills of babyhood are laid upon the teeth with the careless remark: "Oh, its his teeth!" Many, many illnesses are neglected because our inexperienced mother has been told that she can expect "anything to happen when the baby is cutting its teeth." Now, it is true that the babies of many families do have trouble in cutting their teeth, but the majority of babies cut their teeth comfortably and the first knowledge anyone has of it is the appearance of the tooth itself. As the teeth push their way nearer the surface of the gums, there is a broadening and a hardening of the gums themselves, and it is the exception rather than the rule that the baby needs any help in cutting his teeth.

Usually by the time the baby is seven months old it has two central teeth on the lower jaw (the central incisors), which constitute the first group. The second group of teeth to appear is the four upper central teeth which are all through by the time the baby is twelve months old, and are often through at ten months. Then there is a pause of from one to three months before the next teeth appear—the four anterior molars. As these four anterior molars come in, the two lateral incisors appear on the lower jaw, which now gives us, by the time the baby is fourteen or fifteen months old, four central teeth upper, four central teeth lower, and the four anterior molars, which make twelve teeth.

Another pause of two or three months and then we get the four canine, which fill in the space between the first molars and the front teeth. The canine on the upper jaw are commonly known as the eye teeth, while the canine teeth on the lower jaw are spoken of as the stomach teeth. This brings us to the age of eighteen to twenty-four months, when there is still another pause of two or three months, after which time the big teeth or the four posterior molars appear, which completes the first set of twenty teeth—the milk teeth. When baby is twenty months old the milk teeth are often all in. The complete set should appear not later than the thirtieth month.

During the life of the milk teeth the child should be taken to the dentist at least once a year, better once in six months, for all defective teeth must be properly and promptly cared for. Inexpensive but sanitary fillings should be placed in all decayed teeth, for the roots of the first teeth are very soft and infection readily spreads to the jaws and the permanent teeth and serious trouble often begins thus early.

If dentition is seriously delayed, investigation should be started concerning the general condition of the child, for this delay often accompanies ill health.

When the child is six years old, the mother should be watchful, for it is at this time that the first permanent teeth appear just behind the last molar of the milk teeth. They do not replace any of the teeth present, and many times they come through and decay without receiving any attention. It is seldom necessary to assist these milk teeth as they come through the gum, and should the gums become highly colored and swollen it is not wise to lance them, for if the teeth are not ready to come through immediately, the gum only toughens the more and makes the real cutting still more painful.

This is the time to cut down the baby's food as well as to look for other digestive disturbances, for the number of stools may increase and vomiting may occur, and by reducing the quantity and quality of the food and encouraging abundant water drinking, much trouble may be avoided. Under no circumstances urge the baby to eat when he refuses his food, when the gums seem swollen and red during the teething time. You will find that he will enjoy orange juice, pineapple juice, or prune juice. All of these digestive symptoms are simply the result of "feeling bad," and if heavy food of his regular feeding is greatly diminished he will get along much better than if fed his regular allowance of food.

APPEARANCE OF THE TEETH

The normal child has:

Six teeth at one year. Twelve teeth at one and one-half years. Sixteen teeth at two years. Twenty teeth at two and one-half years.

When the child is six years old the first permanent tooth appears just back of the last of the milk teeth. By the time he is seven, the four central teeth, two above and two below, are out and the new ones begin to appear. The order of their appearances is as follows:

Four first molars 6 years Four central incisors 7 years Four lateral incisors 8 years Four first bicuspids 9 to 10 years Four second bicuspids 10 to 11 years Four canines 11 to 13 years Four second molars 12 to 15 years Four third molars 17 to 25 years

DENTAL SUGGESTIONS

A better plan than to lance swollen gums is to rub them gently with ice wrapped in a soft cloth, or to dip the finger in ice water and rub the gums—this often gives the baby much relief.

Often the baby finds comfort in biting on an ivory ring, but the utmost care must be used in keeping it clean and avoiding contamination by allowing it to drop on the floor.

Convulsions are never the symptoms of teething. Consult a physician at once, as such seizures probably spring from causes other than teething.

Cleansing of the teeth should be carried out systematically every morning by means of a piece of cotton which has been dipped in a boric-acid solution or a solution of bicarbonate of soda (common baking soda). A soft brush may be used for cleansing, and when there are particles of food between the teeth they should be removed by strands of waxed floss.

Throughout life, frequent visits should be made to the dentist; during early childhood days he should be on the lookout for symptoms which indicate deformity—narrow jaws and other conditions which affect the permanent teeth. During adolescence and adult life the teeth should be examined every six months and cleansings of the mouth should become a part of the daily toilet.

THE WEIGHT

During the first year, nothing gives us so much information concerning the child's general well-being as the weight. Such a record will not only enlighten the mother concerning the development of the child, but the grown-up child appreciates the record and preserves it along with the other archives of babyhood days. Every Sunday morning, when the father is at home, the baby should be weighed and an accurate record kept. It is important that the baby be weighed each time in the same garments—shirt, band, diaper, and stockings—for every ounce must be accounted for.

Until the baby is five or six months old he should gain from four to eight ounces a week. Anything short of this is not enough and should be reported to the physician. After six months the gain is about a pound each month. This varies somewhat; possibly during the tenth and eleventh month the gain is lessened, but by the close of the first year the baby should have trebled its birth weight.

Dr. Griffith gives us the following very interesting bit of information concerning the weight of boys and girls after the first year, and to him also belongs the credit for the accompanying table showing the growth, height, and weight of the child up to sixteen years of age.

After the first year we notice that, taking it all together, there is a gradual increase in the number of pounds and a decrease in the number of inches added yearly, four inches being gained in both the second and third years, three inches in the fourth and fifth years, and after this two inches a year. The gain in weight is four pounds yearly from the age of three to that of seven years, then five, then six, and then about nine pounds. It sometimes happens that at about the age of nine in girls and eleven in boys there is almost a cessation of growth for a short time. Later, at about twelve years, girls take on a particularly rapid growth, and decidedly exceed boys of the same age in weight, and sometimes in height also. At fifteen or sixteen years the rapidity of growth in girls, both in weight and height, will be greatly diminished, while boys of this age will often begin to develop very rapidly, and will soon materially exceed the other sex in both respects.

TABLE SHOWING GROWTH IN HEIGHT AND WEIGHT

Age. Height. Weight.

Birth 19 inches. 7 lbs. 8 oz. 1 week 7 " 71/2 "

2 weeks 7 " 101/2 " } Gained 1 oz. 3 weeks 8 " 2 " } a day; 1 month 201/2 inches 83/4 " } 7 oz. a week 2 months 21 " 103/4 " }

3 months 22 " 121/4 " } {Gained 3/4 oz. a day; 4 months 23 " 133/4 " } {5-1/2 oz. a week.

5 months 231/2 " 15 " } {Double original weight. 6 months 24 " 161/4 " } {Gained 2/3 oz. a day; {4-2/3 oz. a week. { 7 months 241/2 " 171/4 " } { 8 months 25 " 181/4 " } {Gained 1/2 in. a month. 9 months 251/2 " 183/4 " } { 10 months 26 " 193/4 " } {Gained about 1 lb. a month. 11 months 261/2 " 201/2 " } { 1 year 27 " 211/2 " } {Treble original weight.

2 years 31 " 27 " } { 3 years 35 " 32 " } {Gain 4 in. a year.

4 years 371/2 " 36 " } Double original length. 5 years 40 " 40 " } {Gained 3 in. and 4 lbs. } {a year.

6 years 43 " 44 " } {Gained 2 in and 4 lbs. 7 years 45 " 48 " } {a year.

8 years 47 " 53 " } {Gained 2 in. and 5 lbs. 9 years 49 " 58 " } {a year.

10 years 51 " 64 " } {Gained 2 in. and 6 lbs. 11 years 53 " 70 " } {a year.

12 years 55 " 79 " } 13 years 57 " 88 " } 14 years 59 " 100 " } {Gained 2 inches and 15 years 61 " 109 " } {about 9 lbs. a year. 16 years 63 " 117 " }

GENERAL DEVELOPMENT

The accompanying illustration (Fig. 14), taken from Dr. Yale, represents the developmental changes at one, five, nine, thirteen, seventeen, and twenty-one years. Each figure is divided into four equal parts, and as we watch the development from the baby who at one year, as Dr. Yale says, is four heads high, at the age of twenty-one the legs and the trunk have much outgrown the growth of the head, so that at this age the head is only two-thirteenths or less of the whole length of the body. The legs have grown more rapidly and equal one-half the entire body length. The trunk has not kept pace with the legs, for as you will see from the diagram the line reaches the navel of the child in one year, while in the adult it is much lower. The rapid growth of the legs is accomplished after nine years of age.



The proportions of the head, chest, and abdomen are exceedingly important in the growing child. At the end of the first year the head, chest, and abdomen are about uniform in circumference. The head may measure one-fourth of an inch more, but the chest and abdomen should both measure eighteen inches in circumference at this time. Should the head or the abdomen be two inches larger than the chest; the attention of the physician should be called to it, for either are indicative of conditions that should be carefully investigated.

NORMAL BREAST WEANING

As a general rule the normal, healthy, breast-fed baby is given a feeding of a bottle each day after he is ten months old. These bottles are increased in number until, by the time the baby is a year old, he is gradually weaned from the breast. Should the ninth month of baby's life arrive in the hot summer months we urge the mothers to continue breast feeding, with possibly the addition of some fruit juices, as noted elsewhere, until early autumn. Under no circumstances should the baby be weaned and compelled to use cow's milk during the season of the year when the risks of contamination are greatest. If the baby is nursed up to the close of his first year he hardly need be trained to use the bottle, but may take his food from a cup. From one to two months should always be consumed in weaning the baby, unless sudden weaning is necessitated by ill health, as noted elsewhere. The baby should have, if possible, from thirty to forty days to accustom himself to cow's milk exclusively.

If the child is weaned slowly there should be no trouble with the breasts, but in the instance of sudden weaning the mother should restrict her liquids, put on a tight breast binder, and for a day or two should take a dose of a saline cathartic, which will assist in taking care of the liquids and thus decrease the secretion of milk.

NORMAL BOTTLE WEANING

If the bottle food is agreeing with the baby he should be allowed to use it up to the end of the first year when he will be given whole milk with possibly the addition of a little lime water. We see no reason why the child should give up his bottle during the second year unless other food is refused—unless he will not accept other food than from his bottle—and if you are convinced that he has formed the "bottle habit," then the milk should be put into a tiny cup or glass, and he should learn to sip it along with his solid foods; but if he takes his other foods without any hesitancy, then we know no reason why he should not take his milk in this comfortable manner from his bottle at least two or three feedings each day.

If you desire to wean him from his bottle, serve the first part of it with a spoon from a cup or glass and then give him the remainder in the bottle. The beautiful picture of a big, robust baby lying on his back, knees flexed, both hands holding his beloved bottle still lingers in my mind as one of the pleasant memories of my lad's babyhood days, and at the close of the second year, when the beloved bottle was left behind, I believe I missed something as well as did the lad.

I recall no difficulty with his taking the food from a cup. The success of all normal weanings is due entirely to the fact that it is done gradually and slowly, and under no circumstances should it be roughly and abruptly attempted—particularly in case of the bottle feeding.

TRAINING THE BOWELS AND BLADDER

Reference is made to this subject in another part of this book—where we went into the detail of keeping the daily record of these physiological occurrences—and it was found that the bowels moved and the bladder was emptied at about the same time each day. Any mother, caretaker, or nurse, who will take the time to keep a daily record of the hours of defecation and urination, will observe the time carefully and will catch the child on nearly every occasion before an accident occurs. Often as early as four months the bowels will move in an infant's chamber at regular times each day. The nurse or mother places this receptacle in her lap and holds the child gently and carefully upon it. A little later it can be made to sit on a special chair prepared for the purpose, and at eight or nine months by careful training the urination can be controlled, and by the end of the first year the diapers ought to be discontinued.

If the child has not learned to control the bladder by the age of two years, medical attention should be called to the fact and remedial measures instituted.

BABY'S SPEECH

The baby should begin to talk at one year. He early learns to say "mamma" and "papa," and gradually adds nouns to his vocabulary, so that at eighteen months the normal child should have a vocabulary of one hundred to one hundred and fifty words. As he nears the two-year mark, he has acquired a few simple verbs and he can possibly put three words together, such as, "Willie wants drink." Pronouns come in late, as we all recall that the young child usually speaks of himself by his own name.

Children are born mimics. If you talk baby talk to them, they will talk baby talk back. For instance, a well known author told us just the other day that for many years no other name was given to the sewing machine in his house but the word "mafinge," and not until he went to school did he correct the word "bewhind," for in the nursery he learned the line "wagging their tails bewhind them." Baby talk is very cunning, and often the adult members of the family pick it up and keep it up for years, and only when they are exposed in public, as one mother was on a suburban platform by her four-year-old lad shouting, "Mamma, too-too tain tumin, too-too tain tumin," do they sense their responsibility and realize how difficult it is to form new habits. This poor mother tried in vain to have her little fellow say, as did another little lad two and one-half years old, "Mother, the train's coming; let's get on."

Many words of our beloved language at best are hard to understand; so let us speak correct English to the little folks and they will reward us by speaking good English in return.

If at two years the child makes no attempt at speech, suspicions should be aroused concerning mutism or other serious nervous defects. Medical advice should be sought.

DEFECTIVE SPEECH

All guttural tones which may be occasioned by adenoids or enlarged tonsils, all lisping, stuttering, or defective speech of all words should be taken in hand at the very start, as they are usually overcome by constant repetition of the correct manner of speaking the particular word in question. Children of defective speech need special training, and should in no way be allowed rapidly to repeat little nursery rhymes, as oftentimes this rapid repetition of rhymes by a child with hereditary nervous defects may occasion stuttering or stammering later on.

CALISTHENICS

Special exercise should not be forced upon young children. Physical culture, along with many other things intended for sedentary adults, should never be forced upon little folks who get all of the exercise they need in the many journeys they take building their blocks, sailing their boats, tearing down imaginary houses, making imaginary journeys—from morning until night the little feet are kept busy—never stopping until the sandman comes at sleepy time. Do not yourself attempt to stimulate a child who seems backward. Consult your physician. You had much better put a child out to grow up in the yard by himself with his sandpile than to force calisthenics or advance physical training upon him.

BOW LEGS AND WALKING

Do not attempt to hasten nature in aiding the child to walk. Let him creep, roll, slide, or even hunch along the floor—wait until he pulls himself to his feet and gradually acquires the art of standing alone. If he is overpersuaded to take "those cute little steps" it may result in bow legs, and then—pity on him when he grows up. Sometimes flat foot is the result of early urging the child to rest the weight of the body upon the undeveloped arch. A defect in the gait or a pigeon toe is hard to bear later on in life. A certain amount of pigeon-toeing is natural and normal. If the baby is heavy he will not attempt to walk at twelve months. He will very likely wait until fourteen or fifteen months. The lighter-weight children sometimes walk as early as eleven months, but they should all be walking at eighteen months, and if not, it is usually indicative of backward mentality.

If the training of the bowels and bladder will replace the diapers with drawers, the baby will attempt to walk sooner than when encumbered with a bunglesome bunch of diaper between the thighs. The little fellow runs alone at sixteen months and thoroughly enjoys it, and the wise mother will pay no attention to the small bumps which are going to come plentifully at this particular time.

SUMMARY OF BABY'S DEVELOPMENT

He discovers his hands at three or four months. At six months he sits alone, plays with simple objects, grasps for objects, and laughs aloud from the third to the fifth month. He says "goo goo" at four or five months. At one year he should stand with support, listen to a watch tick, follow moving objects, know his mother, play little games, such as rolling a ball, should have trebled his birth weight, and have at least six teeth, and should use three words in short sentences. At eighteen months he should say "mamma" spontaneously, walk and run without support, should have quite a vocabulary, should be able to perform small errands like "pick up the book," and should have twelve to sixteen teeth. At two years he should be interested in pictures, able to talk intelligently, and know where his eyes, nose, mouth, hands, and feet are. At three years, he should enumerate the objects in a picture, tell his surname, and repeat a sentence with six words.

In the case of a premature baby or a very delicate child, or as a result of a prolonged illness or a very severe sickness, such as spinal meningitis, the time of these mental and physical developments may all be postponed, while rickets, which will be spoken of later, is often the cause of late sitting, late standing, and late walking.

DIET AFTER THE FIRST YEAR

Milk is the principal article of diet during the second year. It should be given with regularity at distinct intervals of four meals a day. It may be given from the nursing bottle, unless the child has acquired the bottle habit and refuses to eat anything else but the food from his bottle, in which case it should be given from a cup. Beginning with the sixth month, aside from his milk, be it breast milk or bottle milk, he is to be given orange juice once each day as well as the broth from spinach and other vegetables. This is necessary to give the child certain salts which are exceedingly essential to the bottle baby.

At the close of the year when he is taking whole milk he should be given arrowroot cracker, strained apple sauce, prune pulp, fig pulp, mashed ripe banana (mashed with a knife), a baked potato with sauce or gravy (avoiding condiments), and a coddled egg. Fruit juices may be added to the diet, such as grape, pineapple, peach, and pear juice. Later in the second year he may be given stale bread and butter, and for desserts he may have cup custard, slightly sweetened junket, and such fruit desserts as baked apple and baked pear.

We do not think it is necessary to give children much meat or meat juices. We appreciate that there is a diversity of opinion upon this subject, but we do not hesitate to say that in the families where meat is little used, the children seem to grow up in the normal manner with sound healthy bodies, sometimes having never tasted it. When meat is used, it should be well cooked to avoid contamination with such parasites as tapeworm and trichina; it should also be well chewed before swallowing, as many of the intestinal disturbances of the older children are due to the swallowing of unmasticated food such as half-chewed banana, chunks of meat, rinds of fruit, and the skins of baked potatoes.

Let the children's diet be simply planned, well cooked, thoroughly masticated, and above all things have regular meal hours, and no "piecing" between meals; and if the mother begins thus early with her little fellow, she will be rewarded some later day by hearing him say to some well-meaning neighbor, who has just given him a delicious cookie or a bit of candy: "Thank you, I will keep it until meal time." Children learn one of the greatest lessons of self control in following the teaching that nothing should pass the lips between meals but water or a fruit-ade. Children in the second year require four meals a day, one of which is usually only the bottle or a cup of milk. These meals are usually taken at six, ten, two, and six in the evening. Oftentimes this early six o'clock meal is just a bottle or cup of milk, as may also be the evening meal.

CANDY

Now, a word about candy. Pure candy is wholesome and nourishing. It is high in calorific value, and children should be allowed to have it if it does not enter the stomach in solutions stronger than ten or fifteen per cent. We can see at a glance that chocolate creams, bonbons, and other soft candies should never be given to children. Candies that they can suck, such as fruit tablets, stick candy, sunshine candy, and other hard confections that are pure, and free from mineral colorings and other concoctions such as are commonly used in the cheaper candies, may safely be given at the close of the meals—but never between meals.

All such articles as tea, coffee, beer, soft candies, condiments, pastries, and fried foods, should be positively avoided in the case of all children under five and six years of age.

The diet from now on will be considered in the chapter "Diet and Nutrition."



PART III

THE CHILD



PART III

THE CHILD



CHAPTER XXV

THE SICK CHILD

To the mother who has passed through the experience of bringing the child into the world is usually given that intuitiveness which helps her in caring for that child when it is well and in recognizing certain symptoms when it is sick. The newborn baby brings with him a large responsibility, but as the weeks pass by his care becomes less and less of a nervous strain, as the routine duties, so nearly alike each day of his little life, have made the task comparatively easy; but when the baby gets sick, particularly if he is under one year of age, and it is impossible for him clearly to make known his wants, and being unable to tell where it hurts or how badly it hurts, the average mother is likely to become somewhat panicky; and this confusion of mind often renders her quite unfit successfully to nurse the sick baby.

THE NURSE

It is often wise to secure the services of a trained nurse, and if the family purse will allow such services, a good, sincere, capable, practical nurse should be engaged, for her firm kindness will often accomplish much more than the unintentional irritability and anxious solicitude of an overworked and nervous mother.

Usually the mother not only attempts the care of the sick baby with the long night vigil—often not having the opportunity to take a bath or change her raiment day in and day out—but she often attempts to manage the entire household as well, including the getting of the meals and keeping the house cleaned, and it is not to be wondered at that her nerves become overtaxed and in an unlooked for moment she becomes irritable and cross with the sick child.

No matter how low the financial conditions of the family may be, outside help is always essential in cases of severe or long-continued illness of the children. Should the mother insist upon caring for the baby herself, then all household duties should be given over to outside help, and as she takes the role of the nurse, the same daily outing and sleep that an outside nurse would receive should be hers to enjoy.

Dr. Griffith has so ably detailed the "features of disease" that we can do no better than to quote the following:[A]

[A] From Griffith's Care of the Baby, copyrighted by W. B. Saunders Company.

POSITION

The position assumed in sickness is a matter of importance. A child feverish or in pain is usually very restless even when asleep. When awake it desires constantly to be taken up, put down again, or carried about. Sometimes, however, at the beginning of an acute disease it lies heavy and stupid for a long time. In prolonged illnesses and in severe acute disorders the great exhaustion is shown by the child lying upon its back, with its face turned toward the ceiling, in a condition of complete apathy. It may remain like a log, scarcely breathing for days before death takes place. Perfect immobility may also be seen in children who are entirely unconscious although not exhausted.