Chapter 18

BABIES AND THEIR CARE

The principles of hygiene are fundamentally the same for young and old. The applications, however, differ at different ages. From the time when physical growth and development are complete until changes due to old age appear, an individual commonly has greater resistance than at other ages, and is able in consequence to endure unfavorable conditions of life with more success.

Babies, on the other hand, are exceedingly sensitive to their environment. Surroundings that are even slightly unfavorable are likely to make babies sick. In order to remain healthy, they must have exactly the right kind of food, in the right quantities and at the right times; their sleep, exercise, and clothing must be carefully regulated; they must be protected from careless handling, from nervous strain, and above all, from the many kinds of infection to which they are peculiarly susceptible. The life of a baby fortunately can be controlled almost completely; when properly regulated it offers, therefore, an unequalled opportunity to see how hygienic principles work out in actual practice.

The primitive mother's instinct to nourish and protect and succor her helpless child was the original form of nursing. Instinct alone, unfortunately, has never accomplished much in preserving health. The human race has now had an experience in the care of infants that extends over thousands of years. Yet today we are still, on the whole, less successful in keeping babies alive than we are in raising domestic animals; we still allow society to continue, like a modern Herod, in its ruthless career of slaughtering the innocents.

About 14 babies out of every 100 born in the registration area[1] of the United States die before reaching the age of one year, while in some of our industrial cities as many as 25 out of every 100 born die before they are a year old. Most of these deaths are preventable. Thus, in a few American cities, the death rates have been so reduced that fewer than 10 babies out of every 100 die before completing the first year; while in Dunedin, New Zealand, as a result of the work of the Society for the Health of Women and Children, the infant death rate has been so reduced that in 1912 only about 4 out of every 100 babies died before they were a year old.

While ignorant mothers, who may or may not be uneducated women, and contaminated milk, are as a matter of fact, chiefly responsible for our high infant death rates, yet as we have already seen, every factor in the environment has its effect upon a baby. This fact has led Sir Arthur Newsholme, an eminent English authority, to say:

"Infant Mortality is the most sensitive index we possess of social welfare. If babies were well born and well cared for, their mortality would be negligible. The infant death rate measures the intelligence, health, and right living of fathers and mothers, the standards of morals and sanitation of communities and governments, the efficiency of physicians, nurses, health officers, and educators."

Care of the child should begin at the earliest possible moment: that is, nearly nine months before he is born. Care before birth, for want of a better name, is called prenatal care of the mother. Every woman who thinks that she is pregnant should put herself at once under the care of a competent physician, so that he can make the necessary examinations as early as possible. If she follows his advice in regard to hygiene and proper regulation of her life, she may be free from anxiety, and may justly expect that her delivery will be a safe and normal process.

A demonstration of the value of prenatal care was recently made by the Boston District Nursing Association. During the year 1915 prenatal care was given to 751 expectant mothers in 5 wards of the city; each woman attended a pregnancy clinic, where she was under the care of an experienced obstetrician, and was visited at intervals by a nurse who kept careful watch of her general condition and gave necessary advice and encouragement. In consequence the death rate among the babies whose mothers had prenatal care was only half as great, through the whole first year of life, as the death rate of babies in the same wards whose mothers had not had prenatal care. Moreover, the rate of still-births was only half as great as the rate among the general population of Boston. If prenatal care can save so many lives, surely it ought to be available for every pregnant woman in the land, including even that generally neglected class of people who are neither very rich nor very poor.

Each baby's birth should be recorded by the registrar of births, and parents should make sure that registration has been attended to in the city or town where they live. In some states birth registration is already obligatory, but in any case it is required by the child's own interest. For instance, in later life it may be necessary for him to prove the date and place of birth in order to establish, among other things, his right to vote and to inherit property, and to settle the question of his liability to military service. Moreover, complete and accurate birth registration is needed by every community because it is essential to such reforms as reducing infant mortality and abolishing child labor.

GROWTH AND DEVELOPMENT

Statements in regard to growth and development are based on observations of many children. It should be remembered that the following figures represent averages only, and that healthy children may vary from them considerably without giving cause for alarm.

AVERAGE SIZE.--The average weight of a baby at birth is from 7 to 7½ lbs. and the average length is about 20 inches, but it is not unusual for a child to weigh anywhere from 5 to 10 pounds at birth and to measure from 16 to 22 inches in length. During the first week of life a baby loses slightly in weight. After the first week a healthy baby should gain from 4 to 8 ounces a week until he is six months old; after that time the weekly gain is less. The weight at birth will usually double during the first five months, and treble during the first year. Consequently, a baby weighing 7 pounds at birth may be expected to weigh 14 pounds when five months old, and 21 pounds when a year old. Weight is one of the most important indications of a baby's condition. He should be weighed every week during the first 6 months, once in two weeks during the second 6 months, and once a month throughout the 2nd year.

MUSCULAR DEVELOPMENT.--A baby at birth is helpless, and during the first few months he has little muscular control. During the third month he ordinarily begins to lift his head, and he can usually hold it up without support by the time he is 3 months old; when 7 to 8 months old he sits erect and begins to play with toys. From this time a baby makes rapid progress; he attempts to stand on his feet, begins to creep, and by the time he is 14 months old he is usually able to stand alone, or even to walk a few steps. He is usually running about without difficulty when fifteen or sixteen months old.

Babies should never be urged to walk or to bear their weight on their feet. If healthy they are generally eager to go about unaided, and like to investigate their surroundings without assistance. If walking is unusually delayed, a physician should be consulted.

DEVELOPMENT OF SPECIAL SENSES.--A new-born baby is unable to distinguish objects, but the eyes are sensitive to light and need careful protection. Hearing, although undeveloped at birth, soon becomes acute; consequently the child should stay in a quiet room. When six or eight weeks old he notices objects, and at three months old he welcomes his mother when he is hungry. A month or two later he begins to distinguish between familiar and unfamiliar faces, and to show approval or disapproval.

DEVELOPMENT OF SPEECH.--A baby six or seven months old begins consciously to utter sounds, and usually can say a few unconnected words by the time he is a year old. The average child, however, does not begin to form sentences of more than two or three words until he is about two years old.

DEVELOPMENT OF TEETH.--The so-called milk teeth are twenty in number; they are followed by thirty-two permanent teeth. The two lower front teeth (central incisors) generally appear when a child is from five to nine months old, and in from one to three months later the four upper front teeth (upper incisors) appear. All the first or milk teeth should have come through by the time a child is two and a half years old, but wide variations occur both in the time and order of appearance and should occasion no uneasiness if the child seems well. Unusual conditions of any sort should be referred to the physician; it is a great mistake to attribute all illness at this time to teething.

The first of the permanent teeth appear when a child is about six years old. Mothers sometimes mistake the first permanent molars for temporary teeth, a mistake that frequently leads to neglect and even extraction of highly important teeth. All but the last four molars, sometimes called wisdom teeth, should be through by the time a child is fifteen. The wisdom teeth may not appear before the 20th or even the 25th year.

NORMAL EXCRETIONS.--A new-born baby should have one or two bowel movements during the first twenty-four hours; the first bowel movements are sticky and almost black in color. After the baby begins to nurse, three to four movements a day are not unusual, and throughout infancy and childhood as well as adult life there should be one or two evacuations of the bowels daily. The character of the stools is more important than the number. While the baby is taking milk only, the movements should be soft, yellow in color, and nearly odorless. Change in frequency of the movements, or appearance of undigested food or curds of milk in the stool, should be carefully noted and if continued, reported to a physician; they may be the first signs of serious digestive trouble.

The urine of an infant should be odorless and colorless. It should be voided at least once during the first twenty-four hours, and much more frequently after the baby begins to nurse. Marked diminution in the amount of urine should be reported to a doctor.

Efforts should be made early to develop habits of regularity in the evacuation of the bladder and bowels. If taken up regularly most children learn to use a chamber for bowel movements by the time they are three months old. Normal children, if properly trained, usually have no bladder discharge during the night after they are 18 months old, and they learn even earlier to indicate a desire to urinate during the day time.

CLOTHING.--The amount and weight of a baby's clothing should depend upon the season; but garments worn next to the skin, except the diaper, should be wholly or partly of wool, the lightest weight in summer and heavier weight in winter. During the first few weeks a baby's abdomen should be supported by a flannel binder about six inches wide, applied snugly but not tightly enough to restrict either the abdomen or chest walls. It may be replaced later by a loosely fitting knitted band worn for warmth only. Such a band is especially necessary if there is tendency to diarrhœa, but in no case should it be discarded before the 18th month. All garments except the diaper and first flannel binder should hang from the shoulders, and should fit loosely but well.

Clothing for babies should be of soft materials and should be simply made. Even the first clothes should not be very long. The weight of very long clothing is an unnecessary burden, and prevents free movements of the legs. At night an entire change of clothing should be made, and a nightgown of warmer material substituted for the petticoat and slip. Most children are dressed too warmly indoors, but in low temperatures they need to be well protected.

Diapers should be soft and absorbent. It may be necessary to wash new diapers several times before using in order to make them soft enough. Care should be taken not to apply them too tightly, or in such a way as to cause pressure on the genitals. They should be changed during the day whenever wet or soiled, and at night when the baby is taken up to be fed. Proper care of diapers is highly important, however laborious. They should be well washed, boiled, and thoroughly dried before they are used a second time. Diapers that have been wet but not soiled should not be dried and used again before being washed. Much work can be saved if pads of loosely woven absorbent material are used inside the diaper to receive discharges. The pads can be burned, but even if washed the labor is less than washing full sized diapers. Like all other infant's garments, diapers should be washed with pure white soap and without starch. Waterproof material used to cover the diaper is almost sure to irritate the baby's skin, and is consequently harmful.

SLEEP.--During his first few weeks a normal baby sleeps about nine-tenths of the time, and should be left undisturbed except for necessary care. He should sleep in a crib, bassinet or basket protected from light and drafts; in no circumstances should a baby sleep in the bed with his mother or any other person. Pillows are unnecessary for babies, and indeed for older children, but if used they should be thin and firm.

The amount of sleep necessary gradually diminishes, but during all the years of growth a child needs more sleep than an adult. The amount of sleep required daily is approximately as follows:

First month 18 to 20 hours Second to sixth month 16 to 18 hours Sixth month to one year 14 to 15 hours One to two years 13 to 14 hours Two to four years 11 to 12 hours

After this time a child should sleep at least ten hours out of the twenty-four. During the first year a nap in the middle of the forenoon and another in the afternoon are desirable. A child who is inclined to sleep so long that his nap interferes with his night's sleep, should be waked from his nap, but at the same hour every day. When a child is a year old, one nap during the day is often sufficient, if he is doing well, but the habit of taking a nap at some time during the day should be continued through the fifth year if possible, or even later.

Babies should not be rocked or otherwise coaxed to go to sleep; they should be made comfortable and then left alone. They learn to go to sleep by themselves as soon as they are convinced that sleep is expected of them, and that no unfounded objections on their part will be regarded. Continued inability to sleep normally usually indicates discomfort or poor general condition, and should be taken up with the doctor. Pacifiers and thumb-sucking should not be allowed, since they lead to changes in the shape of the jaw with resulting imperfect adjustment of the teeth. Soothing syrup and like medicines should never be given to a baby; death or permanent injury has resulted from their use. It is impossible to emphasize too strongly the danger of giving them even a single time.

FRESH AIR.--All that has been said about the importance of fresh air for adults applies with even greater force to infants and children. During his first month especially a baby is susceptible to draughts; nevertheless, the room should be well ventilated and its temperature kept between 68° and 70° F. during the day, and at about 65° F. at night. Even in cold weather the room should be well aired two or three times a day; the baby should be removed to another room while the windows are open. After the baby is three or four months old the windows may be left open at night provided the outside temperature does not fall below freezing. A healthy baby two or three weeks old may be taken out-of-doors for a short time in mild weather; when he is three months old he may be taken out-of-doors even in winter on bright sunny days. The time spent out-of-doors should be gradually increased until the baby stays out the greater part of the day; but he should not be exposed to storms, wind, flying dust, dampness, extremes of temperature, or insects. The eyes should not be covered by veils, but they should be shielded from the direct rays of the sun at all times.

DIET.--A baby, in order to thrive, must have suitable food, given at regular intervals. During the first few months of life no other food can take the place of mother's milk. Breast-fed babies are more robust than bottle-fed babies; more than this, they are less likely to contract infectious diseases or to suffer from digestive disorders. The number of bottle-fed babies who die every year is three times as great as the number of breast-fed babies who die. Many mothers do not understand the risk involved in weaning small babies; and so every year many little lives are lost, and lost needlessly. When poverty forces nursing mothers to wean their babies and seek work outside their homes, one can only say that a society which tolerates such a waste of infant life is indeed regardless of its own welfare.

Special conditions, of course, may make it undesirable for a mother to nurse her baby. No one but the physician is competent to decide this; not even neighbors, grandmothers, other members of the family, or the mother herself. Where artificial feeding must be used, it should be carefully adapted to the individual child, and in consequence it must be prescribed by the doctor. Patent foods, notwithstanding the claims on their printed labels, should be used only under his advice.

INTERVALS OF FEEDING.--Little milk is secreted during the first two days after the birth of a child. The baby should, nevertheless, be put to the breast as soon as he has had his first bath, if the mother is sufficiently rested. Always before and after nursing the mother's nipples should be washed in water that has been boiled. Nursing should be repeated at intervals of six hours during the first two days.

The following schedule for the feeding of healthy babies is given by Holt in "Care and Feeding of Infants." (1917.)

SCHEDULE FOR HEALTHY INFANTS FOR THE FIRST YEAR

------------------+--------+----------+----------+-----------+-------- | | | | | |Interval| Night | No. of | Quantity |Quantity Age |between | feedings,| feedings,| for one | for 24 |meals by| 6 p.m. | in 24 | feeding | hours | day | to | hours | | | | 6 a.m. | | | ------------------+--------+----------+----------+-----------+-------- | Hours | | | Ounces | Ounces 2d to 7th day | 3 | 2 | 7 | 1-2 | 1-14 2d and 3d weeks | 3 | 2 | 7 | 2-3½ | 14-24 4th to 6th week | 3 | 2 | 7 | 3-4 | 21-28 7th week to 3 mos.| 3 | 2 | 7 | 3½-5 | 25-35 3 to 5 months | 3 | 1 | 6 | 4½-6 | 27-36 5 to 7 months | 3 | 1 | 6 | 5½-6½ | 33-39 7 to 12 months | 4 | 1 | 5 | 7-8½ | 35-43 ------------------+--------+----------+----------+-----------+--------

During the period when seven feedings are given in 24 hours the following hours will be found convenient: 6 a.m., 9 a.m., 12 m., 3 p.m., 6 p.m., 10 p.m. and 2 a.m. The 2 a.m. feeding is the one omitted when the number of feedings is reduced from seven to six. Food should be given on exact schedule time; the baby if asleep should be waked for any meal except the one due at 2 a.m.

WATER.--Pure boiled water should be given regularly even to a young baby. He is often satisfied with a little warm water if he is fretful between the hours of nursing. Water may be given from a cup, a spoon, or a bottle; it is desirable, however, for the baby to learn to drink from a cup before the period of weaning begins.

WEANING.--Ordinarily, a baby should be fed from the breast until he is seven months old, either exclusively or with the exception after the second month of one bottle-feeding in twenty-four hours. This exception will do the baby no harm and may be a great relief to his mother. Partial breast-feeding should continue if possible through the ninth month, but every baby should be entirely weaned by the time he is one year old. It may be necessary, if either the baby or the mother is not thriving, to change the food before the ninth month; but it is desirable not to make the change in hot weather. Healthy babies, it should be remembered, increase in weight constantly, and steady gain in weight is the best indication that a baby's food is suitable.

NURSING BOTTLES AND NIPPLES.--Nursing bottles should be of heavy glass, cylindrical in shape, without angles or corners to make cleaning difficult. The number of bottles provided should be two or three more than the number of feedings given in 24 hours.

Short black rubber nipples which slip over the neck of the bottles should be selected. They should be of such a shape that they can easily be turned inside out; a nipple turner costs little, and is well worth the price. Nipples should be discarded when they become soft or when the opening grows so large that the milk runs in a stream rather than drop by drop.

As soon as the baby has finished his meal, the bottle should be removed from his mouth, rinsed in clear hot water, and left standing filled with cold water until a convenient time for boiling all the bottles to be used during the next 24 hours. Sufficient time must be allowed for the bottles to cool thoroughly between the time when they are boiled and the time when they are refilled. When it is time to boil the bottles they should be placed in an agate or other suitable kettle, covered with water, and boiled vigorously for three minutes. A cloth placed in the bottom of the kettle will help to prevent the bottles from breaking. After the bottles have been removed from the boiling water, they should be stoppered at once, either with rubber stoppers or plugs of sterile cotton. The stoppers, if used, should be boiled with the bottles; sterile cotton may be purchased by the package.

An easy and satisfactory method to care for rubber nipples is the following: Provide as many nipples as the number of feedings given in 24 hours, and another, if desired, to be used in case of accident; provide also two cups of ordinary white enamel, each one large enough to hold all the nipples at once. One cup should have a cover; the other should not. To avoid mistakes it is well to have the cups different in shape. As soon as each feeding is finished the nipple should be thoroughly cleansed under running water by scrubbing it inside and out with a nipple brush. The nipple thus cleansed is placed in the cup without a cover. When all the nipples have been used, cleansed, and collected in the uncovered cup, they are transferred into the other cup; water is added, the cup is covered and its contents are boiled for three minutes. The nipples remain covered in the boiled water until needed; they are removed one by one for the successive feedings. Care must be used in removing a nipple to take it by the rim, not to touch other nipples during the process and not to dip the fingers into the water. The best way is to remove them by means of a glass rod, which is boiled with the nipples and kept with them in the cup when not in use. There are several advantages of this method of caring for nipples: it is easy; it reduces to a minimum the necessary handling of the nipples after boiling; and it reduces the probability of using the wrong nipple, since boiled nipples are always in one kind of receptacle and used nipples in another. It also prevents the too common practice of continuing to keep nipples in a supposedly antiseptic solution long after the solution has become badly soiled.

TABLES of diet for children over one year of age may be found in the Appendix, page 322.

BATHING.--Usually the cord has separated and the navel has entirely healed by the time a baby is 10 days old. After this time a daily tub bath should be given; it should be given not less than one hour after feeding. The temperature of the room should be from 70-72°, measured by a thermometer placed in the part of the room where the bath is to take place. In order to avoid chilling or tiring the baby the bath should be given quickly, without confusion or interruption; success can be achieved by using even a moderate amount of foresight. Before undressing the baby everything to be used should be collected and placed within easy reach,--clean clothing, soft towels, 2 wash cloths, pure white soap, powder, absorbent cotton, etc. The bath tub should last of all be filled with water, and its temperature tested by means of a bath thermometer. The temperature of the water should be from 98° to 100°. After the baby is three months old slightly cooler water should be splashed over his chest, back, neck, and arms just after he is removed from the tub, and as he grows older the temperature of his cool splash can be reduced. Children who become accustomed to cool water in this way take kindly to their cold showers later.

The baby's face should be washed first and dried carefully, while his body is still covered. Next the head should be washed; a little soap should be used, but it must on no account enter the eyes. Next the entire body should be soaped with the hand; and then the baby should be placed gently in the bath, his head and shoulders supported by the attendant's left hand and forearm. Care should be taken to rinse off all the soap. The baby should not stay in the tub more than 2 or 3 minutes; after he has been removed from the tub he should be wrapped at once in a soft bath towel. He should be dried gently but thoroughly by patting with soft, warm towels rather than by rubbing. Folds of the skin should be dried with special care. A little powder may be applied, but a baby who is kept both clean and dry will not need much powder, if any. The baby should next be quickly dressed, with as little turning and moving as possible. Clothing should be drawn on over the feet instead of over the head, and the petticoat should be placed inside the slip so that the two garments may go on simultaneously.

EYES.--Secretion accumulating in the corners of a baby's eyes should be removed by means of a bit of absorbent cotton moistened in boiled water. The secretion should be wiped away gently; a different piece of cotton should be used for each eye, and a piece that has been used should not be put back into the water. Further than this, eyes in a normal condition do not need cleansing.

Every person who handles a baby should be very sure that her hands are clean; she should be doubly sure before she touches his eyes, since a baby's eyes are peculiarly susceptible to infection from any source. More than a quarter of all totally blind persons in the United States became blind by infection of the eyes at birth. Blindness of the new born can be prevented in practically all cases if the doctor uses a preparation of silver in the baby's eyes immediately after birth. This treatment is effective and entirely safe.

If at any time the eyelids look red or swollen, or if a drop of matter appears between the lids, the physician should be summoned at once. Total blindness may result if treatment is delayed even a few hours.

MOUTH.--The mouth should be rinsed after feeding by giving the baby a teaspoonful of boiled water. Until the teeth come it does not require other cleansing, and attempts to clean it may injure the delicate membranes that line it. Indeed, except in an emergency, fingers should not be inserted into a baby's mouth. The teeth when they appear should be cleaned by means of a soft tooth-brush.

NOSTRILS.--The nostrils need no cleaning other than removal of mucus that can easily be reached by means of a piece of cotton. If a little vaseline is placed in the nostrils on a small piece of absorbent cotton in the early morning, collections of mucus will usually be softened so that they can be removed easily at bath time.

GENITAL ORGANS.--The genital organs of girl babies should be gently washed twice a day, using absorbent cotton, and tepid water. Treatment other than cleanliness is ordinarily unnecessary. Vaseline may be applied if the genitals are slightly reddened; any discharge or abnormal appearance should be reported to the doctor. In the case of boy babies the foreskin should be gently drawn back twice a week after immersion in the tub; after the parts have been gently washed with absorbent cotton, it should be drawn forward again. No force should be employed in retracting the foreskin; the physician should be consulted if it cannot be retracted easily.

THE DEVELOPMENT OF HABITS.--During his first few months crying is a child's only means of expression, and he quickly learns to make effective use of his limited opportunities. It is important for the mother to distinguish between crying caused by pain, illness, or hunger, and crying caused by temper. These cries are more or less distinctive, but no one can be sure in every case just what a crying baby is attempting to express.

A cry caused by hunger is fretful and often interrupted by sucking the thumb; it ceases when the child is fed. A cry caused by indigestion is similar; the child is relieved for a short time by feeding, but soon begins to cry again. If he has acute pain, such as earache, the cry is sharp, repeated at frequent intervals and accompanied by other symptoms of distress, such as restlessness, contraction of the features, and drawing up the legs. In serious illness the cry is usually feeble, fairly constant except when the child is asleep, and exaggerated by slight causes.

A limited amount of crying is useful exercise for a baby, and should not distress his mother unduly. Moreover, crying may be merely the expression of a wish to be taken up, to be played with, carried about or otherwise amused, to be given a pacifier, or to be indulged in other bad habits. If not indulged in these ways he may cry from temper. The cry of temper is loud and violent, accompanied by vigorous kicking or by holding the body rigid. Proper treatment of the baby may prevent many months of discomfort, and spare him the formation of his first bad habit. All other possible causes for crying should be eliminated. If the child continues to cry when he is warm and dry and comfortable, "It should simply be allowed to cry it out. This often requires an hour and in extreme cases two or three hours. A second struggle will seldom last more than ten or fifteen minutes and a third will rarely be necessary" (Holt). Gas may form in the child's stomach during prolonged crying. It is consequently permissible to take him up after 15 minutes, and hold him erect; he generally expels gas at once, and immediately experiences relief. As soon as he is relieved, he should go back to his crib.

EXERCISE.--Exercise is essential to the development of the body, but during the first few weeks warmth and quiet are so important that a baby should not be disturbed except for necessary care. His position, however, should be changed occasionally; if he lies on the same side constantly the soft bones of the head may become misshapen from pressure. As the baby grows older he needs more exercise, and he may be given an opportunity for it by removing his outer clothing and placing him on a bed in a warm room for a short time each day. Unnecessary handling is not good for a baby at any age.

After he becomes more active, he may play on a mattress or thick blanket placed on the floor. The blanket should be covered with a washable pad or rubber cloth and clean sheet, and the whole should be surrounded by a fence at least two feet high. In such an enclosure a baby may safely be left to play if protected from draughts and cold. Elevated pens that can be folded when not in use are more convenient but more expensive than the home-made arrangement. As soon as a child begins to run about he takes ample exercise, and he may even need to be guarded from too great fatigue, especially toward bedtime. Games and play should be adapted to the age of the child and sufficiently varied to exercise all portions of the body; but they should not be too violent nor too prolonged. Some supervision of children's play is necessary, but they should be given as much freedom as possible and allowed to develop their own initiative.

PLAY AND TOYS.--The desire for play does not develop until a child is about six months old. At this age toys that can be washed, such as those of hard or soft rubber, should be selected. A baby instinctively carries everything to his mouth,--first his thumb, then playthings, and later whatever he may find, no matter how unsuitable. For his safety and protection this habit should be overcome as soon as possible, and he must learn to put nothing in his mouth except food and drink. Relatives are nearly always tempted to give too many and too fragile toys; they merely teach a child to be destructive and constantly to expect something new. Toys are the first possessions of which a child is conscious, and through them many desirable qualities may be developed: neatness and order, gentleness and a feeling of protection toward the helpless doll or Teddy bear, and unselfishness in sharing special treasures with playmates. Later the child may be given pets and made responsible for their care; but animals should not be subjected to unintentional cruelties from small children.

EXERCISES

1. What two factors are chiefly responsible for the deaths of babies under a year old? What other factors contribute? In your city or town what is the number of deaths per 1000 births of babies under one year old?

2. Why is birth registration important to an individual? to a community? Is it required by law in your city?

3. What is the average weight of babies at birth? Describe the rate at which they should gain.

4. At what age may a normal child be expected to sit erect? to stand? to walk? to speak? When should his first teeth appear? his permanent teeth?

5. Describe normal bowel movements of a baby.

6. How should a young baby be dressed?

7. Describe a baby's bath and toilet.

8. Describe the surroundings that are suitable for a baby.

9. What is the best food for a healthy baby? Why?

10. Describe in detail a good daily program for a healthy baby four months old.

11. What habits are desirable for a baby to form, and how may he be trained so that he will form them?

12. Name all the indications that would tell you when a baby was not thriving, and in each case tell what you would do about it.

FOR FURTHER READING

The Care and Feeding of Children--Holt.

The Care and Feeding of the Baby--Truby King.

The Baby's First Two Years--R. M. Smith.

The Care and Feeding of Children--J. L. Morse.

Preventive Medicine and Hygiene--Rosenau, Section III, Chapter II.

Pamphlets:

Prenatal Care, Mrs. Max West.

Infant Care, Mrs. Max West.

Child Care, Mrs. Max West. Published by the Children's Bureau, United States Department of Labor, Washington, D. C. (Free on request.)

The Care of the Baby--Supplement No. 10 to the Public Health Reports, 1913, Government Printing Office, Washington, D. C.

Your Baby: How to Keep It Well--New York State Department of Health, Albany.

Publications of the American Association for the Study and Prevention of Infant Mortality--1211 Cathedral Street, Baltimore, Md. (Free on request.)

Publications of the National Committee for the Prevention of Blindness--130 East 22d Street, New York City. (Free on request.)

FOOTNOTES:

[1] An area including about two-thirds of the population of the United States.