A Manual of Personal Hygiene--6th Edition, Edited by Walter L. Pyle.

Four Epochs of a Woman's Life--Galbraith.

Hygiene and Physical Culture for Women--Galbraith.

The Home and Its Management--Kittredge.

Exercise and Health--F. C. Smith, Supplement 24 to the Public Health Reports, Government Printing Office, Washington.

The Sanitary Privy--Farmers' Bulletin 463, United States Department of Agriculture, Government Printing Office, Washington.

Safe Disposal of Human Excreta at Unsewered Homes--Lumsden, Stiles and Freeman, Bulletin 68, Public Health Reports, Government Printing Office, Washington.

The Disposal of Human Excreta and Sewage of the Country Home--New York State Department of Health, Albany.

Milk and Its Relation to Public Health--Bulletin 56, Hygienic Laboratory, Government Printing Office, Washington.

Milk and Its Relation to Health--New York State Department of Health, Albany.

Other Publications of the United States Public Health Service and of the Departments of Health of the different states and cities.

CHAPTER III

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 quant.i.ties 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 a.s.sociation. 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 cla.s.s 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 7 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 a.s.sistance. 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 diarrha, 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 subst.i.tuted 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, ba.s.sinet or basket protected from light and drafts; in no circ.u.mstances 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.