c^^ ipip iillillli;! ill :;:«;:::::!!;::. m liili jlpiiil! ■ssili ,-..!■ :J|!i uPliiliji Cornell University Library RJ 61.13 Our babies; how to keep them well and ha 3 1924 003 481 839 ('^ '7?I S^itttr ai HUitioio. EDWARD F. DUNNE oovcnnoR February c4, 1916. Dear Sir: I have read with much care and very great Interest the advance copy of the new booklet to te published by the State Board of Health, en- titled "Our Babies, How to Keep Them Well and Happy", and it is my opinion that in placUig this safe and sane information in the hands of ■the mothers of Illinois that you are rendering a service to the commonwealth and especially to our baby citizens, which must be of immeasur- able benefit. Mrs. Dunne, who has mothered thirteen babies of her own, has also read it with much interest and joins me In the hope that a way may be found by which a copy of this valuable publication may oe placed in the hands of every Illincis mother. Yours very sincerely. Governor Dr. C. St. Clair Drake, Secretary, State Board of Health, Springfield, Illinois. i..B?S9&i..^4 THIS LITTLE BOOKLET is presented with the compliments of the Illinois State Board of Health DR. JOHN A. ROBISON, President DR. T. O. FREEMAN DR. R. D. LUSTER DR. E. S. SPINDEL DR. T. B. LEWIS DR. C. ST. CLAIR DRAKE, Secretary and Executive Officer CAPITOL BUILDING SPRINGFIELD, ILL. Additional copies of this booklet may be obtained free on application to the Secretary Our Babies — How To Keep Them Well by dealing with the well baby ; — by keeping infants in the best of health — and it is a matter of all-year-round activity and not of any par- ticular season. Bad air and bad care in winter may pave the way for calamity in summer. In dealing with the dangerously com- municable diseases, there is something spec- tacular which justifies in the public mind the drastic action of the health officer. The sick- ness and death of infants are not accom- panied by alarming incident. The saving of infants is a matter of daily life in the home, — a matter of individual care which the health officer cannot control by force. It involves the care of the child, the feeding of the child, the health of the mother, the home environment, the milk supply, — every detail in the every-day life of the healthy child. It is a part of every mother's day,— the bathing and the clothing of the baby,— the details of its apparently petty ills,— its food, its sleep and its play, and so we have come to look upon this work not as infant saving, but as the more positive thing of "Infant Welfare." Little things are big things in the lives of these little people. The following pages are written in an effort to aid in preventing the illness and death of Illinois babies. It is believed, however, that this end is more directly attained,— not by preaching the ravages of infantile disease,— but by teaching the simple truth about "OUR BABIES AND HOW TO KEEP THEM WELL AND HAPPY." A well baby is a happy baby. A baby is never cross or fretful by its own choice. Our Babies — J-Iow To Keep Them Well The First Essential of Living Well is to be born well. Many of the ills of childhood and many of the serious ills of the mother could be prevented by proper care of the mother prior to and during the birth of the child. From the earliest months of pregnancy, the ex- pectant mother should entrust herself to a competent physician who should outline every detail of her daily Hfe. The details of prenatal care, as it is called, and the details of care at birth lie outside the province of these pages. However, attention is called at this time to the prevention of the great calamity of blindness of the child by proper preventive measures. To a very large extent, blindness is caused by infection of the eyes ' of the infant at birth. This may be prevented by placing in the eyes of the newborn infant a drop or two of a solution of nitrate of silver. This should be done by the physician or midwife regardless of whether there is the slightest suspicion that such infection may occur. It should be a routine measure to which there should be no exception. It is a simple procedure, void of danger and which is ab- solutely effective. The Illinois State Board of Health now provides free, through its many stations throughout the State, convenient containers holding the quantity of nitrate of silver solution required for the individual case. The law of the State requires that physicians and midwlves shall recommend the use of this agency in all cases and the wise and intelligent parent will not only not object to its use, but will insist upon it if the attending physician fails to suggest it. There is no heritage of greater value than the sight of human eyes. The First Duty of the Parent to the child is to have the birth registered at once. Under the Illinois law, there is a registrar in every city, village, township and road district whose duty is to register births and deaths. Be sure to inquire of your physician if your baby's birth is registered or, even better, go to the regRtrar and see for yourself. Birth registration may prove of the utmost importance to your son or daughter in later years. In IlHnois, older children, whose births have not been registered, will be accorded registry upon presentation of the facts of birth to the registrar by the parents or guardian. The baby is the onjy animal that can actually be benefited by an authentic pedi- gree. Pups and colts will never know whether they are registered or not. Our nalur.\- — 11 o:^' To AVr/i Tliein JVell THE HOUSE THAT THE BABY LIVES IN While All Children can not be reared in fine houses, a little intelligent care on the part of the parents even in most moderate cir- cumstances will do much toward guaranteeing the child the important things in home condi- tions : These are fresh air, sunlight, cleanli- ness, dryness and safe sanitation. Poverty does not justify the parents of children in living in crowded tenement districts, in occupying dark and ill-ventilated rooms or in remaining where bad plumbing and bad sani- tary conditions endanger the life and health. As a rule, a clean and simple cottage can be rented in the out- skirts of the town or city for little more or quite as little as one must pay for the dark flat or tenement. The water supply of the household must be safe and manure piles, pools of stagnant water and other insanitary conditions must be removed. Such surroundings are dangerous to adults ; — they are intolerable about the home of the infant. Remember that manure piles are the breeding places of flies and that flies are a definite source of danger to the young child. The home is the center of sentiment. It should mean protection and health and happiness. There is not much joy in insanitary sentiment and danger- ous protecting roofs. Sunlight Is Absolutely Necessary for the young child. The baby's room should be the one, in all the house, which has the largest amount of sunlight. Quite as important is fresh air. The baby's room must be well ventilated night and day and to attain this there should be windows in opposite sides of the room so that there can be cross draft. In moderate weather the windows should always be open. In the coldest weather, the windows should be thrown open wide at fre- quent intervals so that the roofti may be flushed with fresh air. The death rate among children in ill-ventilated rooms is very high. Pneumonia, bronchitis and colds are more often -due to absence of fresh air than to exposure to the outside air. Babies do not want silks and satins ; but they do want sunlight and sanitation. The Temperature of the Baby's Room should be even and readily controlled. Hot air furnaces are said to provide more satisfactory heat than steam or hot water since they assure greater circulation of air. An open grate is of advantage as a means of ventilation ; but can not be relied upon for the complete heating of the room in cold weather. Gas and oil heaters should never be used if they can be avoided. Our Babies — Hoiv To Keep Them Well The room should be so arranged that it can be thoroughly and readily cleansed. The floor should be bare and, if imperfect or rough, should be covered with linoleum. Painted walls offer the advantage that they can be washed down. Unnecessary Furniture Should Be Removed and what there is should be simple and convenient. Aside from the crib, there should be a screen to protect the baby from drafts, a low chair without arms for the nurse or mother, a good set of scales, a bathtub and a basket for toilet articles, a chiffonier for the baby's clothing and two tables, — one for the scales and basket and the other for the baby's bath. The Baby's Bed may be very simple and inexpensive, but should receive care and attention. A light box or ordinary basket, properly prepared, may answer every purpose for the first bed. Table "silencer" or padding, folded several thicknesses, makes an excellent mattress and is readily washed. Mattresses can also be made of bed ticking or heavy muslin, to be filled with clean excelsior or straw. At frequent intervals the filling should be changed and the cover washed and hung in the fresh air and sunlight to dry. A washable pad should cover the straw or excelsior mattress to make it smooth. When the child is older, an ordinary mattress should be em- ployed and this should be protected by a rubber sheet over which a pad is placed. A baby wants warmth, cleanliness and comfort. He isn't interested in mahogany or in polished brass. No Pillow is required for the baby until the end of the second year. The child will sleep better and breathe better with the head not elevated. When a pillow is used, a hair pillow is better than one of feathers. In Covering the Mattress with rubber cloth or oilcloth, tapes should be used so that the covering may be tied on the under side and the cloth kept smooth. If desired, the rubber cloth may be sewed in the form of a pillowcase and the mattress may be enveloped in it. Some physicians and nurses recommend that the baby's blankets be covered with a bleached muslin bag which is sewed on three sides and buttoned on the end. By this arrangement, the blankets are protected from soiling by milk, medicine, etc., and, more important, the baby may be cov- ered and the bed kept straight without tucking the covers under the mattress in the old-fash- ioned way. Every article used in the baby's bed should be of such character that it can be readily washed. COMFORT VERSUS LOOKS TE-ARS-in4IIS-EYES^ndTEAR8-on^15-N0S£- EXCEEWNGp01F^0gS&MY-CLOTHE:5^ WlLL-M«f^lCll#to£VERYON^ "mm. "VERY-fEW^LOT-HfsAND/PiN.T-HEliEEZE- 50-WfiENij5=KOf^EMEMBER.-"^l5-, PLE-A5E — W•M0^■BABY5•EN■IMDToT4^E5L. # ILLINOIS STftTg- BOA.gPoF HgAUH^^ ^OAltTo"'-! M?l4. Our Babies — Horn To Keep Them Well THE CLOTHES THE BABY WEARS Clothing should be adapted to the season and the climate. In summer many babies are "brutally overdressed." _ If the baby is well and perspires, it may usually be assumed that he is overdressed. If his hands and feet are cold or he becomes blue about the mouth, he is not dressed v^rarmly enough. Very young babies should be kept amply warm, but should be grad- ually weaned away from "hothouse conditions." The overdressing, done to prevent colds and bowel trouble, often produces just what it is designed to prevent. The three essentials of the infant's clothing, — aside from the amount to be worn, — are that it shall be loose, smooth and scrupulously clean. A baby is a serious proposition. He isn't a doll to be dressed and undressed, bedecked and be- ribboned for the amusement of an overgrown girl. The Band or binder should be made of unhemmed flannel, six to eight inches wide and a half-yard long. It is used to keep the navel dressings in place ; but it should never be tight. After the navel has healed, a knitted band with shoulder straps should be substituted. A tight band, instead of preventing rupture, may cause rupture. The Baby's Shirt should be of cotton or cotton and wool or silk and wool mixtures and should be open all the way down. All-wool garments are not as much in favor as they once were. They tend to overheat the child and to irritate the skin. The baby should have summer weight and winter weight under- wear. This is the foundation of the infant's clothing and greater or less warmth should be provided by adding or removing other gar- ments. The winter shirt should be light enough so that it will not be uncomfortable in the house. The Petticoat should be part wool, but should be light in weight and, even for the youngest child, should not extend over ten inches beyond the feet. The petticoat should always hang from the shoulders. Slips should be of very soft material, — not over twenty-four inches long — and very simply made. There should be nothing about the neck that may scratch. Starch should never be used in a baby's clothes. 10 Our Babies— 1 1 01V To Keep Them Well Wrappers, of flannel or cotton, as the weath- er dictates, — may be used to take the place of both petticoat and slip if desired. The wrapper should be open all the way down the front. The wrappers may be used as nightgowns when the baby is older. We make our own clothes to suit ourselves. Why not make the bahy's clothes to suit the baby? He _ cares nothing for style. . The Objectionable Features of the Diaper, — the large bulk, the difficulty in laundering, the overheating of the child, — may be overcome by using a light outside diaper of cheesecloth and employing pads of absorbent wool, Turkish toweling, etc., to catch the discharges. No diaper or pad should ever be used after it has been soiled until it is washed, with bland, white soap, rinsed, dried, sunned and aired. The baby should wear part-wool stockings which reach to the diaper in cool weather and, when he begins to crawl about the floor, should have soft shoes that are shaped like his feet. In hot weather, the baby should be barefoot much of the time. THE AIR THE BABY BREATHES Fear of Fresh Air is getting to be a thing of the past. People are now sleeping out of doors who, a few years ago, closed their windows tightly to keep the night air out. The baby needs fresh air as much as does the adult. Except in severe weather, the baby should make his first trip outdoors for a few minutes when two weeks old. The periods out of doors should be increased steadily until, in reasonable weather, the child should be in the fresh air practically all the time. Many babies do splendidly living out in their carriages from morn- ing imtil night even when the weather is quite cool. If, for any reason, such as stormy and dusty weather, extreme cold, etc., the baby can not be taken out, he should be dressed as for an outing and all the windows in the room be opened. In very hot weather, the baby should be taken out early in the morning and should be kept indoors during the hottest part of the day. When outdoors, the baby's eyes should be shaded to avoid direct svmlight and the infant should be protected from flies, mosquitoes and other insects. The creeping pen is of great service in permitting older children to be out of doors without constant close attention from the mother or the nurse. Nothing is cheaper than pure air; nothing more frightfully expensive than foul air. Our Babies— Hozu To Keep Them Well 11 Many parents lament their inability to give their children "bigger opportunities." There is no occa- sion for such lamentation in regard to outdoor life — the "biggest opportunity" for, the child to acquire health. If a Nursemaid is employed, care must be taken in her selection. She must be free from disease, must be honest and conscientious, and must have an intelligent idea of the mental attitude to be taken in handling children. However competent the nurse may seem to be, every mother fails in her duty to her child who does not know for herself that the infant is receiving proper attention. Many mothers who would be shocked at the very suggestion of "farming out" the baby, actually farm their infants out at home by turning them over body and soul to hired help. BATHINGITHE BABY Proper Bathing is very important to the comfort and health of the child. The baby should be bathed every day. The best time is probably before the mid-morning feeding and after the bowels have moved. At bath time, the room should be about 72 degrees in temperature and the baby should be protected from drafts by a screen. The water should be just about body heat. Everything should be ready for the bath before the baby is un- dressed so that there will be no chance of his becoming chilled. The head and face should be washed before removing all of the clothing. The body should be completely soaped with a bland, white soap before the child is placed in the tub. All trace of soap must be rinsed away before the bath is completed. The baby's skin should not be rubbed with the towel, but should be gently patted and the towel should be of very soft material. Powder should be used very sparingly. It should not be used to take the place of properly drying the baby with a towel. Cool baths should not be employed with young babies. With older children, cool sponging may be beneficial provided the child "reacts" promptly, — that is, provided the skin shows a pink, healthy glow after the bath. The perfumes of Araby and the laces of Spain cannot give to a baby the charm to be found in a tub of soft water and a cake of bland soap. BLIND MAN'S BUFF ■"S-i'il linois State Board of Health Cartoon No, 30 It is the first duty of every community to protect its children against the perils to which they, in the very nature of things, are blind Our Babies — How To Keep Them Well 13 THE FOOD THE BABY TAKES Maternal Feeding — or breast feeding — is of the utmost advantage to the baby and every mother who is able to do so, even at great per- sonal sacrifice, should give her child this benefit. Artificial feeding is, at best, a makeshift fraught with grave dangers to the child. The majority of mothers can at least partly nurse their babies if they will. Fear of inability to nurse the child is believed to so affect the flow of milk as to be one of the causes for failure on the part of the mother. Determination to nurse the baby and confidence in being able to do so are very important to success. The flow of milk is stimulated by the efforts of the child to obtain it. Hence, the baby should be put to the breast regularly during the first two weeks, even if there appears to be little or no milk secreted. Among the few things unforgivable is the unwill- ingness of the mother to nurse her child. The Nursing Mother requires an abundance of light, nourishing food. All food is "milk-making food," and it is a serious mistake to overbalance the diet in the hope that stuffing with any particular kind of food will be beneficial. As a rule, overeating will be productive of indigestion and disturbed digestion may affect the breast milk and make it unfit for the child. It is difficult to set down hard and fast rules for the diet of the nursing mother since individual digestive powers vary so widely. The nursing mother should overcome a tendency to constipation by habit and food rather than by medicine. Coffee and tea should be used sparingly if at all. Alcoholic drinks afe best omitted altogether. The mother should drink a quart of milk a day and plenty of pure water. Exercise should be taken in the open air each day, but never to the point of actual weariness. The mother should have plenty of sleep at night and should take a nap each day. Every mother owes it not only to herself but to her baby to see that she has ample recreation and amusement. A great many mothers fail in their duties to their children by remaining too constantly at home and fretting unnecessarily over the child's welfare. Properly clothed and with its few wants satisfied, the average baby does best when let alone and the woman who permits herself to fret over every detail in her child's life, unfits herself for motherhood. It is safer for the baby for the mother to carry a buckeye in her pocket or hang a horse shoe over the door than to follow the superstitions of patent medicine or fads of feeding. 14 Our Babies — How To Keep Them Well The nervousness of the baby is often the reflec- tion of the lack of poise on the part of the mother. Difficulties in Nursing can be overcome, to a large extent, by care on the part of the mother. The baby should be held properly when at the breast. His head should be high enough so that he will not choke ; but so low that his nostrils will not be obstructed by the breast. Too free flow of milk may be controlled by pressure by the mother's fingers. Sore nipples, due to the efforts of the nursing child, should be washed with boiled water or boric acid solution after each nursing and covered at night with a mild ointment. A cracked nipple should receive a doctor's prompt attention. If the breast produces too much milk, relief may be obtained by the employment of a breast pump or by massage. All treatments of the breasts to overcome difficulty in nursing should be carried out under the direction of a physician. Regularity of Feeding is of the utmost importance. Most babies do better if fed at infrequent intervals. Under six months of age, the baby should be fed every three hours. The baby should not be permit- ted to refmain at the breast over twenty minutes. After six months, the feeding should be at four-hour intervals. The baby should never be permitted to go to sleep at the breast. Until the baby is four months old, there should be one feeding at night, but after the fourth month, this is not necessary. Living by rule is difficult. Living by luck is hazardous. Partial Breast Feeding is far better than no breast feeding at all. If the breast does not furnish sufficient food at first, nursing should not be given up ; but modified cow's milk should be added to the breast supply to meet the baby's needs. If the baby is kept regularly at the breast, even after the flow seems to have failed, secretion may be reestablished largely through the baby's efforts. The amount of food secured from the breast by the baby may be determined by weighing the baby before and after each feeding for a period of twenty-four hours and then adding the difference in weights. If the baby is partially fed from the bottle, the opening in the nipple should be very small so that the child will not find it easier for him to get food from the bottle than from the breast. Our Babies — How To Keep Them Well 15 The Weight of the Baby is the best index of successful feeding. The average baby weighs about seven pounds at birth, boys being sHghtly heavier than girls. There is usually a slight loss of weight immediately after birth, but this is regained, as a rule, by the tenth day. During the first month of life, the baby should gain about three-fourths of an ounce a day, while at six months he gains about one-half ounce a day and, at one year, one-fourth ounce a day. Loss of weight is one of the important danger signals of childhood and should suggest to the intelligent parent the calling of a competent physician. During the hot season of the year, however, even if the infant does not gain in weight, great care should be exercised in increasing the quantity of the food. If the baby is well, it is better that he should not gain in weight than that his digestion should be upset by overfeeding. The baby should be weighed on scales such as are used by grocers, having a basket or pan in which to place the child. Ordinary spring scales or steelyards are not sufficiently accurate for weighing children. The dial of the scales is the Dun or Bradstreet of the baby's career. "Artificial Feeding" is the term applied to all substitutes for breast feeding. Cow's milk is the best substitute for breast milk. The milk should come from healthy herds and should be handled with absolute cleanliness at every stage from the cow to the child. In some communities milk produced under the best possible condi- tions and known as "certified milk" may be obtained. The slight increase in the cost of this pure milk is always excellent economy. Reducing the matter to a cold, practical basis, it is cheaper to pay a high price for good milk than to meet the expenses of the sickness of the baby. Ordinary dairy methods, even of prosperous farms, are far from clean. Milk which may appear to be fresh and sweet may contain germs deadly to babies. The production of absolutely pure milk requires scientific knowledge and technical training, rarely found on the average farm or in the average dairy. Hence, unless certified milk can be obtained, it is far safer to heat or cook milk before using. Cooking milk which has been contaminated does not make it pure, but it does prevent increase in contamination through increased growth of germs. Cooking merely makes an unsatisfactory 1 milk less dangerous. 16 Our Babies — Hon' To Keep Them Well It is not so important to know how much fat a milk contains as it is to know how much manure and filth it contains. Pasteurization is a process of heating milk which affords the highest degree of pro- tection to the child without spoiling the milk by overcooking. This consists of heating milk to 145 de- grees, maintaining that temperature for some time, and then cooling rapidly to 50 degrees. This is most conveniently done with the pasteurizers that can be bought on the market, but can be accomplished satisfactorily by simple methods without special equipment. A simple method of pasteurizing is as follows : A kettle or pail of water is put on the stove and permitted to remain until the water is boiling. It is then removed and allowed to stand uncovered for ten minutes in a room at ordinary temperature. The bottles containing the child's milk, loosely corked, are placed in the water, the kettle is covered and allowed to stand for half an hour. The bottles are then taken from the water, cooled rapidly in cold water and placed in the ice box to remain until needed. The milk should not be uncorked from the time the bottle is filled until the time it is given to the baby. Boiling Milk, which is sometimes recommended by the physician in certain conditions, may be accomplished by placing the filled milk bottle in a kettle of water and permitting the water to boil for three- quarters of an hour. The character of the milk is materially changed by boiling and the process consequently unfits milk for ordinary use in feeding infants. The Best of Milk is ruined and made dangerous by careless handhng. Milk is good food for germs and they thrive in it and mul- tiply rapidly. Milk should never be bought in bulk. It should be bottled at the farm or dairy in bottles that have been thoroughly boiled or sterilized with live steam before using. Milk should be kept at the lowest possible temperature from the time it is milked until it is used. Excellent milk may be made exceedingly dangerous by permitting it to stand on the doorstep during hot weather. Milk which has been kept in uncovered pans, pitchers or jars, even in the refrigerator, is not fit for the baby's use. If there is any question as to whether the milk is fresh or if there is any sediment in the bottom of the bottle, it should not be used. In dealing with milk, remember the advice of Mr. Punch: "In case of doubt, don't." Our Babies — J/ow To Keep Them Well 17 What to Feed the Baby that has been deprived of maternal feed- ing is a subject on which even physicians do not all agree. It is safe to say, however, that the best and most satisfactory artificial food is good cow's milk properly diluted and modified to meet the requirements of the individual child. Milk of animals is made up of fat, sugars and proteids; but in the milk of various animals, the proportions of these ingredients differ materially. There is a decided difference in the proportions of these elements in breast milk and cow's milk. For this reason, cow's milk can not be given to the baby without being diluted and otherwise prepared. This is called "modification." While there are certain standard formulas for milk mixtures that suit many babies, it is far wiser, if the baby is to be artificially fed, to consult the physician as to the mixture to be used. Upon the proper feeding of the baby may depend not only his health, but his life or death. Mothers should not experiment in infant feeding if it is found that the baby is difficult to feed. No artificial food is as good as mother's milk. Cow's milk is the ideal food for the calf. Breast milk is the ideal food for the young human. In Case of Indigestion, shown by vomiting or diarrhea, the phy- sician should be called at once; but, pending his arrival, all food should be discontinued and the baby should receive nothing but a little plain, boiled water. Many babies are sacrificed through overfeeding at a time when they should have no food at all. The Proper Feeding of the Baby is so important that the Amer- ican Medical Association has formulated a set of rules based upon a conference of physicians of national reputation. These rules are* as follows : Beginning on the third day, the average baby should be given three ounces of milk daily, diluted with seven ounces of water. To this should be added one teaspoonful of lime water and two level teaspoonfuls of sugar. This should be given in seven feedings. At one week, the average child requires five ounces of milk daily, which should be diluted with ten ounces of water. To this should be added one f 1"^^^.' r^ and one-half even teaspoonfuls of sugar and one ounce of lime water. This should be given in seven feedings. The milk should be increased by one-half ounce about every four days. The water should be increased by one-half ounce every eight days. At three months, the average child requires sixteen ounces of milk daily, which should be diluted with sixteen ounces of water. To this should 18 Our Babies — Ho:i' To Kccf Than ]Vcll be added three tablespoonfuls of sugar and two ounces of lime water. This should be given in six feedings. The milk should be increased by one-half ounce every six days. The water should be reduced by one-half ounce every two weeks. At six months, the average child requires twenty-four ounces of milk daily, which should be diluted with twelve ounces of water. To this should be added two ounces of lime water and three even tablespoonfuls of sugar. This should be given in five feedings. The amount of milk should be increased one-half ounce each week. The milk should be increased only if the child is hungry and is digesting his food well. It should not be increased unless he is hungry nor if he is suffering from indigestion even though he seems hungry. At nine months, the average child requires thirty ounces of milk daily which should be diluted with ten ounces of water. To this should be added two even tablespoonfuls of sugar and two ounces of lime water. This should be given in five feedings. The sugar added may be milk sugar or, if this can not be obtained, cane (granulated) sugar or maltose (malt sugar). At first, plain water should be used to dilute the milk. At three months, sometimes earlier, a weak barley water may be used in place of plain water. It is made of one-half level tablespoonful of barley flour to sixteen ounces of water and is cooked twenty minutes. At six months, the barley flour may be increased to one and a half even tablespoonfuls cooked in twelve ounces of water. At nine months, the barley flour may be increased to three level table- spoonfuls cooked in eight ounces of water. The Amount of Food to be given the baby may be roughly com- puted on the basis that the child is to have one and one-half ounces of milk every twenty-four hours for every pound of his weight. This is in addition to the sugar and water proper for his given age. A convenient table of feeding the healthy baby during the first year is taken from the textbook on "The Care and Feeding of Children" by Dr. L. Emmett Holt : meals by 4ay Age. Hours. Sefond to seventh day 3 Second to third week 3 Fourth to ninth week 3 Tenth week to fifth month. ... 3 Fifth to seventh month 3 Seventh to twelfth month 4 Interval between Night Number Quantity feedings feedings for 1 (10 p.m. in 24 feeding, to 7 a.m.) hours. Ounces. 1 7 11^-2^ 1 7 2-4 1 7 3 -4^ 1 7 31^-5 6 4^-61^ S 6^-9 Quantity for 24 hours. Ounces. 10-17 14-28 21-31 24-35 27-39 33-45 Absolute Cleanliness is imperative in everything that touches the baby's food. This means more than cleanliness of the ordinary good liousekeeper. All utensils employed must be in good condition, free from breaks, cracks and defects and made preferably of enamel ware or aluminum. All utensils must be boiled for at least fifteen minutes before using. The hands and clothing of the person preparing the food must be spot- less. It is necessary that all articles should be made clean and kept clean. To wipe a utensil with a soiled towel after it has been boiled, does away with all the benefit of boiling. Our Babies — How To Keep Them Well 19 The utensils employed in preparing the baby's food should be used for that purpose alone. There should be provided a bottle brush, a graduated glass measure, a half-gallon pitcher, a glass or enamel funnel, a large enamel spoon, a large kettle for boiling the utensils or for pasteurizing and an enamel double boiler. Nursing Bottles should be cylindrical in shape, with wide mouth and short neck, or better, they should have no neck at all. Such bottles can be purchased with graduated measuring marks blown in the glass. There should be no angles in which dirt can accumulate. Every inch of the interior of the bottle must be reachable with the bottle brush. There should be at least as many bottles as there will be feedings during the day so that all bottles can be filled at one time in the morning and the food not disturbed from the time of its preparation to the time of feeding. It is an exceedingly dangerous thing to use one -bottle repeatedly during the day. Carelessness and hurry under such conditions are quite likely and carelessness and hurry are always sources of danger. As soon as the bottle is used, all remaining food should be emptied out and the bottle rinsed with cold water and left standing full of water. Food must never be saved from one feeding to be given at another. New bottles may be toughened by putting them in cold water and bringing to a boil and boiling fifteen to twenty minutes. They should remain in the water until it cools. This will save breakage. A little care for a little while every day will often ' prevent serious catastrophe. Handling the Milk, like every other detail in infant feeding, requires the utmost care. The milk bottle should be rinsed and the top wiped with a clean towel. Very frequently, with the ordinary milk bottle with flat paper cap, dirty water may stand on the cap. A bottle cap which entirely covers the top of the bottle and comes down over the edges, as now used by many dairymen, is much better than the flat 4^^\ cap which fits in the mouth of the bottle. f^, - \JJ^ The food for the entire day must be pre- ^^^^^\ llifM pared at one time. No water should be used either to dilute the milk or to rinse or wash utensils unless it has been previously boiled. When the milk mixture is made, all of the bottles should be filled with the proper amount and stoppered with fresh bottle corks or with plugs of sterile cotton. 20 Our Babies— How To Keep Them Well The milk should then be pasteurized, cooled and placed in the ice box where it is to remain until used, each bottle being taken from the ice box as required. Carelessness for a moment may cause regrets for years. When Ready for Feeding, the cold bottle should be placed in a pan of hot water for warming. The water should not boil or the milk will get too hot. The temperature should be de- termined by dropping a drop of milk upon the mother's arm. The mother must not put the nipple in her mouth to test the temperature. The milk must not be taken from the bottle for warming and the cork or plug must not be disturbed. When the milk is warmed, the stopper is removed and the nipple applied. In doing this, the nipple should be handled by the neck. The part that goes in the baby's mouth must not be touched by the mother's fingers. Conical Nipples, which can be easily turned inside out for clean- ing, should be supplied for each bottle. The hole in the nipple should be sufficiently large that, when the bottle is held with the nipple down- ward, the milk will drop readily. Long nipples or nipples with long tubes should never be used under any circumstances. Such nipples have killed thousands of babies. The Nipples should be washed in warm water immediately after being used and rubbed inside and out with a little salt, again rinsed and boiled for five minutes, dried and placed in a covered jar which has been previously boiled. Nipples should not be kept in water, as this quickly rots the rubber. The Mother or Nurse should hold the bottle during feeding and the baby should be in about the same position as if nursing from the breast. Feeding must not last over twenty rninutes. If the child takes the food very rapidly, the nipple should be occa- sionally withdrawn from the mouth. The baby should be kept awake during the feeding; but, if he does fall asleep, the bottle should be removed and no more food given until the next regular feeding. Every artificially fed baby lives under a distinct disadvantage. Every care must be exercised to reduce this disadvantage to a minimum. Give the baby a chance. Our Babies — Horn To Keep Them Well 21 When Changing from Breast Feeding to artificial feeding, it is the part of wisdom to use a weaker food mixture than would generally be employed for an infant of that age. It is very easy indeed to upset a baby by overfeeding. The wise course is to start with a weak food and gradually increase to a place where the baby seems to get the great- est benefit with the least disturbance from the food. A properly fed baby is contented, gains steadily in weight, does not vomit and has normal bowel movements. If the baby sleeps restlessly, vomits or has a tendency to diarrhea, he is probably being overfed. If breast-fed, the period between the feedings should be lengthened. If bottle-fed, the amount and strength of the food should be decreased. Proprietary Infant Foods, so generally advertised in the markets, should be used only upon the direction of the physician. As a rule, the prepared or patented foods do not contain all of the elements re- quired by the child. The best food for the baby is mother's milk. The next best food is the milk of some other animal designed for the sustenance of the young. Pure Water should be given to the baby in abundance. It is safer to boil all water to be used by the child, and it should be given lukewarm — never very cold. Water should be offered to the baby fre- quently between feedings. The Baby's Stools are an important index of his physical condi- tion. The normal stools are yellow and without offensive odor. Early in life there may be two movements a day, decreasing later to one. In case of decided change in the character or frequency of stools, the doctor should be consulted. The baby can be taught to use the chamber very early in life, thus doing away with the ever-offensive diaper. To train the infant in this way, he should be put on the chamber at the same hour each day — preferably just before the morning bath — and this should be carried out patiently and persistently. The child should never be scolded or fright- ened when being trained. A small enamel cuspidor answers the purpose very well as a cham- ber for a child. For the very young baby this should be used in the mother's lap. It is easier to form good habits than to break bad ones. THE TROUBLES OF TOMMY or the Man Without a Birth Record (SHIFTING PICTURES, SERIES No. 1) THE MLINCIPAL C*= THE. GRAMM^K -.CHOOL HOW OLD IS THl: UTTlE, FCLUOw"? TMe PkOBATiom OFFICER, '"'"oo B^D. SOWWr.QUT WE CAN'T LET VOU The HUR6E. 5 V >ttARb OLD LAST Jul-, Oo To W0R>^ UNTil, "rou ftce rounTEEM, AHD Tou RE SuCH A, THE. PRINCIPAL He. Looft-o Much -iOu<* ER THAN THAT ICftNNoT ADMIT LITTLE CHfSP THAT TOu CftHT BE MoR.e TM^iN TWELVE." HIM UWTIL I AM aunt Ht IS OF SCHOOL AtiE, BuT THAT WILL BE EA'SiLf ThC Bo-f ' HoHEST I AM FOUR-TEEn .' ' pRCVtD 1"^ H£ HAS ft Birth certificate ■ THE PROBATION OFFICt ' LETS SEE fOvB. BIRTH C EgTI>^ICP.TlL THC CLERK OFELEaiOMS- SoWrt 3lE, But THtLAW does mot ALU>VtOU to vote UHUL The MARRIAGC Licerwse Clerk, "that KIO Sfl.1D HE. WAl OLD ENOUi You ARE Twenty -ONE tears oc age. to h et marjucd" the: Toutm ©ut 1 A^i Twenty ome te:ars oi- ag e." chorus, ' di&n t h^e have a butt h ceRtipicate ?' CLERKoFELEatcNS'HftVE -(OU Youra BIRTH CERTIFICATE? T^uwiLi-HAVE thE CLtRK^TTo ' HE HAD No WAT or PROVING THAT H£ WAS TO F;R£_E ^£U_«■ '^E B_ TMA TWENTY -ONE VEAWS op A<^ E ^ THE Girls FftTHER.. C EAR-OUTofHERE, -,ou ^ U SUkHP L tiOl HAVE THE LAWYER: " IN PRoviWl?0 o P HEALTH — CA^RTOOKi' M^ Si You can spare your child these troubles by having his birth recorded Our Babies — Hozv To Keep Them Well 23 THE BABY'S TEETH The First Teeth of the baby begin to appear through the gums about the seventh month of life. The teeth come in groups. At the end of one year, the baby usually has six teeth; at eighteen months he should have twelve teeth and at two years he should have sixteen teeth. While the teeth usually appear at from six to nine months, and while a regular order of appearance is usually followed, there is wide variation both in the time and in the order of appearance, so that the mother need not be concerned if the exact order is not followed, nor if there is delay in appearance. In case the teeth are greatly delayed in appearance, the doctor should be consulted. While there may be great discomfort associated with teething and while there may even be such symptoms as increased bowel movements, occasional vomiting and fretfulness, many of the ills charged to teething are not due to it at all. Serious illness on the part of babies has often been neglected by assuming that the disturbance is simply "due to teeth- ing." Whether teething or not, the cross and sick baby should have the benefit of the doctor's care. Many babies have died because things have been taken for granted. WEANING THE BABY Weaning should be carried out very gradually. The child should be weaned usually at the end of one year, but, if the child is not doing well, if the breast milk is deficient or any other definite reason presents itself, weaning may be carried out earlier. Many physicians advise giving one feeding of artificial food from the bottle each twenty- four hours to all babies as early as the fifth or sixth month, so that the child will be accustomed to taking such food. This makes weaning easier later on. If the baby is weaned at ten months or earlier, bottles should be employed; but if weaned at one year, the food may be taken from the glass or cup direct without the use of bottles. In deciding upon the time of weaning, the baby should have first consideration. It's his stomach that is concerned and his life that's in the balance. In Starting Artificial Feeding, it must be seen to that the mixture is weak enough. A child weaned at nine months should be given the milk mixture ordinarily given to a baby of from four to five months. If this is handled well by the baby, the mixture may be steadily increased in strength. 24 Our Babies — How To Kcc[> Thcin JVrl! Weaning should not be undertaken during the hot weather and the strength of the food should be increased only with the greatest caution at that time. If the baby vomits or if there is undigested food in the stools on increasing the strength of the food, the weaker mixture should be promptly resumed. In dealing with a baby, make haste slowly. There is less danger of underfeeding than of overfeeding. THE BABY'S SLEEP Sleep and plenty of it under the best conditions is required by the baby. The baby should sleep in a bed alone and in a room alone. The conditions in the room should be governed for the baby's welfare only. The very young baby should sleep eighteen to twenty hours out of the twenty-four. At six months, the baby should sleep sixteen hours a day and, at one year, fourteen hours. The average healthy baby will usually get hungry enough to wake every three hours. That is the chief argument for three-hour intervals between feedings. If the baby is asleep at the regular nursing time, he should be gently awakened. The young baby can usually be in bed for the night by 6 o'clock, and, during the first few months, should be taken up and fed at 10 o'clock. After the sixth month, the 10 o'clock feeding may be omitted. If the Baby Is Well, he will not have to be taken up or given any attention after being put to bed. He should be let alone, even though he may cry. A baby readily establishes good habits and bad habits. If he is permitted to cry without notice being taken of it, he will soon cease crying and will learn to go quietly to sleep. If, on the other hand, he learns that his every whimper will bring someone to amuse him, he will become a veritable tyrant. The children who are the most unhappy are those who are most humored by overindulgent parents. The Baby's Sleeping Room should be kept cool. During the first three months of life, the temperature should be about 65 degrees ; but .after three months, the room may be kept at 55 degrees or lower. Ba- bies usually sleep better in a cold room. In very cold weather, the baby should have a flannel nightgown over the cotton nightgown and a thin nightcap may be worn. If hot water bottles, etc., are used, they should be very carefully and securely covered so that the baby will not be burned. Our Babies — How To Keep Them Well 25 The baby that has been played with and over-amused during the day may sleep badly. The sleep may also be disturbed by too much cover, too little cover or by the baby being wet, hungry, thirsty or overfed. A cool or warm bath at bedtime may quiet a restless baby. Medicine should never be given to the baby except on special order from the phy- sician. Soothing syrups and other drugs have killed scores of babies. There is no such thing as a harmless soothing syrup. The baby should never be permitted to go to sleep with anything in its mouth. Thumb and finger sucking should be broken off. Pacifiers, sugar teats and other similar devices are to be absolutely forbidden. If properly handled and trained, the baby will be able to sleep through the ordinary household sounds and noises. It should not be necessary for the members of the household to alter their methods of life to avoid waking the baby. There should be fair play between parents and baby. The baBy should be accorded his rights gener- ously and sanely. He should not be permitted to play the tyrant with those about him. The Baby Is Not a Plaything. Many babies are made restless and nervous by too much amusement and play. For the most part, after the baby's needs have been met, he should be let alone. No one should kiss a baby on the mouth nor should the baby be rocked, jumped or otherwise kept in motion. From the day the baby is born, parents dream of the place he will hold among men — of his future power— his intellectual attainment. If the first years of his life are given over to making him a strong and rugged animal the realization of these dreams will be more assured than in any other way. 26 Our Babies — How To Keep The in Well PREVENTING THE BABY'S ILLNESS The Condition of the Bowels is very important. Even a slight attack of diarrhea should prompt the mother to send for the physician. Pending his arrival, all food should be withheld, except boiled water. After even a slight attack of diarrhea or indigestion, it takes some lime for the digestion to become normal. Care should be exercised for ten days to two weeks after a slight digestive upset and it must be remembered that a second attack may occur with very little to cause it. The baby should have at least one good bowel movement a day. This may be brought about if the child is taught to use the chamber at the same hour each day. Persistence and regularity may prevent or overcome constipation. If the Baby Has a Tendency to Constipation, orange juice may be given once a day after the baby is six months old or oatmeal gruel and fruit juices may be employed. Massaging the abdomen with the hand oiled in warm olive oil may help to promote free bowel movement. In rubbing the abdomen, the hand should follow the course of the large bowel, beginning at the right groin, then upward to the margin of the ribs, then across the body and down the left groin. This gentle massage should be kept up for from five to ten minutes. , Injections and enemas should not be used except on the doctor's order. In all of the illnesses of childhood, it must be borne in mind that serious consequences may develop from the simplest sort of start and hence it is always wiser to bring these apparently trifling ailments to the attention of the family physician. To wait to see how the case "is going to turn out" may mean waiting beyond the time when the disease can be readily cured. Among the common causes of deaths among babies one of the most common is "the advice of a neighbor." The Contagious Diseases of Childhood are infinitely more serious in their consequences than has been realized in the past. Not only do these diseases kill hundreds of children outright, but they leave in their train consequences of the most unfortunate kind. The mildest case of diphtheria may be followed by paralysis or dis- ease of the heart or kidneys. A light attack of measles may end in tuberculosis or fatal pneumonia ; scarlet fever, so mild as to be recog- nized with difficulty, may be followed by serious kidney disease, heart trouble or inflammation of the ear; whooping cough may terminate in tuberculosis, paralysis or rickets — in any of these diseases the complica- tion may be infinitely more serious than the disease itself. The oft-repeated statement that children may as well "have these diseases and be through with them," was a murderous doctrine. If the child is protected from contagious disease, he may escape the dangers attendant upon them altogether for, in most of these diseases, increas- ing age makes infection very unlikely. Our Babies — How To Keep Them Well 27 When the child has "gotten through with contagious diseases," he has often gotten through with life itself. In case of contagious disease in his own house, the intelligent parent will do everything in his power to abide by the rules of the State Board of Health for the control of such diseases. By so doing, he will protect the members of his own family and will protect his neighbors and oth- ers in his community. On the other hand, in the presence of conta- gious disuse in the homes of others, the intelligent citizen will do all in his power to require the observance of the rules for the control of com- municable disease. It isn't an easy thing to be a good citizen. It re- quires a degree of unselfishness and that is an arti- ficial and acquired virtue with most of us. To Prevent and Suppress Contagious Disease, the State Board of Health requires that communicable diseases shall be promptly reported to the health authorities. Every good citizen should encourage his phy- sician to promptly report these diseases if they occur in the home. The honest physician will ignore or even resent the importuning of the unde- sirable citizen who is willing to endanger the entire community by con- cealing the existence of such diseases. The diseases which must be reported to the health officer under the Illinois law are divided into two classes as follows : Acute infectious poliomyelitis, Asiatic cholera, bubonic plague, cere- brospinal fever, chickenpox, diphtheria (membranous croup), leprosy, measles, meningitis (epidemic cerebrospinal). Rocky Mountain spotted fever, scarlet fever (scarletina, scarlet rash), smallpox, typhus fever, whooping cough and yellow fever. Actinomycosis, anthrax, "continued fever'' (over seven days dura- tion), dysentery (a) amebic, (b) bacillary, German measles, glanders, hookworm disease, malaria, mumps, ophthalmia neonatorum, pellagra, puerperal septicemia, rabies, streptococcus, (septic) sore throat, tetanus, trichinosis, trachoma, typhoid and paratyphoid fever and tuberculosis of any form. In all diseases included in class one the premises must be placarded and quarantined, while all the diseases in class two are subject to modified quarantine while some of them only need be placarded. The good citizen will cheerfully comply with all regulations for the prevention of disease however inconvenient it may be for him individ- ually. We all believe in strict adherence to the rules of good citizenship for other people. After Exposure to Disease there is a period in which the disease develops which is known as "the period of incubation." According to the interstate quarantine regulations of the United States the following periods are accepted as incubation periods: Smallpox, 14 days; typhoid fever, 14 days; scarlet fever, 7 days; diphtheria, 7 days ; whooping cough, 10 days ; measles, 14 days. 28 Our Babies — Ilotv To Keep Them Well During these periods, after exposure, the disease is likely to ap- pear and, hence, the exposed child is a probable source of danger during that time. EXCLUSION FROM SCHOOLS Parents Should Assist the health officer in the enforcement of the following rules of the State Board of Health concerning the ex- clusion of children from schools : 1. Whooping Cough. — Children from households in which whoop- ing cough exists must be excluded from schools unless they present a physician's certificate certifying that, to the personal knowledge of the physician, they have had the disease. Children who have not had the disease and who have been removed from the infected premises must be excluded from school for two weeks following such removal. 2. Scarlet Fever. — All children continuing to reside in infected premises must be excluded from schools during quarantine (5 weeks) and at least one week after quarantine is raised. Children who have had scarlet fever and who are removed from the infected premises may attend school after their persons and clothing have been thoroughly dis- infected upon certificate of a physician. All such children must be ex- cluded, however, for one week after the last exposure. 3. Diphtheria. — Children residing in premises in which there is diphtheria must be excluded from schools during the period of quar- antine and for one week beyond the period of quarantine. Children ex- posed to diphtheria and who do not reside in infected premises must be excluded from schools for a period of one week after exposure. 4. Smallpojc. — When smallpox appears in the community and threatens to spread in epidemic form, all unvaccinated children may be excluded from schools. All persons residing in a house in which there is smallpox shall be held in quarantine twenty days after the recovery of the patient, unless such persons have been successfully vaccinated. 5. Chickenpox. — All children who have not had chickenpox re- siding in a household in which there is chickenpox must be excluded from school for two weeks from the day of the last exposure. Children who have not had chickenpox may attend school upon a physician's cer- tificate to that efifect, provided, they do not come in contact with the patient. 6. Mumps. — Children in premises in which there are cases of mumps and who have had the disease may be permitted to attend school upon presentation of a certificate from a physician to the efifect that they have had the disease. Children who have not had mumps must be ex- cluded from schools for three weeks from the day of the last exposure. 7. Infantile Paralysis. — Children in infected families must be excluded from school during the period of quarantine (five weeks). Our Babies — Hotv To Keep Them Well 29 INDEX PAGE Air the Baby Breathes 12 Artificial Feeding- 17, 23 Bathing the Baby 13 Bed, Proper Kind 9 Birth Registration First Duty of Parent 7 Blindness From Birth Infection, Prevention of ■ 7 Bowels, Condition of, Very Important 28 Breast Feeding, Partial Better than no Breast Feeding at all 16 Cleanliness, a Prime Essential 21 Clothes, Proper Kind for Baby 11 Contagious Diseases of Childhood 28 Contagious Diseases, How Soon Develop After Exposure 29 Contagious Diseases, Reporting and Quarantine of 29 Exclusion from School Account Contagious Disease '. 30 Feeding, Artificial 17, 18, 19 Feeding at Night 20 Feeding, Regularity of Utmost Importance 16 Feeding, Rules Formulated by American Medical Association 19, 20 Feeding, Weight Best Index to Successful 17 Food, Absolute Cleanliness Imperative 20 Food, Amounts to be Given at Different Ages 20 Food, Determining What Best for Baby 19 Food the Baby Takes 15, 16, 17, 18, 19, 20, 21, 22, 23 Poods, Proprietary Infant 23 Fresh Air Essential to Baby 's Health ." 12 Heating Baby's Room ? 8 Home Pasteurization of Milk 18 House the Baby Lives in 8 Indigestion 19 Maternal Feeding Best 15 Milk, Care of in the Home 18, 21 Milk for Infant Feeding, Proper Handling of 21, 22 Milk Pasteurization 18 Modification of Cow's Milk Necessary 19 Nursemaid to be Selected with Care 13 Nursing Bottles, Kind and Care of 21 Nursing Mother, Care of 15 Pasteurization of Milk 18 Preventing Illness 28 Prenatal Care 7 Registration of Birth, Parents Should Insist on 7 Reporting and Quarantine of Contagious Diseases 29 Sleep 26 Sleeping Room 26 Stools, an Index to Physical Condition 23 Sunlight, Importance of 8 Teething 25 Weaning the Baby 25 Weight, Best Index to Successful Feeding 17 WHEN YOUR BABY IS SICK CONSULT YOUR DOCTOR 1 .'I ■!!|:'>;i:!: J ill l|ii: iiii !: >i; ! :!!