OOL^UMmAUBJ^A^^^^^^^ RJ61 M83 The care and feeding RECAP i . ffc. ^5 V -r silt ■•- ■CiCt>-. ■.. .i-S> . ;THE CARE AND ,i;i=;^:.x;;f;:';ic^i::i ti.. .»u .;_,., -J EDING OF CHILDREN MORSE "R"^<^\ WX^*^ in tl)p (Etty of N^m fork Uffprpnrp ICtbrarg HARVARD HEALTH TALKS THE CARE AND FEEDING OF CHILDREN BY JOHN LOVETT MORSE PRESERVATIVES FOR FOOD : THEIR USE AND ABUSE BY OTTO FOLIN In Press CARE OF THE SKIN BY CHARLES JAMES WHITE In Preparation THE CARE OF THE TEETH BY CHARLES ALBERT BRACKETT In Preparation HARVARD HEALTH TALKS HARVARD HEALTH TALKS THE CARE AND FEEDING OF CHILDREN BY JOHN LOVETT MORSE, M.D. CAMBRIDGE HARVARD UNIVERSITY PRESS 1914 r H4J^ COPTEIQHT, 1914 HARVARD UNIVERSITY PRESS i'XAj HARVARD HEALTH TALKS PRESENTING the substance of some -■■ of the pubHc lectures delivered at the Medical School of Harvard Univer- sity, this series aims to provide in easily accessible form modern and authorita- tive information on medical subjects of general importance. The following committee, composed of members of the Faculty of Medicine, has editorial supervision of the volumes published: EDWARD HICKLING BRADFORD, A.M., M.D., Dean of the Faculty of Medicine, and Professor of Orthopedic Surgery, Emeritus. HAROLD CLARENCE ERNST, A.M., M.D., Professor of Bacteriology. WALTER BRADFORD CANFNON, A.M., M.D., George Higginson Professor of Physiology. THE CARE AND FEEDING OF CHILDREN THE CARE AND FEEDING OF CHILDREN DIET IN EARLY CHILDHOOD nn HE average well baby of a year, ^ whether it was nursed or not, will usually be taking whole milk or whole milk diluted with a cereal water. It will, perhaps, be taking in addition a little cereal and beef juice, with orange juice, if its bowels are constipated. It will, in most instances, be having five feedings, at three-hour intervals, begin- ning at six in the morning. If it is not already taking cereals, they should be begun at once. The most easily digestible cereals are barley jelly, oatmeal jelly (strained oatmeal), and farina. A tablespoonful of one of these cereals should be given at the beginning of the nine a.m. and six p.m. feedings. HARVARD HEALTH TALKS This amount may be rapidly increased, if it is taken well and does not cause anv disturbance of the digestion. Some of the milk, or milk mixture, should be put on it. It should be salted, but not sweet- ened. It is very important to accustom babies to take cereals without sugar. If they learn to eat them in this way, they will not demand sugar later. This is an important matter, because children are very apt to use too much sugar on their cereals and thereby disturb their diges- tions. If they are not taking beef juice, it should be begun. One tablespoonful of the expressed beef juice should be given at first. This amount may be gradually increased to four tablespoon- fuls. The various beef extracts and liquid preparations of beef juice should never be used. They contain but little nourishment and the liquid preparations contain an appreciable amount of alco- hol. Mutton broth and chicken broth may soon be given part of the time in 10 CARE OF CHILDREN place of the beef juice, beginning with two ounces and working up to four ounces. The beef juice and broth should be given at the beginning of the noon feeding. It must not be forgotten that clear broths have practically no nutritive value and that the food value of beef juice is only one half that of an equal amount of milk. When the baby is thirteen or fourteen months old, zwie- bach and bread crumbs may be added to the beef juice and broth. The list of cereals may be increased after a few months by the addition of cream of wheat, Ralston, wheat germ, and rice. They may also be given at this time stale bread or plain white crackers " in their hands " to eat. At eighteen months, soft boiled or coddled eggs, baked potato, and plain boiled macaroni may be added. At the same time they may have junket, baked custard, and cornstarch pudding as desserts. Butter may be put on their bread at about the same time. The 11 HARVARD HEALTH TALKS bread and crackers may be given plain or toasted, or in the form of milk toast. The simple meats, like roast or boiled chicken, lamb chop, mutton chop, and scraped beef, may be begun at two years. Plain blanc-mange and plain tapioca may be added to the desserts. At two and one-half years the green vegetables, such as peas, string beans, spinach, asparagus and stewed celery, may be given. The peas, string beans, and spinach should be put through a sieve, otherwise they are not easily digested. There is no objection to giving canned peas and string beans. Canned asparagus is, however, not suitable. Other forms of meat, such as roast lamb, roast mutton, beef steak, and roast beef, may now be given. It may be noted here that dish gravy is very un- suitable for children, because it contains a large amount of cooked fat, which 12 CARE OF CHILDREN is very indigestible. Scrambled eggs, dropped eggs, mashed potato, bread pudding, and rice pudding may also be added. If the baby is constipated, orange juice and prune juice may be begun at a year, if they have not already been given. At one and one-half years, it is usually safe to give the pulp of the prunes, baked apples, and apple sauce. This diet may be gradually increased by the addition of boiled and broiled fish and minced meat. Gems and corn cake may be added at about four years, and the desserts increased by the addi- tion of apple tapioca and possibly Span- ish cream. Other desserts which are harmless at this age are simple gelatines, flavored with fruit juices, and prune whip. There is really no objection to plain sugar cookies at this age, provided they are given only occasionally. It is better not to give cake. The following 13 HARVARD HEALTH TALKS is a reasonable diet for a child of from four to six years of age: DIET LIST Milk. Butter. Mutton Broth. Chicken Broth. Beef Juice. Soft Boiled Eggs. Scrambled Eggs. Dropped Eggs. Lamb Chop. Mutton Chop. Roast Chicken. Boiled Chicken. Roast Lamb. Roast Mutton. Beef Steak. Roast Beef. Minced Meat. Boiled Fish. Broiled Fish. French Bread. Stale Bread. Toast Bread. Whole Wheat Bread. Milk Toast. Zwiebach. Plain White Crackers. Plain Educators. Gems. Com Cake. Oatmeal. Pettijohn. Cream of Wheat. Wheat Germ. Ralston. Farina. Rice. Baked Potato. Mashed Potato. Plain Macaroni. Peas. String Beans. Spinach. Asparagus. Summer Squash. Carrots. Lettuce. Stewed Celery. Orange Juice. Baked Apples. Stewed Prunes. Apple Sauce. Junket. 14 CARE OF CHILDREN Baked Custard. Plain Tapioca. Com Starch. Apple Tapioca. Bread Pudding. Gelatines. Rice Pudding. Prune Whip. Plain Blanc Mange. Sugar Cookies. Special Articles of Diet Fruit. Fruit is not a necessary com- ponent of a child's diet, as so many people suppose. A child may grow and thrive perfectly without it. There is, however, no objection to it, provided it is digested by the individual child. If children are constipated, fruit is often useful. Many mothers and nurses think that every baby must have orange juice after it is a few months old. Orange juice is not necessary, however, unless the baby is constipated or is taking a pasteurized or boiled food. If the food is cooked, orange juice is advisable in order to guard against the development of scurvy. Before giving orange juice for constipa- tion, however, it is always advisable to determine first whether the constipation 15 HARVARD HEALTH TALKS is not due to some error in the diet, the correction of which will relieve the con- stipation. It is better not to give the pulp of the orange before children are five or six years old. Bananas are not an easily digestible form of fruit. Many children cannot take them at all. The food value of bananas is, moreover, rela- tively slight. There is no objection to them, however, if the individual child can take them without disturbance. Un- cooked berries should never be given to young children. There is no objection to giving cooked berries to children after they are four years old. Raw fruit is, in general, a rather dangerous article of diet for young children. Cereals. It is very necessary to have cereals thoroughly cooked for children. The cereals which are supposed to be eaten cold without being cooked in the household are not suitable for children. They should never be given to them. 16 CARE OF CHILDREN The only possible exception is shredded wheat biscuit. Cereals should be cooked at least four hours, better longer, in spite of the fact that the directions on the package often prescribe a much shorter time. The most satisfactory way of cooking cereals for children is in a fireless cooker. Cereals cooked in this way are better than those cooked in any other. It is often said that the cereals have been on the stove all night. This sounds very well, but investigation often dis- closes the fact that there has been no fire in the stove. In many instances in which children have disturbances of digestion, the whole trouble is in the cooking of the cereals. Bread and crackers. It is just as im- portant to have bread as it is to have cereals thoroughly cooked. Improperly cooked bread is extremely indigestible. Graham bread, unless light and thor- oughly cooked, is very indigestible. 17 HARVARD HEALTH TALKS Properly cooked Graham bread is a very rare article. Graham bread should, therefore, always be looked upon with suspicion. Many people have an idea that crack- ers are not nutritious. This idea is erro- neous, because crackers are almost pure starch. Bulk for bulk and weight for weight, they are much more nourishing than bread. The best form of crackers are the plain white crackers of various sorts. It is better not to give the sweet- ened or fancy crackers. Graham crack- ers are not suitable for children. Thev are too sweet and relatively indigestible. Oatmeal crackers should never be given, the starch in the oatmeal not being in a readily digestible form. Bran crackers may be given for the relief of constipa- tion, but only on the advice of a physi- cian. Milk. Many people have an idea that if they get pure milk for their children 18 CARE OF CHILDREN during their first year, they have done their full duty, and that after they are a year old, children can then take any sort of milk without harm. This idea is an erroneous one. While it is true that babies are less susceptible to milk infec- tion and milk-borne diseases after the first year than earlier, they are, never- theless, very susceptible during the second and even during the third year, — so susceptible, indeed, that it is almost as important to provide pure milk for them then as it is earlier. It is, in fact, a wise precaution to get certified milk or a milk of that grade for them throughout the whole of early childhood. A very few doctor's visits will cost more than the few extra cents per quart will add up to in a long time. Although milk forms almost the whole of the diet during the first year, and the greater part of it during the first half of the second year, it should form a pro- gressively smaller part afterward. A 19 HARVARD HEALTH TALKS child cannot thrive on a diet made up entirely of milk after it is a year old. Malnutrition and anemia will certainly result, if it does not have some other food in addition to milk. The cause of the development of anemia on an exclu- sively milk diet is as follows. Milk does not contain sufficient iron to cover the baby's need of iron. When the surplus of iron with which the baby is born is exhausted, as it is at or even before the end of the first year, anemia must neces- sarily result. A child should not take over a quart of milk daily after it is two years old. More than this is likely to take away its appetite for other food, which is more necessary for it. It is wiser not to give a baby more than thirty-six or forty ounces of milk during the second half of the second year. Cream. Cream is a distinctly bad arti- cle of diet for young children. It is likely to cause disturbance and to set up 20 CARE OF CHILDREN a peculiar form of indigestion, which it is very hard to correct. It is often given to children to relieve constipation or to fatten them. Constipation in babies and little children is not infrequently, however, the result of an excess of fat in the food. In such cases cream will, of course, increase the constipation, in- stead of relieving it. Failure to gain in weight is very often the manifestation of a disturbance of the digestion. Cream, given with the idea of increasing the weight in these cases, is very likely to increase the disturbance of the digestion and to result in further loss of weight. Eggs. Eggs are a very good article of diet for children who are able to digest them. Many children are, however, seriously poisoned by eggs, while many others are unable to take them continu- ously without having their digestion dis- turbed. Eggs must, therefore, always be begun cautiously and must always 21 HARVARD HEALTH TALKS be thought of as a possible cause of indigestion. Meat. Meat is supposed by most people to be difficult of digestion. This is, how- ever, not the case. It is readily digested by most children, much more readily, in fact, than eggs. It is a useful and neces- sary article of diet after the second year. It is wiser not to give meat to children more than once a day, although when children are unable to eat eggs, they may be given meat or fish twice daily. Sugar. There is no article of food which more often causes indigestion in chil- dren than sugar. Young children should not only not be given candy, but also should not be given sugar on their food, nor given foods like cake, in which sugar is present in considerable amounts. A young child should not know the taste of candy. It should never be given ice cream or sherbet. Sugar is not a neces- 22 CARE OF CHILDREN sary component of the child's dietary, as it is so often said to be. The origin of the belief that it is necessary is probably the fact that children need carbohy- drates in considerable amounts in order to keep up the body heat and to supply energy. There are, however, two kinds of carbohydrates, sugars and starches. The starches are as useful as the sugars. They are, in fact, gradually converted into sugar during the process of digestion and are absorbed in the form of sugar. They do not easily cause disturbance of the digestion, while sugars do. The starches, therefore, can take the place of the sugars. There is, consequently, no need for the use of sugars. Feeding Number of Feedings and Intervals be- tween Feedings. The time at which the average two-year-old child gets its first feeding depends somewhat on how early it wakes up. If it wakes up between 23 HARVARD HEALTH TALKS five and six, as most young children do, it should have some milk or a piece of cracker or bread. If it wakes up later, it should wait until its breakfast, at half- past seven or eight. It then has a light lunch, consisting of some milk, or a piece of bread or a cracker, at eleven or eleven- thirty, before its nap. It has its dinner between one and two, after waking from its nap, and its supper at five- thirty, after which it goes promptly to bed. It may have orange juice early in the morn- ing, instead of the milk or cracker, if desired, or it may have it in the middle of the afternoon, provided it is consti- pated. These hours should be continued throughout the whole of early childhood. A child ought not to have anything to eat between its meals. Food between meals destroys the appetite and disturbs the digestion. The stomach does not have a chance to empty itself properly. The suppers of a child, until it is at least six years old, should be very simple. 24 CARE OF CHILDREN They should consist of milk and cereals, bread or crackers, with a little sauce of some sort. The bread and crackers may be given plain, toasted or in the form of milk toast. Nothing more is required. School lunches. It is a curious fact that many mothers, who are very careful about what their children eat in their own house, send them to school with a lunch composed of cake, cookies, and doughnuts, or other kinds of sweets, apparently thinking that a child can digest things at school which it cannot at home. A child's lunch should consist of bread and butter or a meat sandwich. If soup or milk can be obtained at school, so much the better. Unwillingness to eat. It is often very hard to induce a child who has been properly brought up to eat new articles of food. There is no such trouble, how- ever, with children who have been badly 25 HARVARD HEALTH TALKS brought up, and given a taste of every- thing as soon as they were able to hold it in their hands or to swallow it. They will like and eat almost anything that is given to them. The child that has been carefully fed, on the other hand, is usually suspicious of every new thing and very likely to dislike its taste. Such children must, however, be made to eat what is given to them whether they like it or not, because it is important for older children and adults to eat a general and varied diet. The child that has been allowed to eat a limited diet at home has a very hard time when it first goes out into the world and has to eat what is set before it. Children can be made to eat new things if sufiicient patience and per- suasion are exercised. It is rarely neces- sary to use force. It should be used, however, if they cannot be made to eat in any other way. If, however, it is evident that a child has a great distaste for a certain article of food, it is not fair 26 CARE OF CHILDREN to force it on him too often. He should be made to eat it when it is given to him, but discretion should be exercised in giving it to him. When children have a marked distaste for a certain article of food, this distaste is almost invariably the result of suggestion from the parents. It is surprising how often the statement is made that the child inherits a dislike for a certain article of food from one or both parents. The truth of the matter is, of course, not that the child inherits the dislike, but that it has heard its parents say that they can not eat a certain thing and consequently thinks that it is not a good thing to eat. Parents should be extremely careful not to say that they do not like anything before a child. They should merely refrain from eating it and say nothing. Many children are always teasing for articles of food which they ought not to have. The reason of this is that they have been badly brought up and have 27 HARVARD HEALTH TALKS been given " tastes " of things. Conse- quently, they do not see why they should not have a taste of everything and eat everything. A child that has been prop- erly brought up and that has never been given a taste of anything except of its own food, does not expect to have anything else to eat and will, therefore, never ask for other food. He will be perfectly contented with his own food and it will never occur to him that he can eat anything else. On this account it is bad for a child to begin to sit at the family table too early, many parents being too soft-hearted and weak-minded to resist their children's requests. In any case, a young child should eat its supper alone. People often say that children will get tired of such a routine diet and that they need variety. This is not true. A child will be satisfied with the same diet day in and day out, month in and month out, in the same way that a dog is satis- 28 CARE OF CHILDREN fied with meat and a horse with hay and grain, provided it has never had any- thing else. When a child that has been properly brought up loses its appetite it is not because of the sameness of the food, but because of some disturbance of the digestion or some other illness. The appetite will not be brought back by increasing the variety of its food, but will return when the cause of the illness is discovered and removed. Many children are unwilling to eat because they are so much interested in other things. Such children will often eat much better alone. Other children are too busy to eat. Just as soon as they have satisfied the acute pangs of hunger they want to begin to play again. Such children should be made to sit at the table until they have eaten a proper amount. In fact, a child should not be allowed to leave the table until the family have finished their meal. If they are obliged to sit through the meal they 29 HARVARD HEALTH TALKS eat more and eat more slowly, there being no inducement to bolt their food in order to get away. Loss of appetite. Loss of appetite in a child is always a symptom of fatigue, indigestion, or some other illness. It is never due to the sameness of the food or to a routine diet. If a child loses its appe- tite, it must not be " tempted," as the term is. It is never right to give a child indigestible food, when it refuses proper nourishment, simply to make it eat. Loss of appetite being a symptom of some disturbance or other, the child is less able, even than when well, to digest improper food. Consequently, if a child is to be tempted with improper food, it had better be when his appetite is good and he is well, than when it is poor and he is sick. When a child loses its appetite the correct procedure is always to cut down the food, not to push it or to increase its variety. 30 CARE OF CHILDREN Children should always be made to chew their food properly and not be al- lowed to bolt it. They must never be allowed to wash half-chewed food down with water or milk. On the other hand, they must not be allowed to dawdle at their meals. They must be made to eat their meals in a reasonable time. If they will not eat a sufficient amount in a proper time, they must be made to leave the table and go without food until the next meal. Hunger will soon teach them to eat their meals in a reasonable time. Feeding of the sick. It seems a reason- able proposition that the digestive powers of a sick child are less than those of one that is well. Nevertheless, unless times have changed since my boyhood, sick- ness is the signal for all the female rela- tives and neighbors to bring in jellies and preserves which are unfit for a well child to eat. It is one of the things which " no fellow can find out " why 31 HARVARD HEALTH TALKS people should want to make a sick child sicker. Grandmothers. One of the greatest obstacles to the proper feeding of young children is the opposition and inter- ference of grandmothers. It is a strange fact that the majority of women, al- though they have been good mothers and have brought up their own children sensibly, show no reason whatever in matters relating to their grandchildren. They are willing to give them anything and everything to eat and will, in fact, go out of their way to do so. The most probable explanation of this curious anomaly is that they are not responsible for the care of the children when they are sick. They had to take care of their own children when they were sick, and consequently took good care that they did not get sick. They do not have to take care of their grandchildren, and consequently are not so careful. S2 CARE OF CHILDREN Attention to bowels. It is very im- portant to bring up children to have a movement of the bowels at a regular hour. If a regular habit is established in early childhood, it will persist through life. Even infants can be trained in this way. There is no trouble in train- ing young children. There is more diflS- culty when children go to school, since they are often obliged to hurry off immediately after breakfast. This can be avoided by having the family break- fast early enough to give them ample time for a movement of the bowels before starting. The rest of the family certainly ought to be willing to sacrifice a few minutes of sleep for the good of the children. Constipation is, in the majority of instances, due to some disturbance of the digestion, and should be corrected by regulation of the diet. It must be re- membered in this connection that much harm may be done by attempting to 33 HARVARD HEALTH TALKS correct constipation by giving large amounts of cream, fruit and green vege- tables. All of these things, if given in excess, are more likely to disturb the digestion further than to relieve the constipation. Cream is, moreover, not infrequently the cause of constipation in young children. Water. Children need a large amount of water. They are very active, and con- sequently lose much water in the per- spiration and in the expired air. Strange as it may seem, many young children do not realize that they are thirsty and have to be reminded that they want a drink. Every mother should see that her child has sufficient water between meals. There is no harm in drinking water with the meals, provided it is not used to wash down partially masticated food. It is, in fact, a good plan to finish a meal with a drink of water. 84 CARE OF CHILDREN CLOTHING The child's clothing should be as simple as possible. No normal small boy ever cared, or ever will care, how his clothes look, provided they are easy to get on and off. He is just as happy with a patch on the seat of his trousers and one on each knee as he is in a whole suit. He much prefers overalls, in which he can get as dirty as he pleases, to good clothes in which he has to be careful. The normal little girl's point of view is the same, but many of them, as the result of bad example, begin after a time to notice what they have on and to think about their clothes. This condition of mind must be regarded, however, as pathological rather than physiological. Children that wear fine clothes wear them not for their own enjoyment, but to please the esthetic tastes of their mothers. 35 HARVARD HEALTH TALKS It is very difficult to say how warm a child's clothes should be. They should be warm enough, but not too warm. The temperature of the house in which a child lives should always be taken into consideration in dressing a child. A child who lives in a warm house should not be dressed as heavily as one who lives in a cool house. A child who wears warm clothes in the house does not need as man}^ outside clothes when it goes out of doors as does the child who wears thin clothes in the house. It must be remembered, too, that the outside clothes must be varied according to the tempera- ture, and that a child does not need a heavy coat every day in the winter, whether it is cold or not, simply because it is winter. In fact, there is nothing about the care of children in which there is more opportunity for the exercise of good common sense than in the dressing of children. It should be remembered in this connection that cold feet are often S6 CARE OF CHILDREN the result of an excessive amount of per- spiration from overheating of the feet by too thick stockings. Small bodies, having a greater surface area in relation to their bulk, lose heat faster than larger bodies. Children, therefore, lose heat more readily and more rapidly than do adults. The heat regulatory centers of children are, more- over, less stable and less efficient than those of adults. Young children, there- fore, bear exposure less well than older children and adults. If anyone should go bare-legged and bare-armed in cold weather, it should be the children's par- ents rather than the children. If the mothers were compelled to dress in the same way that some of them dress their children, we should see less blue and chapped bare arms and legs on the street than we do at present. It is a curious fact in our civilization that young babies and strong men wear abdominal bands, while the rest of the S7 HARVARD HEALTH TALKS population goes without them. The abdominal band unquestionably pro- tects the abdomen and its contents against chilling and diminishes, to a cer- tain extent, the chances of the develop- ment of the diarrheal diseases. It is wise, therefore, for young children to wear them. When asked how long they should continue to wear them, I usually say that the girls should wear them until they are old enough to be married, and the boys until they are old enough to vote. Less is said about " hardening " chil- dren than there used to be. In years past, it was commonly supposed that children could be rendered less suscepti- ble to diseases of the respiratory tract by accustoming them to exposure. It is possible that some of those that survived the exposure were less susceptible. Many, however, were killed in the pro- cess. It is, of course, foolish to overdress children and to protect them too much 88 CARE OF CHILDREN against all sorts of exposure. Their resistance is unquestionably weakened in this way. It is also a mistake, how- ever, to suppose that they can be accus- tomed to unreasonable exposure. They are almost always made sick by such exposure or, if not, their resistance is materially weakened. Shoes. It must be remembered that the normal human being toes in and spreads his toes out while walking. Modern shoeing and dancing masters unfortu- nately prevent this to a considerable extent. It must also be remembered that babies and young children have right feet and left feet like adults. Babies and young children should, therefore, from the beginning, wear shoes that are rights and lefts, not, as so many do, shoes shaped like paddles that will go on, but will not fit, either foot. There is nothing which allows the foot to take its natural position so well as a moccasin. 39 HARVARD HEALTH TALKS Young children should, therefore, wear moccasins as long as possible. When it is necessary for them to begin to wear shoes with hard soles, great care should be taken to get shoes which allow the foot to take its natural position. EXERCISE AND SLEEP Exercise. The average baby walks alone at about fifteen months. Many, of course, walk earlier than this and others do not walk alone until some months later. It is important not to encourage them to begin to walk. They will do it as soon as they are able. Deformity of the legs is very likely to result, if they are forced. It must be remembered that young children are unable to walk far at a time. They are fitted to take short, violent exercise, then to rest, then to exercise again, and so on. They are like the puppy and the kitten that play violently for a few minutes, then lie 40 CARE OF CHILDREN down and rest. No adult could follow a child all day without dying of exhaustion. Any adult, however, can use a child up very easily on a walk. When adults are walking with a child, they should not forget the relative length of their legs and those of the child. The adult's legs are so much longer that what is a very slow gait for the adult is a very fast one for the child. The adult must remember how fast he would have to walk to keep up with a giant twelve feet high. In walking with a child, it must not be for- gotten that to the child the curbstone is like a step of the Pyramids to an adult. The child should never be taken by the hand and snaked up on to the sidewalk. The adult would not do this if he real- ized that the child feels as he would feel if a giant grabbed him by the hand and snaked him up on to a platform three feet high. There is, moreover, a real danger of dislocating the child's shoulder in this way. 41 HARVARD HEALTH TALKS The tendency of almost all children is to do too much and to overexert and overfatigue themselves. They almost always need to be held back, not en- couraged to exert themselves. The whole cause of the trouble in many chil- dren who are below par, fretty, and with poor appetites, is that they are over- trained. They are stale in the same way as the athlete who has been working too hard. Rest will immediately restore these children to health. This over- strain has to be sharply looked out for in the younger children of large families. They play with their older brothers and sisters and their companions, and natu- rally try to keep up with them in their games. The result is that they are over- strained and exhausted. Outdoors. The general principle that the air outdoors is better than the air indoors applies in childhood as in adult life. The more out-of-door air that a 42 CARE OF CHILDREN child can get, other things being equal, the better. It is often asked at what temperature it is too cold for a child to go out. This must depend to a con- siderable extent on the average tempera- ture in the given place and to what the child is accustomed. In the neighbor- hood of Boston, it is probably wiser to keep babies and children under four or five years of age in the house when the temperature is below 20"F. It is wiser to keep children who have a tendency to " colds " in the house when it is windy and dusty or damp and chilly. They are very likely to " catch cold " under these conditions and to lose more hours in the fresh air as the result of the " cold " than they would have lost if they had stayed in in the beginning. It is a cur- ious fact that most people think that it injures a child to be wet by rain, but that it does not hurt it at all to be wet through by wet snow. Mothers will carefully guard their children from the 43 HARVARD HEALTH TALKS rain, but will let them play and wallow in the snow as if it could do them no harm. If it is harmful to a child to get wet, there certainly seems no reason why it should make any difference whether it is wet with rain water or snow water. My experience is that it does not, and that many of the respiratory affections seen in children in the winter are the result of undue exposure in the snow. Young children should sleep in rooms with the windows well open. There is, of course, no danger in the night air. In fact, the night air is usually purer than the day air, because there is less dust in it. The bed should be so placed, how- ever, that it is not in a direct draft between two windows. There are very few nights in this climate in which it is not perfectly safe for a child to sleep in a room with the windows wide open. Under such circumstances, however, the child must wear warm clothes and be warmly covered. It may need a night- 44 CARE OF CHILDREN cap and is almost certain to need stock- ings. If it throws out its hands, it should wear mittens. Naps. A child should have a nap in the middle of the day until the nap has to be given up because of attendance at school. Many children will not sleep, even if put to bed, after they are three or four years old. They should, never- theless, be undressed and put to bed in a darkened room, whether they sleep or not. Mothers often say that their chil- dren will not stay in bed when they are put there. They will stay in bed, how- ever, if they do not dare to get up. If they are punished severely if they get out of bed, they will stay there. The benefit which they derive from the rest is well worth the effort necessary to make them stay in bed, even if they do not sleep. Bedtime. Every child, until it is at least six years old, should be in bed by six 45 HARVARD HEALTH TALKS o'clock. The mothers are, as a rule, glad to see them there. The only objec- tion comes from the fathers who, coming home late, wish to have an opportunity to play with their children and to enjoy them. It is unfortunate that the father has to be deprived of this pleasure. If he has the proper regard for the welfare of his child, he should, however, be willing to sacrifice his own pleasure for the good of his child. EDUCATION School. It is an unfortunate fact, from the point of view of health, that it is necessary for a child to go to school. He would be better physically if he could grow up like a young animal. He must, however, get an education and be pre- pared for the business of life. Educa- tion has become so complicated in recent years that it is important for a child to get started on it as early as possible. Children have to begin school earlier, 46 CARE OF CHILDREN therefore, than is advisable from the point of view of their physical welfare. A vast amount of time is, however, wasted during the first years of school, chiefly as the result of incompetent teachers. The best teachers should be assigned to the young children who have to be taught and made to learn, and, if it is necessary to have poor teachers, they should be assigned to the colleges where the students themselves are old enough to want to learn without being forced. If the teachers in the early grades were better, the hours could be shortened and the children would not be deprived, therefore, of their natural rights, pure air and time for play. A part of the evils of school life can be avoided, however, by having open-air schools or, at least, by having the win- dows of the schoolrooms removed or wide open. An abundance of out-of- door air is even more important for young children than for the older ones. 47 HARVARD HEALTH TALKS Stories. Many people make a mistake by telling children stories which are far beyond their mental capacity. It must be remembered that their concepts are very simple, and that Mother Goose stories are more suitable for them than "Ivanhoe" and "Robinson Crusoe." It seems hardly possible that such stories could be read to young children, but the chief cause of ill health and debility in one of my patients of four years was apparently the overstrain consequent on trying to understand these stories. It is very important, also, not to read or tell stories to children which are likely to frighten them. It is difficult for an adult to appreciate how much a young child may be terrified by a story, which to an adult seems ridiculous, or how they will misunderstand something which to an adult is very plain. It is hard to imagine stories more likely to disturb and worry a nervous child than " Little Red Riding Hood " and Heinrich Hoff- 48 CARE OF CHILDREN man's " Slovenly Peter," upon which many of us were brought up. Religion. All children, when they are a few years old, begin to ask questions about religious matters. These ques- tions are extremely difficult to answer. They must, however, be answered in some way. It is wrong to turn the chil- dren off or to refuse to answer them. They must be answered, however, as briefly as possible and in as simple a way as possible. In any event, whatever answer is given must be true. The child must not be deceived in relation to mat- ters of religion any more than in relation to other matters. Obedience. Every child must be taught to obey. They must, moreover, be taught to obey instantly and without question. Like the Noble Six Hundred, '* Theirs not to make reply. Theirs not to reason why." 49 HARVARD HEALTH TALKS Many a child has died as the result of not having been taught to obey. Many children have been killed by accident who would not have been killed if they had been taught to obey a command instantly. Many other children have died as the result of disease, because they had not been taught to obey. Such children resist treatment and refuse food, and die as the result. Many a death certificate which has been signed with the name of some disease should have been signed " improper training by the parents." An adult should never ask a child to do anything unless he means that the child shall do it. If a command is given, it must be obeyed. On the other hand, the adult must be very careful not to give any useless or senseless commands. Above all things, an adult should never threaten to punish a child for doing, or not doing, a certain thing without inflict- ing the punishment if the command is 50 CARE OF CHILDREN disobeyed. A child never has any re- spect for an adult who lies to it. More- over, it never knows whether a given command is to be obeyed or not. It is seldom necessary to inflict corporal punishment. Every child, however, needs it at times. There is nothing which is so effectual or which takes its place. It should be avoided, if possible, but when it becomes necessary, the punishment should be so thorough that the child will not forget it for a long time. The child that is whipped best needs whipping least. A child should never be bribed to do anything which it is right for it to do. He ought to do it simply because he is told to do it. On the other hand, a child should never be asked to do any- thing which he ought not to do. A bribe is, therefore, never necessary. Parents and others dealing with chil- dren should be very careful to avoid fric- tion. A tactful, considerate person 51 HARVARD HEALTH TALKS rarely gives any commands or, if he does, gives them in such a way that friction does not result. If friction does result, and the child refuses to obey a command, the child must be made to mind. When friction arises, the situa- tion must be met and the adult must win. If the adult loses, it is harder for him to win the next time. If the child never wins, he never expects to win. He finally never thinks of disobeying an order. A child should never be deceived. An adult should never lie to a child. A child never forgets that an adult has lied to him. It never forgives a lie, and never respects the person who told it. Children that are not lied to do not lie themselves. Children that are lied to cannot be expected to tell the truth. A child should never be threatened with the doctor. A child should never be told when he is doing wrong that the doctor will come and take him away in 52 CARE OF CHILDREN his bag. He should never be told that if he is not good the doctor will come and give him some bad medicine. He should, on the contrary, be taught to regard the doctor as his best friend, — as he really is. 53 PRINTED AT THE HABVAKD UNIVEKSITT PBE88 CAMBRIDGE, MASS., U.S.A. DATE DUE i^iidsL -, va i^''-^ y.'i h - • ..; *'•-■ V Printed n USA