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

WATER DRINKING

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

URINATION

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

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

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

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

EXERCISE

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

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

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

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

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

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

KISSING THE BABY

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

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

SUCKLING HABITS

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

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

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

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

KEEP BABY WARM

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

BABY'S TEMPERATURE

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

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

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

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

BABY BOUNCING

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

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

CARRIAGES AND GO-CARTS

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

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

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

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

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

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

BOW LEGS

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

LIFTING THE BABY

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

PREVENTION OF FALLS

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

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

THE BABY'S BREASTS

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

VISITING

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

THE RUNABOUT BABY

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

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

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

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

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

TOYS

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

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

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

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

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