Healthy children; a volume devoted to the health of the growing child

Front matter

S. JOSEPHINE BAKED

Class.

Book.

Preface

For many years the health of the baby and the health of the child of school age have received attention from the public health authorities, and particularly in our large cities there have been many opportunities for individual instruction of mothers in the care of little babies or older children. It is only recently, however, that the health of the child between two and six years has received any attention. This period of life has come to be known as the "preschool age." It is the time when the child is past babyhood, yet is not old enough to enter school.

This book deals with the health problems of the preschool age child, but because during this age period the child is particularly susceptible to many of the contagious diseases and to many of the more common infectious diseases, a large part of the book has been given up to a discussion of methods of controlling these diseases and caring for them at home. This consideration of illness, however, should not be allowed to outweigh the realization of the importance of prevention of disease and methods whereby children may be kept well. It is the purpose of the book to accentuate health, not disease, and to show the mother how she may give the child of preschool age

PREFACE the same health care that is now so freely available for the baby. It cannot be too strongly emphasized that this book is not intended to convey information which can be used in place of the expert care of a physician. In every case of illness a doctor should be summoned at the earliest possible moment and his advice and directions followed in detail. In order, however, to explain how health may be maintained, it is necessary for the mother to know something of the early symptoms of the common diseases, how they may be prevented, and the care that will shorten their course and give the doctor the most intelligent type of aid.

As aids to child training and to lay the foundation for education, we have had a marked contribution made to the period of preschool life by Froebel, who gave us the idea of the kindergarten, and by Montessori, who has made practical many unique and valuable ideas in the training of the young child. In health matters, the child from two to six has received little, if any, attention and it is hoped that this book will help mothers to understand the importance of this period of life and give them the information to make healthy childhood continuous with healthy babyhood.

VI

PREFACE

As far as possible, technical terms have been avoided, but occasionally it has been necessary to use them. A glossary will be found in the back of the book, containing explanations of the less understandable terms or words. Because health is affected by so many factors, it has been found necessary to repeat certain details under various headings. In studying any particular subject, every reference to it should be read so that there may be more complete understanding. There is nothing difficult, nor need unusual methods be applied, in order to keep children well. Any effort, however slight, that is applied in that direction, will inevitably result in a finer and better developed race.

S. JOSEPHINE BAKER.

VI i

Contents

Chapter I. Physical and Mental Development Height and weight; development of special senses: speechstuttering or stammering; touch, taste, hearing, smell, sight. Muscular development: play and exercise. Influence of environment Pages 1-28

Chapter II. Personal Hygiene Location of the home; fresh air and ventilation; effect of bad air; heating and temperature. Clothing: outer clothing, under clothing, night clothing, shoes. Bathing: cold baths, warm baths. Sleep and quiet ; night terrors. Hygiene of the nose and throat ; adenoids, enlarged tonsils. Care of the teeth: temporary teeth; permanent teeth. Care of the eyes and ears Pages 29-73

Chapter III. Training for Good Habits Regularity. Training the bladder; bed wetting. Training the bowels; constipation. Thumb-sucking. Nail-biting. Masturbation Pages 74-87

Chapter I

The entire period of childhood is one of growth. There should be a normal, even development of the child's mentality and an equally regular development of the organs of the bod} 7 , the bones and the muscles.

During the first year of life the needs of the baby are mainly physical. As the child grows older, its life becomes much more complex and its mental as well as its physical needs demand attention. The period under five years of age is one of very rapid growth. There is probably no other time in the life history of the individual when both body and mind are so responsive to environment and impressions, and when so much can be done to build up good health as during the preschool age. During this time the child is both mentally and physically extremely sensitive to its surroundings. It is keenly receptive to all impressions and suggestions. Everything that concerns its daily life leaves some impression, therefore it is of the utmost importance that during this time the child's surroundings, associates and training tend toward normal mental and physical development.

While the needs of the child during this period may seem, and are to a great extent, rather diverse, it is a satisfaction to know that there is nothing that pertains to proper development of child life that is not within the reach of every family. It is particularly important during the preschool age that the child should live in decent and clean surroundings, with as much fresh air as possible throughout the twenty-four hours. It is essential that the food be of the proper kind, and given at regular intervals, and that the clothing be suitable. The regular practice of personal hygiene is more important than at any other time of life, except during babyhood. Included in this is the care of all the organs and functions of the body. Sleep, rest, recreation, proper bathing and hygiene of the eyes, ears, nose, throat and excretory organs, such as the skin, kidneys and bowels, are of importance. Not only are such surroundings and personal hygiene of the first importance at this time because of their immediate effect upon the child, but this is the period of life when health habits can be formed which will last as long as the child lives and which make all the difference in after life between poor health or semi-invalidism and good health, and a life that is a satisfaction and a joy.

Increase in Height and Weight i^

The best method we have of determining normal physical development is regular increase in height and weight. These bear a definite relation to each other. The child who shows a normal balance between its height and weight, and an increase in both these points in proper ratio, is a normally developed child, and, in the majority of instances, its nutrition is good. Some children, however, grow very rapidly as far as height is concerned but do not make a corresponding gain in weight. When a child weighs less than it should for its height, it is almost always an indication that there is something seriously wrong with its nutrition. The health of the child depends upon its proper nutrition. Nutrition, as we shall see later, is the result of proper hygienic surroundings and the right kind of food, which is properly digested and used by the body in promoting normal growth. It is important, therefore, to know in every stage of the child's development whether or not it is well nourished. The simplest and easiest way for the mother to determine this is in the relation between height and weight of the child at a given age. There are many other symptoms of undernourishment, which will be discussed later. The particular one which has to do with growth is the most important.

In giving tables of heights and weights, it must be remembered that the average child is being considered. All tables of this kind are made up from the results of examinations of large numbers of children of various nationalities, living under conditions of both city and rural life. It is perfectly possible that a well nourished child may differ to some extent from the standard given as the average for a child of its age. It is safe to say, however, that this difference will not amount to more than ten per cent in either direction, therefore a child need not be considered undernourished or lacking in proper development unless it is at least ten per cent below the average weight in relation to its height and age.

Children should have their height measured each six months and should be weighed once a month. It is wise to keep a chart of the child's weight. Such a chart may be made like the one illustrated on the next page. On this should be placed, in the appropriate column, a dot showing the child's weight on a given date. When the child is weighed the following month a dot should be placed in the next column and a line drawn between the two m i s s s

CO in in s in

S

MONTHS

•to eo fl s

9 s o to ^" <o

CM

<o o

<0 si a

S m

SI

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CO

AVERAGE HEIGHTS AND WEIGHTS OF WHITE CHIL- DREN, BOYS AND GIRLS, UNDER SIX YEARS OF AGE, BY MONTHS, AS FOUND IN NEW YORK CITY.

Age

Under 1 month.

1 month

BOYS

Average Height Inches

21%

23%

24%

25%

26%

26%

27%

27%

28%

28%

28%

29%

29%

30%

30%

30%

31%

31%

31%

31%

32%

32%

33%

Average Weight Pounds

8% 10

11%

13%

14%

15%

16%

17%

18%

19%

19%

20%

20%

21%

21%

22%

22%

23%

23%

24%

24%

25%

25%

26%

GIRLS

Average Height Inches

20%

21%

22%

23%

24%

24%

25%

26%

26%

27%

27%

28%

28%

29%

29%

29%

30%

30%

31%

31%

32%

32%

Average Weight Pounds

8% 9% 11

20% 21% 21% 22% 22% 23

23% 24% 24% 24% 25%

Age

BOYS

Average Height Inches

Average Weight Pounds

GIRLS

Average Height Inches

Average Weight Pounds

25 months.

33%

33%

34%

34%

34%

34%

34%

35%

35%

35%

35%

36%

36%

36%

36%

37%

37%

37%

38%

38%

38%

38%

38%

39%

39%

39%

26%

28%

28%

28%

28%

29%

30%

30%

30%

30%

31%

31%

31%

31%

32%

33%

33%

34%

34%

35%

35%

35%

35%

32%

33%

33%

33%

34%

34%

35%

35%

35%

35%

35%

36%

36%

36%

36%

37%

37%

37%

38%

38%

38%

39%

39%

39%

25%

25%

26%

26%

26%

26%

28%

28%

28%

29%

29%

30%

30%

30%

30%

30%

31%

32%

32%

32%

32%

32%

33%

34%

34%

BOYS

GIRLS

Age

Average Height Inches

Average Weight Pounds

Average Height Inches

Average Weight Pounds

53 moi

54 '

55 '

56 '

57 4

58 '

59 '

60 ' 61

62 4

63 '

64 '

65 '

66 '

67 4 68

69 '

70 '

iths

39% 39% 40%

40%

40%

40%

40%

41%

41%

41%

41%

41%

42%

42%

42%

42%

43%

35%

35%

36%

37%

38%

38%

38%

38%

38%

38%

38%

39%

39%

39%

40%

41%

39% 39% 39% 40

40%

40%

40%

40%

40%

41%

41%

41%

42%

42%

42%

34%

34%

34%

35%

36%

36%

36%

36%

36%

37%

37%

37%

38%

39%

39%

39%

40% dots. A comparison can then be made with the tables shown on pages 6, 7 and 8 showing the height and weight of average children. As the weighing progresses, it may be seen at a glance whether there is a regular increase in weight. The weight at any one particular time is not the most important point to notice. It is essential, however, that there should be a regular and definite gain, and if the weight is stationary for more than two months, or if a loss in weight is shown at any time, immediate attention should be paid to readjustment of the child's life to more nearly meet its needs. It will be noted that the increase in height and weight is not so rapid after the first year, An easy way to remember the right weight for a given age is that the average gain amounts to about five pounds a year from the first to the eleventh years. After that a child will gain an average of ten pounds a year until the time for growth is over.

The gain in height is not so regular. At the end of the first year the baby should measure about twenty-eight inches. Each year thereafter, until the fifth, there should be an average gain of four inches in height. From the fifth to the tenth years the gain Varies from two to three inches. The table will show this increase more in detail.

DEVELOPMENT OF SPECIAL SENSES

While the term ' 'growth' ' commonly refers to increase in size, the development of the child includes its increase in mental power, and increased activity and keenness of the various functions. Some children show an abnormally rapid development. There are many instances of so-called ' 'infant prodigies" where children learn to read and write and even to grasp difficult mental problems at an extraordinarily early age. Such children are the exception, however, not the rule. Unless the child shows unusual mental capacity and the parents are able to control its development with the utmost wisdom, it is better to consider the period from one to five years of age a time when the foundation is laid for good health and good mental development, rather than a time when the child is forced into activity which will interfere with its opportunity for play, recreation, amusement and for the normal training and development which are the right of every child. There is no absolute rule to show the exact progress and development of the special senses in children from one to five years of age. Because of the great variation, we can speak of the subject only in a general way.

Speech

Ordinarily, at the end of one year, the baby has learned to say a few words, and by the time it is eighteen months old these words may be put together into short sentences. The little child, as soon as it learns to talk, almost always uses its first words to ask questions. The curiosity of young children is insatiable. This is not a senseless curiosity, but a perfectly normal one, and speech offers the child an opportunity to satisfy its thirst for knowledge. Speech is used also as a means of expressing the child's own ideas, and the constant use of speech for these two purposes tends to develop it as a mode of expression much more rapidly than is the case in the development of the other senses.

It is necessary to urge some children to talk; others talk incessantly, without urging. The child who must be urged to talk may be simply indifferent, but there is always the possibility of a mental defect when speech has been markedly retarded or is completely absent when the child is two years of age. Under such circumstances, only a thorough physical and mental examination will determine whether or not the child is simply backward or indifferent, or whether there is some physical defect which interferes with speech, or, possibly, some mental defect. In a large number of instances where mental defect is the cause of inability to speak, there is a corresponding deafness, and the child's inattention and apparent inability to hear may often be the first signs noted. Careful attention should be paid to this matter, because if deafness is present in addition to inability to speak, deafmutism should receive early attention at the hands of a specialist.

Stuttering or Stammering

Stuttering, stammering or distorted speech may be the result of some physical defect or a marked nervous condition, or it may be the result of habit. Occasionally, a child's tongue will be bound down to the floor of the mouth by a tiny fold of mucous membrane, and this inability to move the tongue freely leads to distorted speech and difficulty in pronouncing certain words. Such children have a tendency to lisp. Letters like "s" cannot be pronounced clearly, and there is a blurring over of many word sounds. The treatment is simple. Any physician can make a small cut in the mucous membrane, releasing the tongue so that it is freely movable. The operation is not at all dangerous.

Stuttering and stammering sometimes start as a purely nervous habit, because the child has been unduly urged to talk or is of an extremely nervous disposition. As soon as an effort is made to say anything, there is loss of speech control, usually the result of some emotional disturbance. Stammering or stuttering increases the more the child tries to express itself. A great deal may be done in early life to correct this condition by teaching the child to speak slowly and to accent distinctly every syllable of a word. Every effort should be made to overcome the emotional excitement and the nervousness. Such children should never be forced into new experiences that may be mentally disturbing. They should be brought into contact with other children for normal play, but great tact must be used in handling them at all times. Particular care should be taken to see that no one makes fun of their infirmity. In a great number of cases constant attention to slow speech and calming all nervousness will cure stuttering and stammering. However, if the habit becomes established and continues until the child is five years old, it is probable that special treatment will be necessary, and this can be carried on only by someone who has made a special study of the subject.

Touch, Taste, Hearing, Smell

All of these functions develop first in babyhood, but are not keen until the child is past eighteen months of age. Up to that time they have a very limited relation to the child's life, but after the baby passes the age of eighteen months, if it is normally developed, it begins to make conscious effort to use these special senses in order to widen its understanding of its environment.

The function of touch in young children is peculiarly acute. Madame Montessori has taken advantage of this idea in her method of training children, and it has been found possible to develop this sense in very young children to a remarkable and hitherto unthought-of degree. Up to the time a child is five years of age, it is possible to cultivate the delicate sense of touch so that it may become an important aid throughout life. It is easily blunted, if neglected. The child should be encouraged to tell the shape of various articles by feeling them rather than by looking at them, to tell the texture of materials by the sense of touch, to distinguish between soft and hard substances or between smooth and rough materials, to determine the texture of plants, trees and growing things, as well as the texture and character of all familiar, material surroundings. This opens up a wonderful method of training children to be observant, interested and of delicate comprehension. Children who have their sense of touch developed to this extent have acquired something that will add immeasurably to their future pleasure in life.

Taste and smell are not acutely developed during early child life. Children have marked prejudices with regard to certain articles of food, and these prejudices frequently relate to taste. Thus rnilk, which may be very much disliked as a drink, will often be taken when prepared in the form of soups, custards or ice cream. Eggs, when distasteful if eaten alone, will be eaten if disguised as part of some pudding or custard. On the whole, however, the sense of taste is not particularly keen and children will put into their mouths things which would be considered distasteful to an adult with a normally developed sense of taste. Little children do not mind eating mud, clay or even more repulsive things. Fine taste is largely the result of cultivation in later years.

The sense of smell in young children is not well developed. They rarely are sensitive to disagreeable odors or appreciative of delightful ones. If the sense of smell is totally lacking, that is, if the child is unable to distinguish that the rose has perfume or that anything is distinctly repulsive or has a bad smell, it is probable that there is some marked nasal catarrh or nasal occlusion, due to adenoid growths.

Sight

Early development of sight has mainly to do with distinction between light and darkness, recognition of people who are well known, such as father, mother or nurse, or distinguishing bright colored objects. Red is probably the first color that is noticed by the baby, and bright colors have an unusual attraction throughout childhood. It is not until the baby is about two years old that it begins to appreciate objects in their proper relation to each other.

Muscular Development

The condition of the child's muscles is largely dependent upon its nutrition. Muscular tissue develops more rapidly when it is used, and the constant restless activity of the normal child usually results in firm, hard and adequate muscles. Children who are not well nourished suffer from extreme bodily fatigue and their muscles are apt to be flabby and soft, but in a child who is living under the right conditions and who is well nourished, the muscular tissue can be felt all over the body, well rounded and firm, and the child will be active without fatigue.

During the first two or three years of life there is little conscious control of the muscular development. Learning to walk is probably the first expression of conscious muscular control and after the child finds that it can control the movement of its legs and feet, it begins, usually by itself, to learn to control the movements of other parts of the body. Little children also have the power of complete relaxation. This is shown in the way in which they fall. A child running along the street will stumble and fall at full length, only to jump up again and run on as strongly as before. In all probability, such a fall would seriously injure an adult, and certainly there would be a nervous shock. This ability to relax the muscles completely becomes less as the child grows older and becomes more tense and more conscious of its muscular movements. Every effort should be made to allow free muscular development. Loose clothing of every kind, including loose shoes, utter freedom of motion of the arms and legs, provision of opportunities for play which involve use of the muscles of the body, are all essential. Left alone, children will develop their muscular tissue without supervision and there is little, if any, danger of muscular strain in a healthy child who lives the average normal life, with regular hours of sleep and play, and the proper kind of food. Muscular exercise tends to make all organs of the body function in a proper manner. The sedentary child, or one who is brought up much indoors, suffers readily from constipation, indigestion and similar troubles. Often the only thing that is necessary to correct this condition is to provide opportunity for free outdoor play.

Play and Exercise

The normal child has an inherent instinct for play. One of the pathetic effects of city life is the provision that it has been necessary to make for supervision of play for young children. Ordinarily there are only two points about which we need concern ourselves in this connection: the first is that the children have a place to play where they can do so with safety and the other is that their play is not vicious. They may safely be trusted to develop for themselves the type of play which most interests and amuses them, and that type is usually the one which does them most good. Outdoor games should be encouraged. Except in very stormy or extremely cold weather, the child of preschool age should be out-of-doors the greater part of the twenty-four hours. Games of childhood are traditional. They pass from one generation to the next as regularly and inevitably as life itself. No one knows how the old nursery games are passed down from child to child, but, generally speaking, the games of the children of today are not at all unlike those of their parents, their grandparents or even back into the preceding generations.

Except in unusual instances, children do not have to be taught any special games, but one marked characteristic of very early childhood should always be borne in mind. Lack of understanding of this characteristic is more common among the well-to-do than among those less blest with worldly goods. Little children do not care for expensive mechanical toys. They have a creative instinct and want to make their own games and their own play. The imagination of the little child has no limits. An old packing box or piece of cloth that can be made to serve as a tent holds undreamed-of possibilities of happiness. Ninetenths of the normal games of early childhood exist only in the imagination of the child, and if any aid at all is desirable to help children play, it is the kind that cultivates the imagination rather than retards it by furnishing toys which are warranted to go by themselves and which do not need any help from the child. A normal child can have infinitely more fun out of an old box which is dragged along the street by a string to serve as a doll carriage than it can get out of the most perfect mechanical electrically-propelled train that was ever made. Children as well as adults grow by expression and in their play they have the opportunity to express themselves quite naturally, without the restrictions which bear so heavily upon them when they are closely associated with the world of adults, therefore toys for children should be of the simplest. Such things as heaps of sand where they may dig to their heart's content, boxes or blocks which cannot be injured but which may be used by the children to form any object which their imagination desires, and, above all, wide and unrestricted play space, are all that are needed to make the average children healthy and happy. Initiative and the power of expression are marvellously stimulated by this kind of play and are almost always retarded, if not killed altogether, by manufactured play and toys that have had done for them all that the child would wish to do for itself.

During the preschool age there should be no formal children's parties. If birthdays must be observed, it should be in the simplest manner possible, preferably with outdoor play and some very simple refreshments, such as ice cream or custard, in addition to the birthday cake. It is far better, however, for children of this age not to have the stimulation that comes from forced play and the emotional excitement that almost always attends parties.

There is also the possibility of the spread of infection. It is a well-known fact that contagious diseases always increase after the holiday periods. The gathering together of children in parties and entertainments is one of the best known methods of spreading infection. As little children are so particularly susceptible to contagion, children's parties should be extremely rare. The emotional excitement is also very bad for young children. Up to the age of five years the emotions are not definitely under control and many children have had the basis of nervous disorders in later life firmly established as a result of the excitement and artificial life connected with being entertained frequently in early childhood.

Another word of warning should be uttered against having children "show off." The precocious child is always a bore to everyone but its parents. The pleasure that normal children can give is delightful, but the precocious child has not a fair chance, because its parents put it in a position where it is unwelcome to others and where it readily acquires that type of egotism which is of all attributes the most distressing that can be found in childhood. Little children should never be urged to recite, to dance or "show off" in any way before others. The nervous excitement is extremely bad for the child and certainly nothing can be worse than the development of this egotism.

Opportunities for proper play accentuate the great advantages the country child or the child of sensible parents has over children in the city and children who are the victims of over-indulgence and over-care. Old clothes that cannot be hurt, torn stockings and worn out shoes, bruises and bumps, and the opportunity to get throughly dirty with mud pies and sand piles, all belong to the right of childhood. Cleanliness and order can and should be insisted upon, in their proper place, but for the greater part of the day the child should be looked upon as a little, growing animal and allowed free expression of its play instinct.

INFLUENCE OF ENVIRONMENT

Environment consists of all the external surroundings and conditions that affect the development of the person and increase, modify or change the inherited qualities of the individual. It is reassuring to know that, although we may not be able to choose the type of inheritance we would like, and may have to take that which does not accord with our desires, yet we can to a very large extent control our environment, and we can choose and maintain a proper environment for our children. The time when environment has the greatest effect upon the development of the individual is during early life. In human beings, development of the young covers a far greater period of time than it does in the life history of any other species of animal, consequently fathers and mothers have a very great responsibility in seeing that, during the entire period of development, their children have the right surroundings and the right influences.