THE HAPPY BABY THE HAPPY BABY 
EDITORIAL ADVISOR: 
DR. L. EMMETT HOLT 
CONTRIBUTORS: 
DR. L. EMMETT HOLT DR. RALPH LOBENSTINE 
DR. HARVEY J. BURKHART DR. HENRY L. K. SHAW 
NEW YORK 
DODD, MEAD AND COMPANY 
1924 Tm Articles Composing the Happy Baby were first Published in 
THE DELINEATOR and are Copyright, 1922, 1923, 1924 
By THE BUTTERICK PUBLISHING COMPANY 
PRINTED IN U. S. A. 
VAIL-BALLOU PRESS, INC. 
BINGHAMTON ANO NEW YORK FOREWORD 
It is given to only a few in this world to complete their 
life-work. Seldom does a man see the full fruit of his 
labor and come to the end of his day with his circle com- 
plete and his house in order. 
Such a one was Dr. L. Emmett Holt, the famous 
child specialist. Mothers of America know him through 
his great book, "The Care and Feeding of Children'' 
which has run through 28 editions and helped millions 
of mothers rear their babies to health and happiness. 
Now another book is being presented in the interest 
of this nation's children-this book "The Happy Baby," 
which was prepared under the direction of Dr. Holt and 
was one of his last efforts to put into print those prin- 
ciples of preventive medicine which should be known to 
every mother in the world. 
Dr. Holt spent all the mature days of his sixty-eight 
years in the study and care of children. In America to- 
day three monuments of his own building mark his pre- 
eminence in this field. They are the Babies' Hospital 
in New York City, of which he was a founder; the Child 
Health Organization, of which he was a founder; and. 
the Happy Child Department in the Delineator, of which 
he was the editorial advisor. 
In addition to his services to the children of America, 
Dr. Holt was the apostle of child protection for other 
great nations. He died five thousand miles away from 
V VI 
FOREWORD 
home, out in China, where he had gone at the request of 
the Chinese Government and the Rockefeller Medical 
Foundation to set up a new standard for the teaching 
of child health. 
It was Dr. Holt who, at the invitation of foreign gov- 
ernments, went to Europe during the war and after the 
Armistice to help find a solution for the almost hopeless 
problem of saving devastated races. 
Having not only a great and highly trained mind, but 
also a very sensitive and sympathetic soul, the months he 
spent in Europe served the world at the cost of his health. 
When Dr. Holt returned to the United States, time, which 
had always dealt so kindly with him, had at last laid its 
weight upon his body. But he went on with his great 
humanitarian work despite the inroads it was making 
upon his constitution. Almost none of his associates 
realized that Doctor Holt was not in good health, and 
no one outside of his immediate household understood 
the meaning of the program of lessened labors which 
he was forced to adopt in the Spring of 1923. 
Doctor Holt did not accept depleted strength as de- 
feat. He set about deliberately, with great joy in the 
doing and a never-failing profound wisdom, to complete 
the tasks he had already assumed. 
He saw the Child Health Organization merge with 
other child-welfare organizations and come into a strong, 
assured body under the leadership of Herbert Hoover. 
He saw his assistants firmly established in his beloved 
Babies' Hospital, while he stepped out of authority and 
responsibility. 
He brought together specialists in various phases of FOREWORD 
VII 
child health and welfare, and persuaded them to write 
for the Delineator those important articles that are now 
published in this book and others that appear in The 
Happy Child Department of the Delineator. 
Then having arranged his personal affairs, Dr. Holt 
took his world vision and dauntless soul to answer the 
call of a suffering people on the other side of the world. 
He deliberately accepted this faraway work, knowing 
that he was probably taking his last leave of loved ones 
and associates. 
Those who loved Doctor Holt and who had the rare 
privilege of being associated with him find comfort and a 
certain inspiration in the knowledge that he accomplished 
his work in the Orient before his death. 
When the Delineator persuaded Doctor Holt to under- 
take the direction of its Happy Child Department it was 
with the agreement that he should be permitted to set a 
new standard for child-welfare work in lay publications. 
He was told that he could put into its pages any message 
which he and his associates felt ought to be given to the 
mothers of this country. His standard was not always 
easy to maintain, but it was never lowered. And the 
same high standard, under the direction of Dr. Henry 
L. K. Shaw, is being continued now by the Delineator's 
Happy Child Department-as it will be in the years to 
come. 
The United States census of 1922 reported that 1,141,- 
939 babies died in the United States that year. Propor- 
tionately this is more than 14 babies for every American 
soldier killed in the world war. Dr. Holt, in his intro- VIII 
FOREWORD 
duction to the Delineator's "Happy Child" articles said 
-"Scientists interested in this campaign for saving child 
life and improving child health believe that their greatest 
weapon is not medicine but knowledge." And he chose 
the name "Happy Child" because he believed, as he 
himself said, that "the child with a chance, with a healthy 
body, and a properly trained mind, will be the happy 
child." 
Among the noted specialists who assisted Dr. Holt in 
contributing their best knowledge and experience to The 
Happy Child Department of the Delineator are:- 
Dr. Henry L. K. Shaw, 
Consultant of the Division of 
Maternity, Infancy and Child 
Hygiene in the New York State 
Department of Health. 
Dr. Ward A. Holden, 
Ophthamologist of the Neuro- 
logical Institute, Consultant 
Ophthamologist of Roosevelt 
and Manhattan State Hospit- 
als. 
Dr. William H. Park, 
Expert in Bacterial, Public 
Health, and Hygiene. 
Dr. Henry R. Geyelin, 
Assistant Professor of Clinical 
Medicine, Columbia University. 
Dr. Owen R. Lovejoy, 
General Secretary, National 
Child Labor Committee. 
Dr. Harvey J. Burk- 
hart, 
Director of the Rochester Den- 
tal Dispensary. 
Dr. Arnold Gesell, 
Director of the Yale Psycho- 
Clinic at Yale University. FOREWORD 
IX 
Dr. William Palmer 
Lucas, 
Professor of Diseases of Chil- 
dren, University of California. 
Dr. Florence L. McKay, 
Director of the Division of Ma- 
ternity, Infancy and Child Hy- 
giene of the State of New York. 
Dr. Ralph W. Loben- 
stine, 
Chairman of the Medical Ad- 
visory Board of the Maternity 
Center Association of New 
York City. 
Within the last twenty-five years the attitude of the 
whole medical profession toward the health of children 
and the future of the race has changed. Great strides 
have been made in the prevention of disease. As a matter 
of fact, science has progressed so far that almost every 
child born into the world to-day can have a fair chance 
for the healthy body that is so essential to a happy, useful 
life. There is still no royal road to health, but a knowl- 
edge of the rules of health will point unerringly in the 
right direction. 
Realizing that these articles by Dr. Holt and his dis- 
tinguished colleagues present knowledge which should be 
available to all the mothers of America, they are now 
being presented in book form. It is at once a duty 
and a pleasure to do this. And keeping in mind the 
great man who directed this splendid series as well as 
the noble purpose for which it was written, we make a 
two-fold dedication-to the health of the American child 
and to the memory of America's great child doctor, 
the late L. Emmett Holt. 
(Signed) Mrs. William Brown Meloney 
Editor of the Delineator. INTRODUCTION 
It was once thought that there were two things any 
American woman could do, without special training 
-one was to teach school, the other to bring up chil- 
dren. The fallacy in the first was recognized long ago. 
The mistake in the second is equally true, although not 
so generally admitted. The bringing up of children is 
certainly to be classed as one of the occupations requir- 
ing highly skilled persons, if results which are satisfac- 
tory are to be expected. 
The tragedy of life is the fact that so few of those who 
are called upon to meet this responsibility have had any- 
thing approaching adequate preparation or training and 
that such a small number have had even the opportunity 
to acquire it. We know in this world only what we have 
been taught by our own experience or that of others. 
No amount of maternal affection and devotion can take 
the place of knowledge when it comes to be applied to 
such problems as arise in the care of children. The 
lower animals are guided by their instinct to give their 
offspring the right care; but the human mother has 
no such guide. 
Most children are born healthy. Disease, early death, 
feeble constitution and delicate health in adult life are, 
alas! too often simply the consequences of failure to do 
what we might do or the result of ignorant handling of a 
very delicate bit of machinery-the human body-es- 
pecially during the period of growth. 
XI XII 
INTRODUCTION 
In medicine at the present time the greatest interest 
is in the prevention of disease. The great possibilities 
offered in this field are as yet scarcely appreciated, and 
they have their widest application in infancy and child- 
hood. It is realized by all in the health field that the 
principal agency in bringing this about is education. We 
need not simply better educated physicians and nurses, 
but more parents who have some solid health education. 
The most recent and probably the most promising of all is 
the education of children themselves in matters of health. 
In the past almost all the instruction in health given to 
the family came from the family physician, whose chief 
interest, however, was in disease and how to treat it, not 
in health and how to promote it. We are coming to 
believe that the best way to prevent disease is to promote 
health. 
Tradition dies hard. For centuries the occurrence of 
sickness and death was looked upon as a visitation of 
Providence, and disease was regarded as some monster 
which we must fight in the dark. People have always 
stood in awe of the obscure and the mysterious. We 
need to get away from the notion of medicine as a mystery 
and think of it as a science, a science in which effects 
regularly follow causes. We should realize that both 
public and personal health is gained and kept by the ap- 
plication in daily life of known laws of physiology and 
hygiene. 
While the trouble with many persons is that they do 
not know, with a much larger number it is because they 
do not use the knowledge they have. It is true, that it 
is often difficult to know which is reliable, since so much INTRODUCTION 
XIII 
that is exaggerated, sensational and even false, is given to 
the public. 
The experience of the last twenty-five years has taught 
us that the great sacrifice of child life is quite unnecessary 
and that it continues only because of ignorance, indif- 
ference and neglect. Within certain limitations health 
also would be possible for all children; if what is now well 
known were universally applied. There is no royal road 
to learning and none to health. It is gained and kept by 
self-denial, self-control and obedience to the laws of 
health. Oliver Wendell Holmes has said that few people 
have acquired the self-discipline which is necessary if 
one would live to be eighty years old. 
We can have better health for ourselves and our 
children if we will. Physicians who are interested in this 
campaign for saving child life and improving child health 
believe the greatest weapon against disease is not medicine 
but knowledge-accurate, definite knowledge applied 
with plain common sense. In opening their columns to 
a group of physicians who are representatives of organiza- 
tions which are interested in promoting the health and 
welfare of the children of the United States the 
Delineator has taken a step which is bound to have 
far-reaching consequences. 
L. Emmett Holt CONTENTS 
PAGE 
Forewordv 
Introductionxi 
The General Care of the Baby1 
The Care of the Expectant Mother and the New 
Baby10 
Maternal Nursing 38 
Artificial Feeding 54 
Diet Problems of Childhood 72 
Early Childhood . 86 
The Child's Teeth103 
XV THE GENERAL CARE OF THE BABY 
Dr. L. Emmett Holt 
For most women a baby is a new responsibility for 
which she has had no previous preparation or training. 
At the outset she should appreciate the fact that a baby 
is a very delicate piece of machinery, much more compli- 
cated than any automobile. The mistakes and accidents 
of the owner of his first car are not to be compared with 
those which even highly intelligent parents often make 
with their first baby. While they are learning, how they 
blunder! An experienced nurse, like an experienced 
chauffeur, may prevent many accidents; but it is true 
that a relatively small proportion of the mothers in this 
country have experienced nurses, just as it is true that 
the great majority of people drive their own motor-cars. 
People must learn largely from their own experience, 
which is often dearly bought. 
Again, about no subject is so much gratuitous advice 
given by women friends, especially to a young mother, as 
about the care, feeding and bringing up of her first 
baby. 
In general, the first injunction to a young mother is: 
Get the best medical advice that you can and follow it; 
turn a deaf ear to suggestions from all other quarters. 
A young baby is very easily molded; in fact, he is about 
the most plastic living thing in the world. The disposi- 
tion to the formation of habits is amazing, and it is just 2 
THE HAPPY BABY 
as easy to form good habits as bad ones if one begins 
aright at the outset and is consistent. 
Good Habits-A well-trained baby with good habits is 
a constant joy and his care a delight; but an untrained 
baby or a baby who has been trained to bad habits soon 
becomes a tyrant in the household, making life a burden 
to the mother and to all the family. It is really aston- 
ishing how one small individual weighing only about ten 
or twelve pounds soon comes to exercise a power and an 
authority before which all the family bend. I once knew 
a couple who had lost their first baby; the second child, 
as is usual under such circumstances, was badly spoiled 
and soon acquired the habit of not going to sleep unless 
rocked, and then of waking as soon as the rocking was 
stopped; finally he would not sleep at all unless rocked, 
so these devoted but misguided parents were accustomed 
to take their turns in rocking the cradle all night. For- 
tunately, most cradles for babies now are made without 
rockers. 
Importance of Early Training-For the mother who 
must take care of her baby, systematic training is 
absolutely indispensable if she would have regular sleep, 
time for other duties, preserve her health and "keep her 
nerves." Training should be begun in the first weeks of 
life, or, more accurately, in the first week of life. 
The first essential in training is regularity. In infancy 
the habits in which a child is to be trained relate to sleep- 
ing, feeding, bathing, bowel movement, outing, etc. By 
always doing things at the same time, the baby soon 
adjusts himself to the routine which becomes a simple 
matter and runs like clockwork. This early training is a THE HAPPY BABY 
3 
baby's education. If properly trained in such things in 
infancy, it is easy to train him in other respects when he 
is older. 
The enemy of all training is to be found in indulgences. 
These often develop thoughtlessly, merely as a result of 
maternal affection, without the appreciation of their bad 
results. The natural desire of a young mother to "enjoy 
her baby" often leads her to do anything which pleases 
him, even for a short time. Soon he cries if the in- 
dulgences are not repeated: he cries to be rocked, to be 
taken from his crib, to be carried about, to have a light 
in the room, to suck a pacifier. Once these habits are 
begun, they must be continued in order to keep the child 
from crying. In the long run, however, they have just 
the opposite effect, for the one sure way of teaching a child 
to cry is to give him everything that he cries for. The 
converse is also true, that the only way to break such a 
crying habit is never to give a child under any circum- 
stances what he is crying for. 
The cooperation of the father, too, must be secured or 
all the efforts of training are futile. Very often the mother 
finds that with her the child's behavior is perfect, but as 
soon as the father comes home all the bad habits are re- 
peated. The worst sinners of all, however, are usually 
the grandparents, especially the grandmother, and her in- 
fluence is particularly pernicious, as she is supposed by 
her previous experience to know everything about babies. 
The baby is not to be looked upon as a plaything or a 
source of entertainment either for the mother, the relatives 
or friends. The baby is a responsibility and the mother 
is the one person on whom the responsibility rests to see 4 
THE HAPPY BABY 
that the baby has a square deal. The baby has rights 
which should be respected, and on no account should the 
mother allow the baby's rights to be trespassed upon for 
the mere pleasure of friends and relatives. 
Baby's Clothing-The clothing of the baby is pretty 
well standardized and need not be discussed here in detail, 
but certain things should be emphasized. While a young 
baby needs to be kept warm, it is true that very many 
babies are kept too warm, particularly in Summer. The 
amount of clothing must be adjusted to the season of year 
and to the temperature of the room in which the baby 
lives. Even young babies can be kept warm and well in 
a room whose temperature is never over sixty degrees and 
much of the time may be considerably less. If such is the 
room temperature, a hot-water bag or bottle (always care- 
fully covered with flannel) should be in the crib at the 
baby's feet and a blanket wrapped about his body. Such 
children have fewer colds than those kept in very warm 
rooms. In rooms the temperature of which is seventy 
degrees or thereabouts, much less clothing is required. 
Again, thin, underweight babies always need more cloth- 
ing than fat, plump babies. The clothing and covering 
should never be so thick as to keep the baby in a 
perspiration. 
The abdominal band or binder is in very many cases 
discarded much too early. It should be wide and snugly 
applied and basted rather than pinned. It is needed 
for support of the weak muscles and for protection of the 
abdominal organs. With a robust, fat baby it can usually 
be omitted at three months; with a thin, delicate baby it 
is often needed until seven or eight months. With such THE HAPPY BABY 
5 
children, rupture at the navel is apt to occur, especially 
with children who cry a great deal. Rupture is some- 
thing which in most cases is fairly easy to prevent but 
always troublesome to manage and very difficult to cure. 
Care of Baby's Skin-The skin of the young baby is 
very delicate, and chafing and other eruptions easily occur 
unless special care is exercised. The main things to be 
secured are cleanliness and the free use of toilet powder. 
Chafing is usually troublesome about the buttocks or 
genitals, but in fat infants it may occur under the arms, 
in the folds of the neck, legs, groin, etc. It is increased 
by perspiration from too much clothing. To prevent 
chafing, one should not use strong soaps in bathing, should 
avoid friction of the skin, should see that napkins are 
thoroughly rinsed and that the baby's napkin is changed 
as soon as wet or soiled. 
The daily bath is essential to a healthy skin. Up to 
the age of four or five months it should be a tepid bath 
(ninety-five to one hundred degrees) and the temperature 
gradually reduced as the infant gets older. This should 
always be followed, even with young babies, by a quick 
sponge or dash with cold water (sixty to seventy degrees) 
as one of the best means of preventing colds. The bath 
should be given in a warm room and when possible before 
an open fire, and the body dried with very little friction. 
The natural order of events in the baby's day are the 
bath, then the feeding and finally the nap. 
Nursery-The nursery or the room where the baby 
usually spends twenty out of the twenty-four hours 
deserves a few words. As large a room as possible and 
one in which the sun shines at least for part of the day 6 
THE HAPPY BABY 
should be chosen. It should not be heated by a gas-stove 
except perhaps for a short time during the bath. The 
air must be kept pure; the drying of napkins or cooking 
of food should be done elsewhere. Generally the room 
may be cooler than the usual house temperature, certainly 
after the first three or four months. The room and the 
crib should be as simple as possible. The crib should 
have about it only things-curtains, etc.-which can 
readily be washed. 
Outings-Since the air he breathes is quite as impor- 
tant for the baby's health as the food he eats, his outings 
must be given almost as much thought as his diet. For 
babies living in the Atlantic Coast States or Middle West, 
it is not usually desirable to take them out in a baby- 
carriage in the Winter season until they are four or five 
months old. Daily airings in the house, however, may 
be begun at three or four weeks. The baby is dressed as 
for the street, and the windows widely opened, at first 
for only fifteen or twenty minutes; the time is gradually 
lengthened until it is two or three hours twice a day. 
This plan is simpler and easier for the mother, especially 
in cities, than taking the child into the street. Babies ac- 
customed to cool rooms sleep better, have better color, 
better appetites, are less liable to colds and gain in weight 
more regularly than those who are more closely housed. 
In the country a protected porch with southern exposure 
is an ideal place for such outings. 
The air in the nursery should be kept pure and fresh 
by opening windows whenever the baby is out of the 
room. At night the windows may be kept open after 
three months unless the outside temperature is below THE HAPPY BABY 
7 
twenty degrees. Much depends in all these matters upon 
gradually accustoming the child to variations in tem- 
perature. If this is done, little harm, but rather great 
good, will follow. 
In warm weather a baby should live outdoors. There 
is a great advantage in removing all the clothing but the 
napkin and giving the baby a sun bath. At first this 
should be short, only two or three minutes, but it may be 
lengthened by the same time each day until it is one or 
two hours long. The body may be tanned to a brown or 
mahogany color. If done very gradually, sunburn will 
not occur and much benefit will result. 
Quiet Surroundings Essential-Provision for reg- 
ular uninterrupted sleep is one of the essential things 
in the baby's life. The brain actually grows more in 
the first two years than during all the remainder of the 
child's life. If this growth and the development of the 
child's nervous system are to be normal, quiet, peaceful 
surroundings are absolutely necessary. A great deal of 
harm may be done in this period of rapid growth by un- 
duly stimulating and exciting the child. This is often 
done by waking the baby "to show him off" to friends 
and relatives; often by romping play in the latter part 
of the first year. Children who are overstimulated sleep 
badly, cry a great deal, digest their food poorly and are 
nearly always underweight. Some nervous infants will 
not take their food unless in a quiet room by themselves. 
In a very susceptible baby a condition amounting almost 
to nervous prostration or exhaustion may develop as a 
result of such habits as those mentioned. It is a mis- 
fortune when the baby is the only child living in a large 8 
THE HAPPY BABY 
family of uncles, aunts and grandparents, each of whom 
takes a hand in the spoiling. This is especially likely 
to be the case with a bright, precocious child, as many of 
these infants are. Under such conditions the lot of the 
poor mother is often a hard one, particularly if she 
realizes the situation and its possible consequences. Even 
at the risk of offending friends and relatives she, 
as his natural protector, must insist on the baby's 
rights. 
Nervous children were usually nervous infants and 
one can not begin too early to enforce proper home rules. 
A young baby needs a great deal of "intelligent letting 
alone" if he is to grow normally. Otherwise foundations 
are laid very early in life for all sorts of nervous dis- 
orders which develop later. 
Baby's History-Baby's record-book is very desirable. 
I would urge upon every mother to start a book when the 
baby is born in which she records everything of impor- 
tance relating to his health, growth and physical develop- 
ment, his weight, his height, various changes in food, 
dates and particulars of minor or major illnesses, denti- 
tion, sitting and walking alone, early habits, etc., etc. 
Few of the special baby books are to be recommended. 
A simple blankbook of one or two hundred pages is much 
to be preferred. Such a record of the child's progress 
and such a life-history are not only of much interest to 
the mother who keeps it, but may be of the greatest value 
to the physician in his medical care. A mother's mem- 
ory of important events in the child's life is soon hazy 
and records kept on odd sheets of paper are rarely pre- 
served and easily lost. THE HAPPY BABY 
9 
Forbidden Habits and Practices-There are cer- 
tain things which are so obviously bad for all babies that 
they should be specially emphasized: 
1. Habitual thumb-sucking, or the use of the "pacifier" or 
"dummy" to secure temporary quiet. The latter, if persisted 
in, often aggravates disturbances of digestion, while the former 
may lead to deformity of the mouth. 
2. All patent medicines; particularly soothing sirups and 
nostrums, the purpose of which is to relieve colic or "make 
teething easy." 
3. Rocking the baby to sleep; sucking upon empty bottles; 
sleeping upon the mother's breast while nursing, or sleeping in 
the same bed with the mother. 
4. Kissing the baby upon the mouth; allowing any person 
with a cold to hold the baby; sneezing or coughing in the baby's 
face. 
5. Allowing any sick child in the room with the baby, or any 
person with tuberculosis to take care of the baby. 
6. Playing with or unnecessary handling of the baby soon 
after feeding, or violent romping play at any time, especially 
just before bedtime. 
7. Testing the temperature of the milk in the baby's bottle 
by taking the nipple into the mouth. THE CARE OF THE EXPECTANT MOTHER 
AND THE NEW BABY 
Dr. Ralph Lobenstine 
SAVING LIFE BY PRENATAL CARE 
The purpose of this and succeeding articles is to save 
the lives of mothers and children. More than twenty 
thousand maternal lives were needlessly lost last year 
in this country, because the simple facts of child-bearing 
were not understood. 
Ignorance or indifference are responsible for a large 
part of the annual loss in life as well as for much of the 
existing invalidism. 
It is not merely the poor and the uneducated who are 
ignorant on this all-important subject. 
Probably at least seventy-five per cent, of the mothers 
of this country do not consult a physician until near 
the end of pregnancy or until a serious condition 
has developed and life and health are already endan- 
gered. 
Since the dark ages, motherhood has been shrouded in 
a certain amount of mysticism due to ignorance and 
misinformation. 
At no other time of her life is a woman likely to receive 
so much advice or to hear such lurid and disturbing tales. 
Most of these statements are gross exaggeration and do 
no good. Most of the advice is uncertain or is positively 
10 THE HAPPY BABY 
11 
harmful. The mystery of pregnancy is the mystery of 
life. This we can not solve. 
But protection of the mother so that she and her child 
may have a safe delivery is available to all classes and 
conditions of society. It is the duty of parents to put 
aside all the superstitions and false preachments, and to 
learn the simple facts which will save suffering and, in 
many thousands of cases, save life. 
Science has disapproved the tradition about prenatal 
marking of babies. Babies are not born with birthmarks 
or dejormities because of anything their mothers have 
done or seen. In this sense, prenatal influence, that is, 
"marking a baby," does not count. 
But as we shall see, prenatal influence does count when 
one is considering the health of the infant. Certain traits 
of character are handed down; a very few diseases are 
inherited, and perhaps a predisposition to a few others; 
but most of the popular notions are mere superstitions. 
They have no trustworthy basis. A baby may be born 
dead, however, and often is born far ahead of time be- 
cause of inherited disease or because of an accident; 
because of overfatigue of mother, excessive smoking, 
drinking or because of certain diseases that may arise 
during pregnancy. 
Motherhood is a natural physiological process, but 
this does not mean that it therefore runs a normal course. 
The belief, so universally accepted, that it is both natural 
and normal, has brought untold suffering into the lives 
of many. 
Fear, however, should have no place in the mind of 
the mother-to-be. Fear is harmful to both mother and 12 
THE HAPPY BABY 
child. Good common sense and watchfulness are es- 
sential to health; wholesome advice from a good doctor 
or nurse will carry the great majority of mothers safely 
through. If abnormal signs develop, the very best help 
should be sought at once, for the best is none too good. 
The expectant mother, as soon as she is definitely 
aware of her condition, should consult a doctor. If in 
the country, or if for any reason a doctor can not be 
seen with fair frequency, a district or public-health 
nurse will prove of very great help. Lay your cares upon 
the doctor and nurse and then follow faithfully the direc- 
tions given by them. If no doctor or nurse is available 
at this time, much reliable information can be obtained 
from pamphlets for the expectant mother that are issued 
by various State departments of health; certain private 
or public-health organizations and by the U. S. Public 
Health Service and the Children's Bureau in Washington. 
Follow such advice rather than the suggestions of your 
friends. 
The simple, common signs of pregnancy are: Cessa- 
tion of periods, more or less nausea (this rarely becomes 
marked until the fourth or fifth week) and prickling or 
soreness or heaviness of breasts. With these common 
symptoms we frequently find, further, some irritation of 
the bladder; a curious depression, for a few days or a 
few weeks, that the patient herself does not understand; 
a feeling of faintness which is usually relieved by a little 
food; odd fancies or dislikes about individuals, articles of 
diet, etc. Again I repeat, all this need frighten no one. 
These symptoms are all frequent ones and can not be 
considered abnormal in themselves. Cheerfulness and THE HAPPY BABY 
13 
freedom from trivial worries are an enormous help. 
Self-control during pregnancy is very necessary, al- 
though it is more difficult than at other times. Self- 
control is never harmful. 
The advantages of an early visit to the doctor are: 
1. The general state of your health at this time can and 
should be determined, such as the condition of the heart, the 
lungs, kidneys, the blood pressure, etc. (Tuberculosis is usu- 
ally made worse by pregnancy.) 
2. An internal examination will show the doctor whether or 
not there is anything abnormal. 
3. Important advice for the coming months can be given. 
CARE IN EARLY MONTHS 
As I have just said, have a doctor both during preg- 
nancy and at birth, if possible, and always secure the best 
one available. This one suggestion will frequently save 
a patient's health, not infrequently a life, and usually is 
the most economical. Nothing is so expensive as poor 
medical advice. 
Specialists are far too few in number in this field, but 
fortunately the large majority of cases are quite normal 
and can be safely cared for by the general practitioner. 
Seek, then, the best and give them your confidence. 
If obliged to have a midwife, be sure that she is 
properly licensed and clean. No midwife has the right 
to look after abnormal conditions either before or at the 
time of birth. To be sure, some one who reads these 
lines may be planning to have just an old-fashioned un- 
trained midwife or no one but a friend to help her out. 14 
THE HAPPY BABY 
This is, indeed, an unfortunate situation. My sugges- 
tion would be to secure all the wholesome advice possi- 
ble, to then plan well in advance to go to the nearest 
hospital for confinement or to some relatives residing 
in a town with good physicians. This suggestion may be 
difficult to follow and yet, all too often, it is the only safe 
course available. It may cost a sacrifice at the time, 
but may save your life or prevent invalidism later on. 
In no other field of medicine, perhaps, is it so true 
that complications can readily be avoided through sound 
preventive measures. 
Plenty of rest, good food, fresh air and exercise in 
moderation are the essentials to good health in the 
mother-to-be. 
Many mothers feel that housework or office work 
should be given up during pregnancy. One or the other 
of these occupations is necessary to the majority of 
mothers, and they do no harm, providing they are not 
too strenuous and they do not cause too great fatigue. 
Genuine fatigue is the danger sign. 
Overfatigue, no matter what its origin, can not be good 
for the expectant mother. 
Occupying a position which requires exacting mental 
effort will not injure the mentality of the child, but the 
mother should not allow herself to become unduly 
nervous and be deprived of a normal amount of fresh 
air and exercise. 
Heavy factory work should be avoided, but light work, 
in clean surroundings, can do no harm. 
All exercise, in the writer's opinion, should be indulged 
in more carefully than during ordinary times. THE HAPPY BABY 
15 
For those who have the leisure, walking is certainly the 
best form of exercise. Violent exercise, such as horse- 
back riding, much prolonged dancing, violent tennis and 
motoring over bad roads can not be considered whole- 
some or wise. 
Diet: The diet need not differ materially from that 
the individual is accustomed to, yet it is important to 
say that in certain essentials great care should be 
exercised. 
Overeating is always bad, but this is particularly true 
during pregnancy. No food or drink which causes dis- 
comfort should, of course, be taken. This is plain com- 
mon sense. 
Drink at least six glasses of water each day. Too 
much water, despite the opinion of some, may do harm. 
This is particularly true late in pregnancy. 
Drink freely of milk, if milk is readily digested. Use 
vegetables and fruit in abundance, avoiding, however, 
strongly acid ones such as strawberries and canned 
tomatoes. 
Eat meat, meat extracts and eggs sparingly and pref- 
erably not more than once a day. During the last two 
months of pregnancy it is best to avoid beef in any form. 
Avoid alcohol in all of its forms, and, finally, indulge 
sparingly in sweets, particularly rich chocolates. Free 
use of meats and eggs predispose to kidney and liver 
complications. Overindulgence in sweets upsets first the 
digestion and then the liver and finally the kidneys. 
Clothing, Hygiene, Etc.: The body should be kept 
suitably warm and prevented from becoming chilled. It 
is possible to dress attractively and yet sensibly at this 16 
THE HAPPY BABY 
time. The weight of the clothes should hang from the 
shoulders. 
Corsets are an advantage, particularly during the last 
two or three months. During the early months, if un- 
accustomed to corsets, one may dispense with them, 
otherwise the usual ones may be worn, but these should 
not be tight. 
After the first five to six months, at most, maternity 
corsets, properly fitted, in most cases give comfort and 
are of genuine advantage. Round garters should not 
be worn. High heels, of course, are not advisable. 
A Daily Bath (at least a sponge bath), should be 
taken, but not, as a rule, with cold water. 
Cold baths, in my opinion, should not be taken unless 
the individual is long accustomed to them, and never 
around the so-called rest days each month when the per- 
iods would naturally come were the patient not pregnant. 
Both the teeth and the hair feel the effects of pregnancy 
and, if troublesome, should not be neglected. It is en- 
tirely safe to go to a dentist, providing he is a good one. 
Severe dentistry, however, should be avoided. 
Rinsing the mouth frequently with a little milk of 
magnesia will often lessen the damage to the teeth. 
Habitual Constipation is quite difficult to control, 
and yet it should never be neglected; for, if not remedied, 
it is bound to bring serious trouble during the pregnancy. 
Bran bread, plenty of water (two glasses before break- 
fast), and fruit and green vegetables are essential. A 
dessert spoonful of olive-oil at night or some combination 
of senna will prove useful. 
The following is a good recipe for the senna: Take a THE HAPPY BABY 
17 
pound of dried prunes and a pound of figs; remove the 
stones from the prunes and then chop both the prunes 
and the figs in a meat-chopper, as finely as possible; add 
two ounces of senna leaves. To this mixture add a little 
molasses, about two tablespoonfuls, and stir until the 
mass is well mixed. Of this mixture, one to two dessert 
spoonfuls at night will prove of real help. 
Marriage should bring with it a normal desire to have 
children. When this desire becomes a fact, added re- 
sponsibility comes to both husband and wife. Both, 
therefore, need added patience and both will be benefited 
by guidance and instruction. 
The mother's health, yes, her life often, will depend 
upon how she lives during the months preceding her de- 
livery and upon the care she receives at the time of the 
birth of her child and during the early weeks thereafter. 
Duration of Pregnancy: Life starts at the time of 
conception and not at the time the mother first feels the 
baby move. 
The average duration of pregnancy is generally con- 
sidered to be 273 days. The estimated date of confine- 
ment is obtained in the following way: take the first day 
of the last menstrual period, add on seven days and 
count back three months (last period began October 1st; 
add seven days, equals October 8th; count back three 
months, equals July 8th). This will be the nearest date 
you can count on. Naturally the exact date varies con- 
siderably. No rule is perfect, but this one is more widely 
accepted than any other, and comes near the facts. 
Sex of Child : The sex of the child can not, in human 
beings, be satisfactorily controlled; although claims to 18 
THE HAPPY BABY 
the contrary have been made. Even during pregnancy, 
neither physician nor nurse can determine the sex of the 
child accurately in a long series of cases. The writer has 
at times believed, with others, that the sex could, with 
certain limitations, be determined from the rapidity of 
the baby's heart. He now feels that this is quite un- 
reliable. Sex, further, does not influence the manner in 
which the mother carries the child. 
The movements of the baby are felt after four to four 
and a half months. Some feel these a little earlier, some 
not until slightly later. At this time the doctor can 
detect the movements of the baby as well as the baby's 
heart beat. 
All patients should follow, even when apparently well, 
this general plan in the matter of medical supervision: 
Until the seventh month, patients should be seen at least 
once in three weeks. During the seventh and eighth 
months at least once in two weeks, and during the last 
month every week to ten days. If it is impractical to see 
the physician as often as this, it certainly will add much 
to the patient's peace of mind, as well as to her comfort 
and safety, to come in contact with the district or public- 
health nurse at stated intervals. At each visit a specimen 
of urine should be examined, and, if possible, the blood 
pressure taken. 
Those who are really sick during pregnancy, or who 
will probably have a hard time at delivery, should al- 
ways strive to be in a hospital for the confinement. The 
specialist can often handle the difficult case in the home 
safely where another of less experience will fail, but there 
is no question that the hospital is more desirable than THE HAPPY BABY 
19 
the average home in cases where any definite abnor- 
mality exists. 
Every expectant mother should plan to be as quiet as 
possible during the week (three to four days) in which 
she would be unwell were she not pregnant. This pre- 
caution is particularly important at the second and third 
months of the pregnancy. At such time miscarriages are 
more likely to occur. All sexual excitement should be 
avoided around the "rest days" and, again, absolutely 
prohibited in women who have a tendency to miscarry. 
A pregnant woman should have eight to ten hours' 
sleep each night, if possible, and a definite rest during 
the day. 
There is no truth in the old warning not to sleep with 
the arms above the head, but in the later months this 
position may be uncomfortable to the mother and may 
make the child uncomfortably active because of tension 
and pressure on the abdominal muscles. 
Nausea and Vomiting (morning sickness) are liable 
to occur in over one-half of the cases. In some, the 
symptoms last but a few weeks, in others for several 
months. In the majority of cases by the end of three to 
three and a half months patients should be quite well. 
The general rules as to diet are these: Eat wholesome, 
plain food frequently (every two and one-half to three 
hours and in small amounts). Sweets, fried articles of 
food and pastry are especially bad, and must be avoided. 
A little dry food or a cup of clear coffee or tea before 
arising in the morning is often helpful. 
Plenty of fresh air, freedom from fatigue and attention 
to the bowels are absolutely necessary. Small doses of 20 
THE HAPPY BABY 
pure bicarbonate of soda or of milk of magnesia are good. 
During the period of nausea, a simple pill at night, such 
as cascara (three to five grains), Phenolax (one tablet), 
or some simple rhubarb mixture will probably be neces- 
sary, as the state of nausea will not permit the use of 
coarse food usually given for constipation. A hot flax- 
seed poultice applied over the stomach in the early morn- 
ing for one-half hour is often of help. 
Unquestionably, cheerfulness of mind-if one can be 
cheerful under such circumstances-is well worth the 
effort. Should these simple remedies be of little help, 
do not fail, then, to get further advice from a physician. 
Severe vomiting or marked loss of weight must never be 
neglected. 
The breasts should be supported, if heavy, and should 
not be compressed. Many physicians advise no treat- 
ment for them during pregnancy. If any is given, the 
nipples may be sponged twice daily with a little weak 
witch-hazel and then rubbed gently with either lanoline 
or white Vaseline. If the nipples are flat or inverted, 
they need to be specially treated, and for this you should 
consult your physician. 
Persistent constipation, severe headaches, vomiting 
later in pregnancy, spots before the eyes, dizziness and 
any bloody discharge are all danger symptoms and 
demand a speedy visit from a doctor. 
COMPLICATIONS 
The three most common, and, at the same time, serious 
complications of pregnancy are, first, disturbance of the THE HAPPY BABY 
21 
kidneys and liver; second, definite bleeding, and third, 
miscarriage or premature birth, while the child is still very 
small. All of them occur far too often, and all are greatly 
lessened in frequency and severity by prenatal supervi- 
sion. It is in order to prevent serious difficulty with the 
kidneys and liver that frequent examinations of the urine 
are so important. The further along in the pregnancy, 
the more important this becomes, for as the child in- 
creases in size there is a constantly increasing tax upon 
the kidneys and liver, in particular, because the mother's 
blood must rid itself of the increasing waste material now 
coming from two individuals. When symptoms become 
severe, we speak of the condition as toxemia (poisoning.) 
Puffiness under the eyes or about the ankles, vomiting, 
dizziness, difficulty with eyesight, severe headaches, 
changes in the urine and an abnormally high blood 
pressure are the common warnings of a very serious 
condition, with or without convulsions. Careful attention 
to digestion and the bowels, frequent urinary examina- 
tions and when available blood-pressure findings will, in 
most instances, give the warning sufficiently early to ward 
off grave results. A pregnant woman should pass in 
twenty-four hours an average of three pints of urine. 
If there is less than this amount, drinking more water 
is necessary. This is not wise if there is swelling of 
face and legs. On the least sign of trouble of this sort 
one should eliminate salt from the diet. 
The following forms of invalidism result from neglect 
during pregnancy and at child-birth: 
a. All chronic ailments are aggravated by such neglect; 
tuberculosis and kidney conditions in particular. 22 
THE HAPPY BABY 
b. Severe hemorrhages and acute kidney conditions if ne- 
glected are prone to have severe after-results for many 
months. 
c. Much discomfort or semi-invalidism is seen as a result of 
misplacement, lacerations, etc. 
Bleeding: No actual bleeding should occur during 
the pregnancy. In the early months it means either a 
threatened miscarriage or an actual one. In later months, 
if the amount of blood lost is considerable, the condition 
is apt to be serious. One should go to bed at once and 
keep absolutely quiet until a doctor can be secured. If 
no doctor is in the neighborhood and a nurse is near 
by, have her come at once. 
Miscarriage and Premature Birth: Miscarriages 
are very common-indeed much too common. They may 
occur at any time during the early months, but they are 
most frequently seen from the sixth to the fourteenth 
week. They come from a great variety of causes, such 
as heavy lifting, running a sewing-machine, motoring on 
poor roads, tennis, horseback, etc. In very many cases, 
the exact cause can not be determined. The symptoms 
of miscarriage are bleeding, pain, intermittent in character 
and a feeling of pressure very low down. Either one or 
all of these symptoms may be present. The treatment 
is to go to bed at once and call a doctor or to be taken 
to the nearest hospital. The common custom is to take 
miscarriages far too lightly; threatened miscarriages can 
be checked if taken in hand at once, chiefly by continued 
rest; while many, unless carefully handled, will result 
harmfully, both at the time and in the future. Midwives THE HAPPY BABY 
23 
are not competent to handle any but the simplest cases. 
One of the greatest dangers in a miscarriage, as at the 
time of labor, is the danger of blood poisoning because 
of lack of care and cleanliness. Habitual miscarriages 
call for a study of the blood by a competent laboratory. 
LABOR SYMPTOMS 
For those who are going through pregnancy for the 
first time, it is well to be informed regarding the symptoms 
of approaching labor. These signs may occur days or 
weeks before the expected date. The rule is that before 
the actual onset of labor, the baby "drops" or "settles" 
so that more pressure is felt below and there is greater 
comfort in breathing. There may be a slight staining of 
blood or bloody mucus. If either of these signs develop, 
even without pain, notify your doctor or nurse or midwife. 
Labor itself begins with pain in the back or abdomen, 
with or without a little bleeding, with or without a watery 
discharge. Do not get nervous or excited. While await- 
ing your doctor or other attendant, if you are having 
pains, have a kettle full of water boiled and set aside 
to cool. Hot water will be needed, too. If you are not 
going to the hospital, get out the supplies you need for 
the birth, have your bed prepared as shown by the nurse 
or midwife, and keep quiet until assistance comes. The 
long months of preparation are soon to be over. The 
mind is filled with anticipation and hope. 
Labor and Lying-In Period: In anticipation of the 
confinement, certain supplies for use at the time should 
be prepared and this should be done well before the date 24 
THE HAPPY BABY 
set by the doctor or midwife. The baby, too, will need 
a layette, the nature of which will depend entirely upon 
the family purse. There is great comfort in knowing that 
the supplies are ready and in easy reach when wanted. 
Many different lists might be given, but I will content 
myself with mentioning the essentials. Some of these 
will, of necessity, be omitted if funds are not ample. 
2 gowns 
1 pair white stockings 
2 sheets 
6 towels 
These can be sterilized in the 
oven or steamed for one hour, 
or may be bought sterile 
3 to 4 dozen sanitary pads 
2 packages of sterile cotton (J4 pound each) 
10 yards sterile gauze 
Rubber sheet for bed 
2 to 4 pads for bed 
1 bedpan 
At least three ounces of lysol-or 
1 bottle of bichloride of mercury tablets 
2 ounces of tincture of iodine 
2 yards of stout unbleached muslin for binders 
24 inches of narrow tape for the cord 
(This can be bought already sterilized; if not, it should 
be boiled for one-half hour before use) 
1 or 2 agate or enamel pitchers 
2 to 3 agate or enamel basins 
4 ounces of boric acid powder 
1 (2 to 3 quart) douche-bag 
The bed pads are made either from six thicknesses of 
newspaper, open to full size, and covered with freshly THE HAPPY BABY 
25 
laundered old sheeting, tacked in place, or may be bought 
already made up and sterilized. 
baby's supplies (minimum): 
3 doz. diapers 18 x 18 
3 bands 6 x 27 
3 shirts, size 2, cotton and 
wool 
3 petticoats 
3 slips 
2 cloaks and caps 
1 oilcloth or rubber 12 x 18 
inches 
12 large safety-pins 
12 small safety-pins 
Baby scales are desirable 
1 or 2 hot-water bags 
2 muslin pillow-cases 
3 crib blankets, small size 
4 towels; 4 crib sheets 
2 wash-towels, old pieces of 
linen 
1 piece Castile soap 
8 oz. boracic acid powder 
1 package absorbent cotton 
(sterile) 
y2 pt. oil-sweet or albolene 
1 package toothpicks 
Labor: At the onset of labor, the supplies should be 
brought out and arranged for use. Unnecessary furniture 
should be removed, when possible, from the lying-in room. 
At this time it is important to secure either one ounce 
of a one-per-cent, solution of silver nitrate or a twenty- 
per-cent. solution of argyrol. These solutions are used 
immediately at the birth of the child for the eyes. It is 
usually wise to take one hot soap-suds enema, and, if 
there is time, a thorough sponge bath. Labor is rarely 
easy, and yet, on the other hand, it should not be 
approached with fear. Fear acts peculiarly on the pro- 
gress of the labor. It adds to the feeling of pain and, 
at the same time, it is likely to delay the progress by 
causing the contractions of the womb (which cause the 
pain) to be less effectual. Firmness, yet patience and 26 
THE HAPPY BABY 
gentleness on the part of the doctor, nurse or midwife 
add much to the spirit of self-control. Laughing gas and 
ether carefully used by the physician toward the end of 
labor have almost magical effect in easing the last suf- 
fering. Anesthetics do harm, in the writer's opinion, 
when given too early or in large amounts, because of 
fear or lack of self-control. Labor is prolonged thereby 
and rendered more difficult, the baby is more likely to 
be asphyxiated. Midwives are not, as a general rule, 
permitted to administer anesthetics of any kind. 
Chloroform in this country is used in labor far less than 
formerly, as it is not considered, on the whole, as safe 
for either mother or child as ether. 
The majority of cases, if reasonably well handled, come 
through without undue difficulty. The greatest lesson to 
learn in connection with labor-one and all-is that good 
care and perfect cleanliness are absolutely essential. A 
disregard of this surgical lesson is responsible for a great 
amount of illness and many fatalities. With real care, 
there is practically no danger of childbed fever. The 
rule is: No internal examinations, no douches, no instru- 
ments, no pads, no solutions, etc., without surgical 
cleanliness (perfect sterilizing). It would be a great 
blessing to all women in labor were all doctors, nurses 
and midwives to wear freshly boiled (or otherwise 
sterilized) rubber gloves. This may seem fanciful, even 
foolish to many, who are used to old prevailing methods, 
and yet this one precaution will bring its reward a hundred 
times over. 
The actual delivery in the home is either conducted on THE HAPPY BABY 
27 
a hard, clean bed or on a table. Labor is divided into 
three parts. The longest period is called the first stage; 
this occupies many hours, especially with the first child. 
During this first stage the mouth of the womb gradually 
dilates. This process is bound to be slow because of the 
mechanical difficulties that have to be overcome in order 
to allow the child to pass out of the womb. In the strictly 
normal type of case, when the dilation is complete, the 
bag of water breaks and the second stage begins. Dur- 
ing this stage the pains should increase in frequency and 
should be propulsive or bearing down in nature. It is 
at this time that the patient can help to a great extent 
by strongly bearing down with each contraction of the 
womb. The second stage is said to end with the birth 
of the child; it lasts anywhere from a few minutes to 
an average of one to three hours. The third stage ends 
with the expulsion of the placenta or after-birth. This 
requires usually from fifteen to forty-five minutes. The 
doctor or the nurse helps this delivery by firm pressure 
from above on the contracting womb. 
During labor there is usually a slight amount of bloody 
discharge. When the amount appears to be considerable, 
careful watching is necessary, as this may indicate some 
abnormality. In many cases the water comes away in 
the first stage or before the actual onset of labor. It is 
considered a little unfortunate to have this latter occur, 
for it means a dry labor and in consequence, usually, a 
slower labor. During a long first stage, if occurring in 
the daytime, patients should keep up and around as long 
as possible, occupying themselves so as not to have the 28 
THE HAPPY BABY 
time pass altogether too slowly. If going to a hospital, 
the patient should do so as soon as labor begins, often 
preferably before this. 
The baby should be born in a warm room. This is of 
the greatest importance, for early chilling of the body un- 
doubtedly is responsible for certain serious complications. 
The mother, too, is exposed for a considerable period to- 
ward the end of labor, therefore she likewise requires heat. 
After the birth of the baby and the expression of the 
after-birth, it is customary, when a physician is in at- 
tendance, to sew up at once any lacerations that may be 
present. Skill will prevent many tears of the external 
muscles; but others are unavoidable. If these are im- 
mediately attended to, in a surgical way, the results 
should generally be satisfactory. After completing all 
necessary details, a sterile pad having been applied, the 
patient is made as comfortable as possible and allowed 
to enjoy a much-needed rest. 
There is always some bleeding at the end of labor, 
but this should quickly subside. The amount is lessened 
if, during the third stage, an assistant or the doctor 
himself firmly holds the womb with one hand. The 
womb should remain firmly contracted. This condition 
needs watching, particularly after difficult labors. The 
discharge from now on (called lochia) will continue in 
gradually lessening amounts for from two and a half 
to four weeks. In the presence of more than moderate 
bleeding after the birth of the child and placenta, in the 
absence of the physician, one to two teaspoonfuls of 
fluid extract of ergot may be used and ice may be placed 
over the womb. The majority of patients wear an THE HAPPY BABY 
29 
abdominal binder for the first week. During the early 
days this adds much to the mother's comfort, but it does 
not help in any way to restore the figure. 
About ninety-five per cent, of babies are born head 
first, as this seems to be the common position ordained 
by nature; other presentations of the baby are attended 
with slightly more risk at delivery, but in reasonably 
well-trained hands there need be no great alarm. 
Caesarian section can to-day save many infant lives which 
otherwise would be lost because of special complications. 
Care of the Baby at Birth: As soon as the baby 
is born, it is well to hold it up by its feet, making it cry 
lustily. All mucus that may have collected in the nose 
and mouth should be wiped away. The cord is now 
tied in two places with the tape; the piece nearest to the 
baby being applied about three-quarters of an inch from 
the skin edge. After cutting, it is wiped dry with sterile 
gauze or cotton, and a dry sterile gauze square put on 
as a dressing and held on by an abdominal band. 
The eyes are then attended to. Having cleansed the 
eyelids with boric solution, the eyelids are opened and 
two drops of either one per cent, silver nitrate or twenty 
per cent, argyrol introduced. The excess is wiped away 
and in case the silver nitrate is used, the eyes are very 
carefully irrigated with boric acid solution. This pre- 
caution prevents reaction from the silver. The object in 
using these is to prevent the blindness which not in- 
frequently occurs from infection arising in the course of 
the birth. Never fail to have this procedure carried out. 
We now give the baby a good oiling with some form 
of Vaseline or olive-oil; wrap it in a warm towel, and if 30 
THE HAPPY BABY 
scales are handy, weigh it. It is then wrapped in several 
warm blankets, placed on its right side in a basket or crib 
containing a hot-water bag or bottle. Be sure they do 
not leak. The object of the oiling is to help in the 
removal, at the time of its first bath, of the cheesy 
substance called vernix, with which the majority of babies 
are more or less covered. There is no hurry about the 
bath. This should not be given, in the writer's opinion, 
until the baby is well adjusted to the outer world and 
until other, more important things have been attended to. 
It is usually wise to wait for from four to six hours. 
The baby's bath should, of course, be given only in a 
very warm room. 
The bath-water should be comfortably hot-say, 104 
degrees F. The baby is either placed on the lap of the 
nurse or attendant or on a warm baby blanket on a 
bed. The skin is carefully cleaned with liquid Vaseline 
or oil. This must be done gently, as the skin is very 
sensitive; the body, head and face are washed with a little 
Castile soap and water and carefully dried. The baby is 
then dressed in the simplest of clothes. Within six to 
twelve hours, the baby may be put to the breast for a 
few moments, but only for a few moments. The few 
drops that the baby obtains help to satisfy its beginning 
hunger, and, at the same time, the nursing helps to 
stimulate the secretion of the milk. During the first 
twenty-four hours, in addition to the possible once or 
twice at the breast, the baby may receive (a little) warm 
water once in four hours. 
Two to four teaspoonfuls are all it will take. If the THE HAPPY BABY 
31 
mother is much exhausted, the nursing should be post- 
poned. During the second day the feedings may be 
four in number and the water continued. The baby's 
bladder and intestines should now be active. It should 
cry lustily from time to time. 
The practise of giving castor-oil as a routine is be- 
coming less and less common, unless the baby is badly 
constipated or jaundiced (yellow). Under these condi- 
tions it is very useful. The movements are first black 
from the contents of the bowel before birth. Several 
days are generally required for this to disappear. 
Gradually the movements become light yellow, pasty and 
of even consistency. They frequently, however, are a 
little green and contain small curds. The number nor- 
mally varies from one to four a day. 
The further care of the average baby (and it is only 
the average baby we can here consider) is very simple. 
It is customary to give a daily warm sponge bath in a 
warm room and to change to fresh clothing. The 
stump of the cord will usually dry up and drop off within 
five to ten days. If, during this time, the dressing is 
moist or has some slight odor, a fresh sterile dressing 
should be applied. If the stump has distinct odor, it is 
advisable to touch the base thereof with alcohol or argyrol 
(the solution you already have). After the stump has 
come off, and the navel is practically healed, a full tub 
bath is given. 
At times, the "core" of the baby's navel continues 
to discharge beyond two weeks. One or two applica- 
tions, then, with the silver-nitrate pencil will usually 32 
THE HAPPY BABY 
cause rapid healing. A physician or nurse should do 
this. 
The nose and mouth should be kept clean, but all 
cleansing must be done with the utmost gentleness. If 
the eyes show definite discharge and swollen lids, call your 
doctor at once. Not infrequently the baby's breasts 
swell, and in girl babies a little bloody spotting is seen on 
the diaper. These mean temporary activity of the 
glands and call for no treatment. The baby's buttocks 
are often red and sore. This may come from soap in the 
diaper; from prolonged wetting or from changes in the 
stools. The remedy lies in care with the diapers; chang- 
ing frequently; using olive or cotton-seed oil to wipe the 
buttocks with, and in not using powders. Exposing the 
irritated skin to the air and sunlight for a few hours each 
day is beneficial. If results do not come quickly, call 
the doctor. The quality of the milk may have to be 
regulated. 
The commonest causes of death in the new born are: 
Prematurity; weakness due to poor health of mother; 
syphilis, and injury at birth. These are all very, very 
common. In the care of premature or naturally weak 
babies the essentials are these: 
1. Little handling. 
2. Heat-plenty of it (the room should be eighty degrees in 
early days if infant is very small). 
3. Plenty of blankets and hot-water bag. 
4. No visitors. 
5. Breast milk is of the utmost importance every two or three 
hours. THE HAPPY BABY 
33 
THE FIRST MONTH OF THE NEW MOTHER- 
GENERAL ADVICE 
Lying-In Period: The average lying-in period, as 
far as the mother goes is quite uneventful, at least so 
far as complications are concerned. If she has had some 
careful instruction and supervision during pregnancy and 
her health is good, and if her labor has not been too pro- 
longed and has been conducted in a surgically clean 
manner, she should progress evenly and rapidly. It is 
well to remember, however, that no matter what one's 
social or economic position is, this is the great time in life 
to go slowly, for one's future health and happiness depend 
so much upon taking things quietly and peacefully. 
By the end of forty-eight to seventy-two hours, the 
breasts should fill with milk. In some this occurs grad- 
ually, and, in consequence, with little discomfort, and in 
others rather rapidly and with considerable pain. The 
distended breasts can be very troublesome for one or two 
days. At this time the baby should be nursing every 
three to four hours, depending upon the fullness of the 
breasts, or upon the wish of the physician, if there is a 
physician in charge. Some prefer the three-hour and 
some the four-hour schedule. Certainly, if the breasts 
are very painful, the three-hour schedule is preferable 
for the first two or three days. At night the interval 
usually should be at least a four-hour one. In other 
words, from now on the baby should receive not more 
than one nursing between ten-thirty at night and six in 
the morning. The nursing should last twenty minutes. 
This schedule can be continued for many weeks. With 34 
THE HAPPY BABY 
the distention of the breasts during the acute stage, one 
should drink almost nothing. This is highly important 
and with the first suggestion of the milk coming in, a 
saline laxative, such as Epsom or Rochelle salts or citrate 
of magnesia, should be taken. This, too, will help to 
relieve conditions. If there is real pain, ice applied for 
two or three hours will help materially. Others use hot 
flannel stupes to the breasts, but these must be used with 
great care. In premature infants, nursing every two to 
three hours with a longer interval at night is a satis- 
factory schedule. Many make use of a breast-pump to 
get rid of the excess milk. The breast-pump is, however, 
something that should be avoided, if possible. It fre- 
quently does harm. Before and after each nursing, it is 
well to sponge the nipples with boiled boric acid solution, 
and they should be kept covered with either small squares 
of sterilized gauze or with lead nipple shields. A breast- 
binder certainly is an aid to the comfort of the patient 
and helps to protect the breasts. 
Nursing should be carried out in all cases in which there 
is milk in the breasts and in the absence of bad health 
of the mother. For a woman with tuberculosis, severe 
anemia or a bad kidney condition, to nurse is almost 
surely to ruin the health she still possesses. Mother's 
milk is ideal for the baby and no mother should refuse 
to nurse because of trivial or selfish notions. If the 
nipples become painful, the application of a simple 
remedy, such as tincture of benzoin after each nursing, 
will usually relieve the condition. If not, direct pressure 
is removed by the use of a nipple-shield at the nursing. THE HAPPY BABY 
35 
Should a small crack appear in the nipples, the doctor 
or nurse can advantageously touch the raw spot with a 
silver-nitrate pencil. If the breasts are shielded from 
injury and kept scrupulously clean, they should not cause 
trouble after the first few days. 
From time to time, however, one small section of the 
breast becomes tender and painful. There is usually 
some fever. A small abscess in the breast is threatening. 
These breast-infections seldom appear before the end 
of the second week and often not until much later. A 
doctor should at once be notified. In the meantime the 
application of ice is the best of all remedies in the early 
stage. If any pus has formed, a very small opening 
will, as a rule, relieve all symptoms. 
If the mother's milk is insufficient in amount, or if for 
any good reason she can not nurse, cow's milk should be 
given in some form. But artificial jeeding is not nearly 
as easy as nursing. 
The diet of a nursing mother must be abundant and 
wholesome. Contrary to the opinion of some physicians, 
the vzriter believes that certain laxatives as well as a few 
articles of diet, such as strawberries, cauliflower, Brussels 
sprouts, are somewhat liable to upset the child. Milk and 
cocoa, especially after the mother is up and around, are a 
great help. 
Artificial feeding should always be conducted under the 
guidance of a competent physician. The natural desire 
seems to be to make the child gain rapidly, after the early 
loss. This is a great mistake, because over-feeding at 
the start nearly always results in trouble. 36 
THE HAPPY BABY 
The patient who has had no complications may sit up 
in bed on the fifth to the eighth day; sit in a chair on the 
ninth to the fourteenth day and move around thereafter, 
slowly and gradually, depending on the need and ability 
of each particular case. 
Many are living a fairly normal life again at the end 
of two weeks; but this is altogether unwise, unless 
absolutely demanded. Three weeks of quiet are well 
worth while in the end. Many women have organic 
trouble the rest of their lives because they over-exert 
themselves after childbirth. 
Patients who are able to progress slowly usually do not 
go out-of-doors until some time toward the end of the 
fourth week. The writer is conservative in this, but he 
feels the importance of this period of rest. All exercise 
should be begun slowly. 
The majority of married women have heard of the 
condition called "milk-leg" (phlebitis). This condition 
appears most commonly from the ninth to the sixteenth 
day, although, of course, it may not appear until the 
third or fourth week. It is more often in the left leg 
than in the right, and usually begins just below the groin. 
The trouble is due to a localized (generally speaking) 
inflammation of a vein in that part of the thigh. As a 
result of the irritation, the particular vein involved 
becomes closed and the circulation then has to be carried 
through other channels. More or less swelling of the 
thigh and lower leg ensues. There is marked local tender- 
ness for a few days and often a considerable amount of 
fever. Some infection at the time of labor or during 
the first few days thereafter accounts for many of these THE HAPPY BABY 
37 
cases-but not for all. The treatment is rest in bed, 
ice-bag to groin, lower leg elevated slightly. This treat- 
ment should be continued for several days after the 
complete disappearance of the fever and the patients 
should not walk until the swelling has entirely or largely 
subsided. Bad cases will have to wear an elastic stocking 
-at the recommendation of the doctor-for many weeks, 
as under these circumstances walking brings back the 
swelling, unless the leg is supported. 
In closing, may the writer warn all mothers and some 
fathers against undue anxiety and needless fretting. 
Happiness in the possession of a precious young life may 
be utterly marred by the loss of one's sense of proportion. 
If you are a fortunate young mother who is worrying, 
worrying over every little trifle, there is surely some 
consolation and relief in recalling the big inescapable 
fact that, at the very moment you are so distressed, 
thousands of other mothers are doing exactly the same as 
you and with little or no real cause. No one can be 
blamed for anxiety over realities. 
Make a friend of your doctor and your nurse! They 
are genuine help in time of need! MATERNAL NURSING 
Dr. L. Emmett Holt 
The importance of maternal nursing can hardly be 
exaggerated. 
Why should a mother nurse her baby? To most 
women, nursing is a satisfaction and a pleasure. But 
there are other more important considerations. 
In the first place, the mother's milk is the baby's natural 
food; all substitutes for'this we call artificial feeding. No 
one likes the artificial when the real thing is to be had. 
Certainly the baby does not. With the study which 
has been given to artificial feeding very great improve- 
ments have been made in methods and in the substitutes 
for mother's milk; but all of them are much inferior to 
good breast milk. For this there is no perfect substitute. 
Babies who are nursed are stronger, healthier and 
develop better than those who are fed on substitutes. 
They are much less liable to be sick. The death-rate 
among them from diarrheal disease is barely one-eighth 
what it is among bottle-fed babies. 
For artificial feeding the best materials are required; 
especially clean, fresh cow's milk, free from germs of 
disease-certified milk if possible. These are expensive 
and not always to be had at any price. Breast milk is 
always ready and fresh; it is never sour. It does not need 
to be especially prepared and carefully measured. 
Artificial feeding requires much skill and experience. 
38 THE HAPPY BABY 
39 
Breast-feeding can be successfully done by those with 
very little or no experience. 
Under certain conditions, however, a mother should 
not attempt to nurse her baby; these are not many but 
are very important: (1) If the mother has or has 
recently had active tuberculosis; (2) if she is suffering 
from any serious chronic disease such as kidney disease, 
epilepsy, etc.; (3) if she is herself in very delicate health. 
With any of these, nursing is not likely to be of benefit 
to the child, while it may be injurious to the mother 
herself. 
Even though a mother may not be able to nurse entirely 
nor for a long period, there are great advantages to the 
baby in partial nursing, even if continued only a few 
months. Mother's milk contains substances which are of 
much value in the nutrition of the child, and their place 
can not be supplied by other food. 
Again, nursing is a normal physiological function and 
the health of many women is better while nursing a baby 
than at any other time. Very much, however, depends 
upon how the nursing is done. The wear and tear, the 
drain on the health which many women suffer, can be 
greatly lessened and often entirely removed by following 
proper nursing rules. Three rules are especially 
important: These are (1) regularity; (2) longer inter- 
vals between nursings than are often followed, and (3) 
shorter nursing periods. 
Babies are readily trained to regular habits of feeding 
and sleep; these should be begun during the first week of 
life and broken only for some extraordinary occasion. 
Night nursing, a bad habit for the baby and, on account 40 
THE HAPPY BABY 
of disturbed sleep after, exhausting for the mother, can 
with most infants be stopped after the baby is two 
months old so that nothing is given between 10 or 10.30 
p. m. and 6 or 7 a. m. 
A good schedule for the average child is as follows: 
Interval 
Nursings in 
24 hrs. 
Between 10:30 p. m. 
and 6 A. M. 
1st and 2d days 
4 hrs. 
5 
0 
3d day to 2 mos. 
3 hrs. 
7 
1 
2 mos. to 3 mos. 
3 hrs. 
6 
0 
After 3 mos. 
4 hrs. 
5 
0 
There are few healthy babies who can not be trained to 
follow such a schedule. 
It is essential to a baby's health and growth that he 
receive enough of the right kind of food every twenty- 
four hours. The number of feedings in which this is 
given, and the intervals between the feedings, are matters 
of secondary importance; these are things which can be 
arranged to suit the best interests of the mother. 
It has been found, moreover, that the longer interval 
between nursings-four hours after three months-also 
suits the digestion of the average baby much better than 
the shorter intervals-two and one-half or three hours- 
which was formerly much followed. 
Quite as important also is the time the baby is allowed 
to remain at the breast for a single nursing. Most of the 
milk in the breast the baby gets in the first three or four 
minutes. Certainly ten minutes is long enough for a 
baby who nurses upon one side at a time, or six or seven 
minutes on each side for a baby who takes both breasts. THE HAPPY BABY 
41 
The infant who is allowed to nurse twenty-five or thirty 
minutes either falls into the bad habit of alternately 
sleeping and nursing or else of chewing or biting the 
nipples, often making them so sore as to make nursing 
very painful to the mother or perhaps to lead her to 
stop it altogether. There is no more certain sign that the 
supply of milk is scanty than that a baby wants to 
continue nursing for thirty or forty minutes. 
Besides, the mere saving of time to the mother is a 
matter of no small importance. One mother nursed her 
first child every two hours for twenty minutes, or two 
hundred minutes a day; her second child, every four 
hours for ten minutes, or fifty minutes a day. Here was 
a clear saving of two and one-half hours to the mother 
every day and this without detriment but rather with 
positive advantage to her baby. 
Such nursing habits as those referred to lighten the 
burden of the mother greatly. If she spent the time 
thus saved in a daily rest-period, we would see a greatly 
reduced number of women stopping nursing because of 
the drain upon their health and vitality. 
The nervous condition of a mother has much to do with 
her success as nurse. One of quiet, placid temperament 
is more likely to succeed than one of highly nervous 
type. For all who would succeed, freedom from unusual 
worries, cares and excitement is most important. Above 
all, a nursing mother needs plenty of sleep-hence the 
necessity of omitting night nursing as early as possible. 
While she must make nursing her first duty, she should 
lead a natural life with some outdoor exercise every day 
and always have an early bed-hour. 42 
TPIE HAPPY BABY 
The diet, while important, has less influence upon the 
milk supply than the nervous causes mentioned. Not 
many of the common articles of food affect the milk. 
The mother's diet should first of all be suited to her 
own digestion; excessive amounts of sweets, pastry, rich 
and highly seasoned food of all kinds being omitted. 
She needs more fluids than at other times since she must 
supply nearly a quart a day to her baby. Part of this 
extra fluid should be milk, but seldom more than three 
glasses a day; part may be cocoa and cereal gruels, weak 
tea or coffee, vegetable soups and always plenty of water. 
Her diet should consist of milk, cereals, eggs, meat 
once a day, nearly all vegetables, soups, bread and butter, 
plain desserts, and cocoa or weak tea or coffee, but no 
alcoholic tonics or beverages. On account of the ten- 
dency to constipation, she should eat freely of all kinds 
of cooked fruit and fresh raw fruits and drink from three 
to four glasses of water daily. Besides her three regular 
meals she should take a glass of milk in the forenoon and 
gruel or cocoa at bedtime. Most mothers whose infants 
are not thriving to their satisfaction are inclined to stuff 
themselves with extra food, especially with milk, the only 
effect of which is, in many cases, to increase their own 
weight and often to upset the baby's digestion. 
The best guide to success in nursing is the child's prog- 
ress in weight. The average gain of an infant who is 
doing well is six ounces a week during the first five 
months, and four ounces a week during the next three 
or four months. Thus a baby whose birth-weight is seven 
and one-half pounds would weigh about fifteen 
pounds, or double his birth-weight, at five months, and THE HAPPY BABY 
43 
would weigh about nineteen pounds at nine months. 
Of course there are many babies who do better than 
this, especially during the early months, but one should be 
entirely satisfied if this rate of gain is maintained. One 
can not too strongly urge the importance of the weekly 
weight record. Nothing else shows so well whether a 
baby is making normal progress. If a baby falls much 
below this average, medical advice should be sought. 
Nearly always it is either the food or the method of feed- 
ing that is at fault. 
Other evidences of successful nursing besides gain in 
weight are to be found in the child's behavior; he is con- 
tented, comfortable and happy, sleeps well, and has good 
regular bowel movements. The best bowel movements 
are of an orange-yellow color, of a butterlike consistency, 
with a slightly sour but not unpleasant odor. Such 
typical movements are seen in but a small proportion of 
nursing babies. More often the stools are of a pale 
yellow or slightly greenish color and much looser; there 
may be from one to four a day. It is the character, not 
the number, that is important. 
When the milk supply is scanty, nursing should be sup- 
plemented by other food. Often there is quite enough at 
the morning nursing, but not enough for the later feed- 
ings. One might omit one afternoon nursing entirely 
and give one or possibly two feedings from the bottle; but 
a better plan usually is to nurse at the regular hour and 
give a bottle each time after it, except possibly the first 
one in the morning. The less-frequent nursings tend still 
further to reduce the supply of milk. 
What food should be given will be taken up later in 44 
THE HAPPY BABY 
discussing artificial feeding. But there is no objection to 
combining bottle and breast feedings. 
Under such circumstances everything possible should 
be done by the mother to increase her milk supply, by 
such means as rest, undisturbed sleep, a careful diet and 
tonics when necessary. Persistence and a will to succeed 
are important aids. Every help possible should be given 
to the mother and encouragement that she will be able 
to continue nursing; all these things go far toward the 
result. 
Under normal conditions if the milk seems abundant 
and gain in weight is regular, no other food is needed for 
the nursing baby until he is eight or nine months old. 
There is often an advantage in an occasional feeding 
from the bottle, or one bottle each day to accustom the 
child to take his food in this way in case of the mother's 
illness or any circumstances which may make her 
temporary absence necessary. This practice makes wean- 
ing easier, and it also makes it possible for many mothers 
to continue nursing for two or three months longer than 
they could otherwise do. 
The giving of water to infants who are nursed at three- 
hour intervals is not necessary; but when the interval is 
increased to four hours it should be done regularly, 
especially in the warm weather. One or two ounces of 
pure cool water should be given three or four times daily 
between the feedings. 
Weaning should always be gradual when possible. A 
child thus becomes accustomed to other food. If this is 
necessary at six or seven months, it is well to teach a 
child to take the bottle; if not until nine or ten months, THE HAPPY BABY 
45 
it is better at once to feed from the cup or spoon, for if 
the bottle were given it would soon have to be given up. 
A baby of nine months may have one feeding a day 
of four or five ounces of thick cereal gruel, which may 
be made from rice or barley or oat flour, Imperial 
Granum, farina or Cream of Wheat. The last two should 
be cooked for an hour and a half and strained; the others 
for twenty or thirty minutes. To any of these, two or 
three ounces of cow's milk and one-half teaspoonful of 
sugar may be added. After a few weeks the amount may 
be gradually increased and at ten or eleven months two 
feedings a day may be given. The only other thing 
needed is fruit-juice, preferably orange-juice. Of this, 
beginning with two or three teaspoonfuls the quantity 
may be gradually increased to three tablespoonfuls once 
daily, preferably between the other feedings. 
While for serious illness of the mother weaning is 
always necessary, there are many occasions of minor 
illness in which this is not the case. Short illnesses such 
as attacks of tonsilitis, bronchitis, acute indigestion, etc., 
usually make an interruption of nursing necessary and 
the baby should be fed in most cases entirely from the 
bottle for a few days. 
But when the mother has recovered she may nurse 
again; sometimes after as long an interruption as two 
or three weeks her milk will come back, if the baby is put 
to the breast at the regular intervals. At first he may 
get but little and will of course need to be fed after each 
nursing; but if the course is persisted in, the milk will 
in very many cases be back in two or three weeks to its 
previous amount and she may go on and nurse sue- 46 
THE HAPPY BABY 
cessfully for some months longer. Persistence under 
such circumstances is very important. 
The return of the mother's monthly sickness is also no 
reason for weaning. During her periods her milk will 
usually be less in amount and additional food may be 
needed for two or three days. Pregnancy in every 
instance makes it necessary to wean at once. 
UNSUCCESSFUL NURSING 
While it is true that the great majority of mothers who 
will follow the rules laid down in the preceding pages, and 
who are willing to make the necessary sacrifices of other 
interests, can nurse their children successfully, still there 
are some who fail despite all efforts most conscientiously 
made. 
The sooner it is positively known that the baby must 
be articifially fed, the better for his future, for feeding 
with the bottle is more difficult after a baby has been 
seriously upset by several weeks of bad nursing and has 
fallen some pounds below his birth-weight. But we do 
not wish to stop the mother's nursing until quite certain 
she can not succeed. Very many women stop for insuf- 
ficient reasons. The most difficult period is the first three 
or four months. 
The best guides are the baby's weight, the character of 
the bowel movements and his general behavior. 
It is almost indispensable to have scales and to take 
the weight regularly once or even twice a week. All 
babies lose weight during the first two or three days and 
this loss usually amounts to one-half or three-quarters THE HAPPY BABY 
47 
of a pound. After this time some gain should be noted. 
This gain may be slow at first if the mother is not 
especially strong and has had a hard confinement, but a 
stationary weight for three or four weeks is a bad sign, 
while a steady loss during this period is of itself almost 
conclusive proof that the mother is not going to succeed. 
It is very rare under such circumstances that the stools 
are anything like normal. They are usually thin, green 
and contain undigested food; often they are slimy. They 
may be frequent or the baby may also be so constipated 
as never to have a natural movement. 
One does not see the quiet, peaceful sleep so char- 
acteristic of a well-nourished, satisfied child. The day 
naps are short. When awake the baby is fretful, cross, 
colicky and uncomfortable. The nights are a trial, and 
all sorts of measures are adopted to make the child sleep, 
most of them being only temporarily successful. 
With such symptoms as these it is important to 
determine whether the milk is poor and is disagreeing 
with the baby, or simply that the quantity is small. The 
examination of the milk generally gives much less help 
than is expected. It is much more frequent that the 
milk is scanty than that the quality is at fault. The only 
sure way to tell how much milk the child is getting is to 
weigh before and after nursing upon scales which are 
accurate and weigh in half ounces. This should be re- 
peated several times a day. It may be found that after 
a nursing when he should be getting three or four ounces 
he may get barely an ounce. It may be several days 
before one can be certain regarding the amount of milk. 
Much can be learned by the way the child nurses. If 48 
THE HAPPY BABY 
the milk is abundant, he will usually stop voluntarily in 
eight or ten minutes, often in a shorter time. When it is 
very scanty he will often want to nurse thirty or forty 
minutes and will then stop more because tired out than 
satisfied; or he cries when taken from the breast and will 
not go to sleep unless perhaps he is rocked or given a 
pacifier. Some babies will nurse vigorously for a minute 
and then drop the nipple in apparent disgust. That 
a little milk can be pumped from the breast after the 
baby stops is not evidence that the milk supply is plen- 
tiful. 
If the child is steadily losing weight in spite of the fact 
that the mother's health is good and there is nothing 
strikingly wrong in her diet or habits, the chances of 
success are small. But under opposite conditions one 
may reasonably hope to increase the supply and improve 
the quality of the milk. First of all, plenty of rest should 
be secured and, so far as possible, freedom from causes of 
nervous worry. The mother should drink three glasses 
of milk a day, rarely more to advantage. Gentle massage 
of the breasts may be used twice a day for fifteen or 
twenty minutes. 
In all these cases the baby should be nursed at the 
regular hours, and after each nursing receive sufficient 
food from a bottle to satisfy his needs. To persist with 
nursing after a faithful trial has been made for as long 
as five or six weeks and no improvement in condition is 
evident, is generally a mistake. 
If the cause of the unsuccessful nursing is a temporary 
and a remediable one, with improvement in conditions the 
bottle feedings may be gradually reduced until they may THE HAPPY BABY 
49 
be omitted altogether; or it may be desirable to relieve 
the mother permanently of one or two nursings each 
twenty-four hours, especially to allow her sufficient rest 
and undisturbed sleep. 
DIGESTIVE SYMPTOMS IN NURSING BABIES 
Few babies go through the whole nursing period 
without some trouble. Occasional symptoms of indiges- 
tion are not serious, but habitual symptoms need careful 
attention. 
Vomiting is so often seen in babies that are thriving 
exceptionally well that it is looked upon by many old- 
fashioned nurses as a positive advantage. Such, however, 
is not the case. The explanation of the popular impres- 
sion is that babies who vomit frequently are usually 
getting either too much or too rich milk. If it is too 
much milk, the vomiting is apt to occur within a few 
minutes after nursing. The milk is vomited just as it is 
taken. The vomiting is usually without effort and not 
preceded by discomfort; it is simply vomiting from over- 
flow. It is remedied in most cases by shortening the time 
the child is given the breast. The supply is usually 
abundant and the milk comes easily. Even in four or 
five minutes a baby may get more than his stomach can 
well hold. 
If the milk is too rich, the vomiting is of a different 
kind. It is likely to occur long after nursing. It often 
comes up in sour masses, a mouthful or more at a time, 
and may be repeated several times even up to the time 
of the next nursing. 50 
THE HAPPY BABY 
The explanation of this vomiting is that with a very 
rich milk the stomach is not empty after the usual 
time, but may contain some food as long as three or 
four hours after nursing. Of course a second meal should 
not be given until the first one has been digested. The 
nursings in such cases should be further apart than with 
other children. Such babies should never be nursed 
oftener than every four hours and in some cases a still 
longer interval is necessary. 
The mother's diet and habits in such cases usually need 
correction. The amount of solid food taken should be 
reduced, especially such articles as meat and eggs, and 
sometimes the milk also. She should lead a more active 
life. It often happens that, because a baby with such 
symptoms is not gaining normally, the mother is in- 
creasing her food under the impression that the milk is 
poor. This has, of course, the effect of aggravating the 
symptoms of the baby. 
With nearly all babies a certain amount of air is 
swallowed while they are nursing, and it is well in every 
case to place the baby upright or hold him over the nurse's 
shoulder for a few moments and not put him down in his 
crib until he has brought up this wind. Such a pro- 
cedure not only prevents his vomiting but enables him to 
go comfortably to sleep. 
Care is necessary not to confuse such vomiting as has 
been mentioned with that due to obstruction at the outlet 
of the stomach. This is not a common condition. The 
vomiting is quite different from that seen in either of the 
conditions just described. It usually begins from the 
second to the fourth week of life. It is forcible, the food THE HAPPY BABY 
51 
coming with a gush; it is fairly shot out, sometimes to a 
distance of two or three feet. The vomiting is generally 
repeated several times a day. It occurs in most cases 
right after nursing, sometimes while the child is still at 
the breast. In spite of the usual measures to control 
it, it persists. There is steady and sometimes rapid loss 
in weight and the bowels are in most cases constipated. 
The condition is a serious one and a physician should be 
consulted. 
Much more common in nursing infants are the cases 
in which the principal symptom is looseness of the bowels, 
with thin, green stools, often containing white or yellow 
masses called curds. This sometimes happens when the 
milk is very poor, especially in fat, and the child is 
unhappy, restless, colicky and shows little or no gain 
in weight. 
Occasionally a baby may continue to have as many as 
five or six thin, green, sour-smelling movements a day, 
often containing curds and much mucus, yet in spite of 
this he may be above weight and gaining regularly his 
half a pound a week. This is usually due to the fact that 
the milk is too rich and that the sugar of the milk 
especially is causing trouble. 
The remedy in the first case is to supplement the nurs- 
ing by other food. A formula in which a diluted top milk 
is used in most cases agrees better than diluted whole 
milk. Details will be considered in another bulletin when 
artificial feeding is discussed. 
The second group of infants should on no account be 
weaned, but a milk formula to which no sugar has been 
added should take the place of one or even two nursings 52 
THE HAPPY BABY 
a day. The intervals between nursings should be length- 
ened and each nursing shortened. 
Constipation in nursing babies can very rarely be con- 
trolled by anything given to the mother to change her 
milk. Much depends upon early training to regular 
habits. Glycerin suppositories should not be used except 
very occasionally-they are too irritating. The soap 
suppository is less objectionable and may be used for a 
short time. The glutin suppositories are better for 
frequent use. A sufficient stimulus is often obtained 
with a cone of oiled paper which is inserted for a few 
moments just inside the bowel. The regular injection of 
water to produce a movement is not to be recommended; 
a small injection of two or three teaspoonfuls of sweet-oil 
is less objectionable. 
All of these things have for their purpose stimulation of 
the bowel to empty itself; all are useful measures in estab- 
lishing the habit of a regular movement. They should 
therefore be used at the same time each day, preferably in 
the morning and soon after the first nursing, but dispensed 
with as soon as possible. 
A well-trained infant will often quickly acquire the 
habit of a regular daily movement when simply placed 
upon a chamber or, when older, upon a nursery-chair. 
The important thing is regularity and persistence on the 
part of the mother. The habit of a daily enema or a sup- 
pository, unless one is careful, is soon acquired to such 
a degree that the bowels will not move without them. 
Rather less objectionable, and to be recommended for 
a short time to aid in the formation of regular habits, is 
a daily dose of milk of magnesia. Beginning with one THE HAPPY BABY 
53 
teaspoonful at night, the amount should be very gradually 
reduced and after a few weeks omitted altogether. 
Occasional attacks of colic in nursing infants are not 
uncommon and usually not difficult to recognize. The 
baby cries vigorously, draws up his legs and the abdomen 
is usually tense and hard. It is generally caused by gas 
in the bowels. Constipated babies suffer from it most. 
A hot-water bag to the abdomen and gentle rubbing will 
usually start the gas, and when this is expelled the pain 
ceases. A soda-mint tablet dissolved in a few teaspoon- 
fuls of warm water is often useful. Most of the colic 
remedies are objectionable; especially should one not 
resort to frequent dosing of gin and water. When the 
colic is severe and not relieved by any of these means, an 
enema of six or eight ounces of tepid water to which 
half a teaspoonful of glycerin has been added should be 
given. 
Habitual colic is often supposed to exist when the real 
cause of the crying is hunger. Constant fretfulness, poor 
sleep, eager sucking of fingers, a desire to nurse a long 
time and stationary weight are its most striking symptoms. 
The bowels are apt to be constipated. Immediate im- 
provement of all these symptoms when a full feeding from 
the bottle is given is conclusive proof. The proper thing 
in such circumstances is not to wean the baby, but to 
give supplementary feedings after each nursing. . If the 
mother is able to supply even half the food the baby 
requires, she should continue to nurse. ARTIFICIAL FEEDING 
IN BABY'S FIRST YEAR 
Dr. L. Emmett Holt 
At the very outset it should be made clear that there 
is no perfect substitute for breast-feeding. Although 
great improvements have been made in recent years in 
our methods of feeding and in the results obtained, it 
remains true that the feeding of infants on the bottle, 
though easy in many cases, is in some instances very 
difficult even for those of large experience. Careful at- 
tention to details is necessary in all cases. This applies 
to the selection of the milk used, its handling in the 
home, its preparation for the baby and the manner in 
which it is fed. 
By common consent the milk of some other animal has 
been adopted as the best substitute for mother's milk, 
cow's milk being the only one which is generally available. 
Goat's milk is useful when cow's milk can not be had, 
but it possesses no special advantages over cow's milk. 
None of the artificially prepared foods sold in the 
stores is to be compared to cow's milk in value as a food 
for infants. They are sometimes useful as additions to 
milk, but none of them are in any sense substitutes for it 
or for mother's milk. 
Selection of Milk: In selecting cow's milk for feed- 
ing infants it is important to choose milk that is (1) 
54 THE HAPPY BABY 
55 
clean, (2) fresh, (3) from healthy cows and (4) is 
handled only by healthy persons. Milk which meets all 
these conditions is known as "certified" milk. When milk 
that has been so supervised can be obtained, it should 
always be used for infants. It is available in most large 
towns. Such milk is always shipped in bottles. It is 
the only milk delivered in cities and large towns which 
should be used in a raw state. In the country, where 
clean milk can be obtained when but a few hours old, 
raw milk may be quite safe. 
If milk is obtained in bulk quite fresh from the cow, 
that to be used for infant feeding should be strained 
through absorbent cotton or clean linen or cotton cloth 
which has been boiled, or two thicknesses of surgeon's 
gauze, into quart or pint bottles. These bottles should be 
placed in cold spring-water or ice-water up to their necks 
and allowed to stand for at least half an hour. This 
first cooling is very important. The baby's food for the 
day can be made up later when convenient. 
The milk chosen for the baby should preferably be 
herd milk, the mixed milk of several cows. There is no 
objection to using the milk from one cow, except that it 
is likely to vary more from day to day. Milk from 
grade cows is to be preferred to the rich milk of highly 
bred Jerseys or Guernseys. The richest milk is by no 
means the best for the average baby. 
Care of Milk: Milk is a food which is very easily 
contaminated. In the home it is necessary that every- 
thing which comes in contact with it-bottles, cups, 
spoons, etc.-should be carefully sterilized by boiling. 
The milk should be kept in a refrigerator, close against 56 
THE HAPPY BABY 
the ice in Summer, or in the coolest place possible; to 
keep it from souring, the temperature should not be above 
fifty degrees Fahrenheit. There are many ways that 
milk can be contaminated: From dirty or unhealthy 
cows, from the hands of the milkers, from pails, cans or 
other utensils which come in contact with it, etc., etc. 
Sterilizing Milk: To render milk a safer food and 
to keep it longer without spoiling, the practise has come 
into general use of heating it to destroy the germs of 
disease which may have accidentally got into it and also 
those which cause milk to sour. Milk may be heated to 
the boiling-point for ten to twenty minutes (sterilized), 
or it may be raised to one hundred and fifty to one hun- 
dred and sixty degrees Fahrenheit (Pasteurized) and 
kept at this temperature for a longer period, usually thirty 
minutes. 
Milk may be conveniently Pasteurized in the home with 
any of the forms of apparatus sold in the stores, or it 
may be heated simply by placing the bottles of milk in 
a pot containing water up to their necks. This is then 
heated to the boiling-point, the pot removed from the 
stove or range and the milk allowed to remain in the 
water for twenty minutes longer. The bottles are then 
removed and rapidly cooled by placing them first in 
tepid and then in very cold water. They are then placed 
on ice until needed. 
None of the procedures usually followed actually 
renders the milk sterile; but this amount of heat is suf- 
ficient to kill the disease germs, such as those of tuber- 
culosis or typhoid fever, if there are any in the milk, and 
most of the other germs which interfere with its keeping. THE HAPPY BABY 
57 
These temperatures do not destroy spores (the unde- 
veloped germs) and such heated milk must be'kept on ice 
to be safe and used within a comparatively short time, 
generally twenty-four hours. 
The advantages of heating milk in this way are very 
great. It has brought about a great reduction in the 
diarrheal diseases, in typhoid fever and in some others. 
There are, however, some disadvantages, and these 
should also be known and appreciated. Raw milk con- 
tains all three of the vitamins-those mysterious food 
constituents which have been shown to be so essential 
to health and growth. Two of these, vitamins A and B, 
are not known to be affected, but the third one, vitamin 
C, which protects against scurvy, is greatly injured and 
in most cases entirely destroyed by the heating as usu- 
ally done. This is not a reason for stopping the steril- 
ization or Pasteurization of milk used for infant feeding, 
but it is a reason for giving to all babies fed for long 
periods upon heated milk some other food which supplies 
this vitamin, otherwise they are likely after five or six 
months to develop scurvy. If to such a baby there is 
given fresh orange-juice or the juice of fresh or canned 
tomatoes carefully strained, this is sufficient to supply the 
needed vitamin. If the baby receives only sterilized or 
Pasteurized milk from birth, these juices should be begun 
at four or five months in half-tablespoonful doses. The 
amount may be gradually increased until at nine or ten 
months the baby is receiving two tablespoonfuls daily. 
The assertion sometimes made that Pasteurized or 
sterilized milk has little value in nutrition is quite untrue. 
The injury to vitamin C is the only really important in- 58 
THE HAPPY BABY 
jury done to the milk by heating, and this can easily be 
remedied by adding to the diet such juices as those 
mentioned. 
What has just been said about the damage done to 
milk by sterilizing applies also to other processes used 
to preserve milk. In condensed, evaporated and dried 
milk vitamin C is injured to a greater or less degree; in 
most of them it is destroyed. The same danger of 
scurvy exists when they are the baby's food unless orange- 
juice or some equivalent is added to the diet. 
Substitute for Fresh Milk: Something should be 
said regarding these substitutes for fresh cow's milk 
which have just been mentioned. They are widely used 
and their sale is constantly increasing. They make pos- 
sible the use of milk as a food for infants and young 
children in many places where fresh milk is not obtain- 
able. But they are not to be advised as a regular food 
for babies when clean, fresh cow's milk or Pasteurized 
milk can be had. They are, however, very convenient 
for use for short periods, as in traveling. 
Condensed milk has usually been sterilized and has 
cane (granulated) sugar added. Evaporated milk has 
been condensed without any such addition. One pint of 
either of these represents about two and one-quarter 
pints of original milk. Of the two, the evaporated milk 
is usually to be preferred; but neither the evaporated nor 
condensed milk possesses any advantages over dried 
whole milk. 
Latterly there has come into the market canned prep- 
arations known as "filled milk" which are sold under 
a variety of trade names. This is condensed skimmed THE HAPPY BABY 
59 
milk in which the butter fat has been replaced by some, 
usually cheap, vegetable oil. Filled milk should not be 
used for infant feeding; nor should it be confused with 
condensed or evaporated milks. 
Modifying Cow's Milk: While cow's milk is a per- 
fect food for the calf, it is not a perfect food for the baby. 
It differs in several important particulars from mother's 
milk: the fat is in about the same amount, but differs 
somewhat in its nature; the curd is in much larger amount 
and also differs much in kind; the sugar is the same in 
kind, but the amount is only a little more than half that 
which exists in woman's milk. Furthermore, cow's milk 
is never quite fresh, as mother's milk is, and always 
contains germs the number of which depends upon the 
age of the milk, the care with which it has been handled 
and the temperature at which it has been kept. 
All these differences have to be considered in adapting 
cow's milk to the feeding of infants. Certain changes 
or modifications have been adopted for the purpose of 
making it more easily digested. It is important that 
the reasons for these changes should be understood if 
one would feed a baby intelligently and successfully upon 
cow's milk. 
We know as yet no means of changing the fat. As 
this is somewhat difficult of digestion by most infants, 
the only thing we can do is to give less of it than is in 
good mother's milk. 
The curd can be altered in several ways: By diluting 
milk we can reduce the amount of the curd to any point 
desired; by using some thin gruel like barley-water to 
dilute it, we are able very largely to prevent the forma- 60 
THE HAPPY BABY 
tion of large tough curds in the baby's stomach, which 
is one of the things which make it difficult for some babies 
to digest cow's milk. This can also be accomplished in 
other ways-for some infants, simply by boiling the 
milk for a few minutes. 
The sugar when insufficient can be increased to any 
desired amount by adding more sugar. This may be 
either sugar of milk, cane (granulated) sugar or malt- 
sugar. Much the cheapest is cane-sugar, and for most 
infants it answers perfectly well. Milk-sugar and malt- 
sugar are rather more laxative and consequently rather 
better for constipated babies. Malt-sugar as such is 
not used, but is in such preparations as Malt Soup, Karo, 
Dextri-Maltose, etc. These have a further advantage 
in that they can be given in rather larger amounts than 
other sugars without upsetting digestion. 
Formerly it was customary to add lime-water to all 
milk formulas used. It is a question whether this is 
necessary, or for all healthy babies even desirable. 
Bottles and Nipples : The care of bottles and nipples 
is very important. In selecting bottles, those which are 
the easiest to clean should be chosen. These are the 
round bottles with wide mouths. The eight-ounce size, 
graduated, will usually answer for the greater part of 
the first year. One should have as many bottles in use 
as the baby takes feedings a day. After feeding the 
baby, the bottle should be rinsed with cold water and 
then stand filled with water, to which a pinch of cook- 
ing soda has been added until the time for making up 
the food. All the bottles are then washed with hot soap- 
suds and a bottle-brush and placed in boiling water for THE HAPPY BABY 
61 
ten minutes. When cooled, they may be filled with the 
baby's food. 
New Nipples should be boiled for five minutes. It 
is not necessary to repeat the boiling every day, for they 
soon become so soft as to be almost useless. After feed- 
ing, the nipple should be rinsed under the faucet and 
placed in a glass of water containing one-half tea- 
spoonful of soda or boric acid and kept under the water 
by putting a little absorbent cotton over them. Once 
a day nipples should be turned inside out and washed 
with soap and water. The plain black nipples which slip 
over the neck of the bottle are the simplest and best. 
The hole in the nipple should be so large that when the 
bottle is inverted the milk will drop but not flow in a 
stream. Anticolic nipples are a delusion. Colic de- 
pends rather upon the formula used and the condition 
of the baby's digestion. 
In the feeding of any single baby the questions to be 
decided are: first, the amount of food to be given in 
twenty-four hours; second, the proportions of the dif- 
ferent ingredients-milk, sugar, etc.-which make up 
the total; third, the volume of the food, which includes 
besides the things mentioned the amount of water or 
other diluent which is added; fourth the number of 
feedings into which the quantity allowed for the twenty- 
four hours is to be divided and the frequency with which 
the feedings are to be given. 
The amount of food is not determined by the child's 
FEEDING DURING THE FIRST YEAR 62 
THE HAPPY BABY 
age alone, although this is one of the things to be con- 
sidered. One can not say, for instance, that every baby 
four months old should have a certain amount of food. 
One baby at four months may weigh sixteen pounds, 
another at the same age, though not ill, may weigh only 
nine pounds. Evidently the large child needs more 
food than the small one. Two babies six months old may 
weigh exactly the same; one is a quiet, placid, good- 
natured child and sleeps a great deal; the other is very 
active, lively, energetic, of a nervous type. This active 
child works much harder and actually needs more food 
than the quiet one. 
All these things mentioned-the age, the weight and the 
activity of the child-are reflected in his demand for 
food, his appetite. This natural desire, if not perverted 
by bad training or by food of an improper kind, is one 
of the best guides we have to how much food an infant 
or an older child actually needs. 
In feeding a baby no part of the procedure requires 
more experience or better judgement than this of de- 
ciding how much to feed any given child. If too little 
is given, there is no proper gain in weight and the baby 
is fretful and unhappy, usually cries when the bottle is 
emptied and often also before the next feeding-time. 
If too much food is regularly given, the baby either 
refuses some, or if he takes it all, he may vomit or be 
uncomfortable, colicky and sleepless with undigested 
bowel movements, and show here also no proper gain in 
weight. 
Since the food now given is not the baby's natural 
food, it is even more important than in the case of nurs- THE HAPPY BABY 
63 
ing infants that we do not overfeed. There is constant 
danger of this, as the supply is practically unlimited 
and the feeling on the part of most mothers is that, if 
the baby is not gaining as fast as he should, the thing 
to do is to give him more food. 
From what has been said, it is evident that it is very 
difficult to say beforehand exactly how much food a 
given baby should have. What is attempted in the fol- 
lowing directions is to state what an average healthy 
baby of a certain age and weight requires and thrives best 
upon. This will serve as a beginning. The amount 
given to the particular child who is being fed will be 
determined later by watching the symptoms closely and 
increasing or decreasing the food according to the child's 
behavior. 
The simplest formulas are those made from whole 
milk with the addition of sugar and plain water or barley- 
water as a diluent. 
Formulas for Healthy Children for the Early Months 
I 
II 
III 
IV 
V 
VI 
VII 
Milk (ounces) 
3 
3% 
3% 
4 
4% 
4% 
Sugar (ounces) 
% 
% 
% 
% 
% 
% 
% 
Water (ounces) 
7 
63/4 
cy2 
6% 
6 
sy4 
5% 
Flour 
0 
0 
0 
0 
% 
% 
% 
(even teaspoons) 
-- 
- 
- 
- 
- 
- 
Total ounces 
10 
10 
10 
10 
10 
10 
10 
The sugar is here estimated by weight; if cane 
(granulated) sugar is used, one level tablespoonful may 
be reckoned as half an ounce; if milk-sugar or malt- 
sugar, one round tablespoonful as half an ounce. 64 
THE HAPPY BABY 
Formulas of the strength of No. I might be used for 
a new-born baby, the food being increased to II, III, 
etc. every few days, according to the baby's appetite and 
digestion. With an average child, No. VII would usu- 
ally be reached by the end of the first month. 
Later Formulas from Whole Milk for Healthy Infants 
VIII 
IX 
X 
XI 
Milk (ounces) 
5 
5% 
6 
Sugar (ounces) 
% 
% 
% 
% 
Water (ounces) . 
5% 
5 
4% 
4 
Flour (teaspoons) 
1 
1 
2 
- 
- 
> 
Total ounces 
10 
10 
10 
10 
When a formula of the strength of No. VIII is 
reached, the increase should be made more slowly. 
Sometimes for a week, or even two or three weeks, a 
child will gain and be quite satisfied with the same food, 
a slight increase in the amount given being the only 
change necessary. 
Stronger Formulas for Older Infants 
XII 
XIII 
XIV 
XV 
Milk (ounces) 
6% 
7 
7% 
8 
Sugar (ounces) 
% 
% 
% 
% 
Water (ounces) 
3% 
3 
2% 
2 
Flour (even tablespoons) 
% 
1 
1% 
Total ounces 
10 
10 
10 
10 
In all these three groups of formulas the method is 
the same of gradually increasing the proportion of milk THE HAPPY BABY 
65 
and reducing the water, increasing the flour and reduc- 
ing the sugar as the baby gets older. By the time No. 
XI is reached the food will evidently be four-fifths milk 
and one-fifth gruel of flour and water. With most 
children this will be reached by the tenth or eleventh 
month. 
The steps of increase should always be very gradual, 
not greater than is indicated in the formulas given and 
sometimes even more slowly; but how rapidly a child 
will pass from one formula to the next stronger will de- 
pend upon a number of things: the weather (increasing 
more slowly in hot than in cold weather), activity, denti- 
tion and, most of all, the appetite. 
In all the formulas given the quantities needed to 
make up only ten ounces is mentioned. Of course, the 
baby will require much more than this. For twenty 
ounces one should use twice as much of each ingredient; 
for twenty-five ounces, two and a half times; for thirty 
ounces, three times as much, etc. 
The flour used may be barley, rice or oat flour. 
Where to begin at any age with a particular child is 
always a somewhat difficult question to decide. In every 
case the first formula tried is somewhat in the nature of 
an experiment, for one can not tell in advance how well 
a baby can digest cow's milk who has previously never 
taken it. A good general rule is to allow daily, for an 
average healthy baby over two months old, one and a 
half ounces of milk for each pound of weight. Thus, a 
baby weighing ten pounds would require fifteen ounces 
of milk daily; one of sixteen pounds, twenty-four ounces; 
one of twenty pounds, thirty ounces daily. These would 66 
THE HAPPY BABY 
represent average weights at about two months, six 
months and eleven months. But the weight is a much 
better guide than the age to the amount needed. 
Formula Using Top-Milk: There are a good many 
strong children with good digestion who do much better 
when somewhat more fat is given than is present in 
formulas from whole milk. For such babies top-milk 
may be used. By top-milk is meant the upper layer 
removed from milk after standing. It is really thin 
cream. If milk purchased in quart bottles is used, the 
top-milk desired is obtained by removing the upper half 
when it has stood two hours after delivery. If the milk 
is obtained fresh from the cows, the top-milk may be 
removed after it has stood four or five hours in the 
bottles in which it is cooled. The first three or four 
ounces should be carefully dipped off with a spoon or 
small cream-dipper; the balance may be slowly poured 
off. 
Since top-milk is richer than whole milk, less of it should 
be used in making up any of the formulas which have 
been given above. While there are some children who 
may take more, a good rule for the average child is to 
use about three-fourths as many ounces as one would of 
whole milk specified in the formulas. 
Top-milk formulas should not be used for babies 
with feeble digestion and never for those who vomit fre- 
quently. • 
Quantity for One Feeding and Interval of 
Feeding: The variations here considered are quite as 
important as are those in the strength of the food. In 
the following schedule are given the size and number of THE HAPPY BABY 
67 
feedings daily for an average healthy baby at the dif- 
ferent ages: 
First Week: Give seven to fourteen ounces in twenty-four 
hours; divide into seven feedings; give one to two ounces for 
one feeding; feed every three hours during the day; one night 
feeding after 10 p. m. 
Second and Third Weeks: Fourteen to twenty-four 
ounces in twenty-four hours; same number of feedings and 
same intervals as before. 
Fourth to Eighth Week: Twenty-one to twenty-eight 
ounces in twenty-four hours; number of feedings and intervals 
the same. 
Eighth to Thirteenth Week: Twenty-one to thirty 
ounces in twenty-four hours omit the night feeding given after 
10 P. M. Only six feedings in twenty-four hours. 
Three to Six Months: Twenty-five to thirty-two ounces 
in twenty-four hours; divide into five feedings; feed every four 
hours; last feeding at 10 p. m.; nothing more till 6 a. m. 
Six to Nine Months: Thirty to forty ounces in twenty- 
four hours; number of feedings and intervals same as before. 
Nine to Twelve Months: Thirty to forty-two ounces; 
number of feedings and intervals same as before. 
It will be observed that up to three months the quan- 
tities are pretty rapidly increased; after that, very 
slowly. The increase after three months is made chiefly 
in the strength of the food. 
In increasing the quantity, as in increasing the strength 
of the food, the changes should be made gradually or 
digestion is likely to be upset. The increase should 
seldom be made oftener than three or four days. 
The symptom on the part of the baby which calls for 68 
THE HAPPY BABY 
an increase is that he is evidently hungry: he cries before 
feeding-time and when the bottle is taken away, does 
not vomit, has good, well-digested stools but is not mak- 
ing the normal gain in weight. If, however, a baby is 
gaining regularly his six or eight ounces a week, it is 
well not to increase the food, even though he seems to 
be somewhat hungry. A baby of five or six months 
will often go for a month or more on the same food with 
no increase whatever. 
In the schedule above given it will be noted that quite 
a wide range in the daily quantity of food allowed is 
given. Large babies with strong digestion will require 
the larger quantities; for small babies the smaller 
amounts will be sufficient. It is very rarely necessary to 
go either above or below the limits given. 
For babies who vomit frequently, top-milk formulas 
should never be used. They frequently do better when 
part of the cream from the whole milk is skimmed off. 
They should be lifted for a few moments and placed over 
the nurse's shoulder to enable them to bring up any gas or 
air which they have swallowed, then placed in their cribs 
and kept very quiet after feeding. They should not be 
fed oftener than once in four hours. 
Little babies whose bowels are inclined to be loose or 
to move too often should take less sugar than is allowed 
in these formulas; those who are older should not take 
cereal so early and only in smaller amounts. 
Babies who are habitually constipated may have a 
somewhat larger amount of sugar than is allowed in any 
of the formulas and also more fruit-juice. 
Making Up the Food: It is always better to make THE HAPPY BABY 
69 
up the entire food for the day at one time. The barley- 
water is made for young babies the strength of one-half 
tablespoonful of barley-flour to one pint of water and 
boiled for twenty minutes, straining if lumpy. The 
sugar is dissolved in boiled water. This, with the milk, 
is then mixed with the barley-water in a pitcher and the 
whole divided into as many feedings as the baby is to 
take during the twenty-four hours, each feeding being 
put into a separate bottle. The bottles are then stopped 
with cotton and put immediately upon ice, or they are 
Pasteurized or sterilized and then cooled. 
At feeding-time the milk is warmed by placing the 
bottle in a tall pitcher containing water somewhat warmer 
than the hand will bear. The length of time required to 
heat the milk to blood-heat for the baby will, of course, 
depend upon the amount of water in the pitcher. In a 
pint of water the milk will usually be warmed in five 
or six minutes. The temperature may be tested by 
pouring into a spoon and tasting or by dropping a 
little upon the inside of the wrist where it should feel 
warm but not hot. It should not be tested by the nurse 
taking the nipple into her mouth. 
For most babies under six months of age, and certainly 
for all small babies, the bottle should be held by the 
nurse during the feeding and taken away as soon as 
emptied. The baby should never be allowed to go to 
sleep sucking an empty bottle, nor to form the habit of 
alternately sleeping and feeding with the nipple in his 
mouth. From twelve to fifteen minutes should be the 
limit of time allowed for one feeding; many babies take 
their food regularly in ten or less. 70 
THE HAPPY BABY 
Other Food Besides the Bottle in the First Year: 
As soon as a baby is put upon feedings given every 
four hours, it is desirable that water be given between 
the feedings, especially in warm weather. This be- 
comes more important as the baby gets older. Boiled 
water at room temperature may be given one or two 
hours before feeding, from one to three ounces at a time. 
Orange-Juice or the juice of fresh raw or canned 
tomatoes should be begun at five months with babies 
whose milk is Pasteurized or sterilized. Beginning with 
two teaspoonfuls daily, the amount is gradually increased 
to one tablespoonful at six months and two tablespoonfuls 
at nine or ten months. 
Strained Cereal may be begun with most children 
at ten or eleven months. It is given with a spoon, some 
of the milk from the bottle being poured over it. Oat- 
meal, barley, Cream of Wheat or farina may be used. 
The oatmeal should be cooked for three hours, the others 
for one hour and all strained through a fine sieve. At 
first one tablespoonful may be given daily, the amount 
being gradually increased to two tablespoonfuls twice 
daily at eleven or twelve months. 
A Soft Egg may be added to the diet at ten or eleven 
months or the yolk of a hard-boiled egg finely grated may 
be given either one, two or three times a week. 
Vegetable Soups may be begun at about the same 
age; from two to four ounces two or three times a week. 
These are made with meat stock of chicken, lamb or 
beef; several vegetables are cooked in the soup and 
strained out before feeding. 
The only other things to be given during the first THE HAPPY BABY 
71 
year are squeezed beef-juice, which may alternate with 
the vegetable soup, one ounce at a feeding, and a piece 
of thin crisp toast or a crust of bread after the first 
four teeth have been cut. In feeding a child any of 
these different articles the plan should be followed of 
giving them immediately before or after the bottle, not 
of making a separate meal of them. DIET PROBLEMS OF CHILDHOOD 
Dr. L. Emmett Holt 
"What I am to do with Mary to make her take her food 
is beyond me. Here she is nearly six years old; word 
comes from the nurse in her kindergarten that she is six 
pounds under weight and I must take her to a doctor. The 
doctor tells me Mary must drink at least three glasses of 
milk a day, eat cereals twice a day, besides vegetables, 
fruit, bread and butter. Now, I can not get Mary to drink 
even one glass of milk, and as for cereals and vegetables, 
they are almost impossible. Why, it takes me a full hour 
to feed her at dinner-time and nearly as long at breakfast 
and supper! 
"The doctor says she needs more food: 'You must 
contrive in some way to get her to take it, either at meal- 
time or else between meals.' So I tell her stories, I play 
the music-box and resort to all sorts of tricks to get down 
even the little which she takes. You know, she never 
had much appetite. She was past three before I could 
wean her from the bottle, and ever since then meal-time 
has been one long struggle." 
"Doesn't Mary feed herself?" 
"She did a little last year, but she was so slow-she 
would only play with her food until it was stone cold- 
that I simply had to help her; and now she will not eat 
at all unless I feed her. I am utterly worn out with the 
struggle. Unless something can be done soon, I shall 
72 THE HAPPY BABY 
73 
be in a sanatorium-or an insane-asylum. Mary is all I 
have, and I am so anxious and worried. No, I never want 
any more children! What people do with three or four 
is more than I can understand. 
"Since the doctor told me how much food a child like 
Mary needs, I try in every way possible to give it to her, 
but things are no better. All my efforts of coaxing, brib- 
ing, and even trying to force her to take food have had no 
effect. Lately things are rather worse, for she has taken 
to vomiting her food three or four times each week and 
has not gained one ounce in weight." 
FOOD HABITS 
The situation which Mary's mother was facing is not 
an uncommon one. As Mary was an only child, her 
mother had had no previous experience to guide her. 
She had begun wrong in allowing the child to have a 
bottle until she was over three years, the reason given 
being that "it was such a comfort." This was the first 
step in giving the child her own way, in permitting the 
formation of a bad food habit. Mary would take milk as 
long as it was given from a bottle; but when finally 
bottles were stopped, no more milk would she take. 
This is not unusual. Many a child does not get 
throughout childhood the milk needed, simply because the 
habit of drinking milk from a cup was not formed early; 
but instead the bottle was allowed until eighteen months 
or, as in Mary's case, much longer. The bottle should 
not be permitted after a child is a year old, except pos- 
sibly at 10 p. m. for the few months that this feeding is 74 
THE HAPPY BABY 
given. The usual excuse for continuing the bottle is that, 
in this way, the child will take more milk; but the op- 
posite is usually the result. 
The problems involved in bringing up an only child 
are many and it is perhaps not surprising that fond 
parents should do so many unwise things as they seem 
able to devise. Usually it is the mother, but not rarely 
the father, who is the chief offender, neither realizing the 
importance of early training in proper habits. An un- 
trained child is like an unbroken colt; anything but a 
pleasure to those who have to do with him. 
Such a child very soon discovers that he is the most 
important member of the household and that he has only 
to be insistent enough in order to get his own way in 
practically everything. 
If regularity in habits and proper early training are 
important for every child, they are tenfold more necessary 
for children like Mary who are not robust but rather 
delicate. Unfortunately, however, these are just the ones 
who seldom get proper training in an average American 
home. They soon become veritable tyrants in the family. 
SELF-FEEDING 
The second great mistake in this instance was that the 
child was not taught to feed herself. Every child should 
begin this at two years, and at three or three and a half 
no child not ill should be fed by mother or nurse. If 
not very strong and gaining slowly, the mother usually 
concludes that the important thing is to get the child to 
take more food, not appreciating the fact that one is THE HAPPY BABY 
75 
nourished not by what one can be induced to swallow, 
but by what one is able to digest and assimilate. This 
practice of continually getting a child by one ruse or 
another to take more food than the appetite craves almost 
invariably results in indigestion, which still further reduces 
the desire for food. Then, too, the mere habit of being 
coaxed to eat reacts upon the child, like being coaxed to 
any form of behavior, and the more coaxing the less the 
effect. Words have little effect. In fact, the anxious 
pleadings of the mother ("Mary, to please mother won't 
you drink your milk and eat your cereal?") bring no 
response. Children, even very young ones, often seem 
to take special delight in being contrary. 
A problem such as this is solved by applying rules of 
child psychology; never by constantly changing the diet 
and not by the administration of various medicines to 
create an appetite. Such a child likes to be the center 
of the stage and at a very early age seems to enjoy the 
distinction of being difficult to feed and endeavors to live 
up to the reputation which has been acquired. 
The more the difficulties of the case are discussed in the 
presence of the child the worse they become and the 
longer they continue. There is only one remedy: that of 
assuming an attitude of absolute indifference on the part 
of the parent. 
The food, properly prepared and presented in as at- 
tractive a form as possible, should be put before the 
child, but not a word said. At the end of twenty minutes 
it should be removed, again without a word of remon- 
strance, no matter if not a mouthful has been touched. 
It is often well to leave a child quite alone in the room 76 
THE HAPPY BABY 
during this time. Food is not to be offered again until 
the next meal-hour, when the same procedure is repeated. 
This same plan should be followed until the child's 
appetite gets the better of his obstinacy, for in many 
cases this is the real difficulty. It may take two days 
and it may take four or five before the child will eat 
willingly the food offered. If the same policy is con- 
sistently followed, there is usually no great difficulty 
afterward. But the longer the coaxing habit has 
been continued the more nervous the child and 
the more anxious the mother, the longer will be the 
struggle. 
One precaution is necessary while the child is taking 
so little food, and that is to reduce the activity. In most 
cases this is voluntarily done by the child himself. Very 
small children should usually be kept in bed. 
The difference in the general disposition of a child after 
a month or two of the new regime is often very striking. 
Instead of a fretful child, irritable by day and restless 
at night, there is often seen a transformation into a good- 
natured, happy individual. 
FIRMNESS IN PARENTS 
Remarkable creatures of habit these little folks are, 
and it is in most cases quite as easy to form good habits 
as bad ones if one begins early; but one must be regular, 
firm and always consistent. The early habits of children 
relate to things physical-their sleep, their food and the 
manner of eating it, bowel movements, etc. Children 
who are well trained in these respects are usually easy to THE HAPPY BABY 
77 
train in other things; while those who have not been 
trained in them are, as they grow older, usually difficult 
to control in other matters. 
In most cases until the impulse to do the things which 
we desire him to do comes from the child's own will, little 
permanent improvement is to be expected. Any action 
which is the result of pressure from the outside, what- 
ever its character and by whomsoever it is exerted, is very 
short-lived and usually tends to rouse in the child a 
resistance of which the child himself is hardly conscious 
but the results of which are matters of every-day observa- 
tion by all who deal with children. Children, like adults, 
resent being constantly "governed." Nagging invariably 
arouses a spirit of opposition which is intensified in pro- 
portion to the amount of nagging and the frequency with 
which it is repeated. 
It is frequently the parents rather than the child who 
need treatment most. The weak indulgence of parents is 
responsible for very much of the trouble which doctors 
and teachers have with children-especially when the one 
in question happens to be an only child. The discipline 
which comes later in school is a shock which is sometimes 
very hard for such children to bear, but at the same time a 
lesson very much needed. 
The lesson which a child learns with reference to his 
food is carried over by him into his other habits. If only 
parents and nurses could learn the lesson of not seeking 
to influence children by continually talking to them, the 
problems of eating and other habits they are seeking to 
form would be very easy. 
The surprising thing about this whole subject is the 78 
THE HAPPY BABY 
very early age at which these rules will be found to 
apply. These little tots do not reason about these 
matters, but the uniform way in which they all react is 
remarkable. Even those of only two or three years can 
be depended upon to respond as well as those who are 
much older. 
None of these problems are difficult if they are attacked 
with a clear understanding of the psychology of the child 
mind, for all children are very much alike. When these 
problems are attacked blindly by one whose only guide 
is parental affection, they are never solved, but may 
continue to torment for years the lives of those who have 
the care of such children. 
SWEETS 
There are few questions in the diet of children more 
often discussed in the home than the allowance of sweets, 
and there are few with regard to which such positive 
opinions arise, often with so little knowledge of the facts 
involved. For the purpose of this article, sweets are 
meant to include candy and the sugar and sirups used in 
the preparation of food or served upon it when it is 
eaten. 
Have sweets any real value as foods? May they form 
a desirable part of the diet? If so, why are doctors and 
dietitians so constantly preaching against them? In 
what circumstances may they be harmful? Finally, if 
their use is approved, what is a proper allowance of sweets 
for a normal healthy child? In the following pages we 
shall endeavor to answer some of these questions. 
✓ THE HAPPY BABY 
79 
CLASSES OF FOODS 
Foods are divided into three general classes: carbohy- 
drates, fats and proteins. All of these should be supplied 
in our diet. The sugars belong to the first class, as do 
also bread, potatoes and all our cereals. These carbo- 
hydrate foods form a very important and necessary part 
of our diet. We could take all our required allowance 
of them in the form of starchy foods like those mentioned, 
and it would no doubt be possible to take all of it in the 
form of sugar, but for many important reasons this would 
not be desirable. In the process of digestion all of these 
carbohydrates are finally changed into sugar, which is 
burned up in the body to keep us warm or is changed 
into fat and increases our weight. 
Carbohydrate foods as a class are easily digested and 
they are our cheapest foods. In normal times one can 
buy fully six times as many calories, or food-units, in the 
form of carbohydrate as can be bought in the form of 
protein foods and four times as many as can be bought 
in the form of fat foods. It is for these reasons that our 
diet in these modern times is coming to be made up more 
and more largely of foods of the carbohydrate class and 
that the annual consumption of sugar in this country has 
increased from an average of eight pounds a person a 
hundred years ago to over a hundred pounds a person in 
1922. The only large country which consumes much 
more sugar per person than we do in the United States is 
Australia. Most of the European countries use far less 
than we do-Great Britain less than two-thirds as much 
and Italy less than one-sixth as much. Our sweet tooth 80 
THE HAPPY BABY 
has certainly developed marvelously during recent years, 
and it is no wonder that the public all over the country 
is stirred to loud protest when the price of sugar goes up 
a few cents a pound. 
When we come to ask whether these changes which are 
gradually being made in our national diet are beneficial or 
not, there are a number of aspects from which the subject 
must be considered. Several of the foremost authorities 
on diabetes in this country have stated that the large and 
increasing consumption of sugar was to be reckoned as 
one of the important factors in the production of this 
common and serious disease. 
BALANCED RATION 
A large consumption of sugar by children has still 
other and more important drawbacks. The bulletins 
published by the Department of Animal Industry in 
Washington, in advising regarding the feeding of animals, 
have a great deal to say about the advantages of a 
properly balanced ration, which means a food in which 
the fat, protein and carbohydrates are combined in the 
proportions which give the best results: the largest, finest 
and healthiest animals. Now the child, too, is an animal 
whose health and growth are very much affected by his 
food, and the advantages of a balanced ration for the 
growing child are just as real as in the case of a growing 
pig, only parents have not yet had the education to make 
them see it. 
Most mothers follow the line of least resistance in the 
diet of their children, which means that in the selection of THE HAPPY BABY 
81 
their food they give the child what he likes without much 
thought as to whether this is really what he needs. Now 
all children like sweet foods; they take these more readily 
than other food, but, unfortunately, the more sugar al- 
lowed upon the cereal or in other foods the more tasteless 
and flat are other foods not thus sweetened. It comes 
about in many homes that the child does not care for 
his potato, bread and butter and vegetables but wants- 
and too often, alas, gets-two helpings of a sweet dessert. 
Soon he will not eat his oatmeal for breakfast unless 
thickly covered with sugar. I have seen children who 
even refused all milk unless to each glass was added two 
heaping spoonfuls of sugar, which had been allowed 
because the mother had been advised that somehow or 
other he must be induced to take his milk. These ex- 
periences are matters of every-day observation by 
physicians who have the care of children in charge, and 
such habits as those described often continue for years. 
The child has a poor appetite; he must eat something, 
and so his diet comes to have a larger and larger propor- 
tion of sweet foods, the effect of which is to reduce still 
further his desire for other food. 
This food habit has its effect not only upon digestion 
but upon the child's color, his growth, muscular vigor and 
his general resistance to disease. He may be fat, but he 
is flabby, usually tires easily and suffers much from 
flatulence and sometimes abdominal pains. His symptoms 
are due not only to what his diet contains, but quite as 
much to what is lacking. He is no longer getting a 
balanced ration. His health, growth and physical de- 
velopment suffer for the reason that the appetite being 82 
THE HAPPY BABY 
satisfied with carbohydrate foods, fat and protein foods- 
so necessary during the period of growth-are not taken 
in the quantities required for the best results. 
We have spoken of the mistakes and the dietetic sins 
of the mother; but she is by no means the only member 
of the family at fault. Sometimes it is an indulgent 
father who, on the sly, gives the children frequent "treats" 
or else supplies them with the weekly allowance in pennies 
or dimes with which the children themselves supply the 
cause of disturbance. Still more often, probably, it is 
grandmother or an affectionate aunt who is the offender. 
Why it should be thought necessary to give a child 
pleasure in the form of something injurious to his diges- 
tion, it is difficult to comprehend. By making such things 
appear as "a great treat" in the eyes of the child is again 
to distort his view. Besides, the effect is always to in- 
crease the desire for larger amounts and for more frequent 
indulgences. 
The conditions which have been discussed are common 
in many American homes in which the children are con- 
sidered "delicate," "very susceptible to colds," "having 
little ambition for active sports," etc. If only the bad 
results of such food habits could be recognized early, 
the consequences would not be so serious; but because 
they are late in developing and come on so slowly, the 
cause often is not suspected by the parent. 
When candy and sweets are taken between the regular 
meals, their bad effects are usually most marked. The 
INDULGENT PARENTS THE HAPPY BABY 
83 
symptom most often seen is that the child has little or 
no appetite at meal-time. The child who has a daily 
allowance of a few pennies is apt to spend most of them 
on lollypops, and if there is a candy-store or a push-cart 
near the school, the money which is given him to purchase 
his school lunch goes in great part for such items. 
The child's natural craving for sweets is often invoked 
not only as an excuse but even as a justification for such 
practices as we are considering. Every child likes to 
be indulged, and a regular indulgence in sweets constantly 
increases the child's desires until the craving becomes 
excessive and difficult to control. 
EFFECT ON TEETH 
There is another consequence of indulgence in sweets 
which must not be forgotten: Dentists are generally 
agreed that the consumption of sweets increases the 
amount of dental decay and that this is very much in- 
creased unless great care is taken to keep the teeth per- 
fectly clean. Some interesting observations have been 
made in New Zealand upon the frequency of dental decay 
among school children, in which it was shown that the 
nearer the candy-stores were to the schools the greater 
the number of decayed teeth found in the pupils. It 
was also discovered that the teeth of children whose 
parents were too poor to give them pennies to spend for 
sweets were distinctly better than those of the children 
who had pocket-money. 
All of the above considerations make it quite clear that 
although sweets are food, even useful food, great care and 84 
THE HAPPY BABY 
discretion must be exercised in their use; also that the 
quantity allowed children must be very moderate and 
that children's desire for sweets is no guide whatever to 
what this quantity should be. It is also evident that with 
children who suffer from digestive disturbances, and 
especially those with poor appetites, sweets should be 
much reduced and in very many cases entirely excluded 
from the diet; also that sweets are most harmful when 
given between meals, and finally that to allow sweets for 
the reason that the child will eat so little else is invariably 
to make matters worse and to defeat the very purpose we 
have in view. 
PROPER SUGAR ALLOWANCE 
The following may be regarded as a moderate allow- 
ance of sugar or candy for a healthy child of nine or ten 
years: Of sugar on cereals, one even teaspoonful at 
breakfast or supper and not more than this amount on 
fresh or stewed fruit; of candy, one piece with the mid- 
day meal; of ice-cream or fruit-ice, one good tablespoonful 
once a week, possibly twice a week in the Summer; of 
ice-cream sodas, not more than one a week. 
Besides these things, a child will get in his other food, 
such as gingerbread, cookies and plain cake, and in his 
custard and puddings an additional amount of sugar, so 
that his total daily allowance will probably be equal to 
two tablespoons of sugar. So long as this is not exceeded, 
it is not likely that any bad effects will follow. But when 
a child is allowed to help himself the constant tendency is 
that the amount is gradually increased to two or three THE HAPPY BABY 
85 
times the quantities specified, and even then the child is 
no better satisfied-often less so. He has acquired the 
sweet habit and food does not taste sweet unless these 
larger amounts are constantly added. 
With most children the practice of eating much candy 
and sweets and of using an excessive amount of sugar on 
or in food is a habit-a very injurious habit in most cir- 
cumstances, a habit more difficult to control as a child 
grows older and determines for himself what his diet 
shall be. To indulge a child in such a habit in early 
childhood and to expect moderation in his use of sweets 
when he grows older is a serious mistake. Generally, the 
more a child has the more he wants. 
The steadily increasing consumption of sweets in this 
country is a matter of deep concern to those who are 
interested in health, particularly the health of children. 
The Census Bureau in Washington states that the ice- 
cream manufactured increased nearly threefold between 
the years 1914 and 1921 and that the nation's bill for ice- 
cream and confections in 1921 was more than 
$500,000,000! 
What results might we see if a fraction of this sum 
could be used to improve the health and nutrition of 
children instead of, as now, impairing it! There is 
greatly needed an enlightened public opinion, not only 
among parents but among children themselves, to keep 
the use of sweets in their proper place. The indulgence 
of children does not tend to produce the best results either 
physically or morally. Self-control and moderation here 
will be of service in teaching these virtues in other matters 
later in life. EARLY CHILDHOOD 
FEEDING AND OTHER PROBLEMS 
Dr. Henry L. K. Shaw 
When the child slips from his mother's lap and has 
learned to walk, he has entered into the second stage of 
childhood and left babyhood behind. It is unfortunate 
that the term "preschool child" has been applied to this 
period. Better far is it that he should be called a run- 
about or tiny toddler. There is something cold and un- 
inviting about "preschool child," while our heart and 
affection go out to "tiny toddler." 
A Much-Neglected Period: This period is a much- 
neglected one in the life of the child. The mother's at- 
tention is often focused upon a new little brother or 
sister, and the bars are apt to be let down. The imaginary 
perils of teething and the much-dreaded second Summer 
having been passed, the mother relaxes her vigilant care 
and feels the future will now be plain sailing. She has 
studied the baby-books and consulted her physician on 
frequent occasions during the first two years, but now 
there is a tendency to neglect the charts and drop the 
pilot. This is a great mistake, for in many ways this 
period is the most important one in the life of the child. 
In it habits-good and bad-are formed which in- 
fluence the later years; in it slight physical defects and 
nutritional disorders have their origin, which, if un- 
86 THE HAPPY BABY 
87 
checked, will mar or wreck future mental and physical 
development. 
A Time When Habits Are Formed: A child is not 
a small edition of an adult-not an adult in miniature. 
The contrast between the infant and the adult is not as 
striking as that of the tadpole and the frog or the cater- 
pillar and the butterfly, but the differences are almost as 
great. Imagine a baby projected to the size of a man 
and you would have a monstrosity whose head was one- 
fourth the size of its body, with arms and legs out of all 
proportions. The internal organs would show even 
greater contrast. The brain and nervous system 
especially are in an undeveloped or rudimentary condition, 
and this is one of the reasons why the greatest care and 
caution must be taken in dealing with young children. 
The brain absorbs every impression: an oft-repeated act 
or thought leaves its imprint in the brain and becomes a 
habit, and the oftener it is repeated the harder it is to 
overcome. Habits are formed very early in life, but the 
bad ones seem to come much easier than the good ones. 
The best way to prevent a bad habit is never to allow it to 
commence, and this means careful training and the forma- 
tion of only good habits. Young children learn largely 
by imitation, very little by admonition. Home example 
and home environment exert the greatest influence. A 
child brought up under a wrong and evil environment is 
hopelessly handicapped and will seldom fit into the world. 
The old saying "Like father, like son" places responsibility 
upon heredity, while the factor of environment is of 
greater importance. "As the father lives, so lives the 
son" is more to the point. The attitude of an intelligent 88 
THE HAPPY BABY 
parent is "Not as I say, but as I do." The responsibility 
is upon the parents. If a child is allowed to have his 
own way, to dictate to the entire household and become 
a spoiled child, he will grow up without restraint, without 
respect for the parents, persons or authority and without 
any sense of appreciation of law, justice or order. 
The tiny toddler must be disciplined; but discipline 
does not consist in constant nagging, scolding or threats 
of dire punishment. The word "don't" is apt to be so 
overworked that it loses its significance. Some one has 
said that in order to bring children up properly the 
parents should be cleanly wed and the children nobly 
bred, wisely fed and firmly led. 
Nerves Should Be Protected: Eating, sleeping and 
playing are the most important occupations of young 
children. The food question will be discussed later. The 
great activity of the child's mind and body and the 
process of growth uses up a large amount of his strength 
and energy. Nature demands sleep and rest in order 
to recharge the tiny batteries in the nerve-cells of the 
brain and to restore the tissue burnt up from muscular 
action. The younger the child the more sleep is required. 
The runabout of three years should have at least twelve 
hours' sleep in the twenty-four. A child who does not 
get enough sleep and rest" becomes fatigued. This is 
shown by lack of appetite, indigestion, loss of weight, 
excitability and irritability. Regularity in nap-time and 
early bed-time are essential, as children object to wast- 
ing time in sleep, for they do not know when to stop in 
their play and will go on to a stage of exhaustion. The 
daytime nap is very important, and even if they will not THE HAPPY BABY 
89 
sleep, children should be made to rest. The nervous 
child is usually one who is fatigued and not getting enough 
rest or sleep. This fatigue may show itself by sleepless- 
ness, tossing and turning during sleep and by bad dreams 
and night terrors. Each child should have his own bed 
and own room if possible. This should be kept dark and 
reasonably quiet. It should not, however, be necessary 
for the grown-ups to go about on tiptoe and speak in 
whispers after the toddler goes to bed. He can become 
accustomed to ordinary home sounds and noises. He 
should be made comfortable in bed with sufficient cover- 
ings and the room must be well ventilated without direct 
drafts. Sleeping out-of-doors in a screened porch is 
highly desirable. Exciting play and romping just before 
bedtime interferes with sleep and should be avoided; this 
also applies to children's parties and moving-picture 
shows. It is not necessary to rock a child to sleep or 
soothe him with a lullaby. These are bad habits which 
never should be begun. Telling or reading bedtime 
stories gives pleasure both to the child and parent, but 
caution is necessary in the selection. Children have vivid 
and active imaginations and are easily frightened, so 
stories about ghosts, dragons, wolves and "thrillers" must 
be avoided. 
Play and exercise are almost synonymous in early 
childhood. The constant activity of children keeps their 
muscles exercised and their blood in healthy circulation. 
They should play out-of-doors as much as possible and 
by themselves. A child dislikes being fussed over as 
much as older people. 
Incorrect posture is a more common cause of poor 90 
THE HAPPY BABY 
health than is generally recognized. Children can not 
begin too early to cultivate strong and straight backs, 
prominent chests, square shoulders and firm flat bellies. 
The muscles can be trained early by suitable exercises, 
so that correct posture becomes a habit and is main- 
tained unconsciously without effort. Some of the effects 
of poor posture are recurrent attacks of vomiting, consti- 
pation, listlessness, albumin in the urine and curvature of 
the spine. 
Regular Physical Examinations Necessary: It 
is said that in China the doctors are paid only when they 
keep their patients well. This method possesses distinct 
advantages in the protection of both personal and com- 
munity health. Children should receive a thorough 
physical examination by a competent physician at regular 
intervals. Slight defects, if discovered, can be remedied 
before serious and permanent injuries develop. Dentists 
have demonstrated the value of periodic inspection of 
the teeth. The successful merchant takes stock or in- 
ventory at stated intervals to find just how his business 
stands; the banks request our bank-books at certain 
periods in order to balance the account and see that it is 
not overdrawn; automobile dealers urge their patrons to 
have regular inspections made of their automobiles as a 
matter of economy and good business. Our tiny toddler 
is just as much entitled to a physical inventory-a balance 
of his physical capital-and to regular inspections of his 
delicate and complicated machinery. 
Tonsils and Adenoids: The question of tonsils and 
adenoids troubles many parents. Every young child 
has an excess of lymphatic tissue-it is normal and THE HAPPY BABY 
91 
natural. If, however, the tonsils become diseased and 
the adenoid tissue becomes enlarged so that the child can 
not breathe through his nose and has frequent colds and 
ear infections, then consult your physician about their 
removal. There is a tendency among physicians to-day 
toward greater conservatism in regard to this operation. 
Preventable Diseases: About a hundred years ago 
nearly half the deaths of young children were the results 
of smallpox. This peril has been removed by Jenner's 
discovery of vaccination, but to-day many parents un- 
fortunately are very remiss about having their children 
vaccinated. Vaccination should never be neglected, and 
the earlier it is done the better. 
Diphtheria is a common but preventable disease in 
young children. When a child contracts the disease, the 
prompt use of antitoxin will cure it. One of the most 
important of the recent advances in preventive medicine 
is the Schick test, by means of which susceptibility to 
diphtheria may be determined; and the use of what is 
called 'toxin-antitoxin" will prevent such children from 
ever taking the disease. This is a simple, harmless and 
painless procedure and should be more widely employed. 
Whooping-cough is a frequent and dangerous disease in 
young children. However, if a series of injections of 
whooping-cough vaccine are given when the child has 
been exposed, the chances of his contracting the disease 
are lessened. 
Keep your young children away from crowds, motion- 
picture theaters and the like if you want to keep con- 
tagious diseases away. 
All sorts of dangers menace the health of the child. 92 
THE HAPPY BABY 
These may in a general way be placed in three groups: 
First, faulty nutrition and its effects, which will be con- 
sidered in a separate article; second, the infections, some 
of which have been mentioned; third, the numerous dis- 
turbing factors, of ever-increasing importance in this 
restless age, which produce what is popularly called 
"nervousness." 
To protect the child from infections, especially in early 
life, is important. As the toddler grows older he de- 
velops more and more resistance to disease. Some con- 
tagious diseases can only be prevented by avoiding in- 
fection, but many can be warded off by keeping the child 
in good condition. This means out-of-doors, plenty of 
sunshine, proper exercise, the avoidance of fatigue and 
attention to the body functions. These are not to be 
practised once in a while, spasmodically and irregularly, 
but day in and day out until all the habits which make 
for health and a healthy body become firmly established. 
Nervousness is avoided not alone by the above 
measures, but by having the home life as free as possi- 
ble from tension and strife. Too often a nervous mother 
is the cause of a nervous child, and the preventive meas- 
ures must be applied not so much to the child as to its 
older associates. Too early attempts at education, striv- 
ing to make a show child of infant prodigy, efforts to 
keep up appearances in an artificial society way beyond 
the child's resources, account for many an irritable, un- 
stable nervous system and the only remedy is removal 
to a less strenuous life. Carefully regulated habits, 
exercise, baths and massage will help considerably, but 
the fundamental errors must be sought and eradicated. THE HAPPY BABY 
93 
The old Latin adage of a sound mirrd in a sound body 
contains the conditions which will lay a firm foundation 
for the future health and happiness of the tiny toddler. 
FEEDING AFTER INFANCY 
The tiny toddler must eat. As he grows older, nature 
requires a wider range of food materials to supply the 
needs for body-building and development. Food 
must also furnish the fuel necessary to keep the engine 
running at the proper temperature, to replace losses 
from wear and tear, and to provide material not alone 
for new and worn parts, but also to enlarge the machine. 
Besides, the human engine stores away food for a re- 
serve supply to be used in case of sickness and emergency. 
Choosing the Food: It is perhaps unfortunate that 
young children are not, like the lower animals, given the 
instinct of choosing the right kind of food. As it is, 
they are entirely dependent on the judgment and knowl- 
edge of their parents. The object of this article is to 
point out some of the important facts about their feed- 
ing. The nursery age is one of rapid growth and ac- 
tivity, and proper diet and good nutrition are essential 
for normal physical and mental development. Mothers 
are usually very careful about the diet and feeding of 
their babies, but when the third Summer arrives they 
are too apt to relax their vigilance and let down the bars. 
The child himself at this time is less dependent on the 
attention of others and can express his likes and dis- 
likes in a most emphatic and often convincing manner. 
For this reason it is most important that he should be 94 
THE HAPPY BABY 
trained in good food habits and not allowed to drift into 
bad habits in regard to his food and his eating. 
It is difficult to lay down hard-and-fast rules in re- 
gard to the child's diet at this period, as many factors 
such as climate, home, family and social conditions must 
all be taken into consideration. There are, however, 
certain fundamental principles that must be observed in 
order to keep a child healthy, fat and fit. Faulty food 
and faulty feeding-habits sooner or later will result in 
sickness, indigestion and malnutrition. 
Different Kinds of Foods: Foods can be conven- 
iently divided into four rather distinct groups according 
to their chemical composition and functions in the growth 
of the body. Some foods belong only to one or two of 
these groups, while others are in all four. 
The protein foods are those which contain nitrogen 
and are all-important in body-building. The Greek word 
protein means "I take first place." The chief foods in 
this group are milk, meat, fish and eggs, which contain 
the animal protein; and green vegetables and cereals, 
which supply the vegetable protein. Some dietetic 
authorities advise against giving meat in early child- 
hood; they claim it is too stimulating and acid-forming. 
Most physicians, however, strongly favor its use after 
the second year. Doctor Holt found that "vegetable 
proteins are of distinctly lower grade in nutritive value 
than the animal proteins, and that while they may be 
adequate for maintenance, it is hazardous to depend 
upon them for growth." 
The second group includes the sugar and starchy foods, 
which are known as carbohydrates. These are neces- THE HAPPY BABY 
95 
sary to furnish fuel for body heat and muscular energy. 
They also are used to store up reserve food in the form 
of fat. The sugar foods are the sugars, molasses, honey, 
maple-sugar, sweet fruits, beets and carrots; the starch 
foods are potatoes, rice, bread and cereals. 
A third group includes the fats. These, like the car- 
bohydrates furnish heat and energy. The chief foods 
containing a large percentage of fat are butter, cream, 
yolk of egg, bacon, olive and other vegetable oils and 
oleomargarin. 
Minerals and salts compromise the fourth group. 
Though not foods in the sense of the foregoing, they are 
absolutely necessary for the healthy action of the func- 
tions of the body, and in childhood they are especially 
important for growth. These are found chiefly in milk 
and vegetables, but they are also in fruit, cereals, eggs 
and meat. Proper growth is impossible without these 
minerals, but a sufficient quantity is provided in the 
usual diet. A small amount of salt in the preparation 
of cereals, broths, etc., makes them more palatable. 
Pepper and other condiments are not necessary and most 
of them are injurious. 
The amount of the different minerals varies in foods. 
Milk, for example, contains an abundance of lime, so 
essential for the growth of bones and teeth, but very 
little iron. Iron is relatively abundant in green vege- 
tables; potatoes and fruits contain other important ele- 
ments. Most of the minerals contained in vegetables are 
dissolved in the water in which they are cooked; this 
water should be saved to be used in making soups, 
gravies, etc. 96 
THE HAPPY BABY 
Water, while not a food, is most important in the diet 
of children. It cools the body in hot weather and assists 
in the elimination of waste products through the urine, 
stools and perspiration. Water alone should be given 
freely between meals, especially in hot weather. If 
taken at meal-time, it should not be drunk while the 
mouth is full to wash down food without chewing or 
mixing the food with saliva. There is a large amount 
of water in milks, broths, fruit and green vegetables, but 
aside from this a child of three or four years should drink 
two or three glasses a day. 
We read and hear a great deal about vitamins. These 
are certain vital and necessary constituents of food. 
Three vitamins have been recognized and several more 
are awaiting discovery. Vitamins are present in nearly 
all our common foods. A sufficient quantity for health 
and growth will be supplied if the diet contains reason- 
able amounts of unskimmed milk, fruits, green vegetables 
and cereals. 
"A pint of milk, egg, orange and greens 
Will give you your daily vitamins." 
The much-advertised concentrated, dried and dead 
vitamin powders, tablets, etc., are expensive, unnecessary 
and most worthless. 
Amount of Food Needed: The amount of food nec- 
essary to supply all the needs of a growing child depends 
on his age, weight and activity. A child of three to four 
years needs fully twice as much food per pound of body 
weight as an adult. Doctor Holt, after careful investi- THE HAPPY BABY 
97 
gation, found that in a well-balanced diet the child re- 
quires fifteen per cent, protein, thirty-five per cent, fat 
and fifty per cent, carbohydrate to bring about good 
health, proper growth and normal nutrition. Ignorance 
of relative food-values, and the fact that they are cheaper, 
often results in the use of too large an amount of sugars 
and starches in the diet to the exclusion of fatty and 
protein foods and foods containing necessary vitamins 
and salts. 
The Addition of Solid Food: The eruption of the 
first set of twenty teeth is an indication that solid foods 
requiring mastication should be included in the diet. 
Young children must be taught to eat slowly and to chew 
their food thoroughly. This not only aids the digestion, 
but also develops the teeth. If soft, mushy foods are 
given to the exclusion of hard, bulky foods, the children 
will not learn to chew properly and the teeth are prob- 
ably more likely to decay. This also may occur when 
sugars and sweets are allowed to ferment in the mouth, 
especially between the teeth because they are not kept 
clean, so that acids form which penetrate through the 
enamel. 
The Daily Diet : A young child thrives best on three 
meals a day. These should be given at regular hours 
and no food should be given between these hours except 
in special instances. The stomach performs its func- 
tions in a definite cycle and it takes about four hours to 
complete the digestion of a single meal. If more food 
is added before the stomach is empty, the work of di- 
gestion has to begin all over again and the normal cycle 
is disturbed with resulting fermentation and indigestion. 98 
THE HAPPY BABY 
The stomach requires rest between meals in order to do 
its best and most efficient work. 
The following diet is suitable for runabout children of 
the nursery age (two to five years). 
1. Fruit: Orange or grapefruit juice, baked apple, pears 
or stewed prunes. 
2. Cereal: Farina, Cream of Wheat, Pettijohn, oatmeal, 
rice, cracked wheat, Wheatena or com-meal mush, etc. Or, 
in place of the cereal, substitute a soft-boiled, poached or 
scrambled egg, or milk toast with grated yolk of hard-boiled 
egg, or bacon, crisp. 
3. Cup of milk or cocoa made with milk. 
4. Slice of toast, stale bread, bran bread or whole-wheat 
bread and butter. 
Breakfast-7 to 8 a. m. 
Dinner-12 to 1 p. m. 
1. Soup: Chicken, beef or mutton thickened with peas, 
barley or rice. All kinds of vegetables can be cooked in broth 
and strained. Milk or yolk of egg can be used in soup with 
vegetables. 
2. Meats: Chicken, rare roast beef, lamb chop, rare steak 
or boiled or broiled fish. 
3. Vegetables: Baked, boiled or mashed potato, boiled 
sweet potato, asparagus, carrots, spinach, lettuce, peas, string- 
beans, new beets, stewed celery, boiled cabbage, stewed tomatoes. 
One potato and one green vegetable can be taken at one meal. 
All vegetables should be thoroughly cooked and mashed or put 
through a sieve. Macaroni, spaghetti or rice may be given in- 
stead of potato. 
4. Dessert: Custard, junket, corn-starch, rice, bread or 
tapioca pudding, floating-island, baked apple, baked banana, 
home-made ice-cream once a week. THE HAPPY BABY 
99 
5. Cup of milk or stale bread and milk. 
Milk soups, milk toast, bread and milk, crackers and milk, 
and well-cooked cereal, stewed fruit, apple sauce, plain sponge- 
cake, cup of milk or cocoa, stale bread and butter. 
Supper-5 to 6 p. m, 
FOODS TO AVOID 
There are a number of foods which must be avoided, 
as they are unsuitable for young children. 
Meats: Corned beef, dried beef, liver, ham, pork 
sausage, rich sauces and gravies, dressings from roast 
meats or poultry. 
Vegetables: Fried vegetables of all varieties, green 
corn, cucumber, all raw articles-such as celery, radishes, 
onions, etc.-pickles, salads, baked beans. 
Bread and Cakes-Fresh bread, hot breads, rolls, 
rich and spice cakes, griddle-cakes, waffles. 
Desserts : Candy, especially lolly-pops, ice-cream 
cones, nuts, pastry, pies, pop-corn, peanuts. All partic- 
ularly bad when eaten between meals. 
Drinks: Coffee, tea, soda-water. 
IMPORTANCE OF MILK 
Milk is without doubt the best all-round food for chil- 
dren. It is easily digested and contains in proper pro- 
portions, all the elements for body-building. However, 
the toddler must not be allowed to live on milk alone. 
We do not want him to get the "milk habit" and refuse 
to take solid food. A pint and a half of milk is suf- 100 
THE HAPPY BABY 
ficient for nearly all children. Those who dislike to 
drink milk can take it disguised in cocoa, chocolate 
milk, cooked with the cereals, and in soups, custard and 
other desserts. Milk should be looked upon as a food, 
not a beverage or thirst-quencher, and should not be 
given between meals. 
SUGAR 
Sugar is a useful part of the diet, but not in the form 
of candy or granulated sugar. Other carbohydrates can 
be amply supplied in the cereal, fruits and vegetables. 
A tablespoon of granulated sugar a day, including all 
that is used in the food, is quite sufficient. An excess 
of sugar and very sweet foods destroys the appetite for 
the more necessary and nourishing foods. It is a very 
common cause of stomach and intestinal disorders, mal- 
nutrition and decayed teeth in children over two years 
of age. It produces a craving or appetite which may 
be as dangerous to the nutrition of a child as alcohol is 
to an adult. What the nation needs is a Volstead Act 
prohibiting candy and sweets to the young! 
CEREALS 
Cereals are very useful foods when properly cooked 
and should compose about one-third of the diet. A 
well-cooked cereal should be given at least once a day. 
A wide variety is desirable. Cereals can be cooked in 
milk and served with thin cream or butter and not more 
than one teaspoon of sugar. Brown sugar or grated THE HAPPY BABY 
101 
maple-sugar can be used to tempt unwilling children. 
The dry or prepared cereals should not be used for small 
children. Sliced ripe bananas, chopped dates, stewed 
prunes, etc., can sometimes be mixed with cereal before 
serving. Two or three cereals cooked together appeal 
to the tastes of some children. 
Farina, Cream of Wheat, Wheatena, etc., require at 
least one hour of cooking, while the coarser grains, such 
as oatmeal, cracked wheat, rice, corn-meal, etc., require 
at least three hours' cooking in a double boiler. 
The addition of a tablespoon of bran to the cereal is 
helpful for constipated children. Bran bread is also 
laxative and has a high nutritive value. The following 
recipe, which must be baked for two hours, is relished 
by most children. 
3 cups bran 
3 cups white flour 
1J/2 cups milk 
1 cup molasses 
1 teaspoon soda 
LACK OF APPETITE 
Lack of appetite in the tiny toddler disturbs many 
mothers. When this is associated with fever or any 
signs of illness, no food should be given without the ad- 
vice of a physician. The most frequent cause in other 
circumstances is found in the psychology of early child- 
hood. Nearly all children unfortunately pass through 
a so-called "negative phase," when they persist in doing 
the opposite to what is requested or desired. They also 
crave attention. They love to be in the center of the 
stage and in the limelight. They will eat if the stage- 102 
THE HAPPY BABY 
settings are satisfactory and when there are one or more 
persons as an audience who will coax, tell stories or 
otherwise entertain them. Some children who find that 
by simply refusing food they become objects of greater 
attention will persistently and stubbornly refuse to eat. 
The management and control of this refusal is simple 
when its true nature is recognized. 
WEIGH THE CHILD REGULARLY 
The scales and tape measure are valuable guides to 
progress in growth and nutrition. Normal nutrition 
manifests itself both in gain in weight and growth in 
height; while the opposite condition, malnutrition, re- 
sults in loss of weight and retarded growth in height. 
If the child is losing weight, something is going wrong 
and there is danger ahead. Every child of the nursery 
age should be weighed each month and the amount 
charted or recorded for comparison. He should be 
measured and have a thorough physical examination made 
once a year. 
Every tiny toddler is a feeding problem unto himself, 
and the mother's task is to regulate the diet for her own 
individual child. She should understand and appreciate 
the underlying principles of food and feeding, and when in 
doubt or perplexity consult an experienced child special- 
ist, if possible, or the best physician available, and not 
wait until signs of malnutrition and sickness appear. 
The doctor's greatest privilege and duty is to help you 
keep your child healthy and well and to prevent sickness 
and disease which so often are unnecessary. THE CHILD'S TEETH 
Dr. Harvey J. Burkhart 
INSURING GOOD TEETH FOR THE BABY 
There are probably no ills or troubles of early child- 
hood that are as difficult to treat or that have so marked 
an influence on the general health as decayed teeth, 
diseased gums, tonsils and adenoids. Reliable investi- 
gation discloses the fact that more than eighty per 
cent, of the children under five years of age are in need 
of medical or dental attention, practically all of which 
is due to the presence of decayed and abscessed teeth. 
It is, therefore, of the greatest importance to learn 
the cause of the various disorders and to de- 
vise effective measures for their prevention and correc- 
tion. 
Much of the pain and suffering of childhood may be 
avoided by proper attention to the diet and the observ- 
ance of simple rules for the care of the mouth and teeth. 
Dental caries, or decay of the teeth, is a problem that 
has for many years received most careful investigation 
and consideration, but up to this time there is no sub- 
stantial agreement as to its cause and no effective scheme 
has been agreed upon for its control. While many 
plausible and seemingly reasonable theories have 
been advanced, there is none that is generally 
103 104 
THE HAPPY BABY 
accepted. There are, however, measures that may be 
taken to prevent decay that hold much promise for its 
control. 
PRENATAL PRECAUTIONS 
There is no doubt but that in the education of the 
expectant mother will be found the greatest aid in the 
prevention of dental decay. During the period when the 
germs of the teeth are being formed, between the sixth 
and seventh month before birth and from that time until 
the birth of the child, it is of primary importance for her 
to pay careful attention to her diet. Her environment 
should be happy and pleasant and as free as possible from 
nervous strain and irritation. The diet should consist 
of milk, vegetables and fruit in abundance, Graham and 
whole-wheat bread, butter and cream. Rich foods and 
meats should be avoided if possible or eaten in very small 
quantities. 
The maintenance of good health at the period men- 
tioned is an important factor in the development of good 
teeth and a sound body. It is most necessary that the 
mother's mouth be kept in a thoroughly healthy condi- 
tion-free from decayed teeth, unhealthy or bleeding 
gums or any kind of infection. Strict attention should 
be given to the proper brushing of the teeth and cleans- 
ing of the mouth and frequent visits should be made to 
the dentist and dental hygienist for the removal of 
tartar and polishing of the teeth. It is very essential 
that the expectant mother advise freely with her physi- 
cian and dentist, because by their close cooperation evi- THE HAPPY BABY 
105 
dence of malnutrition and disorders about the mouth 
will be quickly discovered. 
MATERNAL NURSING DESIRABLE 
Nutrition plays a prominent part in the prevention of 
dental decay. It has been found that in nearly every case 
where children are breast-fed their teeth are much 
stronger and less liable to decay than those of the bottle- 
fed baby. Good breast milk contains those elements 
which are of primary importance because they combine 
the properties necessary for the development of any 
healthy child. Substitutes for normal breast milk lack 
many of the essentials which provide partial immunity 
at least, from infectious diseases. Whenever possible 
mothers should nurse their babies from six to eight 
months, especially through the first Summer. 
It is very necessary during the nursing period that 
every precaution should be taken by the mother and 
nurse to see to it that no infection is carried to the child's 
mouth by carelessness or neglect. The mucous lining of 
the mouth is very tender and susceptible to disease. Any 
infection conveyed to the mouth is liable to affect the 
lining of the stomach and intestines and cause many 
general systemic disturbances. Before and after nurs- 
ing, the mother's breast should be washed or sponged with 
a weak solution of boric acid. After each nursing the 
child's mouth should be washed with a like preparation. 
This probably can best be done by wrapping cotton or 
linen around a quill, a heavy wooden toothpick or the 
little finger. Precaution should be taken to securely 106 
THE HAPPY BABY 
tie the cotton or linen to the stick so there will be no 
liability of its slipping into the child's windpipe. 
MASSAGING AND CLEANSING GUMS 
The care of the mouth of very young children is most 
important until the time of the eruption of the first baby 
teeth. From birth to the sixth month the mother should 
massage the baby's gums at frequent intervals. Just 
before the teeth are ready to come through the gums 
there is frequently much soreness and inflammation. 
Gentle rubbing of the gums will stop much of the pain 
and will also quicken the absorption of the gums and 
hasten the cutting of the teeth. From the time the first 
tooth makes it appearance until all are in place they 
should be thoroughly cleansed after meals and particu- 
larly just before going to bed. At first very gentle means 
should be used and much patience exercised until the 
child's confidence has been gained and the exercise is 
regarded as one of the playtimes. As the teeth become 
more fully developed, a soft brush should be used; later 
a stiffer bristle may be employed. 
Many methods for brushing the teeth have been sug- 
gested. Any one of them is better than none. Generally 
speaking, it is thought best to use a brush with a rolling 
or rotary motion, using both the right and left hand. 
By employing this method the bristles will be worked 
between the teeth and assist in the removal of particles 
of food and other accumulations. The child should be 
taught to brush not only the teeth, but the gums as well 
in a thorough and vigorous manner for the purpose of THE HAPPY BABY 
107 
stimulating the circulation and producing hard and 
healthy gums. The responsibility for brushing the teeth 
should not be placed upon a young child. It is plainly 
the duty of the parent to assume that responsibility, if 
this very necessary function is to be regularly and 
properly performed. During the illnesses of childhood, 
the secretions and fluids of the mouth become unhealthy. 
At this time particularly there is much need for care- 
ful mouth toilet. Due to a lowered bodily vitality and 
resistance, rapid breaking down of the teeth frequently 
occurs. Regular and thorough cleansing and brushing 
of the teeth and gums is of first importance. No mouth 
can be healthy with accumulations of food between the 
teeth. A dirty mouth is a fertile field for the develop- 
ment of the germs of tooth decay and other bacteria, 
which will cause general systemic troubles. There are 
many good tooth powders, pastes and mouth-washes on 
sale. While none possess elements that will destroy the 
germs of tooth decay, they are useful as cleansing 
agencies because an agreeable and pleasant preparation 
is an inducement for the more frequent brushing of the 
teeth. 
Between the eighteenth and twenty-fourth month, 
when the double teeth of the first set are beginning to 
come through, more particular attention should be given 
to cleansing and brushing. These teeth are liable to 
decay on account of their roughened and fissured tops, 
which provide an easy lodging-place for the germs of 
tooth decay. Particles of food must not be allowed to 
remain on top or between the teeth, because the tooth 
becomes soft and decay soon follows. From the end of 108 
THE HAPPY BABY 
the second year until about the sixth, when the child 
begins to lose his baby teeth, is the period when most 
careful attention should be given and every means pos- 
sible employed to keep them free from decay and the 
mouth in a healthy condition. If it is possible, every 
baby tooth should be retained until the time for the 
eruption of the permanent tooth which takes its place. 
The child should be taken to the dentist at frequent inter- 
vals for examination and the filling of any cavities that 
may appear. 
PREVENTING DECAY 
Decay in children's teeth proceeds very rapidly, and it 
is therefore of the utmost importance that reparative 
work be promptly done. Many of the double teeth may 
be protected from decay by having fissure and tops of 
teeth covered with cement or treated with nitrate of 
silver in anticipation of later trouble. Rapid decay is 
usually an indication of poor physical condition. The 
family physician should be consulted so that the cause 
may be quickly discovered and measures promptly taken 
to correct malnutrition or any other thing that may be 
responsible for the disturbance. Very often a child's 
illness is the result of mouth-breathing due to stoppage 
of the nose by adenoids or the throat by enlarged or 
diseased tonsils. These obstructions are a menace to 
the health of the child, because they do not permit of 
the free breathing of pure air and poison is being con- 
stantly poured into the blood-stream, which weakens and 
retards proper physical development. Immediate cor- THE HAPPY BABY 
109 
rection of these conditions is of the very highest impor- 
tance. They cause a narrowing of the jaw, so that there 
is not sufficient room to accommodate the second teeth. 
CROWDING OF TEETH 
Where there is any observable crowding of the baby 
teeth before the age of five, the dentist should be con- 
sulted and appliances inserted to spread the jaws to make 
more space for the permanent teeth. Early attention 
will save the child much pain and annoyance and the 
parent considerable expense. Much harm results from 
narrow jaws and crooked teeth. The difficulty of keep- 
ing irregular teeth clean and preventing decay is very 
great. A narrow jaw does not provide sufficient room 
for the second teeth and often results in considerable 
facial deformity. Many children have ugly mouths and 
unattractive faces which could have been prevented or 
improved by early treatment. 
Cavities in baby teeth should receive immediate atten- 
tion and some filling material inserted that will arrest 
decay. Through carelessness and neglect this very impor- 
tant measure is not always taken, and as a result the 
child suffers much pain and discomfort. The teeth break 
down rapidly and soon the nerve of the tooth becomes 
inflamed and dies. Many times the jaws and face will 
become swollen and abscesses form. In many cases, 
if prompt relief is not given, the pus breaks through the 
cheek, leaving a permanent scar and depression in the 
face as a result. Parents should be cautioned against 
the use of a hot-water bag, poultice or heat applied in 110 
THE HAPPY BABY 
any manner to the outside of the face. When there 
is evidence of pain, inflammation and swelling, a cold 
pack or compress should be applied outside the mouth 
and every effort made. to keep the pus from breaking 
through the skin. No time should be lost in removing 
diseased teeth. 
GUM-BOILS AND ABSCESSES 
No gum-boil, abscess of any kind or diseased roots 
of teeth should be permitted to remain. Their prompt 
removal is essential to the physicial well-being of the 
child and as a protection to the germs of the permanent 
teeth that are formed at the root-ends of the baby teeth. 
There should be little fear or dread of extraction, as the 
operation is practically painless with .the modern methods 
now employed. There should never be any temporiz- 
ing with diseased mouth or tooth conditions of any form 
or nature. Prompt measures should be taken for the 
removal of any tooth that can not be made healthy and 
useful. A mouth is much better without teeth than 
with diseased ones that are a menace to the health and 
that frequently cause much trouble in remote parts of 
the body. 
If teeth are not kept in good condition, food can not 
be properly masticated. Many foods are prepared for 
digestion in the mouth by thoroughly chewing and mixing 
with the saliva. Improperly masticated foods do not 
assimilate and lose much of their nutritional value. 
Unless there is proper assimilation there can not be good 
health. If the young child is to grow good, strong teeth, THE HAPPY BABY 
111 
the diet should consist of simple and wholesome food. 
Some coarse, hard foods should be provided, which will 
require the child to exercise the jaws and muscles and 
thereby produce a healthier and higher state of 
development. 
USE OF SWEETS 
The use of sugar and sweets to any considerable degree 
should be discouraged. There is usually a sufficient 
amount of sugar in the ordinary foods and fruits to 
satisfy the demands of the body. Excessive use of 
sugar also produces an abnormal demand for the high 
seasoning of foods generally. When taken in large quan- 
tities, it interferes with the processes of digestion. 
Candy is usually given to young children between meals 
to quiet and satisfy them. It is a most pernicious cus- 
tom and does real harm to even a robust child. It has 
practically no food value and takes away the child's ap- 
petite for good and nutritious food. The stomach is in 
need of rest quite as much as any other organ of the body. 
That simple reason alone should be sufficient to convince 
any parent of the unwisdom of permitting such a habit. 
If you would have your child's permanent teeth sound 
and strong, give him a clean mouth, plenty of fresh air 
and nutritious food. 
THE RELATION OF PERMANENT TEETH TO 
GENERAL HEALTH 
The problem of greatest significance in health work 112 
THE HAPPY BABY 
to-day is the education of the public to a proper appre- 
ciation of the benefits to be derived from the mainten- 
ance of a clean and healthy mouth. The wisdom of early 
attention to insure proper mouth condition is recognized 
by leading medical and dental authorities. Infected and 
decayed teeth, abscesses about the mouth and diseased 
tonsils are causes that produce disturbances in various 
parts of the body. It is a well-known fact that the mouth 
is the portal of entry and the breeding-place of various 
forms of bacteria that are liable to cause systemic dis- 
orders of a serious character. Eye and nose infections, 
rheumatism, anemia, inflammation of the glands, heart 
disease, disorders of the liver and kidneys and many 
other complaints are frequently caused by germs of 
disease which have their origin in unclean mouths. 
It is quite probable that appendicitis, ulcers of the 
stomach and other abdominal lesions may be the 
direct result of infections which might have been 
prevented by proper attention to the oral cav- 
ity. 
Dental diseases often impair the health and vitality of 
the child, and because of this weakened state there is an 
interference with intellectual and physical development. 
A child who is ill is more likely to contract contagious 
diseases and can not keep up with school work. Ex- 
tremely nervous children, those with irritable dispositions 
who are difficult to manage in school, are in many in- 
stances greatly relieved and improved by the removal 
of nerve irritation caused by infection in the mouth and 
from aching and decayed teeth. THE HAPPY BABY 
113 
THE COMING OF SECOND TEETH 
While it is most essential to properly care for the tem- 
porary teeth, the period from the sixth to the twelfth 
year, when the permanent teeth are being erupted, is 
the time when most careful and watchful attention should 
be given. Mistakes made at this time are liable to cause 
trouble and discomfort. Probably the most important 
tooth of the permanent set is the sixth-year molar-the 
one which, through ignorance and neglect, is more fre- 
quently lost than any other. This tooth does not take 
the place of any baby tooth, but erupts just back of the 
last double tooth of the temporary set. It is, therefore, 
often confused with, and regarded as, one of the first 
teeth. 
The sixth-year molar may be regarded as the keystone 
to the arch, and its loss is liable to cause an endless 
amount of trouble, principally in the contraction and 
narrowing of the jaw so that there is not sufficient space 
for the other permanent teeth to come in in regular order. 
This tooth is also most important for masticating pur- 
poses, being larger than any other molar. As soon as this 
tooth is erupted, the child should be taken to the dentist 
and serrations, or crevices in the top, filled with copper 
cement or treated with nitrate of silver to protect it from 
decay. The same practise should be followed when the 
bicuspids erupt between the ninth and eleventh years 
and the second permanent molar about the twelfth year. 
If this practise is observed and cavities in other teeth 
attended to promptly until the child is sixteen years of 114 
THE HAPPY BABY 
age, there is very little liability of trouble from tooth 
decay after that time, barring some unusual conditions, 
the result of continued illness or physical breaking down 
■-providing, always, that the teeth are regularly brushed 
and kept clean. 
MALFORMATIONS 
Without doubt some of the most distressing conditions 
are malformations of the jaws and irregular and crooked 
teeth. The causes are many and various-thumb- 
sucking, narrowing of the jaws due to mouth-breathing, 
the result of enlarged tonsils and adenoids, premature 
loss of the sixth-year molar and other temporary teeth, 
and heredity. It is possible now to correct, with the aid 
of modern dental appliances, every case of overshot or 
undershot jaws, or irregular teeth of any kind, so that 
the face may be made normal in appearance and the 
teeth regular and serviceable. When any of these condi- 
tions are observed, the dentist should be consulted and 
no time lost in following his advice. Probably the best 
period for the straightening of crooked teeth and the 
remaking of faces is between the ages of twelve and 
sixteen. Most astonishing and wonderful results can be 
obtained and many otherwise ugly and unattractive faces 
made attractive and beautiful. There is probably no 
service that the dentist renders that is more appreciated, 
nor one which adds so much to the comfort and happiness 
of both the parent and child, as the beautifying of the 
face by regular arrangement of teeth where there is any 
considerable facial deformity due to this cause. THE HAPPY BABY 
115 
There are few habits more injurious or harmful to the 
teeth and jaws than the cracking of nuts with the teeth, 
biting threads and chewing the ends of pencils and pen- 
holders. Very frequently teeth will be weakened, split 
and broken. The enamel and dentine will be cracked 
and leave openings for the lodgment of germs of decay. 
As the person becomes more mature, teeth are liable to be 
forced apart, leaving pockets for food to collect and 
decompose, resulting in an inflammation of the gums that 
causes a loosening and loss of teeth. These are most 
pernicious, dangerous and unclean habits. 
DEAD AND DISEASED NERVES 
It has become a well-recognized fact that teeth with 
dead and diseased pulps or nerves are a menace to health, 
and many obscure troubles are cured by their treatment 
and removal. This has led to wholesale extraction. It 
has been the practice of physicians to send patients to 
professional X-ray photographers to have pictures of the 
roots of the teeth taken and upon the photographer's 
interpretation of the photograph they have ordered the 
extraction of many teeth that were not the cause of the 
trouble. There are filled dead teeth that have rendered 
years of valuable service and are in no way responsible for 
systemic disturbances, and the needless extraction of 
teeth necessary to proper mastication and the maintenance 
of good facial appearance should not be permitted. The 
final interpretation of X-ray photographs of the teeth 
should not be left to a professional photographer. Often 
a darkened area or shadow in a picture does not indicate 116 
THE HAPPY BABY 
the real condition. Competent as many physicians are to 
read X-ray photographs, they should not order extraction 
of teeth until after a conference and a discussion of the 
individual cases with the family dentist. 
Every reliable dentist keeps accurate records and charts 
of operations that will be found of much value in deter- 
mining a proper course of procedure. There should be a 
closer cooperation between the physician and dentist. 
Without cooperation and a good understanding a 
tremendous amount of harm will result and many valuable 
teeth be needlessly sacrificed. No conscientious dentist 
will risk the health of his patient by permitting diseased 
or decayed roots or teeth to remain in the mouth, and he 
should be trusted to make a final decision in disputed 
cases. There is no doubt but that the extraction of teeth 
often relieves or cures many ills, but that is not a sufficient 
reason for their removal until a careful diagnosis and an 
examination of the history of each case is made. 
Susceptibility to colds, intestinal troubles, heart lesions, 
sore throat and many other ailments are often relieved by 
tooth extraction, but because that may be so it is not a 
sufficient warrant for the hasty and ruthless extraction of 
every suspected tooth. 
HARELIP AND CLEFT PALATE 
Some of the most distressing of physical deformities 
are cases of harelip and cleft palate. If the child can 
be operated upon during the first few months after birth, 
really wonderful results may be obtained with little or no 
scar on the lip, as is the case when the operation is THE HAPPY BABY 
117 
performed later. Occasionally cleft palate occurs without 
the harelip. Many times parents, through ignorance or 
lack of observation, do not discover the defect until 
the time when the child should begin to talk. The open- 
ing through the palate and into the nose prevents the 
child from using the muscles necessary for proper articula- 
tion. The attempt of young children with this affliction 
to make themselves understood or to talk as normal 
children do is most distressing and painful to themselves 
and their parents. No cases of oral defects arouse more 
genuine sympathy or demand a higher degree of skill in 
their correction. There are many persons with cleft 
palate who are not aware that relief may be obtained 
by the insertion of a mechanical appliance. Most satis- 
factory results are gained by wearing a plate, or obturator, 
which provides an artificial roof and palate and closes the 
opening. With strict attention given to articulation and 
enunciation, the speech soon improves and often becomes 
practically normal. 
The skill of the present-day dentists has been developed 
to a very high degree. Appliances of various kinds can 
be supplied that will be comfortable, useful and satis- 
factory in appearance. It is desirable to retain as many 
healthy teeth as possible as a means of attachment for 
bridges. Very satisfactory results, however, are obtained 
by the use of partial plates and removable bridges. It is 
often much more desirable to use substitutes that may 
be removed for cleansing purposes than fixed attachments 
about which food may lodge and cause inflammation of 
the gums and an unsanitary condition. The use of plates 
should be avoided as long as possible, but when they 118 
THE HAPPY BABY 
become necessary little time should be lost in obtaining 
them, both for the purpose of improving the personal 
appearance and providing effective means for masticating. 
Constant watchfulness and care of the mouth are vitally 
necessary at all times if the natural teeth are to be 
preserved. Tartar forms about the roots in large and in- 
creasing quantities after maturity. Fillings, crowns and 
repair work of various kinds are more generally needed 
between the ages of sixteen and forty. After that time 
there is usually not so much work of this nature necessary, 
but another danger presents itself; the danger from pyor- 
rhea, or Riggs's disease, due to an inflammation of the 
membrane surrounding the roots, and which, if not 
promptly checked, results in a loosening and loss of the 
teeth. 
PYORRHEA OR RIGGS'S DISEASE 
There is much speculation about the cause of pyorrhea 
and many theories of treatment for its cure advocated. 
It may be said without fear of contradiction that pyorrhea 
will not be found in a mouth where strict attention has 
been given to proper cleaning and care of the teeth. 
There are no medicines that will cure pyorrhea. The 
dentist, by removing deposits and polishing the roots and 
restoring normal articulation, can with the cooperation of 
the patient, cure the trouble when taken in time. If, 
however, the teeth have become badly loosened and there 
is a general weakened physical condition, their prompt 
removal is imperative before others become affected. 
Pyorrhea is primarily a disease of neglect, due to a lack 
of observance on the part of the patient of ordinary pre- THE HAPPY BABY 
119 
cautions for keeping the mouth clean and not infrequently 
unskilful dental service. 
Cancer of the lips and tongue frequently results from 
the irritation caused by the sharp edges of roots, teeth, 
and artificial appliances. Broken or roughened and 
ragged teeth should not be permitted to remain; there is 
much danger of irritation to the mucous lining of the 
mouth, and particularly the tongue. Sores, swellings, 
tumors or any points of irritation about the lips and mouth 
should receive immediate attention from the dentist or 
oral surgeon. 
IMPORTANCE OF GOOD DENTISTRY 
It is necessary for the preservation of the teeth and 
the maintenance of healthy mouth conditions that the 
teeth and gums should be properly and regularly brushed, 
particularly after meals. Silk floss should be drawn be- 
tween the teeth and all particles of food removed. 
Regular visits should be made to the dentist for prophy- 
lactic treatment or tooth-cleaning work. 
There is probably no poorer investment than bad 
dentistry. The monetary waste is the least of the result- 
ing ills. Poor and unsatisfactory dental work is a menace 
to the health and comfort of the individual. Imperfect 
and leaky fillings, badly fitting crowns and bridges hasten 
the process of decay and cause a breaking down and loss 
of the teeth. Gold caps on front teeth are unsightly and 
in most cases unsanitary. There is little or no reason 
to justify this disfigurement. Dentists advertising low 
prices and claiming unusual skill or knowledge should be 
avoided. Honest, skilful and reliable professional men 120 
THE HAPPY BABY 
do not need to appeal for patronage by pretending to do 
impossible things; conscientious and honest service is the 
true professional man's best recommendation. In all 
matters having to do with the well-being of the individual, 
only those medical men and dentists should be employed 
who are known to be well educated and skilful in their 
specialties. To do otherwise would be taking a risk which 
is not justified and might prove to be exceedingly harmful. 
THE END