Hygiene

 Personal aspects of hygiene involve considerations of food, water, exercise, work, sleep, cleanliness and care of some vulnerable parts and vulnerable functions of the body. Question of breast-feeding and feeding of kids have been discussed elsewhere in this book. Some other items of importance for children are dealt with in this chapter.

Food Preparation and Consumption

Food which has not been cooked on fire has great importance for the health of the child. Cooking plays havoc with enzymes and some vitamins and minerals. For consumption of the children, the food has to be softened or mashed and that may require cooking in some cases. This cooking should preferably be done in earthenware or stoneware utensils. Enamelled vessels come next. Brass or copper vessels which have been properly tinned may be a good third. Keep food preparing surfaces clean. Keep it away from flies, rats and animals. Steaming, boiling or baking are acceptable forms of cooking. Roasting is bad, if the colour of the roasted thing changes. Frying is the worst. Cut the food just before cooking. Cook for the shortest time possible but cook thoroughly using a tight fitting lid. The cooked food should preferably go directly from the fire to the table. The strategy should be never to leave the food at temperatures between 5C (41F) and 63C (195F) when harmful bacterial can multiply rapidly, for more than 90 minutes at a time. The food should either be kept heated or kept cooled.

While reheating the food, temperature of more than 75oC (167oF) must be reached to ensure that all harmful bacteria are killed. Use turmeric (haldi) in the child's food after he is one year old. It has many curative properties.

Spend some time in preparing the child for eating. Clean him. Change the napkin after he has been handled for urinating and bowel movement. Wash his face and hands. This routine should be so fixed that once you start with it, the child fells that all this is prelude to feeding. He gets ready for that and starts looking forward to it. Thereafter play with the child for a few minutes in such a way that both of you are laughing and giggling. That is the best time to start feeding him. That will draw the best quality milk from your breasts and that will be absorbed and wonderfully by the baby.

Clean Water

Many diseases are water borne. For continuing in good health it is necessary to have a plentiful supply of safe piped water from a tube-well or a deep hand-pump. Water provides no calories or vitamin but it is very important for the working of the body. A child should drink water between meals in hot weather. Most foods have lot of water in their composition and the child gets most of his water needs in milk etc. But if the child shows need for water then do give him as much as he wants. Water should be boiled for 5 minutes and kept in a sterilized bottle for the baby's use. There is no harm letting children drink all that they feel like drinking.

Where safe water supply is not available and the water has to be drawn from a well, that well should be covered. The mouth of the well should have a cemented apron sloping outwards with a pucca drain carrying the spilt water to some distance for disposal. Animals should be kept away from that source of drinking water. No latrines or soak pits should be allowed near that source. The buckets and ropes for drawing water should be clean e.g. by hanging up buckets rather than putting them on the ground. The home containers of water must be kept clean. Water should be taken out of those containers with a clean ladle or cup. No body should be allowed to put his hands into the container or to drink directly from it. Keep animals out of the house.

It is important that all water drawn from a source other than a safe piped supply should be boiled for about 5 minutes to kill all germs. It should be cooled before drinking. This is very necessary in case of children whose immune system is not yet well developed. If boiling is not possible, store drinking water in a covered container of clean plastic or glass and leave it standing in sunlight for two days before using it.

Environmental Hygiene

Unsafe disposal of faces is one of the major causes of spread of disease. Many illnesses are caused by those very germs which are found in faeces. These germs get into water, into food, utensils and to the surfaces used for preparing food. Latrines should be built and used. If it is not possible to use a proper latrine, people should defecate at designated places away from habitation, paths, play grounds and sources of water supply. After defecating, the faces should be buried right at that very place. So the place for defecating should be so selected that the burial of faeces can be effected right at that place. The faeces of babies and children have as many dangerous germs as the faeces of adults. If children defecate at unusual places, the faeces should be cleared up immediately and either buried or put down in the lartrine. Latrines should be cleaned regularly and kept covered and clean. The faeces of animals should also be kept away from houses and water sources. In case of ?gobar' of the cattle it should be either used in the gas plant or in a manure pit duly covered by earth or made into cakes for fuel use at a secluded place.

Wash your hands with soap and water every time they are used or become dirty. Dirt brings germs onto the hands and via the hands get into the food and the mouth. It is especially important to wash hands with soap after defecated. In villages if soap is not available, people take some earth and rub on their hands and wash the same with water. That does not serve the purpose because the earth used has lot of germs. If soap is not available then only alternative thing that can be used for cleaning the hands is the ashes of burnt wood unmixed with the neighbouring earth.

Children put their hands into their mouths quite often. So it is important to wash a child's hands often especially before giving him food. A child's face should be washed every time he makes it dirty. This helps to keep flies away from the face and prevent eye infections. Soap may be used for such a cleaning of the face but not too often.

Household refuse is a great source of spreading infection . Food scraps and peelings from fruit and vegetables attract the flies and the flies spread the germs. Every family should have a special pit where household refuse is buried or burnt every day if there is no arrangement for collection and removal of such refuse by the municipality or the local body concerned.

Exercise

Baby after he learns to focus on distant objects also, is always on the move. Even before be can crawl he has worked out his own highly individual way of morning round. Never discourage him from his first attempts at being mobile. Give his curiosity and spirit of adventure free rein. He needs your praise and support to go ahead. At about one year, with strength coming to his leg muscles, he would start attempts to stand and then to move with standing support and ultimately to walk. He is continuously making greater efforts. These efforts provide adequate exercise to that lump of flesh and bones, that he is. Still you can encourage your baby's physical development from a very early age by playing simple exercise games. Foe example let the baby lie on his back. He may be encouraged to hold your thumbs. Stretch one arm to the sides and then back across his chest and repeat. The bay will be happy if he can see you doing that and follows your movements. Such movements create a subconscious impression also on the psyche of the baby that there is something like exercise in which movements of the limbs are appreciated and help the body.

Baby Massage

Massage is a delightful activity which interests almost all babies intensely. Massage of the baby has all those benefits that it has for adults. It is one of the most intimate ways of showing your love for the baby. Massage is often a very effective way to calm an excited toddler.

Body massage improves blood circulation to all parts of the body and eliminates the unwanted toxic matter of the body tissues. Massage helps the body to heal itself. Evidence suggests that massage is beneficial to a baby's health and well-being. Dr. Yehudi Gordon, an eminent obstetrician, believes that massage helps to reduce colic, constipation, diarrhoea, coughs, colds and irritability.

Use a light vegetable oil such as sunflower oil or almond oil etc. Avoid such baby oils which are mineral oils and so are not easily absorbed by the skin.

There are no special techniques or sequences for massaging a baby. Just do what comes naturally and you will soon find out what your baby likes the most. Keep your movements smooth, slow and gentle. Glide hands lightly across his tummy in a criss-cross motion. Stroke clockwise in a circle round the navel for colic and stomach aches. Stroke and squeeze arms and legs working from his thighs down to the knees and around to his calves and ankles. Gently massage his neck from his ears to his shoulders and from his chin to his chest.

Massage not only soothes an unsettled baby, it can help calm your nerves as well. Babies need touch. Research has shown that a baby would rather be stroked than fed.

Bed Wetting

Bed wetting at night can happen to a child of any age and is very common in children upto the age of five. Boys are more prone. Most children grow out of this by that age without any special help. Be sure that the child's embarrassment about such an accident is not acute. He should, therefore, be not threatened or put to shame. No fuss should be made of the accident. Instead express confidence that he will soon be staying dry again. Child should feel that he has full parental support in this matter. Offer praise when the child has a dry night.

Parents should require the child to urinate before he goes to bed and also be woken and asked to urinate when the parents go to bed. He should not be taken for urination half awake. He should be told that the next time for urination is the next morning on waking. If a bed side pot is necessary, it should be purchased when the child is also present. Subtle effort is needed to prevent him from feeling guilty. Keep him is drapers till he is ready to stay dry.

There should be a couple of discussions between the child and the parents on the subject. Your tone and attitude should express lack of anxiety. Do not scold or draw his attention to any accident. Do not compare him with others of his age. Be sympathetic.

Bathe the child before going to bed in a bath with some epsom salts added to the water. This will relax him, settle his nerves and draw off some acidity. This may, in due course, ensure a dry bed. A few trials may help you to decide how to proceed further in this behalf.

Thumb Sucking

Where the babies have not had enough sucking at the breast or bottle to satisfy their sucking needs, they take to thumb sucking. This sucking helps babies relieve physical and emotional tension. When a toddler gets too excited and needs to calm down, he starts thumb sucking. Dr. David Levy has pointed out that babies who are fed every three hours do not suck their thumbs as much as babies fed every four hours. When babies learn new skills such as sitting up, crawling or walking, thumb sucking would increase during the frustrating learning period and decrease when the new skills are actually learnt. The thumb sucking could increase to as much as four hours a day.

The sucking need is the strongest in the first three months. From then on it tapers off. When sucking continues after six months, it is for comforting and not an expression of sucking needs. Thumb sucking is generally given up by 6 years of age. But in one case known to the writer, thumb sucking continued till his death at age 70 years. As a practising lawyer he was sucking his thumb when he was not arguing.

One can worry about the effect of thumb sucking on the baby's jaws and teeth. But it seems nothing much can be done to prevent it. It may be a mistake to try to deprive a child of thumb sucking in infancy. Parents should not use elbow splints nor apply bad tasting liquids on the thumb. Thumb sucking does not harm any other parts of the baby.

Eyesight

A baby sometimes cannot open his eyes right away because the normal pressure on his head during birth has caused puffiness. That pressure may have also damaged some tiny blood vessels in his eyes. Both these conditions are absolutely harmless, require no treatment and will correct themselves.

On birth the child can focus his eyes clearly upto a distance of 20-25 cms only. Beyond that on birth, he cannot focus both his eyes at the same time. He may look to be cross eyed. Both of these conditions clear up as his eye muscles develop within a few months and his vision improves rapidly.

The eyes are bathed constantly by a steady flow of tears, not just when the baby is crying. This is why it is unnecessary to put any drops in the eyes while they are healthy. The tear ducts may be blocked and no tears be shed for the first few weeks. Usually blocked duct will clear by itself. You can help by keeping the eye clean.

A mild but chronic infection of the eye lids, most commonly in one eye, may develop. The eye waters and tears excessively. White matter collects in the corner of the eye and along the edges of the eye lids. The discharge may keep the lids stuck together on waking up. This condition is also caused by an obstructed tear duct. It is fairly common, is not serious and does not injure the eye. It may last for a few months but the baby will grow out of it. When the lids are stuck together, soften the crust and open them gently by applying water with your fingers or with a clean wash cloth. A fit of gentle massage could also be given. If the duct does not get cleared even after 4 or 5 months, consult a doctor.

Cases of squints, conjunctivitis and subsisting cross eye should also be shown to a doctor. Baby is born with capacity of eyes to focus upto 20-25 cms only and can manage to focus upto a reasonable distance by eight weeks and by three or four months he can take in more details and build up a three dimensional picture of the world. This enables him to move about without facing danger. His eye for details improves and by 5 or 6 months he can discriminate between different facial expressions and respond accordingly.

Development of normal vision requires plenty of visual stimulation. The parents have to provide this by taking the baby out for sight-seeing. If he is in a stroller, he will be able to look all around him and enjoy the fascination of the unfolding world. This unfolding world will make lasting impressions on his young mind about the beauty of nature and the effect of the environment.

Teething

Generally teething starts at around six months. These primary milk teeth are important as they guide the adult teeth to grow in correct positions. There is no standard time for the baby's teeth to erupt. It would be interesting for you to know that both Julius Caeser and Napolean were born with teeth. If a baby is born with a tooth that should be removed. With the first tooth at six months, the molars are there by 2 ½ years and teething finishes with wisdom teeth coming in at age 20 or thereabout.

Baby would be irritable when a tooth erupts. He will generally have fever, vomiting and even diarrhoea. The gums will be red and swollen. The tooth can be felt through the gum. His cheeks may also be red and he is likely to drool, excessively. Other symptoms of teething are increased thumb sucking, gum rubbing, poor appetite and wakefulness. A small cooled carrot or a piece of hard toast may be given to the baby to chew on. This will make teething less painful. Massage his painful gums with finger tips.

Baby teeth begin to fall out when he is 5 to 6 years of age. The first permanent teeth also start appearing at 6 years of age. Breasts fed generally have healthier teeth because of the nature of mothers milk and the natural rinsing action during breast feeding.

For good dental health, it is important that the child eats right foods in a right manner. By giving sweet foods in between meals increases the exposure of teeth to harmful acids. Give him sweet foods at the end of a meal instead. Do not give him sticky candy. Cheese given at the end of a meal makes saliva alkaline which counteracts the acid that crodes teeth. Eating candy for hours is bad. According to Dr. Hauks in the Dental Survey, apples have a unique mouth cleansing property. They promote the flow of saliva in the mouth. Use of yogurt, because of its helpful bacteria, is specially beneficial for the teeth. Clove oil has been used for centuries to sooth a toothache.

Avoid giving milk or juice in a bottle at bed time. During sleep less saliva is produced and bacteria can develop in the mouth, producing decay acids that erode the protective enamel of the teeth and the mouth can have rotten teeth as early as three years old. Drinking substantial amounts of sweet fruit juice is another cause of early tooth problems.

It has been established that the crowns of all the baby teeth are formed in the gums before birth. These are, therefore, made from what the mother eats during her pregnancy. Milk and cheese, citrus, tomatoes, cabbage and some sunshine taken by the pregnant mother will help in healthy teething. The baby's permanent teeth are being formed within a few months after birth. Then he is getting plenty of vitamins. Let his food then fortified with vitamins C and D.

Fluoride in the water makes stronger teeth. Principal cause of tooth decay is lactic acid manufactured by bacteria that live on sugars and starches. Sugar of the fruits have a brushing action on the teeth.

Once the molars are through, the child could be encouraged and trained to use a soft small tooth brush for care and protection of the teeth.

Sleep

Shakespeare calls sleep the "Chief nourisher in life's feast.'! Sleep, truly, is more than a restorer. It is a nourisher. It is allied to nutrition. Sleep behaviour in children is genetically inseparable from nutrition. The early association between feeding and sleep is extremely close. The baby feeds to sleep and he wakes to feed, which promptly puts him again to sleep. As he grows older, his sleep becomes more defined. He wakes up more decisively. The child has to learn to sleep in the same manner that he learns to creep, stand or walk or to grasp things. He learns to stay awake and to enjoy it. In the same way, he must "learn" to stay soundly asleep in sizeable stretches.

In the beginning the babies feel comfortable sleeping on their stomachs. The pressure on the abdomen relieves the gas pains of colic etc. It is better this way till he learns to change sides. He should be taught to sleep on side with the help of pillows placed to support him. Sleeping on side, should be his position during the latter life.

In the first month or so, wrap your baby in a blanket or a similar cover, covering his feet and upto the neck before you put him down. Before that give the baby a comfort such from the breast, darken the room at night, stroke his back or limbs to soothe him. In the first few weeks 14 to 20 hours sleep per day is quite normal. By 12 weeks the total sleeping hours may get reduced to about normal. By 12 weeks the total sleeping hours may get reduced to about 14 per day, half of it by the way of sleeping through. By the end of the first year the sleeping hours may be about 12 to 13 including two daytime naps. Adults drift to sleep, babies plummet. Babies sleep and are relatively immune to noise. Little children above 2 years of age have to be taught this social skill of going to sleep. As the child grows, this task of putting to sleep becomes more complex. A shift to crib may not be accomplished with ease. Crib may be acceptable for the day time nap but not for the night. By 16 weeks he has passed through his colic syndrome and probably thumb sucking has set in. At age 2 he relates himself to some one else and calls his mother back on some pretext or the other. At age 3 or 3 ½ he is ready for a change from the crib to the bed.

Most sleep difficulties are man-made rather than child made and arise from over rigid methods of management. For example, the folk lore and folk wisdom say that a child will separate from the mother of his own accord in his fourth year. Until then he is too little and helpless to be expected not to want her at night. You may manage to get this age reduced to 3 years by your manipulations, but if at the age of 1 year you want him to sleep in a separate room, his rebellion is natural. A child of that age cannot "learn independence" just by being put in a room by himself. You are thus making him feel unsecure and unwanted throughout his life. This is an important issue. Bring a "lovey" for him. Try to establish that lovey as a substitute for the mother and make that lovey inseparable from him. That may help you.

For avoiding the sleep syndrome take action on some of the following suggestions. To keep him active during the day. Reduce his day nap hours. Do not allow any nap after 3 PM. Mother to go to put him to sleep and have a relaxing routine by the bed-side before actually tucking him in.

He is bound to wake you up at night. You would soon know about the hour of his thus waking you up. Wake him at night before he wakes you. Talk to him, hug him, give him the bottle and kiss him good night again. This will have a far reaching and lasting effect on his psyche.

Never take him out of the bed or rock him. Instead soothe and stroke him with your hand. Occasionally substitute your comforting voice for yourself. Reinforce one particular ?lovey' (doll) always, in every way, so that he carries that lovey to bed with him.

Encourage your child to come into your bed for a cuddle in the morning, no such privilege being granted at night before his getting into his own bed. It is a sensible rule not to take a grown child into the parents' bed to sleep for any reason. One exception, acute illness!