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vi BRIEF CONTENTS
Epilogue 507
Looking Ahead…Making a Difference 507
Appendices 509
A National Health Education Standards 510
B Monthly Calendar: Health, Safety, and Nutrition Observances 513
C Federal Food and Nutrition Programs 516
D Children’s Book List 518
E Nutrient Information: Fast-Food Vendor Websites 523
Glossary 524
Index 531
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Contents
UNIT 1 romoting Children’s Health: Healthy Lifestyles

P
and Health Concerns 1
Chapter 1 Children’s Well-Being: What It Digital Download Teacher Checklist 2-1 Health Observation
Checklist 44
Is and How to Achieve It 2 Digital Download Teacher Checklist 2-2 Warning Signs of Potential Mental
1-1 The Preventive Health Concept 3 Health Problems 44
1-1a National Health Initiatives 4 2-3b Recording Observation Results 45
2-3c Confidentiality of Health Information 45
1-2 ealth, Safety, and Nutrition: An Interdependent
H TeachSource Video Connections Communicating with Parents about Health in
Relationship 8 Early Childhood: A Parent-Teacher Meeting 46
1-2a What Is Health? 8 2-3d Benefits of Health Observations 46
1-2b What Factors Influence Children’s Health? 9
1-2c Safety 10 2-4 Family Involvement 47
1-2d Nutrition 11 2-4a The Family’s Responsibility 47
1-3 Children’s Growth and Development 12 2-5 Health Education 48
1-3a Growth 13 Digital Download Partnering With Families Children’s Oral Health 49
TeachSource Video Connections Infancy Brain
Summary 51 Terms to Know 51 Chapter Review 51
Development 14
Case Study 52 Application Activities 52
1-3b Development 15
Helpful Web Resources 53 References 53
1-4 Promoting a Healthy Lifestyle 18
1-4a Injury Prevention 19
1-4b Body Mechanics and Physical Activity 19 Chapter 3 Assessing Children’s
Digital Download Teacher Checklist 1-1 Proper Body Mechanics for Adults 20
1-4c Oral Health 21
Health 54
Digital Download Teacher Checklist 1-2 Promoting Children’s Tooth 3-1 Health Records 55
Brushing 22 3-1a Child Health Histories 56
1-4d Mental Health and Social-Emotional Competence 23 3-1b Medical and Dental Examinations 58
Digital Download Teacher Checklist 1-3 Strategies for Managing Teacher 3-2 Screening Procedures 58
Stress 25 3-2a Height and Weight 58
Digital Download Teacher Checklist 1-4 Strategies for Increasing Children’s 3-2b Body Mass Index 59
Resilient Behaviors 31 3-2c Vision 59
1-4e Resilient Children 31 Digital Download Teacher Checklist 3-1 Early Signs of Visual Abnormalities in
Digital Download Partnering With Families Growing Your Child’s Infants and Toddlers 60
Brain 32 Digital Download Teacher Checklist 3-2 Signs of Visual Acuity Problems in
Summary 34 Terms to Know 34 Chapter Review 34 Older Children 62
Case Study 35 Application Activities 35 TeachSource Video Connections 0–2 Years: Sensation and Perception,
Helpful Web Resources 35 References 36 Vision in Infants and Toddlers 62
3-2d Hearing 64
Digital Download Teacher Checklist 3-3 Behavioral Indicators of Children’s
Chapter 2 Daily Health Observations 38 Hearing Loss 65
2-1 Promoting Children’s Health 40 Digital Download Teacher Checklist 3-4 Early Signs of Hearing Loss in Infants
and Toddlers 65
2-1a Gathering Information 41
3-2e Speech and Language 67
2-2 Observation as a Screening Tool 41 Digital Download Teacher Checklist 3-5 Strategies for Communicating with
2-3 Daily Health Checks 42 Children Who Are Hearing-Impaired 67
2-3a Method 43 3-2f Nutritional Status 70
TeachSource Video Connections Infants and Toddlers: Daily TeachSource Video Connections Students with Special Needs:
Health Checks 43 The Referral and Evaluation Process 74
vii
viii CONTENTS
3-3 Referrals 74 5-4 Control Measures 117

Digital Download Partnering With Families Children’s Eye 5-4a Observations 117
Safety 75 5-4b Policies 118
Summary 77 Terms to Know 77 Chapter Review 78 Digital Download Teacher Checklist 5-1 Administering Medications to
Children 120
Helpful Web Resources 80 References 80 5-4c Immunization 122
5-4d Environmental Control 124
Digital Download Teacher Checklist 5-2 Universal Precautions for Handling
Body Fluids 124
Chapter 4 Caring for Children with Special TeachSource Video Connections Promoting Children’s Health:
Medical Conditions 82 A Focus on Nutrition in Early Childhood Settings 125
4-1 Inclusive Education: Supporting Children’s Digital Download Teacher Checklist 5-3 How and When to Wash
Success 83 Hands 126
Digital Download Teacher Checklist 5-4 Sanitary Diapering
4-2 Common Chronic Diseases and Medical Procedure 127
Conditions 85
Digital Download Teacher Checklist 5-5 Readiness Indicators for Toilet
TeachSource Video Connections Preschool: IEP and Transition Planning Training 127
for a Young Child with Special Needs 85
5-4e Education 129
4-2a Allergic Diseases 86
Digital Download Partnering With Families Giving Children
Digital Download Teacher Checklist 4-1 Cold or Allergy: How Medication 129
to Tell? 87
TeachSource Video Connections Promoting Children’s Health: Case Study 132 Application Activities 132
Teacher Takes Care of Child with Asthma 90
4-2b Asthma 90
Digital Download Teacher Checklist 4-2 Strategies for Managing Children’s
Asthma Attacks 92
4-2c Anemia 92
Chapter 6 Childhood Illnesses:
Digital Download Teacher Checklist 4-3 Children with Allergies and Identification and Management 135
Asthma 92 6-1 Common Communicable Childhood
4-2d Childhood Cancers 94 Illnesses 136
Digital Download Teacher Checklist 4-4 Children with Cancer 95
4-2e Diabetes 96 6-2 Common Acute Childhood Illnesses 145
Digital Download Teacher Checklist 4-5 Children with Diabetes 97 6-2a Colds 145
6-2b Diaper Rash (Diaper Dermatitis) 146
4-2f Eczema 98 6-2c Diarrhea 147
4-2g Excessive Fatigue 98 6-2d Dizziness 148
4-2h Lead Poisoning 99 6-2e Earaches 149
4-2i Seizure Disorders 101 6-2f Fainting 150
Digital Download Teacher Checklist 4-6 Strategies for Working with Children 6-2g Fever 151
Who Have a Seizure Disorder 102 6-2h Headaches 153
Digital Download Teacher Checklist 4-7 Information to Include in a Child’s 6-2i Heat Rash 153
Seizure Report 103 6-2j Lyme Disease 153
4-2j Sickle Cell Disease 104 Digital Download Teacher Checklist 6-1 Measures to Prevent Tick
Bites 154
Digital Download Teacher Checklist 4-8 Children with Sickle Cell
Disease 105 6-2k Sore Throat 154
6-2l Stomachaches 155
Digital Download Partnering With Families Children with Medical Conditions 6-2m Sudden Infant Death Syndrome (SIDS) 155
and Physical Activity 105
Digital Download Teacher Checklist 6-2 Practices to Reduce the Risk of Sudden
Summary 107 Terms to Know 108 Chapter Review 108 Infant Death Syndrome (SIDS) 157
Case Study 109 Application Activities 109 6-2n Teething 158
Helpful Web Resources 109 References 110 TeachSource Video Connections SIDS: Is There a Biological
Cause? 158
6-2o Toothache 158
Chapter 5 The Infectious Process 6-2p Vomiting 159
6-2q West Nile Virus 160
and Environmental Control 112 Digital Download Partnering With Families When to Call the
5-1 Risk Factors 113 Doctor 161
5-2 Communicable Illness 114
5-3 Stages of Illness 116 Helpful Web Resources 165 References 165
CONTENTS ix
UNIT 2 Keeping Children Safe 167
Chapter 7 Creating High-Quality Digital Download Teacher Checklist 8-4 Examples of Appropriate Toy Choices for
Infants, Toddlers, and Preschoolers 215
Environments 168 8-3b Classroom Activities 216
7-1 Identifying High-Quality Programs 169 Digital Download Teacher Checklist 8-5 Guidelines for the Safe Use of Electrical
Appliances 219
7-1a Educating Families 170
7-1b Resource and Referral Services 170 Digital Download Teacher Checklist 8-6 Safe Substitutes for Hazardous Art
7-1c Professional Accreditation 171 Materials 220
7-2 Early Childhood Program Licensure 171 8-3c Field Trips 220
8-3d Pets 221
7-2a Obtaining a License 172
7-2b Federal Regulations 173 Digital Download Teacher Checklist 8-7 Personal Safety Practices for the Home
Visitor 222
7-3 Features of High-Quality Programs 173 8-3e Personal Safety 222
7-3a Teacher Qualifications 173 8-3f Legal Considerations and Safety Management 222
7-3b Staffing Ratios 174 TeachSource Video Connections Preschool: Safety and Emergency Preparedness 223
7-3c Group Size and Composition 175
7-3d Program Curriculum 175 8-4 Emergency and Disaster Preparedness 224
TeachSource Video Connections The Quality of Child 8-4a Planning for Disasters and Emergencies: Where to Begin 225
Care 175 8-4b Preparing for Action 226
7-3e Health Services 176 Digital Download Teacher Checklist 8-8 Emergency Supply Kit 226
Digital Download Teacher Checklist 7-1 Principles of Emergency 8-4c Practice and Revise 227
Preparedness 177 8-4d Helping Children After A Disaster or Emergency 227
7-4 Guidelines for Safe Environments Digital Download Partnering with Families Sun Safety 228
178
7-4a Indoor Safety 179 Summary 230 Terms to Know 230 Chapter Review 230
TeachSource Video Connections Creating a Safe Physical
Environment for Toddlers 179 Helpful Web Resources 232 References 232
Digital Download Teacher Checklist 7-2 Inventory Checklist: Planning for
Program Security 182 Chapter 9 Management of Injuries
Digital Download Teacher Checklist 7-3 How to Conduct a Fire Drill 183
and Acute Illness 235
Digital Download Teacher Checklist 7-4 Teachers’ Safety Checklist: Indoor and
Outdoor Spaces 185
9-1 Responding to Medical Emergencies 236
7-4b Outdoor Safety 188 Digital Download Teacher Checklist 9-1 Basic First Aid Supplies for Schools 237
Digital Download Teacher Checklist 7-5 General Guidelines for Purchasing Digital Download Teacher Checklist 9-2 Modified First Aid Kits 238
Outdoor Play Equipment 191
9-2 Emergency Care vs. First Aid 239
Digital Download Teacher Checklist 7-6 Teacher Checklist: Sandbox Care and
Maintenance 192 9-3 Life-Threatening Conditions 240
7-4c Transportation 193 9-3a Absence of Breathing 240
Digital Download Partnering with Families How to Identify High-Quality Digital Download Teacher Checklist 9-3 Teacher Checklist: Foods Commonly
Programs 196 Linked to Childhood Choking 243
Summary 198 Terms to Know 199 Chapter Review 199 9-3b Foreign Body Airway Obstruction 243
Case Study 200 Application Activities 200 Digital Download Teacher Checklist 9-4 Objects Commonly Linked to Childhood
Helpful Web Resources 201 References 201 Choking 243
9-3c Anaphylaxis: Life-Threatening Allergic Reaction 246
9-3d Shock 246
Chapter 8 Safety Management 203 9-3e
9-3f
Asthma 247
Bleeding 247
8-1 What Is Unintentional Injury? 205 9-3g Diabetes 248
Digital Download Teacher Checklist 9-5 Teacher Checklist: Signs and Symptoms
8-2 Risk Management: Principles and of Hyperglycemia and Hypoglycemia 248
Preventive Measures 208
9-3h Drowning 249
8-2a Advanced Planning 209 9-3i Electrical Shock 250
8-2b Establishing Safety Policies and Guidelines 210 9-3j Head Injuries 250
Digital Download Teacher Checklist 8-1 Guidelines for the Safe Use of Play 9-3k Poisoning 251
Equipment 210 TeachSource Video Connections Working with Children Who Have Physical
8-2c Quality Supervision 211 Disabilities 252
8-2d Safety Education 212
9-4 Non–Life-Threatening Conditions 253
Digital Download Teacher Checklist 8-2 Positive Strategies for Managing
Children’s Inappropriate Behavior 212 9-4a Abrasions, Cuts, and Minor Skin Wounds 253
9-4b Bites 253
8-3 Implementing Safety Practices 213 9-4c Blisters 254
8-3a Toys and Equipment 214 9-4d Bruises 254
Digital Download Teacher Checklist 8-3 Guidelines for Selecting Safe Toys and Digital Download Teacher Checklist 9-6 Teacher Checklist: Burns—When to Call for
Play Equipment 214 Emergency Medical Assistance (911) 255
x CONTENTS
9-4e Burns 255 10-5a Inservice Training 279

9-4f Eye Injuries 256
10-6 Reporting Laws 279
9-4g Fractures 256
9-4h Frostbite and Hypothermia 257 Digital Download Teacher Checklist 10-4 What to Include in a Written Child
9-4i Heat Exhaustion and Heat Stroke 258 Abuse/Neglect Report 280
9-4j Nosebleeds 259 10-6a Program Policy 280
9-4k Seizures 259
9-4l Splinters 259 10-7 The Teacher’s Role 281
9-4m Sprains 260 10-7a Early Identification and Reporting 281
9-4n Tick Bites 260 10-7b Providing a Supportive Environment for Children 282
9-4o Tooth Emergencies 260 10-7c Building Children’s Resilience 283
Digital Download Partnering with Families Poison Prevention in the Home 261 10-7d Reaching Out to Families 284
Summary 262 Terms to Know 263 Chapter Review 263 Digital Download Partnering with Families Anger Management 285
Case Study 264 Application Activities 264 Summary 287 Terms to Know 287 Chapter Review 287
Helpful Web Resources 265 References 265 Case Study 288 Application Activities 289
Chapter 10 Maltreatment of Children: Chapter 11 Planning for Children’s Health

Abuse and Neglect 267 and Safety Education 292
10-1 Historical Developments
11-1 Family Involvement in Health and Safety Education 293
269
11-2 Teacher Inservice in Health and Safety Education 295
10-2 Discipline vs. Punishment 270
11-3 Effective Instructional Design 295
10-3 Abuse and Neglect 270
11-3a Topic Selection 296
Digital Download Teacher Checklist 10-1 Identifying Signs of Abuse and 11-3b Behavioral Objectives 298
Neglect 272 11-3c Content Presentation 298
Digital Download Teacher Checklist 10-2 Identifying Symptoms of Common Digital Download Teacher Checklist 11-1 How to Evaluate Printed Resource
Sexually Transmitted Diseases (STDs) 274 Material 299
11-3d Evaluation 300
10-4 Understanding the Risk Factors for Maltreatment 275
TeachSource Video Connections Preschool: Health and
TeachSource Video Connections 0–2 Years: Observation Module for Infants Nutrition 300
and Toddlers 276
10-4a Characteristics of Abusive or Neglectful Adults 276 11-4 Activity Plans 301
10-4b Vulnerable Children 276 Digital Download Partnering with Families Evaluating Health and Safety
10-4c Family and Environmental Stresses 277 Information on the Internet 315
10-5 Protective Measures for Programs and Teachers 278 Summary 315 Terms to Know 316 Chapter Review 316
Digital Download Teacher Checklist 10-3 Strategies for Positive Behavior Case Study 317 Application Activities 317
Management 278 Helpful Web Resources 318 References 318
UNIT 3 Foods and Nutrients: Basic Concepts319
Chapter 12 Nutrition Guidelines 320 Summary 335 Terms to Know 336 Chapter Review
336
12-1 Dietary Reference Intakes 322 Helpful Web Resources 338 References 338
12-2 Dietary Guidelines for Americans 324 Chapter 13 Nutrients That Provide Energy
12-2a Additional Nutrition Guidelines 325
TeachSource Video Connections Young Children’s Stages of Play: (Carbohydrates, Fats, and Proteins) 339
An Illustrated Guide 326 13-1 Food as an Energy Source 340
12-3 MyPlate 326 13-1a Energy Utilization 341
13-1b Excess Energy and Obesity 343
12-3a Vegetables 327
12-3b Fruits 327 Digital Download Teacher Checklist 13-1 Health Improvement Tips for Children
12-3c Grains 328 Who Are Overweight 343
12-3d Protein Foods 329 TeachSource Video Connections Child Obesity and School
12-3e Dairy 329 Nutrition 343
12-3f Oils 329
12-3g Empty Calories 330 13-2 Carbohydrates as Energy Sources 344
12-4 Food Labels 13-2a Sugars (Simple Carbohydrates) 344
331 13-2b Starches and Dietary Fiber (Complex Carbohydrates) 346
12-4a Calories from Fat 333
13-3 Fats as Energy Sources 347
Digital Download Partnering with Families Children’s Sugar
Consumption 333 13-3a Saturated Fats 348
CONTENTS xi
13-3b Unsaturated Fats 349 14-3c Vitamins That Regulate Bone Growth 366
14-3d Vitamins That Regulate Energy Metabolism 366
13-4 Proteins as Energy Sources 350 14-3e Vitamins That Regulate Neuromuscular Function 367
Digital Download Partnering with Families Healthy Families 351 14-3f Vitamin Requirements 367
Summary 352 Terms to Know 352 Chapter Review 353 TeachSource Video Connections School Age Children: Teaching
Case Study 353 Application Activities 354 about Nutrition 367
Helpful Web Resources 355 References 355 14-4 Minerals 368
14-4a Minerals That Support Growth 368
Chapter 14 Nutrients That Promote Growth 14-4b Minerals That Build Bones and Teeth 370
14-4c Minerals and Blood Formation 370
and Regulate Body Functions 356 14-4d Minerals That Regulate Energy 371
14-1 Children and At-Risk Nutrients 358 14-4e Minerals That Regulate Neuromuscular Function 371
14-5 Water and Growth 371
14-2 Proteins 359
14-5a Water as a Regulator 372
14-2a Proteins for Growth 359
Digital Download Teacher Checklist 14-1 Non-animal Food Sources of Essential 14-6 Nutrient Functions: A Recap 373
Nutrients 361 Digital Download Partnering with Families Sugary Drinks vs. Water: A Weighty
14-2b Proteins as Regulators 361 Problem 374
14-2c Protein Requirements 361 Summary 375 Terms to Know 376 Chapter Review 376
14-3 Vitamins 363 Case Study 377 Application Activities 377
14-3a Vitamins that Support Growth 363 Helpful Web Resources 378 References 378
14-3b Vitamins and Blood Formation 366
UNIT 4 Nutrition and the Young Child 379
Chapter 15 Feeding Infants 380 15-5f

15-5g
Ear Infection 397
Obesity 397
15-1 Profile of an Infant 381 15-5h Choking 397
Digital Download Teacher Checklist 15-1 Recommended Infant Serving 15-5i Teething 398
Sizes 382 15-5j Constipation 398
Digital Download Partnering with Families Feeding Your Infant 398
15-2 Meeting the Infant’s Nutritional Needs for Growth and Summary 400 Terms to Know 400 Chapter Review 400
Brain Development 382 Case Study 401 Application Activities 401
15-2a P renatal Influence on Infants’ Nutritional Needs and Brain Helpful Web Resources 401 References 402
Development 383
15-2b The First 6 Months 384
15-2c The Teacher and the Breastfeeding Mother 385
Chapter 16 Feeding Toddlers and Young
Digital Download Teacher Checklist 15-2 Supporting the Nursing Children 404
Mother 386 16-1 Developmental Profiles: Toddlers, Preschoolers, and
15-2d The Teacher and the Formula-Fed Infant 386 School-Aged Children 405
Digital Download Teacher Checklist 15-3 Thawing Frozen Breast Milk
Safely 386 16-2 The Challenges of Feeding Toddlers 407
15-2e Preparation of Formula 387 16-2a What Foods Should Be Served and How Much 407
TeachSource Video Connections Infants and Toddlers: Health and Digital Download Teacher Checklist 16-1 Recommended Daily Food Group
Nutrition 387 Intakes 408
16-2b When to Serve Food 410
15-3 Feeding Time for the Infant 388 16-2c Making Mealtime Comfortable, Pleasant, and Safe 410
15-3a Burping 389
16-3 The Challenges of Feeding Preschoolers
15-3b Water 390
15-3c Supplements 390 and School-Age Children 411
16-3a Guidelines for Feeding the Preschooler 412
15-4 Introducing Semi-Solid (Pureed) Foods 391 16-3b Nutrient Needs of School-Aged Children 412
15-4a Developmental Readiness 391 16-3c Feeding Children with Special Needs 413
Digital Download Teacher Checklist 15-4 Age-Related Infant Eating 16-4 Healthy Eating Habits
Behaviors 392
414
15-4b Physiological Readiness 392 Digital Download Teacher Checklist 16-2 Introducing New or Unfamiliar Foods 414
15-4c Infants with Special Needs 394 16-5 Health Problems Related to Eating Patterns 416
15-5 Common Feeding Concerns 395 16-5a Dental Caries 416
15-5a Food Allergies 395 16-5b Obesity 416
15-5b Colic 395 16-5c Hypertension 417
15-5c Vomiting and Diarrhea 396 TeachSource Video Connections Technology and Media Use by Children and
15-5d Anemia 396 Adolescents 418
15-5e Baby Bottle Tooth Decay 396 16-5d Cardiovascular Disease 418
xii CONTENTS
16-5e Diabetes 418 Digital Download Teacher Checklist 18-1 Correct hand washing
16-5f Common Feeding Behaviors and Concerns 419 technique 460
Digital Download Partnering with Families Feeding Toddlers and Young 18-2c Separate Foods 462
Children 421 Digital Download Teacher Checklist 18-2 Checklist for evaluating sanitary
Summary 422 Terms to Know 423 Chapter Review 423 conditions in food service areas 463
Case Study 424 Application Activities 424 18-2d Food Storage 467
Helpful Web Resources 424 References 425 18-2e Cook and Serve Foods Correctly 468
TeachSource Video Connections Promoting Children’s Health: A Focus
on Nutrition in an Early Childhood Setting 470
Chapter 17 Planning and Serving 18-2f Discard Spoiled Food 470
Nutritious and Economical Meals 426 18-3 Hazard Analysis and Critical Control Point 470
17-1 Developing the Menu 427 18-4 Food-Borne Illnesses 473
17-1a A Well-Designed Menu Meets Children’s Nutritional Needs 428
17-1b
A Well-Designed Menu Meets Funding and/or Licensing 18-5 National and International Food Supply
Requirements 429 Safeguards 477
17-1c A Well-Designed Menu Is Appealing 437 18-5a Commercial Food Production 477
17-1d A Well-Designed Menu Includes Familiar and New Foods 437 Digital Download Partnering with Families Wash Those
17-1e Steps in Menu Planning 439 Hands! 479
17-2 Writing Menus 442 Summary 480 Terms to Know 481 Chapter Review 481
17-3 Nutritious Snacks 442
17-3a Suitable Snack Foods 443
17-4 Meal Service 444
Digital Download Teacher Checklist 17-1 Making Mealtime a Pleasant
Chapter 19 Nutrition Education: Rationale,
Experience 445 Concepts, and Lessons 484
17-5 Planning the Menu within Budget 446 19-1 Rationale for Teaching Children About Nutrition 485
17-5a Menu Planning 446 19-1a The Role of Schools in Children’s Nutrition Education 487
17-5b Food Purchasing 446 19-1b Family Involvement in Children’s Nutrition Education 488
17-5c Food Preparation 447 19-2 Planning a Nutrition Education Program
17-5d Food Service 447
17-5e Recordkeeping 447 for Children 488
TeachSource Video Connections School Age: Cooking Activities 447
19-2a Basic Nutrition Education Concepts 489
19-2b Planning Guidelines 490
Digital Download Partnering with Families Planning Healthy TeachSource Video Connections Preschool: Cooking Activities 492
Meals 448
19-2c Safety Considerations 492
Case Study 451 Application Activities 451 19-3 Developing Lesson Plans for Nutrition Activities 494
Helpful Web Resources 452 References 452 19-4 Where Else Do Children Learn About Nutrition? 500
19-4a Family Influence 500
19-4b Teachers 501
Chapter 18 Food Safety 454 19-4c Peer Groups 502
18-1 Food-Related Illness 455 19-4d Television and the Media 502
18-1a Food-Borne Contaminants 456 Digital Download Partnering with Families More Fruits and Vegetables
18-1b Conditions That Promote Bacterial Growth 456 Please 503
18-2 Measures to Keep Food Safe 457 Summary 504 Terms to Know 504 Chapter Review 504
18-2a Examine Food Carefully 459
18-2b Maintain Clean Conditions 459 Helpful Web Resources 505 References 506
CONTENTS xiii
Epilogue 507
Looking Ahead…Making a Difference 507
Appendices 509
A National Health Education Standards 510
B Monthly Calendar: Health, Safety, and Nutrition Observances 513
C Federal Food and Nutrition Programs 516
D Children’s Book List 518
E Nutrient Information: Fast-Food Vendor Websites 523
Glossary 524
Index 531
xiv PREFACE
Preface
Children’s state of wellness has an unquestionable effect on their development and ability to
learn. Our understanding of the factors that shape and influence a child’s well-being, including
nutrition, environmental conditions, and emotional and social health, continues to improve as a
result of ongoing research. In turn, this information has led to noteworthy changes in our views
about health, approaches to health care, and the critical importance of addressing health educa-
tion during the early years. It has also contributed to the development of numerous resources
(e.g., National Health Education Standards, MyPlate, Healthy People 2020, NAEYC’s Standards
for Early Childhood Professional Preparation, National Health and Safety Performance Stan-
dards for Child Care) that currently guide personal and classroom practices. Additionally, our
knowledge of wellness and the importance of promoting healthy lifestyle behaviors draw increas-
ing attention to the pivotal role teachers play in identifying children’s health needs, creating high-
quality environments that are safe and support learning, and providing comprehensive health
education in schools.
Health, Safety, and Nutrition for the Young Child, now in its ninth edition, has become the
standard text in the early childhood field. Its comprehensive approach and well-documented stu-
dent/teacher-oriented focus continue to make it the best-selling, full-color textbook about chil-
dren’s well-being. Most importantly, this book provides students and teachers with a functional
understanding of children’s health, safety, and nutrition needs and guides them in implementing
effective classroom practices. It also emphasizes the importance of respecting and partnering
with all families to help children establish healthy lifestyles and achieve their learning potential.
Health, Safety, and Nutrition for the Young Child accomplishes this by addressing all three essen-
tial components of children’s wellness in one book:
.. promoting children’s health through awareness, assessment, early identification of special
health needs, and meaningful health education
.. creating and maintaining safe learning environments and fostering children’s understanding
and development of protective behaviors
.. meeting children’s essential nutrition needs by planning healthy meals, providing safe and
nutritious food, and educating children about consuming a nutritious diet.
Extensive resources, lesson plans, teacher checklists, video clips, references, and family education
materials are also provided throughout the book to aid busy students and practicing teachers in
making a difference in children’s lives.
The Intended Audience

First and foremost, Health, Safety, and Nutrition for the Young Child is written on behalf of young
children everywhere. Ultimately, it is the children who benefit from having families and teach-
ers who know how to protect and promote their safety and well-being. The term families is used
throughout the text in reference to the diverse caring environments in which children are cur-
rently being raised and that may or may not include their biological parents. The term teachers
is used inclusively to describe all adults who care for and work with young children-including
xiv
PREFACE xv
educators, therapists, coaches, camp leaders, administrators, health care providers, legislators,
and concerned citizens, whether they work in early education centers, home-based programs,
recreation activities, public or private schools, community agencies, or after-school programs.
The term teacher acknowledges the important educational role that families play in their chil-
dren’s daily lives. Its use also recognizes the valuable contributions of the many educators who
dedicate their lives to children.
Health, Safety, and Nutrition for the Young Child is written for several primary audiences:
.. Students and preservice teachers who have chosen a career in early education
.. Experienced teachers in community schools, home-based programs, early childhood cen-
ters, Head Start programs, agencies that serve young children, and before- and after-school
programs
.. Allied health professionals and child advocates who work in any role that touches children’s
lives
.. Families, who are children’s most important teachers!
Organization and Key Content

The ninth edition of Health, Safety, and Nutrition for the Young Child maintains its original pur-
pose to focus attention on the three critical areas that influence children’s well-being: promoting
children’s health (Unit 1); creating high-quality, safe environments (Unit 2); and, supporting chil-
dren’s nutrition (basic and applied), healthy eating behaviors, and nutrition education (Units 3
and 4). This arrangement maximizes student learning and offers instructors flexibility in design-
ing their courses. However, the interrelatedness of these three subject areas must not be over-
looked despite their artificial separation.
Chapter content is presented in a clear, concise, and thought-provoking manner. It reflects the
latest research developments and applications regarding children and wellness within a diverse
and family-oriented framework. Key topics, including national health initiatives, children’s men-
tal health, bullying, fostering resilience and social-emotional competence, brain development,
childhood obesity, emergency and disaster preparedness, and food safety have been added and
updated. More information about children with special health challenges and school-aged chil-
dren has also been provided. Without a doubt, this comprehensive book is a resource that no
teacher (new or experienced) should be without!
New Content and Special Features

The ninth edition continues to include numerous features, tables, and checklists designed to
engage students, reinforce learning, and enhance their ability to apply the information in con-
temporary educational settings:
.. Chapter Content Linked to National Association for the Education of Young Children Pro-
fessional Preparation Standards—NAEYC standards, identified at the onset of each chapter,
enable students to relate chapter content to the association’s professional education framework.
.. New Learning Objectives—correlated to the main sections in each chapter show students
what they need to know to process and understand the content. After completing the chapter,
students should be able to demonstrate how they can use and apply their new knowledge and
skills.
.. New Digital Downloads—include most of the Teacher Checklists presented in the textbook for
students to download, often customize, and use in the classroom! Look for the Digital Down-
loads label that identifies these items.
.. New Did You Get It? quizzes—allow students to measure their performance against the learn-
ing objectives in each chapter. One question for each learning objective is featured in the
xvi PREFACE
textbook to encourage students to go to CengageBrain.com, take the full quiz, and check their
understanding.
.. New Chapters—Several chapters have been rewritten, reorganized, and expanded to improve
student learning. A new section, Emergency and Disaster Preparedness, has been added to
Chapter 8. Former Chapters 14 and 15 have been combined into a new Chapter 14, “Nutrients
That Promote Growth and Regulate Body Functions (Proteins, Vitamins, Minerals, and Water.”
Technical detail has been replaced with material that is easier for students to understand. Chap-
ter 18, “Food Safety,” has been reorganized and new information added to draw attention to a
serious health concern.
.. New Teach Source Video Connections—feature footage from the classroom to help students
relate key chapter content to real-life scenarios. Critical-thinking questions provide opportuni-
ties for in-class or online discussion and reflection.
.. New Partnering with Families—is a feature designed to address the importance of family
engagement and inclusion in children’s health, safety, and nutrition education. Information
on a variety of topics is provided in letter format for busy teachers to copy and send home or
share with families in a newsletter, program handbook, website posting, parent conference, or
bulletin board display.
.. Additional Teacher Checklists—are a well-received feature that has been expanded in every
chapter to provide teachers with quick, efficient access to critical information and best prac-
tices. Beginning practitioners will find these concise reference lists especially helpful in learn-
ing new material. Experienced teachers and administrators will appreciate their easy access for
classroom use and staff training purposes. Most of the Teacher Checklists are also available as
Digital Downloads.
.. New Connecting to Everyday Practice—presents real-life situations that challenge students to
resolve common dilemmas by applying chapter content. Thought-provoking questions encour-
age self-reflection and group discussion.
.. Classroom Corner Teacher Activities—showcases lesson plans aligned with the National
Health Education Standards. Learning objectives, materials lists, and step-by-step procedures
are provided to save teachers preparation time and present children with meaningful learning
experiences.
.. New Did You Know . . . ?—offers interesting facts in a new marginal feature to increase student
curiosity and interest in chapter content.
.. Monthly Calendar of National Health, Safety, and Nutrition Observances—provides a
month-by-month listing of national observances and related website resources that teachers can
use when planning learning experiences for children. This information is located in Appendix B.
.. Children’s Book List—is an extensive, updated collection of children’s books that can be used
for teaching about health, safety, and nutrition while also encouraging literacy skills. This
resource is located in Appendix D and includes titles that address topics such as dental health,
mental health, self-care, safety, nutrition, special needs, and physical activity.
Chapter-by-Chapter Changes
Chapter 1 Children’s Well-Being: What It Is and How to Achieve It
.. New information on national health programs and initiatives, including National Health Edu-
cation Standards, Coordinated School Health Program, Healthy People 2020, Children’s Health
Insurance Program, and Let’s Move.
.. Emphasis placed on health promotion and its effect on children’s learning, development, and
behavior.
.. New information on early brain development, cultural influences on health, childhood stress,
bullying, and cyber-bullying.
.. New TeachSource Video Connections feature: “Infancy Brain Development.”
PREFACE xvii
Chapter 2 Daily Health Observations

.. Additional Teacher Checklists highlighting key information for easy access.
.. New references reinforcing teachers’ role in early identification.
.. New TeachSource Video Connections features: “Infants and Toddlers: Daily Health Checks”
and “Communicating with Parents about Health in Early Childhood: A Parent-Teacher
Meeting.”
Chapter 3 Assessing Children’s Health
.. Greater emphasis placed on the teacher’s role in identifying health problems (e.g., vision, hear-
ing, language, nutrition) that affect learning.
.. New Teacher Checklists for easy access to critical information.
.. Additional content on childhood obesity and the short- and long-term consequences on health
and learning.
.. New TeachSource Video Connections features: “0–2 Years: Sensation and Perception, Vision
in Infants and Toddlers” and “Students with Special Needs: The Referral and Evaluation
Process.”
Chapter 4 Caring for Children with Special Medical Conditions
.. New section on inclusive classrooms and special education services, including a discussion of
the Individuals with Disabilities Education Improvement Act (IDEA), Individualized Educa-
tion Plans (IEPs), Individualized Family Service Plans (IFSPs), and Individualized Health Ser-
vices Plans (IHSP).
.. Updated information on the signs, symptoms, and management strategies for common chronic
childhood diseases and medical conditions.
.. New TeachSource Video Connections features: “Preschool: IEP and Transition Planning for a
Young Child with Special Needs” and “Promoting Children’s Health: Teacher Takes Care of
Child With Asthma.”
Chapter 5 The Infectious Process and Environmental Control
.. The latest national childhood immunization recommendations (and chart).
.. New information on classroom infection control practices, including hand washing and green
cleaning products.
.. Newly issued warnings and recommendations on mixing bleach solutions.
.. New TeachSource Video Connections feature: “Promoting Children’s Health: A Focus on Nutri-
tion in Early Childhood Settings.”
Chapter 6 Childhood Illnesses: Identification and Management
.. New information on Sudden Infant Death Syndrome (SIDS).
.. New Teacher Checklists highlighting critical information about childhood illnesses.
.. New TeachSource Video Connections feature: “SIDS: Is There a Biological Cause?”
Chapter 7 Creating High-Quality Environments
.. New information on safety features associated with high-quality environments, including out-
door play areas for children.
.. More emphasis on the importance of outdoor play and physical activity in the prevention of
childhood obesity, diabetes, and behavior problems.
.. Field-based activities and a new case study reinforce application of chapter content to everyday
practice.
.. New TeachSource Video Connections features: “The Quality of Child Care” and “Creating a Safe
Physical Environment for Toddlers.”
Chapter 8 Safety Management
.. New section on emergency and disaster preparedness, including strategies for helping children
to cope following such an event.
.. Additional information on school security.
.. New TeachSource Video Connections feature: “Preschool Safety and Disaster Preparedness.”
xviii PREFACE
Chapter 9 Management of Injuries and Acute Illness

.. Updated emergency and first aid techniques from the American Heart Association and Red Cross
.. New information on initial injury assessment and assembling first aid kits.
.. New section on anaphylaxis (life-threatening allergic reaction).
.. New TeachSource Video Connections feature: “Working with Children Who Have Physical
Disabilities.”
Chapter 10 Maltreatment of Children: Abuse and Neglect
.. New research-based information about the immediate and long-term emotional, cognitive, and
economic effects maltreatment has on children’s development.
.. New information on vulnerable children, cultural implications, strategies for increasing
resilience, and anger management.
.. Updated booklist that teachers and families can use to address maltreatment with children and
to build resilience.
.. New TeachSource Video Connections feature: “0–2 Years: Observation Module for Infants and
Toddlers.”
Chapter 11 Planning for Children’s Health and Safety Education
.. Updated information on the National Health Education Standards and Health Education
Curriculum Analysis Tool (HECAT).
.. New lesson plan on “Yoga and Wellness.”
.. Additional teacher resources and children’s book lists to use for lesson planning.
Chapter 12 Nutrition Guidelines

.. New information on the Dietary Guidelines for Americans, Dietary Reference Intakes (DRIs),
MyPlate, Healthy People 2020, and food labels.
.. Emphasis placed on eating locally and the role of physical activity in health promotion.
.. New TeachSource Video Connections feature: “Young Children’s Stages of Play: An Illustrated Guide.”
Chapter 13 Nutrients that Provide Energy (Carbohydrates, Fats, and Proteins)

.. Additional information on childhood obesity, excess energy consumption, and weight manage-
ment strategies for children.
.. New Teacher Checklists highlighting key nutrient information.
.. New TeachSource Video Connections feature: “Child Obesity and School Nutrition.”
Chapter 14 Nutrients that Promote Growth and Regulate Body Functions (Proteins, Vitamins,
Minerals, and Water)
.. New chapter that combines Chapters 14 and 15 from the eighth edition. Content is presented in
less technical terms and restructured to promote better understanding.
.. New section on at-risk nutrients in children’s diets.
.. Additional information about vegetarian meal patterns.
.. New case study challenges students to apply chapter content to real-life situations.
.. New TeachSource Video Connections feature: “School-Age Children: Teaching about Nutrition.”
Chapter 15 Feeding Infants

.. New emphasis on the feeding relationship and its effect on infant biological, learning, and
developmental needs.
.. Additional information on nutrient contributions and early brain development.
.. New tables on behavioral signs of hunger and fullness (satiety).
.. New recommendations regarding vitamin D and fluoride supplementation.
.. New TeachSource Video Connections feature: “Infants and Toddlers: Health and Nutrition.”
Chapter 16 Feeding Toddlers and Young Children

.. New guidelines for feeding preschool and school-age children aligned with the national standards.
.. New information on safety considerations for children who have special feeding challenges
and/or health problems.
PREFACE xix
.. Additional information on increasing children’s acceptance of unfamiliar foods and media

influence on children’s food preferences and eating habits.
.. Updated information on feeding challenges and health problems (e.g., cardiovascular heart
disease, diabetes, hypertension) related to children’s dietary habits.
.. New TeachSource Video Connections feature: “Technology and Media Use by Children and
Adolescents.”
Chapter 17 Planning and Serving Nutritious and Economical Meals
.. New meal planning guidelines based on revised National School Lunch Program and Healthy
Hunger-Free Kids Act standards.
.. New resource tables and additional Teacher Checklists.
.. Suggestions for incorporating more whole grain products, fresh produce, and ethnic foods into
children’s meals.
.. New TeachSource Video Connections feature: “School-Age Children: Cooking Activities.”
Chapter 18 Food Safety

.. Reorganized content that reflects contemporary food safety concerns, research, and practices.
.. New tables highlighting pesticide residues on fresh produce and safe cooking temperatures.
.. New section added on national and international efforts to improve the safety of food supplies,
including commercial food production practices.
.. New TeachSource Video Connections feature: “Promoting Children’s Health: A Focus on Nutri-
tion in an Early Childhood Setting.”
Chapter 19 Nutrition Education: Rationale, Concepts, and Lessons
.. Greater emphasis placed on family engagement and educating children about healthy eating
and physical activity.
.. Lesson plans that include children’s book lists.
.. New Teacher Checklists highlighting key nutrient information.
.. New TeachSource Video Connections feature: “Preschool: Cooking Activities.”
Pedagogy and Learning Aids

Each chapter includes additional pedagogical features based on sound educational principles that
encourage active student-centered learning, mastery, and application. The features also reflect
student differences in learning needs, abilities, and styles.
.. Bulleted lists are used extensively throughout the book to present important information in a
concise, easy-to-access format.
.. Multicultural color photographs taken on location at centers and schools show children as
they work and play in developmentally appropriate settings.
.. Full-color illustrations and tables reinforce and expand on important chapter content.
.. A bulleted Summary concludes each chapter and recaps the main points of discussion.
.. Terms to Know are highlighted in color throughout the chapters. Each term is defined on the
page where it initially appears and also in a comprehensive glossary located at the end of the book.
.. Chapter Review offers thought-provoking questions to reinforce student learning and compre-
hension. Questions can also be used for group discussion.
.. Case Studies present real-life situations that require students to analyze and apply basic theory
to solving everyday problems.
.. Application Activities provide in-class and field projects that encourage students to practice
and reinforce what they have learned in each chapter.
.. Helpful Web Resources take advantage of technology to extend student learning beyond the
pages of this book and to access valuable resource materials.
xx PREFACE
Ancillaries for Students

Early Childhood Education CourseMate
Cengage Learning’s Early Childhood Education CourseMate brings course concepts to life
with interactive learning, study, and exam preparation tools that support the printed text-
book. Access the eBook, Did You Get It? quizzes, Digital Downloads, TeachSource Videos,
flashcards, and more in your Education CourseMate. Go to CengageBrain.com to register or
purchase access.
TeachSource Videos
The TeachSource videos feature footage from the classroom to help students relate key chapter
content to real-life scenarios. Critical-thinking questions provide opportunities for in-class or
online discussion and reflection.
Ancillaries for Instructors

Early Childhood Education CourseMate
Cengage Learning’s Early Childhood Education CourseMate brings course concepts to life
with interactive learning, study, and exam preparation tools that support the printed textbook.
CourseMate includes the eBook, quizzes, Digital Downloads, TeachSource Video Cases, flash-
cards, and more—as well as EngagementTracker, a first-of-its-kind tool that monitors student
engagement in the course. The accompanying instructor website, available through http://
login.cengage.com, offers access to password-protected resources such as Microsoft Power- ®
®
Point lecture slides and the online Instructor’s Manual with Test Bank. CourseMate can be
bundled with the student text. Contact your Cengage sales representative for information on
getting access to CourseMate.
Instructor’s Manual
An online Instructor’s Manual accompanies this book. It contains information to assist the
instructor in course design, including sample syllabi, discussion questions, teaching and learning
activities, field experiences, learning objectives, and additional online resources.
Online Test Bank

Extensive multiple choice, true/false, short answer, completion, and essay questions accom-
pany each chapter and provide instructors with varied strategies for assessing student
learning.
Online PowerPoint Slides

These vibrant PowerPoint lecture slides for each chapter assist you with your lecture by providing
concept coverage using images, figures, and tables directly from the textbook!
Cengage Learner Testing Powered by Cognero

.. Author, edit, and manage test bank content from multiple Cengage Learning solutions.
.. Create multiple test versions in an instant.
.. Deliver tests from your LMS, your classroom, or wherever you want.
PREFACE xxi
Acknowledgments
A special thank you is extended to the instructors, students, and colleagues who use Health,
Safety, and Nutrition for the Young Child in their classes and professional endeavors. Their
suggestions continue to influence and improve each new edition. I would also like to rec-
ognize the contributions of dedicated teachers and families everywhere who strive to better
children’s lives.
I am grateful to have had the opportunity to again work with Lisa Mafrici, who has been
my developmental editor on several book editions. Her professional expertise, insight, and
encouragement have always been exceptional and led to a well-deserved promotion in the
midst of this revision project. Although she will truly be missed, I wish her the very best! I
also want to acknowledge and thank Kate Scheinman, who bravely stepped into an ongoing
revision. She made the transition smooth, has been a pleasure to work with, and helped to
produce another beautiful and improved edition. I would also like to extend my gratitude
to Mark Kerr for his continued support, vision, and enthusiasm. The field is a better place
because of his hard work and dedication. I thank Teresa, Catherine, and the production staff
at Wadsworth Cengage Learning, who exercised their “Cinderella effect” and turned manu-
script pages into a thing of worth and beauty! Thank you, too, to the many other behind-the-
scenes individuals who contributed so much to making this book a success and to getting the
word out!
Finally, I want to thank my husband and family for their patience and understanding during
times when writing took precedence over times spent together.
I also offer my sincere appreciation to the following reviewers for sharing so many construc-
tive suggestions:
Margaret Annunziata, Sharon Hirschy,

Davidson County Community College Collin County Community College
Vella Black-Roberts, Bridget Ingram,
Ohlone College Clark State Community College
Dawn Burgess, Sharon Little,
San Diego Community College South Piedmont Community College
Cindy Calhoun, Rajone Lyman,
Southern Union State Community College Houston Community College
Johnny Castro, Janelle Meyers,
Brookhaven College St. Charles Community College
Mary Cordell, Dawn Munson,
Navarro College Elgin Community College
Karan Demchak, Sandra Owen,
Allan Hancock College Cincinnati State Technical and Community
College
Irene Den Bleyker,
University of New Mexico Gallup Olivia Wagner Wakefield,
Central Carolina Community College
Heather Flatness,
Wenatchee Valley College Janette Wetsel,
University of Central Oklahoma
Adrienne Gunn,
Santa Monica College Andrea Zarate,
Hartnell College
Marissa Happ,
Waubonsee Community College
xxii PREFACE
About the Author

Lynn R. Marotz received a Ph.D. from the University of Kansas, an M.Ed. from the University of
Illinois, and a B.S. in nursing from the University of Wisconsin. She served as the health and safety
coordinator and associate director of the Edna A. Hill Child Development Center (University of
Kansas) for 35 years. She has worked closely with students in the Early Childhood teacher edu-
cation program and taught undergraduate and graduate courses in the Department of Applied
Behavioral Science, including issues in parenting, health/safety/nutrition for the young child,
administration, and foundations of early childhood education. She provides frequent inservice
training in first aid, children’s safety, recognizing child abuse, childhood obesity, and identifying
children’s health problems for early childhood students and community educators.
Lynn has authored several invited chapters on children’s health and development, nutrition,
and environmental safety in national and international publications and law books. In addition,
she is the co-author of Developmental Profiles-Pre-Birth through Adolescence, Motivational Lead-
ership, and By the Ages. She has been interviewed for numerous articles about children’s nutrition
and well-being that have appeared in national trade magazines, and has served as a consultant
for children’s museums and training film productions. Her research activities focus on childhood
obesity and children’s health, safety, and nutrition. She has presented extensively at international,
national, and state conferences and held appointments on national, state, and local committees
and initiatives that advocate on children’s and families’ behalf. However, it is her daily interac-
tions with children and their families, students, colleagues, and her beloved family that bring true
insight, meaning, and balance to the material in this book.
CHAPTER 1 Children’s Well-Being: What It Is and How to Achieve It 1
UNIT
1
Promoting Children’s
Health: Healthy Lifestyles
and Health Concerns
Children’s Well-Being: What It Is
1 and How to Achieve It
2 Daily Health Observations
3 Assessing Children’s Health
Caring for Children with Special

4 Medical Conditions
The Infectious Process and
5 Environmental Control
Childhood Illnesses: Identification
6 and Management
1
2 unit 1 Promoting Children’s Health: Healthy Lifestyles and Health Concerns
chapter
Children’s Well-Being: What
It Is and How to Achieve It
Monashee Frantz/Getty Images
2
2
3
Standards Chapter Links
.. #1 a and b: Promoting child development and learning
.. #2 a, b, and c: Building family and community relationships
4
.. #4 a, b, c, and d: Using developmentally effective approaches to connect with children and families
.. #5 a, b, and c: Using content knowledge to build a meaningful curriculum
.. #6 b, c, d, and e: Becoming a professional
.. Field Experience
Learning Objectives
After studying this chapter, you should be able to:
LO 1-1 Define the preventive health concept and describe several national programs that address
children’s health needs.
LO 1-2 Explain how health, safety, and nutrition are interrelated and discuss factors that
influence the quality of each.
LO 1-3 Describe typical growth and developmental characteristics of infants, toddlers, preschool-
age, and school-age children.
LO 1-4 Discuss ways that teachers can be proactive in promoting children’s wellness in the areas
of injury prevention, oral health, physical activity, and mental health.
Our ideas about health, disease, and the health care system are undergoing significant change.
Individuals are beginning to realize that they must assume a more proactive role in maintaining
personal health, and cannot continue to rely on the medical profession to always make them well.
In part, this change is fueled by escalating medical costs, a lack of health insurance, and disabling
conditions for which there are no current cures. In addition, and perhaps even more significant,
are research findings that demonstrate positive health outcomes when people adapt healthy life-
style behaviors (Maxwell et al., 2012; Daniels, Pratt, & Hayman, 2011).
1-1 The Preventive Health Concept

The concept of preventive health recognizes that individuals are able to reduce or eliminate
many factors that threaten personal wellness (Figure 1–1). It implies that children and adults are
able to make choices and engage in behaviors that improve the quality of life and lessen the risk of
disease. This includes practices such as establishing healthful dietary habits (eating more fruits,
vegetables, whole grains, and low-fat dairy products), implementing safety behaviors (wearing
seat belts, limiting sun exposure), engaging in daily physical activity, and seeking early treatment
for occasional illness and injury.
preventive health – personal and social behaviors that promote and maintain well-being.
3
FIGURE 1–1 Examples of preventive health practices.
A preventive health approach involves a combination of personal practices and national

initiatives.
On a personal scale:
– eating a diet low in animal fats
– consuming a wide variety of fruits, vegetables, and grains
– engaging in aerobic and muscle-strengthening activities regularly
– practicing good oral hygiene
– using proper hand washing techniques
– avoiding substance abuse (e.g., alcohol, tobacco, drugs)
– keeping immunizations up-to-date
On a national scale:
– regulating vehicle emissions
– preventing chemical dumping
– establishing safety standard and inspecting food supplies
– measuring air pollution
– providing immunization programs
– fluoridating drinking water
– monitoring disease outbreaks
The early years are a critical time for children to establish preventive behaviors. Young chil-
dren are typically more receptive to new ideas, curious, eager to learn, and have fewer unhealthy
habits to overcome. Teachers, families, and health care providers can capitalize on these qualities
and help children to develop practices that will foster a healthy, safe, and productive lifetime.
Although the preventive approach emphasizes an individual role in health promotion, it
also implies a shared responsibility for addressing social and environmental issues that affect the
quality of everyone’s well-being, including:
.. poverty and homelessness
.. food insecurity
.. inequitable access to medical and dental care
.. adverse effects of media advertising
.. substance abuse (e.g., alcohol, tobacco, drugs)
.. food safety
.. air and water pollution
.. discrimination based on diversity
.. unsafe neighborhoods
In addition to helping children learn about these complex issues, adults must also demon-
strate their commitment by supporting social actions, policies, and programs that contribute to
healthier environments and lifestyles for society as a whole.
1-1a National Health Initiatives

The positive health outcomes that are achievable through preventive practices continue to attract
increased public interest, especially with respect to young children. Poor standards of health,
safety, and nutrition have long been known to interfere with children’s ability to learn and to
ultimately become healthy, productive adults. As a result, a number of large-scale programs have
been established to address children’s health needs and to improve their access to preventive
services. Descriptions of several initiatives follow; information about federal food programs for
children is located in Appendix C.
Healthy People 2020 The nation’s plan for improving the

▼ Early childhood is a prime time for teaching
standard of health for its citizens is outlined in the Healthy preventive health practices.
People 2020 initiative. It supports and strengthens the same
underlying philosophy of health promotion and disease pre-
vention presented in the original Healthy People 2000 docu-
ment. It challenges communities to increase public health
awareness and improve accessibility to preventive health ser-
vices by encouraging better collaboration and coordination
among agencies. It urges individuals to assume a more active
role in achieving personal wellness, especially with regard to
the prevention of heart disease, obesity, and diabetes. Many
of the goals and objectives targeted in the Healthy People 2020
plan also have direct application for schools and early child-
hood programs (Table 1–1). For example, teaching anger
management skills, increasing outdoor play and physical
activity in children’s daily schedules, serving nutritious foods,
providing more health and nutrition education, and creating
safe learning environments reflect teachers’ commitment to
the Healthy People 2020 ideals.
National Children’s Agenda A similar Canadian proposal

aimed at health promotion for children is outlined in a report
entitled A National Children’s Agenda: Developing a Shared
Vision. This document presents a comprehensive agenda of
© Cengage Learning
goals and objectives for addressing children’s health care and

safety needs. It also embraces the importance of the early
years and supports the vision of creating a unified approach
to helping children achieve their full potential.
Children’s Health Insurance Program The Children’s Health Insurance Program (CHIP) pro-
vides low-cost health insurance to children in income-eligible families who don’t qualify for
Medicaid and cannot afford private coverage. The program is aimed at improving children’s
health and ability to learn through early identification and better access to preventive health
care (Colby, Lipson, & Turchin, 2012). Services covered by the program include free or low-
cost medical and dental care, immunizations, prescriptions, mental health treatment, and
hospitalization.
CHIP is administered in each state through a combination of state and federal appropriations.
Each state must submit a Child Health Plan describing how the program will be implemented,
how eligibility will be determined, and how eligible children will be located. The Affordable Care
Act extends reauthorization of the program through 2015 and expands service to an additional
four million eligible children (Centers for Medicare & Medicaid Coverage, 2013).
TABLE 1–1 Healthy People 2020 Objectives

Areas targeted for improving children’s health include the following:
●● physical activity and fitness ●● immunizations and infectious diseases
●● nutrition and weight status ●● oral health
●● substance abuse ●● maternal, infant, and child health
●● mental health ●● access to health services
●● sleep health ●● health education
●● environmental health ●● vision, hearing, and communication disorders
●● injury and violence prevention
Source: Adapted from Healthy People 2020. (2012). U.S. Department of Health & Human Services.
Healthy Child Care America The primary objective of the Healthy Child Care America
(HCCA) initiative is to foster high-quality improvements in out-of-home child care pro-
grams. HCCA, supported by the U.S. Department of Health and Human Services, the Child
Care Bureau, and the Maternal and Child Health Bureau, was established in 1995 to coor-
dinate the mutual interests of health professions, early education professionals, and families
in addressing children’s health and safety. The program is administered by the American
Academy of Pediatrics (AAP) and has been instrumental in launching several large-scale
educational campaigns, including Moving Kids Safely in Child Care, Tummy Time, Back
to Sleep (for parents), Back to Sleep in Child Care Settings, and the Health Futures cur-
riculum. Grant-supported offices, located in every state, have been established to evalu-
ate and strengthen existing community infrastructure and to assist with new initiatives for
improving children’s health and safety in early childhood programs and access to preven-
tive health care. Extensive resource information is available on their website (http://www
.healthychildcare.org).
National Health and Safety Performance Standards for Child Care National concern for
children’s welfare led to a collaborative project among the American Academy of Pediatrics
(AAP), the American Public Health Association (APHA), and the National Resource Center
for Health and Safety in Child Care and Early Education (NRC) to develop health, safety, and
nutrition guidelines for out-of-home child care settings. The resulting document, Caring for Our
Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child
Care (3rd ed.), continues to identify quality standards and procedures for ensuring children’s
health and safety while they attend organized out-of-home care (Table 1–2) (AAP, APHA, &
NRC, 2011). This document can be accessed at www.nrckids.org.
The current system allows individual states to establish their own child care licensing
standards, which has resulted in significant differences in quality. The National Health and
Safety Performance Standards attempt to address regulatory inconsistencies by proposing a
uniform set of standards based on what research has identified as best practices. The National
Association for the Education of Young Children (NAEYC) recently endorsed and aligned
their accreditation criteria with the National Health and Safety Performance Standards
(NAEYC, 2012).
TABLE 1–2 National Health and Safety Performance Standards
Comprehensive guidelines address the following areas of child care:

●● staffing – child staff ratios, credentials, and training
●● activities for healthy development – supervision, behavior management, partnerships with families,
health education
●● health promotion and protection – sanitation and hygiene practices, safe sleep, illness and medication
management
●● nutrition and food services – nutritional requirements, food safety, nutrition education
●● facilities, supplies, equipment, and environmental health – space and equipment requirements,
indoor/outdoor settings, maintenance
●● playgrounds and transportation – space, water areas, toys, transportation safety
●● infectious diseases – respiratory, blood-borne and skin conditions, immunizations
●● children with special health care and disability needs – inclusion, eligibility for special services, facility
modifications, assessment, service plans
●● policies – health/safety, emergency plans, personnel, child records
●● licensing and community action – regulatory agencies, teacher/caregiver support
Source: Adapted from AAP, APHA, & NRC. (2011). Caring for our children: National health and safety performance
standards (3rd ed.). Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health
Association. Also available at http://nrckids.org.
No Child Left Behind The No Child Left Behind (NCLB) Act of 2001 authorized significant
reforms of the K–12 educational system and strengthened partnerships with Head Start, Even
Start, and early education programs in center- and home-based settings. It acknowledged fami-
lies as children’s first and most important teachers, the educational contributions of early child-
hood programs, and the importance of fostering early literacy skills (understanding and using
language) to ensure children’s readiness for, and success in, schools. The bill also provided funding
to cover child care costs for low-income families, health care coverage for eligible children, and
prenatal services for pregnant women. However, its main purpose was to improve educational
outcomes for all children by holding educators more accountable. Several states were granted
waivers in 2011 allowing them to opt out of the NCLB Act’s required provisions if they agreed to
establish their own performance standards.
Coordinated School Health Program In 1988, the Centers for Disease Control and Preven-
tion (CDC) proposed a new school health services model called the Coordinated School Health
program. At the time, teachers were being pressured to ensure children’s success in school while
studies demonstrated a strong association between children’s health and academic outcomes. It
became clear that traditional delivery methods were failing to address children’s complex health
needs and that a different approach was needed.
The Coordinated School Health program assumes a preventive health approach and
emphasizes the collaborative involvement of teachers, administrators, staff, students, families,
media, and community partners to promote children’s well-being. Eight interactive standards
and their corresponding performance indicators serve as curriculum guidelines for grades
K–12 (Figure 1–2).
The National Children’s Study One of the most comprehensive studies of children’s health
ever undertaken in the United States was authorized by the Children’s Health Act of 2000. This
longitudinal study is being led by the Eunice Kennedy Shriver National Institute of Child Health
and Human Development (NICHD) and is currently following over 100,000 children from birth
to age 21. The purpose of the study is to examine genetic and environmental effects on children’s
FIGURE 1–2 Coordinated school health program components.
Health
Education
Family/
Community Physical
Involvement Education
Health
Health
Promotion
Services
for Staff
©Dmitriy Shironosov/Shutterstock.com
Healthy
Nutrition
& Safe School
Services
Environment
Counseling,
Psychological,
Psychological &&
Social Services
Did You Get It? health and their potential contributions to disease. It will eventually yield
one of the most expansive information databases ever compiled about
The Children’s Health Insurance children’s growth and development, differences in access to health care,
Program provides healthcare
and the incidence of disease. Data obtained from the study will also be
coverage, and the Healthy
Child Care America initiative
used to improve children’s health and well-being through future policy
focuses on the __________ of formulation, funding, and service interventions.
child care programs. Let’s Move! The Let’s Move! initiative was established by First Lady Michelle
a. regulation
Obama in 2010 to address the problem of childhood obesity in the United
b. improvement
c. licensing
States. The program encourages children and their families to achieve a
d. insuring healthier lifestyle by improving eating habits and increasing physical activ-
ity. Schools are challenged to provide healthier meals for children, increase
Take the full quiz on CourseMate.
opportunities for physical activity, and incorporate more health and nutri-
tion education into their curriculum. A companion initiative, Let’s Move!
Child Care, was launched the following year and challenges all child care
providers to adapt similar improvement measures. Informational resources
can be accessed on the initiatives’ websites.
▼ Active play is essential for children’s health and development.

1-2 Health, Safety,
and Nutrition: An
Interdependent
Relationship
Health, safety, and nutrition are closely inter-
twined and dependent on one another. The sta-
tus of each has a direct effect on the quality of
the others. For example, children who receive
all essential nutrients from a healthful diet are
more likely to reach their growth potential,
benefit from learning opportunities, experi-
© Cengage Learning
ence fewer illnesses, and have ample energy

for play. In contrast, children whose diet lacks
critical nutrients such as protein and iron may
develop anemia, which can lead to fatigue,
diminished alertness, growth and academic
failure, and loss of appetite. When children lack interest in eating, their iron intake is further com-
promised. In other words, nutritional status has a direct effect on children’s health and safety, and, in
turn, influences the dietary requirements needed to restore and maintain well-being.
A nutritious diet also plays an important role in injury prevention. The child or adult who
arrives at school having eaten little or no breakfast may experience low blood sugar, which can
cause fatigue, decreased alertness, and slowed reaction times and, thus, increase an individual’s
risk of accidental injury. Similarly, overweight children and adults are more likely to sustain inju-
ries due to excess weight, which may restrict physical activity, slow reaction times, and increase
fatigue with exertion.
1-2a What Is Health?

Definitions of health are as numerous as the factors that affect it. In years past, the term
referred strictly to an individual’s physical well-being and the absence of illness. Contemporary
health – a state of wellness. Complete physical, mental, social, and emotional well-being; the quality of one health element affects the state of the others.
definitions view health from a broader perspective and recognize it as a state of physical, emo-
tional, social, economic, cultural, and spiritual well-being. Each interactive component is
assumed to make an equally important contribution to health and to affect the functional activ-
ity of the others. For example, a stressful home environment may be contributing to a child’s
asthma attacks, stomachaches, or headaches; in turn, a child’s repeated illnesses or chronic
disability can profoundly affect the family’s emotional, financial, social, and physical stability
and well-being.
The current health concept also recognizes that children and adults do not live in isolation,
but are active participants in multiple groups, including family, peer, neighborhood, ethnic, cul-
tural, recreational, religious, and community. Children’s health, development, and opportunities
for learning are directly influenced by the positive and negative experiences that occur in each
setting. For example, children growing up in a poor, urban neighborhood may be at greater risk
for becoming obese because they have fewer safe places for outdoor play and limited access to
fresh fruits and vegetables. In other words, children’s health and development must be considered
in the context of their social and environmental conditions.
1-2b What Factors Influence Children’s Health?

Health is a dynamic and complex state. It is a product of continuous interactions between an
individual’s genetic makeup, environmental conditions, and personal experiences (Figure 1–3).
For example, an infant’s immediate and long-term health is influenced by his or her mother’s
personal lifestyle practices during pregnancy: her diet; use or avoidance of alcohol, tobacco,
and certain medications; routine prenatal care; and exposure to communicable illnesses or toxic
stress. Mothers who fail to maintain a healthy lifestyle during pregnancy are more likely to give
birth to infants who are born prematurely, have low birth weight, or experience a range of special
challenges (McCormick et al., 2011). These children also face a significantly greater risk of devel-
oping chronic health problems and early death. In contrast, a child who is born healthy, raised
in a nurturing family, consumes a nutritious diet, lives in a safe environment, and has numerous
opportunities for learning and recreation is more likely to enjoy a healthy life.
Heredity Characteristics transmitted from biological parents to

their children at the time of conception determine all of the genetic
traits of a new, unique individual. Heredity sets the limits for FIGURE 1–3 Health is an interactive and
continuously changing state.
growth, development, and health potential. It explains, in part, why
children in one family are short while those from another family are
tall or why some individuals have allergies or require glasses while
Physical
others do not.
Understanding how heredity influences health can also be use-
ful for assessing a possible inherited tendency, or predisposition, Cu l
ltu
ral nta
to certain health problems, such as heart disease, deafness, cancer, Me
diabetes, lactose intolerance, or mental health disorders. Although
a family history of heart disease or diabetes may increase one’s risk, Health
it does not imply that an individual will actually develop the condi-
Ec
tion. Many lifestyle factors, including physical activity, diet, sleep, and itu
al on
om
ir
stress levels, interact with genetic material (genes) and can alter the Sp ic
child’s chances of ultimately developing heart disease or any number

Social
of other chronic health diseases.
Environment Although heredity provides the basic building

materials that predetermine the limits of one’s health, environment
heredity – the transmission of certain genetic material and characteristics from biological parents to a child at the time of conception.
predisposition – having an increased chance or susceptibility.
▼ Heredity sets the limits for a child’s growth,

plays an equally important role. Environment encom-
development, and health potentials. passes a combination of physical, psychological, social,
economic, and cultural factors that collectively influence
the way individuals perceive and respond to their sur-
roundings. In turn, these experiences shape a person’s
behaviors and potential health outcomes. For example,
two cyclists set off on a ride: One is wearing a helmet, the
other is not. The choices each has made could potentially
have quite different outcomes if they were to be involved
in a serious collision. The helmet-wearing cyclist may
suffer only minor scrapes and bruises while the cyclist
without a helmet may sustain a serious head injury that
could have significant health, economic, social, and psy-
© Cengage Learning
chological consequences.
Examples of several environmental factors that sup-
port and promote healthy outcomes include:
.. making nutritious food choices
.. participating in daily physical and recreational activities
.. getting 8 to 9 hours of uninterrupted nighttime sleep
.. having access to high-quality medical and dental care
.. reducing stress levels
.. residing in homes, child care facilities, schools, and workplaces that are clean and safe
.. having friends and opportunities to form stable and meaningful relationships
There are also many environmental factors that have a negative effect on health. For example,
exposure to chemicals and pollution, abuse, illness, obesity, prenatal alcohol exposure, sedentary
lifestyles, poverty, acute and chronic stress, food insecurity, violence, or unhealthy dietary
choices can interfere with children’s optimal growth and development.
1-2c Safety
Safety refers to behaviors and measures taken to protect individuals from unnecessary harm. It is
especially important that adults who work with young children view this responsibility seriously.
Unintentional injuries are the leading cause of death among children from birth to 14 years in the
United States and Canada and, sadly, many of these instances are avoidable (CDC, 2012; Safe Kids
Canada, 2012). Young children are especially vulnerable to unexpected and serious injury because
their developmental skills seldom match their level of enthusiasm and curiosity. Every adult who
works with, or cares for, young children has a significant responsibility to maintain the highest
standards of supervision and environmental safety.
Factors Affecting Children’s Safety Protecting children’s safety requires a keen awareness of
their skills and abilities at each developmental stage (Marotz & Allen, 2013). For example, know-
ing that toddlers enjoy hand-to-mouth activities should alert teachers to continuously monitor
the environment for small objects or poisonous substances that could be ingested. Understand-
ing that preschoolers are spontaneous and exceedingly curious should cause adults to take extra
precautions to prevent children from wandering away or straying into unsupervised water
sources. Children who have developmental disabilities or sensory disorders are at increased risk
of sustaining unintentional injury and must be monitored continuously (Cavalari & Romanczyk,
2012). In-depth discussions of environmental safety and safety management are presented in
Chapters 7 and 8.
sedentary – unusually slow or sluggish; a lifestyle that implies inactivity.

food insecurity – uncertain or limited access to a reliable source of food.
1-2d Nutrition
The term nutrition refers to the science of food, its chemical components nutrients, and their
relationship to health and disease. It includes all processes involved in obtaining nutrients from
foods—from the ingestion, digestion, absorption, transportation, and utilization of nutrients to
excretion of unused products. Nutrients are essential for life and have a direct effect on a child’s
nutritional status, behavior, health, and development.
Nutrients play critical roles in a variety of vital body functions, including:
.. supplying energy
.. promoting growth and development
.. improving resistance to illness and infection
.. building and repairing body tissue
A wide variety of foods must be consumed in the recommended amounts to meet the
body’s needs for essential nutrients. However, many family and environmental conditions,
including financial resources, transportation, geographical location, cultural and religious
preferences, convenience, and nutrition knowledge, can affect the quality of a child’s diet. Most
children in the United States live in a time and place where food is reasonably abundant. Yet,
there is increasing concern about the number of children who may not be getting enough to
eat or whose diets do not include the right foods (Okechukwu et al., 2012). Also, because many
young children spend the majority of their waking hours in out-of-home child care programs
or school classrooms, care must be taken to ensure that their nutrient needs are being met in
these settings.
Nutrition’s Effect on Children’s Behavior, Learning, and Well-being Children’s nutritional

status has a significant effect on their behavior and cognitive development. Well-nourished chil-
dren are typically more alert, attentive, physically active, and better able to benefit from learning
experiences. Poorly nourished children may appear quiet and withdrawn, or exhibit hyperac-
tive and disruptive behaviors in the classroom (Liu & Raine, 2011). They are also more prone to
injury because of decreased alertness and slower reaction times. Children who are overweight
also face a range of social, emotional, and physical challenges, including difficulty participating in
physical activities, ridicule, emotional stress, and peer exclusion (Su & Aurelia, 2012). Additional
information about children’s specific nutrient needs and challenges associated with over- and
under-consumption of foods is presented in Chapters 12 through 19.
Children’s resistance to infection and illness is also directly influenced by their nutritional
status (Weill, 2012). Well-nourished children experience fewer illnesses and recover more quickly
when they are sick. Children who consume an unhealthy diet are more susceptible to infections
and illness and often require longer time to recuperate. Frequent illness can interfere with a
child’s appetite, which may limit his or her intake of nutrients important for the recovery
process. Thus, poor nutrition can create a cycle of increased susceptibility to illness and
infection, nutritional deficiency, and prolonged recovery.
Teachers have an exceptional opportunity to protect and promote children’s well- Did You Know...
being. Their knowledge of children’s development and health, safety, and nutritional that children who eat breakfast
have better problem-solving
needs can be applied when planning learning activities, classroom environments, skills, more energy, lower
meals and snacks, and supervision. In addition, teachers can implement sanitation obesity rates, and feel more
and early identification practices to reduce children’s unnecessary exposure to illness cheerful?
and infection. Furthermore, they can support the concept of preventive health by serv-
ing as positive role models and providing children with learning experiences that encour-
age a healthy lifestyle.
nutrients – the chemical substances in food.

resistance – the ability to avoid infection or illness.
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)
The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.
NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.
MAKONDE LOCK AND KEY AT JUMBE CHAURO

This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]
MODE OF INSERTING THE KEY
With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
“We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
BRAZIER
Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT
SMOOTHING WITH MAIZE-COB
CUTTING THE EDGE

FINISHING THE BOTTOM
LAST SMOOTHING BEFORE

BURNING
FIRING THE BRUSH-PILE

LIGHTING THE FARTHER SIDE OF
THE PILE
TURNING THE RED-HOT VESSEL
NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK
DRAWING THE BARK OFF THE LOG
REMOVING THE OUTER BARK

BEATING THE BARK
WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT
MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN

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Health, Safety, and Nutrition for the

Young Child, 9th Edition ■ Standalone

UNIT 1  romoting Children’s Health: Healthy Lifestyles

3-3 Referrals 74 5-4 Control Measures 117

UNIT 2 Keeping Children Safe 167

9-4e Burns 255 10-5a Inservice Training 279

Chapter 10 Maltreatment of Children: Chapter 11 Planning for Children’s Health

UNIT 3 Foods and Nutrients: Basic Concepts319

UNIT 4 Nutrition and the Young Child 379

Chapter 15 Feeding Infants 380 15-5f

The Intended Audience

Organization and Key Content

New Content and Special Features

Chapter 2 Daily Health Observations

Chapter 9 Management of Injuries and Acute Illness

Chapter 12 Nutrition Guidelines

Chapter 13 Nutrients that Provide Energy (Carbohydrates, Fats, and Proteins)

Chapter 15 Feeding Infants

Chapter 16 Feeding Toddlers and Young Children

.. Additional information on increasing children’s acceptance of unfamiliar foods and media

Chapter 18 Food Safety

Pedagogy and Learning Aids

Ancillaries for Students

Ancillaries for Instructors

Online Test Bank

Online PowerPoint Slides

Cengage Learner Testing Powered by Cognero

Margaret Annunziata, Sharon Hirschy,

About the Author

2 Daily Health Observations

3 Assessing Children’s Health

Caring for Children with Special

Monashee Frantz/Getty Images

1-1 The Preventive Health Concept

FIGURE 1–1 Examples of preventive health practices.

A preventive health approach involves a combination of personal practices and national

1-1a National Health Initiatives

Healthy People 2020 The nation’s plan for improving the

National Children’s Agenda A similar Canadian proposal

goals and objectives for addressing children’s health care and

TABLE 1–1 Healthy People 2020 Objectives

TABLE 1–2 National Health and Safety Performance Standards

Comprehensive guidelines address the following areas of child care:

FIGURE 1–2 Coordinated school health program components.

▼ Active play is essential for children’s health and development. 

ence fewer illnesses, and have ample energy

1-2a What Is Health?

1-2b What Factors Influence Children’s Health?

Heredity Characteristics transmitted from biological parents to

child’s chances of ultimately developing heart disease or any number

of other chronic health diseases.

Environment Although heredity provides the basic building

▼ Heredity sets the limits for a child’s growth,

sedentary – unusually slow or sluggish; a lifestyle that implies inactivity.

Nutrition’s Effect on Children’s Behavior, Learning, and Well-being Children’s nutritional

nutrients – the chemical substances in food.

Newala, too, suffers from the distance of its water-supply—at least

The water-supply of New Newala is in the bottom of the valley,

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAKONDE LOCK AND KEY AT JUMBE CHAURO

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

Some consolation was afforded me by a brassfounder, whom I

UNIT 1 romoting Children’s Health: Healthy Lifestyles

UNIT 2 Keeping Children Safe 167

UNIT 3 Foods and Nutrients: Basic Concepts319

UNIT 4 Nutrition and the Young Child 379

▼ Active play is essential for children’s health and development.