The stomach is the source of much trouble in infancy, and the leading symptoms of disturbance are vomiting, flatulence, and pain. The belching of wind and the regurgitation of food are not necessary post-prandial sequelae during infancy, although many nurses hold a contrary opinion. Such errors as too rapid or too frequent feeding, which are apt to induce vomiting, must be corrected. The regular regurgitation of food after a meal implies that too much has been taken, and that the stomach has been over-filled. If this is allowed to become habitual, dilatation of the stomach will follow. The treatment should be to reduce the amount given at each meal. In cases of acute indigestion in infants, with pain and vomiting, all food should be stopped, and only sips of hot water or hot barley-water given until some hours after the vomiting has ceased. In all cases of vomiting in infants no food should be given until the stomach has been thoroughly rested for some hours.
When vomiting occurs an hour or two after a meal, it is probably due to incomplete digestion of the food which is refused exit by the pylorus. This is a condition which, if it becomes chronic, is apt to be accompanied by pain, flatulence, and wasting. The fault may He in the nature of the food, or possibly in some idiosyncrasy in the infant's stomach. When these evidences of gastric irritation are present, a condition which is often called gastritis or gastric catarrh, it is essential to find out the cause.
In the case of breast-fed infants this may entail an examination of : (1) the mother, (2) the breast milk, and (3) the infant.
(1) It is but too common to find that a woman who does not habitually take alcohol will consume a couple of pints of beer or stout daily when she is nursing, in the belief that she thereby increases her nursing power. The alcohol thus taken may lead directly to indigestion and vomiting in the infant. The substitution of cows' milk for alcoholic beverages in the mother's dietary will often enable the infant to digest the breast milk satisfactorily. If the mother is leading too strenuous a life, as represented in the upper classes by social gaieties, and in the lower by severe physical labour, the milk may be so altered as to become indigestible. The habits of the mother must be carefully inquired into and regulated. Sometimes the anxiety of the mother over any disturbance in her infant may so react on the milk as to make it indigestible. It is well to reassure her, if possible, as to the nature of the disturbance, and to secure for her that tranquillity of mind which is necessary for successful nursing. One must also make careful inquiries as to whether any other food besides the breast is being given. Many mothers have lost faith in breast milk as a complete diet for infants, and think some "food" is necessary. The cause of gastric irritation in the healthy child of a healthy nursing mother will often prove to be some thick barley-water or patent food or other unsuitable nutriment given with the view of strengthening the infant. When this has been stopped the gastric irritation soon ceases.
(2) An examination of the breast milk may show that it is too rich in proteins, in which case Dr. Eustace Smith recommends plenty of farinaceous and vegetable food for the mother, and a few ounces of barley-water for the infant before taking the breast. If the milk is found to be too rich in fat, a diminution in the amount of food taken by the mother is indicated. In somewhat rare instances the gastric trouble arises from an unusually large size of the fat globules, a fault which cannot be remedied. Overfeeding on the part of the mother is another possible source of trouble in the infant.
(3) An examination of the infant is always called for in order to find out whether there is any local or constitutional disease present which is the cause of the gastric symptoms. It is manifestly useless to expect successful results from diet if organic disease is overlooked. Congenital pyloric stenosis may be taken as an example of local disease, and syphilis as an example of constitutional disease.
As regards bottle-fed infants one must inquire into the quantity and quality of the meals and the frequency of the feeding times. In many cases when these are properly regulated the stomach disturbance will cease. A common fault is to give the milk too concentrated. The use of improperly prepared barley-water is a frequent cause of gastric disturbance. In some cases whole barley is used and boiled down into a thick mass which is added to the milk. In other cases ground barley is boiled and added to the milk. Both these methods are unsuited for infants under the age of nine months, who cannot digest a quantity of unconverted starch. The barley will not only remain undigested itself but will cause so much gastric disturbance as to interfere with the digestion of the milk. The use of tinned foods and " infants foods " is also a common cause of gastric trouble, although as a rule they are more apt to induce intestinal indigestion. Reference may also be made to the habit in certain classes of giving young infants a taste of what is going at the family table, some potato, or sausage, or a drop of beer. This method of feeding must be put a stop to.
In other cases it will be found that neither a cessation of improper feeding nor a return to physiological feeding will relieve the gastric symptoms. Other measures will then be called for and will be discussed in connexion with chronic gastro-intestinal indigestion.
In children over two years of age acute gastric irritation is usually traceable to some error in diet. This may take the form of a surfeit of raw apples, ice-cream, strawberries, pineapple, sweets, etc. - one cannot tell what the vagaries of a boy's appetite may be.
The stomach should be rested by a total abstinence from food for twelve hours, only sips of hot water being given. At the end of that time food may be resumed, in small quantities at first, and should consist of some weak chicken or mutton soup. An attack of acute gastric catarrh may sometimes be induced by a severe chill, as from a wetting or cold feet, or prolonged exposure. In such cases all appetite is lost, the digestion is much weakened, and any strong food leads to vomiting. In the acute stage it is not advisable to give much food, as it will simply increase the gastric disturbance. Peptonized milk, albumin water, and weak chicken or veal soup may be given in feeds of three or four ounces at a time. If food of this character is rejected, champagne may be given in doses of half an ounce every four hours, and sips of hot water frequently, if desired. Rectal feeding is rarely called for, as the disturbance is only temporary.