Syrup, M x. [10 minims]

Aq. menth. pip., ad 3 i. [1 dram]

After this has been taken the child should be laid down for a quarter of an hour until soundly asleep.  Then very gently he can be carried to his mother and the nipple inserted.  If in this way a few days of sound sleep and less disturbed digestion can be secured, the difficulty will in most cases permanently be overcome.  The steadier suction and more efficient emptying of the breast will promote a freer flow of milk, and the deeper and more prolonged sleep will lower greatly the needs of the child for food.  Most of the babies who show this fault are thin, meagre, and fidgety, and with some increase of muscular tone.  The head is held up well, the limbs are stiff, the hands clenched, the abdomen retracted, with the outline of the recti muscles unusually prominent.  If we can relax this exaggerated state of nervous tension, if we can help them to become fatter and to put on weight, the dyspepsia will disappear with the other symptoms.

It is a question still to be answered whether the rare conditions of pyloric spasm and pyloric hypertrophic stenosis are not further developments of the same disturbance.  Certainly these grave complications appear most commonly in infants with a pronounced nervous inheritance, and, as might be expected, they are more commonly found in private practice than among the hospital classes.

In passing, we may note that there are babies who exhibit the opposite fault, and in whom the contrary regimen must be instituted.  Premature children, children born in a very poor state of nutrition, and children born with great difficulty, so that they are exhausted by the violence of their passage into the world, are apt to show the opposite fault of extreme somnolence.  They are so little stimulated by their surroundings, and they sleep so profoundly, that the sucking reflex is not aroused.  Put to the breast they continue to slumber, or after a few half-hearted sucking movements relapse into sleep.  We must rouse such children by moving them about and stirring them to wakefulness before we put them to the breast.

Once the child has been got to the breast, once the milk has become firmly established, we have overcome the first great difficulty which besets us in the management of nervous little babies, but it is by no means the last.  Restlessness and continual crying must be combated or digestion suffers, and may show itself in a peculiar form of explosive vomiting, which betokens the reflex excitability and unrest of the stomach.