CHRONIC DYSPEPSIA IN CHILDREN OF SCHOOL AGE

Abstract

The term u chronic dyspepsia in children is used to connote a group of symptoms, varying in degree and in proportion, which together form a common clinical picture. For the most part it arouses no memory of exact morbid anatomy or of precise deviations from the normal in functional activity. The picture presented to our minds is somewhat as follows. The child is ailing, dull, and listless, lacking vitality and composure. The appetite is poor and capricious, the tongue coated, and the breath heavy and perhaps foul. The complexion is muddy, wrhile the faci?s, with sunken eyes, or puffy eyelids and dark orbital rings, is itself characteristic enough to suggest the nature of the malady. There may be abdominal pains of varying degrees of severity, from slight discomfort to attacks of colic; or pain may be absent. The pain may occur after food, but is seldom gastric in position, being more often about the umbilicus or along the course of the large intestine. It may be related to the passage of flatus or precede defaecation. The general nutrition is usually im paired,, the child losing weight in severer forms, failing to gain weight in milder. On the other hand, the weight may be satisfactory but there is a general tonelessness of skin and muscles. The stools are variable, in some cases in frequent, in others too frequ?pt, but always irregular. They may be uneven in their consistence, particoloured, offensive, and contain mucus or even blood, and food which has not been digested. There may be slight nocturnal fever, perhaps with bouts of higher fever, coincidently with which the odour of the breath and the abdominal symptoms become more evident. Sleep is restless, often disturbed by dreams or night terrors. In some cases there is wakefill ness. In the morning the child is tired and drowrsy, and dislikes getting up. During the day he is easily exhausted and fatigued, liable to headaches, and lacks concentration or interest in his school work, being slow in acquisition and poor in performance. Psychical symptoms take an im portant place, but are more prominent in some cases than in others, depending in their degree, in part at least, on hereditary psychical traits. The child is apt to be morose, despondent, resistant, and irritable, solitary in habit, taking no part in games, and subject to fits of crying and of temper. Examination of the abdomen may reveal no abnormal physical signs, or there may be some persistent or intermittent abdominal distension, related chiefly to flatu lent distension, but in some cases in part to faecal accumu lation* There may be considerable indicanuria.