Spitting Up & Reflux in the Breastfed Baby • KellyMom.com

By Kelly Bonyata, BS, IBCLC

© Paul Hakimata – Fotolia.com

My baby spits up – is this a problem?

Spitting up, sometimes called physiological or uncomplicated reflux, is common in babies and is usually (but not always) normal. Most young babies spit up sometimes, since their digestive systems are immature, making it easier for the stomach contents to flow back up into the esophagus (the tube connecting mouth to stomach).

Babies often spit up when they get too much milk too fast. This may happen when baby feeds very quickly or aggressively, or when mom’s breasts are overfull. The amount of spitup typically appears to be much more than it really is. If baby is very distractible (pulling off the breast to look around) or fussy at the breast, he may swallow air and spit up more often. Some babies spit up more when they are teething, starting to crawl, or starting solid foods.

A few statistics (for all babies, not just breastfed babies):

• Spitting up usually occurs right after baby eats, but it may also occur 1-2 hours after a feeding.
• Half of all 0-3 month old babies spit up at least once per day.
• Spitting up usually peaks at 2-4 months.
• Many babies outgrow spitting up by 7-8 months.
• Most babies have stopped spitting up by 12 months.

If your baby is a ‘Happy Spitter’ –gaining weight well, spitting up without discomfort and content most of the time — spitting up is a laundry & social problem rather than a medical issue.

Some causes of excessive spitting up

• Food sensitivities can cause excessive spitting. The most likely offender is cow’s milk products (in baby’s or mom’s diet). Other things to ask yourself: is baby getting anything other than breastmilk – formula, solids (including cereal), vitamins (fluoride, iron, etc.), medications, herbal preparations? Is mom taking any medications, herbs, vitamins, iron, etc.?

• Babies with Gastroesophageal Reflux Disease (GERD) usually spit up a lot (see below).

• Although seldom seen in breastfed babies, regular projectile vomiting in a newborn can be a sign of pyloric stenosis, a stomach problem requiring surgery. It occurs 4 times more often in boys than in girls, and symptoms usually appear between 3 and 5 weeks of age. Newborns who projectile vomit at least once a day should be checked out by their doctor.

My older baby just started spitting up more – what’s up?

Some older babies will start spitting up more after a period of time with little or no spitting up. It’s not unusual to hear of this happening around 6 months, though you also see it at other ages. If the spitting up is very frequent (particularly if baby does not seem well), consider the possibility of a GI illness.

If baby does not seem ill, then here are some possible causes:

• It’s unlikely that your baby has suddenly developed a sensitivity to something in your milk, unless there’s something really new in your diet or you’re eaten LOTS of a particular food very recently. Any foods that baby eats are more likely than mom’s foods to cause the spitting up. Has baby started solids recently or tried a new food? Are you or baby taking any new medications? Have you or baby started taking vitamins or changed your vitamins?
• Has baby been fussier than normal, and/or crying more lately? If so, he is probably swallowing more air than usual, which can cause the spitting up.
• Spitting up can be caused by teething. When teething, babies tend to drool more and often swallow a lot of that extra saliva – this can cause extra spitting up.
• A cold or allergies can result in baby swallowing mucus and spitting up more.
• Baby may be hitting a growth spurt and swallowing more air when he nurses, especially if he’s been “guzzling” lately.
• If you tend to have oversupply or a fast let-down, some moms see renewed symptoms (which can include spitting up) after a growth spurt.

Essentially, though, if your baby is healthy and doing well despite the spitting up — gaining well, having enough wet/dirty diapers — then this is a laundry problem rather than a medical issue.

Gastroesophageal Reflux Disease (GERD)

A small percentage of babies experience discomfort and other complications due to reflux – this is called Gastroesophageal Reflux Disease. These babies have been termed by some as ‘Scrawny Screamers’ (as compared to the Happy Spitters). There seems to be a family tendency toward reflux. GERD is particularly common in preemies (due to their immaturity) and in babies with other health problems. GERD usually improves by 12-24 months.

Following are symptoms of GERD — there are varying degrees and need your doctor’s involvement to diagnose:

• Frequent spitting up or vomiting; discomfort when spitting up. Some babies with GERD do not spit up – silent reflux occurs when the stomach contents only go as far as the esophagus and are then re-swallowed, causing pain but no spitting up.
• Gagging, choking, frequent burping or hiccoughing, bad breath.
• Baby may be fussy and sleep less due to discomfort.

Warning signs of severe reflux:

• Inconsolable or severe fussiness or crying associated with feedings.
• Poor weight gain, weight loss, or failure to thrive. Difficulty eating. Breast/food refusal.
• Difficulty swallowing, sore throat, hoarseness, chronic nasal/sinus congestion, chronic sinus/ear infections.
• Spitting up blood or green/yellow fluid.
• Sandifer’s syndrome: Baby may ‘posture’ and arch the neck & back to relieve reflux pain–this lengthens the esophagus and reduces discomfort.
• Breathing problems: bronchitis, wheezing, chronic cough, pneumonia, asthma, aspiration, apnea, cyanosis.

GERD may cause babies to either undereat (if they associate feeding with the after-feeding pain, or if it hurts to swallow) or overeat (because sucking keeps the stomach contents down in the stomach and because mother’s milk is a natural antacid).

Current information on reflux indicates that testing or treatment for reflux in babies younger than 12 months should be considered only if spitting up is accompanied by poor weight gain or weight loss, severe choking, lung disease or other complications. Per Donna Secker, MS, RD in the article Gastroesophageal Reflux Disease, “The infant with significant reflux who seems to be growing well and has no other significant health problems benefits most from little or no therapy. ”

When GERD is suspected, many doctors first try a trial of various reflux medications (without running tests), to see if the medications improve baby’s symptoms. If testing is done, a 24-hour pH probe study () is the current “gold standard” for reflux testing in babies; this is a procedure where a tube is placed down baby’s throat to measure the acid level at the bottom of the esophagus. A barium swallow (upper GI) is not so invasive (baby swallows a barium mixture, then an x-ray is taken) but is not really effective for diagnosing reflux in babies, since most babies will reflux when given barium. An upper GI will not identify whether baby’s stomach contents are higher in acid or if there has been any esophagus damage due to reflux, but it will show if there are any blockages or narrowing of the stomach valves that may be causing or aggravating the reflux. Additional tests may be recommended in certain circumstances (see the links below for additional information). In rare cases, when baby has very severe reflux that is not relieved by medication, surgery may be recommended.

Breastfeeding Tips

• Aim for frequent breastfeeding, whenever baby cues to feed. These smaller, more frequent feedings can be easier to digest.
• Try positioning baby in a semi-upright or sitting position when breastfeeding, or recline back so that baby is above and tummy-to-tummy with mom. See this information on upright nursing positions.
• For fussy, reluctant feeders, try lots of skin to skin contact, breastfeeding in motion (rocking, walking), in the bath or when baby is sleepy.
• Ensure good latch to minimize air swallowing.
• Allow baby to completely finish one breast (by waiting until baby pulls off or goes to sleep) before you offer the other. Don’t interrupt active suckling just to switch sides. Switching sides too soon or too often can cause excessive spitting up (see Too Much Milk?). For babies who want to breastfeed very frequently, try switching sides every few hours instead of at every feed.
• Encourage non-nutritive/comfort sucking at the breast, since non-nutritive sucking reduces irritation and speeds gastric emptying.
• Avoid rough or fast movement or unnecessary jostling or handling of your baby right after feeding. Baby may be more comfortable when help upright much of the time. It is often helpful to burp often.
• As always, watch your baby and follow his cues to determine what works best to ease the reflux symptoms.

What can I do to minimize spitting up/reflux?

• Breastfeed! Reflux is less common in breastfed babies. In addition, breastfed babies with reflux have been shown to have shorter and fewer reflux episodes and less severe reflux at night than formula-fed babies [Heacock 1992]. Breastfeeding is also best for babies with reflux because breastmilk leaves the stomach much faster [Ewer 1994] (so there’s less time for it to back up into the esophagus) and is probably less irritating when it does come back up.
• The more relaxed your infant is, the less the reflux.
• Eliminate all environmental tobacco smoke exposure, as this is a significant contributing factor to reflux.
• Reduce or eliminate caffeine. Excessive caffeine in mom’s diet can contribute to reflux.
• Allergy should be suspected in all infant reflux cases. According to a review article in Pediatrics [Salvatore 2002], up to half of all GERD cases in babies under a year are associated with cow’s milk protein allergy. The authors note that symptoms can be similar and recommend that pediatricians screen all babies with GERD for cow’s milk allergy. Allergic babies generally have other symptoms in addition to spitting up.
• Positioning:
  • Reflux is worst when baby lies flat on his back.
  • Many parents have found that carrying baby in a sling or other baby carrier can be helpful.
  • Avoid compressing baby’s abdomen – this can increase reflux and discomfort. Dress baby in loose clothing with loose diaper waistbands; avoid “slumped over” or bent positions; for example, roll baby on his side rather than lifting legs toward tummy for diaper changes.
  • Recent research has compared various positions to determine which is best for babies with reflux. Elevating baby’s head did not make a significant difference in these studies [Carroll 2002, Secker 2002, Craig 2004], although many moms have found that baby is more comfortable when in an upright position. The positions shown to significantly reduce reflux include lying on the left side and prone (baby on his tummy). Placing the infant in a prone position should only be done when the child is awake and can be continuously monitored. Prone positioning during sleep is almost never recommended due to the increased SIDS risk. [Secker 2002]
  • Although recent research does not support recommendations to keep baby in a semi-upright position (30° elevation), this remains a common recommendation. Positioning at a 60° elevation in an infant seat or swing has been found to increase reflux compared with the prone (tummy down) position [Carroll 2002, Secker 2002].
  • As always, experiment to find what works best for your baby.
• If your child is taking reflux medications, keep in mind that dosages generally need to be monitored and adjusted frequently as baby grows.

What about thickened feeds?

Baby cereal, added to thicken breastmilk or formula, has been used as a treatment for GER for many years, but its use is controversial.

Does it work? Thickened feeds can reduce spitting up, but studies have not shown a decrease in reflux index scores (i.e., the “silent reflux” is still present). Per Donna Secker, MS, RD in Gastroesophageal Reflux Disease, “The effect of thickened feedings may be more cosmetic (decreased regurgitation and increased postprandial sleeping) than beneficial.” Thickened feeds have been associated with increased coughing after feedings, and may also decrease gastric emptying time and increase reflux episodes and aspiration. Note that rice cereal will not effectively thicken breastmilk due to the amylase (an enzyme that digests carbohydrates) naturally present in the breastmilk.

Is it healthy for baby? If you do thicken feeds, monitor baby’s intake since baby may take in less milk overall and thus decrease overall nutrient intake. There are a number of reasons to avoid introducing cereal and other solids early. There is evidence that the introduction of rice or gluten-containing cereals before 3 months of age increases baby’s risk for type I diabetes. In addition, babies with GERD are more likely to need all their defenses against allergies, respiratory infections and ear infections – but studies show that early introduction of solids increases baby’s risk for all of these conditions.

The breastfeeding relationship: Early introduction of solids is associated with early weaning. Babies with reflux are already at greater risk for fussy nursing behavior, nursing strikes or premature weaning if baby associates reflux discomfort with breastfeeding.

Safety issues: Never add cereal to a bottle without medical supervision if your baby has a weak suck or uncoordinated sucking skills.

Additional Information

Spitting Up: Is it Reflux? by Anne Smith, IBCLC

LLL FAQ on breastfeeding and reflux

Gastroesophageal Reflux in Young Children by Pamela Tyler, M. S., CCC SLP

The Children’s Digestive Health and Nutrition Foundation (CDHNF)

NASPGHAN Guidelines on Pediatric GERD and Guidelines Summary on Pediatric GERD from the Children’s Digestive Health and Nutrition Foundation (CDHNF)

North American Society for Pediatric Gastroenterology and Nutrition (NASPGHAN)

Bailey DJ, Andres JM, Danek GD, Pineiro-Carrero VM. Lack of efficacy of thickened feeding as treatment for gastroesophageal reflux. J Pediatr 1987 Feb;110(2):187-9.

Carroll AE, Garrison MM, Christakis DA. A Systematic Review of Nonpharmacological and Nonsurgical Therapies for Gastroesophageal Reflux in Infants. Arch Pediatr Adolesc Med. 2002;156:109-113.

Craig WR, Hanlon-Dearman A, Sinclair C, Taback S, Moffatt M. Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children under two years. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003502.

Ewer AK, Durbin GM, Morgan ME, Booth IW. Gastric emptying in preterm infants. Arch Dis Child Fetal Neonatal Ed. 1994 Jul;71(1):F24-7. “On average, expressed breast milk emptied twice as fast as formula milk.”

Heacock HJ, Jeffery HE, Baker JL, Page M. Influence of breast versus formula milk on physiological gastroesophageal reflux in healthy, newborn infants. J Pediatr Gastroenterol Nutr. 1992 Jan;14(1):41-6.

Iacono G, et al. Gastroesophageal reflux and cow’s milk allergy in infants: a prospective study. J Allergy Clin Immunol. 1996 Mar;97(3):822-7.

Khorosheva EV, Sorvacheva TN, Kon’ IIa. Gastroesophageal reflux in nursing children: normal or pathology? Vopr Pitan. 2001;70(5):22-4.

Miyazawa R, Tomomasa T, Kaneko H, Tachibana A, Ogawa T, Morikawa A. Prevalence of gastro-esophageal reflux-related symptoms in Japanese infants. Pediatr Int. 2002 Oct;44(5):513-6.

Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 1997 Jun;151(6):569-72.

Omari TI, Rommel N, Staunton E, Lontis R, Goodchild L, Haslam RR, Dent J, Davidson GP. Paradoxical impact of body positioning on gastroesophageal reflux and gastric emptying in the premature neonate. J Pediatr. 2004 Aug;145(2):194-200.

Orenstein SR, Shalaby TM, Putnam PE. Thickened feedings as a cause of increased coughing when used as therapy for gastroesophageal reflux in infants. J Pediatr 1992 Dec;121(6):913-5.

Orenstein SR. Prone positioning in infant gastroesophageal reflux: is elevation of the head worth the trouble? J Pediatr. 1990 Aug;117(2 Pt 1):184-7.

Parrilla Rodriguez AM, Davila Torres RR, Gonzalez Mendez ME, Gorrin Peralta JJ. Knowledge about breastfeeding in mothers of infants with gastroesophageal reflux. P R Health Sci J. 2002 Mar;21(1):25-9.

Ravelli AM, Tobanelli P, Volpi S, Ugazio AG. Vomiting and gastric motility in infants with cow’s milk allergy. J Pediatr Gastroenterol Nutr. 2001 Jan;32(1):59-64.

Salvatore S, Vandenplas Y. Gastroesophageal reflux and cow milk allergy: is there a link? Pediatrics. 2002 Nov;110(5):972-84.

Sicherer SH. Clinical aspects of gastrointestinal food allergy in childhood. Pediatrics. 2003 Jun;111(6 Pt 3):1609-16.

Tobin JM, McCloud P, Cameron DJS. Posture and gastro-oesophageal reflux: a case for left lateral positioning. Arch Dis Child 1997;76:254-258.

What Parents Need To Know ReadySetFood
– Ready, Set, Food!

Nearly half of all GERD cases for babies under one year of age are caused by milk allergies. Keep reading to find out why your baby is spitting up, and how you can help them keep food down.

Babies gurgle, cry, blow bubbles and of course spit up. From time to time your baby is likely to spit up or exhibit a reflux when feeding. Young babies do not have a developed digestive system. Food can sometimes travel from the stomach back into the esophagus. This may happen for a few different reasons.

In this article we will cover:

• What causes infant reflux (GER)

• Tips to reduce infant reflux

• How Ready, Set, Food! can end infant reflux in older babies

Why is my baby spitting up? 

For young babies spitting up is common, especially during the first three months. This condition, known as infant reflux, infant acid reflux or gastroesophageal reflux (GER) is due to a still developing valve at the esophagus. This valve, the esophageal sphincter muscle sits between the esophagus and stomach entrance. When a small baby’s stomach is too full, stomach contents easily pass the valve into the esophagus and travel up causing infant reflux. 

As your baby’s body grows and develops so does this tricky valve, meaning less spitting up.

Breastfeeding and bottle feeding can both cause infant reflux. For strategies on how to best feed to avoid infant reflux in both cases we recommend this article.

Is my baby’s spit-up normal?

The appearance of the spit up can vary with the amount of time your baby had to digest it.

While the stomach contents may look like breastmilk or whatever was ingested, it is mostly made up of saliva and stomach acids. If concerned your baby is not eating enough because of how much they spit up do not rush to re-feed them. They are likely spitting up from eating too much or eating too quickly. 

Spit up that has had some time to digest in your baby’s stomach may have a more vomit like appearance. The smell may be sour, and the texture will likely be curdled. 

Babies that exhibit the above when spitting up are “happy spitters”. If your baby remains comfortable during and after spitting up they are likely not affected by their gastroesophageal reflux (GER). Gaining weight normally and a casual disposition are both signs of a happy spitter. You can expect your baby to grow out of their GER within the first year. Less than 10% of babies still spit up regularly after this point. In these cases there could be an allergy or gastrointestinal (GI) issue.

When should I be worried?

Any vomit that is forceful or projectile is cause for alarm. Gastroesophageal Reflux Disease (GERD) is much more severe than a “happy spitter”. If you notice any of these symptoms alongside reflux intervention is necessary: 

• Baby is visibly distressed

• Muscle contractions when spitting up

Babies who suffer from GERD should not wait to grow out of infant reflux. Spit ups for sufferers of GERD might not lessen. The correlated symptoms can also damage their small bodies if not addressed. Call your doctor if your baby suffers from any of the symptoms above for the best course of treatment.

Your baby may have another GI issue if GERD is not detected. To learn more about GERD, we recommend this article. 

How can I prevent my baby from spitting up?

If you are certain your baby is a “happy spitter” there are safe ways to ease their discomfort. Here are some tips for helping your baby keep food down: 

• Don’t bounce baby or play 20-30 min after meals

GER peaks at 2-4 months and usually lasts until 8 months. If your baby begins to spit up more after 6 months you should consider what foods have been added to their diet. As babies get older their valve should be able to keep more food down. Reasons for increased infant reflux after 6 months include: 

• A cold where mucus causes more spit up

• Growing babies swallowing more air due to eating more quickly

Nearly half of all babies suffering from GERD have a milk allergy. While GER is common, GERD should not be taken lightly. If your babies GER worsens with age or develops into GERD you may be dealing with an allergy to milk proteins. 

Inspect the ingredient list in your babies formula for possible allergens. If you have recently changed brands your baby may have a sensitivity to a new ingredient. For breastfeeding mothers consider any new foods that have been added to your diet. If your baby is transitioning to solid foods and spitting up more, they may have a food allergy.

If your baby has other symptoms of not being well you should contact your family doctor.

Using Ready, Set, Food! For Reflux Babies

Half of GERD cases are due to milk allergy or intolerance. If your baby has a milk intolerance, Ready, Set, Food! is safe to use if you believe your baby may have a milk intolerance. For those babies with a diagnosed milk allergy, Ready, Set, Food! offers peanut only and peanut + egg systems, perfectly customized to your family’s needs. 

——————————–

All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship. Always seek the advice of your own pediatrician in connection with any questions regarding your baby’s health.

These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure, or prevent any disease. If your infant has severe eczema, check with your infant’s healthcare provider before feeding foods containing ground peanuts.

Baby Spit-Up & Throwing Up

Your baby just spit up. Or maybe he vomited. You’re not sure which it was or whether you should be worried. If he spit up, probably not. Baby spit-up isn’t usually an issue. 

Also known as reflux, spit-up is simply the flow of food from your little one’s stomach to his mouth.  

It’s common, not painful, and might happen from time to time until your baby is about a year old. Baby spit-up is often just the result of a still-developing digestive system or overfeeding. 

The difference between spit-up and vomit is outlined below. If you have further questions or concerns, contact your healthcare provider.  

Spitting up is a common occurrence in healthy infants early in life. This is partly because of immaturity of their digestive system. It’s relatively harmless and usually resolves as the digestive system matures, when your baby reaches 12 to 14 months of age.    

Spit-up is sometimes called by other terms like “regurgitation” and “gastroesophageal reflux. ” They’re just fancier ways of saying spit-up, with a minor difference. Regurgitation and reflux refer to the backwards movement of the stomach (gastric) contents up into the esophagus—and at times into the mouth. When the contents of your baby’s tummy spill out of his mouth, it’s called spit-up.

It’s all about tummy size. At birth, your baby’s tummy is about the size of a small marble. After 3 days, it is about the size of a ping-pong ball, but still can’t hold much.¹ Until he’s about 4 months old, your baby’s tummy can hold only small amounts of milk at a time. Too much milk during feedings can cause your baby to spit up or be fussy.  

Babies also have less developed muscles in the upper esophagus, which makes it easier for fluids to flow back up from the stomach.  

Spitting up can also happen when your baby burps (called a wet burp) or swallows too much air. It isn’t painful to your baby, and most babies don’t even realize they have done it.

As long as your baby is healthy and gaining weight, spit-up should be seen as just a normal part of his development.  

It may look like a lot when it’s on your shirt, but the amount of liquid your baby spits up isn’t as much as you think. Usually, it’s just 1 or 2 tablespoons at a time. If your baby spits up more than this—or if his spitting up is the effect of respiratory events like choking, coughing, or wheezing—ask your pediatrician if there is a reason to be concerned. 

Babies and Spit-Up: What’s Normal, What’s…

There’s a developmental reason for why infants are prone to spitting up, says Dr. Dixon, and it has to do with the muscle that surrounds the esophagus called the lower esophageal sphincter (LES).

It can be difficult to know what is the normal amount of spitting up and what’s a problem that could require a doctor’s attention. Here, Rebecca M. Dixon, M.D., FAAP, a pediatrician at Indiana University Health, shares some expert advice.

Why babies spit up

There’s a developmental reason for why infants are prone to spitting up, says Dr. Dixon, and it has to do with the muscle that surrounds the esophagus called the lower esophageal sphincter (LES). “As the stomach squeezes to empty, this muscle is also supposed to squeeze so that what’s in the stomach will move down to the rest of the intestines,” she explains. “Babies are born with a weak LES, and like all muscles of the body, it strengthens with time,” she says. “Infant who are premature have even lower LES tone.”

“It’s like trying to squeeze a water balloon that has holes on the top and bottom,” says Dr. Dixon. “That’s why it’s normal for babies to have some reflux, which is when the fluid comes back up the esophagus and out of the mouth or even sometimes through the nose.” In most cases, the problem resolves once a baby reaches six months of age or so, because by that time they’re eating more solid food, they’re not lying down all the time and their LES muscles are stronger.

Some simple measures can help

One change that may help minimize spitting up is to reduce the volume of formula or breast milk you give your baby at one time, and decrease the amount of time between feeds. “So if you’re normally feeding your baby three ounces of breast milk or formula every three hours, you’d switch to two ounces every two hours,” says Dr. Dixon. Because the baby’s stomach is not as full, reflux is less likely to occur.

After every feed, make sure you burp the child well, and then try to hold your baby upright (or at least a 45-degree angle) for about 30 minutes. Don’t put the baby in a car seat or bouncy seat, says Dr. Dixon, “because being scrunched up like that with a full belly makes it more likely that they’ll spit up. In the past, pediatricians used to use medication frequently, but they’ve been shown to not be particularly effective so we’re using them less and less,” says Dr. Dixon.

Signs of a more serious problem

Even if your child is spitting up with every feed, as long as they are gaining weight and having adequate wet diapers (meaning at least one every eight hours), those are signs that the baby is getting adequate nutrition and hydration. When it becomes “more than just a laundry problem,” is when a baby is having difficulty gaining weight. “That’s a sign that your baby is spitting up more than he or she is taking in,” she says.

If your baby is having projectile vomiting with every feed, and you notice fewer wet diapers (less than one every eight hours), those could be signs of a more serious issue. “If this is the case, your baby should be seen by a doctor within 12 to 24 hours,” says Dr. Dixon.

— By Patricia Scanlon

Babies and Spit Up – When to See the Pediatrician

For many first-time parents, baby spit up can be a bit terrifying. There is a very fine line between what is “normal” and when you should seek help from your pediatrician.  Dr. Jessica Long helps to clear up some common spit up misconceptions…

When I found out I was pregnant with my first daughter, I daydreamed about lazy mornings cuddling with her, taking long walks together through our neighborhood, introducing her to all of my favorite childhood spots in DC, and of course all of the adorable clothes. What did not play a starring role in my motherhood fantasy was the amount of spit up that would end up on her, me, my husband, the dog, and really anything within a four foot diameter after she ate. Her spitting caused her no distress and certainly did not slow down her impressive weight gain but wow did it lead to a lot of laundry.

Spit up is an incredibly common baby phenomenon. In fact, more than half of babies younger than 3 months old spit up daily. For most babies, gastroesopahgeal reflux (GER) is a natural occurrence that, while annoying, causes no health problems and improves with time.   However, in some babies it may cause complications – in which case we call it GERD (gastroesophageal reflux disease) – and requires evaluation by your pediatrician.

For all of those parents out there with “happy spitters” who smile while you grab your tenth burp cloth of the morning, there are thankfully some simple things you can do to help reduce the amount of curdled milk you are scrubbing off the sofa.

First off, there’s only so much room in that tiny baby belly and if it gets overfilled with milk there is nowhere for it to go but out. Do your best to not overfeed your baby. Also, try to minimize gas in your baby’s belly so that, as a gas bubble escapes, it doesn’t bring up half the meal as well. Some babies need to take burp breaks in the middle of their feeding as well as at the end in order to not have a wet burp down your back shortly after eating.

While tummy time is important for motor development and can help to relieve gas, it is best to avoid it right after feeding. That extra pressure on the stomach is more likely to send its contents all over the living room rug. Holding your baby upright for 20-30 minutes after eating also helps to keep everything in her stomach right where it belongs.

Still spending more time with the laundry machine than enjoying that sweet social smile of your baby? It is important to have regular follow up with your pediatrician to ensure that gastroesophageal disease is ruled out. Talk with your pediatrician to see if diet changes would be helpful. Some breastfed babies may be sensitive to dairy or egg and having mom avoid these foods could cut down on spit ups. Similarly, a formula fed baby might prefer a hydrolyzed formula. Adding a small amount of oatmeal to bottle feedings has also been shown to help reduce the amount of spit up. However, chat with your baby’s doctor before altering anyone’s diet.

With spit up, time is the best remedy. As your child grows, spitting up will be less of an issue and your little one will be on to new and exciting problems such as desperately wanting to play with electrical outlets and finding every choking hazard accidentally left around your house. Parenthood is a journey and spit ups will soon be a distant memory. The overabundance of laundry in your home will unfortunately be an ongoing problem.

8 Tips Stop My Baby Spitting Up Curdled Milk and Crying

Every parent knows that there’s a learning curve to raising a kid. But the reality of seeing your baby spitting up curdled milk and crying is a little bit more jarring than parenting books describe. That colicky heave their little body does while spitting up curdled milk can unnerve even experienced parents.

Before you freak out, try to remember that babies are born with a blank slate and need to learn EVERYTHING. Including feeding. For the first few months, when their organs are getting a hang of living outside mommy, their digestive system tends to misbehave. The conventional wisdom is to pat your infant on the back until they let out a loud burp.

But if the sheer number of burpees used per week suggests anything, it’s that baby’s spit. A lot. Even after they’ve been burped. Is it a cause for concern? In most cases, no – it’s just one of those things that babies do. Understanding what to expect is a good way to know when everything’s A-OK and when you need to see a doctor.

If you want to learn about the difference between Enfamil formula for newborn and infant, check this post on Enfamil newborn vs infant.

What is Considered Normal?

A baby spitting up curdled milk is practically a rite of passage. It’s estimated that at least 50% of babies would have done so before clocking 3 months. It’ll be more abnormal for a baby to be raised without ever spitting up curdled milk than otherwise. Appreciate all those burpees you get at baby showers, because you’ll be dealing with your fair share of baby spit-ups.

What’s considered normal? If a baby’s relatively content, comfortable, has no trouble breathing after a spitting session and isn’t rejecting food or losing weight, they’re doing alright. In fact babies like this are termed “happy spitters”. Unhappy spitters tend to react the opposite way. Reflux tends to cause heart burn, so the baby will be uncomfortable and can have trouble breathing. Sometimes, because of how undeveloped their bodies are, the food goes through the wrong tube and ends up in the lungs. If not noticed and treated, it can trigger a host of health concerns including pneumonia.

If it looks like your baby’s spitting out the entire content of their stomach, observe how frequently it occurs, what the content of the spit-up is and if they’re losing any weight as a result. If they’re happy to get back to feeding, don’t call the hospital just yet. As frustrating as it can be, try not to panic by remembering that spitting up doesn’t always mean there’s an underlying medical issue.

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Spitting Up Vs. Vomiting

With a spit up, the content of your baby’s stomach flows easily through the mouth. Possibly followed by a burp. You’ll notice curdled milk dribbling from the sides of your baby’s mouth. However, with a vomit, the flow’s more forceful – with the projectile shooting several inches out of the mouth. Now onto what the content of a spit up should look like.

What’s Does Normal Spit Up Look Like?

Curdled milk usually comes out “chunky” looking, with bits of saliva mixed in. If your baby spits the milk out immediately after feeding, it can still look like normal baby formula. As long as there’s no color in the regurgitated spit up, then you shouldn’t be too worried. If the content of your baby’s spit up contains bile (it’ll look greenish and yellowish) or blood (it may look brownish), you shouldn’t even be reading this but be on a call to your pediatrician. There are many reasons why babies spit up curdled milk, let’s take a look at each one.

Causes: Why is My Baby Spitting Up Curdled Milk?

Underdevelopment

The human digestive system is made up of a very coordinated gastrointestinal tract. You eat, food passes through the esophagus, down to the stomach. Before food passes down the esophagus, a tissue flap located above the windpipe, called the epiglottis, directs its flow to the esophagus. It essentially blocks entry of food and liquids to the windpipe and lungs. In infants, these organs are poorly coordinated, so the tissue flap might not close in time. Hence breast milk or formula can end up entering the wrong pipe into the lungs – which triggers coughing and spitting. This rarely happens.

What’s more common is the underdevelopment of the valve/muscles that allows food to go up or down. A ring-like valve (pylorus) located at the bottom of the esophagus relaxes to let food pass, and contracts to prevent that food from going back up. In infants, this muscles aren’t fully functional, so can’t prevent food from going back up. This is one of the most common reasons babies spit up. Even though there are some things you can do to manage spitting resulting from underdevelopment, there’s nothing you can do to speed up said development, so don’t torture yourself. By the 5th month, most babies would have better digestive systems so this won’t be a problem.

Overfeeding

Babies consume a lot of nutrients compared to their size, those that get aggressive during mealtimes become overfilled fast and thus overflow. Most parenting books/blogs tell you you’re supposed to nurse your baby for about 15 minutes because that’s when the good “boob juice” begins to flow. So your job is to coax your baby to nurse moderately until the 15 minute mark. Some babies don’t get this and will literally try to chug down the milk like you’d chug beer at a frat party. Forcefully chugging milk can trigger milk ejection reflex, so they’d have to spit some of it out.

Often times, it’s not the baby’s fault, you might just have an overflow of milk. If your baby’s breastfeeding directly from the source and not from expressed milk in a bottle, they’re at the mercy of the milk flow. When the flow’s forceful, your baby will be taking in a lot of milk very quickly and might not even last 5 minutes before getting full and choking on the excess. A baby’s stomach is as small as a golf ball, so filling it really won’t take much. If the ejected food contains stomach acid, i.e. acid reflux, it might cause heart burn in the baby, in which case, you’ll need a doctor.

Food Sensitivity/Allergy

There’s a reason mothers are encouraged to feed their babies breast milk EXCLUSIVELY for the first 6 to 12 months. Since a baby spends the first 9 months in its mommy’s belly, he/she is already familiar with her flora and eating habits. There’ll be no surprises in the breast milk. However, feeding your baby with formula immediately after birth – even when it can’t be helped – can trigger allergic reactions. If your baby’s being introduced to solids, monitor how they react to what they eat very carefully.

Aside from introducing new foods to your baby, you, as the mother also has to watch your diet. Suddenly changing your diet can reflect in your breast milk and cause food sensitivity in your baby. You’d need to eat a lot more of the new diet for there to be any significant change in your breast milk. If you introduce any new vitamins or medication to your or your baby’s diet, observe your babies reaction. In some cases, the baby will reject the food.

Pyloric Stenosis

This condition is so rare your baby is more likely to develop all other symptoms simultaneously than have it. With pyloric stenosis, the pylorus muscular valve responsible for relaxing and letting food into the small intestine and contrasting to hold food in, thickens and blocks the passage way. It usually occurs within the first 3 to 5 weeks of birth, and is noticed more often in white boys, who might have inherited it, than any other race.

A baby with pyloric stenosis seems hungry all the time since whatever they’re fed never stays put. Because of the blockage, ingested food gets vomited. You might notice some stomach contractions as the body tries to squeeze what little food it can through the blocked passage. It’ll usually be unsuccessful, which is when the body ejects it. This condition is very chronic as babies can become severely dehydrated and lose weight. The only way to resolve this blockage is through surgery. If your baby’s older than 6 months, and is still fussy, you can rule this out, as pyloric stenosis is even rarer amongst babies older than 3 months.

Swallowing Air

When babies hit a growth spurt, they tend to guzzle a lot more enthusiastically – swallowing extra air. Curious or crying babies tend to take multiple breaks while feeding to look around before returning to their meal. In doing so, they then to swallow up more air wit their milk. When air gets trapped in with fluids, it has to come out one way or another. Sometimes it comes out through the mouth as a burp, along with some of the ingested breast milk, other times it comes out through your baby’s nose.

Feeding Position

Infants spend a good amount of time on their backs, sometimes parents forget that they’re not meant to be in that position while they feed. Lying your baby immediately after feeding can cause him/her to throw up their meals. Remember babies aren’t adults who can couch potato all day without immediate consequences.

Tight Clothes

Baby clothing/diaper sizes are there for a reason. A too tight diaper or elastic band can put excessive pressure on the abdomen and cause your baby to spill out the content of his belly.

Related Post: Pampers VS Huggies: Which Is Best Diaper Brand

Preventive Measures: How Do I Get My Baby To Stop Spitting Up?

8 Tips for my

baby spitting up curdled milk

1.Don’t Overfeed

Respect that your baby has a tiny tummy. Opt to feed your baby often, but in small quantities – preferably every 3 to 4 hours. It’s estimated that the size of a baby’s stomach is the same as their fist. So if you’re giving your baby a bottle, place it near their fist and compare the quantity in the bottle to their fist. The more even it is, the less likely you are to overfeed. Try not to wait too long in between meals because hungry babies are angry babies.

2.Manage Milk Flow

If your breast milk flows fast, express it into a bottle, so your baby can feed at a slower pace. Make sure you pick the right nipple hole; one that’s not too big that your baby gulps and gags on too much milk, and one that’s not so small it frustrates your baby into guzzling plus air.

3.Feed in an Upright Position

Feeding your baby while he’s slouched or curled up in your arms won’t do him any favors. Experiment with the most comfortable position for you both that offers a straight path to the belly. Keep the baby’s head tilted upwards, and the lower body down. You want gravity to do some of the work that your baby’s underdeveloped system can’t yet do.

4.Keep Feeding Sessions Quiet and Calm

Babies can get distracted by noise while feeding. This can cause them to take frequent breaks that cause them to swallow air in between sips. After feeding, most doctors suggest you keep your baby horizontal for at least 30 minutes before they can start playing. It’s a lot harder than it seems, but try keeping them stable for at least 15 minutes. No jostling, no bouncing, no infant swings. Just no sudden movements of any kind.

5.Keep Pressure off Their Stomach

Not only will lying your baby on the back lower the probability of sudden infant death (SID), it also keeps extra pressure from the stomach. In the same vein, ensure your baby’s wearing the right clothing and diaper size, so their abdomen isn’t pressured to spill its content.

6.Burp Your Baby

Sometimes air is unavoidable while a baby’s feeding. In fact, whenever your baby pauses in between sips, take the time to burp him. This way, what all the gas will be let out before even more milk is consumed. If your baby doesn’t burp several minutes after they’ve been patted down, they probably don’t need to just yet.

7.Monitor Diet

Nature probably didn’t intend for inter-species breastfeeding, but humans have gone along with it. Formula made with cow milk is often the biggest culprit when you find babies spitting excessively. Try changing it. If you’re breastfeeding, ask the pediatrician what meals you can take to guarantee a healthy breast milk supply.

8.Medication

In extreme cases, e.g. when your baby’s fussy from an acid reflux, your doctor may prescribe some medication to help with the heart burn, and to prevent the acid from causing damage to sensitive linings. In other cases, the drugs prescribed may be to help move things from the stomach to the small intestines to prevent it from coming back up.

Baby Spitting Up Curdled Milk FAQ

Note that most of these questions have been answered within the article – in more depth. If a response doesn’t sufficiently answer your question, refer to the main article.

When should I be Concerned About Baby Spit Up?

Spit ups are very normal in infants. But if your baby starts showing signs of dehydration – seen from a decrease in the amount of urine contained in diapers, a sunken soft spot on the head, or a lack of tears while crying, call a pediatrician. Normal spit ups shouldn’t result in weight loss, and the curdled milk that spit shouldn’t be colored – just white. Unlike adults, babies can’t afford to lose nutrients, so contact your health care professional if you notice any of these.

How do I Know if my Baby is Spitting or Vomiting?

Spitting is technically a mild form of vomiting. In most cases, the projection and force with which the meal is regurgitated, will determine the exact condition. Spit ups rarely cause discomfort to babies.

Should I Feed my Baby After Spitting Up?

While the spit up may seem like the entire content of your baby’s belly, it’s usually no more than a table spoon, so you don’t need to top off. Because overfeeding can make a baby spit up, your kid might just be emptying out the excess. Just wait for some minutes until your baby starts fussing for more.

At What Age Will my Baby Stop Spitting Up?

As your baby grows, their gastrointestinal tract should be able to relax and contract when they’re supposed to, keeping the content of stomach where they belong. Babies generally stop spitting up around the ages of 6 and 7 months – just when they start sitting without help. A few babies will keep spitting into their 12th month.

Will Gripe Water Help with Spitting Up?

The herbs in gripe water aid with digestion, so technically it may help relieve spitting – but only for a few symptoms. For example, if your baby has gas and won’t burp, gripe water might help. But there are numerous reasons why your baby could be spitting up, so don’t just throw gripe water at your baby.

How do I Stop My Baby Spitting Up Curdled Milk?

Burp your baby after every meal, so they pass out gas. Space out feeding every 3 to 4 hours, and ensure your baby’s not gulping and gagging but feeding slowly. Keep the baby in an upright position for 15 to 30 minutes after feeding before lying him on the bed (on his back). Monitor you and your baby’s diet.

Why is My Baby Spitting Up Curdled Milk and Crying?

Reasons your Baby Spits Up and its Solution – IFMCH

Did you know 50% of 0 to 3-month-old babies spit up at least once a day? And most of the babies will completely stop spitting up by 12 months. Babies spitting up is not so uncommon for mothers. If you are a mother, you probably have had wiped away the spit countless times. Some babies do it more than others and it can me due to formula milk or breast milk. It is more of a laundry issue than a medical one as spitting up simply adds to the mountain of laundry.

What exactly does spit up mean? It is just a mild throwing up or regurgitation of saliva, food or milk.  All the reasons that babies spit up are nothing to worry about because it is not painful for your baby. If your baby is healthy and is gaining as much weigh as she should, then there is absolutely nothing to worry about. A healthy baby will gain six ounces every week and will wet diapers once every six hours.

Reasons for Spitting Up

Here are some of the reasons that your baby will spit up:

1. Partially Developed Valve

Your baby has an immature digestive system right now. For food to go down into the stomach, it has to pass through the esophagus. In the stomach it mixes up with the stomach acid and then passes down into the intestine to be further digested. A valve exists between the stomach and esophagus that keeps the food from jumping up into the esophagus. Babies don’t have a completely developed valve which is why the food goes back into the food pipe and ends up in spitting. This is also called infant reflux.

2. Small Stomach

Did you know your baby’s stomach is the size of a tiny marble at birth? So yes, the baby’s stomach is really small and it cannot hold a lot of food. It is no wonder you need to feed them after every few hours. After three days, it becomes the size of a ping pong ball and still cannot hold much. It is after about four months that the baby’s stomach is able to hold small quantity of milk.  Filling them up too much with milk means the food will not go past the valve that is present between esophagus and stomach and result in spitting up. As your child grows, stomach grows and the valve also develops completely which means no more spitting up and no more mountains of laundry.

3. Over feeding

Over feeding can occur when your child feeds too aggressively or when your breasts happen to be too full. As the baby has a small stomach, he is not able to hold a lot of milk. Gastrointestinal reflux causes it to return back from the stomach into the food pipe. This eventually results in spitting up.

4. Swallowing Air:

Babies who have just started feeding are still in the process of learning how to drink milk. They don’t know at what speed they should be drinking. At times they drink too fast or take huge gulps of milk that they end up swallowing air with milk. The trapped air needs a route outwards and this results in spitting up of some liquid.

Ways to Reduce Spitting Up In Babies

You cannot prevent spitting up altogether but you can certainly minimize how often you baby spits up. Here are some simple ways you can try:

1. Quit overfeeding

The rule of the thumb should be frequent but lesser feeding. Remember your baby’s stomach is too small. He can’t hold a lot of milk and ends up spitting up.

2. Don’t feed when your baby is lying down

When you feed your baby while he is lying down, he might choke and spit up

3. Check the size of nipple hole

If you are giving your baby a bottle, make sure the nipple hole isn’t too small. Your hungry angel might want more milk and suck harder. He might actually end up swallowing air. In case the hole is too big, he will drink so fast that he might drink too much. This can also cause spitting.

4. Get the cold treated

Babies suffering from flu or cold tend to swallow the mucus and spit up more than usual. Treat the cold to prevent excessive spitting

5. Hold the baby in upright position

You need to hold your baby upright while feeding and even after feeding. This lets the milk pass through without any obstruction.

6. Burp your Baby

After feeding and even during feeding, take some time out to burp your baby. It helps to prevent air from trapping inside the baby. Babies get tired while feeding and take a break. You can burp him during this break. It helps to release air and prevent spitting.

90,000 Can a baby choke on saliva?

I think CF13’s answer is accurate on. I just want to add some support / extension information.

I am assuming that by “asphyxiation” you mean a significant event such as death or aspiration pneumonia, not just coughing or vomiting. The latter are actually ways to clear your throat (kind of the opposite of choking).

Without going into details, there are reflexes that help us survive very well.Coughing and / or swallowing vomit to keep the airway clear is one of them.

People who die of suffocation from vomiting are those who in some way suffer from neurological disorders. For example, heroin use, severe intoxication, loss of consciousness (not the same as sleep!), Stroke or prematurity (born before these reflexes are refined) can dull this reflex, which is why such deaths can occur in these populations. …

Children who are neurologically unharmed will clear the airways very well, even from profuse vomiting.

Fatal suffocation is very rare, except for health-related reasons. The number of fatal suffocating deaths has not increased since sleep recommendations began. In most of the few reported cases of fatal suffocation, the infant slept on its stomach.

To answer your questions directly,

Can a baby choke on saliva?

Yes, just as it is possible for your spouse (say, he has gastroesophageal reflux).

Do we need to worry about her choking that much?

No. As long as you’re not worried about your spouse choking on sleep, you don’t need to worry about your child, although worrying about children is very common, normal, and natural.

What if she spits up while we sleep?

Usually, when children spit in their sleep, they just swallow it, or it ends up on the baby’s sheet / collar, etc. Nobody even wakes up.But if she’s going through tough times for some reason, her cough / pain should wake you up. If you sleep in a different room ( is not recommended in according to the American Academy of Pediatrics), please use the monitor set to “loud” to detect any distress. Dividing a room, done right, is a recommendation.

_{Study: More research is needed on the effects of room sharing on children’s sleep, AIDS prevention}

90,000 FIELDS IN THE CITY.Sheets to France

Shupashkar [Cheboksary]: Russica – Face of Chuvashia, 1998.

… suddenly – like an echo of a distant glade in the city of fields Record of 1969 ROSES: DEDICATIONS WITHOUT NAME Yves Bonnefoy the river – already different – surrounds us turning much into its other waves and is cold transparent and united and it’s too late to say: “we are there “she is one one No-Cleanliness January 30, 1965 PIERRE EMMANUEL: RECORD MADE WHILE TRANSLATING HIS POEMS and you worry more and more about the uselessness of a thing for a piece of paper every day: you tear the paper:” I am not different myself “: how poor a pencil is !. … – and who will peck the beggar’s thing from the inside? – and who will speak? ..

1966 ANOTHER ROSE: FOR HENRY MICHO Ensuite elle fut prise dans l’Opaque NM there is another rose – the soul of the family! oh rose – whitened trumpeting to the point of my melancholy! – about the kind of vision: it hurts to my eyes! – as once upon a time, as in the days of simple grief: son and field: things visited 1966 TO A HOLIDAY IN CHILDHOOD (Marc Chagall: lines sketched out to his failed exhibition; Moscow, 1967) children! you are a hearth: a fire-turner distant in the noisy celebration of the family! – I give you a dream: step: with admiration 1967 PIERRE EMMANUEL: TWO VOICES 1 – where did the river such Death come from: such an immense Dream! and all – not yours 2 – not a Dream – and all your soul is not you but I looked through it in you 3 – how do I know about this ?…. 1968 QUIET: DEAR LITTLE (Inscription on the book) Pierre Jean Jouve has awakenings the winter hour is that and this friend – as if the light of day in the verlaine “la neige incertaine” is begging – the warmth of suffering: and there is – “Sueur de sang” – and everything is easy – like rare snow – in a fall: between thought and the other: adjacent and composed: by a sufficient reminder – hinting that in 1968 JUANU MIRO: BUBBLES OF VOICES and here behind the Yellow painted I sleep and “Sleep your feet – I say – and sleep your hands” and vowels And once and E and O and again And they fly shining in the centers of bubbles of golden saliva – from a whispering mouth! – they fly through Yellow and the holes are left and cold and I wake up January 24, 1969 FROM “ROSES: DEDICATIONS” (The inscription on the book) to Patrice de La Tour du Pen, like after many years to a hungry half-eaten bread – once thrown into the grass, it seems to those present in the world: so they grieve us in our dreams! – with our whole life in the form of things, then it’s as if we ourselves were taking pictures of something reasonable. .. – let this about more than “me” greet all things-images: from the whole “Une Somme de Poesie” 1969 MAX ERNST: ROSE-TWIN is punched – and as if not into the sunlight, but into the light-in-the-Idea – and a double rose is placed: as if in the room 1969 SINGING “WITHOUT PEOPLE” (Inscription on the book) VL will only be sung! all the singing will be about you! – and let it remain the center-basis of singing – Your “I – e smm” – so precious to me: (and pure so – as the mind thinks wounded! ..) – as if there is somewhere (hidden sacrament) blood where God is prepared 1971 QUIET: FROST (Christmas recording) P.Le Maroua in the branches – (from the sky: no action: the sky) – oh: The middle! – a promise (in the Meeting) silent: with a quiet Vow – (in a meeting) December 25, 1979 KNOWING – IN THE FAR VK Losskoy, again – an inscription on the book message-man … – “special” hours! .. – and I bow to you – from the height of my gaze – as brotherhood: suffering-fires … …) November 7, 1981 ——————————————- ————————————- SHOROHI-AND-RUSHING DREAM: MANUSCRIPTS. .. une immense douleur a chaque page. Lautreamont. From a letter Coming out of the Sun – the perfume contains white! – in the woods illuminated from within: girls’ games! – and in this non-our time the lights are scattered: and the heart is among them June 12, 1965 RECORD Flambeaux eteints du monde … Nerval and touching dust-From-side-beloved: “Oh, the higher field, you are the wind for centuries !. . “and touching the dust-Itself-for-the-Storm:” Oh light – the last decay! About the field – without it! .. ” – in the dust – the bottom: mind-not- “I” crackle – flame !…. – in the wind of the look of desolation bright light 1967 “SWALLOW”: A METHOD OF BINDING (From the cycle “Jacob’s Limb”) I. B. is for displaying the eM-eSky lattice in the phenomenon-glow of the Country-Carbonation: fire sign her! – and in its directions as if fiery in the cellars: Homeland-Zareva! – while the sign of another fiery figure looms: in the brain – as if in some kind of mouth: in itself the unexpected! – and is felt by the scheme of the distant: and red-hot: what is happening in 1969 ILARI VORONKA o Wounding po – br and with k and!. … – … and that wound is a flower in-you-in-others, bottomlessly expanding: and-color-and-blood-and-thought … understood: our flowers are in bloom … (we all bloom with parts of scarlet Today) 1969 AND: IN FRONT OF YOU (From the cycle “Jacob’s Limb”) and you Paper-like-in-Holes you are so checked without shame: in front of you Like a Blowing One: and the Be-Sskoe – for sounds – the place is open on the Face-Gnienya: and he says, as if blowing, “We’ll put it in your face”: as if he were moving in drafts: in himself – as if in a building: leads 1969 WITHOUT A NAME Again – in memory of Ilari Funnel and burrowing into sleep – as if: in the hay I see slowly: here he is – peering from himself, erasing the snow – all the same: “la farine blanche d’une joie… “- without a whisper (and soon – without a face): this is how an even light that tingles higher and higher increases: emptiness – behind old common visions – (always as if it were like this: like a light in a dream from the face of a peasant – my suffering without a border is light) 1974 ————————————————- ——————————- POEMS OF ANTOINE SCENE: FLOWER MAN (Antoine Vitez) in danger-City for the fragility of the gaze – through the dazzling fear (as if in sightlessness) of the City-Building – blows-flutters-and-blows with fire-whiteness – to the stage: in torture-radiance of glances-and-gestures: – man in e t e n e!. … – (like – before waking – jasmine flickering – with light-impulses) … – and participation in the circle of Radiance is admiration-silence – (unexpected role: a liberated look-person) May 3, 1977 TWO DAYS – CONSCIOUS SUN Antoine Vitez 1 Sun – today: it disappears behind the clouds of a long day – monotonously slow; then, breaking through suddenly, it illuminates our world, as if – from a forgotten word – the narration starts again, – in which – both His Right and Possibility: like – from time to time – an indistinct whisper: for us. The light on the roofs is like a talk.Like an unheard song. So it goes – all day. Suddenly – as if in my thoughts a random guess: “drama” (as someone whispered). Is it a day of the earthly world? – significant or “common”? – or the Action as something of a certain in the All-Encompassing-World – where is the Sun – how is the word? .. – (and only one is given Immutably-One, – guessing a little – about the difference between Them: in the Unchanging). However, we are in it, in this inaudible DRAMA, that included us in itself and did not rush us. The Day of the Sun is so conscious (in a hectic day).2 Sun-Worker. How work about, – yes, how work about It – in the afternoon of September – once – in the mountains of Dagestan, when we were climbing – in impenetrable fog – we were from the Sulak canyon! It worked, freeing the World from the fog. Like fists. Like a seeing mind. Thought. The answer. I just wanted to say: “Sun-Worker, Sun-Worker, Sun-Thinker.” The years have passed. And about m – that’s the only thing that has been said. (As a child inspires with a smile about himself: “I am a smile”: so – the Sun was Himself! .. – Clear self-determination.) 1977 PROMELK-BLUE: INSTEAD OF LETTER A.V. and this visitor in the morning this dexterous and adult baby titmouse – in the Theater-child- “Universum” – (ax these strong legs are like supports in the memory of the tenacious-Mandelstamov’s couplet phrase) – this is living green in the white snowstorm of Moscow – a flash-note of love – into the nebula – nerve-left January 25, 1979 I: VERBA COLOR Antoine Vitez, even a flying titmouse mother is like a tree! – we are the deviation: the wind! (writers can see such a Beginning) – (with some, perhaps, volatile warmth) . .. – everything is in a web: from the threads of the last Winter-Deflection! – and these lumps… – about the Mother-Tree – a silk whisper March 9, 1979 AND THEY ARE QUIET DURING ILLNESS O wonderful weakness to Antoine: steps to the heart … – transitions like into a forest glow: into silence … – imperceptibly descending due to weakness of the eyes: by the trembling of twilight in thinking – (like drumming) going down (circular steps) – to the empty-calm – in the coolness of me-those around (about even-with-me-cooling “property”! like transparency) to a few things – about truly white-headed sisters ( papers-things) 1982 ——————————————— ———————————– FROM ANTUAN VITEZ’S POEMS WITHOUT A NAME just after the last soldiers’ festivities cold morning – work : oh this creeping creature, this dog.This last summer (the beginning of summer is always a nightingale, she said, in the garden, she said) that same old man on a rock (oh comedy) was blind with this dog – and now it has been two years since then ( it was the beginning of summer – before the nightingale) irrevocable – oh yes – the invariable young deceased: not the one with a bare chest with a wood splinter to dig something out there not that worthless workaholic or companion of the blind (oh comedy again) but that leper and that friend the leper that same deceased friend on a cold morning ACCEPTABLE – IT CAN BE – WORDS In memory of Rene Kaliska next to him fought lying rejected next to fought on on the slope of the hill, the defeated fought defeated, beating to death, shining for a long time silvered – beating doomed fighting wounded in the side on the wounded slope of this mountain – motionless, shining, knocked down about how long there was lying fighting, shining with the last rays: battle and battle at the foot of the bed, battle and knight and battle – next to bed illuminated by a lamp SIMULTANEOUSLY Renaissance. .. almost Resurrection … – even a louse … – Finally, things that exist: their right and their property … – … And now – your father – in an extraordinary hour: collapsed soon … – having learned – a little ABOUT THIS what the eyes produce – and what the glance produces – (and does not receive)? – light … – I often thought that my eyes would never die … – in the ground (maybe like buttons on the tunic of the dead) like the eyes of a young man lying under the leaves buried in a swamp, rejected by his mother by his brothers – (about a fresco of countless War) – they will sparkle endlessly for Eternity ——————————————– ———————————— WITHOUT RUNNING TO ANOTHER FIELD: IN THE HEAT OF WINTER Rene Sharu the bonfire god ! – this is an open field, passing everything through (and milestones and wind and points of distant mills: more and more – as if from this world – as if not in reality – receding: oh all this – sparks – not tearing the flame of a non-universal fire) I am – without traces from whatsoever, a non-universally shining God-bonfire 1970 SONG ABOUT SNOWLESS WINTER J. Vala-Boden and say something Moscow is snow, even if only one breath is even the sky, so for snowdrifts and wasteland from hillocks (“and the soul” speaking) aggravating the hovering of the day above the ground and you (as if in your ear about wait) that the ravines are not you see and know – and it will remain whirling clean and graves will arise gardens where the absence of stars is like a country over a country and also – they will bloom goodbye (maybe you will remember it without tears) in the voids of a free glow, showering a “child” (forever – a jewel – a long time ago) 1982 THOUGHT IN EVENING RASPBERRY L.and S. a breath of happiness when the head is spinning from the raspberry tree! .. – guess: what was it – bliss? – House? (in fact: in the family it was also in childhood – when they were surrounded by relatives) – it was the homeland (and only including the forgotten house)! .. – further – friend – destruction (and we continued calling “life”) – but – remained (and the head is spinning happiness-as-far-memory)! . . – so – in the pre-sunset raspberry-tree they were looking for the berries of the forest (with peaceful blows in the memory of many eyes): what brings home and country back – by a push-radiation? and family (with the illumination of the host – who loved by kinship)? – what – finally – from a letter – from a raspberry tree – forests and fields from a house-as-a-stone can breathe – bliss? – (oh this freshness: you have already touched yourself! – with illumination-firmness is harder than perhaps the concept of the world) – this – which loves like a home (a spring of illumination-childhood) – and continues: with our relatives and country and our endless destiny !…. – blowing like a raspberry, I know where the radiation began: I see a childish – female – somewhere – a face as a breeze: I would simply say (I lead to the simplicity of the conclusion) that I am happy with happiness for the happiness that is! – a miracle is always simple (and a mystery – what is simple – but a miracle …) 1982 NOT RUNNING TO A FRIEND Jacques Roubaud is not a wind, but with the freshness of a long bad, some kind of slippery-ruddy – as if with the whispering of movement, a knowing feeling of trouble: this is something – slightly shudders in the house – like in a field: it stands white next to – with books: as if it comes through – near the river bank where from the light – the remainder: only some glare-and-shreds of misfortune – in the grasses: and all at once – suddenly – like open night : naked – in darkness and illumination in it silence: as if everyone walk and walk – in a circle illuminated precisely and brightly. .. and again in the warmth – there is badness: and the distortion of the air again – at the face! – directions moving by something – all the same – rosy-shapelessly swelling in your house 1983 ROSE OF WHITEBOOK To the wonderful master of the book – Marcel Fonfred, doubts are still like yesterday – fogs-drifts are endless and a meager semblance of freedom – silence – among them: but soon – the breath entered : like a voice! – moving – along the edge line – of the edges of the supposed rose-flicker and where it was to turn red-and-white was to be delayed – with a strong heartbeat in a long melancholy purifying itself to the spirit – its foundation: and deeper – only pure pain (do not disturb even with breathing!) – work… – it is as if in the alternation of light and rubbish, it is the spirit that indicates where to expand with the movement of light – like the glow of the sight of the many-mind-focal: the hand – whiteness-raising: into the world! – even the joy was forgotten (a little – emptiness): something tells – to move away: (a start – it was not clear for a long time): and – as if from nowhere – suddenly the rose became calmly brightening while as if forgotten by childhood whispered in the forearms in the collarbones: “I knew you inspiration you are a tremor unlike anything else: in the wrists! – as pure as the singing of a child, shivering as if the excitement of breath – while calming down from sweet crying” 1984 —————- ————————————————– ————– NOTES The section “Roses: Dedications” includes, basically, poems that are donative inscriptions on the book “Poets of France”, published in the Chuvash translation in 1968. The poems dedicated to the outstanding French director, theater theorist, artist and poet Antoine Vitez (1931-1990), with whom the author had a great friendship, are especially highlighted. * Then it was hidden by impenetrability (French). * indistinct snow (French). * bloody sweat (French). * Title of the collected works of La Tour du Pen: “Poetic summary” (French). * Famous French Russianist. In 1982, the Paris publishing house “Syntaxis” published a collection of poems by G. Aygi “Marked Winter” prepared by her.* Huge pain on every page. Lautréamont (French). * Extinct lights of the world. Nerval (French). * French poet of Romanian origin (1903-1946). Committed suicide as a result of prolonged mental depression. * White flour of joy (French).

FGBNU NTSPZ. ‹› Early childhood schizophrenia (statics and dynamics) ››

The regressive type of disorders in the manifest period was found in 16 children (3 of them were girls). These disorders occurred on average at the age of 2 years 7 months (in 7 children at 1 year – 1 year 8 months, in 5 children – 2! / 2 years, in 2 children – at 3 years old and in 2 children – at 4/2 years ).

The state developed from a drop in activity, an increase in the devastation of emotionality, indifference, and the extinction of affective reactions to the environment. At the same time, the cheerfulness characteristic of children, creativity in games disappeared, and satiety appeared in activities. However, it soon became clear that the change of scenery, a new game, and spectacles also did not give them the same pleasure. Attempts by parents to distract children, to awaken their interest in their surroundings, to activity ended in failure.An indifference again came to replace revival.An instability of activity gradually became noticeable: lethargy, indifference for a short time were replaced by an unusual for them higher activity, and then the activity again fell.Most of the time the children spent in inaction, sat with an indifferent gaze into the void, rarely changed their position, only sometimes stopped their attention on external phenomena It was easier for them to keep their attention on long-term non-changing events, they became interested in pouring water, rain, snow, loose substances . .. Sometimes, on their own initiative, they rolled the toy car back and forth, beat it rhythmically or shifted it from hand to hand. Gradually, the circle of their activities narrowed, the games were repeated, became more and more monotonous and acquired the character of a stereotype.Later, even more primitive, previously overcome movements and gestures were revealed: shaking with the hands, jumping, spinning, swaying, which supplanted all other purposeful actions.

Active protest, dissatisfaction and rejection also gradually disappeared, being replaced by a detachment from everything. Children stopped responding to requests, orders, threats, punishments. Slowly, but steadily, their interest in communicating with their relatives dropped. If in the first months of illness the children felt an increased need for parental attention, they did not let them go.from themselves, then soon they seemed to completely cease to notice the presence and departure of their parents. Emotional responses to peers also fell. Children lost the ability to sympathize with someone else’s misfortune and empathize with joy. They stopped making requests and answered questions less and less. Speech was simplified, phrases were shortened. Some began to repeat the same words and expressions from day to day. Some children developed echolalia, neologisms; personal pronouns in the 1st person in relation to themselves were replaced by pronouns in the 2nd and 3rd persons, impersonal forms of verbs began to be mainly used, instead of detailed phrases – simple, finally, interjections and inarticulate sounds.The timbre and modulation of voice and laughter changed: laughter became soundless or inadequately loud, or completely disappeared. There was a transition to autistic speech, blurred, whispering, muttering. Its communicative purpose was almost completely lost. Some children stopped speaking and did not utter a single word, except for indistinct sound combinations, while others, with great affective interest and need, sometimes used separate words or short phrases that reflected their rare desires.

Children lost their self-care skills. They ate sloppily, forgot how to use a spoon, grabbed food with their hands, chewed badly, swallowed it in large pieces! Some changed their appetite: they refused cereals, jelly, meat, milk. Attention was drawn to the complete indifference to the clothes: the children did not notice whether the clothes were on or inside out, and whether the clothes were completely, whether the dress was clean, or whether the buttons were buttoned. Neatness skills disappeared: children stopped using the potty, urinated anywhere, became untidy with feces.Gradually, a complete detachment from the environment came. Some children spent most of the day sitting or lying, sometimes running, “immersed in themselves”, or still playing with their own hands, even less often with a toy: twirling, or simply holding it in their hands At times, they stopped their attention for seconds on the surrounding objects, furniture that came into their field of vision. Then they could touch them with their fingertips. Some of the children muttered something while others remained silent. This behavior was repeated day after day.These disorders usually developed within 3-6 months, rarely longer.

Parents did not immediately notice the changes in the child’s behavior, but when they discovered them, they tried to explain the change by concomitant pathogenic factors. They usually included somatic diseases and minor mental trauma (acute respiratory diseases, mild and moderate childhood infectious diseases, separation from relatives). In most observations, it was possible to establish that somatogenic asthenia and such phenomena as irritable weakness, depression, affective instability after somato and psychogenia, soon disappeared.The child’s condition returned to the previous one, and the symptoms of regression appeared later, that is, there was practically no evidence of a provable causal relationship between the coming drop in the activity of psycho- and somatogenies.

At the same time, their significance as a triggering factor or their weighting role was not always completely ruled out, especially when hazards arise against the background of an incipient regression. In the predominant number of observations, the symptoms of regression appeared outside the context of external hazards.

The disease began gradually, but the manifest state in these cases was almost inseparable from the expanded and final state. The average duration of the initial period is virtually indefinable because of the catastrophically fast, after 3-6 months, the onset of total regression, which essentially exhausted all the symptoms of the disease in children. In these cases, the listed regressive manifestations should be considered both as the initial symptoms of the disease and as signs of an expanded state.

Affective disorders in the manifest period in combination with neurosis-like disorders were observed in 19 children (4 of them were girls). On average, the onset of the process occurred in 4 patients at the age of 2 years 3 months, in 15 – at 3 years 8 months. In the latter, disorders in the manifest period were more complex, fear and anxiety were more distinct and combined with hypnogagic hallucinations.

Some children initially developed obsessive movements, ticoid twitching and hyperkinesis in the muscles of the face, shoulder girdle, and trunk.Stuttering was noted in 2 patients. All children at the same time became restless, affectively unstable, dissatisfied with those around them. Ordinary small reasons, to which children had not previously paid attention, now aroused irritation, often with agitation, a desire for self-aggression; they rushed about crying, biting their hands, hitting themselves in the face. At times they whined monotonously, swayed like a pendulum. The uneven mood was combined with unreasonable ridiculous protests. The children did not fulfill requests, especially prohibitions.They immediately developed hysterical reactions with a deliberate desire for ostentation: children screamed, rolled on the floor, made sweeping movements with their arms and legs. If relatives did not pay attention to them, they tried to pull, spit, bite them. Appetite changed, dropping to almost complete refusal of food. Some developed hyperesthesia, a special intolerance to unusual and loud noises, to the touch of clothing, which they often threw off themselves. The suppressed-anxious state was repeatedly replaced by a more balanced one – then the children again had a desire to play, communicate with relatives.A state of fragile balance was established, ready at any second to be replaced by an explosion of discontent with negative actions. Gradually, the periods of relief were shortened and the condition worsened even more: in 4 children, due to the addition of symptoms of regression (in them, the onset of the disease refers on average to the age of 2 years 3 months), and in the remaining 15 children (with the onset of the process at 3 years 3 months) – in connection with sleep disorders, increased fear and the appearance of hypnogagic hallucinations. For the latter, night and day sleep was upset, the children did not fall asleep for a long time, whispered something, sometimes asked someone close to lie with them. The night’s sleep became weak, the insignificant noise woke up the sick; waking up in the middle of the night, they did not fall asleep until morning. Sometimes children woke up crying in fear. Children under the age of 4 said they were “scared”. Some at the same time looked away from certain parts of the room, pulled back and hid their hands, as if they were afraid to touch “something.” Sometimes they said: “there is Winnie the Pooh”, “wolf”, “bus”. Only in isolated observations, when the children were convinced and firmly projected outward the cause of fear, defining it by a constant name, could it be assumed that they had hypnogagic hallucinations.

In some children, these experiences were combined with senestopathic sensations or tactile hallucinations, then they assured that they were bitten by insects. Night attacks of fear were repeated. On several occasions, children also experienced fear during the daytime. Raptoid states appeared on some days. In such cases, the children were suddenly seized by an acute fear: they rushed about, tried to run somewhere, cried, tore off their linen. If such states occurred in children outside the home, they could suddenly pounce on strangers, tore their clothes on them, fall into the mud, run, unaware of the danger, onto the carriageway.The duration of the raptoid states is from half an hour to 1, rarely 2 hours. After that, the child calmed down for a while, and then similar states were repeated.

Subsequently, in these children, the periods of relative calm were shortened. Game disappeared, speech changed, affective reactions to the environment faded away. Symptoms of regression appeared in behavior. In these cases, despite the manifestation of the disease with affective disorders, its lability, anxious mood, that is, seemingly disturbances that do not portend a serious outcome, the disintegration of the psyche also set in rather quickly.

The average duration of the manifest stage in these 15 children was slightly longer than in 4 younger patients, and approached 12 months, during which all of the above disorders were found, and then regressive manifestations, cataton-like excitement and states of spontaneity were added to them.

Follow-up observation at an average age of 10 showed the formation of a deep oligophrenic defect in children. Periodically, they had mood swings: a decreased mood with adynamia and aspontaneity was replaced by more active states with an increased mood, increasing motor stereotypes, impulsivity.And also periodically there was a deepening of catatonic manifestations, fear, hallucinations appeared.

Patient I, born in 1968. On the line of father and mother, there are many relatives with strange characters and gifted ones. The maternal grandmother is pedantic, anxious. His maternal grandfather, a pilot, had an unrestrained disposition. After retirement, he became gloomy, washed down and soon died tragically in a disaster. Mother is a philologist, talented, active, hard-working. Until adolescence, timid, sensitive.Over the next 15 years, she suffered a number of erased depressive and mixed states with accentuated drives, hysterical and psychopathic traits in behavior. The father is a doctor, cold, does not live with his family, is not interested in his son. In adolescence – asocial behavior, in subsequent years was distinguished by pathological distrust, periodically there were declines in working capacity, fear.

Examined from pregnancy, proceeding with toxicosis Childbirth at the 36th week of pregnancy, dry Weight of the newborn is 2800 g, length 49 cm.Applied to the breast on the 3rd day, actively sucked. In infancy, he was calm, did not react to discomfort. Early development ahead of schedule. At 1 year 3 months he spoke in phrases, named parts of the body. After a year, playful, cheerful. I paid attention to children, but preferred to play alone. By the age of one and a half he was reciting large poems by heart, but he expressed requests in an indefinite form: “To write.” I could not stand open doors – I immediately covered them, I did not like rearrangements in the house – if a thing disappeared from its place, I immediately noticed, worried, cried. He demanded to take off his clothes even with small spots of dirt. He loved cars and walks in new places. From the age of 2, he became more fussy, less interested in games. From 2 years old to 8 months, he periodically became anxious, seeing flies, demanded to drive them away, muttered something. A month later, the condition worsened even more. Woke up crying, screaming until blue in the face, rolling on the bed, trying to throw off his clothes, throwing bed linen, biting his hands, pinching, hitting himself. Nothing was comforting. Suddenly, at the same time, he began to look around, saying: “The butterfly flies” (it was in winter).With dissuasion, he peered into space in front of him and asserted: “There is a butterfly.” When they showed a book with drawings of butterflies, to calm him down, he threw the book, screamed heart-rendingly, and hid. In the next 2 months he “became stupid before our eyes”: he stopped playing, nothing attracted him, as if he didn’t hear any questions, looked and didn’t seem to see anything around. If they took the hand, he strained, trembled, tried to break free, ran to the side, protested to any influence. Only on some days for a few minutes, less often for 1-1 / 2 hours, enlightenment came, then again answered questions, recalled poems, briefly concentrated on reading a book.In the future, such light gaps became less and less. They took out for a walk with difficulty, and walked only one and one route. At the sight of children, he was excited, shouted, could hit the child, grab a toy, immediately throw it away. Sometimes he became very lethargic, climbed under the table, bed and lay there for hours without moving. On other days, fussiness increased, crawled, jumped on the couch for a long time, ran, threw things along the way, sometimes threw them out on the street at lightning speed, threw everything off the table.If they made requests, they did the opposite of those required. From the age of 3 years 2 months received treatment with sonapax, seduxen, haloperidol, but the condition continued to worsen.

At the age of 3 years 6 months at an outpatient appointment, brought into the doctor’s office, experienced fear, fought off relatives, shouted, let go of his hands, strove somewhere, did not allow himself to be examined, did not pay attention to persuasion. A week later, during a second examination, he initially behaved the same way, shouted, tried to jump off his mother’s arms and immediately ran to her, there was an expression of fear on his face, looked around in horror, screamed even louder.After about 30 minutes, he calmed down.He began to run around the office, not paying attention to the doctors. Sometimes he touched objects with his fingertips, sometimes he grabbed a toy and immediately released it from his hands. As if I had not heard the questions, there was no reaction to the loud knocking either. Only at the request of his mother did he sometimes begin to perform the necessary action, but did not complete it and again walked around the office.

In terms of physical development, he lagged behind his peers. No pathological phenomena were found in the neurological status. Due to the parents’ refusal to hospitalize the child, he continued to be treated at home with haloperidol, seduxen, and sedatives.

At the age of 3 years 8 months – 4 years, the mood became smoother, attacks of fear – less often, sometimes during such an attack he shouted: “You are afraid” I became less agitated, less often threw things away, fell asleep easier. Sometimes he suddenly spoke close to the point: he would ruin something and say that he “broke my grandmother’s closet”. I remembered the previous Words, especially those that I had learned in 2 years before my illness. Sometimes he expressed in words a request: “Give me a sandwich.” However, in general, the behavior remained monotonous and was repeated from day to day in a stencilled manner.I didn’t acquire anything new, I didn’t possess self-service skills. Periodically re-excited: ran, jumped, was afraid of something. Over the next 4 years, the state changed little.

At the age of 8 he was treated for 6 months in a psychiatric hospital. In the department we passively subordinate Spontaneously did not apply to the staff. When trying to involve him in classes, the game silently walked away from everyone. Inactive. He ate and dressed with help, but did not ask to go to the toilet. The mood is even. There was no fear. When reminded about butterflies, there was no reaction.He rejoiced at the arrival of his mother, climbed into her bag, took out sweets, often immediately walked away from his relatives and ate presents. After the doctor, I repeated simple words, determined the name of household items, and experienced difficulty in qualifying actions. Pronunciation of words is either babbling, melodious, or distinct. The stock of knowledge is sharply limited and does not use the available knowledge. Left to himself, he can go to the doctor, take his hand like a thing, turn the clock hands, turn on the tap, turn on the water, turn on and off the TV. On impulse, he moves a pencil on paper, writes some letters, immediately tears the sheet into pieces. Not attached to anyone. Shuns children. He does not know his bed, but he goes to his room, knows a place at the table. Sometimes he runs, shakes his hands, mutters something, is impulsive.

Neurological and somatic disorders were not revealed. Blood and urine tests without pathology.

The patient’s condition was approaching the final one, it was determined by the phenomena of dissociated oligophrenic defect, residual catatonic disorders, detachment from the environment, lack of elementary contacts with staff and children.

The disease began at the age of 2 years 8 months subacutely, with anxious mood, fear, visual hallucinations. After 1-2 months regression of behavior began, at the same time catatonic excitement joined, which was replaced by states of akinesia. Catatonic arousal was characterized by motor excitement combined with negativism, impulsive actions, ambivalence, and phenomena of mutism. The disease was preceded by a distorted development: anticipatory terms of early development with a delayed development of self-awareness, insufficient contacts with peers, features of pedantry, exaggerated cleanliness.A feature of the development of the final state is the ability to develop, although insignificant, as well as a continuing tendency towards the progression of the disease, as evidenced by the periodic aggravation of the patient’s condition throughout the course of the disease. Finally, 8 months before the manifestation of the process, the first signs of the disease appeared in the form of an indistinct drop in activity. It remains only to emphasize the absence of psychosis and obvious schizophrenia in the relatives of probands on both lines of kinship. Manifest disorders of the third type, characterized by mood lability, anxiety affect, a feeling of antipathy towards relatives and fear of eating, were observed in 7 children (3 of them were girls).The beginning of the process, on average, fell on 5-6 years of age, except that almost all patients had transient psychotic episodes even earlier.

The first symptoms of the disease included neurosis-like disorders: tics, hyperkinesis, unnecessary movements. And then the instability of affect, explosiveness, incontinence, easily arising crying and screaming began to be revealed. At first, the irritation in children was removed under the influence of persuasion, and then simple demands, change of clothes, change of place of stay, walks, return home, failure in games — all this caused an explosion of discontent and crying, screaming, and protest reactions.Negativism grew, the children did everything the other way around, for example, they would brush their hair, and they would ruffle their hair, and so on. Often they felt the unusualness of their condition and said to their relatives: “I got sick, my head is not like that.” At the same time, hyperesthesia, especially intolerable unusual sounds and touches became. Increased sensitivity was combined with fear. In an unusual situation, the child was frightened. At first, the children sought help: they ran to their relatives; when they heard an unpleasant sound, they hid behind their mother, and then alienation grew, contacts with relatives were broken, the children stopped sharing their fears and worries.Worry, anxiety, fear at times increased sharply, there was fussiness, throwing, running, ending in a motor storm. Children in fear rushed somewhere, waved their arms, threw themselves on the floor, banged their heads on objects, shoved adults with their feet if they were helped. If they were held back, they screamed, squealed, exploded. Left to themselves, they did not calm down, rushed about and became even more anxious. The child’s appearance during this period reflected a state of deep tension and fear.The reaction of the motor storm gave way to calmness, the children became lethargic, but the tension remained in the facial expressions. They were whispering something unintelligible or moving their lips soundlessly, suddenly looking around, scared of something. This condition is not monotonous. During the day, there were periods of relaxation of tension with age in relation to adequate behavior, former liveliness, but these gaps became less and less frequent. Tension and discontent grew in the evening. Then the child did not go to bed, in anxiety he changed his position all the time, walked.

The night sleep became shallow, intermittent. Children woke up screaming, crying, looking around in fear. Determining with certainty the cause of the fear in these patients is difficult. Whether the fear was an unaccountable reflection of anxiety noted at that time or a consequence of the addition of illusory and hallucinatory disorders, or only an increased ability to imagine, with the presentation of frightening images, it was not possible to find out from the patients. Their experience of fear is autistic and there was almost no contact with relatives.Children at this time did not turn to their relatives, kept away from caresses, did not allow themselves to be touched, repelled from themselves all who tried to console them. During this period, a sudden unreasonable hostile attitude towards one of the family members arose. In some children, this attitude was justified by the feeling that this relative was “alien” to them, while in others the antipathy was not explained in any way. When questioned, the children explained their ill will in different ways: “He has black eyes,” “He is black,” “She is old.” The feeling of hostility was not corrected from the outside, the patients did not succumb to dissuasion. Often, relatives, driven to despair by the child’s wrong attitude, resorted to active coercion and beatings.Naturally, this did not have the desired effect. The feeling of antipathy was often so strong that the sick children did not stay in the same room with the person to whom it manifested itself. In the presence of these persons, they fussed and caused them all kinds of harm: they pushed, pinched, spat, and hit them. The hostile attitude sometimes extended to another family member, whom the children also began to alienate.

At the same time, some patients developed a special attitude to food. Before eating, the children forced their relatives to try the food.In this case, they did not express the generally accepted ideas of poisoning, they expressed it in the fear of eating “bad food.” At the same time, some began to be afraid to eat with dirty hands, washed them many times without expressing ideas of contamination, some said that they were afraid to stain food.

At this stage, the condition of some children stabilized somewhat, while others continued to get heavier, and then illusory visual deceptions of the senses appeared. The spots on the wall and floor suddenly seemed like insects.Hallucinatory disorders were accompanied by a feeling of fear: children screamed, hid, and were afraid of being “bitten”. Then there was a state of anxiety with confusion. The children looked around, looking for something in anxiety, did not recognize their relatives and the place where they were. Sitting on the lap of the mother, they asked: “Where is mom?” They immediately called her correctly and again recoiled in alarm, obviously frightened by her appearance and not recognizing her mother. The dream was finally upset. Periodically, anxiety and fear were accompanied by agitation, and then catatonic excitement with impulsive actions and mutism was added.Even later, the final state and developmental delay were formed.

Here is an observation of malignant schizophrenia that began in a similar way.

Patient K., born in 1961. Mother, born in 1931, a kindergarten teacher, graduated from the correspondence department of the Pedagogical Institute. Shy, timid. She is attached to the child, her daughter’s illness is hard going. Father, born in 1930, worker. Secretive, irritable, oppressive, cold. The paternal grandmother is quarrelsome, inadequately suspects those around her of theft, that she is being “hurt”, “slandered”, she is unbearable in the family.In feelings, it is polar: sometimes located, then unexpectedly vicious, picky, unfriendly. The paternal uncle left the family due to the difficult nature of the mother.

Examined from a normal pregnancy and childbirth. In infancy, she is not crying. She kept her head by 3 months, sat by 6 months, began to walk by 12 months. She walked early, by the age of one she uttered the first words, by the age of 2 she spoke in phrases. She was happy with her mother and father. In terms of development, she was ahead of her peers, loved new toys, clothes, was clean. She copied adults in games, was perceptive, quick-witted, agile, dexterous, always found something to do for herself.From the age of one, one feature was noted: she did not respond to strangers. If they called a dumb one, she was angry, but still she did not even give her name.

From the age of 2, she gave up daytime sleep, but remained active and vigorous. At the age of 3 she was brought to the village by her parents. There she suddenly became afraid of shadows. The fear lasted for a month and disappeared without treatment. After that, at the age of 3-4 years, she was healthy, but less often than before, she turned with requests and questions to her relatives. From the age of 4, she became taciturn: when questioned, a complete orientation in the environment was revealed.

At 4 years and 8 months, she became anxious, capricious, did the opposite. In the next 2 months, anxiety increased. Suddenly she hated her grandmother, chased her away, beat her, bit her, shouted that she was “a stranger.” She did not take anything from her hands, trampled sweets, although it was evident that she felt a desire to eat them. Sometimes the parents resorted to punishment. The condition worsened, she got up and went to bed with tears, everything was not according to her, she was instantly satiated with everyone. She did not allow herself to be cut, refused to go to the bathhouse. If they washed, they immediately stained their face.When she was 5 years old, 2 months old, she was taken out into the air to the village. On the way, when going to bed, she got excited, screamed, was afraid of the dark, demanded to take her in her arms, did not recognize her mother. On the spot, she called small spots on the wall bedbugs, she was afraid that they would bite her, she moved away from her mother. She repeated the phrases addressed to her verbatim. I did not notice the toys. Uncertainty about the actions appeared. From time to time she would go berserk: she tore her hair, clothes, scattered things that came into view, banged her head against the wall. When the girl calmed down for a while, the parents, trying to cheer her up, invited their peers, but the patient took the toys away from them and said that she was tired of them, asked to drive them away.Brought home, she remained anxious, afraid of someone, gazing intently at the closet, demanded that they tell who was there. From 5 years 4 months for a month was treated in the children’s department of a psychiatric hospital. She did not follow the instructions, repeated the questions addressed to her word for word, walked up and down the ward for a long time. The expression on her face was detached, the smile was replaced by an expression of fright, shuddered, immediately screamed, rushed somewhere. She did not react to persuasion. I fell asleep. only in the presence of staff.Sleep was interrupted unexpectedly, woke up screaming, crying, afraid of something. Treatment with elenium, meprobamate, sedatives without effect. Discharged at the request of the mother. Upon discharge from the hospital, she remained in poor condition. In the morning, they hardly got out of bed. She did not dress herself, did not eat. She broke objects that fell into her hands, tore clothes into small pieces, rolled balls of bread with her fingers. They were taken out into the street with resistance. She did not fulfill requests, sometimes she repeated the addressed speech. Gradually, the condition began to improve somewhat.The girl again began to listen to her mother’s words, fulfilled some of her requests, improved her sleep, and began to eat herself. But at 6 years and 2 months, the condition worsened even more. Waking up, she sighed heavily, beat herself on the head, shouted: “Tear off my head … I’m tired of my head.” She began to drive her mother away from herself, sometimes calling her “a tourist, angry.” She muttered something, then whispered, then repeated the words addressed to her. Periods of anxiety were followed by states of immobility with passive obedience.

At the age of 6 years, 3 months for 2 months was treated in a psychiatric hospital.The correct physique, on the part of the internal organs of the pathology, was not revealed. Urine and blood tests are normal. No pathological signs were found in the neurological status. On the roentgenogram of the skull, there are moderate features of hydrocephalus.

Mental status: hospitalization was difficult. On the first day in boxing, she was restless, knocking on the windows, shouting out individual words, repeating phrases addressed to her. Throwing toys. Sometimes, at the request, I got up and sat down. She did not serve herself.In the following days, she was untidy, smeared herself with feces. She ate only from her hands, made inarticulate sounds. Nothing caught her attention. She sat or lay for a long time in one position. Suddenly she jumped up, made several jumps and sat down again. From time to time everything shrank, gazed with fear into the corner of the room, moved her lips in horror, and then sat motionless again. At night, I woke up in fear, did not let go of the staff.

Treatment with haloperidol, tizercin, and then stelazine, chlorpromazine, tryptisol was unsuccessful.Most of the day, she lay or sat in one place at the table. Sleep was intermittent, fears remained. Sometimes in the mornings, when it was quiet in the room, I tried to play, transferred a toy from hand to hand, babbled something. Once she said clearly “I don’t eat that.” Sometimes she looked at the children playing for a short time, then crawled under the bed and lay there inactive. At times she laughed silly, masturbated, kissed her hands, asked to kneel down to the staff. On a meeting with relatives, the mother pushed aside, then pulled the father by the hand from the department, then immediately sat down, put her head on his lap, let herself be hugged.Discharged with little or no improvement.

From 6.5 to 16 years old she is at home, receives antipsychotics and tranquilizers. Most of the time inactive, passive. From time to time it becomes tense, runs, jumps, throws things out on the street, in fear always peers into the same corner of the room, shouts, says something inarticulate. At the same time, hostility to the grandmother intensifies, beats her with fierceness, pushes her, seeks to annoy. Over time, the mother began to admit that she completely depends on her.Dresses with her help. Eats sluggishly. Occasionally, feeling fear, he rushes to bed, covers himself with a blanket. Requests are expressed either by gestures or by 1-2 words.

Examined by us at the age of 16 years 2 months. Physical development is age appropriate. Sexual metamorphosis is complete. On the part of internal organs without pathology. She was brought to the reception by her mother, at first she did not let her go. He does not answer the doctor’s questions, only sometimes echolalically repeats the last words or syllables of the questions. She answers the same questions asked by her mother.Thus, it is possible to establish that the patient’s stock of knowledge is limited to elementary everyday ideas. He names the objects in the pictures in the ABC book, finds it difficult to determine the actions, knows the colors, children’s poems, body parts, his name, the city in which he lives. He strokes the doll, pushes the cubes away, leafs through the book, not fixing himself on the pictures, but attracts the very process of turning pages Resists inspection, undresses with the help of his mother. The movements are awkward. Motives easily dry up; many actions are left unfinished.Left to herself, she remains in complete inactivity for a long time, then suddenly jumps up and walks around the office. The expression on the face is changeable, sometimes wary, sometimes detached, then illuminates with a smile, then begins to grimace Spits on fingers or licks them, and then touches walls and chairs with them. When asked if he wants to go home, he looks around helplessly at his mother, then takes her hand and, without saying a word, pulls the mother towards the door.

Clinical and dynamic observation of the patient for 11 years makes it possible to trace the course of the disease.At the last examination, the patient’s condition is determined by the underdevelopment of an oligophrenic type, lethargy of impulses, residual catatonic disorders, a persistent feeling of antipathy towards one of the relatives, fear and, possibly, hallucinations are periodically actualized.

The disease arose in a child with an outstripping rate of mental development, with features of increased sensitivity, difficult adaptation in a new environment, which affected either elective mutism or the appearance of fear.The disease manifests itself at the age of 4 with a deepening of autism; after 7-8 months, affective instability is established with a predominance of anxious mood and negativism. This state is, as it were, resolved for some time by the formation of a feeling of antipathy towards one of the relatives. With a further deepening of the disease, an anxious-fearful state with confusion, false recognitions, hallucinations ends with a catatone-like excitement, and an oligophrenic-like defect is formed later.By the form of the course, this observation can be attributed to continuous malignant schizophrenia.

Types of advanced conditions in malignant schizophrenia. Following the manifest one, an extended period of the disease arose. Despite the fact that it was difficult to draw a line between them, the sharp aggravation of the condition since the addition of motor disorders and symptoms of regression gave grounds to attribute them to the phenomena of the extended period. The structure of deployed states is heterogeneous. In addition to the form of the course of the process, it depended on the age and level of development of the child at that stage of the course of the disease.

Motor excitement in combination with regression of behavior, motor skills, and partly speech was observed in 22 children aged 1 to 5 years. In this state, outwardly, the children looked detached and at the same time strove to walk and run. The surroundings did not attract them, they did not pay attention to the staff, peers, toys. Their gaze is directed into space, at times, as it were, inside themselves. Then the axes of the eyeballs are either reduced to the nose, or brought upward, which resembled strabismus. Grimaces periodically appeared on their faces: children twisted their mouths, stretched their lips into the proboscis, puffed out their cheeks, wrinkled their foreheads, raised their eyebrows, moved their lips.In addition to constant walking, children made different movements: rubbed hand in hand, stretched out their fingers and immediately squeezed them into a fist , put one finger after another, quickly threw all fingers forward, could change these movements to supinating ones, sharply twisting their palms outward, again made fingering movements with fingers or shaking movements with their hands.They flapped their arms like wings, put their pretentious hands behind their heads, behind, and back, and immediately rotated them with their brushes. The muscles of the torso were periodically strained. The arms, bent at the elbow joints, were pressed to the body, then the arms were turned around the axis so that the palms were suddenly turned outward, and the back of the hands pressed against the thighs. During the period of excitement, they had a special gait – a mannered step, in a rush, was replaced by a usual step, which could be combined with an incorrect positioning of the body sideways. A measured step was interspersed with an accelerated one – then the children made fast runs.It was possible to step with support not on the entire foot, but only on its inner or outer edge, on the toes. There was a fall on one or the other leg, and then the gait resembled the gait of a limping person. Sometimes children walked on sharply straightened legs at the knee joints, as if with ankylosis of the knee joints, or excessively bending their knees, knocking themselves on the buttocks with their heels. Often they ran monotonously in a circle or in a straight line. At the same time, the eyes were screwed up, then almost closed, then wide open.It is impossible to list all the movements of children. All of them were characterized by looseness and at the same time stiffness, excessive grotesque scope, its limited scope, incommensurable rhythm and pace, and in general, awkwardness and lack of focus. All these features created the quirkiness, pretentiousness and mannerism of movements. Each patient had movements that were characteristic only of him, a touch of individuality.

This peculiarity of movements always confuses the observer and constantly requires the exclusion of neurological disorders.However, in their mannerism, the unexpected disappearance of originality and the changeability of motor forms, movements always differ from similar pathological neurological symptoms of organic origin. Such motor excitement is accompanied, to varying degrees, by pronounced negativism. Movement is usually difficult to interrupt, the child actively moves away from everyone who tries to approach him, sit down or lay him down. The patient ignores the request to make any other movement. If a child in this state is taken by the hand, he tries to escape, to free himself from the touch, usually without looking at the person taking him.At this time, the child pushes away the toys, put them forcibly into the hand immediately or after a short time, throws them away, or simply drops them, unclenching the fingers. Seating such children can only be done by force. Released, they immediately rise and begin walking, running and other actions. Running is interrupted by jumping in one place with shaking hands. Periodically, walking and running are interspersed with impulsive laughter or tears.

Even if the mother took such a child in her arms, he still tried to free himself.True, this protest was short-lived, exhausted, the child calmed down in the mother’s arms, remaining passive for some time, then again repeating the previous attempts to free himself. Characteristically, these children walked and jumped throughout the day, stopping for very short periods of time and showing no apparent fatigue. These states ended as if for no reason. There were days when the child became lethargic, sat for a long time or lay inactive. Despite the state of spontaneity, the children adopted pretentious positions.For example, they stood on all fours in the crib, resting their heads on the pillow, or, sharply bending their neck, pressing their chin tightly to their chest, rested against the pillow with the back of their heads, and bent at the waist. Sometimes, bent in half at the waist, they half-stood, leaning sideways against the wall. Some stood on their heads, others curled up, but did not assume an embryonic position. When raised, the children stood, making ambitious movements, stamped in place or took a step forward and immediately pulled back.Sometimes, when asked to show their tongue, they tightly pressed their lips together and closed their eyes. At times they uttered indistinct sounds without opening their mouths.

When checking muscle tone, they did not freeze in assigned positions, but made repulsive movements and only after that they passively obey the staff. In some periods, the Children were so passive that they completely obeyed all manipulations, dutifully followed into the procedural room, being seated — they did not change their positions for a long time. At the same time, true waxy flexibility with numbness in children under 3 years old, and more often up to 5 years old, was not observed.Hypotension and sometimes alternating muscle tone were noted. At this time, the children were, as if deaf, did not respond to calls, knocks, claps; sometimes they still showed a reaction in the form of eye movements or a slight turn of the head. They did not stop looking at the person addressing them, looked into space, overhead, or actively turned away.

During the day, the children had an urge to make a directed movement: they stretched their hand to bread, a toy. Often, halfway through, without completing the movement, they took their hand back, sometimes they repeated the correct and reverse action several times.If they performed the correct action, then often at an accelerated pace, impulsively, angularly, but sometimes at their own request they could make a complex movement: they inserted the key into the keyhole, opened the refrigerator, the door.

There were no obvious emotional reactions in the children, except for protest and withdrawal from everyone. Attempts to start a game with them did not arouse reciprocal desires in them, but only the desire to leave. Feeding and caring for them was perceived with protest. There was no interest or attention on the face; lack of expression and mask-like nature prevailed.

Sleep was intermittent, children woke up in the morning or in the middle of the night and lay awake for a long time. Sometimes at night they tried to get out of bed and walked non-stop around the room. These pronounced states of motor excitement and spontaneity were interspersed with calmer states, when children were immersed in primitive play: twirling their fingers in front of their eyes, sometimes taking toys, holding them and playing, tapping them, inflating specks, crawling after them on the floor on all fours; they could suddenly substitute a chair to the table and, having climbed onto it, take a treat, or walked to the right door when they were taken out for a walk.

During the acute period, it is difficult to distinguish between symptoms of regression and catatonic disorders. Nevertheless, it can be noted that in the absence of catatonic disorders, regressive and complex movements corresponding to the age of the child can take part in purposeful and play movements. However, in such cases, they are always performed with a certain emotional attitude, elements of joy and, despite the monotony of movements, they are often replaced. Then children look at their movements, smile, making them, they are not impulsive and negative, ambivalent.

Catatonic states are also often combined with disorders of the regressive type, but along with them, during the period of catatonic arousal, children perform the same movements impulsively or with a tinge of violence. The movements are extremely monotonous. The same actions are not interrupted for a long time, they proceed against a “cold” emotional background and, moreover, are combined with the phenomena of negativism and ambivalence. Children, performing these movements, do not experience fatigue for a long time (outwardly).

It is even more difficult to distinguish complete mutism from the phenomena of complete speech regression, which often follows mutism.Revealing the understanding of speech, the possibility of echolalia, speech in response to a whisper, delayed answers give reason to assume mutism of a catatonic nature. In these children, mutism of a similar nature is often combined with partial regression of speech. With the further development of the disease, motor disorders are in the nature of residual stereotyped movements. Motor excitement, but no symptoms of regression (found in 9 children on average between 3 and 5 years). This excitement was characterized mainly by walking and running, which were periodically impulsively interrupted by even faster runs in an indefinite direction without a sense of danger, impulsive laughter, screaming, and crying.At the same time, walking resembled normal walking, but the child could not stop. Even hungry, seated by force at the table, he grabbed food, immediately ran out from the table and continued his measured run, most often in a circle, less often in a straight line or from obstacle to obstacle. At the same time, sick children for a long time did not experience fatigue, which is usual for a healthy child, and if it did arise, then several hours after the onset of excitement. The excitement proceeded with features of negativism; at the same time, it was not possible to note the phenomena of wax flexibility, hypertonicity, although with each attempt to influence the patient, an active desire to avoid touching arose.

In some children, excitement was accompanied by mutism. Some of them, at night or during the day in silence, especially in the absence of people, unexpectedly uttered words, phrases: “Call a doctor! Sit here! ” At the same time, as a rule, the intonations were infantile, the speech was of a changing tempo, and the voice was of timbre and volume; now low, now high, now quiet, now turning into a cry. Speech could be chanted and melodious, blurred and distinct. By the construction of phrases and the absence of manifestations of regression in such speech, one could judge about the predominant mutism of a catatonic nature.

In a number of patients, motor excitement was combined with pronounced ideational excitement: in children 3-5 years old — in the form of muttering, in children over 5 years old — in the form of incoherent memories. The structure of motor excitation is similar to that described above.

Speech excitement was expressed in speech pressure, which periodically arose during the day. Often, when asked a question, the children began to speak to the point, but they immediately deviated from the topic and continued their non-stop and incoherent speech. Attempts to interrupt them were ignored.Their speech was a stream of words, syllables, snatches of memories, fragmentary facts about the present, echolalia of phrases spoken by someone. The children literally spoke to the point of exhaustion, and if at the beginning of the speech flow they could still walk monotonously, then they usually sat down and continued talking. The child drooped with fatigue, turned pale, leaned against the back of a chair or lay down on the table and talked all the time. As an example, we cite the speech of the patient V. to tear … He will jail you … “and so on.The words were pronounced now absolutely clearly, sometimes distorting by inserting unnecessary letters and syllables, omitting letters, altering words, chanting, tearing words and not completing the syllables, contaminating the last and first syllables., rhyming incomprehensible phrases: “Dzattsyk-ettsyk.” Memories usually reflected unpleasant, sad, frightening events, aggressive desires to kill someone, bury them in a hole, etc. When trying to talk to them, the children turned away, closed their eyes, covered their faces with their hands. They also responded to the desire of relatives to hug with a protest, throwing their arms off themselves.

However, these patients had periods when they became more accessible, they could concentrate on the teacher’s tasks, accurately draw a line with a pencil, look at the pictures in the book, and hold the proposed toy in their hands. But these purposeful actions were always interrupted by impulsive actions with aggression and re-starting motor excitement. The patients again swiftly walked around the ward, scattered the pictures and toys they had just examined, spoiled them, gnawed them, as if not noticing anything around.Walking like hitting oncoming, they themselves did not run away and did not resist when other children gave them change. If they were forced to listen, they turned their heads to the side, attempts to play with them turned away, tried to leave. The expression on his face became detached, without a glimmer of attention and interest. Such patients resembled automatic robots.

The most severe conditions, when manifest disorders were followed by pronounced chaotic catatonic excitement, were observed in 7 children, on average, at the age of 2 years and 10 months.In such a state, the children, left to themselves, did not remain in peace for a minute. They rushed about the room, periodically making impulsive, aggressive actions. The movements were chaotic, disorderly: the patients ran swiftly from place to place, then stopped motionless, then with even greater force rushed somewhere. Their hands were not at rest for a minute. They grabbed things and objects that came across in the way, broke them, hit the oncoming ones, shouted shrilly, squealed. They fiercely resisted trying to hold them back.They were not distracted or attracted by anything. Put to bed, the children were striving all the time. get out of bed, climbed the net, hung from it like a monkey, upside down, clinging to the bed bars with their feet. When they were released, they immediately ran out to the middle of the room and performed more and more destructive actions. They threw oilcloth off the table at lightning speed, threw chairs, or sometimes suddenly, stopping at the wall, made climbing movements with their arms and legs, as if they continued to crawl along it.And then they could, with unexpected speed, climb onto an adult standing next to him, trying to hit him, poke a finger in the eye. When the tension grew, they violently tore at their linen, tore apart the sheets, inflicted injuries on themselves, banged their heads against the wall, the bed, could break and knock out their teeth, pulled out their hair, bite their hands to their wounds and did not cry, “were silent”. Sometimes they only uttered inarticulate sounds in fierceness. The expression on the face was tense, at times it was distorted by a grimace of suffering or discontent. The children refused to eat, when they were fed, they pushed the plates away, threw them off the table. Food poured into their mouths was spit out.They became unkempt, urinated anywhere, and even recovered when feeding, some withholding urine. Sleep in such patients is also upset: more often in the evening the children did not sleep for many hours, falling asleep in the morning. Falling asleep in the evening, waking up at 2-3 o’clock in the morning and again plunged into a state of excitement, which practically did not respond to therapy. During periods of such excitement, children lost weight, their faces became haggard, their nose sharpened, the skin acquired an earthy gray color, bluish circles appeared under the eyes, the lips became covered with crusts, and the smell of acetone began to emanate from the mouth.

Chaotic excitement in these children differed little from chaotic catatonic excitement in adults – it was more intermittent and with it, as with all other excitations of the catatonic type in children, some symptoms characteristic of catatonic excitement in adults were absent – there was no hypertonicity, catalepsy, stiffness, but there was always impulsiveness, negativism, ambivalence. In all these observations, chaotic excitement is a prognostically unfavorable symptom, since it is usually followed by the final state.

Catatonic agitation with symptoms of numbness and negativism was observed in only one child with continuous malignant schizophrenia at the age of 3–2 years. Catatonic-hebephrenic disorders occurred in 6 children (4 of them were girls), aged 5-8 years. These states determined motor excitement against the background of rapidly changing mood. The whole state is very labile, with it there are easy transitions from excitement to correct behavior, to aggression with outbursts of impulsive excitement with foolishness, grotesque coquetry, accentuation of drives, characteristic speech with deliberate pueril intonations, and sometimes intonations reminiscent of adults, with ridiculous mannered responses.Here is a brief extract from the medical history.

Patient G., 7/2 years old. The first years of her life developed ahead of her peers, but after a year she was very timid and attached to her family. She was sent to a nursery at 1 year 3 months, closed up and, despite the presence of speech, did not answer the questions of the staff. At home, I also began to speak less, there was a coldness towards my mother.

At 3 years 3 months was taken out with a kindergarten to the country. A week later I did not recognize my mother, did not answer her questions. Only a few hours after meeting her, she began to answer in a whisper, and then in a normal voice.

At the age of 5 she was placed in a sanatorium for somatically weakened children. There was an acute development of fear, began to see terrible dreams. Then there was a feeling that she had “songs” in her head, she was afraid to go to bed. Became hostile to older women, calling them “witches.” She retired, talked to herself. The condition steadily worsened, a year later, excitement with impulsive actions of the catatonic-hebephrenic type joined.

When she was 7/2 years old in the hospital, she was in a state of catatonic-hebephrenic excitement.I couldn’t stay calm for a minute. She walked around the ward and immediately sat down on a chair, jumped up and sat down again, already backwards, Threw her legs on the back of the chair, then sat down on the table, transplanted from the table to the floor, and finally squatted down at the chair leg. Suddenly, gutturally screamed Once again jumped up and walked on tiptoe, saying to herself: “Well, think that you are on high heels. You can think. Well, go, go. And this is a handbag. ” At the same time, the girl looked in front of her, withdrew her bent hand and slightly waved it, as if holding a bag.She asked all the women passing by her with stereotypical questions “What kind of stockings do you have? Is it nylon or mesh? ” Not listening to the answer, she ran back, jumped, lifted the hem of her dress, exposed her clothes, grimaced, and laughed. And then she walked around the room again, imitating the gait of a flirtatious woman, deliberately smiling, bending at the waist, emphatically moving her hips. Suddenly she jumped on her toes, whispered something and rhymed: “Model – vaudel”. She became prim, covered her eyes with her hand and turned away, stretched her lips with her proboscis, then opened her mouth wide, throwing her head back.Suddenly she squatted, looked under the table, looked at something on the floor, pretentiously folded her fingers, brought them to her face and then, lifting her dress, rubbed her stomach. Immediately, with a piercing cry, she pounced on the staff, children, hit them. Just as suddenly she calmed down, became overly affectionate, tried to snuggle up to any passer-by or a person standing nearby. And again she was foolish again, cutesy, spoke incomprehensibly, with mannered intonations and pathos: “You came, my mother, in October, right? Yes, school … “She could correctly name herself and immediately say:” Tanya Chentsova, Nemtsova … “When asked about age she answered:” Six, what is six? ” Little, I am one year old, I can’t … I don’t like ”.And at the same time, the girl had a certain amount of knowledge.

Outwardly sloppy, untidy. I didn’t play with children. At the age of 8, she was transferred to a psychiatric hospital, to a department for children with severe damage to the central nervous system.

The considered catatonic-hebephrenic states from the catatonic-hebephrenic states at an older age were distinguished by a greater naturalness of behavior, the presence of a pronounced play component in behavior, instability and brevity of these states, its intermittency with other types of motor excitation.

Catatonic hallucinatory states with signs of bewilderment and confusion, periods of enchantment arose subacutely in 10 children aged 5 to 6 years. Manifested the process of affective lability, alternating phase mood disorders, and in some patients anxiety, antipathy towards relatives. In the expanded state, cataton-like excitement, acute anxiety, with tension, impulsivity, and aggression arose. When the condition worsened, the phenomena of bewilderment and confusion developed.Children lost their orientation in their surroundings, did not understand where they were, looked around, and were striving somewhere. Their faces now expressed bewilderment, now became enchanted. The children moved around the room. So, the puff in front of them was something in the air. Some at the same time suddenly pronounced the name of the toys and grabbed the emptiness. Sometimes they thought that their mother had come to them, and they turned to her. After coming out of the state of confusion, they said that they “went to my mother.”

At the same time, some patients developed autistic fearful fantasies.It seemed to the patients that “wolves are walking,” “old old women,” that the things around them were “looking” at them. Later, sleep was upset. The children did not sleep for several nights in a row. Detachment grew, at times there were deceptions of recognition (the mother seemed to be a stranger, etc.). During the day, the children remained anxious, peering with fear at certain parts of the room. Sometimes they immediately covered their faces with their hands and staggered back. During this period, it was possible to identify the presence of true hallucinations, and sometimes at the same time, pseudo-hallucinations.Patients sometimes said that there was “music and song” in their heads, then they experienced an unpleasant smell from food (“the food smells bad”).

Periods of sharp tension and fear were replaced by depression with thoughts of death, or by absurd foolishness with unreasonable laughter, grimacing, grimacing, increased drives. The variability of the clinical picture of the disease was observed for several weeks, and then a state of catatone-like or catatonic-hebephrenic excitement set in, and regressive disorders were added.The final state with residual catatone-like, catatonic-hebephrenic and hallucinatory disorders was rapidly forming, and an oligophrenic-like defect was being formed.

The following types of the expanded state were found at the end of the 1st – the beginning of the 2nd year of life. The idea of ​​the initial period of the disease was based in these cases mainly on anamnestic data and only isolated observations. However, we consider it necessary to dwell on them in order to raise the question of early disorders, which must be paid attention to in the further study of childhood schizophrenia.

Let us analyze motor excitement in sick children of 9-12 months of age, when they turned from lethargic or ordinary into extremely active: they began to jump prematurely, tried to sit down, tried to get up, it was almost impossible to lay them down without swaddling. In contrast to motor activity, the emotional reaction to the mother, her distinction with strangers, disappeared. Children tried to bite their mother during feeding, pushed her away, some refused to breastfeed.The newly acquired skills disappeared, appetite decreased. Anxiety gave way to lethargy. Such disorders, intermittently, lasted from several weeks to 2-5 months. Thus, the child’s activity during the period of excitement only outwardly resembled the physiological mobility of healthy children. In the movements of sick children, repetition, monotony, a change in excitement with lethargy became noticeable. Their motor development was not complicated. Emotional monotony and excessive indifference to the environment, as well as regression of certain skills, began to be found.

If such conditions were prolonged or arose after the establishment of walking, propulsive running was observed without considering the danger. The considered general motor excitement at a level accessible to this age of patients without the phenomena of numbness, active and passive negativism, echopraxia, ambivalence is difficult to define as catatonic. Most of all, “it resembled the intensified, stereotyped, physiological activity of the child. However, in the future, symptoms of delayed development appeared, which indicated the severity of the transferred condition.Therefore, similar conditions should be the subject of careful research in the future.

Motor excitement at an early age was also observed in the form of hyperkinesis, tics of the facial muscles, closing the eyes, and periodic tensions in the muscles of the body and arms. Such motor disorders were replaced by spontaneity, in which sick children stayed for a long time in a relaxed position in bed, did not respond to the calls, calls from their parents, refused food, and developed exhaustion. At the same time, some of the hyperkinesis resembled convulsive seizures, which were diagnosed in this way in 2 patients.However, the absence of loss of consciousness, the alternation of motor excitement by lethargy, ventures

characteristic regression of words, motor skills, indifference to relatives, the phenomenon of spontaneity, and. not the usual post-attack lethargy helped to distinguish them from paroxysmal disorders in organic lesions of the central nervous system. Further observations of these children confirmed the correctness of the assumption about the presence of special forms of motor excitement in the form of hyperkinetic symptoms of schizophrenic origin.At a more mature age, 3 of these patients developed excitations of the catatonic type. In 4 patients between one and one and a half years of age, only states of lethargy were found, without somatic and psychogenic provocation. These children lost their acquired skills: they stopped sitting, lay for most of the day, indifferent to their mother, did not walk, did not react to hunger, lost their first words.

The states of lethargy could be of an affective, catatonic, and regressive nature in the circle of manic-depressive psychosis, psychogenicity, and schizophrenia.It is difficult to distinguish between them. The degree of violation; contacts, the depth of lethargy and akinesia, loss of skills, indifference could have a diagnostic value in determining the psychopathological essence of these states. Complete denial of contacts with loss of skills is the least characteristic of endogenous affective disorders proper and is more likely to be characteristic of catatonic or regressive manifestations in schizophrenia. Phase endogenous mood disorders are characterized by their interchangeability, a greater brightness of affective disorders.In the case under consideration, we were faced with excitement, aggression, indifference to the environment and emotional insensitivity. It should be recognized that it is extremely difficult, and sometimes impossible, to differentiate between catatonic schizophrenic lethargy and adynamic depression in manic-depressive psychosis or psychogenic states in patients of this age.

Anatomy of the Kremlin Frenzy

Especially for Crimea.Realii

The annexation of Crimea was the final stage in the building of a corporate state of the fascist type in Russia.The legalization and glorification of violence, the seizure of foreign territories, propaganda driven mad by its own lies, and the cult of “getting up from your knees” faced reality. On the one hand, “Krymnash”, and on the other – real politics, in which the Kremlin’s weight on the world stage is decreasing every day. Powerless anger and outright blackmail have become the hallmark of the Russian elite, as it were.

Users of social networks called the reaction of Russian official commentators to the terrorist attacks in Brussels as “choral ossotinization”.Alas, you can’t think of it more precisely. Everyone was outdone by the “eternal” leader of the party, which by a misunderstanding was called “liberal-democratic”, Vladimir Zhirinovsky. Splashing saliva, he yelled on the air of the Kremlin TV channel: “It is beneficial for us. Let them die! ”

It’s funny to talk about it, but by capturing the Ukrainian peninsula, Russian President Vladimir Putin breathed new life into NATO

After “Krymnash” he threatened to restore the Russian empire and start bombing Poland and the Baltic states if NATO “threatened” Russia.Two years have passed. The alliance noticeably strengthened its positions in Europe, the Turks shot down a Russian bomber. The Old World is once again consolidating around Washington, and the situation vaguely resembles the period of the Cold War, but with the difference that the modern downshifting country does not have half the political and economic power of the USSR. It’s funny to talk about it, but by capturing the Ukrainian peninsula, Russian President Vladimir Putin breathed new life into NATO.

Strengthening the Alliance, if you look at the situation from the Kremlin bell tower, an undoubted challenge for Putin and Zhirinovsky.And where is the “bombing” of Poland and the Baltic states? Instead, Russian dignitaries rage on social media. The head of the State Duma Committee on International Affairs Alexei Pushkov was naughty to the leadership of the Western military bloc, which is supposedly doing the wrong thing.

“While Stoltenberg, without remembering himself, is fighting an imaginary“ Russian threat ”and deploying troops in Latvia, people are blown up under his nose in Brussels,” he wrote on his Twitter account.

Terry Ukrainophobe Sergei Markov , who was the confidant of the Russian president during the 2012 elections, said that the French did not change their policy towards the Kremlin after the terrorist attacks.Belgium is doing the same. Consequently, Markov believes, explosions in European capitals will continue. He named Berlin as the next target.

Russian propagandists are very fond of arguing that “cooperation” with Moscow will supposedly help to avoid trouble, but how this will happen and how the Kremlin can help, they are modestly silent

“Russia and Germany must urgently establish cooperation to prevent terrorist attacks in Berlin, in order to prevent them,” the odious politician said.Russian propagandists are very fond of speculating that “cooperation” with Moscow will supposedly help to avoid trouble, but they are modestly silent about how this will happen and how the Kremlin can help. What does it mean? Spiteful escapades with elements of blackmail. Pushkov’s comment can be interpreted as a hint: “If you don’t start negotiating with us, the explosions will continue.” Markov is not burdened with official status, so he can speak more openly.

Not surprisingly, the head of the SBU Vasily Gritsak made a “Russian trace” in the Brussels terrorist attacks.The Kremlin’s response was, to put it mildly, inadequate. Prime Minister Dmitry Medvedev called the chief of the Ukrainian secret service a “jerk”. The head of the presidential administration of Russia Sergei Ivanov used the word “degenerate”. Has Gritsak hit the mark since the Kremlin leaders are so furious?

The genesis of “Krymnash” and the trends characteristic of the Kremlin’s European policy indicate that the aggressive reaction to the explosions has two main reasons. First, unconcealed malice that the EU or, more broadly, the West as a whole refuses to accept Putin’s “cunning plan” for Ukraine: the honorable surrender of the “terrorist republics” of Donbass, taking into account the interests of the Kremlin, the lifting of sectoral sanctions, the recognition of Crimea as de facto Russian territory or at least a delay of 10-15 years.Brussels and Washington methodically sweep aside all the Kremlin’s wishes, constantly pointing out the Russians to get out of the Ukrainian land. The policy of German Chancellor Angela Merkel causes undisguised irritation in Moscow. It is thanks to her efforts that the position of the European community on the sanctions remains unchanged. Russian propagandists tried to launch a dirty information campaign against Berlin, where migrants allegedly kidnapped and raped “Russian girl Lisa”.

The second, shameful flight of the Russian contingent from Syria was probably provoked by some kind of ultimatum from Washington.The decision was taken so quickly and unexpectedly that the threat must have been significant. There can be two options: the oil embargo, the promulgation and subsequent freezing of the accounts of the Russian elite in European and American banks. The children of these cannon, misulin, spring and other made “patriots” have long settled in the “rotten” West. The son of the Russian attorney general is a resident of Switzerland. For them, non-recognition of “Krymnash” and further sanctions mean significant financial losses.They tear throats and spit poison not for the sake of “state greatness”, but for the sake of their own pockets.

Sergei Stelmakh , political observer

The views expressed in the “Opinion” section convey the point of view of the authors themselves and do not always reflect the position of the editorial board

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