Vomiting, diarrhoea, and infection.

The first stage of life, in the words of Jaques from As You Like It, is "first the infant mewling and puking in the nurse's arms . . ." Many normal babies vomit, but if the baby is essentially normal the vomiting is either infrequent or is of small amounts at the end of a feed. In fact, these latter small vomits are called regurgitation or possettingterms not precisely defined but which carry on implication that the vomiting is not serious. Vomiting may carry serious implications when the vomit is bile-stained, blood-stained, excessively large and forceful, or is associated with other findings: vomiting with diarrhoea, vomiting in a baby who is obviously unwell, vomiting in a baby with abdominal distension, vomiting associated with weight loss or weight that is static. A few points from the history may be helpful. If there has been hydramnios, high intestinal obstruction becomes more likely, as it does if vomiting occurs just after feeds are given. In lower intestinal obstruction vomiting is more likely to be delayed beyond the first 24 hours. A family history of cystic fibrosis, congenital hypertrophic pyloric stenosis, or Hirschsprung's disease suggests the possibility that the disease has recurred in this generation.