A baby or a child throwing up is never a pretty sight. It has multiple causes- some common and harmless and others serious and potentially dangerous.
That’s why any repeated vomiting in a baby or a child should never be taken lightly. It demands prompt medical attention and evaluation.
Vomiting in newborn baby and young infants:
One major thing to know in this age-group is to understand the difference between the simple regurgitation (reflux) and vomiting. Vomiting is much more forceful and projectile ejection of entire stomach contents whereas in reflux, small quantity of stomach contents slowly dribbles out. Most of the common cases of ‘vomiting’ in this period actually belong to ‘regurgitation/reflux’ variety.
- Gastroesophageal reflux (GER):
There is a valve (sphincter) situated at the lower end of food-pipe which guards against the upward reverse movement of stomach contents. In the early months of life, this valve is slightly lax. Whenever there is any increase in intra-abdominal pressure while coughing, crying, laughing, moving or passing stools; it can cause this valve to further relax, resulting in upward movement of stomach contents.
The fact that infants are mainly on liquid milk feeds in this age, also makes this upward movement easy.
In simple GER, the babies usually spit out small amounts of curdled milk occasionally. They don’t show any outward ill effects and are happy and playful. Their weight-gain pattern is normal.
Usually these cases of mild reflux need no treatment. The condition improves with passing months and after introduction of semisolid foods.
- Gastro-Esophageal Reflux Disease or GERD is a term used for severe cases of reflux.
Here: The reflux frequency is higher; the regurgitated amounts are higher, the baby is often irritable and either not gaining or losing weight.
The treatment of GERD may need special milk formulas, specific medicines and sometimes, even surgery.
- Other important causes:
- Feeding errors (wrong feeding position, not burping well after feeds and overfeeding) are common simple causes of vomiting in this age-group.
Correction of these errors usually solves this vomiting problem
- Among serious causes of vomiting in newborn and early infancy period are
- Congenital abnormalities (like congenital hypertrophic pyloric stenosis and metabolic errors)
- Surgical conditions (like intessusception)
- Significant infection (anywhere in the body!)
These cases show severe vomiting and associated symptoms/signs. They need urgent medical attention and management of underlying cause.
Vomiting in toddlers and children:
- Common causes
- Common infections (Viral/bacterial gastroenteritis and upper respiratory infections)
- Motion sickness,
- Food intolerance/allergy
- Medicinal side-effects
- Unusual causes
- Serious infections (Meningitis, typhoid, viral hepatitis)
- Surgical conditions (like appendicitis)
- Accidental poisonings
Danger signals in the infant/ child is vomiting:
- Sick look
- High fever
- Lethargy/ Drowsiness
- Greenish bile-stained vomiting
- Severe abdominal pain/ distention/lump
- Severe diarrhea or constipation
- Bloody stools
- Headache/Neck-pain or rigidity
- Less urination
- Refusal to accept feeds/ fluids
- Signs of dehydration
Things to do when the infant/ child is vomiting:
- Just administering anti-vomiting medicines is not the right way of treating it. One must identify and treat the underlying condition causing vomiting.
- Seek a medical opinion if the vomiting is frequent or severe.
- Don’t stop feeding unless your doctor has advised you to do so. In breastfed babies, breast feeding should be continued as usual. In formula-fed babies, it is better to dilute the formula. In children, semisolid foods (rice kanjee, khichri, soups, mashed fruits, fruit juices and yoghurt) are good options.
- Don’t stop giving fluids but give them (Pediatric ORS and similar fluids) as small sips.
- Sometimes urgent investigations like blood and urine tests and X-rays and Ultrasonography might be necessary to find out the cause of vomiting.
