Infants, both breastfed and bottle fed, have a tendency to regurgitate milk for various reasons, many of which are not due to any disease process. This effortless regurgitation or spitting up of milk is known as possetting. With vomiting, the regurgitated contents are pushed out with force. A list of causes of vomiting in infants and toddlers is discussed under Baby Vomiting.
In cases where the vomiting is persistent or recurrent and accompanied by other problems like the inability to gain weight and thrive, listlessness, fever, diarrhea, difficulty breathing or signs of dehydration needs to be investigated and managed by a medical professional.
Vomiting After Every Feed
Possetting after feeds is a common occurrence. It often accompanies burping. However, vomiting after every feed may be due to :
- Pyloric stenosis. Thickening of the pylorus, which is the muscular valve between the stomach and duodenum (first part of the small intestine). It is more likely to occur in boys than in girls and is most common between 3 weeks to 6 months of age. There may be projectile vomiting approximately 30 minutes after every feed or only after some feeds. Other accompanying symptoms may include abdominal pain, constant hunger, dehydration and failure to thrive. Surgery is the treatment of choice.
- Gastroesophageal Reflux Disease (GERD). This may be the cause of vomiting after a feed. The lower esophageal sphincter or LES, which is the muscular ring between the esophagus and stomach that normally prevents the stomach contents from flowing back into the esophagus, is defective and may not close properly. This allows the acidic stomach contents to pass into the esophagus. With strong gastric contractions during digestion, the stomach contents may pass out into the esophagus with force. Most babies outgrow GERD by the time they are 1 to 2 years old, but it may persist in some children.
- Over feeding
- Not burping the baby after meals.
- Milk intolerance (lactose)
Vomiting with Diarrhea
Dehydration is likely to arise if the condition is not treated promptly and adequate rehydration therapy is not commenced. With infants, rehydration may have to be via the IV route.
- Gastroenteritis due to a viral, bacterial or parasitic infection. It is usually acute and the most common cause of sudden vomiting and diarrhea in infants.
- Food poisoning
- Milk intolerance
- Intestinal obstruction. In infants, intussusception is one of the more common causes of intestinal obstruction. It is the telescoping of one portion of the intestine into the adjacent segment. Initially there is diarrhea with vomiting, followed by the typical red “currant jelly” stool.
Vomiting with Abdominal Pain
It is difficult to identify abdominal pain in an infant. While toddlers may be able to express the discomfort or pain in the abdomen, younger infants may instead cry incessantly especially if firm pressure is applied on the abdomen, sometimes quieten down with light massaging of the abdomen and curl up to try to ease the pain.
- Pyloric stenosis
- Intestinal obstruction