Although babies tend to frequently regurgitate after meals (possetting), vomiting itself should not be taken lightly as it may be due to some underlying pathology. This can range from more acute causes like viral gastroenteritis to serious conditions like gastric outlet or intestinal obstruction or even meningitis. In toddlers however, regurgitation may arise for other reasons like ingesting small objects, triggering the gag reflex by putting objects in the mouth and food poisoning due to the tendency to explore the environment.
Generally if vomiting is persistent or accompanied by other features like diarrhea, fever, dehydration and/or listlessness, then immediate medical attention should be sought so that the appropriate treatment can be commenced. If vomiting is occasional and the baby does not seem distressed then a wait-and-watch approach may be adopted.
Possetting or spitting up (effortless regurgitation or bringing up of breast milk or formula after a feed) is confused with vomiting. Vomiting is not an effortless activity. It is the inability to keep down food or liquids, and the forced throwing up of ingested milk, water, formula or any food through the mouth.
Vomiting is a protective reflex, the purpose of which is to remove toxic materials from the gastrointestinal tract to prevent its absorption into the blood stream. It is discussed in detail under What is Vomiting?
Causes of Baby Vomiting
Most of the conditions where vomiting is a prominent feature include :
- Viral gastroenteritis is the most common and is usually acute.
- Bacterial gastroenteritis is less frequent and more often associated with poor hygiene, especially when handling dirty diapers and the baby or inadequate sterilization of feeding bottles. This type of gastroenteritis may be the result of bacterial action (food infection) or the action of bacterial toxins (food poisoning).
- Symptoms : Diarrhea, vomiting after feeding
- Other Infections
- Ear infection
- Respiratory tract infections – pneumonia, whooping cough
- Urinary tract infections
An obstruction usually causes projectile vomiting. Some of the causes in babies includes :
- Pyloric stenosis
- Intestinal obstruction – blocked bowel (small intestine) or blocked colon (large intestine)
- Congenital narrowing of a part of the alimentary tract
For a list of possible causes, refer to Projectile Vomiting in Babies.
- Lactose intolerance
- Milk allergy
- Early introduction of solid foods
- Ingesting poisons or toxins
- Indigestion (non-ulcer dyspepsia)
- Gastroesophageal reflux disease
- Prolonged bouts of crying
- Motion sickness
- Head injury
When to Call the Doctor
The following conditions should prompt medical attention.
- Vomiting lasting more than a few hours.
- Vomiting accompanied by diarrhea (refer to Sudden Vomiting and Diarrhea).
- Vomiting with fever above 100 degree (refer to Baby Fever).
- Not passing urine for more than 6 hours.
- Signs of dehydration such as dry lips and mouth, dry skin, crying without tears, excessive sleepiness, depressed fontanelle (the soft portion on the skull in babies), loss of skin turgor (felt by pinching up the skin on the abdomen – tenting of skin is seen in dehydration).
- The baby appears to be in severe pain.
- Bulging fontanelle.
- Blood in vomit or vomiting bile.
- Lethargy, confusion, irritability.
- Neck rigidity.
- Shortness of breath.
- Vomiting after a head injury.
Treatment of Baby Vomiting
Treatment will be directed at the cause of vomiting and breastfeeding should not be stopped during this time. Dehydration should be prevented or at least identified early. If vomiting eases, an oral rehydration solution (ORS) may be given to replenish the lost fluid and electrolytes caused by vomiting and accompanying diarrhea if present.
Liquids and solid feeds may be stared gradually as the baby’s vomiting settles. No medication should be given without the doctor’s advice. Avoid using anti-emetics in children unless advise by a pediatrician.