Vomiting in Infants

Spitting up or regurgitation is very common during a baby’s first few months of life. About a third of normal, healthy babies spit up, usually right after feeding.

In older children and adults, an elastic-like muscle at the entry to the stomach closes like a valve to prevent liquids from being pushed back up. In babies, however, this valve or sphincter isn’t fully effective until between 6 and 12 months of age. Since it isn’t fully developed yet, the valve is easily pushed back by the contents of the stomach – resulting in regurgitation or spitting up. Regurgitation often occurs after overfeeding, or in combination with burping. Such events are considered normal.

Measures to Be Taken

• It’s important not to overload your baby’s stomach, or it will “spill” its contents, causing your baby to spit up. Instead, give your baby less to drink during a feeding, but feed him or her more frequently.
• Don’t move your baby about too vigorously after a feeding.
• How you position your baby during the twenty minutes after a feeding is important. Any upright position, such as holding your baby to your shoulder, will help reduce regurgitation.
• However, unlike spitting up, vomiting is characterized by the forceful expulsion of the contents of the stomach.

It’s important to know the difference between vomiting and spitting up because repeated vomiting can be a signal of a more serious illness, and because it can easily lead to dehydration.

Vomiting is generally projectile, which means that it may be so forceful to fall at quite some distance. Dehydration is a dangerous condition in which excessive loss of body fluids results in a potentially life-threatening imbalance of water and essential body salts.

Causes

Possible causes of vomiting in infants are (0 to 6 months):

• Congenital pyloric stenosis, a constriction in the outlet from the stomach. (With this disorder, the infant, usually male, less than 4 months old vomits forcefully after each feeding but otherwise appears to be healthy.)
• Disturbed equilibrium from bouncing the baby immediately after feeding.
• Food allergies or milk intolerance.
• Gastroenteritis (infection of the digestive tract that usually causes vomiting with diarrhea).
• Gastroesophageal reflux.
• Hole in bottle nipple may be wrong size.
• Infection, often accompanied by a fever or runny nose.
• Intestinal obstruction, evidenced by recurring attacks of vomiting, and crying or screaming as if in great pain.

Treatment

Infants who are vomiting repeatedly should be seen be a physician.

Do not give infant water, as this may lead to electrolyte imbalances. Instead, hydration should be maintained by using 1/2 strength formula or oral rehydration solutions such as Pedialyte given in frequent small amounts.  Start with 1 teaspoon every 5 minutes and slowly increase the amount. Once full feed amounts are reached and the infant has gone 8 hours without vomiting, return to regular feeding.

Most of the time, vomiting in children is caused by gastroenteritis, usually from a virus infecting the gastrointestinal tract. These infections are usually short-lived. However, if your child is not able to take fluids adequately, and diarrhea is also there, she could become dehydrated.

Home Measures

• Never give plain water to a young infant unless an amount is directly specified by your child’s doctor.
• Offer your infant small but frequent amounts – about 2 to 3 teaspoons, or up to 1/2 ounce – of an oral electrolyte solution (such as Pedialyte or Ricelyte, which are available at most supermarkets or pharmacies) approximately every 15 to 20 minutes. Oral electrolyte solutions are balanced with salts to replace what is lost with vomiting or diarrhea, and they also contain some sugar. It’s especially important for young infants that any fluids given have the correct salt balance.
• Unflavored electrolyte solutions are best for younger infants.
• Gradually increase the amount of solution you are giving if your infant is able to keep it down for more than a couple of hours without vomiting. For instance, if your infant takes 4 ounces normally per feed, work slowly up to giving this amount of Pedialyte over the course of the day.
• Do not give more solution at a time than your infant would normally eat. This will overfill an already irritated tummy and will likely cause more vomiting.
• After your infant goes more than 8 hours without vomiting, you can reintroduce formula slowly to your infant. Start with small (1/2 to 1 ounce), more frequent feeds and slowly work up to your infant’s normal feeding routine. If your infant already eats rice or cereal, it’s fine to start solid feedings in small amounts again.

If vomiting is persistent, accompanied by very high temperatures and/or increasing lethargy, or if vomit contains blood, medical attention should be sought immediately.