Baby being sick after each feed
Vomiting (0-12 Months)
Is this your child's symptom?
- Vomiting (throwing up) stomach contents
- Other names for vomiting are puking, barfing and heaving
Causes of Vomiting
- Viral Gastritis. Stomach infection from a stomach virus is the most common cause. Also called stomach flu. A common cause is the Rotavirus. The illness starts with vomiting. Watery loose stools may follow within 12-24 hours.
- Food Allergy. Vomiting can be the only symptom of a food reaction. The vomiting comes on quickly after eating the food. Uncommon in infants, but main foods are eggs and peanut butter.
- Coughing. Hard coughing can also cause your child to throw up. This is more common in children with reflux.
- Serious Causes. Vomiting alone should stop within about 24 hours. If it lasts over 24 hours, you must think about more serious causes. An example is a kidney infection. A serious cause in young babies is pyloric stenosis. See below for more on this.
Pyloric Stenosis (Serious Cause)
- The most common cause of true vomiting in young babies.
- Onset of vomiting is age 2 weeks to 2 months
- Vomiting is forceful. It becomes projectile and shoots out.
- Right after vomiting, the baby is hungry and wants to feed. ("hungry vomiter")
- Cause: The pylorus is the channel between the stomach and the gut. In these babies, it becomes narrow and tight.
- Risk: Weight loss or dehydration
- Treatment: Cured by surgery.
- Mild: 1 - 2 times/day
- Moderate: 3 - 7 times/day
- Severe: Vomits everything, nearly everything or 8 or more times/day
- Severity relates even more to how long the vomiting goes on for. At the start of the illness, it's common for a child to vomit everything. This can last for 3 or 4 hours. Children then often become stable and change to mild vomiting.
- The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid.
- The younger the child, the greater the risk for dehydration.
Dehydration: How to Tell
- The main risk of vomiting is dehydration. Dehydration means the body has lost too much water.
- Vomiting with watery diarrhea is the most common cause of dehydration.
- Dehydration is a reason to see a doctor right away.
- Your child may have dehydration if not drinking much fluid and:
- The urine is dark yellow and has not passed any in over 8 hours.
- Inside of the mouth and tongue are very dry.
- No tears if your child cries.
- Slow blood refill test: Longer than 2 seconds. First, press on the thumbnail and make it pale. Then let go. Count the seconds it takes for the nail to turn pink again. Ask your doctor to teach you how to do this test.
When to Call for Vomiting (0-12 Months)
Call 911 Now
- Can't wake up
- Not moving
- You think your child has a life-threatening emergency
Call Doctor or Seek Care Now
- Dehydration suspected. No urine in over 8 hours, dark urine, very dry mouth and no tears.
- Stomach pain when not vomiting. Exception: stomach pain or crying just before vomiting is quite common.
- Age less than 12 weeks old with vomiting 2 or more times. Exception: normal spitting up.
- Vomited 3 or more times and also has diarrhea
- Severe vomiting (vomits everything) more than 8 hours while getting Pedialyte (or breastmilk)
- Head injury within the last 24 hours
- Weak immune system. Examples are sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
- Vomiting a prescription medicine
- Fever over 104° F (40° C)
- Fever in baby less than 12 weeks old. Caution: Do NOT give your baby any fever medicine before being seen.
- Your child looks or acts very sick
- You think your child needs to be seen, and the problem is urgent
Contact Doctor Within 24 Hours
- All other infants (age less than 1 year) with vomiting. See Care Advice while waiting to discuss with doctor.
Seattle Children's Urgent Care Locations
If your child’s illness or injury is life-threatening, call 911.
- Federal Way
Care Advice for Vomiting
- What You Should Know About Vomiting:
- Most vomiting is caused by a viral infection of the stomach.
- Vomiting is the body's way of protecting the lower gut.
- The good news is that stomach illnesses last only a short time.
- The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid.
- Here is some care advice that should help.
- Formula Fed Babies - May Give Oral Rehydration Solution (ORS) for 8 Hours:
- If vomits once, give half the regular amount of formula every 1 to 2 hours.
- If vomits formula more than once, offer ORS for 8 hours. If you don't have ORS, use formula until you can get some.
- ORS is a special fluid that can help your child stay hydrated. You can use Pedialyte or the store brand of ORS. It can be bought in food stores or drug stores.
- Spoon or syringe feed small amounts. Give 1-2 teaspoons (5-10 mL) every 5 minutes.
- After 4 hours without throwing up, double the amount.
- Return to Formula. After 8 hours without throwing up, go back to regular formula.
- Breastfed Babies - Reduce the Amount Per Feeding:
- If vomits once, nurse half the regular time every 1 to 2 hours.
- If vomits more than once, nurse for 5 minutes every 30 to 60 minutes. After 4 hours without throwing up, return to regular nursing.
- If continues to vomit, switch to pumped breastmilk. (ORS is rarely needed in breastfed babies. It can be used if vomiting becomes worse).
- Spoon or syringe feed small amounts of pumped milk. Give 1-2 teaspoons (5-10 mL) every 5 minutes.
- After 4 hours without throwing up, return to regular feeding at the breast. Start with small feedings of 5 minutes every 30 minutes. As your baby keeps down the smaller amounts, slowly give more.
- Pumped Breastmilk Bottle-Fed Infants - Reduce the Amount per Feeding:
- If vomits once and bottle-feeding breastmilk, give half the regular amount every 1-2 hours.
- If vomits more than once within last 2 hours, give 1 ounce (30 mL) every 30 to 60 minutes.
- If continues to vomit, give 1-2 teaspoons (5-10 mL) every 5 minutes. Only if not tolerating breastmilk, switch to ORS (e.g., Pedialyte) for every 5 minutes for a few hours.
- After 4 hours without vomiting, return to regular feedings. Start with 1 ounce (30 mL) every 30 minutes and slowly increase as tolerated.
- Stop All Solid Foods:
- Avoid all solid foods and baby foods in kids who are vomiting.
- After 8 hours without throwing up, gradually add them back.
- If on solid foods, start with starchy foods that are easy to digest. Examples are cereals, crackers and bread.
- Do Not Give Medicines:
- Stop using any drug that is over-the-counter for 8 hours. Reason: Some of these can make vomiting worse.
- Fever. Mild fevers don't need to be treated with any drugs. For higher fevers, you can use an acetaminophen suppository (such as FeverAll). This is a form of the drug you put in the rectum (bottom). Ask a pharmacist for help finding this product. Do not use ibuprofen. It can upset the stomach.
- Call your doctor if: Your child vomits a drug ordered by your doctor.
- Try to Sleep:
- Help your child go to sleep for a few hours.
- Reason: Sleep often empties the stomach and removes the need to vomit.
- Your child doesn't have to drink anything if his stomach feels upset and he doesn't have any diarrhea.
- Return to Child Care:
- Your child can return to child care after the vomiting and fever are gone.
- What to Expect:
- For the first 3 or 4 hours, your child may vomit everything. Then the stomach settles down.
- Vomiting from a viral illness often stops in 12 to 24 hours.
- Mild vomiting and nausea may last up to 3 days.
- Call Your Doctor If:
- Vomits clear fluids for more than 8 hours
- Vomiting lasts more than 24 hours
- Blood or bile (green color) in the vomit
- Stomach ache present when not vomiting
- Dehydration suspected (no urine in over 8 hours, dark urine, very dry mouth, and no tears)
- You think your child needs to be seen
- Your child becomes worse
And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Last Reviewed: 12/23/2022
Last Revised: 09/21/2022
Copyright 2000-2022 Schmitt Pediatric Guidelines LLC.
Pyloric Stenosis (for Parents) - Nemours KidsHealth
What Is Pyloric Stenosis?
Pyloric stenosis is a condition that can affect the gastrointestinal tract in babies. It can make a baby vomit forcefully and often, and can lead to other problems, such as dehydration. Pyloric stenosis needs medical care right away.
What Happens in Pyloric Stenosis?
Food and other stomach contents pass through the pylorus, the lower part of the stomach, to enter the small intestine. Pyloric stenosis (pie-LOR-ik stih-NOE-sis) is a narrowing of the pylorus. When a baby has pyloric stenosis, this narrowing of the pyloric channel prevents food from emptying out of the stomach.
Pyloric stenosis (also called infantile hypertrophic pyloric stenosis) is a type of gastric outlet obstruction, which means a blockage from the stomach to the intestines.
Pyloric stenosis affects about 3 out of 1,000 babies in the United States. It's more likely to affect firstborn male infants and also runs in families — if a parent had pyloric stenosis, then a baby has up to a 20% risk of developing it. Most infants who have it develop symptoms 3 to 5 weeks after birth.
What Causes Pyloric Stenosis?
It's thought that babies who develop pyloric stenosis are not born with it, but have progressive thickening of the pylorus after birth. A baby will start to show symptoms when the pylorus is so thick that the stomach can't empty properly.
The cause of this thickening isn't clear. It might be a combination of several things. For example, use of erythromycin (an antibiotic) in babies in the first 2 weeks of life or antibiotics given to moms at the end of pregnancy or during breastfeeding can be associated with pyloric stenosis.
What Are the Signs & Symptoms of Pyloric Stenosis?
Symptoms of pyloric stenosis typically begin when a baby is around 3 weeks old. They include:
- Vomiting. The first symptom is usually vomiting. At first it may seem that the baby is just spitting up often, but then it tends to become projectile vomiting, in which the breast milk or formula is ejected forcefully from the mouth, in an arc, sometimes over a distance of several feet. Projectile vomiting usually takes place soon after the end of a feeding, although in some cases it can happen hours later.
The vomited milk might smell curdled because it has mixed with stomach acid. The vomit will not contain bile, a greenish fluid from the liver that mixes with digested food after it leaves the stomach.
Despite vomiting, a baby with pyloric stenosis is usually hungry again soon after vomiting and will want to eat. It's important to know that even with the vomiting, the baby might not seem to be in great pain or at first look very ill.
- Changes in stools. Babies with pyloric stenosis usually have fewer, smaller stools (poops) because little or no food is reaching the intestines. Constipation or poop with mucus also can happen.
- Failure to gain weight or weight loss. Most babies with pyloric stenosis will fail to gain weight or will lose weight. As the condition gets worse, they might become dehydrated.
Dehydrated infants are less active than usual, and they may develop a sunken "soft spot" on their heads and sunken eyes, and their skin may look wrinkled. Because less pee is made, they can go more than 4 to 6 hours between wet diapers.
- Waves of peristalsis. After feeds, increased stomach contractions may make noticeable ripples, which move from left to right over the baby's belly as the stomach tries to empty itself against the thickened pylorus.
It's important to call your doctor if your baby has any of these symptoms.
Other conditions can cause similar problems. For instance:
- gastroesophageal reflux (GER) usually begins before 8 weeks of age. GER involves lots of spitting up (reflux) after feedings, which can look like vomiting. But most babies with GER don't have projectile vomiting, and while they might have trouble gaining weight, they usually have normal poops.
- a milk protein allergy also can make a baby spit up or vomit, and have diarrhea. But these babies don't have projectile vomiting.
- gastroenteritis (inflammation in the digestive tract that can be caused by viral or bacterial infection) also can cause vomiting and dehydration. But babies with gastroenteritis usually also have diarrhea with loose, watery, or sometimes bloody stools. Diarrhea usually isn't seen with pyloric stenosis.
How Is Pyloric Stenosis Diagnosed?
The doctor will ask detailed questions about the baby's feeding and vomiting patterns, including what the vomit looks like. The doctor will do an exam, and note any weight loss or failure to maintain growth since birth.
The doctor will check for a lump in the abdomen. If the doctor feels this lump, which usually is firm and movable and feels like an olive, it's a strong indication that a baby has pyloric stenosis.
If pyloric stenosis seems likely, the doctor probably will order an abdominal ultrasound. The enlarged, thickened pylorus will show on ultrasound images. The doctor may ask that the baby not be fed for several hours before an ultrasound.
Sometimes doctors order a barium swallow instead of an ultrasound. Babies swallow a small amount of a chalky liquid (barium). Then, special X-rays are done that let the doctor check the pyloric area for any narrowing or blockage.
The doctor also might order blood tests to check levels of electrolytes (minerals that help keep fluids balanced and vital organs working properly). An electrolyte imbalance often happens due to the ongoing vomiting of stomach acid and dehydration, and needs to be corrected.
How Is Pyloric Stenosis Treated?
When an infant is diagnosed with pyloric stenosis, either by ultrasound or barium swallow, the baby will be admitted to the hospital and prepared for surgery. Any dehydration or electrolyte problems in the blood will be corrected with intravenous (IV) fluids, usually within 24 hours.
Doctors do a surgery called pyloromyotomy (pie-lor-oh-my-OT-uh-me) to relieve the blockage. Using a small incision (cut), the surgeon examines the pylorus and separates and spreads the thick, tight muscles. This relaxes and opens those muscles.
The surgery can also be done through laparoscopy. This technique uses a tiny scope placed through a small cut in the belly button, letting the doctor see the area of the pylorus. Using other small instruments placed in nearby incisions, the doctor can complete the surgery.
Most babies return to normal feedings fairly quickly, usually 3 to 4 hours after the surgery. Because of swelling at the surgery site, a baby may still vomit small amounts for a day or so. If there are no complications, most babies who have had pyloromyotomy can return to a normal feeding schedule and go home within 24 to 48 hours of the surgery.
If you're breastfeeding, you might worry about continuing while your baby is hospitalized. The hospital staff should be able to provide a breast pump and help you use it so that you can continue to express milk until your baby can feed regularly.
After a successful pyloromyotomy, your baby won't need to follow any special feeding schedules. Your doctor will probably want to examine your child at a follow-up appointment to make sure the surgical site is healing properly and that your baby is feeding well and maintaining or gaining weight.
Pyloric stenosis should not happen again after a pyloromyotomy. If your baby still has symptoms weeks after the surgery, there might be another medical problem, such as gastritis or GER, so let your doctor know right away.
When Should I Call the Doctor?
Pyloric stenosis is an urgent condition that needs immediate treatment. Call your doctor if your baby:
- has lasting or projectile vomiting after feeding
- is losing weight or not gaining weight as expected
- is less active than usual or is very sleepy
- has few or no stools (poops) over a period of 1 or 2 days
- show signs of dehydration, such as more than 4 to 6 hours between wet diapers, a sunken "soft spot" on the head, or sunken eyes
Spitting up and vomiting in infants
Spitting up and vomiting in babies is a common reason for visiting a doctor.
Regurgitation and vomiting is a reflex action that occurs when receptors located in various anatomical zones are irritated, incl. in the stomach, esophagus, pharynx, oral cavity. The signal is transmitted to the vomiting center, which is located in the medulla oblongata and a gag reflex occurs.
What is the difference between regurgitation and vomiting?
The difference lies in the volume and kinetics (movement) of the gastric contents expelled to the outside. When regurgitation occurs, leakage occurs without the participation of the diaphragm and abdominal muscles, i.e. passively. There is little content, up to about 10-15 ml. If the child does not swallow it, it quietly expires from the oral cavity. When vomiting, a wave-like bending of the upper half of the body occurs as a result of contraction of the muscles of the diaphragm and the anterior wall of the abdomen, the volume of vomit is greater, and they are erupted with pressure from the oral cavity with an ejection trajectory of up to 50 cm. In children of the first year of life, this is defined by the term "fountain vomiting" . nine0003
Regurgitation is observed only in children of the first year of life and, mainly, up to 6 months. Contribute to this anatomical and physiological features of the esophagus and stomach of the baby. Their esophagus is short and wide, the angle of connection of the esophagus with the stomach is less pronounced, and its obturator function is weak. These regurgitations are physiological. They can be after each feeding, up to 15 ml, do not affect the well-being and weight gain of the baby. They can also be caused by excessive feeding, aerophagia (swallowing air while sucking), straining during intestinal colic. The frequency and volume of such regurgitation decreases with the growth of the child. With the introduction of complementary foods, and this is a thicker food, regurgitation stops or becomes much less frequent. nine0003
If regurgitation persists in a child older than 1 year, then this is a sign of a pathological process.
Vomiting, unlike regurgitation, is accompanied by vegetative symptoms - increased salivation, pallor of the skin, palpitations. This is due to the fact that next to the vomiting center there are additional centers of autonomic regulation, which are reflexively excited, and active biological substances such as serotonin, dopamine, histamine and others are released into the blood. nine0003
Regurgitation and vomiting, from the moment of eating, may occur during feeding, after feeding for the first 20-30 minutes or delayed, sometimes after several hours.
Regurgitation and vomiting that occurs immediately after feeding unchanged breast milk or formula may be due to narrowing of the esophagus. If they persist until the next feeding, and the milk / mixture is curdled, has a sour or musty smell, then this is the result of a long standing food in the stomach. The reason for this may be the low tone of the muscle layer of the stomach and, as a result, its peristalsis or narrowing of the output section due to an anomaly in the development or high tone of the sphincter of the lower stomach. With narrowing of the duodenum, bile is present in the regurgitated masses. nine0003
Gastroesophageal reflux is a common cause of regurgitation in infants. It is likely that there is a complex problem here, starting with the immaturity of the gastrointestinal tract and disorders of the central nervous system. Perinatal injuries of the central nervous system accompany every second child. Their manifestations are varied. Regurgitation and vomiting can be facilitated by an increase in intracranial pressure, disorders in the segment of the cervical spine, and so on. Therefore, quite often, when carrying out rehabilitation measures for neurological dysfunctions, a positive effect is manifested in the form of a decrease or cessation of regurgitation. A hernia of the esophageal opening of the diaphragm will also manifest itself in a similar way. nine0003
We should not forget about allergic gastrointestinal reactions in the form of regurgitation and vomiting. The most common cause of this is cow's milk protein. With intolerance to cow's milk protein, inflammation of the mucous membrane of the esophagus, stomach and intestines occurs. And, as a result of this, regurgitation and vomiting, pain and increased gas formation, diarrhea or constipation.
Rare endocrine disorders (adrenogenital syndrome) are manifested by vomiting in children from the first weeks of life. In such cases, vomiting is frequent, there may be an admixture of bile, the child loses weight due to loss of fluid and nutrients, and severe metabolic disorders develop. nine0003
Vomiting can also be caused by an intestinal infection. Viral gastroenteritis is now common. It must be remembered that the younger the child, the more severe the disease. Within a few hours, the child's condition can go from satisfactory to extremely serious.
As you can see, the causes of regurgitation and vomiting in children of the first year of life are quite diverse, but most often these are transient conditions that disappear with the growth of the child.
Prevention of regurgitation in children of the first months of life is quite simple. Don't overfeed your baby. If he cries, it does not always mean that he is hungry. Excess feeding leads to increased gas formation and colic, during which the child is worried, straining, thereby increasing the likelihood of spitting up. After feeding, hold the baby more upright so that he can burp the swallowed air. This will take 15-20 minutes. If the child is bottle-fed, do not change his formula milk without the recommendation of a pediatrician. nine0003
If the child has frequent regurgitation and vomiting, it is necessary to consult a pediatrician or gastroenterologist to diagnose the cause. To make a diagnosis, it is sometimes enough to carry out simple and affordable diagnostic methods in a polyclinic. These include an ultrasound of the stomach and, if necessary, stool tests. However, the approach in each case is individual. Examination and treatment will be assigned to your baby, depending on the diagnosis. Perhaps it will be preventive measures or a certain milk formula, perhaps drug therapy. Rarely, but it happens that it is necessary to examine the child in a hospital and surgical treatment. nine0003
Article | Neurotic vomiting in children
Bobylova M.Yu. (neurologist)
Vomiting in children is not an independent disease, but a manifestation of various diseases. Vomiting can be caused by disorders of the gastrointestinal tract, metabolic diseases, tonsillitis, inflammation of the nasopharynx, pneumonia, influenza, SARS, acute appendicitis. Such vomiting is treated by a pediatrician. But there are also vomiting associated with dysfunction of the central nervous system. It develops in children of the first months of life who have undergone hypoxia during fetal development or childbirth. After 6 months, habitual vomiting is often associated with improper introduction of complementary foods if the child is force fed. Also, vomiting can be a sign of increased intracranial pressure. Vomiting attacks are characteristic of the childhood form of migraine. nine0003
In infants , especially in the first 3 months of life, regurgitation of a small amount of food (15-30 ml) 2-3 times a day is a common occurrence that disappears with the growth of the child. The horizontal position of the baby and the relatively large amount of food predispose to the occurrence of regurgitation in healthy infants. It is also characteristic of regurgitation when swallowing air during breastfeeding, when there is not enough breast milk in the mammary gland, or when the baby does not capture the areola. With artificial feeding - swallowing of air occurs when the nipple is not completely filled with milk, when there is a large hole in the nipple, when the position of the bottle during artificial feeding is horizontal. nine0003
Swallowing air is more common in infants who are hyperexcitable, greedily sucking, and also with general muscular hypotension.
Regurgitation, unlike vomiting, occurs suddenly, does not affect the behavior and general well-being of the child, while children do not lose weight gain.
Helping a baby with spitting up: firstly, immediately after feeding and during sleep, you should hold the baby in an upright position. If regurgitation has occurred, it is necessary to turn the child's head to one side, toilet the child's nose and mouth (clean it from food debris). Wash and caress the baby. nine0003
Feeding rules must be observed: the baby should be fed in a semi-upright position, which helps to expel swallowed air. These babies should sleep with their heads up.
If regurgitation is frequent and profuse, and the baby begins to lag behind in weight, then this may be a manifestation of a disease of the stomach or intestines (pylorospasm or pylostenosis). It is necessary to contact a pediatrician for timely examination, diagnosis, treatment and prevention of complications. nine0003
Neurological disorders as a cause of vomiting in a child
The vomiting center of a person is located in the brain, therefore, in case of any damage to the head (trauma, infection, vegetative-vascular dystonia, increased intracranial pressure), vomiting occurs not associated with food intake and fever .
Vomiting in children under 1 year of age is associated with hypoxia during fetal development and at birth.
Neurotic vomiting develops as a manifestation of neurotic reactions in response to nasty and undesirable actions: coercion, protest against punishment, feeding. Functional vomiting in such children is more often combined with refusal to eat, with selectivity in food, behavioral changes, and stubbornness. More common is functional vomiting in children who are emotional, easily excitable, vulnerable. There are no signs of intoxication of the body, pain in the stomach, diarrhea or temperature in the child. This behavior requires prompt treatment to a neurologist. nine0003
Vomiting in children, even if it is not accompanied by diarrhea and fever, requires the attention of parents. In no case should you self-medicate, since for each disease the methods of treatment are different.
Only a doctor can recognize the causes of the problem after a series of examinations. To clarify the cause of constant vomiting in a child, it is necessary to clarify when it began, what kind of character it is (periodic, after each feeding), whether it is somehow connected with food intake and with the time of day. Important information about possible diseases is also provided by the diagnosis of vomit. The masses are checked for the presence of mucus, bile, milk, blood, digested and undigested food debris.