My baby is vomiting…
[mme_highlight] Vomiting is one of the most common reasons for parents to take their child to the Emergency Department. The most frequent conditions that cause vomiting in infants are gastroesophageal reflux, pyloric stenosis and intestinal obstruction. Preventing dehydration and spread and being aware of alarm signs are fundamental measures. [mme_highlight]
Vomiting is one of the most common reasons for parents to take their child to the Emergency Department. Vomiting is not a disease, but a non-specific symptom which is often related with benign self-limited conditions, but it can also be associated with serious illness. The reason for vomiting varies with age, but the most frequent is a viral infection.
What can be considered vomiting?
Vomiting can be defined as an oral expelling of the gastric content, either in a voluntary or involuntary way, associated with a contraction of abdominal and thoracic muscles. It should be distinguished from spitting up (regurgitation), in which the gastric content comes to mouth without contraction of abdominal muscles. However, in infants, this distinction may not be easy to make, as some infants reflux in large amounts or forcefully.
Why does vomiting appear?
Vomiting occurs when a message to do so reaches the “vomiting center” in the brain. This message can be transmitted from various triggers, such as an infection, food poisoning, certain medicines or motion.
Vomiting is a response of the body to eliminate potentially harmful substances and, in this sense, it is beneficial. However the use of medicines or manual induction of vomiting is not recommended even if a child has ingested a harmful substance; in this case, call the emergency number immediately.
What are the most common causes of vomiting in infants?
Gastroesophageal Reflux
Gastroesophageal reflux (GER) is the most common cause of vomiting in the first year of life; generally, it is self-limited (this means it goes away without any treatment). It results from the immaturity of the lower esophageal sphincter (a muscle between stomach and esophagus). The presentation signs and symptoms are generally regurgitation, refusal to eat, poor weight gain, irritability and episodes in which the baby turns blue (cyanotic).
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Prevalence of Gastroesophageal Reflux during the first year of life
- 4 to 5 months of age: 67% of all babies have GER
- 6 to 7 months of age: 21% of all babies have GER
- 12 months of age: 5% of all babies have GER
Prevalence – The total number of cases of a disease in a given population at a specific time.
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Intestinal Obstruction
Depending on the location of the constriction, vomits can appear bile-stained (“greenish”); if this is the case, take your child immediately to the emergency department. If the constriction is more proximal (more close to esophagus), generally the vomitus is not bile-stained and can be caused by different conditions (pyloric stenosis, upper duodenal stenosis, gastric volvulus, or annular pancreas).
Pyloric Stenosis
If the pyloric muscle is too thick, this can lead to an obstruction, and children may present with non-biliary vomitus during the first weeks of life. This condition is nowadays early diagnosed, using an ultrasound examination of the abdomen.
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Epidemiology data for Pyloric Stenosis
- Prevalence in population – 3:1000 (3 babies per 1000 live births)
- More common among boys – 4:1 (4 boys for each girl with pyloric stenosis)
- 30% of cases occur in firstborn children
Prevalence – The total number of cases of a disease in a given population at a specific time.
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Gastroenteritis
This condition is characterized by a sudden onset but also a fast resolution, most times without any specific treatment. It is more frequent during winter season and caused by a viral infection – most frequently Rotavirus. Vomiting can be the only symptom during the first two days of a Rotavirus infection. Bacterial gastroenteritis may be associated with more prolonged and severe illness.
What can I do to help my infant?
Monitor your child’s hydration: Vomiting leads to a great loss of water from body, so your child can become dehydrated. If your child is thirsty and presents a slightly dry mouth, give her/him fluids. Do not give time for signs of severe dehydration to appear; these are: dry mouth, decreased quantity of urine (6 or more hours without going to the bathroom or wetting a diaper), lack of tears when crying, sunken eyes.
Oral rehydration therapy: Vomiting leads body to lose water and fluids, which are very important for health balance, so in cases of dehydration these have to be replaced with a liquid solution that contains glucose (a sugar) and electrolytes (sodium, potassium, chloride).
Medicines: Always seek for medical advice before giving your child’s a medicine. Your doctor can recommend the use of antiemetics to prevent vomiting from occur, this way preventing dehydration if your child is vomiting repeatedly.
Preventing spread: Wash your hands and your child’s! It is a simple measure but very effective to prevent spreading a gastroenteritis. Your child should not go to school until she/he stays without a vomiting episode for 24 hours.
Summary and Recommendations
- The most frequent conditions that cause vomiting in infants are gastroesophageal reflux, pyloric stenosis and intestinal obstruction.
- Preventing dehydration and preventing spread if a contagious cause is present are fundamental measures.
- Be aware of alarm signs:
- any episode of vomiting in a newborn;
- vomiting that lasts more than 24 hours in an infant;
- green or blood-stained vomitus;
- signs of dehydration;
- refusal to eat;
- if your child seems more sleepy than usual;
- high fever.
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References
- Nelson, S, Chen, EH, Syniar, GM, Christoffel, KK. Prevalence of symptoms of gastroesophageal reflux during infancy: a pediatric practice-based survey. Pediatric Practice Research Group. Pediatr. Adolesc. Med. 1997; 151:569-572.
- Ikeda H, Matsuyama S, Suzuki N, et al. Small bowel obstruction in children: review of 10 years experience. Acta Paediatr Jpn 1993; 35:504.
- Sondheimer JM. Vomiting. In: Pediatric Gastrointestinal Disease: Pathopsychology, Diagnosis, Management, 4th ed, Walker WA, Goulet O, Kleinman RE, et al (Eds), BC Decker, Ontario 2004. p.203
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