Vomiting in babies

Most babies vomit small amounts from time to time and bring up some milk when they burp. This is known as possetting and is usually nothing to worry about. You can tell when your baby is vomiting rather than posseting because there will be a lot more coming out.

Vomiting is also very common (up to half of all babies) and in most cases will resolve with time. Although it might look like they are vomiting a lot, most babies continue to grow normally and do not look particularly distressed.

As long as your baby seems otherwise healthy and continues to gain weight, there's usually no need to worry or seek further help.

Does your baby seem unhappy or distressed as well as vomiting?

Check the following:

If you are breastfeeding, seek advice from a breastfeeding specialist, either a specially trained health visitor or a breastfeeding counsellor. It is possible that your baby is not latching properly.

If you are bottle feeding, ensure your baby is in the right position (sitting almost upright) and that you use the recommended amount of powder (it is quite easy to use too much if you have changed product, or using a different scoop than the one provided in the tin).

It is also quite easy to give your baby too much milk when you are bottle feeding. Their stomach is only small and most babies need little and often: 6-7 feeds per day is the norm, including at night. Your health visitor can help review how much milk you baby should need and the timing of the feeds.

More information is available on the baby centre website.

If all the above measures are not working there are some evidence that thicker or thickened formula may help, so you could try to change the formula (your pharmacist should be able to advise you). However, if after 2 weeks you are still concerned, seek advice from your GP.

Possible causes of excessive vomiting include:-

  • Reflux
  • Cow’s milk intolerance
  • Pyloric stenosis
  • A stomach bug (gastroenteritis)
  • An infection
  • Blood or bile in the vomit

This is usually nothing to worry about if your baby was well before he vomited. It may happen when the force of vomiting causes tiny tears in the blood vessels lining the food pipe, or if you are breastfeeding, your nipple(s) are bleeding.

However, call your GP if your baby continues to have blood in their vomit or if the amount is increasing. They will probably want to see a sample of the vomit if it contains blood or bile, so, although it may be an unpleasant task, try to save some. Green bile can indicate that your baby’s intestines are blocked, a condition that needs immediate attention.

Reflux

  • Some degree of reflux is completely normal in babies as the muscular valve at the end of the food pipe, which keeps food in the stomach, is still developing. Reflux may cause your baby to bring up milk after a feed, and can also give him/her hiccups. As long as your baby is growing normally and is not showing any marked signs of distress, there is no need to worry.
  • More severe reflux can cause your baby to cry and be sick, often after feeding. The long name for severe reflux is gastro-oesophageal reflux disease (GORD). This means that when your baby's tummy is full, food and stomach acid flow back up their food pipe causing discomfort and pain.
  • If you have tried the measures described above and seen no improvement, see your GP. They will review your child’s symptoms and ask you about the formula you have used, and may possibly prescribe an antacid designed for babies.

Cow's milk protein allergy

  • Cow's milk proteins are found in many types of formula milk. They'll also make their way into your breastmilk if you eat or drink milk or other dairy products, such as cheese and yoghurt.
  • If your baby has a cow's milk allergy, they may vomit after feeding. It can be difficult to tell the difference between this and reflux. But if your baby has problems with cow's milk, they may also have:
    • eczema
    • colic
    • diarrhoea or constipation
    • trouble putting on enough weight
    • history of allergies in your close family

If you're worried that your baby has problems with cow's milk, there are steps you can take. If you breastfeed your baby, you could try cutting cow's milk from your diet for 2 weeks. If your baby is formula-fed, trying a hypoallergenic formula may help.

Talk to your doctor before trying these, though. They will check your baby's symptoms first, so they can be sure of what's causing them.

Pyloric stenosis

  • This is a rare condition that can cause your baby to vomit forcefully within half an hour of feeding.
  • Pyloric stenosis is most likely to begin when your baby is about six weeks old, but could show up at any time before they reach four months of age. It can sometimes run in families, and boys are about four times more likely to get it than girls.
  • It happens because the muscle controlling the valve leading from the stomach into the intestines has thickened, stopping enough food and milk to get through, so it stays in the stomach and then comes back up. The problem is easily corrected with minor surgery.

A stomach bug

  • If your baby's vomiting begins suddenly, or if they also have diarrhoea, they may have a tummy bug (gastroenteritis). Gastroenteritis is usually caused by a viral infection and needs no specific treatment. An attack of vomiting will generally subside six hours to 24 hours after it starts.
  • Do not stop giving your baby milk. If you are breastfeeding, continue doing so. If your child is on formula, do not dilute it.
  • Babies under 6 months of age are at more risk of becoming dehydrated than older children, which is why it is important to make ensure that they are drinking enough. Give your baby oral rehydration fluids in between feeds or after each watery stool. Your pharmacist will be able to advise you about which solution is best for your baby. Little and often tends to work best – in hospital, babies are given 1 or 2 tablespoons (5-10 mls) of fluid to drink every 5-10 minutes. You can try using a syringe to give fluids to your child.

Infection

Your baby may be vomiting because they have an infection. This is usually associated with a temperature above 38°C / 100.4°F. Although the most likely cause is a viral infection, other causes include urinary tract infections or very occasionally a more serious illness such as meningitis or sepsis. Signs of a serious infection include:

  • becomes pale and floppy going blue around the lips
  • is fretful or excessively miserable when touched
  • becomes difficult to rouse
  • is finding it hard to breathe
  • develops a rash that does not disappear with pressure (the Glass Test)

Your child needs urgent help if any of these features are present - go to the nearest hospital emergency (A&E) department or phone 999.

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