Vomiting may be nature’s efficient way of clearing out our systems, but it’s always unpleasant and exhausting and if you were a mum-to-be who suffered from nausea during your pregnancy you’ll sympathise even more when your baby is sick.
Most babies spit-up, or sick-up from time to time. This possetting, or dribble of undigested food, is normal and nothing for mums to worry about. But if your baby vomits in large amounts, more often than usual, projectile vomits, or if her vomit is yellowish or greenish then it is time to see the doctor.
The concern is that your baby may throw up so frequently that she becomes dehydrated. Signs of dehydration include:
sunken eyes or doughy skin
dry skin or lips
a sunken fontanelle
discoloured hands and feet
strong yellow urine
fewer wet nappies than usual
If your baby has a spate of vomiting you can, and should, carry on breastfeeding because when a baby is sick, breast milk is better tolerated than any other fluid and vitamins and antibodies in your milk will help your baby fight her illness.
Try nursing her for shorter periods frequently throughout the day (small amounts of liquid are less likely to trigger vomiting than larger amounts).
What’s normal and what’s not?
It’s common for babies to vomit frequently in the early weeks as they adjust to feeding and their bodies develop. You can tell when your baby is vomiting rather than just possetting because there will be a lot more coming out, not just a few teaspoons trickling down her chin. It can be frightening for your baby, so she’s likely to be distressed.
What causes it?
Everything from car sickness to indigestion can cause your baby to be sick – even a prolonged bout of crying or coughing can trigger this reflex. So you may see quite a lot of vomiting in your baby’s first few years.
An attack of vomiting will generally subside six to 24 hours after it starts, without any particular treatment apart from a change in diet.
Vomiting can also be triggered by colds (usually from baby swallowing too much mucus), or an ear infection. As long as your baby seems otherwise healthy and continues to gain weight, there’s usually no need to worry.
When should I worry?
During your baby’s first few months, vomiting is usually caused by mild feeding problems, such as her tummy being too full. After the first few months, a sudden onset of vomiting is more likely to be caused by a stomach virus, such as gastroenteritis, which is often accompanied by diarrhoea.
Gastroenteritis is an infection of the gut that damages the inner lining of the intestine. The injured lining leaks fluid and allows food to pass through without absorbing any nutrients.
Good hygiene habits can help reduce the chance of gastroenteritis because the micro-organisms which cause it are usually passed from hand to mouth. So wash your hands thoroughly with soap after handling dirty nappies or using the toilet.
Once your child is a little older, vomiting could be a symptom of more serious illnesses. Call your doctor if you notice any of the following warning signs in your baby:
Refusal to feed.
Vomiting for more than 12 hours, or vomiting with great force.
A non-blanching rash, which is a rash that doesn’t fade when the skin is pressed.
Sleepiness or severe irritability.
A bulging fontanelle.
Shortness of breath.
A swollen tummy.
Blood or bile (a green substance) in the vomit (see below).
Persistent forceful vomiting in a newborn within half an hour of eating (see below).
What else should I look out for?
Blood or bile in the vomit – This sometimes happens when the force of regurgitation causes tiny tears in the blood vessels lining the food pipe (oesophagus). Your baby’s vomit may also be tinged with red if she has swallowed blood from a cut in her mouth or has had a recent nosebleed. While it may look alarming it is usually nothing to worry about.
However, you must call your doctor if your baby continues to have blood in her vomit or if the amount is increasing. The doctor will probably want to see a sample of the vomit if it contains blood or bile, so try to save some to take with you. Green bile can indicate that the intestines are blocked, a condition that needs immediate attention!
Persistent or forceful (projectile) vomiting in a newborn within half an hour of eating may be due to pyloric stenosis. This is a rare condition that is most likely to begin when a baby is a few weeks old, but could show up at any time before the age of four months.
Babies with this condition vomit when a muscle controlling the valve leading from the stomach into the intestines has thickened so much that it won’t open up enough to let food through. The problem is remedied with minor surgery, and it does require immediate medical attention.
How can I help her recover?
Keep her hydrated. When your baby vomits, she’s losing precious fluids and it is important to replace them. Your doctor will most likely prescribe an oral rehydration solution (ORS), to feed her a couple of times an hour, alongside her usual breastmilk and water.
Feed your weaned baby a bland diet for 24 hours (for example bananas, rice, toast). Don’t give her fruit juices or carbonated drinks.
Return to your routine. If your baby hasn’t vomited for 24 hours, you can begin moving back to her usual diet, but keep giving her plenty of fluids. Start with easy-to-digest foods such as cereal or yoghurts.
Sleep heals. Keep your baby quiet and help her to rest. Her stomach should empty into the intestines during sleep, relieving her need to vomit.
If your baby attends childcare or nursery, keep her at home until at least 48 hours after her last episode of vomiting.