Dr hive: infant vomitting

[busymama7]

I have a 4.5 month old fully breastfed baby. He has been projectile vomitting since Thursday night. At first I thought it was a bug but now I'm not so sure. He threw up all Thursday night and Friday then none at all Saturday then 5 am Sunday 9 pm Sunday and just now (9:30 pm Monday). He has not had a fever and except for Friday has had mostly normal diapers. Maybe a little less wet but I'm changing them as often. His poop is a little weird but not excessively so. Less quantity of poop probably but he is one of those that does a huge one every few days with smaller ones in between or none in between. He hasn't had a huge one in all these days but many smaller ones. Not diarrhea though.

 

He has always been a very very spitty baby but this is different. This is shoot across the room vomitt. It is always during a feed(lovely for me) or right after. I can sense it coming usually by the way he moves or his face.

 

I am at my wits end and will probably take him in tomorrow but I really hate to waste time if there isn't anything they can do. He is not dehydrated. I am watching very closely for that. He is very happy and does not act sick at all!

 

My husband thinks he is reacting to spicy food we are eating. I don't think it is anything all that spicy! Today was a soup with chicken and corn and salsa (mild) and beans. No kick at all. It could be some other allergen but would it have just started all the sudden? I have not eaten anything recently that I don't eat all the time. Our diet is pretty consistent.

 

I am in the middle of moving my family of ten out of the home we have been in for 12 years and into a temporary house while we search for a new one. This is a busy busy week and I really don't have time to take him to the doctor just to be told he is not dehydrated and who knows why he's throwing up. I already know that :). The only other thing I can find online is pyloric stenosis and he doesn't really seem to fit the signs for that. He holds down most of his feedings except for the normal small spit ups. And then the vomitting 1-2x in 24 hrs.

 

If it is just a bug and its taking awhile to get over it then I can keep doing what I'm doing as he really is fine. No signs of dehydration. He does not act sick though. At all.

 

Any thoughts?

[Deee]

I don't want to be alarmist and I'm not a doctor, but you need to go to the doctor as soon as possible. It could be pyloric stenosis, where the sphincter at the base of stomach fails to open. The stomach fills, cannot empty, and the only way out is the projectile vomit. While the condition is present from birth, it usually becomes problematic at around 4 months of age. You need to act fairly quickly: vomiting in young babies is serious. My son was investigated for pyloric stenosis, but was eventually diagnosed with severe reflux. I've got a really high vomit tolerance these days!

D

[happypamama]

If nobody else in the family has had a bug, I'd probably take him to the doctor, but I'd probably also wait a few more days.

 

If anyone else has had a stomach bug, it could just be that. Several of my children had a bug last spring; my older two threw up once or twice, the third one not at all, and the fourth one was about eight months old at the time and fully breastfed. He threw up a couple of times a day for a couple of days, but then he continue to throw up once or twice a day, usually at night, for about a week. It was weird that it lasted longer than it did for everyone else, but he was fine; I just watched him for dehydration and tried to offer nursings more often.

 

It could be a reaction to dairy or something else in your diet, not necessarily spicy food.

[magnificent_baby]

Projectile vomiting going on that long needs to be addressed as soon as possible. Please don't wait a few days. Hope it turns out to be nothing!

[ashfern]

My son had projectile vomiting and was eventually diagnosed with reflux. He also had an allergy to cow's milk which made it worse.

[stripe]

Can you call the doctor and at least speak to a nurse? I would be concerned by projectile vomiting.

[busymama7]

Thanks for all the replies. I just woke to him throwing up all over me again so we are just going in this morning. Hopefully it's nothing but just to be sure.

[busymama7]

Ok dr says his symptoms are not consistent with either a virus or pyloric stenosis. He thinks it is reflux turning more severe. He says it is unlikely to be my diet.

 

He gave me a scrip for zantac but wants me to feed him a bit of cereal to thicken his feeds :( first before meds. I am pretty opposed to this idea and told him I really couldn't use infant cereal. He suggested making my own which I can do and have done. But I normally don't even consider solids until 9-10 months. I am really struggling with this idea. :(

[anotherbrother]

I would think cereal would make reflux worse not better.

 

I have no advice about an alternative. Good luck, hope baby feels better soon.

[melissad2]

IME the Zantac just helps decrease the acidity making the reflux not as bothersome. It does not decrease spitting up. Prevacid reduces the production of acid in the stomach. I didn't have much success with Zantac for mine at all!

[busymama7]

I would think cereal would make reflux worse not better.

 

I have no advice about an alternative. Good luck, hope baby feels better soon.

 

That is my worry but I don't have an alternative either :(

[busymama7]

IME the Zantac just helps decrease the acidity making the reflux not as bothersome. It does not decrease spitting up. Prevacid reduces the production of acid in the stomach. I didn't have much success with Zantac for mine at all!

 

Did the Prevacid reduce the spitting up? Did you baby ever projectile?

[melissad2]

 

 

Did the Prevacid reduce the spitting up? Did you baby ever projectile?

It did help the projectile spitting up. My middle ds had reflux pretty bad and Prevacid saved my sanity.

[Ravin]

I would give the meds without cereal and see if it helps, while seeking alternative to premature introduction of solids.

 

 

[busymama7]

 

It did help the projectile spitting up. My middle ds had reflux pretty bad and Prevacid saved my sanity.

 

Did you ever tie it to anything in your diet? I'm conflicted because people are telling me it could be anything from tomatoes to chocolate to dairy. My dr said it would cause diarrhea if it was something I was eating. It's just so weird because it started all the sudden and is 1-2 times a day. And at the point that reflux should be getting better not worse?

[Mrs Mungo]

Do you have overactive let-down? That can get worse as baby nurses less frequently.

[busymama7]

I would give the meds without cereal and see if it helps, while seeking alternative to premature introduction of solids.

 

 

So I really can't decide if a teaspoon of real food a few times a day is really worse than a pharmaceutical. So I tried some homemade oatmeal baby cereal. He still has the tongue thrust thing going on and most of it ended up all over us. What he did manage to "swallow" he just gagged on. I just kept thinking this is so dumb and why I don't do spoon feeding of four month olds.

[busymama7]

Do you have overactive let-down? That can get worse as baby nurses less frequently.

 

 

Yes I have always struggled with that. But much less with my last few babies because i think my body finally figured out i was only feeding one :) and my supply is more regulated. And this baby really wants both sides at a feeding and had been taking that just fine for a few months. Would i go back to block feeding?

[Mrs Mungo]

Yes I have always struggled with that. But much less with my last few babies because i think my body finally figured out i was only feeding one :) and my supply is more regulated. And this baby really wants both sides at a feeding and had been taking that just fine for a few months. Would i go back to block feeding?

 

 

If baby wants both sides and is gaining well, then I would try hand-expressing a little before a feed before going back to block feeding. I had this problem with my eldest and she ate like this "gulpgulpgulpgulpgulp *projectile vomit* gulpgulpgulpgulp *projectile vomit*. It would just repeat until everything calmed down enough for her not to have to gulp. Hand-expressing before feeds helped a lot.

[hmvaughan4]

Both of my boys had reflux and were on meds. DS3 was really bad, but it was made worse by a milk allergy. Once we fixed that, the reflux was reduced greatly.

[happypamama]

I would give the meds without cereal and see if it helps, while seeking alternative to premature introduction of solids.

 

That's what I would do as well, and I'd start cutting things out from my diet. Dairy would be the first thing I'd cut out, and it can take two weeks to clear it from your system; it also hides under lots of names.

[happypamama]

Also, my spitty (not vomiting, just spitty) babies were very spitty around the four-month mark; I think it's because they start taking in more at a time, and they also realize that it tastes good and feels good, and they don't always want to quit nursing. ;) Have you tried burping him in the middle of a nursing session, and/or block feeding? They may help get the milk to stay down.

[busymama7]

 

 

That's what I would do as well, and I'd start cutting things out from my diet. Dairy would be the first thing I'd cut out, and it can take two weeks to clear it from your system; it also hides under lots of names.

 

I am always a millimeter away from a break down anyways and the thought if this is pushing me over :(. I know all about how difficult it is to remove dairy. I've done it before. And now I just want to cry. In fact, I just might.

 

I still think its weird to come on so suddenly.

[busymama7]

Also, my spitty (not vomiting, just spitty) babies were very spitty around the four-month mark; I think it's because they start taking in more at a time, and they also realize that it tastes good and feels good, and they don't always want to quit nursing. ;) Have you tried burping him in the middle of a nursing session, and/or block feeding? They may help get the milk to stay down.

 

This kinda makes sense. I do burp him between sides but almost every time he has thrown up it has been while or just after nursing to sleep or back to sleep. Maybe it's just more milk than he needs or can handle.

[happypamama]

Let yourself cry! A good cry is often cathartic. The idea of removing dairy makes me panic too, and I know I'd have to have a good sob first before I could get moving on new diet plans.

 

I know it's hard if he's sleeping, but could you try keeping him upright for a bit after feeding him? If it's happening while he's lying down, helping him stay upright might help keep the milk in his stomach. I would definitely try stopping him in the middle of a side to burp him too, or massage his tummy while he's nursing -- that might get the air bubbles moving in the opposite direction so they come out as gas instead of burps.

[busymama7]

Let yourself cry! A good cry is often cathartic. The idea of removing dairy makes me panic too, and I know I'd have to have a good sob first before I could get moving on new diet plans.

 

I know it's hard if he's sleeping, but could you try keeping him upright for a bit after feeding him? If it's happening while he's lying down, helping him stay upright might help keep the milk in his stomach. I would definitely try stopping him in the middle of a side to burp him too, or massage his tummy while he's nursing -- that might get the air bubbles moving in the opposite direction so they come out as gas instead of burps.

 

 

Last night he nursed to sleep and was resting up on my shoulder when he woke up and threw up. Maybe 10-15 mins after finishing.

[busymama7]

 

 

If baby wants both sides and is gaining well, then I would try hand-expressing a little before a feed before going back to block feeding. I had this problem with my eldest and she ate like this "gulpgulpgulpgulpgulp *projectile vomit* gulpgulpgulpgulp *projectile vomit*. It would just repeat until everything calmed down enough for her not to have to gulp. Hand-expressing before feeds helped a lot.

 

 

I am fairly stinky at hand expressing and don't own a pump. I can't even figure out the logistics of this. I am away from home A LOT. I don't know where I would express. I mean I'm really comfortable nursing wherever I am. Not so much expressing ;)

[Deee]

You need to see another doctor. A doctors opinion is not enough to rule out pyloric stenosis. The recent increase in projectile vomiting is a big indicator. I get that the medical system in the US is expensive, but your baby needs some additional testing, including a scan to rule out PS and perhaps a barium swallow to confirm reflex (my son had both tests). Zantac will make the vomit less acidic and therefore reduce any burning of the oesophagus caused by repeated vomiting. It helps about 50% of cases. It was a God send for us because it settled DS, stopped him screaming all day and allowed him to sleep. Zantac won't stop the reflux. You can buy thickening agents that you mix with expressed breast milk to help it stay down. This didn't work for us. We introduced solids (rice cereal and stewed pears) at 3.5 months. I was very reluctant because we have lots of non-food allergies in the family, but there have been no ill effects, and frankly, DS was so thin we didn't have much choice. Other things that helped included sitting him up straight after feeds, chocking up the end of his bed, no bouncing, giggling, excitement after eating, no tummy time, and sleeping on his side to reduce the risk of choking. We all survived the first year and he's now a strapping 12 year old, 5'8 and still skinny. He eats endlessly and can vomit on demand (charming boy!).

 

Happy to discuss this via PM if you want to

D

[ktgrok]

Ok dr says his symptoms are not consistent with either a virus or pyloric stenosis. He thinks it is reflux turning more severe. He says it is unlikely to be my diet.

 

He gave me a scrip for zantac but wants me to feed him a bit of cereal to thicken his feeds :( first before meds. I am pretty opposed to this idea and told him I really couldn't use infant cereal. He suggested making my own which I can do and have done. But I normally don't even consider solids until 9-10 months. I am really struggling with this idea. :(

 

 

That's old school advice. Thickening his food won't really help..it all gets liquidy once it is in the stomach. And grains can CAUSE reflux for heaven's sake. Plus, it will change the gut flora, set him up for future allergies, etc. No way. Not with a breastfed infant.

[busymama7]

You need to see another doctor. A doctors opinion is not enough to rule out pyloric stenosis. The recent increase in projectile vomiting is a big indicator. I get that the medical system in the US is expensive, but your baby needs some additional testing, including a scan to rule out PS and perhaps a barium swallow to confirm reflex (my son had both tests). Zantac will make the vomit less acidic and therefore reduce any burning of the oesophagus caused by repeated vomiting. It helps about 50% of cases. It was a God send for us because it settled DS, stopped him screaming all day and allowed him to sleep. Zantac won't stop the reflux. You can buy thickening agents that you mix with expressed breast milk to help it stay down. This didn't work for us. We introduced solids (rice cereal and stewed pears) at 3.5 months. I was very reluctant because we have lots of non-food allergies in the family, but there have been no ill effects, and frankly, DS was so thin we didn't have much choice. Other things that helped included sitting him up straight after feeds, chocking up the end of his bed, no bouncing, giggling, excitement after eating, no tummy time, and sleeping on his side to reduce the risk of choking. We all survived the first year and he's now a strapping 12 year old, 5'8 and still skinny. He eats endlessly and can vomit on demand (charming boy!).

 

Happy to discuss this via PM if you want to

D

 

 

My baby is FAT and happy. He was 18.3 pounds this am. He is so easy going its almost unbelievable. It's the reason I never took him in for the reflux. It was my understanding that it was a laundry problem in the absence of gain issues or a miserable baby.

 

What you mention about keeping him upright and such we have done to manage the reflux up to this point and it does help. This vomitting thing is something else entirely. He either vomits before he is done or right after.

 

I am fine with taking him in again but figured I should try the dr suggestions first. Plus he is peeing and just had a big poo and is keeping down the majority of his feeds so it is hard to imagine its something as serious as pyloric stenosis.

[melissad2]

 

 

Did you ever tie it to anything in your diet? I'm conflicted because people are telling me it could be anything from tomatoes to chocolate to dairy. My dr said it would cause diarrhea if it was something I was eating. It's just so weird because it started all the sudden and is 1-2 times a day. And at the point that reflux should be getting better not worse?

 

 

The only thing in my diet that seemed to bother him was broccoli and beans. I did have over active letdown so I did the block feeding thing which also helped!

[busymama7]

 

 

 

That's old school advice. Thickening his food won't really help..it all gets liquidy once it is in the stomach. And grains can CAUSE reflux for heaven's sake. Plus, it will change the gut flora, set him up for future allergies, etc. No way. Not with a breastfed infant.

 

 

Ya. That's what I thought. But I don't know what else to do. If its not hurting him I guess I can just deal with the inconvenience of him vomitting all over. But the dr did say there are concerns with untreated reflux also. So do the meds?

 

Why the heck did it all of the sudden with no warning and no changes get so much worse? It's not like he vomitted occasionally before and no is doing it more often. He has never done more than a spit up. But he did spit up after every feeding.

 

This just makes no sense to me. :(

[Deee]

It's this rapid onset that makes me think its pyloric stenosis. If he's fat and happy that's good - it will buy you some time to figure out what's going on.

D

[zoobie]

A friend of mine got tons of great info from here: http://www.infantreflux.org/

 

Hope you figure it out soon.

[Plateau Mama]

Has this child always been more spit up than normal? If so I'd lean towards reflux. It is common for more projectile spit up/vomit around 4 months. It's because they are staring to be more a active (rolling, awake more, etc).

 

My youngest always spit up tons as an infant. Around 4 months old the spit up started flying.

[busymama7]

It's this rapid onset that makes me think its pyloric stenosis. If he's fat and happy that's good - it will buy you some time to figure out what's going on.

D

 

Me too. I was actually surprised when the doctor said it wasn't. I do feel like it is not an urgent situation so I will just keep a close eye on it for now.

[busymama7]

A friend of mine got tons of great info from here: http://www.infantreflux.org/

 

Hope you figure it out soon.

 

Thanks! Going to spend some time there now :)

[busymama7]

Has this child always been more spit up than normal? If so I'd lean towards reflux. It is common for more projectile spit up/vomit around 4 months. It's because they are staring to be more a active (rolling, awake more, etc).

 

My youngest always spit up tons as an infant. Around 4 months old the spit up started flying.

 

Ok that's good to know! He has been very spitty all along. With your youngest when it started flying at 4 months was it entire feedings? I know they always says it looks like more than it is but this seriously everything in his stomach and he usually heaves 2-3 times right after each other to get it all out. It's not like normal spit up with some force behind it. Also he is always being held still when it happens. Hmmm. Thanks :)

[Mandamom]

Ya. That's what I thought. But I don't know what else to do. If its not hurting him I guess I can just deal with the inconvenience of him vomitting all over. But the dr did say there are concerns with untreated reflux also. So do the meds?

 

Why the heck did it all of the sudden with no warning and no changes get so much worse? It's not like he vomitted occasionally before and no is doing it more often. He has never done more than a spit up. But he did spit up after every feeding.

 

This just makes no sense to me. :(

 

When my son developed reflux at around 3 months or so there was little warning. It seemed like one day he was fine and the next day he started reacting. By the next day I removed dairy from my diet and within 3 days he was back to normal.

 

I mentioned it to my ped (not that I was going to change what I was doing) and her comment: "if what you are doing is working, keep doing it". Apparently, 30 years ago, she took her own kids off of dairy due to undiagnosed food reactions and got a lot of resistance.

 

i hope you figure it out soon.

[Plateau Mama]

 

 

Ok that's good to know! He has been very spitty all along. With your youngest when it started flying at 4 months was it entire feedings? I know they always says it looks like more than it is but this seriously everything in his stomach and he usually heaves 2-3 times right after each other to get it all out. It's not like normal spit up with some force behind it. Also he is always being held still when it happens. Hmmm. Thanks :)

 

 

I don't think it was entire feelings, but it was 12 years ago. I just remember ALWAYS smelling like puke. ALWAYS. My dr had her on Zantac and something else that was over the counter. I can't remember what it was.

[Deee]

Watch his tummy after a feed. Can you see waves of muscle activity?

D

[busymama7]

I wanted to give an update now that life has settled down and bit and we got moved :)

 

My baby is no longer vomiting at all. The early morning one continued daily then every other day but he hasn't in several days now. I did not give him solids or meds as I just couldn't bring myself to. What I did was give him infant probiotics.

 

The reason I thought of this was becaus I had heard it could help with reflux and he was having weird sticky, stinky poos. I had seen this type of poo before so I thought hard and remembered it was with one of my daughters when she had systemic yeast as a newborn.

 

I started with the probiotics and not only is he not vomitting but his poops are back to normal and he is barely even spitting up. He still does a bit but much less frequently and less quantity too.

 

I actually think now that he did have a virus initially and it messed up his system and made his reflux worse.

 

Anyways thanks for all your ideas and support. I am happy to have everything looking so good for him especially after a crazy crazy move and stressful week and VERY happy that I didn't have to eliminate any food ;)

[melissad2]

:party:

 

Good news!

[fairfarmhand]

Yay!