All children vomit from time to time - here's how to tell if the cause is something serious.
What is vomiting?
Young babies regularly bring up a little of their milk. This is known as posseting and is nothing to be worried about as long as he is healthy, feeding well and gaining weight. But if he repeatedly brings up large amounts of milk he may be unwell. If your child vomits continuously it's important to tackle the cause to prevent him becoming dehydrated. The three conditions that can affect a baby's digestive system are gastroenteritis, reflux and pyloric stenosis.
Gastroenteritis
This stomach infection can be caused by a virus or bacteria. Symptoms include: vomiting and/or diarrhoea, griping stomach pains, refusing feeds or no appetite and fever. 'The most serious danger associated with gastroenteritis is dehydration, which can be critical if your young baby' says GP Dr Mina Goyal. Call your doctor if your baby is less than two months old or if he is showing signs of dehydration. Otherwise you can treat your baby at home for the first 24 hours. Start by giving him a rehydrating solution. If you're breastfeeding, continue to offer him feeds after he has had the rehydrating solution. If you're bottlefeeding, it's best to give him only rehydrating solution for the first 24 hours. But if milk is the only thing he'll take, dilute it to a quarter strength with cooled, boiled water. If he is on solids, offer him a little plain boiled rice and/or bananas plus fluids (as described for bottlefed babies), for the first 24 hours. After this, gradually reintroduce other foods, starting with pureed fruit and vegetables.
Reflux
This common condition is caused by a weakness in the entrance of your baby's stomach, which causes food or milk to pass back into the oesophagus - the tube leading from his throat to his stomach. It usually rights itself by the time your baby is one. Symptoms include persistent vomiting, regurgitating food or milk, crying, irritability and poor weight gain. If your baby has any of these symptoms, contact your GP. Your doctor may suggest certain measures to stop milk and food flowing back into the oesophagus, for example, encouraging your baby to sleep in his cot with his head raised, and sitting him up after feeds. If your baby is weaned, try:
* Adding less liquid to solid foods
* Offering him fluids little and often
Pyloric stenosis
In this condition, the outlet from your baby's stomach to his small intestine is constricted, so only tiny amounts of milk pass into the intestine while the rest is vomited back. Much less common than reflux, it appears in babies who are less than six weeks old. Symptoms include crying and fretfulness, forceful projectile vomiting, infrequently soiled nappies, weight loss, listlessness and dehydration. See your GP as soon as possible. If he or she suspects pyloric stenosis, your baby will be referred to hospital for an ultrasound scan to confirm this. 'If your baby has pyloric stenosis, he will probably be put on a drip to rehydrate him before having a simple operation to widen the outlet from the stomach to the small intestine,' explains Dr Goyal.
Is he dehydrated?
Persistent vomiting may cause dehydration, which can be serious in babies and young children. Contact your GP if your child has:
* Sunken eyes
* Sunken fontanelle
* Dry nappies
* Dark-coloured urine
* Loose, dry or flushed skin
* Furred tongue
* Drowsiness or listlessness
How can it be treated?
It's important to prevent your child from becoming dehydrated, especially if he also has a fever or diarrhoea. Don't force him to eat. You may find that before he feels well enough to eat he will probably be able to drink fluids. Encourage him to drink as much as possible, even if he only has a few sips at a time. If he brings up this too, let him go for an hour or two without food or fluids, not even water. When he has gone for several hours without vomiting and can hold down fluids, let him try a small portion of any food he fancies. Avoid milk, dairy products or foods with large amounts of insoluble fibre, such as raw fruits, vegetables and bran cereals, until his stomach is properly settled. Start him off on toast, porridge, bananas, apple-sauce or other cooked fruits, or a soft-boiled egg.
Alternative treatment
Herbs, such as camomile tea, can help to settle the stomach. Try the homeopathic remedy ipecac 6c for vomiting. Give it every hour, or every 15 minutes if the vomiting is severe, for up to ten doses. Chinese herbalism can sometimes help when vomiting is caused by a food blockage or a digestive weakness.
Emergency checklist
Contact your doctor immediately if he has any the following symptoms:
* He vomits after every feed for six hours
* His nappies are dry for three hours or more, or a he doesn't urinate for six hours
* He has vomited for 12 hours
* He is vomiting and has a stomach ache that has lasted for three hours
* He refuses drinks
* His lips and mouth are dry
* The vomit is greeny-yellow
* He has a high fever
* He has rash