1 year old spitting up curdled milk: The request could not be satisfied
How to Help a Child Who Is Throwing Up
Babies and toddlers get sick quite a bit during the first few years of life. While it might seem startling to see your baby throw up for the first time, it’s actually quite common and often nothing to worry about.
In many cases, baby vomiting goes away on its own with a little TLC from you. But sometimes a toddler or baby throwing up can be a sign of something more serious that warrants a check-in with your pediatrician.
If your baby or toddler is vomiting, read on for the potential causes and when your child might need treatment.
Vomiting vs. spit up: What’s the difference?
During the first year of life, it’s usually very normal for babies to spit up frequently. Newborns have an immature sphincter between the esophagus and stomach, which allows food to easily come back up. In older babies, a little milk can make its way out when burping. Vomiting, on the other hand, is more forceful and may be caused by an underlying infection or condition that may require medical attention.
If your baby has no other symptoms and the discharge looks cheesy, it’s probably ordinary spit up. Spitting up should decrease with age. Be sure to talk to your doctor if your baby spits up every time she eats and isn’t gaining weight.
If your baby or toddler is vomiting and has other symptoms, such as fussiness after feedings, rashes or diarrhea, let your doctor know.
Why do babies and toddlers throw up?
Babies and toddlers may throw up for a number of reasons.
In the first few months of life, vomiting could be due to GERD (gastroesophageal reflux disease). Projectile vomiting in infants may be due to hypertrophic pyloric stenosis, which requires immediate medical attention. Later on, baby vomiting may be linked to motion sickness, food allergies, a gastrointestinal virus or food poisoning. Rarely, vomiting may be due to appendicitis, which is an emergency.
Read on to narrow down the potential cause for your toddler or baby’s vomiting:
All babies spit up to some extent, but a baby repeatedly coughing and vomiting is a common sign of GERD. In babies with GERD, food backs up from the stomach into the esophagus because the esophageal muscle isn’t strong enough to keep it down, causing complications from acid reflux.
If your baby’s spit up gets worse with time and she has other symptoms, your doctor may diagnose GERD.
In addition to baby vomiting, other common GERD symptoms include:
- Refusal to eat
- Crying or arching the back during feedings, which may mean your baby is in pain
- Fussiness after feedings
- Blood or green color in the spit up
See your pediatrician if you think your baby has GERD. A few strategies may help your baby feel better, including feeding smaller amounts of food more frequently, switching formula or bottles, and keeping baby upright for 20 to 30 minutes after feedings. Your doctor may also recommend medications that safely treat the symptoms of GERD.
Motion sickness happens when you’re moving and the signals from your inner ears, eyes, muscles and joints don’t match up with how your brain processes movement. Your child might vomit when she’s in a car or boat or after she going on a playground swing or theme-park ride. Motion sickness tends to be more common in children and usually comes on suddenly.
Other symptoms of motion sickness beyond vomiting in children may include:
- Pale or blue skin or mucous membranes
- Lack of interest in food
There’s no need to call your doctor if your child has occasional motion sickness; try to avoid giving your child a heavy meal just before car rides and offer the window seat. If motion sickness becomes a problem, consult your doctor for advice.
Food allergies or intolerance
Your baby may have food allergies or a food intolerance if she vomits almost immediately after eating. About 90 percent of all food allergies are caused by peanuts, tree nuts, milk, eggs, soy and wheat. (Keep in mind, that doesn’t mean you shouldn’t feed your baby these foods; in fact, doctors usually recommend starting them sooner to prevent food allergies.)
Other symptoms of a food allergy or intolerance in babies and toddlers may include:
- Skin rashes
- Swelling of the lips or tongue
- Watery eyes
More serious symptoms of a food allergy include pale or blue skin, difficulty breathing or loss of consciousness. If you spot any of these symptoms, call 911 immediately.
Otherwise, schedule an appointment with your pediatrician if you notice these symptoms after your child eats. Your child’s doctor will diagnose a food allergy with a blood test or a skin-prick test.
A gastrointestinal virus
Gastrointestinal viruses, like rotavirus, are common and spread quickly among children in day care and other group settings. Your baby or toddler may have a gastrointestinal virus if she’s vomiting, and has other symptoms such as:
- Stomach pain
Doctors usually recommend carefully watching your child and giving her bland foods (if your baby is eating solids) and plenty to drink. But be sure to call your doctor right away if your baby or toddler has signs of dehydration (more on that below).
Foodborne bacteria like salmonella or E. coli can cause gastrointestinal symptoms including vomiting. Food poisoning is a prime suspect if the whole family gets sick with similar symptoms around the same time — it’s likely due to something everyone ate. Symptoms caused by the most common food poisoning germs can begin anywhere from six hours to six or seven days after exposure.
Other symptoms of food poisoning may include:
- Stomach pain
Most of the time food poisoning goes away on its own in a few days, although occasionally antibiotics are in order. (See below for food poisoning symptoms that deserve a call to the doctor.) In the meantime, ask your pediatrician how to keep your child comfortable and hydrated, and ask whether your child should drink an oral rehydration solution (like Pedialyte).
Appendicitis is a relatively common but serious infection that’s most common in kids 10 years and younger but very rare in children under 3. The appendix becomes blocked, allowing bacteria to grow and causing inflammation and abdominal pain. It’s important to get your child checked out immediately, as the appendix can rupture and spill its contents into the abdominal cavity — which is a medical emergency.
In addition to vomiting, symptoms of appendicitis include:
- Stomach pain that’s usually around the belly button and may move to the lower right part of the belly; it might come and go and get increasingly intense
- Loss of appetite
- Low fever
- Swollen belly
If you suspect your little one has appendicitis, call her pediatrician immediately or head to the ER. Doctors may run any number of tests, including CT scans or blood tests, to diagnose appendicitis. If your child does have appendicitis, her appendix will need to be removed — usually with a minimally invasive surgery that typically takes less than an hour.
Pyloric stenosis is a narrowing of the pyloric sphincter muscle (a muscle located between the stomach and small intestine) that keeps food from passing into the small intestine. The condition usually begins when your infant is between 2 weeks and 2 months old; your doctor may suspect pyloric stenosis if your baby forcefully vomits after feeding. The following symptoms warrant a check-in with your doctor:
- Baby projectile vomiting (very forceful vomiting) within 30 minutes of feeding
- Bloody vomit
- Constant hunger (because your baby isn’t digesting enough food)
- Weight loss
- Wave-like contractions (known as peristalsis) across your baby’s tummy after eating
A stomach ultrasound, X-rays and a blood test are used to diagnose the condition; it’s cured with surgery.
How to help your baby or toddler after they throw up
If your baby or toddler is vomiting, trust your instincts and don’t hesitate to call the doctor if something feels off. Fortunately, vomiting often goes away on its own, and there’s usually no need to worry if your child seems to be her usual self and is well enough to eat and play.
If you suspect a stomach bug, it’s a good idea to keep your child out of day care for at least 48 hours after the last time she vomited or had diarrhea.
Since vomiting can cause dehydration, your goal is to keep your baby or toddler hydrated. Give your child small sips of water or broth (avoid sugary drinks like juice until your child is feeling better). If you’re worried your baby or toddler might be dehydrated, ask your doctor about giving her an oral rehydration solution like Pedialyte. If she’s eating solids and still has an appetite, feed her the same foods she usually enjoys.
When should you seek treatment for a baby or toddler who is vomiting?
Vomiting can sometimes be serious. If you’re concerned about your baby’s vomiting, it’s always a good idea to check in with your doctor.
Call your doctor or head to the ER if your child:
- Vomits repeatedly and can’t keep down fluids
- Continues vomiting for more than 24 hours
- Has signs of dehydration, including fewer diapers (or less frequent trips to the potty), darker urine, sunken eyes or fontanel, tearless crying or listlessness
- Has vomit that’s green or bloody
- Is floppy or seems less responsive
- Is extremely irritable
- Has severe abdominal pain
- Is forcefully or strenuously vomiting
- Has a hard or bloated belly
- Has swelling or pain in the scrotum (in boys)
- Has pale or blue skin, difficulty breathing or loss of consciousness after eating (which may signal a food allergy)
You should also call the pediatrician’s office right away if you suspect food poisoning and your child has:
- Been vomiting for more than 12 hours
- Diarrhea that doesn’t get better in two days
- A fever of 100. 4° F
- Feces that are bloody or black
- Bloody vomit
- Severe stomach pain
- Signs of dehydration
Spitting Up in Babies – familydoctor.org
The medical term for “spitting up” is gastroesophageal reflux. It happens when milk or solid food in the stomach comes back up into your baby’s esophagus. The esophagus is the tube that connects the mouth and the stomach.
Spitting up isn’t the same as vomiting. Babies usually don’t notice when they spit up. Vomiting is forceful and painful.
Spitting up is common for babies because their digestive system isn’t fully developed yet. It most often occurs when they’ve eaten too much or swallowed air while feeding. Spitting up is common for most babies until about the time they can eat solid foods (around 6 months to 1 year of age).
These symptoms can be scary, especially for first time parents. In most cases, simple spitting up can be normal and does not usually mean the baby has an allergy or intolerance. Slowing down or altering feeding often improves these symptoms.
Path to well being
Each baby is different in how often and how much they spit up. There are things you can do to help prevent or ease spitting up.
Feed your baby in an upright position. Try to feed in a calm setting so your baby isn’t anxious or distracted. If you breastfeed, burp your baby after each feeding or when you change breasts. If you bottle-feed, burp your baby every 3 to 5 minutes. Make sure the hole in the bottle’s nipple is the right size. If it’s too large, milk can come out too fast. If it’s too small, air bubbles can form.
After a feeding, let your baby’s stomach settle. Continue to hold them in an upright position for 20 to 30 minutes. Avoid laying them down or moving them around too much.
Try not to overfeed your baby. Some babies spit up less if you give them less milk at each feeding but feed them more often.
Things to consider
Spitting up is messy, but it’s normal during your baby’s early months. It rarely involves choking, coughing, or pain.
However, you should contact your doctor if you notice your baby:
- Is not gaining weight.
- Spits up a large amount of milk (more than 1 or 2 tablespoons).
- Spits up or vomits forcefully.
- Has fewer wet diapers than normal.
- Seems very tired or sluggish.
- Spits up green or brown liquid.
See your doctor if your baby has any of the symptoms listed above. First, your doctor will check to see if your baby is healthy and growing well. Next, he or she will check to see if your baby has breathing problems. If your doctor thinks your baby is fine, nothing else needs to be done.
If your baby’s reflux is causing health problems, your doctor may prescribe medicine. This medicine is the same one used for heartburn in adults. The doctor may do other tests if your baby still doesn’t gain weight or develops other symptoms.
Questions to ask your doctor
- Is my baby’s spitting up normal or do they have a reflux problem?
- What is causing my baby to spit up and is there anything I can do to prevent it?
- Is my baby spitting up because of a reaction to something they or I ate?
- At what age can I expect my baby to stop spitting up?
- Is my baby at risk for any health problems?
National Institutes of Health, MedlinePlus: Spitting Up – Self-Care
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
My baby frequently vomits. What’s causing this?
There are lots of reasons why your baby may be vomiting. It’s difficult as a parent to work out what’s wrong, because he can’t tell you. Here are reasons why babies get sick, starting with the most common:
Most babies vomit small amounts from time to time, and bring up some milk when they burp. This is reflux, also called possetting or spitting up, and is normal if your baby is under a year old.
The medical name for reflux is gastro-oesophageal reflux (GOR). Babies get reflux because the muscular valve at the end of their food pipe, which keeps food in the stomach, is still developing. This means that when your baby’s tummy is full, milk and stomach acid can flow back up his food pipe.
Your baby may hiccup, cough or splutter as he brings up milk. He may also be wheezy after a milky burp. As long as your baby is otherwise well, and is putting on weight, reflux is nothing to worry about.
However, more severe and persistent reflux, called gastro-oesophageal reflux disease (GORD), can cause your baby to be sick more often after feeding. He may cry and cough a lot too. Only a few babies have GORD, and it usually affects premature babies more than full-term babies.
If your baby isn’t feeding well or is being sick a lot, see your doctor.
An illness or infection
Your baby may be vomiting because he has an infection. In your baby’s early years, his immune system is still developing, so he’s likely to pick up lots of infections. Each time he catches a bug, his immune system will fight it and get stronger.
Nearly all children catch a tummy bug (gastroenteritis) before they’re five years old, so your baby is likely to be affected at some point. If he has gastroenteritis, he’ll have diarrhoea as well as vomiting.
Take your baby to the doctor if he’s less than six months old. Otherwise, you can care for him at home. Encourage him to have plenty to drink, his usual milk, or sips of water, so he doesn’t get dehydrated. If you’re worried that he’s not having enough to drink, or he has a fever, see your doctor.
The serious infection meningitis can cause vomiting. Thankfully, meningitis is rare, but it needs immediate treatment to prevent it from becoming life-threatening. Call an ambulance if your baby has meningitis symptoms. Learn what meningitis symptoms look like.
Other, more common, infections can cause vomiting, including:
Take your baby to the doctor if you think he has a UTI. With an ear infection, you can wait 24 hours to see if he gets better before seeking medical advice.
Cow’s milk protein allergy
If your baby’s allergic to cow’s milk, it means his immune system is sensitive to the proteins in dairy produce. This is different from cow’s milk intolerance, which is a reaction to lactose, the natural sugar in milk. Lactose intolerance is rare in babies, however some temporarily become intolerant to lactose after a tummy bug.
Many formula milks contain cow’s milk protein. Proteins also make their way into your breastmilk in tiny amounts if you drink milk or eat dairy products, such as cheese and yoghurt. CPMA is more common in formula-fed babies than in breastfed babies.
If your baby has CPMA, he may bring up milk after feeding. It can be difficult to tell the difference between this and reflux. But if your baby has CMPA, he may also have:
If you’re worried that your baby has problems with cow’s milk, see your doctor before making any changes to your diet.
Pyloric stenosis is a rare condition that causes vomiting. It happens because the muscle controlling the valve leading from the stomach into the intestines has thickened. This means your baby’s milk feed will not pass through the valve at the bottom of his stomach into his intestines. Instead, milk stays in his stomach or he regurgitates it into his food pipe.
Pyloric stenosis is most likely to begin when your baby is about six weeks old. At first, he’ll start to bring up small amounts of milk after a feed. This will get worse and he will begin to projectile vomit. The milk he brings up may be curdled and yellow.
Boys are more likely to get pyloric stenosis than girls. Pyloric stenosis always needs correcting with minor surgery. See your doctor if you think your baby has pyloric stenosis, as it needs swift treatment to make sure your baby stays hydrated and well-fed.
Learn more in our article: Vomiting: what’s normal and what’s not.
Last reviewed: October 2018
Why Babies Spit Up – HealthyChildren.org
All babies spit up― especially after gulping down air with breastmilk or formula. When the stomach is full or a baby’s position suddenly changed after a feeding, you’d better have a cloth handy. The stomach contents can force the sphincter open and flood back up the esophagus.
Some babies spit up more than others. So, what can you do―if anything―to reduce the amount? How do you know if your baby’s symptoms are part of a larger problem?
Here are some answers for the American Academy of Pediatrics (AAP).
Common Parent Concerns About Spit Up
My baby spits up a little after most feedings.
- Possible cause: Gastroesophageal reflux (normal if mild)
- Action to take: None. The spitting up will grow less frequent and stop as your baby’s muscles mature. It often just takes time.
My baby gulps her feedings and seems to have a lot of gas.
- Possible cause: Aerophagia (swallowing more air than usual)
- Action to take: Make sure your baby is positioned properly.
My baby spits up when you bounce him or play after meals.
- Possible cause: Overstimulation
- Action to take: Keep mealtimes calm. Limit active play for about 20 minutes afterward.
My baby’s spitting up has changed to vomiting with muscle contractions that occur after every feeding. The vomit shoots out with force.
- Possible cause: Pyloric stenosis or another health problem that requires diagnosis and treatment.
- Action to take: Call you pediatrician right away so he or she can examine your baby.
I found blood in my baby’s spit-up or vomit.
- Possible cause: Esophagitis or another health problem that requires diagnosis and treatment.
- Action to take: Call you pediatrician right away so he or she can examine your baby.
Remedies for Spitty Babies
Regardless of whether or not your baby’s spit up warrants watchful waiting or medical intervention, there are some simple feeding suggestions that can help you deal with the situation at hand.
Here are 5 tips to reduce your baby’s spit up:
Avoid overfeeding. Like a gas tank, fill baby’s stomach it too full (or too fast) and it’s going to spurt right back out at you. To help reduce the likelihood of overfeeding, feed your baby smaller amounts more frequently.
Burp your baby more frequently. Extra gas in your baby’s stomach has a way of stirring up trouble. As gas bubbles escape, they have an annoying tendency to bring the rest of the stomach’s contents up with them. To minimize the chances of this happening, burp not only after, but also during meals.
Limit active play after meals and hold your baby upright. Pressing on a baby’s belly right after eating can up the odds that anything in his stomach will be forced into action. While tummy time is important for babies, postponing it for a while after meals can serve as an easy and effective avoidance technique.
Consider the formula. If your baby is formula feeding, there’s a possibility that his formula could be contributing to his spitting up. While some babies simply seem to fare better with one formula over another without having a true allergy or intolerance, an estimated 5% of babies are genuinely unable to handle the proteins found in milk or soy formula―a condition called milk-soy protein intolerance (MSPI). In either case, spitting up may serve as one of several cues your baby may give you that it’s time to discuss alternative formulas with your pediatrician. If your baby does have a true intolerance, a 1- or 2-week trial of hypoallergenic (hydrolyzed) formula designed to be better tolerated might be in store.
Try a little oatmeal. Giving babies cereal before 6 months is generally not recommended—with one possible exception. Babies and children with dysphagia or reflux, for example, may need their food to be thicker in order to swallow safely or reduce reflux. In response to concerns over arsenic in rice, the American Academy of Pediatrics (AAP) now recommends parents of children with these conditions use of oatmeal instead of rice cereal. See Oatmeal: The Safer Alternative for Infants & Children Who Need Thicker Food for more information.
The best way to reduce spit up is to feed your baby before he or she gets very hungry. Gently burp your baby when he or she takes breaks during feedings. Limit active play after meals and hold your baby in an upright position for at least 20 minutes. Always closely supervise your baby during this time.
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
Baby Spit Up Through the Nose (What is Normal?)
As the mother of a newborn or infant, you’ve probably seen your baby spit up more than once. Possibly even seen the milk come through your baby’s nose.
It can be quite frightening watching all that milk or formula make a reappearance, especially when it pours through the nose. It can make your little one upset but rest assured it’s a regular and natural occurrence.
Babies spit-up. A lot. To ease your mind, we’re here to discuss why it happens and how you can reduce the chances of it happening again.
Spit up Through the Nose. Is It Normal?
Reflux in infants is when the milk comes back up from the baby’s stomach and out the mouth or nose. It usually isn’t a serious problem, and it can happen in healthy babies several times per day, though it’s less common after 18 months (1).
The natural reflex that pushes the milk back up is something your baby has no control over. The nose and throat are connected (2), and if spit-up happens quickly, it can be projectile and take you by surprise.
Several things may cause your baby to spit up frequently:
- Stomach valve: A sphincter muscle connects your baby’s stomach and esophagus. This muscle, the lower esophageal sphincter, is immature in newborns and sometimes allows food to escape into the esophagus (3).
- Distractions: When your baby gets distracted while feeding, the suck-swallow reflex can be disrupted. Large amounts of milk may be swallowed, causing slight choking, sending milk back out the nose.
- Swallowing air: If your baby is really hungry, he or she might feed in a rushed, gulping manner. This can cause them to ingest air as well. The air can then return later, bringing the milk with it.
- Coughing or sneezing: Your baby has little control over their body when newborn (4). The simple act of sneezing or coughing can cause milk to come back up the esophagus.
Spit-up Versus Vomit
Spit-up is normal and happens often, but it is less severe than vomiting. Vomiting is the forceful expulsion of the stomach’s contents (5). Spit-up is an easy flow, like the milk that comes out with a burp.
Many things can trigger the part of the brain that stimulates the reflex action of vomiting. They include:
- The nerves in the stomach or intestine reacting to inflammation or irritation due to an infection or a blockage.
- Chemicals that are present in the blood, likely from drugs or poison.
- Motion sickness that is triggered by the middle ear.
Your baby may occasionally vomit due to rotavirus or a mild stomach infection (6). However, it shouldn’t be a regular occurrence. If it doesn’t pass quickly and your child shows signs of illness, we recommend contacting your healthcare provider.
How Can I Reduce How Often My Baby Spits Up?
Let’s face it, spit-up isn’t a pleasant part of child-rearing. It stains clothes, and your blankets will require frequent washes and changes. Plus, if your baby is on formula, it doesn’t exactly smell great.
There’s good news, though. Here are a few things that you can do to reduce the chances of frequent spit up from your little one:
- Try to feed your baby on time as much as possible: If your baby is overly hungry, they may gulp and swallow air, increasing the chance for spit up later on.
- If your baby is bottle-fed, make sure that the hole on the nipple isn’t too large: A larger nipple hole may cause your baby to get too much milk too quickly.
- Feed your baby in a room with minimal distractions: A nice quiet spot will keep your baby focused on eating instead of what is going on around them. This may be the most difficult thing to fix if you have other children to care for.
- Finally, don’t overdo the feeding: If your baby is acting full, even if they’ve eaten less than usual, trust their instincts (7). Don’t try to force them to eat more than they want or need.
- Immediately after your baby is done feeding, burp them: You can reduce a lot of spit-up by simply making sure your baby has been properly burped.
- Try to keep your baby upright for a few minutes: This will allow the milk to flow down into the stomach and not be left in the esophagus.
- If your baby falls asleep, put them on their back: Your baby will automatically swallow or cough out any milk in their throat. Sleeping on the back will help them clear the fluids, should they spit up in their sleep (8).
- Refrain from putting tight clothing on your baby after feeding: You’ll want to avoid putting pressure on the stomach. This can include pulling the diaper on too tight.
When to Call Your Doctor
Spitting up is a bit bothersome in general, and spitting up through the nose, in particular, may freak you out. Try to keep in mind that it’s completely natural. However, there are a few symptoms that you may want to discuss with your doctor, should they occur:
At the End of the Day
Spitting up, even out of the nose, is a normal part of your baby’s development. So, as long as they’re feeding well, gaining weight, and aren’t overly fussy, things are probably just fine.
Taking precautions like burping, holding your baby upright, and not overfeeding, will minimize as much of the spit up as possible. If concerned, be sure to contact your baby’s pediatrician or doctor.
Spitting Up & Reflux in the Breastfed Baby • KellyMom.com
By Kelly Bonyata, BS, IBCLC
© Paul Hakimata – Fotolia.com
My baby spits up – is this a problem?
Spitting up, sometimes called physiological or uncomplicated reflux, is common in babies and is usually (but not always) normal. Most young babies spit up sometimes, since their digestive systems are immature, making it easier for the stomach contents to flow back up into the esophagus (the tube connecting mouth to stomach).
Babies often spit up when they get too much milk too fast. This may happen when baby feeds very quickly or aggressively, or when mom’s breasts are overfull. The amount of spitup typically appears to be much more than it really is. If baby is very distractible (pulling off the breast to look around) or fussy at the breast, he may swallow air and spit up more often. Some babies spit up more when they are teething, starting to crawl, or starting solid foods.
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A few statistics (for all babies, not just breastfed babies):
- Spitting up usually occurs right after baby eats, but it may also occur 1-2 hours after a feeding.
- Half of all 0-3 month old babies spit up at least once per day.
- Spitting up usually peaks at 2-4 months.
- Many babies outgrow spitting up by 7-8 months.
- Most babies have stopped spitting up by 12 months.
If your baby is a ‘Happy Spitter’ –gaining weight well, spitting up without discomfort and content most of the time — spitting up is a laundry & social problem rather than a medical issue.
Some causes of excessive spitting up
- Food sensitivities can cause excessive spitting. The most likely offender is cow’s milk products (in baby’s or mom’s diet). Other things to ask yourself: is baby getting anything other than breastmilk – formula, solids (including cereal), vitamins (fluoride, iron, etc.), medications, herbal preparations? Is mom taking any medications, herbs, vitamins, iron, etc.?
- Babies with Gastroesophageal Reflux Disease (GERD) usually spit up a lot (see below).
- Although seldom seen in breastfed babies, regular projectile vomiting in a newborn can be a sign of pyloric stenosis, a stomach problem requiring surgery. It occurs 4 times more often in boys than in girls, and symptoms usually appear between 3 and 5 weeks of age. Newborns who projectile vomit at least once a day should be checked out by their doctor.
My older baby just started spitting up more – what’s up?
Some older babies will start spitting up more after a period of time with little or no spitting up. It’s not unusual to hear of this happening around 6 months, though you also see it at other ages. If the spitting up is very frequent (particularly if baby does not seem well), consider the possibility of a GI illness.
If baby does not seem ill, then here are some possible causes:
- It’s unlikely that your baby has suddenly developed a sensitivity to something in your milk, unless there’s something really new in your diet or you’re eaten LOTS of a particular food very recently. Any foods that baby eats are more likely than mom’s foods to cause the spitting up. Has baby started solids recently or tried a new food? Are you or baby taking any new medications? Have you or baby started taking vitamins or changed your vitamins?
- Has baby been fussier than normal, and/or crying more lately? If so, he is probably swallowing more air than usual, which can cause the spitting up.
- Spitting up can be caused by teething. When teething, babies tend to drool more and often swallow a lot of that extra saliva – this can cause extra spitting up.
- A cold or allergies can result in baby swallowing mucus and spitting up more.
- Baby may be hitting a growth spurt and swallowing more air when he nurses, especially if he’s been “guzzling” lately.
- If you tend to have oversupply or a fast let-down, some moms see renewed symptoms (which can include spitting up) after a growth spurt.
Essentially, though, if your baby is healthy and doing well despite the spitting up — gaining well, having enough wet/dirty diapers — then this is a laundry problem rather than a medical issue.
Gastroesophageal Reflux Disease (GERD)
A small percentage of babies experience discomfort and other complications due to reflux – this is called Gastroesophageal Reflux Disease. These babies have been termed by some as ‘Scrawny Screamers’ (as compared to the Happy Spitters). There seems to be a family tendency toward reflux. GERD is particularly common in preemies (due to their immaturity) and in babies with other health problems. GERD usually improves by 12-24 months.
Following are symptoms of GERD — there are varying degrees and need your doctor’s involvement to diagnose:
- Frequent spitting up or vomiting; discomfort when spitting up. Some babies with GERD do not spit up – silent reflux occurs when the stomach contents only go as far as the esophagus and are then re-swallowed, causing pain but no spitting up.
- Gagging, choking, frequent burping or hiccoughing, bad breath.
- Baby may be fussy and sleep less due to discomfort.
Warning signs of severe reflux:
- Inconsolable or severe fussiness or crying associated with feedings.
- Poor weight gain, weight loss, or failure to thrive. Difficulty eating. Breast/food refusal.
- Difficulty swallowing, sore throat, hoarseness, chronic nasal/sinus congestion, chronic sinus/ear infections.
- Spitting up blood or green/yellow fluid.
- Sandifer’s syndrome: Baby may ‘posture’ and arch the neck & back to relieve reflux pain–this lengthens the esophagus and reduces discomfort.
- Breathing problems: bronchitis, wheezing, chronic cough, pneumonia, asthma, aspiration, apnea, cyanosis.
GERD may cause babies to either undereat (if they associate feeding with the after-feeding pain, or if it hurts to swallow) or overeat (because sucking keeps the stomach contents down in the stomach and because mother’s milk is a natural antacid).
Current information on reflux indicates that testing or treatment for reflux in babies younger than 12 months should be considered only if spitting up is accompanied by poor weight gain or weight loss, severe choking, lung disease or other complications. Per Donna Secker, MS, RD in the article Gastroesophageal Reflux Disease, “The infant with significant reflux who seems to be growing well and has no other significant health problems benefits most from little or no therapy.”
When GERD is suspected, many doctors first try a trial of various reflux medications (without running tests), to see if the medications improve baby’s symptoms. If testing is done, a 24-hour pH probe study () is the current “gold standard” for reflux testing in babies; this is a procedure where a tube is placed down baby’s throat to measure the acid level at the bottom of the esophagus. A barium swallow (upper GI) is not so invasive (baby swallows a barium mixture, then an x-ray is taken) but is not really effective for diagnosing reflux in babies, since most babies will reflux when given barium. An upper GI will not identify whether baby’s stomach contents are higher in acid or if there has been any esophagus damage due to reflux, but it will show if there are any blockages or narrowing of the stomach valves that may be causing or aggravating the reflux. Additional tests may be recommended in certain circumstances (see the links below for additional information). In rare cases, when baby has very severe reflux that is not relieved by medication, surgery may be recommended.
- Aim for frequent breastfeeding, whenever baby cues to feed. These smaller, more frequent feedings can be easier to digest.
- Try positioning baby in a semi-upright or sitting position when breastfeeding, or recline back so that baby is above and tummy-to-tummy with mom. See this information on upright nursing positions.
- For fussy, reluctant feeders, try lots of skin to skin contact, breastfeeding in motion (rocking, walking), in the bath or when baby is sleepy.
- Ensure good latch to minimize air swallowing.
- Allow baby to completely finish one breast (by waiting until baby pulls off or goes to sleep) before you offer the other. Don’t interrupt active suckling just to switch sides. Switching sides too soon or too often can cause excessive spitting up (see Too Much Milk?). For babies who want to breastfeed very frequently, try switching sides every few hours instead of at every feed.
- Encourage non-nutritive/comfort sucking at the breast, since non-nutritive sucking reduces irritation and speeds gastric emptying.
- Avoid rough or fast movement or unnecessary jostling or handling of your baby right after feeding. Baby may be more comfortable when help upright much of the time. It is often helpful to burp often.
- As always, watch your baby and follow his cues to determine what works best to ease the reflux symptoms.
What can I do to minimize spitting up/reflux?
- Breastfeed! Reflux is less common in breastfed babies. In addition, breastfed babies with reflux have been shown to have shorter and fewer reflux episodes and less severe reflux at night than formula-fed babies [Heacock 1992]. Breastfeeding is also best for babies with reflux because breastmilk leaves the stomach much faster [Ewer 1994] (so there’s less time for it to back up into the esophagus) and is probably less irritating when it does come back up.
- The more relaxed your infant is, the less the reflux.
- Eliminate all environmental tobacco smoke exposure, as this is a significant contributing factor to reflux.
- Reduce or eliminate caffeine. Excessive caffeine in mom’s diet can contribute to reflux.
- Allergy should be suspected in all infant reflux cases. According to a review article in Pediatrics [Salvatore 2002], up to half of all GERD cases in babies under a year are associated with cow’s milk protein allergy. The authors note that symptoms can be similar and recommend that pediatricians screen all babies with GERD for cow’s milk allergy. Allergic babies generally have other symptoms in addition to spitting up.
- Reflux is worst when baby lies flat on his back.
- Many parents have found that carrying baby in a sling or other baby carrier can be helpful.
- Avoid compressing baby’s abdomen – this can increase reflux and discomfort. Dress baby in loose clothing with loose diaper waistbands; avoid “slumped over” or bent positions; for example, roll baby on his side rather than lifting legs toward tummy for diaper changes.
- Recent research has compared various positions to determine which is best for babies with reflux. Elevating baby’s head did not make a significant difference in these studies [Carroll 2002, Secker 2002, Craig 2004], although many moms have found that baby is more comfortable when in an upright position. The positions shown to significantly reduce reflux include lying on the left side and prone (baby on his tummy). Placing the infant in a prone position should only be done when the child is awake and can be continuously monitored. Prone positioning during sleep is almost never recommended due to the increased SIDS risk. [Secker 2002]
- Although recent research does not support recommendations to keep baby in a semi-upright position (30° elevation), this remains a common recommendation. Positioning at a 60° elevation in an infant seat or swing has been found to increase reflux compared with the prone (tummy down) position [Carroll 2002, Secker 2002].
- As always, experiment to find what works best for your baby.
- If your child is taking reflux medications, keep in mind that dosages generally need to be monitored and adjusted frequently as baby grows.
What about thickened feeds?
Baby cereal, added to thicken breastmilk or formula, has been used as a treatment for GER for many years, but its use is controversial.
Does it work? Thickened feeds can reduce spitting up, but studies have not shown a decrease in reflux index scores (i.e., the “silent reflux” is still present). Per Donna Secker, MS, RD in Gastroesophageal Reflux Disease, “The effect of thickened feedings may be more cosmetic (decreased regurgitation and increased postprandial sleeping) than beneficial.” Thickened feeds have been associated with increased coughing after feedings, and may also decrease gastric emptying time and increase reflux episodes and aspiration. Note that rice cereal will not effectively thicken breastmilk due to the amylase (an enzyme that digests carbohydrates) naturally present in the breastmilk.
Is it healthy for baby? If you do thicken feeds, monitor baby’s intake since baby may take in less milk overall and thus decrease overall nutrient intake. There are a number of reasons to avoid introducing cereal and other solids early. There is evidence that the introduction of rice or gluten-containing cereals before 3 months of age increases baby’s risk for type I diabetes. In addition, babies with GERD are more likely to need all their defenses against allergies, respiratory infections and ear infections – but studies show that early introduction of solids increases baby’s risk for all of these conditions.
The breastfeeding relationship: Early introduction of solids is associated with early weaning. Babies with reflux are already at greater risk for fussy nursing behavior, nursing strikes or premature weaning if baby associates reflux discomfort with breastfeeding.
Safety issues: Never add cereal to a bottle without medical supervision if your baby has a weak suck or uncoordinated sucking skills.
Spitting Up: Is it Reflux? by Anne Smith, IBCLC
LLL FAQ on breastfeeding and reflux
Gastroesophageal Reflux in Young Children by Pamela Tyler, M.S., CCC SLP
The Children’s Digestive Health and Nutrition Foundation (CDHNF)
NASPGHAN Guidelines on Pediatric GERD and Guidelines Summary on Pediatric GERD from the Children’s Digestive Health and Nutrition Foundation (CDHNF)
North American Society for Pediatric Gastroenterology and Nutrition (NASPGHAN)
Bailey DJ, Andres JM, Danek GD, Pineiro-Carrero VM. Lack of efficacy of thickened feeding as treatment for gastroesophageal reflux. J Pediatr 1987 Feb;110(2):187-9.
Carroll AE, Garrison MM, Christakis DA. A Systematic Review of Nonpharmacological and Nonsurgical Therapies for Gastroesophageal Reflux in Infants. Arch Pediatr Adolesc Med. 2002;156:109-113.
Craig WR, Hanlon-Dearman A, Sinclair C, Taback S, Moffatt M. Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children under two years. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD003502.
Ewer AK, Durbin GM, Morgan ME, Booth IW. Gastric emptying in preterm infants. Arch Dis Child Fetal Neonatal Ed. 1994 Jul;71(1):F24-7. “On average, expressed breast milk emptied twice as fast as formula milk.”
Heacock HJ, Jeffery HE, Baker JL, Page M. Influence of breast versus formula milk on physiological gastroesophageal reflux in healthy, newborn infants. J Pediatr Gastroenterol Nutr. 1992 Jan;14(1):41-6.
Iacono G, et al. Gastroesophageal reflux and cow’s milk allergy in infants: a prospective study. J Allergy Clin Immunol. 1996 Mar;97(3):822-7.
Khorosheva EV, Sorvacheva TN, Kon’ IIa. Gastroesophageal reflux in nursing children: normal or pathology? Vopr Pitan. 2001;70(5):22-4.
Miyazawa R, Tomomasa T, Kaneko H, Tachibana A, Ogawa T, Morikawa A. Prevalence of gastro-esophageal reflux-related symptoms in Japanese infants. Pediatr Int. 2002 Oct;44(5):513-6.
Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of symptoms of gastroesophageal reflux during infancy. A pediatric practice-based survey. Pediatric Practice Research Group. Arch Pediatr Adolesc Med 1997 Jun;151(6):569-72.
Omari TI, Rommel N, Staunton E, Lontis R, Goodchild L, Haslam RR, Dent J, Davidson GP. Paradoxical impact of body positioning on gastroesophageal reflux and gastric emptying in the premature neonate. J Pediatr. 2004 Aug;145(2):194-200.
Orenstein SR, Shalaby TM, Putnam PE. Thickened feedings as a cause of increased coughing when used as therapy for gastroesophageal reflux in infants. J Pediatr 1992 Dec;121(6):913-5.
Orenstein SR. Prone positioning in infant gastroesophageal reflux: is elevation of the head worth the trouble? J Pediatr. 1990 Aug;117(2 Pt 1):184-7.
Parrilla Rodriguez AM, Davila Torres RR, Gonzalez Mendez ME, Gorrin Peralta JJ. Knowledge about breastfeeding in mothers of infants with gastroesophageal reflux. P R Health Sci J. 2002 Mar;21(1):25-9.
Ravelli AM, Tobanelli P, Volpi S, Ugazio AG. Vomiting and gastric motility in infants with cow’s milk allergy. J Pediatr Gastroenterol Nutr. 2001 Jan;32(1):59-64.
Salvatore S, Vandenplas Y. Gastroesophageal reflux and cow milk allergy: is there a link? Pediatrics. 2002 Nov;110(5):972-84.
Sicherer SH. Clinical aspects of gastrointestinal food allergy in childhood. Pediatrics. 2003 Jun;111(6 Pt 3):1609-16.
Tobin JM, McCloud P, Cameron DJS. Posture and gastro-oesophageal reflux: a case for left lateral positioning. Arch Dis Child 1997;76:254-258.
Why does my baby spit up so much? — Plateau Pediatrics
Nearly all babies spit up to some degree. Occasionally, though, a baby seems to vomit so much that parents wonder if something is wrong.
Persistent spitting up in babies is called reflux (also called gastroesophageal reflux or GER.) Reflux is never concerning in an otherwise normal baby who is growing and developing normally. It will sometimes seem that a baby vomits more than he eats, and may seem amazing that he grows or gains weight at all! These “happy spitters” do quite well, and are chubby more often than scrawny. Most show significant improvement by 6 months of age, and almost all are better by their first birthday.
In our experience, most “spitty babies” are formula fed. This is because formula flows much faster from a bottle than human milk does from the breast. It’s a lot easier to “overeat” when the baby doesn’t have to work to get the milk. Babies also don’t “know when to say when.” An infant’s stomach is not much bigger than his two fists together; babies will try to eat more, resulting in vomiting. The baby will then be hungry again, causing a second rapid feeding (and often more vomiting.)
Reflux can be very smelly. Many parents are concerned when they see nasty-smelling curdled milk in their child’s vomit. However, this is what milk mixed with stomach acid looks like; it’s not a sign of something strange. Reflux can indeed be messy, but it’s not harmful to an otherwise normal baby. If reflux bothers you, here are some things you can do to help it:
Feed your baby in the upright position.
Offer your baby smaller feedings that are more frequent. This is the single biggest change you can make to help reduce spitting up. For example, most one month olds spit up if they take 4 oz at a time every four hours. The same baby will probably be much less “spitty” with 2 oz every two hours – which is still the same total amount of milk in a 24 hour period. Most newborns can only take an ounce or two at a time; most four-month-olds get “spitty” beyond 4 ounces at a time.
Elevate the head of your baby’s bassinet or crib at an angle of about 15 degrees. This gets gravity on your side. (Let your baby lie flat or stand up; a seated position such as in a car seat can actually cause more reflux.)
Burp your baby well in the middle of and after feedings. “Barracuda babies” who ravenously take a complete feeding in 10 minutes swallow lots of air with their milk.
Try a different type of bottle. There are new “airless” bottles that reduce the amount of air babies swallow with feedings, available at some of our local pharmacies. These bottles also result in slower milk flow, helping infants to feed slower overall.
Add a teaspoon of rice cereal to a bottle to thicken the feedings.
What if these things don’t work?
Let us know if the above suggestions don’t work. Sometimes we can recommend other changes if reflux persists, like prescription medication. Vomiting is rarely caused by formula intolerance, and so we don’t usually recommend changing formulas simply for persistent spitting up.
When is spitting up worrisome?
Extremely forceful (“projectile”) vomiting. Although seen in many normal children, it can be the sign of severe blockage if it happens more than once.
Dehydration, as seen by decreased saliva, tears, and urine (see our information sheet on dehydration.)
Weight loss or minimal weight gain in a child under the age of 1. Ask us if you are concerned about your baby’s weight gain.
Peculiar vomit, containing bile (bright green) or blood (red or brown.)
Associated with other symptoms which are themselves concerning, like severe belly pain or distension, wheezing, profuse diarrhea, and/or severe skin rashes. These should be reported to your doctor immediately.
90,000 Preventive measures against regurgitation in children
Regurgitation is a spontaneous discharge of gastric contents into the esophagus and mouth. This condition is common in infants and is often a cause for concern for parents. The frequency of regurgitation syndrome in children of the first year of life is 18-50%: up to 4 months – 67%, up to 6 months 24%, up to 1 year 5%. In most cases, the regurgitation is “benign” and disappears on its own after 12-18 months.In this case, “benign” or physiological regurgitation characterizes:
child’s age up to 12 months;
regurgitation 2 or more times a day for 3 or more weeks;
sufficient weight gain;
The child has no signs of metabolic disorders, diseases of the gastrointestinal tract or the central nervous system.The child has no difficulty in swallowing or feeding, there is no forced body position.
Do not confuse regurgitation with vomiting. When a child regurgitates, the abdominal muscles do not tighten. When vomiting, on the contrary, muscle tension occurs and the release of food flows by pressure not only through the mouth, but also through the nose. In some cases, general anxiety, pallor, cold extremities may occur. Often, with vomiting, the temperature rises, loose stools appear, which is a sign of an infectious disease.Vomit may contain unchanged milk, mucus, blood or bile.
What explains physiological regurgitation
What is the reason for the tendency of babies to regurgitate? This phenomenon is explained by the peculiarity of the structure of the gastrointestinal tract of young children. At the age of one year, the esophagus is shorter and wider, physiological narrowing is poorly expressed. The stomach is located horizontally, its capacity is small, and the muscles that close the entrance to the stomach and prevent the backflow of contents into the esophagus are poorly developed.As the baby begins to walk, the axis of the stomach becomes more vertical. The capacity of the stomach increases by the year from 30-35 ml to 250-300 ml. The secretory apparatus matures, the work of the closure muscles (sphincters) improves, which leads to a gradual decrease in frequency and the disappearance of regurgitation. The listed features explain the predisposition of young children to regurgitation and even the inevitability of this condition. However, there are measures to help reduce the frequency of regurgitation.
Factors contributing to physiological regurgitation include:
Overfeeding.Overfeeding begins to suffer, as a rule, actively sucking babies, with abundant milk production, as well as when switching to artificial or mixed feeding with incorrect calculation of the required amount of milk mixture. Regurgitation appears immediately or some time after feeding in an amount of 5-10 ml. The milk can flow out unchanged or curdled.
Swallowing air while feeding (aerophagia).A similar situation arises if the baby is eagerly sucking on the breast, and the mother’s milk is not very abundant; due to the inverted, flat nipple of the mother’s breast, since the child cannot fully capture the nipple and areola; with artificial feeding, if the opening at the nipple of the bottle is large enough or the nipple is not completely filled with milk. Infants with aerophagia often feel anxious after feeding, and the abdominal wall swells (the belly swells up). After 10-15 minutes, the swallowed milk flows out unchanged, which is accompanied by a loud sound of airy belching.
Intestinal colic or constipation. These conditions lead to increased pressure in the abdominal cavity and disruption of the movement of food through the gastrointestinal tract, provoking regurgitation.
Until the child is four months old, regurgitation of up to two teaspoons of milk after feeding or one regurgitation during the day for more than three spoons is considered the norm. You can check the volume of regurgitation in the following way: take a diaper, pour one teaspoon of water on its surface, and then compare this spot with the spot formed after the next regurgitation.
Pathological regurgitation can occur due to:
surgical diseases and malformations of the digestive system;
hernia of the diaphragm;
pathology of the central nervous system, trauma of the cervical spine during childbirth;
food intolerance, lactase deficiency;
increased intracranial pressure.
Such regurgitation is characterized by intensity, systematicity, the child regurgitates a large volume of milk. At the same time, a violation of the general condition of the baby is noted – the child is whiny, loses or does not gain weight, cannot eat the amount of food necessary for his age. In such a situation, an examination should be carried out by a pediatrician, gastroenterologist, surgeon, allergist, neurologist. It also requires examination and exclusion of anomalies in the structure of the upper gastrointestinal tract, the preservation of regurgitation for more than 1 year.
Scale for assessing the intensity of regurgitation:
Less than 5 regurgitation per day with a volume of no more than 3 ml – 1 point.
More than 5 regurgitation per day with a volume of more than 3 ml – 2 points.
More than 5 regurgitation per day with a volume of up to half of the amount of formula or breast milk no more than in half of feedings – 3 points.
Spitting up a small amount of milk for 30 minutes or more after each feeding – 4 points.
Regurgitation from half to full volume of formula or breast milk in at least half of feedings – 5 points.
Regurgitation with an intensity of 3 or more points requires a visit to a doctor.
Preventive measures against regurgitation in children
If regurgitation is of a physiological nature, then treatment or correction in this case is not worth it.It is necessary to deal with the elimination of the cause, if possible, and carry out prevention.
The prevention of regurgitation in children includes the following measures:
Postural therapy: when feeding, it is necessary to hold the baby at an angle of 45 °, make sure that he completely captures the nipple with the areola; after feeding, keep the baby in an upright position (“column”) for 20 minutes to evacuate the swallowed air.Thanks to this, the air trapped in the stomach will be able to escape. If nothing happened, then put the baby down and after a minute or two, lift him vertically again.
Make sure the hole in the bottle is not too big and the nipple is full of milk. Experiment with your nipples – maybe the other will be better. Milk should come out in drops, not in a trickle.
Lay your baby belly down on a firm base before feeding.
After feeding, try to minimize the physical activity of the baby, do not bother him unnecessarily, but change clothes only if there is an emergency.
Do not allow diapers or clothing to squeeze the baby’s abdomen.
If the baby’s appetite is good, then it is better to feed him often, but in small portions, otherwise, due to the large volume of food, the stomach may overflow, and this, as a result, leads to regurgitation of excess food.
The surface in the bed on which the baby lies should rise by 10 cm at the head.
In addition, it is possible to use special milk “thickeners” or antireflux mixtures, which the doctor will help to choose.
In the case when regurgitation begins to increase in frequency, or becomes abundant, or first began after six months of the baby’s life, or does not decline by one and a half to two years of life, the child should be consulted with a pediatrician.Additional help from a gastroenterologist is likely to be needed.
In our Family Medical Center you can always find highly professional help.
Regurgitation and vomiting in children
The regurgitation syndrome is one of the most common reasons for parents of young children to visit a pediatrician and a surgeon. The reasons for regurgitation in children under 1 year old are different: anatomical and functional features, neurological disorders, infectious processes, malformations or other problems.The mechanism that prevents regurgitation and vomiting in children is very complex and depends on the anatomical structure and physiological processes of the child. The formation of this mechanism occurs in the last trimester of pregnancy and continues in the first months of a child’s life. Although regurgitation and vomiting can be a symptom of various diseases, these processes themselves are physiological, i.e. normal. Abnormal discharge of stomach contents into the esophagus is called gastroesophageal reflux, and the mechanism that prevents vomiting is called the antireflux mechanism.
Anti-reflux mechanism in children
In children, the nervous regulation of the antireflux mechanism is very complex and is easily disturbed by external and internal factors. Regurgitation and vomiting easily occur in children with an immature antireflux mechanism, if the mode or volume of feeding is incorrectly selected, as a reaction to artificial mixtures, at the slightest sign of infectious processes. This is especially often observed in children with intrauterine growth retardation and premature babies, as well as in severe pregnancy and toxicosis, caesarean section, complicated childbirth, etc.d.
When to see a doctor
Despite the fact that moderate regurgitation in a child under 6 months is considered a variant of the norm, parents must be sure to tell the pediatrician about this during a routine examination. The reason for serious concern and immediate examination of the child is an increase in the frequency or increase in the volume of regurgitation, the appearance of streaks of blood or an admixture of bile, a delay in gaining or weight loss, and a high temperature. In this case, it is necessary to urgently consult a surgeon in order to exclude surgical reasons.
In most cases, an ultrasound examination (ultrasound) is necessary to establish an accurate diagnosis and select the correct treatment. An experienced doctor of ultrasound diagnostics helps to establish the correct diagnosis in more than half of the cases. Sometimes flexible gastroscopy, X-rays, or computed tomography of the abdominal organs are done for a more accurate diagnosis.
When surgery is required
Pyloric stenosis or impaired permeability of the outlet of the stomach, is the cause of the most severe regurgitation syndrome (vomiting “fountain”) in children under 2 months of age, accompanied by severe weight loss and increasing deterioration in the child’s condition.This disease requires urgent surgical attention. In leading clinics, such operations are performed using a minimally invasive laparoscopic method. The modern level of development of surgery and pediatric anesthesiology makes it possible to use the endoscopic technique of surgery even in children in the first weeks of life.
There are also other causes of regurgitation that require surgical intervention, such as hiatal hernia, esophageal chalasia (gaping), and others. These malformations are characterized by impaired formation of the antireflux mechanism and lead to constant regurgitation in the child, impaired weight gain, loss of appetite, chronic cough, bronchial asthma, and anemia.If drug therapy is ineffective, then gastrofundoplication surgery is indicated, in which an artificial antireflux valve is surgically formed. Like many other interventions, in modern children’s clinics, this operation is performed laparoscopically – with less trauma, minimal blood loss, minimal cosmetic defect and quick recovery of the child after surgery.
Of course, vomiting and regurgitation can be symptoms of many other diseases and occur at any age of the child.So, vomiting is often noted in acute appendicitis and intestinal obstruction, it can be a symptom of intestinal infection, intoxication, etc. In addition to the disease itself, vomiting and profuse regurgitation are dangerous because the child loses a large amount of water and salts necessary for life, which can lead to dehydration – exsicosis. The younger the child, the faster the breakdown of compensatory mechanisms and the aggravation of his condition occurs. Therefore, the appearance in a child of symptoms of vomiting or severe regurgitation in young children requires immediate medical attention to identify the causes, establish the correct diagnosis and choose the optimal treatment, and, if necessary, surgical.
Experienced pediatricians and surgeons are on duty around the clock at the EMC Children’s Clinic, who provide emergency and planned assistance to children of different ages, starting from the first days of life.
If surgical treatment is required, the method of choice in our clinic is minimally invasive endoscopic surgical interventions, which in most cases allow the child to go home on the day of the operation. The operation is accompanied by an experienced anesthesiologist who selects modern and safe anesthesia for each child individually.Postoperative wards are equipped with high-tech equipment, where 24-hour monitoring systems are installed, and a separate nurse continuously monitors the condition of young patients.
In the comfortable hospital of the EMC Children’s Clinic, parents can stay with their child all the time, open round-the-clock visits for family and friends, which allows to provide maximum comfort for the child and parents.
Hematoma of the external genital organs.- Medicine
is a hemorrhage in the PZhK in the area of the labia majora, perineum or perineum tissue. In some cases, the hematoma extends above the pelvic fascia, and blood accumulates in the parametrium tissue, sometimes rising to the renal region in the back and to the navel in front.
The occurrence of hematomas is usually associated with a mechanical effect that damages blood vessels. Factors that reduce blood clotting, elasticity of the vascular wall are important.
Hematomas rarely occur during pregnancy (trauma), usually during surgery (forceps, fetal extraction), rapid or protracted labor.More often on the left, which is due to the asymmetric development of the lower cardiac veins: the left is more developed than the right; it matters that more often in the first position (when most of the head is released – the back of the head, which more strongly compresses the soft tissues and vessels of the left half of the pelvis).
Clinic Pain, constriction at the site of formation.
Detection of a blue-purple tumor of a tight-elastic consistency in the labia majora. The entrance to the vagina is located eccentrically, the genital slit looks like a zigzag.External bleeding is absent. With a large hematoma, there may be more or less pronounced signs of anemia. Vaginal hematomas are more difficult to diagnose. A vaginal or mirror examination reveals a blue-purple swelling, giving a sensation of fluctuation with a fresh hematoma, and a crunching sensation with an old one. The most difficult to recognize are supravaginal hematomas. With their rapid spread in a large size, signs of internal bleeding appear, a tumor in the parametria is determined by palpation.The swelling appears soon after childbirth. The absence of signs of inflammation makes it possible to distinguish hematoma from parametritis. Hematomas are usually unilateral, occur more often with normal or low-grade fever.
With large hematomas on the uterus, at the site of the greatest discrepancy of the tissues, foci of necrosis appear. Hematomas can fester, which leads to putrefactive decay of tissues, the general condition of the woman in labor worsens, the temperature rises. With the rapid growth of a hematoma or its suppuration, there may be a rupture.A breakthrough can occur in the vagina, in the rectum. Large hematomas that occur before the birth of the fetus can be an obstacle to childbirth through the birth canal, and if they rupture, life-threatening bleeding is possible.
Bed rest. Locally – an ice pack, a pressure bandage, hemostatic agents: vicasol, calcium chloride, aminocaproic acid, ergot preparations.
Indicators of work of the obstetric hospital.
1.The total number of births. Depends on the number of beds: OKB – 75 beds, 1000 – 1100 deliveries per year.
2. Average annual bed occupancy. In N = 300 days (2 months for general cleaning, 1 month 2 times).
3. Average bed-day – 15 (average length of stay in bed).
4. Bed turnover – how many patients for the given bed-days (in the OKH – 120%)
5. Premature birth 4 – 6% in the usual hospital, OKB – 11%.
6. Late gestosis of OKB – 23%
7.Bleeding during childbirth OKB – 2%
8. Birth traumatism OKB – 8.8%
9. Frequency of surgical interventions (CS) OKB – more than 30%
10. Postpartum complications 1.6%
11. Postpartum infectious diseases 1.2%
12. Postoperative bed-day – 11 days
13. Maternal mortality. For 100 thousand live births (mortality from pregnancy, childbirth, abortion, ectopic pregnancy) – over 5 years, more than 1600 women in childbirth.Only 1/3 – from pregnancy and childbirth, 2/3 – from abortion. Complications of pregnancy and childbirth: 1) late gestosis; 2) bleeding. At the OKB, maternal mortality is 17.2 per 100,000 newborns.
14. Perinatal mortality – calculated (the number of children who died in the first 7 days + the number of stillbirths (ante- and intranatally)) x 1000 – the number of children born alive and dead. Calculated in ppm. Perm region 16 – 18 ppm. OKB – up to 34 ppm.
Intracranial injury (ICT) has 3 degrees of severity.
Hemorrhages by localization:
– Supratentorial + subdural
– Mixed nature.
The basis of HFT is mechanical injury, but it may not exist (injury due to increased fragility of blood vessels – in premature infants, with chronic hypoxia).
3 degrees of impaired intracranial circulation according to the Blind.
Grade 1 – moderate in severity and short-term functional disorders of the craniocerebral circulation, sluggish reaction to stimuli, moaning breathing, decreased muscle tone, skin cyanosis, decreased sucking activity, slow recovery of body weight loss. Treatment: mode – absolute rest, half-sitting position with the head end raised, an ice pack towards the head. Oxygen through a probe, hemostatic therapy: vicasol, ethamsylate, vitamins of group B. FFP, anticonvulsants: relanium, seduxen.
2 degree – the clinic is more pronounced, longer, excitability, shortness of breath, hypertonicity, tremor of the limbs, reflexes are absent, a large decrease in body weight, a symptom of the setting sun – the eyeball rolls up, the pupils are not visible. Treatment: the same + infusion therapy for the prevention of cerebral edema (plasma, albumin), diuretics, anticonvulsant therapy. Dibazol for the central nervous system. When regurgitating – antispasmodics. Nootropics, calcium gluconate.
Grade 3 – more pronounced symptoms + convulsions.
1 degree – if the improvement within 3 – 4 days, then favorable.
2, 3 degree: 1) death
2) disabled person, if survived (encephalopathy, paralysis, cerebral palsy, debility). Then the neurological department (children are observed by a neurologist for 2 years).
Spinal injury (up to 80%).
Cause: the spinal column is easily stretchable, but the spinal cord is not.
Mechanisms: the head was born, the head does not rotate, it was turned on its own, which turned the neck (rotational).Distraction – stretching the head. Compression mechanism.
Clinic: restless child, spitting up, moaning breathing, cyanosis of the nasolabial triangle, inactive sucking, bruising at the site of injury, shortened or elongated neck, fixed torticollis, tachypnea, bradycardia, flaccid mono- and paraparesis.
Treatment: mode – gentle (gentle swaddling, feeding through the nipple or through a tube), hemostatics, analgesics, Shants collar in case of injury to the cervical spine or a donut bandage (for fixation) is placed under the head more often in the cervical, less often in the lumbar spine …When the vertebrae are displaced, the traumatologist performs reposition with immobilization of the spinal column. Sedatics, hemostatics, vitamins of group B.
Prevention of birth trauma in children: treatment of extragenital and obstetric pathology (lead to chronic fetal hypoxia). Gentle obstetric manual. Pudendal anesthesia and episiotomy. With KS – observance of the biomechanism of childbirth.
are pathological conditions (maladjustment syndrome) that are associated with pregnancy, worsen its course and disappear after it.
1. Early – in the first half of pregnancy, usually in the first 12 weeks
2. Late – in the second half of pregnancy
1. Vomiting of pregnant women (emesis gravidarum)
2. Drooling (ptyalismus)
3. Excessive vomiting (hyperemesis gravidarum)
4. The clinic from the gastrointestinal tract develops against the background of EHP (cholecystitis, panritis, JBI , hepatitis)
By severity: mild, moderate, severe.
|Signs||Grade 1 (neurosis of patients)||Grade 2 (toxicosis of patients)||Grade 3 (dystrophic changes|
|1 general condition||Satisfactory|| Moderate
12 9032 HELL
|Norm||Decrease to 100 mm Hg||Decrease of more than 100 mm Hg|
|3 pulse||Norm||Up to 100||More than 100|
|4 times a day)||Up to 5 – 10||Up to 20||Over 20|
|5 Weight loss||No||Up to 5 kg||Over 5kg|
|6 Drooling||Up to 200 ml||Up to 200 ml||More than 1 liter|
|8 protein in urine||No||0.033 g / L||0.066 g / L or more|
|9 acetone||No ++|
|10 temperature||Norm||Subfebrile||37.5 0 and above|
|11 skin||Not changed||Dry function|
|Not changed||Jaundice||Jaundice, liver dystrophy|
Treatment will depend on the severity.Grade 3 – termination of pregnancy and treat the background on which all this arose.
1. Regimen: at 1 degree – outpatient, at 2, 3 degrees – stationary (3 degrees – bed rest)
2. Food – eat half-reclining, chilled food, fractional frequent meals, should there is what he wants.
3. Influence on the central nervous system – maximum rest, sedatives (valerian, motherwort up to 16 weeks, after – small tranquilizers), electrosleep, acupuncture, hypnosis.
4. Antiemetic – cerucal, chlorpromazine, epairazine, droperidol, suprastin, pipolfen.
5. Infusion therapy – molar solutions, glucose, ascorbic acid, albumin, vamine, levamine.
6. Treatment of EGP
7. Vitamins, trace elements (iron, potassium, calcium)
Symptomatic treatment – symptoms gradually disappear by 16 weeks.
Frequency: in healthy women – 12%, in women with EGP 20 – 40%.
The main link is generalized arteriolospasm – changes in the body as a whole + changes in organs and systems. Microcirculation is impaired, this leads to a decrease in the BCC
hypovolemia (gestosis – chronic hypovolemic shock), hypoproteinemia, acidosis, chronic DIC.
1. Kidneys – decreased microcirculation up to ARF.
2. Liver – microcirculatory disorders leading to liver failure.
3. Brain – encephalopathy of pregnant women + edema (possibly hemorrhage)
4.The fundus of the eye – angiopathy (arteries narrow, veins expand), then edema, hemorrhage, there may be retinal detachment.
5. Placenta – FPN, which leads to chronic hypoxia and fetal malnutrition, placental abruption.
A. Pure 1% – in healthy people.
Combined 2% – with EGP (start earlier, flow harder, are treated worse).
B. By stages:
1. Preclinical – there are no symptoms, there are changes in the body – pregestosis .
2. Monosymptomatic gestosis – 1 symptom
3. Polysymptomatic gestosis (nephropathy, preeclampsia, eclampsia)
V. Clinically: 1. dropsy
G. By severity: according to Savelyev
|Symptoms||0 points||1 point||2 points||3 points|
|1.Edema||No||On the legs or pathological weight gain||On the legs + anterior abdominal wall||Generalized|
|2. Proteinuria||No||0.033 –|
|3. Syst. AD||Less than 130||130 – 150||150 – 170||170 and above|
|4.Diast. AD||Up to 85||85 – 90||90 – 110||110 and above|
|5. Duration of pregnancy, at which the first diagnosis is toxicosis||36 – 40 weeks or in childbirth||35 – 30 weeks||24 – 30 weeks and earlier|
|6. Fetal hypotrophy (growth retardation)||No||1 – 2 weeks delay||For 3 weeks or more|
|7.Background diseases||no||Disease manifestation before pregnancy||Disease manifestation during pregnancy||Disease manifestation outside and during pregnancy|
Mild nephropathy – 7 or less points; 8 – 11 points – moderate; 12 or more points – hard. The scale characterizes the condition of patients during the examination.
– this is the preclinical stage of gestosis, in which there are no symptoms of gestosis, but there are changes in the woman’s body. Task: in time to diagnose and treat (prevent severe forms).
Diagnostics. Registration of women in the ZhK.
1. Weighing – pathological weight gain (PPV). Normally, in the second half of pregnancy – 300 – 400 g per week.
2. HELL – asymmetry of pressure on the hands of more than 10 mm Hg; decrease in pulse pressure = 30 or less mm Hg.
3. Functional tests:
· Orthostatic test: blood pressure in the supine position, then sitting – the difference is 15 or more mm Hg
· Test with physical activity: sit down 15 times – increase in blood pressure (normally after 5 minutes it should recover ), but it does not return to normal
· Raise your hands and clench them into fists, hold them above your head for 2 – 3 minutes, paresthesias, soreness in the hands, paleness appear.
4. In the blood: with BHC – dysproteinemia, decreased albumin-globulin coefficient; in the KLA – a decrease in platelets (DIC develops gradually) to 160 thousand or less.
Dropsy or edema of pregnancy. Edema is visible and hidden. By severity, 4 degrees:
1 degree – edema of the lower extremities
2 degree – + edema of the anterior abdominal wall
3 degree – + edema of the face
4 degree – anasarca.
1 degree – the woman lies down on the couch, press on the tibia, pits remain.
2nd degree – a trace from a stethoscope on the abdomen.
3rd degree – forever.
4th degree – everywhere.
2. Decrease in daily urine output (at least 3 days) less than 900 ml per day
3. Blister test McClure-Aldridge – s / c 2 – 3 ml saline, the faster it dissolves, the more tissue hydrophilicity , ate edema, then slowly
4.Positive ring symptom
5. The ankle joint increases in circumference by more than 1 cm per week
Normal in pregnant women – less than 130/80 mm Hg. Hypertension options:
1. 140/90 mm Hg – an absolute increase
2. relative – an increase of 30% compared to the initial
3. An increase in blood pressure in one arm.
Zangeimeister’s triad: edema, hypertension, proteinuria.
3 degrees of severity:
|Signs||1 severity||2 severity||3 severity|
|1. Swelling||1 degree||2 – 3 degree|
|2. Hypertension (syst. BP)||More than 170|
|3. Proteinuria||Up to 1 g / L||Up to 3.3 g / L||More than 3.3 g / l|
The degree is determined by the most pronounced symptom (if all 3 symptoms correspond to different degrees).There are not always three symptoms – atypical nephropathy.
Zangemeister triad + brain syndromes.
1. Headaches in the frontal and occipital regions
2. Visual impairment (angiopathy leading to edema in the fundus) – blurred vision, veil, double vision.
3. Nausea and vomiting of central genesis
4. Pain in the epigastric region and right hypochondrium (as a result of hemorrhage under the liver capsule and in the stomach)
5.Changes in behavior – unreasonable euphoria, lethargy (non-contact, sleepy)
6. There may be additional syndromes according to Repina:
· ARVI phenomena – acute nasal congestion (as a result of mucosal edema), hoarse voice, but there is no rise in temperature, no runny nose, no hyperemia
· As a result of edema of the ear canal – hearing impairment
· Hyperemia of the facial skin
· Paresthesias and heaviness in the lower extremities and in the head.
– the most severe degree of PTB (late toxicosis of pregnant women), convulsive variant.
Atypical eclampsia – grade 3 nephropathy, turning into coma (non-convulsive variant) as a result of cerebral hemorrhage.
4 degrees of seizures:
1. Preconvulsive period (initial) – fibrillar twitching of the facial muscles (grimaces, sardonic smile) 20 – 30 seconds.
2. Period of tonic convulsions (striated muscles) – no breathing, opisthotonus (arch, the woman rests on the heels and on the back of the head), there may be a biting off of the tongue as a result of a spasm of the chewing muscles (trismus).Duration 20 – 25 seconds.
3. Period of clonic seizures – alternating contraction of various muscle groups for 20-30 seconds, foam, hoarse breathing.
4. The phase of the seizure resolution. 2 options: 1) favorable – the patient comes to her senses, there may be a relapse of the seizure, the more relapses of seizures, the worse.
2) without regaining consciousness, falls into an eclampsic coma, there may be a fatal outcome (cerebral hemorrhage, asphyxia, heart failure, pulmonary edema), therefore, active prevention of PTB is necessary.
Principles of prevention and early treatment of PTB.
1. Conducting health-improving and therapeutic-health-improving measures for the prevention, detection and treatment of EGP in girls, adolescents, women before pregnancy.
2. Identification of the degree of risk of developing the disease: pregnant women with EGP (kidney disease, HD, COPD, endocrinopathies, chronic tonsillitis and the transfer of several childhood infections (scarlet fever)) are at increased risk.
Moderate risk group: patients + obesity, heart defects, chronic liver diseases.
Contribute to the development of PTB:
Presence of PTB in a hereditary history
Presence of PTB in a previous pregnancy
-factor and system AB0
· Social and household factors: bad habits, occupational hazards, unbalanced nutrition.
3. Planning pregnancy.Women at risk of developing PTB should be advised of the timing of conception so that the development of pregnancy occurs in the summer, summer-autumn periods.
4. Timely detection and diagnosis of preclinical (pregestosis) and early stages of PTB.
5. Enhanced dispensary observation of women at risk of developing PTB. Their visit to the gallbladder once every 2 weeks in the 1st half of gestation, and once a week in the 2nd half of pregnancy – tests for the detection of pretoxicosis and early forms.
6.Eliminate negative emotions. Rational mode of work and rest, exclusion of mental and physical overstrain, walks in the fresh air before bedtime.
7. Rational and balanced nutrition. Especially useful are products containing complete proteins, irreplaceable AA: milk, kefir, cottage cheese, yogurt, boiled meat and fish, mild cheese. In the 2nd half of pregnancy: the need for carbohydrates – due to fruits rich in vegetable fiber, vitamins, trace elements, mineral salts, vegetable fats.The amount of liquid – no more than 1 – 1.2 liters, a decrease in the amount of table salt to 3 – 5 g / day, especially with a tendency to edema In this case, every other day – sanasol (salt without sodium), 1.5 – 2.0 g each with the second course.
Diet for PTB: 4 meals a day at 3-hour intervals. Eliminate sugar and limit flour products. Rich in complete proteins, salt restriction, alternating with sanasol. Liquid 1.0 – 1.2 l / day. Vegetables (up to 1 kg) and fruits (no more than 500 g): black currants, strawberries, apples, apricots, carrots, cabbage.Total calorie intake is 2800 – 3200 kcal / day.
For pregnant women with PPV more than 400 g, with dropsy and nephropathy 1 – 2 times a week – fasting days: apple, cottage cheese, apple-cottage cheese. In this case, half-bed mode.
8. Pregnant women at 20 – 22, 28 – 33, 35 – 37 weeks for 10 – 15 days preventive measures: diet – table number 7, vitamins (“Gendevit”) 1 tablet 2 – 3 times a day, herbal medicine – tincture of motherwort, infusion of valerian root, infusion of rose hips in a glass every day instead of tea or compote, infusion of kidney tea, infusion of birch buds, infusion of blue cornflower flowers, infusion of bearberry leaves, oxygen-vitamin herbal cocktails, galascorbin, rutin, methionine, potassium preparations , tocopherol acetate (vitamin E) 3 times a day.Central electroanalgesia, auricular acupuncture.
3 courses of herbal medicine (in each trimester), electro-nasal galvanization, collar according to Shcherbak.
Etiopathogenetic therapy of PTB – childbirth (while there is pregnancy – there will be gestosis). Thus, mainly symptomatic therapy.
Therapeutic and protective regimen + sedation
Therapy should correspond to the severity of gestosis
The route of administration of drugs should correspond to the severity of gestosis: with dropsy – orally, with eclampsia – parenteral
Vaginal childbirth – gentle acceleration, delivery (KS)
In the 2nd period, the application of obstetric forceps: – eclampsia
– HELL over 170/100
– deterioration of the functions of all systems and organs
· Complex multicomponent therapy:
– mode: on an outpatient basis with pregestosis and dropsy of the 1st degree or in a day hospital, all the rest only in a hospital.If not heavy – free mode, with moderate severity – half-bed, heavy – bed.
– table number 7 (up to 1.0 – 1.2 liters of liquid and salt 3 – 5 g / day), fasting days
– drug therapy – the main direction – generalized angiospasm:
1. Sedatics (small tranquilizers)
3. Magnesium sulfate according to Brovkin: 25% solution of 24 ml (6 g dry matter) IM with novocaine on the first day after 4 hours 4 times, then 12 hours break, for 2nd day after 6 hours 4 times, break, after 8 hours 3 times, 4th day after 12 hours 2 times.Effects: antihypertensive, antispasmodic, sedative, narcotic, anticonvulsant, reduces cerebral edema, reduces urine output
4. Corinfar, calcium channel blockers
5. Centrally acting drugs (chlorpromazine, droperidol, clonidine, capoten)
6. Ganglioblockers , pentamine – inconsistently (for a rapid decrease in blood pressure)
7. Beta-blockers: anaprilin (increases the tone of the uterus, better in the later stages – closer to childbirth, at first it is impossible)
8.Beta-adrenomimetics (lowering the tone of the uterus) – alupen, partusisten
9. Diuretics (chemotherapy and phytotherapy)
Treatment of hypovolemia, hypoproteinemia (infusion therapy):
1. The more severe the gestosis, the smaller the volume of infusion therapy. Saline solutions are not allowed, since everything goes into the tissues, infusion therapy is not more than 400 ml / day.
2. Protein preparations (FFP)
3. Drugs that normalize microcirculation (reogluman, reopolyglucin), with moderate severity up to 800 ml, with mild up to 1 liter.
Treatment of chronic DIC:
1. Anticoagulants. If a woman is not in labor – heparin (12 hours after childbirth with severe gestosis)
2. Disaggregants – curantil, trental, aspirin, compliamin, nicotinic acid
3. Vitamin C + rutin, ascorutin – to strengthen the vascular wall.
FPN treatment: + antihypoxant. Therapy: nootropics, actovegin, aevit, pressure chamber, vitamin E, glucose with ascorbic acid without insulin.