Vomiting in Babies

1. Introduction

  • Definition: Vomiting in children and babies refers to the forceful expulsion of stomach contents through the mouth, which can occur due to a variety of causes ranging from minor infections to more serious conditions.
  • Epidemiology: Vomiting is a common symptom in infants and children and a frequent reason for paediatric consultations.
  • Significance: While occasional vomiting is usually benign, persistent or severe vomiting may lead to dehydration, malnutrition, or indicate an underlying medical condition requiring intervention.

2. Causes and Risk Factors

  • Causes:
    • Common in Infants and Babies:
      • Gastroesophageal reflux (GER).
      • Overfeeding or improper feeding techniques.
      • Milk protein intolerance or allergy.
    • Infections:
      • Gastroenteritis (viral, bacterial, or parasitic).
      • Respiratory infections (e.g., bronchiolitis, sinusitis).
      • Urinary tract infections (UTIs).
    • Surgical or Structural Causes:
      • Pyloric stenosis (projectile vomiting in infants).
      • Intussusception (vomiting with abdominal pain and bloody stools).
      • Congenital malformations (e.g., malrotation, Hirschsprung’s disease).
    • Neurological Causes:
      • Increased intracranial pressure (e.g., meningitis, hydrocephalus, trauma).
      • Migraine (cyclical vomiting syndrome).
    • Others:
      • Food poisoning or ingestion of toxins.
      • Metabolic disorders (e.g., inborn errors of metabolism).
      • Motion sickness.
  • Risk Factors:
    • Poor hygiene or exposure to infections.
    • Feeding issues (e.g., improper bottle positioning, formula intolerance).
    • Prematurity or chronic illnesses.

3. Pathophysiology

  • Vomiting in children is triggered by stimulation of the vomiting centre in the medulla oblongata.
    • Peripheral Triggers: Gastrointestinal irritation (e.g., infections, food intolerance).
    • Central Triggers: Stimulation of the chemoreceptor trigger zone (CTZ) by toxins, infections, or metabolic disturbances.

4. Symptoms and Features

  • Associated Symptoms:
    • Diarrhoea and fever (gastroenteritis).
    • Cough or nasal congestion (respiratory infections).
    • Abdominal pain or distension (surgical causes like intussusception).
    • Signs of dehydration: Dry mouth, sunken eyes, reduced urine output, lethargy.
  • Red Flag Symptoms:
    • Projectile vomiting (pyloric stenosis).
    • Vomiting bile (green vomit) or blood.
    • Severe lethargy, irritability, or altered consciousness.
    • Persistent vomiting lasting >24 hours in infants or >48 hours in older children.

5. Complications

  • Dehydration and electrolyte imbalances (e.g., hypokalaemia, metabolic alkalosis).
  • Failure to thrive or malnutrition in prolonged cases.
  • Aspiration pneumonia.
  • Worsening of underlying conditions (e.g., intestinal obstruction).

6. Diagnosis

  • Clinical Features: History (onset, duration, associated symptoms) and physical examination.
  • Laboratory Tests:
    • Serum electrolytes and glucose (to assess dehydration and metabolic disturbances).
    • Stool analysis (if diarrhoea is present).
    • Blood cultures or inflammatory markers if infection is suspected.
  • Imaging:
    • Abdominal ultrasound: For pyloric stenosis or intussusception.
    • X-rays or CT scans: For suspected obstruction or perforation.
    • Cranial imaging (CT or MRI): For neurological causes.

7. Management Overview

  • Goals: Identify and treat the underlying cause, relieve symptoms, and prevent complications such as dehydration.
  • Approach: Rehydration therapy (oral or intravenous), nutritional support, and targeted treatment for specific causes.

8. Treatment Options with Cost (USD)

  • Symptomatic Relief:
    • Oral rehydration solutions (ORS): ~$10–$20 per pack.
    • Antiemetics (e.g., ondansetron): ~$10–$30 per course (use cautiously in young children).
  • Condition-Specific Treatments:
    • Antibiotics for bacterial infections (e.g., amoxicillin for UTIs): ~$10–$20 per course.
    • Proton pump inhibitors (e.g., omeprazole for GER): ~$10–$20 per month.

9. Advanced Treatment Options with Cost (USD)

  • Surgical Interventions:
    • Pyloromyotomy for pyloric stenosis: ~$10,000–$15,000.
    • Reduction of intussusception (via enema or surgery): ~$5,000–$10,000.
  • Hospitalisation:
    • IV fluids and monitoring for severe dehydration: ~$500–$1,500 per day.

10. Pharmacological Treatment

  • First-line: ORS for rehydration and ondansetron for acute vomiting episodes.
  • Second-line: Prokinetics (e.g., domperidone) for delayed gastric emptying or GERD.
  • Condition-Specific:
    • Antibiotics for infections.
    • Antihistamines (e.g., dimenhydrinate) for motion sickness.

11. Medication Tables

Table 1: Doses and Side Effects

DrugIndicationDoseCommon Side Effects
OndansetronAcute vomiting relief0.15 mg/kg/dose orally or IVHeadache, constipation
DomperidoneGERD or motility disorders0.25–0.5 mg/kg/dose 3 times dailyDry mouth, abdominal cramps
DimenhydrinateMotion sickness1.25 mg/kg/dose orally every 6–8 hoursDrowsiness, dizziness
AmoxicillinBacterial infections50–90 mg/kg/day in 2–3 dosesDiarrhoea, rash
Proton pump inhibitorsGERD or gastritis1–2 mg/kg/day orallyHeadache, abdominal pain

Table 2: Brand Names and Approximate Costs (USD)

DrugBrand NamesApprox. Cost
OndansetronZofran$10–$30 per course
DomperidoneMotilium$15–$30 per month
DimenhydrinateDramamine$5–$15 per bottle
AmoxicillinAmoxil$10–$20 per course
OmeprazolePrilosec$10–$20 per month

12. Lifestyle Interventions

  • For Infants: Feed smaller, more frequent meals and burp after feeding to reduce reflux.
  • For Older Children: Encourage bland, easily digestible foods (e.g., crackers, rice, bananas) during recovery.
  • Avoid spicy, fatty, or acidic foods that may worsen symptoms.
  • Ensure proper hygiene practices, such as handwashing, to prevent infections.

13. Monitoring Parameters

  • Monitor hydration status (e.g., urine output, skin turgor).
  • Evaluate weight gain and growth in infants with recurrent vomiting.
  • Assess for resolution of symptoms and improvement with treatment.

14. Patient Counseling Points

  • Educate parents on recognising signs of dehydration and when to seek medical attention.
  • Explain proper feeding techniques to prevent overfeeding or reflux.
  • Emphasise completing prescribed treatments for infections or underlying causes.
  • Reassure parents that mild or occasional vomiting is common and often resolves without complications.

15. Special Populations

  • Premature Infants: Higher risk of GERD and other complications; monitor closely for growth and symptoms.
  • In Children with Chronic Illnesses: Address underlying conditions like metabolic disorders or neurological impairments.
  • In Breastfed Infants: Advise mothers on potential dietary changes if milk protein allergy is suspected.

16. Prevention

  • Practise good hygiene to minimise infections (e.g., handwashing, cleaning feeding bottles).
  • Avoid overfeeding and ensure proper bottle positioning during feeding.
  • Limit exposure to motion sickness triggers during travel.
  • Address dietary intolerances or allergies promptly.

17. FAQs

  1. What causes vomiting in children and babies?
    Answer: Common causes include gastroenteritis, GER, infections, and overfeeding.
  2. When is vomiting a concern in children?
    Answer: If vomiting is persistent, projectile, or accompanied by dehydration or blood.
  3. How is vomiting treated in children?
    Answer: With rehydration, antiemetics, and treatment of the underlying cause.
  4. What are the signs of dehydration in children?
    Answer: Dry mouth, sunken eyes, lethargy, and reduced urine output.
  5. Can vomiting be prevented?
    Answer: Practising good hygiene, avoiding overfeeding, and managing underlying conditions can help.
  6. Is vomiting normal in babies?
    Answer: Occasional spitting up or mild vomiting is common but persistent vomiting warrants evaluation.
  7. What is projectile vomiting?
    Answer: Forceful vomiting that may indicate pyloric stenosis in infants.
  8. Can teething cause vomiting?
    Answer: Teething does not directly cause vomiting; look for other causes.
  9. Are antiemetics safe for children?
    Answer: Yes, certain antiemetics like ondansetron are safe when prescribed by a doctor.
  10. What foods should be given after vomiting?
    Answer: Bland foods like bananas, rice, applesauce, and toast (BRAT diet).
  11. Can GER cause vomiting in infants?
    Answer: Yes, GER is a common cause of vomiting in babies.
  12. How can I prevent motion sickness in children?
    Answer: Use antihistamines like dimenhydrinate and ensure good ventilation during travel.
  13. Can milk allergies cause vomiting?
    Answer: Yes, cow’s milk protein allergy can lead to vomiting and other symptoms.
  14. What is cyclic vomiting syndrome?
    Answer: A condition with recurrent vomiting episodes, often linked to migraines.
  15. When should I see a doctor for vomiting in my child?
    Answer: If vomiting persists >24 hours in infants or >48 hours in older children, or if severe symptoms are present.