Newborn keeps throwing up

Vomiting in children and babies

It's normal for babies and children to vomit occasionally. In most cases, it will last no longer than one to two days and isn't a sign of anything serious.

The most common cause of vomiting in children and babies is gastroenteritis. This is an infection of the gut usually caused by a virus or bacteria, which also causes diarrhoea. The symptoms can be unpleasant but your child will usually start to feel better after a few days.

However, persistent vomiting can sometimes cause your child to become severely dehydrated and occasionally it can be a sign of something more serious, such as meningitis.

This page outlines what to do if your child keeps vomiting and describes some of the common causes of vomiting in children and babies.

If your child has a high temperature, you can also read a separate page about fever in children.

What to do

If your child vomits, you should keep a close eye on them. Trust your instincts and contact your GP immediately if you're worried.

If the cause is just a tummy bug, your child should still be feeling well enough to eat, play and be their usual self. In this case, keep feeding them as normal and offer them regular drinks (see below).

But if they don't seem themself – for example, if they're floppy, irritable or less responsive – they may be seriously ill, so you should get medical help immediately.

When to get medical advice

You should contact your GP if:

your child is repeatedly vomiting and is unable to hold down fluids
you think they're dehydrated – symptoms of dehydration can include a dry mouth, crying without producing tears, urinating less or not wetting many nappies, and drowsiness
their vomit is green or contains blood
they have been vomiting for more than a day or two

Go to your nearest accident and emergency (A&E) department if your child is vomiting and develops sudden and severe tummy pain, or they're floppy, irritable or less responsive

Call 999 for an ambulance or go to your nearest A&E department immediately if they're vomiting and have a headache, stiff neck and a rash.

Looking after your child at home

In most cases, you can treat your child safely at home. The most important thing you can do is make sure they keep drinking fluids to prevent dehydration.

If your baby is vomiting, carry on breastfeeding or giving them milk feeds. If they seem dehydrated, they will need extra fluids. Ask your GP or pharmacist whether you should give your baby oral rehydration solution.

Oral rehydration solution is a special powder that you make into a drink. It contains sugar and salts to help replace the water and salts lost through vomiting and diarrhoea.

Children who are vomiting should keep taking small sips of clear fluid, such as water or clear broth. Fruit juice and fizzy drinks should be avoided until they're feeling better. If they're not dehydrated and haven't lost their appetite, it's fine for your child to eat solid foods as normal.

Again, speak to your GP or pharmacist if you're concerned about dehydration. They may recommend an oral rehydration solution for your child. Contact your GP or practice nurse if your child is unable to hold down oral rehydration solution.

If your child has diarrhoea and is vomiting, they shouldn't go to school or any other childcare facility until 48 hours after the last episode of diarrhoea or vomiting.

Read more about treating gastroenteritis in children.

Causes of vomiting in children

There are a number of possible causes of vomiting in children, which are described below.

Gastroenteritis

Gastroenteritis is an infection of the gut. It's a common cause of vomiting in children and usually lasts a few days.

Food allergy

Food allergies can cause vomiting in children, as well as other symptoms, such as a raised, red, itchy skin rash (urticaria) and swelling of the face, around the eyes, lips, tongue or the roof of the mouth.

Watch out for foods that may bring on vomiting and see your GP for a diagnosis if you think your child may have a food allergy.

Other infections

Vomiting can sometimes be a sign of an infection other than gastroenteritis, such as urinary tract infections (UTIs), middle ear infections, pneumonia or meningitis.

Contact your child's GP if they're vomiting and experiencing additional symptoms of an infection, such as a high temperature (fever) and irritability.

Appendicitis

Appendicitis is a painful swelling of the appendix, a finger-like pouch connected to the large intestine. It causes severe tummy pain that gets worse over time.

If your child has tummy pain that's gradually getting worse, contact your GP, or if they aren't open call NHS 24's 111 service immediately. You should call 999 for an ambulance if they have pain that gets worse quickly and spreads across their tummy.

In most cases of appendicitis, the appendix will need to be surgically removed as soon as possible.

Poison

Accidentally swallowing something poisonous can cause your child to vomit. If you think this is the case, contact your GP immediately or take your child to your nearest accident and emergency (A&E) department.

Causes of vomiting in babies

These include:

gastroenteritis
a food allergy or milk intolerance
gastro-oesophageal reflux – where stomach contents escape back up the gullet
too big a hole in the bottle teat, which causes your baby to swallow too much milk
accidentally swallowing something poisonous
congenital pyloric stenosis – a condition present at birth where the passage from the stomach to the bowel has narrowed, so food is unable to pass through easily; this causes projectile vomiting
a strangulated hernia – your baby will vomit frequently and cry as if they are in a lot of pain; this should be treated as a medical emergency
intussusception (where the bowel telescopes in on itself) – as well as vomiting, your baby may look pale, floppy and have symptoms of dehydration

Vomiting (0-12 Months)

Is this your child's symptom?

Vomiting (throwing up) stomach contents
Other names for vomiting are puking, barfing and heaving

Causes of Vomiting

Viral Gastritis. Stomach infection from a stomach virus is the most common cause. Also called stomach flu. A common cause is the Rotavirus. The illness starts with vomiting. Watery loose stools may follow within 12-24 hours.
Food Allergy. Vomiting can be the only symptom of a food reaction. The vomiting comes on quickly after eating the food. Uncommon in infants, but main foods are eggs and peanut butter.
Coughing. Hard coughing can also cause your child to throw up. This is more common in children with reflux.
Serious Causes. Vomiting alone should stop within about 24 hours. If it lasts over 24 hours, you must think about more serious causes. An example is a kidney infection. A serious cause in young babies is pyloric stenosis. See below for more on this.

Pyloric Stenosis (Serious Cause)

The most common cause of true vomiting in young babies.
Onset of vomiting is age 2 weeks to 2 months
Vomiting is forceful. It becomes projectile and shoots out.
Right after vomiting, the baby is hungry and wants to feed. ("hungry vomiter")
Cause: The pylorus is the channel between the stomach and the gut. In these babies, it becomes narrow and tight.
Risk: Weight loss or dehydration
Treatment: Cured by surgery.

Vomiting Scale

Mild: 1 - 2 times/day
Moderate: 3 - 7 times/day
Severe: Vomits everything, nearly everything or 8 or more times/day
Severity relates even more to how long the vomiting goes on for. At the start of the illness, it's common for a child to vomit everything. This can last for 3 or 4 hours. Children then often become stable and change to mild vomiting.
The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid.
The younger the child, the greater the risk for dehydration.

Dehydration: How to Tell

The main risk of vomiting is dehydration. Dehydration means the body has lost too much water.
Vomiting with watery diarrhea is the most common cause of dehydration.
Dehydration is a reason to see a doctor right away.
Your child may have dehydration if not drinking much fluid and:
The urine is dark yellow and has not passed any in over 8 hours.
Inside of the mouth and tongue are very dry.
No tears if your child cries.
Slow blood refill test: Longer than 2 seconds. First, press on the thumbnail and make it pale. Then let go. Count the seconds it takes for the nail to turn pink again. Ask your doctor to teach you how to do this test.

When to Call for Vomiting (0-12 Months)

Call 911 Now

Can't wake up
Not moving
You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

Dehydration suspected. No urine in over 8 hours, dark urine, very dry mouth and no tears.
Stomach pain when not vomiting. Exception: stomach pain or crying just before vomiting is quite common.
Age less than 12 weeks old with vomiting 2 or more times. Exception: normal spitting up.
Vomited 3 or more times and also has diarrhea
Severe vomiting (vomits everything) more than 8 hours while getting Pedialyte (or breastmilk)
Head injury within the last 24 hours
Weak immune system. Examples are sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
Vomiting a prescription medicine
Fever over 104° F (40° C)
Fever in baby less than 12 weeks old. Caution: Do NOT give your baby any fever medicine before being seen.
Your child looks or acts very sick
You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

All other infants (age less than 1 year) with vomiting. See Care Advice while waiting to discuss with doctor.

Seattle Children's Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Bellevue
Everett
Federal Way
Seattle

Care Advice for Vomiting

What You Should Know About Vomiting:
- Most vomiting is caused by a viral infection of the stomach.
- Vomiting is the body's way of protecting the lower gut.
- The good news is that stomach illnesses last only a short time.
- The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid.
- Here is some care advice that should help.
Formula Fed Babies - May Give Oral Rehydration Solution (ORS) for 8 Hours:
- If vomits once, give half the regular amount of formula every 1 to 2 hours.
- If vomits formula more than once, offer ORS for 8 hours. If you don't have ORS, use formula until you can get some.
- ORS is a special fluid that can help your child stay hydrated. You can use Pedialyte or the store brand of ORS. It can be bought in food stores or drug stores.
- Spoon or syringe feed small amounts. Give 1-2 teaspoons (5-10 mL) every 5 minutes.
- After 4 hours without throwing up, double the amount.
- Return to Formula. After 8 hours without throwing up, go back to regular formula.
Breastfed Babies - Reduce the Amount Per Feeding:
- If vomits once, nurse half the regular time every 1 to 2 hours.
- If vomits more than once, nurse for 5 minutes every 30 to 60 minutes. After 4 hours without throwing up, return to regular nursing.
- If continues to vomit, switch to pumped breastmilk. (ORS is rarely needed in breastfed babies. It can be used if vomiting becomes worse).
- Spoon or syringe feed small amounts of pumped milk. Give 1-2 teaspoons (5-10 mL) every 5 minutes.
- After 4 hours without throwing up, return to regular feeding at the breast. Start with small feedings of 5 minutes every 30 minutes. As your baby keeps down the smaller amounts, slowly give more.
Pumped Breastmilk Bottle-Fed Infants - Reduce the Amount per Feeding:
- If vomits once and bottle-feeding breastmilk, give half the regular amount every 1-2 hours.
- If vomits more than once within last 2 hours, give 1 ounce (30 mL) every 30 to 60 minutes.
- If continues to vomit, give 1-2 teaspoons (5-10 mL) every 5 minutes. Only if not tolerating breastmilk, switch to ORS (e. g., Pedialyte) for every 5 minutes for a few hours.
- After 4 hours without vomiting, return to regular feedings. Start with 1 ounce (30 mL) every 30 minutes and slowly increase as tolerated.
Stop All Solid Foods:
- Avoid all solid foods and baby foods in kids who are vomiting.
- After 8 hours without throwing up, gradually add them back.
- If on solid foods, start with starchy foods that are easy to digest. Examples are cereals, crackers and bread.
Do Not Give Medicines:
- Stop using any drug that is over-the-counter for 8 hours. Reason: Some of these can make vomiting worse.
- Fever. Mild fevers don't need to be treated with any drugs. For higher fevers, you can use an acetaminophen suppository (such as FeverAll). This is a form of the drug you put in the rectum (bottom). Ask a pharmacist for help finding this product. Do not use ibuprofen. It can upset the stomach.
- Call your doctor if: Your child vomits a drug ordered by your doctor.
Try to Sleep:
- Help your child go to sleep for a few hours.
- Reason: Sleep often empties the stomach and removes the need to vomit.
- Your child doesn't have to drink anything if his stomach feels upset and he doesn't have any diarrhea.
Return to Child Care:
- Your child can return to child care after the vomiting and fever are gone.
What to Expect:
- For the first 3 or 4 hours, your child may vomit everything. Then the stomach settles down.
- Vomiting from a viral illness often stops in 12 to 24 hours.
- Mild vomiting and nausea may last up to 3 days.
Call Your Doctor If:
- Vomits clear fluids for more than 8 hours
- Vomiting lasts more than 24 hours
- Blood or bile (green color) in the vomit
- Stomach ache present when not vomiting
- Dehydration suspected (no urine in over 8 hours, dark urine, very dry mouth, and no tears)
- You think your child needs to be seen
- Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 10/20/2022

Last Revised: 09/21/2022

Regurgitation and vomiting in children

Regurgitation syndrome is one of the most common reasons for parents of young children to visit a pediatrician and a surgeon. The causes of 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, in themselves these processes are physiological, i. e. normal. The pathological reflux 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 easily disturbed under the influence of 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.

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 should definitely 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 bile impurities, a lag in recruitment or weight loss, and high temperature. In this case, it is urgent to consult a surgeon to rule out surgical causes.

Diagnostics

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, for a more accurate diagnosis, a flexible gastroscopy, X-ray examination, or computed tomography of the abdominal organs is performed.

When surgery is required

Pyloric stenosis, or impaired patency of the gastric outlet, is the cause of the most severe regurgitation syndrome (vomiting "fountain") in children under 2 months, accompanied by severe weight loss and progressive deterioration of the child's condition. This disease requires urgent surgical care. In leading clinics, such operations are performed using a minimally invasive laparoscopic method. The current level of development of surgery and pediatric anesthesiology allows the use of endoscopic surgery techniques even in children in the first weeks of life.

There are also other causes of regurgitation that require surgical intervention, such as hiatal hernia, chalazia (gaping) of the esophagus, and others. These malformations are characterized by a violation of the formation of the antireflux mechanism and lead to constant regurgitation in a child, impaired weight gain, decreased appetite, chronic cough, bronchial asthma, and anemia. If drug therapy is ineffective, then a gastrofundoplication operation 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 a quick recovery of the child after the operation.

Of course, vomiting and regurgitation can be symptoms of many other diseases and occur at any age of the child. Thus, vomiting is often observed in acute appendicitis and intestinal obstruction, it can be a symptom of an 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 disruption of compensatory mechanisms and the worsening of his condition. 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 select the optimal treatment, and, if necessary, surgical.

Experienced pediatricians and surgeons are on duty around the clock at the EMC Children's Clinic, providing emergency and planned care to children of all ages, starting from the first days of life.

If surgical treatment is required, the method of choice in our clinic is minimally invasive endoscopic surgery, which in most cases allows the child to go home on the day of the operation. The operation is accompanied by an experienced anesthesiologist, who individually selects modern and safe anesthesia for each child. Postoperative wards are equipped with high-tech equipment, where round-the-clock monitoring systems are installed, and a separate nurse continuously monitors the condition of small patients.

In the comfortable hospital of the EMC Children's Clinic, parents can stay with their child all the time, round-the-clock visits are open for relatives and friends, which ensures maximum comfort for the child and parents.

Spitting up and vomiting in infants

Spitting up and vomiting in babies is a common reason to see a doctor.

Regurgitation and vomiting is a reflex action that occurs when receptors located in various anatomical zones are irritated, incl. in the stomach, esophagus, pharynx, oral cavity. The signal is transmitted to the vomiting center, which is located in the medulla oblongata and a gag reflex occurs.

What is the difference between regurgitation and vomiting?

The difference lies in the volume and kinetics (movement) of the gastric contents expelled to the outside. When regurgitation occurs, leakage occurs without the participation of the diaphragm and abdominal muscles, i.e. passively. There is little content, up to about 10-15 ml. If the child does not swallow it, it quietly expires from the oral cavity. When vomiting, a wave-like bending of the upper half of the body occurs as a result of contraction of the muscles of the diaphragm and the anterior wall of the abdomen, the volume of vomit is greater, and they are erupted with pressure from the oral cavity with an ejection trajectory of up to 50 cm. In children of the first year of life, this is defined by the term "fountain vomiting" .

Regurgitation is observed only in children of the first year of life and, mainly, up to 6 months. Contribute to this anatomical and physiological features of the esophagus and stomach of the baby. Their esophagus is short and wide, the angle of connection of the esophagus with the stomach is less pronounced, and its obturator function is weak. These regurgitations are physiological. They can be after each feeding, up to 15 ml, do not affect the well-being and weight gain of the baby. They can also be caused by excessive feeding, aerophagia (swallowing air while sucking), straining during intestinal colic. The frequency and volume of such regurgitation decreases with the growth of the child. With the introduction of complementary foods, and this is a thicker food, regurgitation stops or becomes much less frequent.

If regurgitation persists in a child older than 1 year, then this is a sign of a pathological process.

Vomiting, unlike regurgitation, is accompanied by vegetative symptoms - increased salivation, pallor of the skin, palpitations. This is due to the fact that next to the vomiting center there are additional centers of autonomic regulation, which are reflexively excited, and active biological substances such as serotonin, dopamine, histamine and others are released into the blood.

Regurgitation and vomiting, from the moment of eating, may occur during feeding, after feeding for the first 20-30 minutes or delayed, sometimes after several hours.

Regurgitation and vomiting that occurs immediately after feeding unchanged breast milk or formula may be due to narrowing of the esophagus. If they persist until the next feeding, and the milk / mixture is curdled, has a sour or musty smell, then this is the result of a long standing food in the stomach. The reason for this may be the low tone of the muscle layer of the stomach and, as a result, its peristalsis or narrowing of the output section due to an anomaly in the development or high tone of the sphincter of the lower stomach. With narrowing of the duodenum, bile is present in the regurgitated masses.

Gastroesophageal reflux is a common cause of regurgitation in infants. It is likely that there is a complex problem here, starting with the immaturity of the gastrointestinal tract and disorders of the central nervous system. Perinatal injuries of the central nervous system accompany every second child. Their manifestations are varied. Regurgitation and vomiting can be facilitated by an increase in intracranial pressure, disorders in the segment of the cervical spine, and so on. Therefore, quite often, when carrying out rehabilitation measures for neurological dysfunctions, a positive effect is manifested in the form of a decrease or cessation of regurgitation. A hernia of the esophageal opening of the diaphragm will also manifest itself in a similar way.

We should not forget about allergic gastrointestinal reactions in the form of regurgitation and vomiting. The most common cause of this is cow's milk protein. With intolerance to cow's milk protein, inflammation of the mucous membrane of the esophagus, stomach and intestines occurs. And, as a result of this, regurgitation and vomiting, pain and increased gas formation, diarrhea or constipation.

Rare endocrine disorders (adrenogenital syndrome) are manifested by vomiting in children from the first weeks of life. In such cases, vomiting is frequent, there may be an admixture of bile, the child loses weight due to loss of fluid and nutrients, and severe metabolic disorders develop.

Vomiting can also be caused by an intestinal infection. Viral gastroenteritis is now common. It must be remembered that the younger the child, the more severe the disease. Within a few hours, the child's condition can go from satisfactory to extremely serious.

As you can see, the causes of regurgitation and vomiting in children of the first year of life are quite diverse, but most often these are transient conditions that disappear with the growth of the child.

Prevention of regurgitation in children of the first months of life is quite simple. Don't overfeed your baby. If he cries, it does not always mean that he is hungry. Excess feeding leads to increased gas formation and colic, during which the child is worried, straining, thereby increasing the likelihood of spitting up. After feeding, hold the baby more upright so that he can burp the swallowed air.