Projectile spitting up in infants

Pyloric Stenosis (for Parents) - Nemours KidsHealth

What Is Pyloric Stenosis?

Pyloric stenosis is a condition that can affect the gastrointestinal tract in babies. It can make a baby vomit forcefully and often, and can lead to other problems, such as dehydration. Pyloric stenosis needs medical care right away.

What Happens in Pyloric Stenosis?

Food and other stomach contents pass through the pylorus, the lower part of the stomach, to enter the small intestine. Pyloric stenosis (pie-LOR-ik stih-NOE-sis) is a narrowing of the pylorus. When a baby has pyloric stenosis, this narrowing of the pyloric channel prevents food from emptying out of the stomach.

Pyloric stenosis (also called infantile hypertrophic pyloric stenosis) is a type of gastric outlet obstruction, which means a blockage from the stomach to the intestines.

Pyloric stenosis affects about 3 out of 1,000 babies in the United States. It's more likely to affect firstborn male infants and also runs in families — if a parent had pyloric stenosis, then a baby has up to a 20% risk of developing it. Most infants who have it develop symptoms 3 to 5 weeks after birth.

What Causes Pyloric Stenosis?

It's thought that babies who develop pyloric stenosis are not born with it, but have progressive thickening of the pylorus after birth. A baby will start to show symptoms when the pylorus is so thick that the stomach can't empty properly.

The cause of this thickening isn't clear. It might be a combination of several things. For example, use of erythromycin (an antibiotic) in babies in the first 2 weeks of life or antibiotics given to moms at the end of pregnancy or during breastfeeding can be associated with pyloric stenosis.

What Are the Signs & Symptoms of Pyloric Stenosis?

Symptoms of pyloric stenosis typically begin when a baby is around 3 weeks old. They include:

Vomiting. The first symptom is usually vomiting. At first it may seem that the baby is just spitting up often, but then it tends to become projectile vomiting, in which the breast milk or formula is ejected forcefully from the mouth, in an arc, sometimes over a distance of several feet. Projectile vomiting usually takes place soon after the end of a feeding, although in some cases it can happen hours later.
The vomited milk might smell curdled because it has mixed with stomach acid. The vomit will not contain bile, a greenish fluid from the liver that mixes with digested food after it leaves the stomach.
Despite vomiting, a baby with pyloric stenosis is usually hungry again soon after vomiting and will want to eat. It's important to know that even with the vomiting, the baby might not seem to be in great pain or at first look very ill.
Changes in stools. Babies with pyloric stenosis usually have fewer, smaller stools (poops) because little or no food is reaching the intestines. Constipation or poop with mucus also can happen.
Failure to gain weight or weight loss. Most babies with pyloric stenosis will fail to gain weight or will lose weight. As the condition gets worse, they might become dehydrated.
Dehydrated infants are less active than usual, and they may develop a sunken "soft spot" on their heads and sunken eyes, and their skin may look wrinkled. Because less pee is made, they can go more than 4 to 6 hours between wet diapers.
Waves of peristalsis. After feeds, increased stomach contractions may make noticeable ripples, which move from left to right over the baby's belly as the stomach tries to empty itself against the thickened pylorus.

It's important to call your doctor if your baby has any of these symptoms.

Other conditions can cause similar problems. For instance:

gastroesophageal reflux (GER) usually begins before 8 weeks of age. GER involves lots of spitting up (reflux) after feedings, which can look like vomiting. But most babies with GER don't have projectile vomiting, and while they might have trouble gaining weight, they usually have normal poops.
a milk protein allergy also can make a baby spit up or vomit, and have diarrhea. But these babies don't have projectile vomiting.
gastroenteritis (inflammation in the digestive tract that can be caused by viral or bacterial infection) also can cause vomiting and dehydration. But babies with gastroenteritis usually also have diarrhea with loose, watery, or sometimes bloody stools. Diarrhea usually isn't seen with pyloric stenosis.

How Is Pyloric Stenosis Diagnosed?

The doctor will ask detailed questions about the baby's feeding and vomiting patterns, including what the vomit looks like. The doctor will do an exam, and note any weight loss or failure to maintain growth since birth.

The doctor will check for a lump in the abdomen. If the doctor feels this lump, which usually is firm and movable and feels like an olive, it's a strong indication that a baby has pyloric stenosis.

If pyloric stenosis seems likely, the doctor probably will order an abdominal ultrasound. The enlarged, thickened pylorus will show on ultrasound images. The doctor may ask that the baby not be fed for several hours before an ultrasound.

Sometimes doctors order a barium swallow instead of an ultrasound. Babies swallow a small amount of a chalky liquid (barium). Then, special X-rays are done that let the doctor check the pyloric area for any narrowing or blockage.

The doctor also might order blood tests to check levels of electrolytes (minerals that help keep fluids balanced and vital organs working properly). An electrolyte imbalance often happens due to the ongoing vomiting of stomach acid and dehydration, and needs to be corrected.

How Is Pyloric Stenosis Treated?

When an infant is diagnosed with pyloric stenosis, either by ultrasound or barium swallow, the baby will be admitted to the hospital and prepared for surgery. Any dehydration or electrolyte problems in the blood will be corrected with intravenous (IV) fluids, usually within 24 hours.

Doctors do a surgery called pyloromyotomy (pie-lor-oh-my-OT-uh-me) to relieve the blockage. Using a small incision (cut), the surgeon examines the pylorus and separates and spreads the thick, tight muscles. This relaxes and opens those muscles.

The surgery can also be done through laparoscopy. This technique uses a tiny scope placed through a small cut in the belly button, letting the doctor see the area of the pylorus. Using other small instruments placed in nearby incisions, the doctor can complete the surgery.

Most babies return to normal feedings fairly quickly, usually 3 to 4 hours after the surgery. Because of swelling at the surgery site, a baby may still vomit small amounts for a day or so. If there are no complications, most babies who have had pyloromyotomy can return to a normal feeding schedule and go home within 24 to 48 hours of the surgery.

If you're breastfeeding, you might worry about continuing while your baby is hospitalized. The hospital staff should be able to provide a breast pump and help you use it so that you can continue to express milk until your baby can feed regularly.

After a successful pyloromyotomy, your baby won't need to follow any special feeding schedules. Your doctor will probably want to examine your child at a follow-up appointment to make sure the surgical site is healing properly and that your baby is feeding well and maintaining or gaining weight.

Pyloric stenosis should not happen again after a pyloromyotomy. If your baby still has symptoms weeks after the surgery, there might be another medical problem, such as gastritis or GER, so let your doctor know right away.

When Should I Call the Doctor?

Pyloric stenosis is an urgent condition that needs immediate treatment. Call your doctor if your baby:

has lasting or projectile vomiting after feeding
is losing weight or not gaining weight as expected
is less active than usual or is very sleepy
has few or no stools (poops) over a period of 1 or 2 days
show signs of dehydration, such as more than 4 to 6 hours between wet diapers, a sunken "soft spot" on the head, or sunken eyes

Spitting Up - Reflux

Is this your child's symptom?

Spitting up small amounts of breastmilk or formula. Also called reflux.
Spitting up 1 or 2 mouthfuls of milk at a time
No effort or crying
Normal symptom in half of young babies

Symptoms of Normal Spitting Up

Smaller amounts often occur with burping ("wet burps")
Larger amounts can occur after overfeeding
Most often seen during or shortly after feedings
Occurs mainly in children under 1 year of age
Begins in the first weeks of life
Caution: normal reflux does not cause any crying

Complications of Spitting Up (GERD)

Most infants are "happy spitters." Normal spitting up (normal reflux) occurs in half of babies. It does not cause crying or colic.
Normal crying occurs in all babies. Frequent crying (called colic) occurs in 15% of babies. Crying and colic are not helped by heartburn meds. These meds also have side effects.
If they develop complications, it's called GERD (gastro-esophageal reflux disease). This occurs in less than 1% of babies.

Symptoms of GERD

GERD problems occur in less than 1% of infants:

Choking on spit up milk
Heartburn from acid on lower esophagus. Infants with this problem cry numerous times per day. They also act very unhappy when they are not crying. They are in almost constant discomfort.
Poor Weight Gain

Cause

Poor closure of the valve at the upper end of the stomach (weak valve)
Main trigger: overfeeding of formula or breastmilk
More than half of all infants have occasional spitting up ("happy spitters")

Reflux Versus Vomiting: How to Tell

During the first month of life, newborns with true vomiting need to be seen quickly. The causes of vomiting in this age group can be serious. Therefore, it's important to tell the difference between reflux and true vomiting.

Reflux

The following suggests reflux (normal spitting up):

You've been told by a doctor your baby has reflux
Onset early in life (85% by 7 days of life)
Present for several days or weeks
No pain or crying during reflux
No effort with spitting up
No diarrhea
Your baby acts hungry, looks well and acts happy.

Vomiting

The following suggests vomiting:

Uncomfortable during vomiting
New symptom starting today or yesterday
Forceful vomiting
Contains bile (green color)
Diarrhea is also present or
Your baby looks or acts sick.

Pyloric Stenosis (Serious Cause)

This is the most common cause of true vomiting in young babies.
Onset of vomiting age 2 weeks to 2 months
Vomiting is forceful. It shoots out of the baby's mouth. This is called projectile vomiting.
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.

When to Call for Spitting Up - Reflux

Call Doctor or Seek Care Now

Blood in the spit up
Choked on milk and turned blue or went limp
Age less than 12 weeks and spitting up changes to vomiting (forceful or projectile)
Age less than 1 month old and looks or acts abnormal in any way
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

You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

Chokes a lot on milk
Poor weight gain
Frequent crying
Spitting up is getting worse
Age more than 12 months old
Spitting up does not get better with this advice
You have other questions or concerns

Self Care at Home

Normal reflux (spitting up) with no problems

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

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Care Advice for Spitting Up (Reflux)

What You Should Know About Spitting Up:
- Spitting up occurs in most infants (50%).
- Almost always doesn't cause any pain or crying.
- Spitting up does not interfere with normal weight gain.
- Infants with normal reflux do not need any tests or medicines.
- Reflux improves with age.
- Here is some care advice that should help.
Feed Smaller Amounts:
- Skip this advice if age less than 1 month or not gaining weight well.
- Bottlefed Babies. Give smaller amounts per feeding (1 ounce or 30 mL less than you have been). Keep the total feeding time to less than 20 minutes. Reason: Overfeeding or completely filling the stomach always makes spitting up worse.
- Breastfed Babies. If you have a good milk supply, try nursing on 1 side per feeding. Pump the other side. Switch sides you start on at each feeding.
Longer Time Between Feedings:
- Formula. Wait at least 2½ hours between feedings.
- Breastmilk. Wait at least 2 hours between feedings.
- Reason: It takes that long for the stomach to empty itself. Don't add more milk to a full stomach.
Loose Diapers:
- Do not put the diaper on too tight. It puts added pressure on the stomach.
- Don't put pressure on the stomach right after meals.
- Also, do not play too hard with your baby during this time.
Upright Position:
- After meals, try to hold your baby in the upright (vertical) position.
- Use a front-pack, backpack, or swing for 30 to 60 minutes after feedings.
- Decrease the time in a sitting position (such as infant seats).
- After 6 months of age, a jumpy seat is helpful. The newer ones are stable.
- During breast or bottle feeds, hold your baby at a slant. Try to keep your baby's head higher than the stomach.
Less Pacifier Time:
- Frequent sucking on a pacifier can pump the stomach up with swallowed air.
- So can sucking on a bottle with too small a nipple hole.
- The formula should drip 1 drop per second when held upside down. If it doesn't, the nipple hole may be clogged. Clean the nipple better. You can also make the nipple hole slightly bigger.
Burping:
- Burping is less important than giving smaller feedings. You can burp your baby 2 or 3 times during each feeding.
- Do it when he pauses and looks around. Don't interrupt his feeding rhythm in order to burp him.
- Burp each time for less than a minute. Stop even if no burp occurs. Some babies don't need to burp.
Add Rice Cereal to Formula:
- If your baby still spits up large amounts, try thickening the formula. Mix it with rice cereal.
- Start with 1 level teaspoon of rice cereal to each ounce of formula.
Acid Blocking Medicines:
- Prescription medicines that block acid production are not helpful for normal reflux.
- These medicines also can have side effects.
- They do not reduce excessive crying from colic.
- They are only useful for symptoms of heartburn.
What to Expect:
- Reflux gets better with age.
- After learning to sit well, many babies are better by 7 months of age.
Call Your Doctor If:
- Spitting up changes to vomiting (forceful or projectile)
- Poor weight gain
- Your baby does not get better with this advice
- 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: 11/21/2022

Last Revised: 01/13/2022

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The baby is spitting up: is this normal? - The health of your body

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Your baby has just finished eating and you suddenly hear a "noise".

This is a sound that you probably quickly developed into disgust. A noise indicating that a shower is taking place soon comes out of the child's mouth and is carried along the entire road. This noise brings with it a lot of emotions - and usually none of them are positive.

You may worry that your child is sick and not getting enough food. You may be afraid to change clothes for the third time today or for the tenth time in a week to clean the saliva from the carpet.

You may also feel sad and helpless, making it seem like there is nothing you can do to stop your baby from spitting up.

When there are so many emotions in the head, it is difficult to understand: is this normal or not? Let me offer you help.

content

What is normal regurgitation?

It is normal for babies to spit out breast milk or formula from time to time. Fluid filling for most babies is a quick and smooth up and down flow of fluid during or after a feed.

Drinking alcohol does not usually cause problems or weight loss. While phlegm may seem like a lot of liquid (especially after the third time you wipe it up in one day!), most of the time it's actually a small amount.

Although regurgitation is common, some newborns may develop complications called gastroesophageal reflux disease (GERD).

Here are some signs that your child is not experiencing regurgitation but GERD:

choking on saliva when he comes out
unhappy, uncomfortable child due to obvious heartburn or painful reflux during the day
poor weight gain weight

If you notice signs of GERD (or signs of any other disease, including vomiting), it's time to see a doctor!

What causes regurgitation?

So why does everything that a child eats come back? This is due to a developmental milestone that is not as easy to spot as smiling or sitting.

In older children and adults, the muscle located between the esophagus and stomach keeps liquids and food where they belong. Until this muscle is mature (especially in the first year of life), regurgitation can be a problem, especially if the stomach is too full or its contents sink down.

Spitting in the first year of life is considered normal development.

Other causes of spitting include:

aerophagia, i.e. intake of more air than usual
overstimulation caused by bouncing, tummy tuck, etc.

Another cause may be pyloric stenosis. Appearing in the first months of a child's life, this condition causes intense muscle contractions that occur after feeding, resulting in projectile vomiting. Infants with pyloric stenosis are usually hungry immediately after vomiting. Surgery is used to correct this problem.

If your child shows signs of pyloric stenosis, it is important to see a pediatrician as medication or treatment may be needed.

What is the difference between saliva and vomit?

While it is important to be able to tell if an incoming fluid is suction or vomiting, it can sometimes be difficult to identify this signal. There are several different factors that can usually help you find the answer between them.

Spitting is usually fast and mostly silent. Babies who spit are usually happy before, during, and after.

Regurgitation is most common in the first months of a child's life and usually occurs less frequently until the child is 1 year old or older. (Spitting up usually starts before the baby is 6 months old, if it occurs.)

Vomiting is almost always just one of the symptoms of a larger disease, not the disease itself. Therefore, vomiting is usually seen along with other symptoms such as fever or diarrhea.

Vomiting pains often end quickly and stop quickly because they are associated with the underlying disease. In addition, vomiting is often accompanied by an output noise and has a greenish bile color in the liver.

When does the spitting problem occur?

When your child is spitting, it is normal for him to wonder if he is okay. Fortunately, there are signs that something is going on beyond the usual spitting up, and you should contact your child's doctor.

If your child has the following symptoms, it is time to see a pediatrician:

lose weight
looking untidy all day because of discomfort -green) and texture.

Your child's doctor will be able to review your symptoms and run tests to determine if your child has GERD, pyloric stenosis, or any other potential condition. If so, they are likely to use medications and/or medical procedures to intervene.

Especially in the first months of life, vomiting can be severe. During illness, newborns may be especially prone to dehydration. Whether your baby is spitting up or vomiting, it is important to keep an eye on your baby to make sure he or she is getting enough fluids if he or she is sick.

If you're wondering whether or not to see a doctor and how quickly your child will need help, keep in mind that not all parts of saliva are the same!

Normal regurgitation can usually be resolved at home and does not require a visit to the pediatrician.
If your child has been spitting up in the past 12 months, the amount of spitting up has increased, or he seems to be losing weight, tell your doctor (usually taking during office hours is enough - no need to rush).
If your baby is spitting up or vomiting blood or bile, choking on milk to the point that it turns blue or bloated, or is under 12 weeks old and the spitting up makes you vomit from a projectile, a trip to the doctor is guaranteed.

Spitting Tips

If spitting makes both you and your baby feel better, you can try to reduce the amount of spitting you both experience.

Try smaller channels. If you are breastfeeding, consider breastfeeding on one breast only after feeding and expressing milk from the other breast. If you are bottle feeding your baby, consider reducing the amount of formula or breast milk offered at any time.
Keep baby upright for 20-30 minutes after feeding. Avoid bouncing or fast and rough movements.
Start breastfeeding and take frequent breaks to separate.
Avoid tight and tight clothing and diapers that can put pressure on your baby's tummy.
If you are breastfeeding, consider experimenting with your own diet. Avoiding certain foods, such as dairy products, can help your baby's stomach digest breast milk better.
Avoid sleeping on your stomach. Sleeping on your back is not only recommended to prevent SIDS, sleeping on your stomach can only increase the amount of spitting!
Do not add solids to the bottle unless your doctor has told you to.
If your baby falls asleep but is happy and gaining weight, there is no need to feed him again right away.

Takeaway

Although it can definitely be unpleasant to hear the “noise” start again, spitting is a common activity for many children. If your child is happy and has gained weight, it is likely that everything will be fine if he is a little sloppy.

Be sure to take a few deep breaths and a few paper towels most of the time to get things back on track.