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What should I do if my baby's vomiting?

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Throwing up is usually no cause for alarm. But in some cases it can signal a serious health problem. Here's how to tell when your baby's vomiting needs immediate medical attention — and how to deal with vomiting that doesn't require a doctor's care.

Call 911 immediately if:

• Your baby's having trouble breathing
• He shows signs of severe dehydration, like sunken eyes, cold, splotchy hands and feet, excessive sleepiness or fussiness, or sunken fontanels (the soft spots on his head)

Take your baby to the emergency room if:

• He seems in severe pain. Your baby obviously can't explain what's going on, but you know him best and can probably tell when he's in considerable pain. He could have a blockage in his bowel or some other problem that needs immediate attention.
• His vomit contains bile (a green substance) or blood that resembles dark coffee grounds. The doctor will probably want to see a sample of the vomit if it contains blood or bile, so as distasteful as it is, you should try to save some in a plastic baggie. Green bile can indicate that the intestines are blocked, a condition that needs immediate attention.
• He has a swollen, tender abdomen. This could indicate a buildup of fluid or gas, a blocked intestine, a hernia, or some other digestive tract problem. Blockages are uncommon but serious.
• He vomits more than once after suffering a head injury, which may indicate a concussion.

Call your baby's doctor if:

• Your baby's been vomiting for more than 24 hours. For some illnesses, this is perfectly normal, but check with the doctor to be sure.
• He shows signs of becoming dehydrated. These can include decreased urination (more than six to eight hours without a wet diaper), dry lips and mouth, crying without tears if he's more than a couple weeks old (it takes two to three weeks for a baby to shed his first tears), lethargy, and dark yellow urine.
• The vomit contains blood. A little blood in the vomit is usually nothing to worry about, as the force of vomiting can cause tiny tears in the blood vessels lining the esophagus. Your baby's vomit may also be tinged with red if he's swallowed blood from a cut in his mouth or a nosebleed within the last six hours. But call the doctor if your baby continues to have blood in his vomit or the amount increases. As mentioned above, if the blood resembles dark coffee grounds, go to the emergency room right away.
• He has violent, persistent vomiting within half an hour of eating. This may be a sign ofpyloric stenosis (see below). Contact the doctor as soon as possible.
• You notice a yellowing of your baby's skin or the whites of his eyes, which is a sign ofjaundice. Jaundice accompanied by pain in the upper right side of the abdomen (which, of course, your baby won't be able to describe for you) may signal hepatitis.

Call a poison control center if:

• You suspect your baby has swallowed something poisonous. Call the American Association of Poison Control Center's national emergency hot line at (800) 222-1222 or your local poison control center immediately. If you can identify what he's swallowed — for example, you find an empty medicine bottle — tell the medical experts what it is and they'll give you exact instructions for taking care of your baby.

SYMPTOM GUIDE

Is it serious? Find out fast

Experts used to tell parents to keep either syrup of ipecac or activated charcoal on hand for poisoning emergencies. But that's no longer the case: Ipecac is not an effective treatment for poisoning — most emergency rooms don't even use it anymore — and activated charcoal hasn't been proven a safe or effective remedy to give children at home.

If you have ipecac in your home, the American Academy of Pediatrics (AAP) recommends that youdispose of it immediately and safely. (Never throw away any medications in a garbage can that your baby can get into.)

 

How can I keep my baby from getting dehydrated?

Dehydration can be a serious problem for babies, and if your baby is vomiting (or has a fever or diarrhea), he's losing precious fluids.

One way to keep your baby hydrated when he's been vomiting is with an electrolyte solution as soon as he's able to keep liquids down. Such solutions are sold over the counter in most drugstores — ask your pharmacist.

Don't force your baby to drink the electrolyte solution when he's still vomiting frequently (every five or ten minutes). But after his tummy's been calm for half an hour or so, offer him slow, frequent sips — say 1 teaspoon (5 cc) every ten minutes for a couple of hours. Then — if he tolerates that well — increase the amount to 2 teaspoons (10 cc) every five minutes. Continue to progress slowly until the vomiting eases up.

Juice can sometimes make matters worse (especially if your baby also has diarrhea), but if he's old enough to drink juice and it seems the best way to keep him hydrated, you can give it a try. Don't increase the amount of juice he normally drinks in a day, but you might try diluting it with water. (So if he's drinking 3 or 4 ounces of juice in a day, you might dilute this to 6 or 8 ounces of liquid.) Don't give your baby carbonated drinks or water.

Once your baby's tummy seems fine, you can resume formula feeding or breastfeeding. (Some moms breastfeed a bit while giving their babies electrolyte solution, while others wait. Take your cues from your baby.)

What about medications ?

Don't give your baby any prescription or over-the-counter anti-nausea medication unless his doctor recommends it.

And never give medications containing aspirin to a baby. Aspirin can make children susceptible to Reye's syndrome, a rare but potentially fatal illness.

When can my baby eat solids again?

Once your baby's vomiting diminishes or stops and his appetite returns, you can slowly reintroduce other fluids as well as healthful foods if he's on a solid diet. The AAP recommends that a child recovering from stomach troubles resume a normal diet as soon as possible: Offer whatever solid foods your baby normally eats, including complex carbohydrates (like breads, cereals, and rice), lean meats, yogurt, fruits, and vegetables — but steer clear of fatty foods.

This differs from the BRAT diet (bananas, rice, applesauce, and toast) that doctors used to prescribe. Studies show that reintroducing a standard diet can actually shorten recovery time by half a day because it restores essential nutrients that the body needs to fight infection.

Why is my baby vomiting?

Babies vomit for a number of reasons. And while it's always disconcerting for you and scary for your baby — it may even make him cry — vomiting usually isn't serious. (For guidance on when to see a doctor, see the first section of this article.)

Vomiting is different from spitting up, which your baby will also do, typically after a feeding. When a baby spits up — whether it's a few teaspoons trickling down his chin or a sizable amount on your shoulder — it comes out effortlessly, without seeming to upset his tummy or the rest of his body.

If your baby's throwing up, you'll want to find out what's causing it, both to confirm that he's okay and to make him more comfortable. Possible causes include:

Feeding problems
During your baby's first few months, vomiting is most likely linked to feeding problems, such as overfeeding or indigestion. A less common cause is an allergy to proteins in your breast milk or formula.

Viral or bacterial infection
Once your baby's a few months old, a stomach flu or other intestinal illness is the most likely culprit. If a virus or bacteria has infected your baby's stomach lining or intestine, other symptoms may include diarrhea, loss of appetite, abdominal pain, and fever. The vomiting usually stops within 12 to 24 hours.

Other infections
Congestion or a respiratory infection can lead to vomiting, especially during a coughing fit. A urinary tract infection and even an ear infection can sometimes cause nausea and vomiting. Throwing up can also be a symptom of serious illnesses like pneumonia,meningitis, appendicitis, and, in rare cases, Reye's syndrome.

Reflux
If your otherwise healthy baby throws up right after eating, chances are gastroesophageal reflux disease (GERD) is to blame. Reflux happens when the muscle between your baby's esophagus and stomach isn't working properly, allowing food and gastric acid to gurgle up from the stomach into the throat.

Although your baby can't tell you about his discomfort, he may also have an upset tummy and a burning sensation or irritation in his throat and chest. The problem will probably disappear by his first birthday, when the muscle gets stronger.

It's important to talk with the doctor if you think your baby may have GERD, though, because it can cause poor weight gain and other medical problems, and the doctor can prescribe medicine to help make your baby more comfortable.

Pyloric stenosis
This condition is most likely to occur in the first few weeks of life and rarely shows up after a baby's 6-month birthday. Babies with pyloric stenosis vomit when the muscle leading from the stomach into the intestines thickens so much that food can't pass through.

This usually causes forceful projectile vomiting. Because it can lead to malnutrition, dehydration, and other health problems, it requires immediate medical attention. If you think your baby may have this condition, contact his doctor as soon as possible. Pyloric stenosis can be corrected with surgery.

Motion sickness
Some babies and children tend to get motion sickness, which can be a problem if your daily routine includes a car trip. Experts believe that motion sickness happens when there's a disconnect between what your baby sees and what he senses with the motion-sensitive parts of his body, such as his inner ears and some nerves.

Poisonous substance
Your baby could be vomiting if he's swallowed something toxic, such as a drug, plant, medicine, or chemical. Or he may have gotten food poisoning from contaminated food or water. He may also have diarrhea.

Excessive crying
A prolonged bout of crying or coughing can trigger the gag reflex and make your baby throw up. Although it's troubling for both of you, throwing up during a crying spell won't physically harm your baby. If he appears otherwise healthy, there's no reason to be concerned.

Can I do anything to prevent vomiting?

Yes, several strategies are worth trying:

• If your baby vomits after feedings, give him smaller amounts and burp him more often. Don't bounce him on your knee, put him in a bouncy chair, or let him get too active right after he eats — the food needs time to settle in his tummy. Keeping him upright for about half an hour after he's finished eating also helps.
• If your baby has a lot of phlegm and mucus from a respiratory infection, try using abulb syringe to clear his nose. He probably won't enjoy it, but it isn't painful and may provide some relief.
• To help minimize motion sickness, schedule plenty of stops during your trips to give your baby a chance to get some fresh air and calm his tummy. If he's eating solids, give him a small snack before the trip — having something in his stomach will help. And offer plenty of fluids to keep him hydrated; otherwise he may get headachy or even dizzy or weak, which will only make him more miserable.