When does my doctor need to be involved?
Call your doctor if your baby’s vomiting is persistent or uncontrollable. This includes a baby who continues to vomit despite an empty stomach (called dry heaving) or who continues to vomit over several hours, unable to tolerate any liquids. Call if the colour of the vomit is red, dark brown, or black. These are all colours associated with blood. Green vomit contains bile and is also worrisome – a doctor should evaluate any child who has it.
Anytime you think that the vomiting is becoming projectile, your baby should be evaluated for pyloric stenosis.
What tests need to be done, and what do the results mean?
Vomiting rarely requires medical tests. In the case of bloody or green vomit, however, an X-ray may be helpful to look at the bowels. X-rays can show poor functioning in the intestines.
If there is blood in the vomit, then a complete blood count may be done to make sure that the baby is not losing too much blood. In extreme cases, if there is a significant amount of bleeding associated with the vomiting, then a small camera can be inserted through the mouth into the esophagus, stomach, and intestine in order to look for the source of the blood. This is called endoscopy.
If pyloric stenosis is suspected, then a physical exam may reveal a small round lump where the outlet of the stomach is. This lump, which feels like an olive, represents the actual thick and tight pyloric sphincter. To confirm the diagnosis, your doctor will do an ultrasound. Sometimes babies must drink some milk during the ultrasound so that the liquid can be followed down to the stomach and the outline of the enlarged pyloric sphincter can seen.
What are the treatments?
The main treatment for most types of vomiting is time. If an infection (such as a virus or bacteria) is the cause, then the infection will typically pass and the vomiting will subside. Some infections – such as parasites – require treatment with specific medications.
There are medications available to stop acute vomiting. These medications, called antiemetics, are rarely used in infants but may be recommended if a child is becoming dehydrated. The most common of these is promethazine (also called Phenergan), given in the form of a rectal suppository since the oral form usually will not stay down in a vomiting child.
If pyloric stenosis is the cause of the vomiting, then the treatment is surgery. The surgery is a relatively simple procedure whereby the thickened, tight pylorus is cut to release the pressure on the outlet of the stomach. Children are often drinking within hours of the surgery, and the forceful spitting up resolves completely.
What are the possible complications?
The most worrisome complication of persistent vomiting or longstanding pyloric stenosis is dehydration. Dehydration can become quite severe, especially in a small baby with little reserve.
Repetitive or forceful vomiting can also cause tears in the lining of the esophagus. When this occurs at the lower end of the esophagus, it is called a Mallory-Weiss tear. Its hallmark is bright-red blood with vomiting.