Vomiting In Newborns: Is It Cause For Concern?

It is common for newborns to vomit, and in most cases, it is not something to worry about. The most common type of vomiting in newborns is called posseting or spitting up, where the baby brings up small amounts of milk after feeding. This usually gets better as the baby grows. However, there are times when vomiting may indicate something more serious, such as a blockage in the intestines or a bowel obstruction, especially if the vomit is green or contains blood. Other signs of concern include frequent and forceful vomiting, dehydration, refusal to feed, and vomiting lasting longer than a day or two.

Projectile vomiting may indicate a bowel obstruction

It is common for newborns to vomit, and in most cases, this is not a cause for concern. Mild vomiting occurs because a young baby is still getting used to feeding, digesting, and eliminating milk. On average, a newborn baby's stomach can only hold around 20 millilitres, so it doesn't take much milk for them to fill up and vomit the excess. This is known as "possetting", which refers to small amounts of milk brought up after a feed.

However, vomiting can also be a sign of illness or complications. If your baby seems unwell, has a temperature, is not feeding well, has diarrhoea, a rash, or experiences any other symptoms, seek medical advice.

Projectile vomiting, or forceful vomiting, can be a symptom of a blockage at the outlet of a baby's stomach. If it occurs after most or all feeds, it may indicate a bowel obstruction, which requires immediate medical attention. Bowel obstruction in newborns is a serious condition that requires the involvement of a team of pediatric surgeons and neonatologists.

Bile (green, not yellow) in the vomit is a key indicator of a bowel obstruction. This is known as bilious vomiting. If a newborn is vomiting bile, it should be presumed that there is a bowel obstruction until proven otherwise. A supine abdominal X-ray will usually reveal an abnormal gas pattern, such as distension of the stomach and proximal duodenum.

Other signs of a bowel obstruction include:

• Bloody diarrhoea
• Abdominal distention
• Imperforate anus
• Dilated bowel loops
• Air-fluid levels

If a bowel obstruction is suspected, a naso- or orogastric tube should be placed immediately to decompress the stomach, followed by physical examination and abdominal X-rays. Treatment for bowel obstruction includes urgent surgical referral, IV fluids, gastric drainage, and assessment for other congenital abnormalities.

Vomiting with blood may be caused by swallowing maternal blood

It is normal for newborns to vomit, and in most cases, this is insignificant. However, as normal as vomiting is, it can be worrying for parents. Vomiting can be a sign of illness or complications, but for most babies, it occurs because their digestive systems are still developing.

Types of vomiting

• Possetting: Small amounts of milk brought up after a feed.
• Reflux: Occurs when the valve at the top of a baby's stomach is not tight enough to keep milk in.
• Projectile vomiting: Vomiting with force, which can be a symptom of a blockage at the outlet of a baby's stomach.

When to see a doctor

• If you are concerned about your baby's vomiting.
• If your baby is showing other signs of illness, such as a temperature, diarrhoea, or a rash.
• If your baby seems lethargic, sleepy, and not interested in feeding.
• If your baby is losing weight and not thriving.
• If there is blood or bile in their vomit.
• If their vomiting isn't stopping or is getting worse.

Vomiting with blood

While vomiting is common in newborns, it is important to be alert to the presence of blood (red or black) in the vomit, as this can indicate a more serious issue. Vomiting with blood may be caused by the baby swallowing maternal blood during birth or breastfeeding, particularly if the mother has a cracked and bleeding nipple. This can irritate the baby's stomach and cause vomiting. In rare cases, the baby may be bleeding due to conditions such as haemorrhagic disease of the newborn (HDN) or stress ulceration. If you notice any blood in your baby's vomit, it is important to seek medical advice.

Reflux is a common cause of vomiting in newborns

It is normal for newborns to vomit, and in most cases, it is insignificant. However, vomiting can sometimes be a sign of illness or complications. One common cause of vomiting in newborns is reflux, which occurs when the valve at the top of the baby's stomach is not tight enough to keep milk in, and the food from the baby's stomach returns to the oesophagus. This is because a newborn's gut and digestive tract are still developing.

Reflux, or gastroesophageal reflux (GER), is very common among babies in their first year of life. About 50% of infants up to 3 months old show signs of reflux, and about 66% of infants show daily signs of reflux by 4 months. However, by 7 months, this number drops to 14%, and it's less than 5% by 10 to 14 months. In most cases, reflux is harmless and not a cause for concern. It usually gets better on its own as the baby gets older and their oesophagus develops further.

Symptoms of reflux in babies include bringing up milk or being sick during or shortly after feeding, coughing or hiccupping when feeding, being unsettled during feeding, swallowing or gulping after burping or feeding, crying and not settling, and not gaining weight due to insufficient food intake. In some cases, babies may experience silent reflux, where they do not bring up milk or vomit but still exhibit other signs of reflux.

If you suspect your baby has reflux, there are some things you can try to ease their discomfort. These include holding your baby upright during and after feeding, burping your baby regularly during feeds, giving formula-fed babies smaller feeds more frequently, and ensuring your baby sleeps flat on their back. If your baby is formula-fed, your doctor may recommend a powder that can be mixed with formula to thicken it or a pre-thickened formula milk.

While reflux is usually harmless, it is important to monitor your baby's vomiting pattern and frequency. If you are concerned about your baby's vomiting, or if they exhibit other signs of illness, such as lethargy, diarrhoea, or blood in their vomit, you should seek medical advice.

Vomiting may be caused by a food allergy or intolerance

It is normal for newborns to vomit, and in most cases, it is insignificant. However, vomiting may be caused by a food allergy or intolerance.

Food allergies are a common cause of vomiting in babies. Along with hives, vomiting is one of the most common symptoms of a food allergy reaction in infants and young children. It is important to distinguish between vomiting and spitting up, as spitting up is common in babies due to their immature digestive systems. If your baby forcefully expels food and seems uncomfortable or in distress, they are likely vomiting rather than spitting up.

Immediate-type food allergies, also known as IgE-mediated food allergies, cause symptoms such as hives, swelling, and vomiting soon after consuming the trigger food, usually within minutes to two hours. On the other hand, delayed-type food allergies are rarer and involve GI symptoms like vomiting, diarrhea, stomach pain, and abdominal pain, which can occur hours to days after consuming the allergen. One rare type of delayed food allergy that heavily involves vomiting is FPIES (food protein-induced enterocolitis syndrome).

Food intolerances are different from food allergies as they do not involve the immune system. However, they can still cause GI symptoms such as vomiting, diarrhea, stomach pain, and gas. Food intolerance symptoms typically develop hours to days after consuming the trigger food.

If you suspect that your baby's vomiting is due to a food allergy or intolerance, it is important to consult your doctor. They can help guide you in identifying any food triggers and determining the best course of action to manage your baby's condition.

Gastroenteritis is a common infection that causes vomiting

It's normal for newborns to vomit, and in most cases, it's insignificant. However, vomiting can sometimes indicate an illness or complication. Gastroenteritis, an infection of the gut (intestines), is a common condition that causes vomiting in newborns. It is characterised by inflammation of the digestive tract, particularly the stomach and intestines, and has various origins. Here are some detailed instructions on recognising and addressing gastroenteritis in newborns:

Causes of Gastroenteritis

Gastroenteritis is typically caused by a virus, bacterium, or germ. In newborns, the virus is usually of the rotavirus type, but enteroviruses and adenoviruses can also be the cause. It can be spread through contact with contaminated surfaces, objects, or caregivers' hands. Additionally, food poisoning from bacteria such as Escherichia coli or Salmonella in baby food can lead to gastroenteritis. Water contaminated by bacteria or other microbes is another common cause, particularly in areas with inadequate sanitation.

Symptoms of Gastroenteritis

The primary symptom of gastroenteritis is diarrhoea, often accompanied by vomiting. Diarrhoea is characterised by loose or watery stools, occurring at least three times in 24 hours. Abdominal cramps, fatigue, and loss of appetite may also be present. Blood or mucus in the stools can be indicative of a more severe infection. Dehydration is a significant risk associated with gastroenteritis, as the loss of fluids and essential mineral salts like potassium and sodium can quickly become concerning.

Recognising Dehydration

It is crucial to monitor your baby for signs of dehydration, including dark circles or sunken eyes, a hollow soft spot on the head, a dry tongue, persistent skin folds on the stomach, decreased urine output, dark-coloured urine, and increased sleepiness or weakness. Dehydration is one of the main reasons for hospitalisation in young children, so it is vital to take preventive measures and seek medical attention if needed.

Preventing Dehydration

To prevent dehydration, regularly weigh your baby to monitor for weight loss, which should not exceed 5% of their normal weight. Additionally, observe your baby's behaviour—if they seem weak, cry without producing tears, or appear generally unwell, consult a doctor.

Managing Gastroenteritis

When noticing symptoms of gastroenteritis, speak to your doctor and continue to provide your baby with breast milk or their usual milk. Divide meals into smaller, more frequent feedings to prevent your baby from refusing food. Rehydration solutions, broths, and probiotic foods like yoghurt can help maintain hydration and restore intestinal flora.

When to Seek Medical Advice

While most cases of gastroenteritis resolve within a few days, it is important to seek medical advice if your baby is under six months old, has an underlying medical condition, exhibits a high temperature, shows signs of dehydration, appears drowsy or confused, is unable to keep fluids down due to vomiting, has blood in their diarrhoea or vomit, or experiences severe abdominal pain.

Frequently asked questions