Persistent Vomiting may be signs of health complications in infants – Paediatrician

Medical experts specializing in children’s health advise that when infants vomit persistently, it could be a sign of a more serious medical condition, thus causing concern for parents.

According to pediatricians, continuous vomiting in infants may indicate various health issues, including gastric reflux, intestinal blockages, gastroenteritis, and urinary tract infections, among others.

While the specialists recognize that occasional vomiting in babies may not be a significant health problem, they stress the importance of seeking immediate medical attention if it becomes uncommon and persistent.

In an interview with PUNCH HealthWise, Professor John Okeniyi, a Consultant Paediatrician at the Obafemi Awolowo University Teaching Hospital Complex in Ile-Ife, Osun State, explained that persistent vomiting in infants can be caused by allergic reactions to certain foods, such as cow’s milk protein.

He further pointed out that metabolic disorders like galactosemia (a condition affecting the body’s processing of galactose, a simple sugar) or urea cycle disorders can also lead to vomiting in infants.

Additionally, infants with neurological disorders such as hydrocephalus (an abnormal buildup of cerebrospinal fluid in the brain’s ventricles) or brain tumors can experience frequent episodes of vomiting.

Prof. Okeniyi emphasized the importance of parents being able to differentiate between vomiting, regurgitation, and posseting. Although they may appear similar, each has distinct characteristics and occurs in different circumstances.

He said, “Vomiting, or emesis, refers to the forceful expulsion of stomach contents through the mouth. It is typically preceded by nausea and involves complex coordinated muscular contractions. It is often accompanied by heaving or retching, where the diaphragm and abdominal muscles contract forcefully, aiding in the expulsion of stomach contents. Vomiting can be caused by various factors, including gastrointestinal infections, side effects of medications, or underlying medical conditions.

“Regurgitation is the passive flow of stomach contents back up into the oesophagus, usually without any associated forceful contractions or effort. It occurs due to a malfunction of the lower oesophageal sphincter or lower throat junction, which is the muscular valve that separates the oesophagus or throat from the stomach. When this junction fails to close properly, stomach contents, such as food or acid, can reflux back into the oesophagus. Regurgitation is commonly experienced in gastroesophageal reflux disease (GERD) or certain anatomical abnormalities.

“Posseting is a term often used to describe the gentle, effortless expulsion of small amounts of milk or formula from a baby’s mouth. It is a common occurrence in infants and is different from vomiting or regurgitation. Posseting is typically associated with feeding and occurs due to the immaturity of the baby’s digestive system or an overfilled stomach. It is not forceful or accompanied by retching, and the baby is usually content after posseting.”

According to Professor Okeniyi, there have been instances where babies have shown allergic reactions to proteins found in their mother’s milk, particularly when the mothers consume certain allergenic foods.

The pediatrician also mentioned that some infants may exhibit symptoms such as wheezing, coughing, or breathing difficulties as a result of allergic reactions to breast milk.

“Less common symptoms may include irritability, colic-like behaviour, poor weight gain, or failure to thrive. If a mother suspects that her baby may have a breast milk allergy, it is important to consult with a healthcare professional, such as a paediatrician or allergist. They can help evaluate the symptoms, determine the underlying cause, and provide appropriate guidance and support. In some cases, they may also recommend dietary changes for the breastfeeding mother or alternative feeding options for the infant, such as hypoallergenic formulas.

“It’s important to note that persistent vomiting in infants should be evaluated by a healthcare professional for proper diagnosis and appropriate treatment. They will consider the baby’s symptoms and medical history, and may conduct further tests or examinations to determine the underlying cause and provide the necessary care.”

Contrarily, Dr. Olayinka Ibrahim, a Senior Consultant Paediatrician at the University of Ilorin Teaching Hospital in Kwara State, explained that vomiting in babies is not solely caused by the immaturity of their gastrointestinal system. He added that infants can also partially regurgitate already digested breast milk.

Dr. Ibrahim further emphasized that introducing infant formula at an early stage could potentially result in the development of allergic reactions to cow milk proteins.

“While all organs are present at birth, they mature over time including the gastrointestinal and kidney systems. Hence, the best-suited nutrition for a newborn appropriate development and maturity is breast milk.

“While genetics play some role in the allergy development in children, exposure to cow milk proteins has been found to be strongly linked with allergy. This is one of the reasons exclusive breastfeeding is encouraged in the first six months of life before the introduction of other complementary feeds.

“If a baby is okay and has no medical problem, he or she may occasionally regurgitate feed, which is partly digested breast milk with a cheese-like appearance. There is no problem as this will subside as the baby grows older.

“However persistent vomiting and projectile vomiting with poor growth require further evaluation by professionals,” he advised.

Continuing, the paediatrician said, “Infant formulas are derivatives of cow milk, which is known to cause serious allergies in infants. The degree of allergy varies from mild to severe. Most cases fall into the mild to moderate categories and could be disturbing to an infant.

The severe form is not uncommon, but it could occur in some babies. There are various disorders of gastrointestinal that could cause persistent vomiting, for example, intestinal obstruction and infection.”

According to a publication in the MSD Manual by Deborah Consolini, a Clinical Assistant Professor of Pediatrics at Thomas Jefferson University Hospital, persistent vomiting in infants can indicate a serious medical condition. This can include a stomach or intestinal blockage, as well as increased pressure inside the skull.

Consolini’s paper highlights gastroenteritis, an infection affecting the digestive tract, and gastroesophageal reflux disease as the primary causes of persistent vomiting in infants.

She further explained that persistent vomiting in infants can be life-threatening, particularly because it can lead to a blockage in the passage out of the stomach for infants between three to six weeks old.

“Children with warning signs should be immediately evaluated by a doctor, as should all newborns. A child whose vomit is bloody and resembles coffee grounds, or is bright green, and children with a recent (within a week) head injury. If children appear uncomfortable even when not vomiting and their discomfort lasts more than a few hours, should probably be evaluated by a doctor.

“For other children, signs of dehydration, particularly decreased urination and the amount they are drinking help to determine how quickly they need to be seen. The urgency varies somewhat by age because infants and young children can become dehydrated more quickly than older children. Generally, infants and young children who have not urinated for more than 8 hours or who have been unwilling to drink for more than 8 hours should be seen by a doctor.

“The doctor should be called if children have more than six to eight episodes of vomiting, if the vomiting continues more than 24 to 48 hours, or if other symptoms (such as cough, fever, or rash) are present. Children who have had only a few episodes of vomiting (with or without diarrhoea), who are drinking at least some fluids, and who otherwise, do not appear very ill rarely require a doctor’s visit.”