Experts in children’s health say parents should have cause to worry when babies vomit persistently, warning that it could be an indication of a serious underlying medical condition.
The paediatricians noted that an infant that vomits non-stop may be suffering from conditions like gastric reflux, intestinal blockages, gastroenteritis, and urinary tract infections, among others.
While the experts acknowledged that babies occasionally vomit and that it may not be a major health issue, they encouraged parents to seek urgent medical attention if it becomes unusual and persistent.
Speaking with PUNCH HealthWise, a Consultant Paediatrician at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Professor John Okeniyi, said allergic reactions to certain foods, including cow’s milk protein, can lead to persistent vomiting in infants.
He explained that certain metabolic disorders, such as galactosemia (a disorder that affects how the body processes a simple sugar called galactose), or urea cycle disorders can cause vomiting in an infant.
He noted that infants with neurological disorders like hydrocephalus (a neurological disorder caused by an abnormal buildup of cerebrospinal fluid in the ventricles (cavities) deep within the brain) or brain tumours may also cause frequent vomiting.
Prof. Okeniyi, said parents should be able to distinguish between vomiting, regurgitation, and posseting, adding that despite appearing similar, they have distinct characteristics and occurs under 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.”
Prof. Okeniyi said there have been cases of babies having allergic reactions to proteins present in their mother’s milk, especially for mothers that consume certain allergenic foods.
The paediatrician further said some infants may experience wheezing, coughing, or difficulty breathing due to 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.”
Meanwhile, a Senior Consultant Paediatrician, University of Ilorin Teaching Hospital, Kwara State, Dr. Olayinka Ibrahim, said vomiting in babies may not entirely be due to gastrointestinal system immaturity, adding that an infant may partly regurgitate digested breast milk.
He noted that the early introduction of infant formula may lead to 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.”
In a paper published in the MSD Manual by a Clinical Assistant Professor of Paediatrics at the Thomas Jefferson University Hospital, Deborah Consolini, it was stated that persistent vomiting in an infant can be a sign of a serious medical problem, such as a blockage in the stomach or intestine, or increased pressure within the skull.
Consolini in the paper also identified gastroenteritis, which is known as an infection of the digestive tract, and gastroesophageal reflux disease as the main causes of persistent vomiting in infants.
She noted that persistent vomiting in infants can be life-threatening as it can cause a blockage of the passage out of the stomach in infants between three to six weeks.
“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.”
