Patient's question:
Patient Age: Nine monthsDescription of Symptoms: Vomited shortly after eating milk in the morning.
Doctor's answer:
Types of Pediatric Vomiting and CareVomiting is a symptom caused by the reverse peristalsis of the esophagus, stomach, and intestines, accompanied by strong spasmodic contractions of the abdominal and diaphragmatic muscles, forcing the contents of the esophagus and gastrointestinal tract to be expelled from the mouth. Vomiting is sometimes a natural defensive mechanism of the human body, which can expel harmful substances ingested, thereby providing protection. Almost any infection or emotional stress can cause vomiting.
There are three types of vomiting:
1. Milk Reflux
Most common in infants under 6 months, especially newborns. This is related to a horizontal stomach, relaxed pyloric sphincter, tense pyloric sphincter, and improper feeding. It is characterized by a small amount of milk refluxing into the mouth or spilling out of the mouth. Generally, improving feeding methods or age-related growth can lead to self-healing. The second is regurgitation: due to increased jaw and pharyngeal muscle activity, stomach contents reflux into the mouth. This phenomenon is more common in infants over 6 months and is often accompanied by abnormal mental states, leading to malnutrition and developmental delays.
2. Common Vomiting
Often preceded by nausea, followed by vomiting one or several times. Persistent or repeated vomiting is pathological and is commonly seen in gastrointestinal infections, overeating, and recurrent vomiting.
3. Projectile Vomiting
Usually without nausea before vomiting, with a sudden expulsion of large amounts of stomach contents through the mouth or nose. This is often caused by conditions such as pyloric obstruction, gastric torsion, and increased intracranial pressure.
### Newborn Vomiting
Newborn vomiting is one of the common symptoms during the neonatal period:
1. Vomiting with curdled milk
Seen in improper feeding, gastric torsion, gastroesophageal reflux, and pyloric spasm.
2. Vomiting with bile
Seen in congenital annular pancreas, malrotation of the intestine, and gastrointestinal duplication.
3. Vomiting with abdominal distension
Seen in congenital megacolon, anorectal malformations, meconium ileus, and meconium peritonitis.
4. Vomiting with fontanelle bulging
Seen in hydrocephalus, neonatal hypoxic-ischemic encephalopathy, and intracranial hemorrhage.
5. Vomiting with physical abnormalities
Seen in congenital adrenal hyperplasia and galactosemia.
### Acute Vomiting
Acute gastritis or enteritis is caused by viruses, toxic substances, or bacterial infections and is often accompanied by diarrhea and abdominal pain.
### Periodic Vomiting (Recurrent Vomiting)
Periodic vomiting, also known as recurrent vomiting, is a persistent and refractory type of vomiting that often begins between 2–4 years of age and does not occur after puberty. The exact cause is unknown, but it is generally believed to be related to constitutional factors. Upper respiratory infections, emotional fluctuations, fatigue, and irregular diet are common triggers. Its characteristics include repeated sudden attacks of frequent vomiting, which last for 1–3 days before subsiding.
### Neurotic Vomiting (Psychogenic Vomiting)
Characterized by recurrent vomiting without organic lesions, it is often associated with psychosocial factors. It is triggered by unpleasant environments or psychological stress, leading to repeated involuntary vomiting episodes, usually occurring after meals. The vomiting is sudden and projectile, with no obvious nausea or other discomfort, and does not affect appetite. The child can eat after vomiting.
### Care Tips
Some children frequently vomit. For vomiting caused by non-organic lesions, parents should know how to care for their child to reduce recurrence. Here are some tips:
1. Feeding Position
- Preferably hold the baby while feeding. If lying down, use a head-elevated position.
- For breastfeeding, wipe the nipple with warm water before each feeding and support the breast with four fingers, placing the thumb on the areola to slow milk flow.
- For bottle-feeding, wash the bottle with boiling water before each feeding and ensure the nipple is fully filled before feeding. Avoid excessively large nipple holes.
- After feeding, hold the baby upright and pat their back to expel swallowed air. Avoid quickly lifting the legs to change diapers immediately after feeding.
2. For Infants with Frequent Vomiting (After Excluding Organic Lesions and Gastrointestinal Inflammation)
- Most likely due to gastroesophageal reflux. Choose a head-elevated side-lying position, with the head elevated by 15°.
- For infants with gastroesophageal reflux, use a lateral prone position for 20 minutes each time, 2–4 times daily.
- Ensure specialized care during prone positioning to prevent apnea, which can reduce reflux frequency, vomiting episodes, and aspiration, thereby avoiding aspiration pneumonia and suffocation.
3. Recurrent and Neurotic Vomiting
- Strengthen physical exercise to improve constitution, maintain a regular lifestyle, avoid overeating, and keep the mind calm. Do not force feeding.
- Avoid adding pressure to the child, as this may worsen vomiting.
- Arrange a reasonable lifestyle, including a feeding schedule, physical exercise, and increased sleep time.
- Avoid excessive attention to the child’s vomiting symptoms in front of others. Avoid showing nervousness or concern to boost their confidence in treatment.
- Keep the environment clean. Promptly handle vomit and replace soiled clothes, bedding, and sheets to prevent further irritation.
- Stay by the child’s side during vomiting for emotional support. After vomiting, help them rinse their mouth and bathe frequently to remove lingering odors from vomiting.
4. For Children Prone to Vomiting, Especially After Colds or Coughing
- Strengthen nutrition and physical exercise to improve immunity. Consider taking colostrum or transfer factor to prevent colds.
- Maintain a regular and moderate diet. Avoid overeating. Ensure food is fresh and hygienic. Avoid spicy, smoked, or greasy foods.
5. Vomiting During Medication
- Ensure medication is not too hot or cold. For difficult-to-feed children, use small, frequent doses.
- If necessary, take a sip, pause, and then continue.
- Clean the child’s mouth, face, and neck promptly after vomiting. Replace soiled clothes and bedding.
6. Children with Sensitive Pharyngeal Reflexes
- These children may vomit easily with a cold. Inform the doctor about this during visits. Recommend easily digestible liquids or semi-liquids, avoiding overeating (usually half of their normal diet).
### Special Reminder
Most vomiting is caused by gastritis or enteritis. Parents should monitor their child’s bowel movements and shape, seek medical attention promptly, and follow the doctor’s advice. Additionally, encourage the child to drink light saltwater.
- For mild vomiting, provide easily digestible fluids in small, frequent amounts.
- For severe vomiting, temporarily withhold food.
- During vomiting, place the child in a side-lying position or lower their head to prevent aspiration.
Pay attention to the vomiting pattern, frequency, characteristics of vomit (shape, odor), relationship with meals, mental state, appetite, bowel and bladder habits, and accompanying symptoms. Promptly inform the doctor to aid diagnosis and treatment.