Patient's question:
BR>Age of the patient: Newborn, three weeksRecently, the baby often spits up milk, with varying amounts most of the time. Mostly it is milk, occasionally with milk curds. Twice, it even choked out of the nose. Also, the stomach often makes gurgling sounds. Please ask if this is normal or if there is a gastrointestinal problem, and how to solve it?
Medical history: None
Onset and duration of the current illness: One week
Doctor's answer:
Hello! First of all, I wish your child a speedy recovery! I will discuss the issue of "newborn vomiting" with you. Vomiting is a symptom caused by various reasons, such as the reverse peristalsis of the esophagus, stomach, and intestines, accompanied by strong spasmodic contractions of the abdominal muscles and diaphragm, forcing the contents of the esophagus and gastrointestinal tract to gush out of the mouth. Vomiting is sometimes also a natural defensive mechanism of the human body, which can expel harmful substances ingested and thus provide protection. Almost any infection or emotional tension can cause vomiting.1) Vomiting is generally classified into the following three types:
1. Spit-up (Milk Reflux) – This is most common in infants under 6 months, especially newborns. It is related to a horizontal stomach, relaxed pyloric sphincter, tense pyloric sphincter, and improper feeding. It is characterized by small amounts of milk refluxing into the mouth or spilling out of the mouth. Generally, improving feeding methods or as the child grows older, it can resolve on its own. The second type is regurgitation: Due to increased muscle activity in the jaw and pharynx, 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 growth and development disorders.
2. Common Vomiting – Nausea often precedes vomiting, followed by vomiting a small amount of content or multiple times in a row. Persistent or repeated vomiting is pathological and is more common in gastrointestinal infections, overeating, and recurrent vomiting.
3. Projectile Vomiting – Vomiting often occurs without nausea, with large amounts of stomach contents suddenly expelled through the mouth or nose. This is usually caused by conditions such as pyloric obstruction, gastric torsion, or increased intracranial pressure.
2) Newborn Vomiting:
1. Newborn vomiting is one of the common symptoms during the neonatal period:
① Curd-like vomit: Seen in improper feeding, gastric torsion, gastroesophageal reflux, pyloric spasm, etc.
② Vomit containing bile: Seen in congenital annular pancreas, malrotation of the intestine, gastrointestinal duplication, etc.
③ Vomiting with abdominal distension: Congenital megacolon, anorectal malformations, meconium ileus, meconium peritonitis, neonatal necrotizing enterocolitis, etc.
④ Vomiting with bulging fontanelles: Hydrocephalus, neonatal hypoxic-ischemic encephalopathy, intracranial hemorrhage, etc.
⑤ Vomiting with physical abnormalities: Congenital adrenal hyperplasia, galactosemia, etc.
2. Acute Vomiting – This is caused by viral, toxic, or bacterial infections and is often accompanied by diarrhea and abdominal pain.
3. Periodic Vomiting (Recurrent Vomiting) – This is a persistent, refractory type of vomiting that often begins between 2–4 years of age and does not recur 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 eating habits are common triggers. Its characteristic is repeated, sudden, frequent vomiting that lasts for 1–3 days before subsiding.
4. Neurotic Vomiting (Psychogenic Vomiting) – This is characterized by recurrent vomiting without organic lesions and is often related to psychosocial factors. It is triggered by unpleasant environments or psychological stress, leading to repeated, involuntary vomiting episodes, usually occurring after meals. The vomit is projectile without significant nausea or discomfort, and the child’s appetite is not affected. They can eat again after vomiting.
3) Nursing 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 upright 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, rinse the bottle with boiling water before each feeding, fill the nipple with milk, and then feed. 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 after feeding.
2. For Infants with Frequent Vomiting: If organic lesions or gastrointestinal inflammation are ruled out, it is likely gastroesophageal reflux. A head-elevated, side-lying position with the head raised 15° is beneficial. For infants with gastroesophageal reflux, a lateral prone position for 20 minutes, 2–4 times daily, can help. However, during prone positioning, there must be to prevent apnea. This can reduce reflux frequency, vomiting episodes, and the risk of aspiration, thereby preventing aspiration pneumonia and suffocation.
3. Periodic and Neurotic Vomiting:
- Strengthen physical exercise to improve constitution, maintain a regular lifestyle, avoid overeating, and keep the mind calm. Do not force the child to eat.
- Avoid putting any pressure on the child, as this may worsen vomiting.
- Arrange the child’s life reasonably, including a feeding schedule, physical exercise, and increased sleep time.
- Family members should not pay excessive attention to the child’s vomiting, avoid showing nervousness or concern in front of the child, and boost their confidence in treatment.
- Keep the environment clean, promptly clean up vomit, and change soiled clothes, sheets, and bedding to avoid further irritation.
- Stay by the child’s side during vomiting for emotional support. After vomiting, help them rinse their mouth and bathe them frequently to remove lingering odors from vomiting.
4. For Children Prone to Vomiting, Especially After Colds or Coughing:
- Strengthen nutrition and physical exercise to boost immunity. Consider taking colostrum or transfer factor to prevent colds.
- Eat on a regular schedule, avoid overeating, ensure food is fresh and hygienic, and avoid spicy, smoked, or greasy foods.
5. Medication-Induced Vomiting:
- When administering medication, ensure the liquid is not too hot or cold. For difficult-to-feed children, use small, frequent doses. If necessary, pause for a moment before continuing.
- After vomiting, clean the child’s mouth, face, and neck promptly, and change soiled clothes and sheets.
6. Children with Sensitive Pharyngeal Reflexes:
- If vomiting occurs easily with colds, inform the doctor. Such children should eat easily digestible liquids or semi-liquids and avoid overeating, usually consuming about half their usual amount.
4) Love Reminder: Most vomiting is caused by gastritis or enteritis. Parents should pay attention to their child’s bowel movements and shape, seek medical attention promptly, and follow the doctor’s advice. Additionally, encourage the child to drink light salt water.
- If vomiting is mild, feed them easily digestible fluids in small, frequent amounts.
- If vomiting is severe, temporarily withhold food.
- During vomiting, have the child lie on their side or lower their head to prevent aspiration.
- Pay attention to the vomiting pattern, frequency, vomit characteristics (shape, odor), relationship to eating, mental state, appetite, bowel movements, and accompanying symptoms. Inform the doctor promptly to aid diagnosis and treatment.
If you find this answer helpful, please do not disappoint me by not clicking "Accept as Answer" in a timely manner.