Why Is My Baby Vomiting?

Milk flows with force out of your baby’s mouth. Is she vomiting or refluxing? Many babies are said to be vomiting when they are in fact refluxing. It's helpful to know the difference as the cause and treatment differs. Find out how to recognize the difference, what causes vomiting and when a vomiting baby needs to see a doctor.

What is vomiting?

Vomiting is a forceful action where the contents of the stomach are propelled up through the esophagus (food pipe) and out of the mouth. Projectile vomiting is where stomach contents 'shoot out' (like a fountain) to a distance sometimes many feet away.

Nausea and retching often accompany vomiting. Nausea is the feeling of having an urge to vomit. Retching (sometimes referred to as 'dry retching') is when the actions of vomiting are made but nothing comes up. Diarrhea and fever are also frequently linked with vomiting (but not always). Diarrhea is frequent watery bowel movements and fever (an elevated body temperature) is when your baby feels hot to touch.

How is vomiting different to spitting up (possetting)?

Parents often become concerned when their baby spits up, mistakenly believing their baby is vomiting due to illness. Spitting up, which is associated with gastro-esophageal reflux, occurs in approximately 50 to 70 percent of healthy babies. Spitting up is most often due to normal body functions of infants and is not a sign that anything is wrong.

Forceful vomiting is quite different from spitting up which is effortless (though it can appear like it's forceful at times). Unlike vomiting, spitting up occurs without warning and is not linked with signs of illness, such as fever, nausea, retching or diarrhea. (These symptoms can and do occur with babies who spit up, for reasons that are not connected.)

What causes vomiting in babies and children?

Most people think vomiting is controlled by the stomach, but this is not correct! The brain controls the mechanisms involved in vomiting. Many different conditions can cause vomiting; sometimes the reason for vomiting has nothing at all to do with a problem related to the stomach or digestive tract.

Vomiting is very common in babies and children. Well babies may occasionally vomit, often for no identifiable reason. This can be a small or a large projectile vomit. Where vomiting is repeated it is generally because of illness. In most cases the reason is due to a viral gastro-intestinal infection, occasionally vomiting can be a symptom of a more serious illness.

Reasons for vomiting in babies and children may include:

food poisoning;
gastro-intestinal infection (see diarrhea for more information);
colds and flu;
chest infections, such as pneumonia or bronchitis;
sore throat due to tonsillitis or strep throat;
gastro-esophageal reflux disease (GERD);
Urinary tract infection (UTI);
appendicitis;
hepatitis;
blockage in the bowel, such as pyloric stenosis or duodenal atrasia;
food or milk allergy or intolerance;
ingestion (eating or drinking) or inhalation (breathing in) of toxins;
medications - such as antibiotics;
head injury;
infections of brain tissues, such as meningitis;
dizziness - motion sickness;
overeating;
excitement;
extreme anxiety or emotional stress.

Other causes are also possible. Any illness can cause vomiting, especially in infants. Sometimes no reason can be found.

The amount of milk that is spit up can range from a tiny amount, which sloshes up and out of a baby's mouth (often coming up with a burp) to large amounts*, which can unexpectedly 'shoot out' of a baby's mouth.

*Often what looks like large amounts is not as much as it seems. Even 1 oz (30ml) can appear huge when it comes from a tiny baby.

In rare cases spitting up can be linked with complications such as a failure to gain sufficient weight or weight loss (when excessively large amounts of milk are brought back up, time and time again); or esophagitis (inflammation of the food pipe) when stomach acid is repeatedly regurgitated/refluxed into the esophagus. (See gastro-esophageal reflux for more information.)

When to see a doctor!

Most babies and children vomit easily and recover quickly. A single vomiting episode, without other signs of illness, is not a cause for concern. However, repeated vomiting may be a sign that your child needs medical attention.

See a doctor if your child...

has a fever;
vomiting lasts for longer than 12 hours; (If your baby is younger than 3 months, after 2 vomits in a row.)
vomit contains blood (this can be red or coffee colored);
vomit contains bile (green colored vomit, not related to green food);
shows any signs of dehydration;
has any swelling or sharp pain in the abdomen;
becomes confused or listless;
vomits following a fall;
ingests or inhales anything toxic. (Telephone the Poisons Information line in your country for advice immediately).

What you can do to help!

In most cases, where vomiting is related to a gastro-intestinal infection, vomiting generally only lasts for 12 - 48 hours (diarrhea will last for much longer). Usually, after the stomach is empty, vomiting or retching only occur a further 3 or 4 times.

While your child is vomiting, care should be taken to prevent dehydration due to fluid loss (especially if she also has a fever or diarrhea). Before your child feels well enough to eat again, she will probably be able to drink fluids. Encourage her to drink clear fluids frequently (such as oral rehydration solutions e.g. Pedialyte, Gastrolyte etc.) even if she can manage only a few sips at a time.

Once vomiting has settled for a period of 8 hours, it is generally fine to offer your child her regular diet. (See Dehydration for more on when and what to offer.)

When a toddler vomits unexpectedly, it's important to make sure she has not swallowed medications, household liquids or other poisons. Contact the Poisons Information Line in your country immediately if you discover your child has swallowed something toxic.

Do not use medication to try to stop the vomiting, unless advised to do so by a doctor.

DISCLAIMER: This information should not be used as a substitute for the medical care and advice of your child's doctor. There may be variations in treatment that your child's doctor may recommend based on individual facts and circumstances.

Written by Rowena Bennett.