When should Parents worry about infant vomiting

Vomiting among new born/infant is often considered normal but sometimes we neglect it by staying as thinking it normal. My one month old baby had to go through pylorus surgery due to excessive vomiting. The doctors say pylorus stenosis happens due to abnormal thickening in abdominal passage. Thus, the food cannot pass through the passage resulting forceful vomiting. The surgery was successful. There is no instances of vomiting now. Despite of successful surgery, we as a parents became too late for quick and proper diagnosis. At the beginning, every visitors at home told vomiting was not a big problem. Every mothers had their own experiences. I heard saying "vomiting is normal and good for baby's health and respiratory phenomenon". Days passed by from weeks to nearly a month but my baby still continued to vomit with no signs of improvement. Between we had been to hospitals as but it could not diagnosed the proper cause. I belong to Newar family where we also believe in traditional healers. It did not take seconds to trust my family members and seek help from gurujis/maa for traditional healing methods. After so many hospital visits and medical consultations, we came to know our baby had a rare issue called "Pylorus" which means baby needs immediate surgery. We are extremely thankful to Dr. Madhusudan Kayastha , who examined my baby suggesting to do perform immediate ultrasounds. The reports directed the baby had to be immediately under go the surgery .

We had discussed with Dr. Madhusudan Kayastha, paediatrics with few important questionnaires that every new parents should be careful about.

1) It is often believed that baby vomiting is quite normal in new born, when should we start worrying about it?

It is actually not normal but usually seen after feeding newborn with small amount, and if the vomitus is curdy in nature. It's worrisome when vomiting is always present after feeding despite proper positioning and attachment during feeding followed by burping and when amount of vomitus is profuse and there is change in colour of vomitus.

2) We have seen lots of parents/family take infants to the traditional healers (maa/priests/gurujis) for treatment. As a medical doctor, what do you think is it a good practice ?

Following such beliefs before consulting your doctor obviously is wrong. One should consult physician or respective doctors when you fall ill. But my personal view is that once you start with proper management of your disease following a physician's advice, I don't mind patients visiting such traditional healers. There is no such scientific proofs that they cure/heal your disease but at least this type of practice built up patients and parents confidence so that it accelerates disease healing process.

3) What frequency of vomiting is considered normal among babies per day? when should parents consult a doctor regarding baby vomiting?

I haven't come across with exact such data or such cut off numbers. Usually in new born small amount curdy like vomitus is common which occur frequently after feeding but not always.

Vomiting may be problematic in following situations-

- When amount is huge occuring from mouth and nose or projectile (jet like emmission)

- Change in colour of milk like greenish color

- Vomiting occurs after each feed despite applying proper technique of breast feeding

- Vomiting associated with abdominal distention, loose stool, fever or any other clinical symptoms.

4) In current context, medical reports varies according to hospitals, what do you think parents should act to get the appropriate medical reports of their babies?

My personal experience says now we are becoming more mechanical depending on medical lab reports and slowly we are degrading our clinical judgement capacity. Above that in pediatric practice we should b less invasive that is lesser number of investigations to be done. That doesn't mean that we avoid doing investigations like if the child is sick and requires admission, we do relevant investigations. 

Regarding in variations of lab reports, we should rely investigations from reputed hospitals or lab which are in continuous surveillance and quality check.

5) It is suggested by medical consultants that a mother should do exclusive breast feeding till six months , but in such busy work routine of a parents, does it hamper baby's health if exclusive breast feeding is not performed ?

We strongly recommend exclusive breast feeding for six months. And if not done, it obviously have short term as well as long term effects. Short term effects are lack of nutrition for their proper growth as well as diminished immunity and long term are for their final growth and intellectual capacity.

Working mother or busy life style is one of the major factors for not being able for this. But most parents are unaware of fact that breast milk can be stored for certain hours like in room temperature it can be stored for 8 hrs and in fridge for 24 hrs.

5) What is pylorus stenosis? Is pylorus a rare issue or it is frequently occurring among infants?

Pylorus is the terminal part of stomach which continues as small intestine. The hypertrophy of pylorus leads to narrowing of the lumen which leads to gastric outlet obstruction so that the infant vomit each time s/he is fed.

Incidence of pyloric stenosis is 3 to 5 per 1000 live births so this is not so uncommon where male are affected more than female child.

6) All babies are meant to vomit (small amount to large volume)  which is considered normal, when should parents be self aware that baby actually needs medical attention due to vomiting problem?

As stated above vomiting associated with other systemic symptoms and abnormal color of vomitus or projectile vomiting should alarm the parents.

In case of pyloric stenosis, child vomit almost all milk usually few minutes after feeding and there is small visible distension seen in upper part of abdomen. Child vomits after each feed so there is also no adequate weight gain as expected.

7) Does surgery permanently heals pylorus or it may recur in future?

Common surgery done for this is pyloromyotomy which gives good results and there is rare chances of recurrence with few post operative complications.

8)What suggestions would you like to provide to parents regarding baby"s health specially in the context of vomiting ?

Vomiting is a common problem seen in new born as their sphincter mechanism is not well developed so baby should be fed well with proper technique as mentioned earlier followed by burping and there are also other symptoms associated with vomiting that should make the parents alert. Repeated vomiting can also cause pneumonia if there is history of aspiration. Aspiration, if in huge amount that hold breathing, causing sudden death also! So vomiting should never be taken lightly in infants. My advice is consult your doctor if there is repeated episodes of vomiting and it should be addressed as soon as possible.

Note: Child's health is important so seeking medical help is more cautious than depending any other methodologies.