Projectile vomiting (pyloric stenosis)

Projectile vomiting (pyloric stenosis)

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My newborn is vomiting forcefully after feeding. What's going on?

Projectile vomiting after a feeding is a hallmark symptom of a condition called pyloric stenosis, which usually starts a few weeks after birth. If your baby is vomiting forcefully, call his doctor right away. Babies who can't keep food down need help quickly to avoid dehydration, weight loss, and other complications.

All babies spit up – in that bubbly, wet-burp way. This is different. When a baby has pyloric stenosis, the muscle in the lower part of the stomach, called the pylorus, thickens and blocks the flow of food into the small intestine. There's no mistaking the gushing.

How common is pyloric stenosis?

About 1 in 500 babies develops pyloric stenosis, but it's rarely found in babies older than 12 weeks.

What are the risk factors for pyloric stenosis?

Risk factors for pyloric stenosis include:

  • Male, especially if firstborn
  • Caucasian
  • Preterm birth
  • Cesarean section delivery
  • Maternal smoking during pregnancy
  • A parent who had pyloric stenosis
  • A mother who took certain antibiotics late in pregnancy or while breastfeeding
  • Taking certain antibiotics (such as erythromycin and azithromycin) in the first weeks of life
  • Bottle feeding (Note: Further study is needed to determine if the risk is related to formula or the bottle feeding itself.)

Does pyloric stenosis have other symptoms besides projectile vomiting?

Yes. If your baby has pyloric stenosis, he may also have:

  • Wavelike contractions across his upper abdomen – after eating and before vomiting – as the stomach muscles try to push the food past the pylorus
  • Eagerness to start feeding, followed by anxiety and fretting before vomiting
  • A swollen tummy
  • Constant hunger
  • Weight loss
  • Signs of dehydration, such as dry mouth, lethargy, a sunken fontanelle (soft spot), and going for six hours without a wet diaper
  • Fewer bowel movements or constipation

How is pyloric stenosis diagnosed?

After asking about your baby's symptoms and examining her, the doctor may order the following tests:

  • Ultrasound of her belly: This quick and painless procedure uses sound waves to create a picture of the inside of her body.
  • Blood tests: These will measure your baby's level of electrolytes.
  • Barium X-ray: Your baby will drink a bottle of a chalky solution containing barium, and then pictures will be taken of her pylorus in action.

What is the treatment for pyloric stenosis?

Surgery. The operation, called a pyloromyotomy, involves making a single cut in the pyloric muscle. That's almost always enough to relax the valve so it behaves normally.

How risky is the surgery for pyloric stenosis?

It's pretty safe, as far as surgeries for babies go. Pyloromyotomy is the most common surgery for newborns. The procedure is usually laparoscopic, so it's considered minimally invasive. (Laparoscopic surgery involves small incisions.)

How long will my baby be in the hospital after surgery?

Usually a day or two. In the hospital, intravenous (IV) fluids are given to provide fluids and other nutrients for the baby. These are typically stopped the day after surgery, and breast or formula feeding resumes.

How will my baby feel after surgery?

Your baby's tummy may be sore for a day or two after the operation.

Don't be surprised by an occasional eruption after the procedure. Most babies who've had the surgery vomit forcefully a few more times, and the sight of it so soon can be frightening. It's nothing to worry about, though.

If your baby is still spouting more than a couple of days after the operation, however, it's time to call the doctor. Chances are slim, but your baby may be in that 1 to 2 percent who need a second procedure.

Does pyloric stenosis have long-term effects?

Almost never. After the surgery, the pylorus should function normally, showing no sign of its still-abnormal size.

Learn more

Watch the video: What is pyloric stenosis? (June 2022).