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Baby projectile vomiting and pyloric stenosis

Dr Roger Henderson
Reviewed by Roger HendersonReviewed on 29.04.2024 | 3 minutes read

Projectile vomiting is when vomit flies out of a baby’s mouth forcefully. It will project like an arc several feet back, and looks quite different to the undramatic dribble of possetting. One important cause of projectile vomiting is pyloric stenosis, which affects 2-4 in 1,000 newborn babies.

Pyloric stenosis occurs when there is a progressive thickening of the lower aspect of the stomach, causing a tightening or narrowing of the outlet of the stomach where it goes into the small intestine. This tightening means food can’t leave the stomach, causing an obstruction, and it requires immediate medical attention and treatment. The symptoms often occur in the first 5 weeks of life. It is more common in children whose parents had pyloric stenosis as a child, and in first-born males.

What are the symptoms of pyloric stenosis?

Symptoms usually begin in a baby who is 2-4 weeks old and otherwise healthy. The first and main one is usually vomiting. It might look like posseting initially but gradually reveals itself to be projectile in nature, occurring shortly after feeds, or occasionally hours later.

Because of increased vomiting, babies are often hungry and irritable and want to feed more often. Over time they will have difficulty gaining weight and may even lose weight quickly. Because less food is digested, they may also have fewer bowel movements. Another sign you may notice is their tummy is rippling or contracting after feeding. It's really important to look out for signs of dehydration in babies who are vomiting repeatedly.

It’s important to say that it’s really common for newborn babies to vomit, and the overwhelming majority of these don’t have pyloric stenosis.

How is it diagnosed?

The doctor will examine baby’s tummy (there may be a lump the size of an olive present), check their weight and the trend in weight gain, and look for any signs of dehydration. Sometimes blood tests are required to check the severity of dehydration.

Pyloric stenosis is usually confirmed with an ultrasound scan of the tummy as this is very good at showing any thickening of the pylorus.

How is it treated?

If pyloric stenosis is confirmed, a small operation called a pyloromyotomy will need to be done and this is usually performed by keyhole surgery. It involves cutting through the stomach thickening to release the pylorus, thereby clearing the obstruction and fixing the cause. After surgery, you will notice an immediate improvement in your baby and they shouldn’t need any further surgeries. This procedure is very effective and successful.

Could it be anything else?

There are other causes of vomiting. If this is something that has happened over a short period, then it could be a stomach bug. Diarrhoea may appear alongside, and this doesn’t occur with pyloric stenosis. Another cause could be reflux. Most babies don't have projectile vomiting with this, but they do have a lot of spit-up after feeding, and they will cry and look uncomfortable. Finally, milk protein allergy can cause stomach contents to appear again, but this is never projectile in nature.

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Dr Roger Henderson
Reviewed by Roger Henderson
Reviewed on 29.04.2024
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