Projectile Vomiting in a Baby

Projectile vomiting describes very forceful vomiting that is seen in babies with a blockage at the end of the stomach. It is not unususal for babies to vomit - spilling in babies is normal. Sometimes, these vomits can be forceful and even come out the nose - this is not necessarily what we call projectile, it might just be forceful vomiting.

To understand more whether your baby has projectile or forceful vomiting, read on. The information on this page is summarised below.

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What is projectile vomiting?

It is very forceful vomiting. It is so forceful that often the mother, or whoever is feeding the baby, doesn't even get any vomit on them - it sprays up and over them!

Forceful vomiting will often mean the vomit even comes out the nose. However, vomiting that is projectile will come up in a fountain-like spray that misses the mother (or whoever is holding the baby) but may hit someone on the other side of the room.

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What is its significance?

In young babies, projectile vomiting can be a sign of pyloric stenosis. If your baby has one forceful vomit and then manages the next feeds without vomiting, there is probably nothing much to worry about, but if your baby vomits most feeds and they are large forceful vomits, you will need to have your baby reviewed by a doctor.

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What is Pyloric Stenosis?

Pyloric stenosis is a condition where the muscle at the outlet of the stomach (called the pylorus) gets thickened and so blocks the passage from the stomach to the small intestine. As the stomach contracts to push the food (milk) out of the stomach, it has to push hard to overcome the tight pylorus. When the pylorus is very tight, the milk finds it easier to go up rather than down and so goes up the esophagus and the baby has projectile vomiting.

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Who gets Pyloric Stenosis?

Usually, pyloric stenosis occurs in young babies. Babies are usually getting to about 4 weeks old by the time the symptoms cause alarm. Some babies are younger and some are older. Although, pyloric stenosis can occur in any baby, it does occur slightly more in first born boys. There can be a history of pyloric stenosis in the family but there isn't always.

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How would I know if my baby had Pyloric Stenosis?

Your baby would have projectile vomiting, which would be getting worse as time went by. It usually occurs quite soon after a feed or even during a feed. Your baby would be hungry because the milk would not be getting through, and so he would feed hungrily, but he would eventually start to look scrawny - as he wouldn't be gaining weight because he's vomiting all his milk.

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How is Pyloric Stenosis diagnosed?

A doctor will do an examination of the abdomen while the baby is relaxed, (usually when the stomach is empty - sometimes we get the baby to suck on a pacifier / dummy). In pyloric stenosis, we can often feel a small swelling (about the size of an olive) where the thickened pylorus is. We call that a pyloric tumour. It is not a cancerous tumour and as long as it is treated, there are no long term risks. Sometimes, an ultrasound scan will be needed for diagnosis - it will show the enlarged pylorus.

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How is Pyloric Stenosis treated?

A small operation is needed - the surgeon just cuts the thickened muscle. It is a relatively easy operation in experienced hands. Sometimes, babies need to have fluids before the operation as their blood acid status can be abnormal after vomiting a lot - you lose acid when you vomit.

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After the Pyloric Stenosis is treated, will my baby have problems?

No. Babies usually cope with this operation very well and once its treated, they grow and develop normally with no problems.

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Is all projectile vomiting due to Pyloric Stenosis?

No. If your baby has occasional forceful or projectile vomiting but is growing and otherwise well, you probably don't need to worry.

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Last reviewed 31 August 2011

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Dr Maud MD

Dr Maud MD (MBChB, FRACP, FRCPCH), a specialist pediatrician, provides health information and medical advice for parents of babies and toddlers. Read more about Dr Maud.



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