06 Dec The Puking Infant

The mother of a 6-week-old infant was concerned because her daughter was always throwing up. She was initially breast-feeding the baby but then switched to formula when the baby reached three weeks of age, thinking it may help with the spitting up. Initially the spitting up decreased for a few days, but then it became more frequent. The mother tried several other formulas with no improvement. The infant was happy but always seemed to be hungry. Over the course of one week, the spitting up became more frequent and forceful. The mother became extremely concerned because, by six weeks of age, her daughter was having projectile vomiting with every feeding and could barely keep down any formula. She was seen by her doctor and an ultrasound was ordered which immediately revealed the problem.

The muscle in the lower part of the stomach, the pylorus, had slowly become enlarged and caused a narrowing to the point that formula was not able to empty from the stomach. This is called pyloric stenosis.

Pyloric Stenosis

Pyloric stenosis is a condition that can affect the digestive tract during infancy. Essentially, it is a blockage from the stomach to the small intestine.

• Most commonly presents between three to six weeks of age
• Occurs in 3 out of 1,000 babies born in the United States
• Affects male infants more than female infants
• Tends to run in families, so there is a higher risk if a parent had pyloric stenosis as a baby

Causes and Signs of Pyloric Stenosis

The pylorus, the muscular valve between the stomach and small intestine, becomes abnormally thickened and does not allow the stomach contents to empty. This leads to forceful vomiting, dehydration, and weight loss. Infants with pylorus stenosis often act excessively hungry since they keep vomiting their milk. The exact cause of the thickening of the pylorus muscle is not known, but it has been associated with using the antibiotic erythromycin toward the end of pregnancy and within the first two weeks of the infant’s life.

Common signs include:

• Spitting up that progresses to vomiting with force (projectile vomiting)
• Constantly hungry despite vomiting
• Hard stools or constipation because feedings are not being digested
• Weight loss or lack of weight gain
• Dehydration, sunken eyes, or decreased wet diapers

How It’s Diagnosed and Treated

There are two main ways to diagnose pyloric stenosis:

• Ultrasound to measure the thickness of the pylorus muscle
• Upper GI barium study to visualize the pyloric region of the stomach to detect a blockage

The treatment for pyloric stenosis is a pyloromyotomy. This is a surgical procedure that involves cutting through the thickened pylorus muscle so the blockage is relieved. Most babies are able to resume feedings within a few hours after the surgery.

What Happened to the Puking Baby?

The ultrasound revealed a severely thickened pylorus muscle. The diagnosis of pylorus stenosis was made and the patient was admitted to the hospital. A pyloromyotomy was performed successfully by the pediatric surgeons. The infant was started on bottle feedings and went home the next day without any further vomiting.

If you are concerned that your infant may have pyloric stenosis, then please speak to your child’s doctor. If you would like more information about gastrointestinal (GI) digestive disorders and nutrition in children, please contact Dr. Mona Dave’s Frisco Office or Request Appointment Here.