Yes, that would be 10ft or more across the room. No exaggeration. When my baby was vomiting like this, I was stunned. Then terrified. And horrified.
I wasn’t a first-time mother either. This was my second child, my daughter. My elder child, my son, never vomited like this and he was fed the same way: breast followed by bottle. He always finished his milk well, never had colic or any gastro intestinal problems, never even had diaper rash, gained weight accordingly and hit all his milestones exactly on time.
So what could be wrong this time?
My daughter wasn’t a newborn at the time. She was about two to three months of age and I was feeding her the same way I had been feeding all this while. Then suddenly, one night, immediately after finishing her bottle, the entire contents of what she drank shot straight out of her mouth. The throw up was with such force, everything she ate flew across the room and hit the wardrobe about 10ft away.
The vomit was fresh milk. It was what she drank moments ago and it came out so violently that it also exited through her nose. I looked at her, shocked, and she looked back, just as shocked. And then she began to cry.
Projectile Vomiting Vs Spitting Up or Reflux
Projectile vomiting is not to be confused with spit-up or reflux or regurgitation. Almost all, if not all babies spit up during the burping session after a feed. That is why parents are advised to place a towel on their shoulder when they put their infant over it as they burp him. About a tablespoon or more of the milk he has just fed on will probably come out along with the air he belches out. That’s normal. That’s not vomiting at all.
Both breast-fed and formula fed babies will spit up once in a while, sometimes once a day, sometimes more frequently. You must remember, your baby is short, much shorter than say…even a one-year-old toddler or an adult, and the stomach is smaller in size too, along with a shorter esophagus length.
Baby’s diet is also all liquid, and he is constantly in a lying down position. When he drinks, the milk goes down the esophagus and goes past the gastroesophageal (GE) sphincter to reach the stomach. The GE sphincter is a muscle that is supposed to keep the stomach contents from coming back up out of the mouth.
The problem is, in a young baby, the GE sphincter muscle is lax and when the stomach is full of milk, some of the contents will slosh right back up especially when you shift his position to burp him. Spitting up or reflux usually occurs immediately after a feed or it may occur an hour or two after feeding. It usually just flows out of the mouth and dribbles on to his chest and bedding. This is also the reason why babies need a bib or some dribble towel when they feed.
Typically, spitting up will happen when the child is a newborn up until the age of three months and typically, it will stop by the time he is sitting up at six to nine months old. In an upright position, gravity will help to keep the milk down and also, the GE sphincter and stomach muscles would have grown stronger by this time.
As Mayo Clinic says, “Spitting up is common in healthy babies. During their first three months, about half of all babies experience their stomach contents coming back up into the esophagus, a condition known as gastroesophageal reflux, infant reflux or infant acid reflux.”
Not to confuse you with so many terms, here is a video that explains in detail why spitting up occurs in babies and why it’s pretty normal.
Reflux or Spitting Up in Babies or Does he have GERD?
GERD stands for Gastroesophageal Reflux Disease. It’s like heartburn. If your baby is irritable, arches his back and cries, refuses the breast or bottle, spits up regularly and shows pain because the digestive acid coming up from his stomach is burning the esophagus, loses weight or the weight plateaus, has difficulty breathing and has fewer wet diapers ─ he could be having GERD. You need to talk to your pediatrician about this. In fact, go see him whenever you are in doubt.
The good news is ─ sometimes GERD clears up on its own. Like normal spitting up, it goes away as soon as his stomach muscle tone increases and he is spending more time in an upright position rather than lying down.
GERD may also happen to an older child such as during teething or when he is transitioning to solids. Or he may be reacting badly to the milk formula.
When Vomiting is Violent
However, when vomiting is violent and sudden and the contents shoot out several feet across the room and it happens after every feed, then you know ─ there is something wrong with baby.
Here are some pictures and videos of projectile vomiting although what is seen here is considered “mild” or even funny when compared to many life threatening emergency scenarios.
If projectile vomiting happens only once or once in a while, it usually isn’t much cause for concern and you really needn’t rush to the hospital. This is especially so if your child is otherwise well and thriving, is alert, hasn’t lost weight or seem to be in any kind of distress. He has probably been overfed and conditions at the time didn’t allow for proper digestion.
However, if he is projectile vomiting after each and every feed, he looks weak and dehydrated because he hasn’t kept down a single drop of feed, then it’s time to head to the Emergency Ward. Your baby may have an obstruction in the gastrointestinal tract such as Pyloric Stenosis and it is preventing him from absorbing any nourishment while making him lose precious fluid from his body.
What is Pyloric Stenosis?
Pyloric Stenosis, also called Infantile Hypertrophic Pyloric Stenosis, is a problem that affects 1.5 to four per 1000 Caucasian babies between birth and six months of age. The incidence is much lower in Asian children however. Pyloric Stenosis causes projectile vomiting that very quickly leads to dangerous levels of dehydration and starvation. Once diagnosed, the baby will probably need surgery called Pyloromyotomy.
“Pylorus” means “gate” in Greek. This gate or Pylorus is located at the lower portion of the stomach at the junction that connects to the small intestine. In Pyloric Stenosis, the muscles in this part of the stomach become enlarged, narrowing the opening of the Pylorus which prevents food from moving from the stomach into the intestines. Hence all the milk the baby has drunk shoots out of his mouth yet he will be constantly hungry and have little bowel and bladder movement. A baby with Pyloric Stenosis will have no energy, cry with no tears and may have a sunken fontanelle.
If you want to understand Pyloric Stenosis in detail, here is a video presentation.
Pyloric Stenosis, the Symptoms & How it is Different from Reflux
Which Babies are at Higher Risk for Pyloric Stenosis?
- Caucasian babies seem to develop Pyloric Stenosis more frequently than babies of other races. In Asia, the incidence is rare but not non-existant. In a study done on 67 Malaysian infants admitted to General Hospital in Kuala Lumpur in 1981, it was found that out of the three major races, Indians were most susceptible to the condition. In all the cases, the babies were between the ages of three to eight weeks old and 43.3% of them had a history of vomiting constantly for more than three weeks. In another study on intestinal obstruction in 1985, the 270 Malaysian children studied showed that 12% had Pyloric Stenosis. The rest had other types of intestinal obstruction such as Hirschsprung’s disease (19.3%) followed by intussusception (18.9%) ─ mostly affecting Chinese and Malay, then Pyloric Stenosis.
- Boys develop Pyloric Stenosis four times more often than girls.
- Usually occurs in first-born full term male child.
What Happened to my Daughter in the End
In the case of my infant daughter’s sudden onset of projectile vomiting, the story had a happy ending ─ to my great relief.
She only projectile vomited three times in all, and only at night when I was the one feeding her.
The first time it happened, I cleaned and soothed her back to calmness, mopped up the mess, then gave her the bottle again a short while later. She kept the food down this time around and went to sleep happily after that with no further incident.
At this time, she was already taking quite a full bottle, maybe as much as 8oz if I remember correctly. I was a fulltime working mum and had a maid to help out but I always insisted on taking care of my baby myself when I came home.
The second time it happened was two nights later. The night before, the feeding was fine and I regained my confidence a little from the success I had. It was false hope however because this time when it happened yet again, I truly despaired, then panicked and yelled for the maid.
Why was this happening?
My maid came running and helped clean up and then, out of wanting to help, she offered to feed my daughter for me. My daughter never vomited when fed by the maid in the day. I always checked on her feeds. It only happened at night when I was feeding her and that got me truly perplexed. Perhaps I was always too much in a rush to get everything done on time, what with work the next day and two young children to take care of. Some research says maternal anxiety and stress have something to do with infant vomiting. I watched the maid as she fed my baby and sure enough, my daughter finished her bottle happily and nothing untoward happened after her feed.
The next night I made sure to adjust my position so that my daughter was not bent at the waist when feeding. I noticed that when the maid was handling her, she was standing up and was holding my baby in an almost vertical position ensuring that no part of the baby’s torso was bent while she was drinking. I tried to replicate that hold but could not. But I did my best to adjust the positioning.
Maybe it was my anxiety, maybe it was my nervousness but as I feared, less than a minute after she finished her bottle, the entire contents spewed across the room again.
Alright, I thought. This cannot go on any longer. I was very concerned about the milk coming out of her nose ─ it must have been painful for her ─ and she may be breathing in the vomit into her lungs. It could cause my baby longterm harm if she keeps vomiting like that. I did think of bringing her to the hospital but then I noticed, she never vomited at all when fed by the maid. She was drinking the same amount, it was the same formula and she finished her bottle just as quickly.
So from that day onwards I decided it was best to leave the feeding to the maid. Maybe she knew better and I certainly didn’t want to compromise my baby’s well-being any further. That being done, all incidents of vomiting stopped as abruptly as it began.
I ask my daughter today if she remembers the time when she was like Linda Blair in The Exorcist, projectile vomiting 10ft across the room and frightening the life out of me, she replies that she doesn’t remember any of it at all.
And maybe that’s because those vomiting episodes never registered a thing on the Richter Scale of her life.
She has grown up healthily and is otherwise fine and that was the only major episode of her growing up days that I can remember to this day.
Babies vomiting or spitting up or regurgitating or even projectile vomiting, is not usually a medical issue unless the vomiting is incessant and accompanied by other symptoms such as a bloated stomach, weight loss, pain, distress, dehydration, lethargy, a refusal or inability to feed, dry diapers or blood in the stools and vomit, fever and so on. There are a million reasons why a child vomits. Whenever you are unsure, it is best to see your pediatrician to find out if there is an issue.
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