Projectile vomit is the name given to the vomit which arrives with a great amount of force and usually travels a small distance horizontally before dropping down.

The phenomenon is more common in babies with baby projectile vomiting sometimes being indicative of pyloric stenosis. If your baby vomits forcefully after a feed but keeps other feeds down without any issues, then you shouldn’t worry. However, if the baby can’t keep most of the feeds in and throws them out via large and forceful vomits, you would have to take your baby to a doctor.

Baby Projectile Vomiting Can Be a Problem

Projectile vomiting in babies sometimes points to pyloric stenosis which is a condition that normally affects babies aged between two and eight weeks. The condition affects the pylorus (muscle at the stomach’s outlet) and makes it thicker than normal. As a result, it stops the stomach from pushing the milk into the small intestine. The stomach therefore contracts to apply extra pressure on the milk to move into the small intestine. However, with the pylorus too thick (thus the opening being too narrow) to let anything pass, the milk finds an easy path upwards, moves upwards rather than moving downwards and therefore, the milk travels quickly from the esophagus and the baby endures a projectile vomit.

However, it is not like all cases of baby projectile vomiting turn out to be pyloric stenosis. An occasional projectile vomit is usually fine. The problem comes up if projectile vomit becomes a habit for the baby.

Pyloric stenosis symptoms: It usually causes the baby to feed in a very eager manner but makes the baby very anxious or fretful once the feeding ends. This happens because the milk can’t pass through to the intestine and the baby gets ready for a forceful vomit. There is a noticeable contraction around the baby’s upper abdomen just after feeding if the baby suffers from pyloric stenosis, as the stomach is trying to pressurize the fluid to pass the pylorus.  

What Causes Projectile Vomiting in Baby?

Pyloric stenosis is not a birth defect and develops in babies after they are born. The thickening of pylorus is a gradual process and the baby would start showing symptoms once the muscle thickens to the point that the stomach can’t empty properly any longer.

There is no exact known cause of pyloric stenosis. It is normally believed that pyloric stenosis is a result of multiple factors. In some cases, pyloric stenosis is associated with using erythromycin during the first two weeks after the baby is born. In other cases, baby projectile vomiting is associated with the use of antibiotics by the mother either during the latter part of pregnancy or while breastfeeding the baby.

How Common Is Pyloric Stenosis?

Every one in five hundred young babies go on to develop pyloric stenosis. The condition usually manifests itself in the first few weeks. There is hardly a case of pyloric stenosis in babies who are aged six months or older.

Pyloric stenosis affects males more than females with firstborns usually more prone to it. The condition also affects a greater number of white babies as compared to Hispanics, blacks and Asians. If one of the baby’s parents suffered from the condition, there is a greater chance of the baby suffering from it too.
As already mentioned above, the condition is more common in babies who are given antibiotics after birth or whose mothers take antibiotics while they breastfeed their baby.

When Is Projectile Vomiting in Baby a Problem?

Baby projectile vomiting is vastly different from the wet burps that babies normally have after a feeding. In a projectile vomit, most of the fed milk comes out and would travel a significant distance. The vomited milk may appear curdled and this happens because the acid in the stomach curdles the milk.

The basic concern with pyloric stenosis is that the baby vomits too frequently and becomes incapable of keeping the fluids down. This leaves the baby at risk of being dehydrated and the baby’s nutritional needs just won’t be met. Adults are normally able to stay hydrated even after vomiting a few times but since the babies have far smaller bodies, they can’t tolerate losing too much fluid. It’s not just the milk that gets out in the vomit, important minerals like sodium and potassium accompany the vomit too and this doesn’t bode well for the baby’s health.

Another reason for concern about pyloric stenosis is that babies having the condition may also suffering from another condition like:

• Dehydration (the signs of dehydration include laziness, no urination for over 6 hours, a dry mouth etc.)
• Loss of weight
• Loose stool
• Infrequent bowel movement
• Swelling over the stomach region

There is no waiting with pyloric stenosis as it is a condition that needs immediate checkup by the doctor. You should get in touch with your doctor if the baby vomits forcefully and shows one of these symptoms:

• Projectile vomit after every feeding
• Loss of weight
• Loss of energy and little to no activity
• No bowel movement in 24 to 48 hours
• No urination for more than 6 hours

What to Do About Baby Projectile Vomiting

The doctor would most likely do an ultrasound of the baby’s belly after examining the baby. The doctor is also likely to order blood tests in order to know the baby’s level of electrolytes as there is a chance that the electrolytes would have dropped down because of the constant vomiting. If the doctor thinks the situation is more serious, the doctor would also ask for a barium X-ray. The baby would have to drink a solution that contains barium and the pictures taken afterwards would then reveal the problem with the pylorus.

• In case the doctor diagnoses your baby projectile vomitsdue to pyloric stenosis, a surgery would be required. The surgery is named pyloromyotomy and has a simple procedure. The doctor makes a small cut in the baby’s pyloric muscle so that the valve relaxes and resumes normal behavior.
• If the doctor also finds out that the baby is dehydrated, the baby would also be given fluids and nutrients through an IV tube. This would be done before the surgery itself. The surgery is not very risky. The doctors perform the surgery a number of times with newborns and they are successful all the time.
• The baby would be kept at the hospital for around 24-48 hours and the baby would be kept on IV until that point. Once the IV is removed, the baby can then be given breast or formula milk. The baby may stay a bit disturbed for a couple of days after the surgery as the operated region would stay sore for a couple of days.
• It is likely that the projectile vomit won’t stop for a couple of days after the surgery. This is common however and you shouldn’t worry about it. If the vomiting continues even after two or three days, then you should get in touch with the doctor again. This doesn’t happen very often though around 2% of the cases usually require a second operation for the problem to be resolved permanently.