The forceful ejection of stomach content-through the mouth. Vomiting is not the same as spitting up or regurgitating, when a small amount of previously swallowed material (usually breast milk or formalin reenters an infant’s mouth without force. Spitting up is not uncommon during the first year of life because the sphincter (a ring like muscle) between the esophagus and the stomach does not always close tightly or may reopen much of the time at this age. During the first year, the sphincter gradually matures and tightens, reducing the number of spitting-up episodes.

Forceful vomiting is always a significant symptom in an infant younger than three months of age. It may be related to milk protein intolerance and could require formula substitution. It may also be a symptom of a partial or complete obstruction of the gastrointestinal tract. the most common such obstruction in infants is gastric stenosis, a condition in which the muscles of the segment of small intestine just beyond the stomach thicken and block the outlet of the stomach. The vomiting associated with this condition is so forceful that it called projectile vomiting. Additional symptoms will include failure to gain weight and a general look of undernourishment. This condition is most common for the firstborn children in their family.

The most common cause of vomiting in older children is infection. Vomiting of this type is frequently accompanied by nausea, abdominal cramps, and in some cases fever. The infection may be in the stomach (gastroenteritis, also called stomach flu which there can be both diarrhea and vomiting. Vomiting  is sometimes caused by stimulation of brain’s vomiting center by toxins that circulate as the resualt of infections elsewhere, such as in the throat.

Sometimes vomiting is so forceful it produces a tear in the esophagus. In such instances there may be some amount of blood in the vomited material. The presence of amounts of vomited blood is a serious concerts that should be evaluated by a physician immediately.

The danger of dehydration

The main concern with repeated vomiting, especially accompanied by diarrhea, is that the infant may be dehydrated from fluid loss. When these losses are increased thirst and a modest decrease in urine o(fewer wet diapers) will occur. If so, call your physician for advice, which may include a recommendation for foes direct evaluation.

The following symptoms indicate more severe dehydration and, with rare exception, call for immediate evaluation:

• Constant thirst (in an older child who can express this need)

• Dry mouth and lips

• Fewer tears when crying

• No urine production for 8 to 12 hours, indicating that the kidney is conserving fluids

• Sunken eyes

• A sunken fontanelle (the soft spot in the skull, most readily felt during the first six months of life)

• Skin texture that is no longer elastic but more like bread dough.

• Persistent fussing in an infant, especially if it is more of a whine than a vigorous cry

Even more serious dehydration (with fluid losses of more than 10 percent of the child’s normal body weight) will be suggested by the presence of these symptoms:

• Cool and/or mottled skin

• Rapid, thready pulse

• Rapid respirations

• Moaning or grunting, or a weak, feeble cry

• Marked listlessness with lack of interest in play or feeding, little response to being handled, and (in an infant) markedly reduced movements of arms and legs

A baby or young child with these symptoms is likely to be in trouble and should be evaluated immediately in an emergency-room setting.

Prevention and Treatment of Dehydration

Your child’s doctor will give specific advice for prevent-or correcting dehydration, which will depend to a degree on the age of your child and the severity of problem. Usually some effort will be made to rest for a day or two while the infection runs its course. Traditionally, this has involved giving the infant/child one or more forms of clear liquids-water, clear soup, clear juice-which are supposed to be absorbed more easily when the bowel is inflamed or enlarged by infection. However, research of the small intestine has led to the development of a variety of oral rehydrating solutions (ORS), which work more effectively with the body’s mechanisms absorbing fluid. These solutions contain specified amounts of sodium, potassium, and glucose mixed together, can be safely used by infants and children of all, and are effective in treating both mild and severe dehydration.

Premixed ORS is available at drugstores in products such as Pedialyte, Rehydralyte, and Infalyte. It is this type of solution, not the traditional clear liquids, that is best suited to treat acute gastroenteritis, especially in children under two years of age ORS may be given by bottle, spoon, or even dropper, usually in frequent small amounts. If the rehydrating solution isn’t flavored, its taste can be improved by adding one tablespoon of Jell-O powder to one tablespoon of boiling water, and then adding this mixture to an eight-ounce bottle of the solution.)Your doctor will specifically recommend the type and minimum quantity of solution you should give to your child. A typical routine is to give a teaspoon to a table-spoon (depending on the child’s size) every ten minutes for an hour and then doubling the amount each hour if vomiting does not occur.

Breast-fed infants can continue nursing but with frequent shorter feedings (for example, ten minutes every hour or two, using one side at a time). If vomiting persists in a nursing infant, the doctor may recommend using a rehydrating solution for a few hours.

In most cases of gastroenteritis, after eight hours without vomiting, foods such as rice cereal or applesauce for infants, or bread, rice, mashed potatoes, or crackers for older children can be eaten in small amounts. If vomiting recurs, oral intake should be ceased for an hour, and rehydrating fluid can be started again. Vomiting accompanied by significant pain in the abdomen, whether generalized or localized, may indicate the presence of an acute medical problem such as appendicitis. Vomiting accompanied by intermittent abdominal pain and blood in the stool may indicate an obstruction or a bacterial infection. If vomiting and abdominal pain persist for more than a few hours, the child should be examined by a physician.