SPITTING UP, VOMITING, AND PYLORIC STENOSIS (Birth-12 Months) What is happening inside my baby's body? Spitting up is often normal.
Vomiting is not.
Distinguishing between the two is difficult, as both happen relatively frequently among infants.
The reason food tends to come back up in infants has to do with the anatomy of the stomach and intestines.
Milk travels down to the stomach by way of the esophagus, a long narrow tube connecting the mouth and the stomach.
Once the milk lands in the stomach, it must be emptied out into the intestine.
Everything is meant to flow in one direction - down.
In order to make sure digested food follows the right path, there are muscles along the way to direct the flow.
There is one at the end of the esophagus where it meets the beginning of the stomach (called the lower esophageal sphincter, or LES) and another one at the outlet of the stomach where the stomach meets the intestine (called the pyloric sphincter).
These muscles prevent food from reentering the area it has just left.
When the LES is loose and does not work well, food can flow easily from the stomach back up the esophagus.
This spitting up is called reflux.
When the stomach itself is irritated - in the case of an infection or when the muscles of the stomach are in spasm - there will be vomiting.
Compared with the spit-up of reflux, vomit is more forceful and sometimes more voluminous.
Finally, in infants the pyloric sphincter can cause a problem at the outlet of the stomach.
The pyloric sphincter almost always works well - sometimes too well.
It can become so thick and strong in some babies that the contents of the stomach have trouble passing through this muscle, and the milk gets backed up into the stomach.
This is called pyloric stenosis.
When the milk fills the stomach, it overflows into the esophagus.
In this case, it doesn't just come out as spit-up - it comes out as remarkably forceful vomit.
Many parents describe it as "projectile" and say that it can shoot up to ten feet from the baby's mouth! Pylotic stenosis occurs almost exclusively in infants.
What can I do? Distinguish between spit-up and vomit.
If your baby is vomiting, then stop offering liquids until the vomiting has subsided.
After an hour or two, liquids can be reintroduced slowly, by the spoonful or dropper or in the form of a damp washcloth to suck on.
If your baby can tolerate very small amounts of liquid without vomiting, then offer more.
Even if your baby seems very thirsty and wants to drink a lot of liquid, remember that the more the baby drinks at a time, the more likely she is to throw it up again.
Once your child is tolerating small amounts of liquid, you can gradually increase the amount offered.