Most babies vomit small amounts from time to time and bring up some milk when they burp. This is known as posseting and is usually nothing to worry about. You can tell when your baby is vomiting rather than posseting because there will be a lot more coming out.
Vomiting is also very common (up to half of all babies) and in most cases will improve with time. Although it might look like they are vomiting a lot, most babies continue to grow normally and do not look particularly distressed by it.
As long as your baby seems otherwise healthy and continues to gain weight, there’s usually no need to worry or seek further help. There are some simple things you can do to help.
However, vomiting can occasionally be a sign of an underlying problem such as severe reflux, milk allergy, pyloric stenosis, a stomach bug, or infection (see below). Below are some signs to look out for if you are worried.
When should I worry and what should I do?
Call 999 or go to A&E now if your child:
- Has green vomit (like the colour of spinach or peas)
- Becomes pale, mottled and feels abnormally cold to touch
- Has pauses in their breathing lasting more than 10 seconds, is grunting or is going blue around the lips
- Is stiff or rigid or makes repeated, jerky movements of arms or legs that don’t stop when you hold them (a fit or seizure)
- Becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
- Develops a rash that does not disappear with pressure (the ‘Glass Test’)
- Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
Call 111 or ask for an urgent GP appointment if your child:
- Vomits forcefully (shoots across the cot or the room)
- Not interested in feeding and/or looks dehydrated (dry mouth, sunken eyes, no tears, drowsy, no wet nappies in the last 8 hours or sunken fontanelle (soft spot on the head)
- Is becoming drowsy (excessively sleepy) or irritable (unable to settle them with cuddles, toys, TV or snacks) – especially if they remain drowsy or irritable despite their fever coming down
- Has trouble putting on weight or is constantly arching their back and crying when feeding
- Ongoing vomiting with blood in the poo
- Is getting worse or you are worried
If none of the above symptoms are present and your child:
- Continues to feed well
- Has plenty of wet nappies
- Baby wakes up or cries regularly for feeds
- Additional advice is also available to young families for coping with crying with babies who are well go to https://iconcope.org
Conditions that can cause a baby to vomit:
- Some degree of reflux is completely normal in babies as the muscular valve at the end of the food pipe, which keeps food in the stomach, is still developing. Reflux may cause your baby to bring up milk after a feed and can also give him/her hiccups. If your baby is growing normally and is not showing any marked signs of distress, there is no need to worry.
- More severe reflux can cause your baby to cry and be sick, often after feeding. The long name for severe reflux is gastro-oesophageal reflux disease (GORD). This means that when your baby’s tummy is full, food and stomach acid flows back up their food pipe causing discomfort and pain.
- If you have tried the measures described above and seen no improvement, see your GP. They will review your child’s symptoms and ask you about the formula you have used and may possibly prescribe an antacid designed for babies.
Cow milk proteins are found in many types of formula milk. They’ll also make their way into your breastmilk if you eat or drink milk or other dairy products, such as cheese and yoghurt.
If your baby has a cow’s milk allergy, they may vomit after feeding. It can be difficult to tell the difference between this and reflux. But if your baby has problems with cow’s milk, they may also have:
- Diarrhoea or constipation
- Trouble putting on enough weight
- History of allergies in your close family
If you’re worried that your baby has problems with cow’s milk, there are steps you can take. If you breastfeed your baby, you could try cutting cow’s milk from your diet for two weeks. If your baby is formula-fed, trying a hypoallergenic formula may help.
Talk to your GP or health visitor before trying these, though. They will check your baby’s symptoms first, so they can be sure of what’s causing them.
This is a rare condition that can cause your baby to vomit forcefully within half an hour of feeding.
Pyloric stenosis is most likely to begin when your baby is about six weeks old but could show up at any time before they reach four months of age. It can sometimes run in families, and boys are about four times more likely to get it than girls.
It happens because the muscle controlling the valve leading from the stomach into the intestines has thickened, stopping enough food and milk to get through, so it stays in the stomach and then comes back up. The problem is easily corrected with minor surgery.
A stomach bug
If your baby’s vomiting begins suddenly, or if they also have diarrhoea, they may have a tummy bug (gastroenteritis). Gastroenteritis is usually caused by a viral infection and needs no specific treatment.
Do not stop giving your baby milk. If you are breastfeeding, continue doing so. If your child is on formula, do not dilute it.
Babies under 6 months of age are at more risk of becoming dehydrated than older children, which is why it is important to make ensure that they are drinking enough. Give your baby oral rehydration fluids in between feeds or after each watery stool. Your pharmacist will be able to advise you about which solution is best for your baby. Little and often tends to work best – in hospital, babies are given 1 or 2 tablespoons (5 to 10 mls) of fluid to drink every 5 to 10 minutes. You can try using a syringe to give fluids to your child.
Your baby may be vomiting because they have an infection. This is usually associated with a temperature above 38°C / 100.4°F. Although the most likely cause is a viral infection, other causes include urinary tract infections or very occasionally a more serious illness such as meningitis or sepsis. Signs of a serious infection include:
- becomes pale and floppy going blue around the lips
- is fretful or excessively miserable when touched
- becomes difficult to rouse
- is finding it hard to breathe
- develops a rash that does not disappear with pressure (the Glass Test)
Your child needs urgent help if any of these features are present – go to the nearest hospital emergency (A&E) department or phone 999.
Healthy baby that is vomiting?
If you are breastfeeding, seek advice from a breastfeeding specialist, either a specially trained health visitor or a breastfeeding counsellor. It is possible that your baby is not latching on properly.
If you are bottle feeding, ensure your baby is in the right position (sitting almost upright) and that you use the recommended amount of powder (it is quite easy to use too much if you have changed product, or using a different scoop than the one provided in the tin).
It is also quite easy to give your baby too much milk when you are bottle feeding. Their stomach is only small, and most babies need little and often: 6 to 7 feeds per day is the norm, including at night. Your health visitor can help review how much milk your baby should need and the timing of the feeds.
However, if after two weeks you are still concerned, seek advice from your health visitor or GP.
Where should you seek help?
- If it is non-urgent, speak to your local pharmacist or health visitor.
- Or contact you GP practice and a qualified member of the clinical team will assess if your child needs to be seen urgently. For an urgent out-of-hours GP appointment, call NHS 111.
- You should only call 999 or go your nearest A&E department in critical or life threatening situations.