Virtually all newborn babies occasionally spit up partially digested milk or formula soon after feedings. A baby who, starting around the second to fourth week of life, begins to spit up with increasing force and frequency may have a malformation of the digestive tract known as pyloric stenosis. In this disorder, the muscle surrounding the opening between the stomach and duodenum (the first part of the small intestine) is abnormally thick, stiff and narrow. As a result, food cannot pass into the duodenum and forceful regurgitation occurs. The vomiting eventually makes the baby weak, constipated, dehydrated and malnurished.
Pyloric stenosis is fairly common, affecting about one out of every 250 babies. For unknown reasons, the condition affects four times as many boys (commonly the first-born male in a family) as girls and occurs in whites more often than in black, Hispanic or Asian infants. Likewise, the cause is unknown, although genetics may play a role, since pyloric stenosis seems to run in some families.
WHEN SHOULD I SUSPECT THAT MY BABY HAS PSLORIC STENOSIS?
Forceful vomiting, known medically as projectile vomiting, is the hallmark of the condition, but it may not appear immediately. Instead, the early signs of pyloric stenosis may resemble normal (but unusually frequent) infantile burping and spitting up, with the stomach contents flowing out the nose as well as the mouth. Within several days, however, projectile vomiting develops, with powerful stomach contractions ejecting the vomit one to four feet from the baby's mouth. This development is understandably alarming, and it usually prompts the parents to call the pediatrician right away.
In most cases, the baby vomits soon after a meal. The vomiting associated with pyloric stenosis can, however, occur several hours after feeding. Although the milk is curdled from being in the stomach, it does not contain the greenish-yellow bile characteristic of more complete digestion. The vomit may also contain black or rust-tinged material, which is actually blood from the irritated stomach lining.
Despite their inability to keep milk down, babies with pyloric stenosis nurse and take bottles eagerly because they're hungry. After a few days of vomiting, however, their weight gain and output of urine and stool drop off, and they may become weak and listless. Fever may also develop.
HOW CAN THE PEDIATRICIAN TELL IF MY BABY HAS PYLORIC STENOSIS?
Your report about when the vomiting developed and how it occurs will make the pediatrician consider the possibility of pyloric stenosis. A physical examination can usually pin down the diagnosis. In many cases, the doctor can actually feel the thick, hardened muscle in the upper right side of the baby's abdomen and see the abnormal movements of the stomach muscles. Sometimes, the doctor or nurse watches the baby eat and observes subsequent vomiting.
If the diagnosis is unclear, an ultrasound examination of the abdomen may be needed. This test uses the echoes from high-frequency sound waves projected into the abdomen to obtain a video image of the pyloric muscle, stomach, and surrounding organs.
WHAT TREATMENTS ARE AVAILABLE
The standard treatment is surgery to widen the thick muscle obstructing the stomach outlet. If the baby is not dehydrated, the operation may be done as soon as the condition is diagnosed. Many infants, however, need extra water and minerals delivered through an intravenous line for a few days before they can undergo surgery.
The operation is done under general anesthesia (so that the baby feels nothing) and lasts less than an hour. The surgeon reaches the stomach outlet through a cut in the upper right side of the baby's abdomen. The obstruction is removed by making a lengthwise cut through the tough and overgrown muscle fibers blocking the stomach outlet.
CARING FOR A BABY WITH PYLORIC STENOSIS Before surgery:
• If your pediatrician has advised you to withhold feedings, offer a pacifier for the baby to suck.
• Be as calm and relaxed as possible when handling the baby. If you are at ease, your baby will be soothed.
• If the baby is hospitalized for fluid therapy a few days before surgery, stay with him or her as much as possible.
After surgery:
• Don't be alarmed by the tubes and intravenous lines attached to your baby.
• Expect the baby to continue vomiting for a day or two until the stomach heals.
• Help the nurses feed the baby. The first feeding—a sugar-water solution— may be given several hours after surgery. The baby can have small amounts of formula or milk after about 24 hours.
• If you are breast feeding, the baby can begin to nurse for a few minutes at a time on the day after surgery. To keep your milk supply up, express milk every four hours while the baby is unable to nurse.
GETTING HELP
Call your doctor if:
• Your baby has repeated episodes of projectile vomiting
• Your baby spits up after every feeding and seems hungry all the time
• Your baby begins having fewer bowel movements and fewer wet diapers
