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Medical Author:

John Mersch, MD, FAAP

John Mersch, MD, FAAP

Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

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Medical Editor:

David Perlstein, MD, MBA, FAAP

David Perlstein, MD, MBA, FAAP

Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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• If your baby shows signs of dehydration (which may be difficult to recognize in infants)
• A decrease in the number of wet diapers
• A sunken soft spot (fontanelle) on the top of the head
• Lack of tears when crying
• Lethargic behavior or extreme irritability
• If weight loss is a concern: Normal infant spitting up should not cause a loss of weight. If this is a concern, the doctor should be contacted to check the child's weight in order to compare this to previous measurements.
• If the spitting up is forceful and shoots out of the mouth (plyoric stenosis)
• This type of vomiting can be a sign of a condition called pyloric stenosis.
• This condition usually appears in the first several weeks of life and is caused by an abnormal narrowing of the valve leading from the stomach to the intestine.
• This causes gradually worsening projectile vomiting after every feeding that usually develops over several days.
• Affected children seem hungry between feedings and may lose weight or become dehydrated.
• Pyloric stenosis is diagnosed based on physical exam as well as an ultrasound or X-ray that shows the narrowing of the valve to the intestines.
• Pyloric stenosis is treated with a minor surgical procedure.
• If other worrisome signs of illness appear, including fever, diarrhea, difficulty breathing, or abnormal fussiness
• If the material being spit up contains excessive mucous or blood
• This is generally not a simple case of spitting up and needs to be investigated further.

Normal infant spitting up does not require emergency treatment. The following situations may signal a different, more serious cause for the vomiting, and the child should be taken to the hospital's emergency department.

• If the infant stops breathing, becomes limp, or has any blue color change during a spitting up episode: With normal spitting up, the child may choke or gag briefly but should not stop breathing or turn blue.
• If the spit up appears green or brown: A green or brown color of the spit up may be a sign of a blockage in the intestine.
• If for any reason the child appears to be seriously ill and in your judgment cannot wait to be seen at the doctor's office

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