what's normal and what's not about vomiting

Is it normal for my baby to vomit?

It's common for babies to vomit frequently in the early weeks as they adjust to feeding and as their bodies develop. You can tell when your baby is vomiting rather than just possetting (bringing up small quantities of milk), because there will be a lot more coming out, not just a few teaspoons trickling down his chin. It can be frightening for your baby, so he's likely to cry.

Everything from car sickness to indigestion can cause your baby to be sick – even a prolonged bout of crying or coughing can trigger this reflex. So you may see quite a lot of vomiting in your baby's first few years.

An attack of vomiting will generally subside six to 24 hours after it starts, without any particular treatment apart from a change in diet (see below, abouthow to deal with vomiting). As long as your baby seems otherwise healthy and continues to gain weight, there's usually no need to worry.

When should I worry?

During your baby's first few months, vomiting is probably caused by mild feeding problems, such as his tummy being too full. After the first few months, a sudden onset of vomiting is more likely to be caused by a stomach virus, such as gastroenteritis, which is often accompanied bydiarrhoea.

Your baby may also be sick when he has:

• a cold
• a urine infection
• an ear infection

Once your child is a little older, it can sometimes be a symptom of more serious illnesses. Call your doctor if you notice any of the following warning signs in your baby:

• Signs of dehydration, including a dry mouth, lack of tears, sunkenfontanelle, and fewer wet nappies than usual (less than six nappies a day).
• A fever, with a temperature of 38 degrees C or higher if he is younger than three months, or 39 degrees C or higher if three months or older.
• Refusal to breastfeed or drink his formula milk.
• Vomiting for more than 12 hours, or vomiting with great force.
• A non-blanching rash, which is a rash that doesn't fade when the skin is pressed.
• Sleepiness or severe irritability.
• A bulging fontanelle.
• Shortness of breath.
• A swollen abdomen.
• Blood or bile (a green substance) in the vomit (see below).
• Persistent forceful vomiting in a newborn within half an hour of eating (see below).

Blood or bile in the vomit:This is usually nothing to worry about. It may happen when the force of regurgitation causes tiny tears in the blood vessels lining the food pipe (oesophagus). Your baby's vomit may also be tinged with red if he has swallowed blood from a cut in his mouth or has had a nosebleed in the past six hours.

However, call your doctor if your baby continues to have blood in his vomit or if the amount is increasing. The doctor will probably want to see a sample of the vomit if it contains blood or bile, so, although it may be an unpleasant task, try to save some. Green bile can indicate that the intestines are blocked, a condition that needs immediate attention.

Persistent or forceful vomiting in a newborn within half an hour of eating:This may be due to pyloric stenosis, a rare condition that is most likely to begin when your baby is a few weeks old, but could show up at any time before he reaches four months.

The baby vomits when a muscle controlling the valve leading from the stomach into the intestines has thickened so much that it won't open up enough to let food through. The problem is simple to remedy with minor surgery, but it does require immediate medical attention.

How should I deal with vomiting?

Every child is going to be sick sooner or later, and usually it's nothing to worry about. Like every other part of parenthood, it's something you'll soon get used to, and there are steps you can take to help him get better:

• Keep him hydrated:When your baby vomits, he's losing precious fluids. It's important to replace them so he won't getdehydrated. To do this, give him sips of oral rehydration solution (ORS), such as Dioralyte, a few times an hour, alongside his usual breastmilk or full-strength formula, and water. Don't give your baby fruit juices or carbonated drinks.
• Ease him back into his routine:If your baby hasn't vomited for 12 to 24 hours, you can begin moving back to his usual diet, but keep giving him plenty of fluids. Start with easy-to-digest foods such as cereal or yoghurt. You can also try using frozen clear liquids, such as ice lollies, if your child is over 12 months.
• Help him rest:Going to sleep may also help settle your baby. The stomach often empties into the intestines during sleep, relieving his need to vomit.

Don't give your child anti-nausea medicines (prescription or over-the-counter), unless your GP has prescribed them.

If your baby attends childcare or nursery, keep him at home until at least 48 hours after his last episode of vomiting.