Management of Vomiting in Infants

Initial Assessment

The American College of Radiology suggests that determining if vomiting is bilious or non-bilious is crucial, as bilious emesis suggests obstruction distal to the ampulla of Vater and requires urgent evaluation 1, 2
Assessing for forceful (projectile) vomiting is important, as it may indicate obstruction versus regurgitation, which is more common and benign 1, 2
Evaluating weight gain and other symptoms is necessary, as infants with normal weight gain and no other symptoms are less likely to have obstruction 1, 2

Gastroesophageal reflux (GER) is the most common cause of vomiting in the first weeks of life, often related to overfeeding, according to the American College of Radiology 1, 2
Congenital GI tract abnormalities, such as malrotation with or without volvulus, atresia of the antropyloric region, annular pancreas, and atresia/stenosis of the small bowel or colon, should be considered in neonates with persistent vomiting 1, 2
Formula intolerance or lactose intolerance may also cause vomiting, as noted in MMWR Recommendations and Reports 3, 4

For mild vomiting without dehydration, the Centers for Disease Control and Prevention (CDC) recommends administering small, frequent volumes of fluid (5 mL every minute) 3, 4, 5
Oral rehydration solution (ORS) should be used to replace fluid losses, as suggested by MMWR Recommendations and Reports 3, 4, 5

Breastfed infants should continue nursing on demand, according to MMWR Recommendations and Reports 3, 4
For formula-fed infants, continuing with full-strength formula if tolerated, or considering lactose-free or lactose-reduced formulas if formula intolerance is suspected, is recommended by MMWR Recommendations and Reports 3, 4

Bilious vomiting requires immediate evaluation for malrotation with volvulus, as suggested by the American College of Radiology 1, 2
Projectile vomiting is concerning for pyloric stenosis and requires urgent evaluation, according to the American College of Radiology 1, 2
Signs of dehydration not responding to oral rehydration require emergency evaluation, as noted in MMWR Recommendations and Reports 3, 4
Abdominal distension or tenderness requires urgent evaluation, as suggested by the American College of Radiology 1, 2