Infant Vomiting: Causes and Solutions for Formula-Fed Babies

Issues with drinking milk and abdominal problems?

Hello doctor, my baby is now over two months old.
Since birth, he has had a tendency to spit up formula milk, and now the amount has decreased from 150 ml to 90 ml, yet he still spits up immediately after feeding.
In the past two days, the vomiting has increased and is more forceful, resembling projectile vomiting.
Recently, an ultrasound report indicated that his stomach is filled with gas.
I would like to know if the formula might not be suitable for him, causing the gas and spitting up.
He is currently drinking S-26 Platinum formula approximately every 3.5 hours, six times a day.
Is this overall milk intake sufficient for my baby? We have also been doing tummy massages and using probiotics, but he still experiences significant spitting up.
Please advise, thank you.

Ai, 20~29 year old female. Ask Date: 2021/11/20

Dr. Pei Rensheng reply Pediatrics

Hello,
1.
If there is projectile vomiting within three months, be cautious about the possibility of hypertrophic pyloric stenosis.

2.
You can visit a pediatric gastroenterology clinic to arrange for abdominal X-rays and ultrasound examinations for diagnosis.

3.
The daily milk intake should be 100-200 CC/KG/DAY.
For example, if a child weighs 6 KG, they should consume 600-1200 CC per day.
If feeding six times a day, this would be 100-200 CC per meal.

4.
The nutritional value of S26 Platinum is acceptable; however, you may also consider trying a hydrolyzed protein formula to see if it alleviates any gas issues.

Wishing you health, happiness, and safety!
Sincerely,
Dr.
Ren-Sheng Pei
Attending Physician, Pediatrics
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2021/11/20

More Info

Infant vomiting, particularly in formula-fed babies, can be a concerning issue for parents. It is essential to understand the potential causes and solutions to manage this condition effectively. In your case, your baby is experiencing frequent vomiting, which has increased in severity, resembling projectile vomiting. This can be alarming, but there are several factors to consider.

Causes of Vomiting in Infants
1. Gastroesophageal Reflux (GER): One of the most common causes of vomiting in infants is gastroesophageal reflux, where the contents of the stomach flow back into the esophagus. This is often due to the immaturity of the lower esophageal sphincter in infants, which may not close properly, allowing milk to escape back up.

2. Overfeeding: If a baby is fed more than their stomach can handle, it can lead to vomiting. The fact that you have reduced the feeding amount from 150ml to 90ml suggests you are trying to manage this, but it’s crucial to ensure that the baby is still receiving adequate nutrition.

3. Formula Intolerance or Allergy: Some infants may have difficulty digesting certain types of formula, leading to gastrointestinal discomfort, gas, and vomiting. If your baby is experiencing increased gas and discomfort, it may be worth considering whether the current formula (S26 Platinum) is suitable for them.

4. Air Swallowing: Babies often swallow air while feeding, especially if they are feeding too quickly or if the nipple flow is too fast. This can lead to gas buildup and discomfort, resulting in vomiting.

5. Underlying Medical Conditions: In some cases, vomiting can be a sign of a more serious condition, such as pyloric stenosis, which is a narrowing of the opening from the stomach to the intestine. This condition typically presents with projectile vomiting and requires medical evaluation.

Solutions and Recommendations
1. Feeding Techniques: Ensure that your baby is in a comfortable position while feeding. Hold them upright and try to keep them in an upright position for 20-30 minutes after feeding to help reduce reflux. Additionally, consider using a slower-flow nipple if you suspect that your baby is feeding too quickly.

2. Burping: Frequent burping during and after feeds can help reduce the amount of air swallowed and alleviate gas buildup. Try burping your baby after every 1-2 ounces of formula.

3. Formula Adjustment: If you suspect that the current formula is causing issues, consult with your pediatrician about switching to a hydrolyzed formula, which is easier to digest and may help reduce vomiting and gas. It is essential to transition gradually to allow your baby to adjust to the new formula.

4. Monitor Feeding Schedule: Feeding every 3.5 hours is generally appropriate for a baby of your age, but ensure that the total daily intake meets their nutritional needs. The average intake for infants is about 100-200 ml per kg of body weight per day. If your baby is not gaining weight adequately or seems hungry after feeds, you may need to adjust the amount or frequency of feeding.

5. Consult a Pediatrician: Given the increase in vomiting severity and the description of projectile vomiting, it is crucial to consult your pediatrician. They may recommend further evaluation, including an ultrasound or other diagnostic tests, to rule out any underlying conditions.

Conclusion
Infant vomiting can be distressing for both the baby and the parents. By understanding the potential causes and implementing some practical solutions, you can help manage your baby's symptoms. However, it is vital to maintain open communication with your healthcare provider to ensure that your baby is healthy and receiving the appropriate care. If the vomiting persists or worsens, do not hesitate to seek medical advice for further evaluation and management.

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