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I have a 9 month old who woke up at 4:30 AM, hiccuped, then vomited. The vomit was breastmilk white, with some remnants of solids from dinner the previous evening. She is breastfed with the introduction of solids with each meal. She did not have anything new to eat the evening before. As is typical for her, she woke around 2:30 AM for a breastmilk feeding.

The weird part is that there seems to be nothing strange or different about her aside from that episode of vomiting. She has never vomited or even spit up in her life up till now. Temperature feels normal, and she is acting her normal happy self, and was her normal happy self before bedtime the night before.

To the question: What could be the causes of vomiting in an otherwise normally acting pre-toddler? Is there anything to look out for that may help to determine if she is coming down with something? I'm not very concerned at all - just curious.

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To clarify, is the baby actually vomitting, or just spitting up? "Vomiting is the forceful throwing up of stomach contents through the mouth. Spitting up (most commonly seen in infants under one year of age) is the easy flow of stomach contents out of the mouth, frequently with a burp." –  Beofett Aug 28 '13 at 14:55
    
It was definitely vomiting. As mentioned in the question, there were remnants of the solids she consumed last night. The volume was fairly significant. –  Steven Bone Aug 28 '13 at 18:48
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Spit-up can easily include solid remnants of previous meals, and even a few teaspoons looks like a significant volume once it comes out. The main difference is the force with which the contents come out, not the consistency or volume (i.e. did it come launching out of her mouth, or did it fill her mouth and spill down her chin?). –  Beofett Aug 28 '13 at 18:58
    
It came launching out of her mouth, and was forceful enough to go at least 12" horizontally, while she was laying down with her head turned to the side (unfortunately, towards me, hence the 'at least' disclaimer). There is no question that it was vomiting. I'm also fairly certain there was no aspiration. –  Steven Bone Aug 28 '13 at 19:32
    
Yep, that sounds like vomit! Thanks for bearing with my questions. –  Beofett Aug 28 '13 at 19:50

3 Answers 3

up vote 3 down vote accepted

My daughter did this once at about 5 months. It was concurrent with some extra runny stools. I didn't think it was serious enough to take her to the pediatrician since it only happened once, but I did think it was a good excuse to call the nurse hotline through my insurance. What the phone nurse told me was that she probably had a small virus but nothing serious and that we could wait it out unless it got worse. Baby Center has a good list of reasons to be concerned with vomitting here. They include:

Call 911 immediately if:

  • Your baby's having trouble breathing
  • He shows signs of severe dehydration, like sunken eyes, cold, splotchy hands and feet, excessive sleepiness or fussiness, or sunken fontanels (the soft spots on his head)

Take your baby to the emergency room if:

  • He seems in severe pain. Your baby obviously can't explain what's going on, but you know him best and can probably tell when he's in considerable pain. He could have a blockage in his bowel or some other problem that needs immediate attention.
  • His vomit contains bile (a green substance) or blood that resembles dark coffee grounds. The doctor will probably want to see a sample of the vomit if it contains blood or bile, so as distasteful as it is, you should try to save some in a plastic baggie. Green bile can indicate that the intestines are blocked, a condition that needs immediate attention.
  • He has a swollen, tender abdomen. This could indicate a buildup of fluid or gas, a blocked intestine, a hernia, or some other digestive tract problem. Blockages are uncommon but serious.
  • He vomits more than once after suffering a head injury, which may indicate a concussion.

Call your baby's doctor if:

  • Your baby's been vomiting for more than 24 hours. For some illnesses, this is perfectly normal, but check with the doctor to be sure.
  • He shows signs of becoming dehydrated. These can include decreased urination (more than six to eight hours without a wet diaper), dry lips and mouth, crying without tears if he's more than a couple weeks old (it takes two to three weeks for a baby to shed his first tears), lethargy, and dark yellow urine.
  • The vomit contains blood. A little blood in the vomit is usually nothing to worry about, as the force of vomiting can cause tiny tears in the blood vessels lining the esophagus. Your baby's vomit may also be tinged with red if he's swallowed blood from a cut in his mouth or a nosebleed within the last six hours. But call the doctor if your baby continues to have blood in his vomit or the amount increases. As mentioned above, if the blood resembles dark coffee grounds, go to the emergency room right away.
  • He has violent, persistent vomiting within half an hour of eating. This may be a sign of pyloric stenosis (see below). Contact the doctor as soon as possible.
  • You notice a yellowing of your baby's skin or the whites of his eyes, which is a sign of jaundice. Jaundice accompanied by pain in the upper right side of the abdomen (which, of course, your baby won't be able to describe for you) may signal hepatitis.

Call a poison control center if:

  • You suspect your baby has swallowed something poisonous. Call the American Association of Poison Control Center's national emergency hot line at (800) 222-1222 or your local poison control center immediately. If you can identify what he's swallowed — for example, you find an empty medicine bottle — tell the medical experts what it is and they'll give you exact instructions for taking care of your baby.

You can get more about the reasons for vomitting at the link provided if you're interested, but it sounds from your description like your child might be fighting off a minor infection and you just need to keep an eye out. However if you have any concerns please contact a medical professional for advice.

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Especially with breastfed babies, stomach bugs often only seem to affect them in a really minor way. I'd bet money the rest of you will be laid low with D&V within 24 hours! –  Vicky Aug 29 '13 at 11:01
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Our pediatrician has a daily call time, and we took advantage of it (great feature to have in a ped, BTW): "It's probably a stomach bug, expect periodic vomiting for a couple of days followed by possible diarrhea. She said keep nursing her (all the milk she can drink), go easy on solids (do blander stuff- bananas, rice cereal, applesauce) Let her sleep as much as she wants, make sure diapers are wet every 4-6 hours. If vomiting ramps up call back." She followed up the vomiting episode with two increasingly soft stools and some diarrhea later in the day, still her normal self thankfully. –  Steven Bone Aug 29 '13 at 12:36
    
Remembering back a year ago when this happened to us I realized that it happened on a Saturday. Otherwise I would have called the pediatricians because the nurses staff the phone during office hours and turn it over to the doctors if need be. Thankfully we didn't end up needing it as our daughter was 100% normal in about 24 hours. –  justkt Aug 29 '13 at 12:42

This is the first occurrence? Might be that she got some air down under the 2:30 feeding and when you got her up, it disturbed that bubble enough to make her spit up a bit.

Make sure after the feeding, even if she's out cold, to get as many burps out as you can. Air bubbles are sneaky.

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Thank you for the comment - it was definitely vomiting, so in this case air was not the cause. –  Steven Bone Aug 29 '13 at 12:30

If this is that you have recently started to introduce solids, it might be a reflex reaction triggered by the hiccup. The stomach is not very used to get anything other than milk or water. I would not be too concerned if there are no other symptoms or it does not happen again shortly.

If this happens several times, you might want to call your physician about it.

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She has been on solids for 3 months, so I don't believe this was the case. Thank you for the comment. –  Steven Bone Aug 29 '13 at 12:31

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