Vomiting: What's normal and what's not

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 child is vomiting rather than just possetting (bringing small quantities of milk back up) because there will be a lot more coming out, not just a few teaspoons trickling gently down his chin. It can also be frightening for your baby, so he's more likely to cry.

Everything from car sickness to indigestion can cause your baby to vomit - 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. Vomiting will generally subside within six to 24 hours after it starts, without any particular treatment aside from a change in diet. 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 due to mild feeding problems such as overfeeding. After the first few months, it's more likely to be caused by a stomach virus, although vomiting can occasionally signal an infection in the respiratory system, the urinary tract, or even the ear. Once your child is a little older, it can be a symptom of more serious illnesses. Don't hesitate to call your doctor if you notice any of the following warning signs in your baby:

• severe abdominal pain;

• a swollen abdomen;

• lethargy or severe irritability;

• convulsions;

• strenuous, repeated vomiting or vomiting that continues beyond 24 hours;

• signs of dehydration, including dry mouth, lack of tears, depression of the "soft spot" on your baby's head, and decreased urination (wetting fewer than six nappies a day);

• and, blood or bile (a green substance) in the vomit;

A little blood in the vomit is usually nothing to worry about. This may happen when the force of regurgitation causes tiny tears in the blood vessels lining the oesophagus. Your baby's vomit may also be tinged with red if he has swallowed blood from a cut in his mouth or a nosebleed within the last six hours. But do call your doctor if your child 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, you should try to save some. Green bile can indicate that the intestines are blocked, a condition that needs immediate attention.

• persistent forceful vomiting in a newborn within half an hour of eating.

This may be due to pyloric stenosis, a rare cause of vomiting 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.

Try not to worry too much. Every child is going to be sick sooner or later, and usually it's nothing to be concerned about unless he happens to do it all over your brand new shirt. Like every other part of parenthood, it's something you'll soon get used to.

How should I deal with vomiting?

When your baby vomits, he's losing precious fluids. It's important to replace them so he won't get dehydrated. To do this, give him an electrolyte solution (such as Oral Rehydration Solution, but ask your doctor for a recommendation) or clear liquids such as water or diluted apple juice - these are the easiest things for your baby to keep down. Experts recommend the following plan:

• Once he has stopped vomiting, start giving your baby small amounts of water or electrolyte solution (if you've got one to hand) every half-hour to an hour.

• If he manages to keep this down, give him 2oz / 50ml of electrolyte solution alternated with 2oz / 50ml of clear liquid every half-hour.

• After he's managed to keep down two of these doses without vomiting, add half-strength milk or formula, and increase the quantity of each feed to 3 or 4oz / 80-100ml every three or four hours.

If your baby hasn't vomited for 12 to 24 hours, you can start moving back to his regular diet, but keep giving him plenty of fluids. Start with easy to digest foods like cereal or yoghurt. You can also try using frozen clear liquids, such as ice lollies if your child is over 12 months.

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 any anti-nausea medicines (prescription or over-the-counter) unless your paediatrician has prescribed them.