Dr Phil Kieran: My three-month-old baby is puking up a lot 

We see different types of vomiting in the clinic. Possetting or mild reflux is the most common type.

Dr. Phil Kieran

GENERAL PRACTITIONER

My three-month-old son pukes up a lot, particularly after feeds. His older brother didn’t vomit much even though he had reflux. I’m not sure what is normal. What do you think?

Every new parent (even those with medical training as I found out when my first child was born) worries that their child may have something wrong that they will miss. Vomiting is common in infants and it can vary a lot.

When you have made it through the baby stage with your first child, you could be forgiven for thinking you have it figured out, But when your second child behaves entirely differently, you may start to doubt yourself.

If your child is not distressed by the vomiting and is gaining weight at the expected rate, you almost certainly have nothing to worry about (other than the amount of laundry that frequent vomiting creates).

We see different types of vomiting in the clinic. Possetting or mild reflux is the most common type. This is where babies bring some of their feed up into their mouth and swallow it again. They can sometimes spit up a little of it. This doesn’t cause distress and is entirely normal.

Reflux is more dramatic and can bring up larger volumes of feed. This can range from a large mouthful of vomit to looking like they have brought the whole feed back up.

Usually this doesn’t cause any distress but some babies will experience pain with it. This will show as arching of the back and dramatic upset. If this happens, talk to your GP, who will assess your child and may suggest medication.

One of the most common causes of severe reflux is overfeeding, so I urge parents to stop breastfeeding when the baby is satisfied and if formula feeding not to exceed the recommendations on the box. A good rule of thumb is about 150ml of formula for each kilo of weight six to eight times a day until three months and four to six times per day from four to six months.

The most dramatic type of vomiting is projectile vomiting. This is a term I have heard parents frequently use, but only a few times was it accurate. A projectile vomit happens shortly after a feed, usually consisting of the whole feed content and sprays from the child’s mouth very forcefully, (in some instances travelling a few feet over your shoulder if you have the baby held up).

This can occur around two months of age and can be a sign that the exit of the stomach is blocked. If this happens, you need to see your GP immediately.