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  1. Jayanta Banerjee, specialist trainee fifth year paediatrics1,
  2. Mita M Roy, general practitioner2,
  3. Sheetal Bhojani, specialist trainee fifth year paediatrics1,
  4. Naina Emcy, consultant paediatrician1
  1. 1Southend University Hospital NHS Foundation Trust, Southend SS0 0RY
  2. 2South West Essex Primary Care Trust, Basildon SS14 3HG
  1. Correspondence to: J Banerjee docjayanta{at}hotmail.com
  • Accepted 7 April 2010

A 6 week old baby boy, first child of young white parents, presents with recurrent episodes of vomiting from age 3 weeks. He was born at term after an uneventful pregnancy.

What issues you should cover

This presentation is common and generally falls into one of three categories:

  • Those requiring reassurance and parental advice.

  • Those with minor problems that can be successfully managed in primary care.

  • Those with serious disorders requiring specialist paediatric attention.

  • Duration and progression of symptoms—thriving babies who vomit after each feed may simply be overfed. Progressive vomiting with faltering growth suggests gastro-oesophageal reflux or milk intolerance. Acute vomiting in a previously thriving baby might be caused by a serious illness such as sepsis.

  • Character of vomiting—large volumes of projectile vomit within 30 minutes of feeding suggest pyloric stenosis. Alternatively, effortless vomiting might indicate possetts.

  • Colour or content of vomit—bilious vomiting, particularly in babies, might indicate bowel obstruction, so clarify the meaning of “bilious” with parents by showing colours to compare, for example milk, yellow, bilious, or blood stained.

  • Type of feed—ask about volume and frequency. Knowing the different …

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