Ongoing vomiting in an infant

A four week old infant is brought to see you by her mother who is concerned that her baby vomits after feeds several times a day. The baby is otherwise well, formula fed, and is thriving with no other symptoms.

Involuntary passage of a baby’s stomach contents back up the oesophagus is a common, normal physiological event. The infant might or might not regurgitate or vomit shortly after feeding, several times a day.1 This is known as gastro-oesophageal reflux (GOR), and can be associated with feed refusal, crying, and back arching.² As the lower oesophageal sphincter has not yet matured, milk refluxes through the opening into the oesophagus, causing discomfort for the infant (fig 1). GOR resolves without investigation or treatment.

Consider gastro-oesophageal reflux disease (GORD) if symptoms of regurgitation interfere with the baby’s quality of life or cause complications, such as poor weight gain, difficulty in sleeping, and recurrent chest infections1.1

It can be difficult to distinguish between colic—excessive, frequent crying in a well baby—and GOR, GORD, or “fussy eating” because of the overlap of symptoms and the lack of useful investigations. In one Australian cohort study, GOR was reported by parents in almost a quarter of infants. Symptoms commenced in the first month of life in 50% of cases and resolved by six months for 75% of infants.2 In comparison, prevalence …