Vomiting in a baby

Vomiting is the expulsion of stomach or intestinal contents through the mouth and nasal passages. Vomiting is a common symptom in children, and the younger the child, the easier it is. The mechanism of vomiting is a sharp relaxation of the diaphragm and a simultaneous, sharp contraction of the abdominal wall muscles, when the stomach contents are forcefully pushed into the esophagus. Vomiting occurs when the vomiting center in the brain stem is irritated, where there are chemoreceptors that react to substances circulating in the blood. Therefore, vomiting can occur with almost any disease and especially with brain damage.

Causes of vomiting in a child

Vomiting in a child may be caused by:

• obstruction of the digestive tract at the level of the esophagus (atresia, chaldzia, achalasia, diffuse spasm, stenosis, foreign body, periesophagitis, etc.);
• pyloric spasm (pylorospasm, congenital hypertrophic pyloric stenosis);
• spasm of the duodenum (atresia, Ladd's syndrome, annular pancreas, etc.);
• spasm of the small and large intestines (atresia and stenosis, meconium ileus and its equivalents);
• intussusception;
• malrotation syndromes;
• chronic pseudointestinal obstruction, etc.).

Vomiting is also accompanied by other gastrointestinal diseases in children, namely: hepatitis, cholelithiasis, pancreatitis, appendicitis, peritonitis, Hirschsprung's and Crohn's diseases, food allergies, celiac disease, cow's milk protein intolerance and other malabsorption syndromes. Vomiting is often observed in sepsis, severe pneumonia, otitis media, urinary tract infections, adrenal insufficiency, renal tubular acidosis, metabolic disorders (phenylketonuria, lactic acidosis, organic aciduria, galactosemia, fructose intolerance, tyrosinosis, etc.).

Repeated acetonemic vomiting usually occurs in young children, with significant disturbances in water-electrolyte metabolism and acid-base balance developing. Acetonemic vomiting should be distinguished from cepyuacidosis, which can develop in diabetes mellitus. Sudden vomiting without a preceding feeling of nausea is observed in pathology of the central nervous system (intracranial hypertension, hydrocephalus, hemorrhages, tumors, meningitis, etc.). Severe uncontrollable vomiting occurs with cerebral edema caused by metabolic disorders (e.g., Reye's syndrome, poisoning, intoxication). In some cases, violent vomiting itself can cause damage to the mucous membrane of the cardiac part of the stomach, accompanied by bleeding (Maplory-Weiss syndrome).

A distinction is made between so-called psychogenic vomiting and psychogenic nausea, which are divided into the following variants:

• Vomiting due to increased anxiety (as a manifestation of fear of some important events);
• Reactive vomiting (unpleasant associations: sausage-feces, wine-blood, pasta-worms, etc.);
• Neurotic vomiting (manifested in two variants: hysterical vomiting, which occurs in stressful and conflict situations, and habitual vomiting, as an expression of suppressed emotions);
• Psychotic vomiting in psychoses.

Neurotic vomiting is more typical for older children. If a child is forced to eat, then habitual vomiting can appear not only in infancy, but also in preschool age. Sometimes it is enough for a child to just look at food to provoke vomiting. Signs that have diagnostic value include:

• time of appearance - on an empty stomach in diseases with portal hypertension; immediately or soon after eating in acute gastritis and peptic ulcer; at the end of the day in case of gastric evacuation disorders;
• the smell of vomit - rancid oil due to increased formation of fatty acids in hypo- and achlorhydria; rotten, putrid when food stagnates in the stomach; ammonia or reminiscent of urine in patients with chronic renal failure; fecal in gastrointestinal fistulas and intestinal obstruction;
• impurities in vomit - mucus (gastritis), pus (phlegmon of the stomach), bile (duodenogastric reflux, chronic duodenal obstruction). streaks of blood with strong multiple vomiting movements; abundant discharge of pure blood in cases of ulcers, Mallory-Weiss syndrome. Bloody vomiting is usually combined with tarry feces.

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