Strep throat is still lingering this time of year and I saw one of my cute patients who told me “my froat is on fire.” I had just seen this family earlier in the week when they brought in their one month old for a check up.
During their visit, their mom commented that the baby had been vomiting and spitting up a lot more in the last several weeks. The baby was all bundled up and in his car seat, so I said, “oh well, let’s weigh him and see how he is doing while we do a throat culture on his brother”.
Well, guess what? The baby had lost 1 lb in two weeks!! So, when I went back in to the exam room, I told the mom that this baby was indeed the sicker of the children and he had just “come along for the ride”. Thank goodness for small miracles.
I then examined this little boy and he looked thin, wasted and a bit dehydrated. But, he was one of those “easy” babies and did not fuss and cry even though he was vomiting so much that he was losing weight.
The first thing that popped into my mind was that he might have pyloric stenosis. Pyloric stenosis is due to the fact that the muscle surrounding the outlet from the stomach to the intestine (the pylorus) is thickened and thereby blocks the movement of food (milk in this case) from the stomach to the intestine.
Pyloric stenosis usually occurs in infants between 3 – 6 weeks of age, and is more common in males than females and is seen in about 1/500 newborns. It also runs in families.
The typical baby with pyloric stenosis develops projectile, forceful vomiting that begins at several weeks of age (different than spitting up, and reflux etc), and becomes more frequent over time.
Almost, every baby will have an episode or two of projectile vomiting but with pyloric stenosis you notice that the baby vomits within 30 – 60 minutes of a feeding and it happens every time. The milk comes out with such force that it literally may spew a foot or two. When you see the vomiting it is pretty impressive, such force coming out of such a small body.
I must say that there have been several times in my practice when I have tried to feed a baby thinking, “this baby just is a spitter and these parent’s need reassurance”, only to swallow those words as the vomit sprays from one side of the exam room to the other. Time for an ultrasound!!
Pediatricians are taught to feel the baby’s abdomen for the hypertrophied pyloric muscle which can feel like an olive, but often it takes an ultrasound or an upper GI to make a definitive diagnosis.
Once the diagnosis is made, a pediatric surgeon will be consulted to do a pyloromyotomy (where they will clip the muscle) which is a fairly easy procedure. Many children will require some IV hydration prior to surgery and can often go home within 24 hours after the surgery and have a full recovery. The scar is barely noticeable.
So…the moral of the story is thank goodness for bringing both children to the pediatrician. This little boy has already been seen by the surgeon and will be operated on in the morning.
That’s your daily dose for today. We’ll chat again tomorrow.