As we have noted earlier spitting up is a disconcerting but very common reaction through the early months. The infant may drink four ounces with vigor and then, a few minutes or even hours later, bring up what seems to be an equally large amount. What distinguishes this regurgitation from the vomiting of a baby who is sick with infection or has some other serious problem? As the first step in this assessment parents might ask themselves the following four questions:
I. Is the baby sucking and feeding with vigor or have I had to force him, more or less, to take his milk?
2. Did he take in a good volume of fluid and really spit up only the last ounce, or did he take in only a relatively small amount and spit up most of it?
3. Does he vomit at every feeding or just once or twice a day?
4. Most important, how is he functioning otherwise? Is he alert. moving about? Is the pattern of his bowel movements typical and are the stools of “good” color (see page my)? Or does he look pale, seem either lethargic or excessively irritable, and is he either producing no stools or having very frequent abnormally colored movements?
With factual answers to these questions in hand, the parent is in a good position to decide (if she feels that self assured) whether she needs the doctor’s advice, and she is also prepared to provide the doctor with useful information on which to base a judgment.
Parents should regard with suspicion any infant whose pattern of bowel movements changes suddenly, in particular if the color of the stools changes to green and remains so consistently (not just once or twice)
and if the movements become very watery and explosive. Sick babies usually pass many stools. Two or three green, watery, and explosive movements may be sufficient to disturb parents. There are some babies, both breast-fed and bottle fed, who may have eight or even ten loose stools a day, but as long as the movements remain yellow in color and do not have much water content, the frequency is of little significance.
At the other extreme, many infants have only one bowel movement every other day and some perfectly normal babies (especially breast-fed infants) may skip two or three days between movements. It may be worth adding that the same illness that afflicts an older child or an adult with a cold may produce diarrhea in the infant. Furthermore, irritability and diarrhea may be the only manifestations of earache or sore throat in an infant. The intestinal tract of the infant can represent the main symptomatic pathway for a variety of stresses, infectious or otherwise.
Finally, diarrhea is relatively common in infancy. Usually it is a benign problem that will respond to dietary management alone. Nevertheless, there are good reasons for concern. At this very early age diarrhea can be associated with some degree of dehydration. Because of his smaller reserve of fluids, the infant develops dehydration more quickly than his older sibling does. Accordingly, if you become concerned about your baby’s diarrhea, call the doctor early. He will have suggestions to prevent dehydration.
Whatever attitude one may have toward constipation (infrequent bowel movements) , one should certainly not regard it as an illness in infancy unless it is associated with the following conditions:
1. Unexplained vomiting, usually persistent and projectile.
2. Distension of the abdomen.
3. Failure to gain weight
4. Pallor, weakness, listlessness, or excessive irritability.
5. Excessive difficulty in passing a stool, including blood on the stool. Remember that most normal infants fuss and fume, and may grow red in the face for several minutes while expelling a stool.