New mums know that baby sick is something that will happen as they raise their infant. But when vomiting is a copious and regular it is time to consider the possibility of a more serious cause than simple infant reflux.
Pyloric Stenosis is a condition that affects the gastrointestinal tract in infants. The condition, which usually presents between the ages of two weeks and two months and affects around one in 500 babies, is caused by an abnormally thickened muscle in the pylorus – the outlet at the bottom of the stomach.
Over time, the muscle thickens to a point where almost nothing is able to pass through to the small intestine, making it impossible for an infant to digest feeds.
Without intervention pyloric stenosis can cause serious problems – babies will become dehydrated, malnourished and will suffer the effects of salt imbalances.
Symptoms of Pyloric StenosisWhile parents of infants with Pyloric Stenosis will usually have a feeling that something is not right, the symptoms can be mistaken for those of infant acid reflux (sometimes referred to as baby reflux) meaning there could be a delay in appropriate treatment. Parents should be on the lookout for the following:
- Vomiting after feeds - infants with Pyloric Stenosis will bring back their feeds on a regular basis, often in a forceful or projectile vomiting episode. Babies with Pyloric Stenosis will often be hungry again straight after a feed and vomiting episode.
- Changes to toilet habits - A baby with Pyloric Stenosis may have smaller and fewer stools as food is not being digested. They may also begin to go longer between wet nappies due to dehydration.
- Dehydration - a depressed fontanelle (the soft spot on baby’s head) and doughy looking or wrinkled skin.
- Rippling tummy after feeds - as the baby’s muscles try to push the food through the narrowed pylorus the waves of movement, or peristalsis, can sometimes be seen moving across the infant's stomach.
- Weight loss - a baby with Pyloric Stenosis will stop gaining weight and will eventually begin to lose weight.
How is Pyloric Stenosis Diagnosed?
A parent who suspects Pyloric Stenosis should contact their healthcare professional immediately and explain their baby's symptoms. It can help to keep a feeding log, noting how much the baby feeds and how often they vomit, and show this to the doctor.
If Pyloric Stenosis is suspected the doctor will feel the baby’s stomach to see if they can find the mass of the thickened pylorus and may send baby for an ultrasound to confirm the diagnosis.
Alternatively the doctor may give the baby a barium meal where a chalky liquid is given and then x-rays taken in order to be able to track the process of digestion.
Surgical Treatment for Pyloric Stenosis
Pyloric Stenosis needs surgical treatment to allow baby to feed properly.
On admission to hospital a baby with Pyloric Stenosis will likely be put on a drip to rehydrate them and correct their salt levels.
Feeds will be stopped and the stomach drained through a tube inserted through the nose to ready the infant for surgery.
The treatment for Pyloric Stenosis is an operation called a pyloromyotomy or Ramstedt’s procedure. The surgery involves cutting through the thickened muscle of the pylorus.
The pyloromyotomy is minimally invasive and can now be performed by laparoscopic, or keyhole, methods meaning scarring is reduced.
Recovering from Pyloric Stenosis
After surgery babies will be gradually weaned back onto their feeds starting with the tiniest amounts and following a strict ‘little and often’ protocol.
It is not unusual for babies who have been treated for Pyloric Stenosis to have further vomiting incidents as they recover, but these should be fewer and less frequent.
Pyloric Stenosis rarely recurs and infants who have been treated usually go on to feed well and thrive.
References
Pediatrics, Pyloric Stenosis, Jagvir Singh, MD
Pyloric Stenosis Information Sheet, Great Ormond Street Hospital/ UCL Institute of Child Health
This article is intended for information only – anyone with concerns about their child’s health should consult a health professional.
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