Differential Diagnosis for 3-Week-Old with Non-Bilious Emesis
Single Most Likely Diagnosis
- Gastroesophageal Reflux Disease (GERD): This condition is common in infants and presents with non-bilious emesis after feeding, which can become more frequent and forceful over time. The fact that the baby still feeds well and acts hungry supports this diagnosis, as GERD typically does not lead to refusal of feeds or significant weight loss in the early stages.
Other Likely Diagnoses
- Pyloric Stenosis: Although typically presents with bilious emesis, some cases can start with non-bilious vomiting. The increasing frequency and forcefulness of the emesis could suggest pyloric stenosis, especially if the vomiting becomes projectile.
- Overfeeding or Incorrect Feeding Technique: This can lead to non-bilious emesis, especially if the baby is fed too much or too quickly, causing gastric distension and subsequent vomiting.
- Food Protein-Induced Allergy (e.g., Cow's Milk Protein Allergy): Can cause non-bilious emesis, among other symptoms like fussiness and skin rashes, although these might not be immediately apparent.
Do Not Miss Diagnoses
- Intestinal Obstruction: Conditions like duodenal atresia or stenosis, and other forms of intestinal obstruction, can present with bilious emesis but early stages might be non-bilious. Missing this diagnosis can lead to severe dehydration, electrolyte imbalances, and even death.
- Infectious Causes (e.g., Urinary Tract Infection): Although less common, infections can cause non-specific symptoms including vomiting in infants. A high index of suspicion is needed, especially if there are other signs of infection.
- Congenital Anomalies (e.g., Esophageal Atresia, Tracheoesophageal Fistula): These conditions can present with feeding difficulties and emesis, and are critical to diagnose early for appropriate management.
Rare Diagnoses
- Metabolic Disorders: Certain metabolic disorders can present with vomiting among other symptoms. These are rare but critical to diagnose early as they can have significant morbidity and mortality if not treated promptly.
- Neonatal Adrenal Insufficiency: A rare condition that can cause vomiting, among other symptoms like hypotension and electrolyte imbalances. Early diagnosis is crucial for survival.