What should I do if my 2-week-old infant is vomiting after feeding?

Managing Vomiting in a 2-Week-Old Infant After Feeding

For a 2-week-old infant vomiting after feeding, first rule out warning signs that require immediate medical attention, then implement feeding modifications including smaller, more frequent feedings and proper positioning after meals to manage what is likely normal physiologic reflux. 1, 2

Initial Assessment

When your 2-week-old infant is vomiting after feeding, consider these important distinctions:

Normal Reflux vs. Concerning Symptoms

• Normal reflux (common): Small amounts of regurgitation or "spitting up" during or shortly after feeding
• Warning signs (seek immediate medical care):
  • Forceful/projectile vomiting
  • Green or yellow (bilious) vomit
  • Blood in vomit
  • Signs of dehydration (dry mouth, fewer wet diapers, sunken fontanelle)
  • Refusal to feed
  • Weight loss or poor weight gain
  • Excessive irritability or lethargy

Home Management Strategies

Feeding Modifications

• Feed smaller amounts more frequently to reduce stomach distension 1
• Burp frequently during and after feedings (every 1-2 oz or every 5 minutes)
• For breastfed infants:
  • Consider a 2-4 week trial of maternal diet that restricts cow's milk and eggs, as milk protein allergy can mimic reflux symptoms 1
• For formula-fed infants:
  • Consider a 2-week trial of extensively hydrolyzed protein formula if milk protein allergy is suspected 1
  • Thickened feedings may help (1 tablespoon dry rice cereal per 1 oz formula) for full-term infants 1

Positioning Techniques

• Hold infant upright for 20-30 minutes after feeding 2
• Avoid placing infant in car seats or semi-reclined positions immediately after feeding as this can worsen reflux 2
• Avoid seated and completely flat positions right after feeding 1

When to Seek Medical Attention

Immediate Medical Care (Emergency Room/Urgent Care)

• Projectile (forceful) vomiting, especially in a 3-4 week old infant (possible pyloric stenosis) 2
• Bilious (green) vomiting (possible intestinal obstruction) 1
• Signs of dehydration (decreased urination, dry mouth, sunken fontanelle)
• Lethargy or extreme irritability

Call Your Pediatrician

• Vomiting persists despite feeding changes
• Poor weight gain
• Blood in vomit or stool
• Refusal to feed
• Excessive crying or apparent pain with feeding

What to Expect at the Doctor's Visit

If medical evaluation is needed, your doctor may:

• Check weight and growth parameters
• Assess hydration status
• Examine the abdomen for abnormalities
• Consider imaging studies if warranted:
  • Abdominal ultrasound for suspected pyloric stenosis in infants with forceful vomiting 2
  • Upper GI series for other concerns 1

Important Reminders

• Most infant reflux is normal and resolves by 12 months of age 3
• Medications are rarely needed for simple reflux in otherwise healthy infants 1, 2
• Avoid exposure to tobacco smoke, which can worsen reflux symptoms 1

Remember that while vomiting is common in infants, persistent symptoms or warning signs should prompt medical evaluation to rule out more serious conditions.