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Suggest Remedies For Persistent Cough And Vomiting In An Infant
Question: Hi Doctor,
my daughter is 1 month and 5 days old. she was born at 38 weeks by c-section, her weight at birth was 2.5kg and now at 4 months she is 4kg.
She is a normal baby, she was born with blocked eye duct so now she tears without any crying , the doctor told us to give her massage near her nose. She wakes up with yellow mucus on her eyes which she was given tobrex 1 drop for 5 days when we were discharged from hospital, she got slightly better after the tobrex and we stopped it when she was 5 days old.
We took her for check up when she was 3 weeks old, on 11/10/2016, because the yellowish discharge on her eyes came back and also because she strains a lot after eating and burps with difficulty and also she had projectile vomiting two to 3 times with in 3 weeks. The doctor prescribed us tobrex for her eye discharge again, and nasal spray, fentisil for some blocked nose , he also prescribed bonissan himalaya for the straining from gasses.
as for the projectile vomiting the Doctor told us that it could be due to infection or also due to something known as pyloric stenosis, he suggested us to do ultrasound to rule out pyloric stenosis however we decided to wait for few more days and if we see she is still vomiting then we will go to check her. the doctor also assured us that since she is gaining good weight he kind of thinks it's not pyloric stenosis.
today she is 1 month and 5 days old and she vomited after the doctor visit almost 3 to 4 times, 2 of them was forceful projectile vomit that came from her nose as well and the other 2 was slight vomiting but wets the whole bed.
she now also has cough for 4 days that got worse today
Questions .
1, what could be the cause of this vomiting?
2. Most of the time when my daughter vomits, she is either straining hard or trying to burp? and sometimes she vomits after we wake her up every three hours to feed even if she doesn't want...
a.i thought could it newborns vomit projectile vomit because of overfeeding?
b.could she be vomiting with trying to pass burp?
3.could this vomiting be due to this coughing ? or some infection in the lungs or stomatch?
4.what do you suggest us to do regarding the coughing she just recently developed?
my daughter is 1 month and 5 days old. she was born at 38 weeks by c-section, her weight at birth was 2.5kg and now at 4 months she is 4kg.
She is a normal baby, she was born with blocked eye duct so now she tears without any crying , the doctor told us to give her massage near her nose. She wakes up with yellow mucus on her eyes which she was given tobrex 1 drop for 5 days when we were discharged from hospital, she got slightly better after the tobrex and we stopped it when she was 5 days old.
We took her for check up when she was 3 weeks old, on 11/10/2016, because the yellowish discharge on her eyes came back and also because she strains a lot after eating and burps with difficulty and also she had projectile vomiting two to 3 times with in 3 weeks. The doctor prescribed us tobrex for her eye discharge again, and nasal spray, fentisil for some blocked nose , he also prescribed bonissan himalaya for the straining from gasses.
as for the projectile vomiting the Doctor told us that it could be due to infection or also due to something known as pyloric stenosis, he suggested us to do ultrasound to rule out pyloric stenosis however we decided to wait for few more days and if we see she is still vomiting then we will go to check her. the doctor also assured us that since she is gaining good weight he kind of thinks it's not pyloric stenosis.
today she is 1 month and 5 days old and she vomited after the doctor visit almost 3 to 4 times, 2 of them was forceful projectile vomit that came from her nose as well and the other 2 was slight vomiting but wets the whole bed.
she now also has cough for 4 days that got worse today
Questions .
1, what could be the cause of this vomiting?
2. Most of the time when my daughter vomits, she is either straining hard or trying to burp? and sometimes she vomits after we wake her up every three hours to feed even if she doesn't want...
a.i thought could it newborns vomit projectile vomit because of overfeeding?
b.could she be vomiting with trying to pass burp?
3.could this vomiting be due to this coughing ? or some infection in the lungs or stomatch?
4.what do you suggest us to do regarding the coughing she just recently developed?
Brief Answer:
If weight gain is normal it could just be regurgitation
Detailed Answer:
Hi....If weight gain is normal at 25-30 Grams per day, it could just be regurgitation and you need not worry about it.
Coming to your queries -
1. If weight gain is normal at 25-30 Grams per day, it could just be regurgitation and you need not worry about it.
2a. Over feeding could be a reason.
2b. Burping will not cause projectile vomiting.
3. Coughing can induce vomiting, but not for so many weeks, like this. Infection of stomach and lungs cannot go on like this for almost 4 weeks at this age without getting complicated.
4. At this age cough is a protective reflex and should not be treated at all. If there is no fast breathing or respiratory distress and feeding difficulty, please ignore this cough.
Regards - Dr. Sumanth
If weight gain is normal it could just be regurgitation
Detailed Answer:
Hi....If weight gain is normal at 25-30 Grams per day, it could just be regurgitation and you need not worry about it.
Coming to your queries -
1. If weight gain is normal at 25-30 Grams per day, it could just be regurgitation and you need not worry about it.
2a. Over feeding could be a reason.
2b. Burping will not cause projectile vomiting.
3. Coughing can induce vomiting, but not for so many weeks, like this. Infection of stomach and lungs cannot go on like this for almost 4 weeks at this age without getting complicated.
4. At this age cough is a protective reflex and should not be treated at all. If there is no fast breathing or respiratory distress and feeding difficulty, please ignore this cough.
Regards - Dr. Sumanth
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks doctor for the quick response.
can regurgitation be seen as projectile vomiting with some of the vomit coming out of nostrils? most of the information i read suggest that regurgitation is simple spit up of few digested milk.
The kind of vomit she had is projectile vomiting which in some occasions included nostrils, it's usually after feeding, one time she vomited all the milk simultaneously after it was some yellow/grenish sticky thing.
I also noticed that she passes stool right after she vomits as well.
I checked her weight just now and she is still 4kgs , when we went to the doctor she was 3.9kg wich was on 11/10/2016. could that be considered sufficient weight gain?
Also i would appreciate if you can give me some details on why you don't suspect the cause to be pyloric stenosis or other causes ? what other signs would we see if she could have pyloric stenosis and how is it different from her case now?
thank you again
can regurgitation be seen as projectile vomiting with some of the vomit coming out of nostrils? most of the information i read suggest that regurgitation is simple spit up of few digested milk.
The kind of vomit she had is projectile vomiting which in some occasions included nostrils, it's usually after feeding, one time she vomited all the milk simultaneously after it was some yellow/grenish sticky thing.
I also noticed that she passes stool right after she vomits as well.
I checked her weight just now and she is still 4kgs , when we went to the doctor she was 3.9kg wich was on 11/10/2016. could that be considered sufficient weight gain?
Also i would appreciate if you can give me some details on why you don't suspect the cause to be pyloric stenosis or other causes ? what other signs would we see if she could have pyloric stenosis and how is it different from her case now?
thank you again
Brief Answer:
Suggestions on vomiting and passing stools after feeding
Detailed Answer:
Hi.... I understand your concern.
Your child is gaining almost 60 grams per day. Initially in the first 10 days of life babies lose 10% of their body weight and regain it again by 10th day. So in this manner it has been 25 days now and the baby is 4 kilos. That mean she has gained 1500 grams in 25 days which is almost 60 grams per day. This cannot happen if the child is having hypertrophic pyloric stenosis. The baby would have been not gaining appropriate weight and would have been feeling to thrive. Moreover hypertrophic pyloric stenosis is more common in male babies.
This is the reason why I am not considering hypertrophic pyloric stenosis.
Babies can vomit or regurgitate whole milk which has been fed. Even if it is regurgitation or vomiting, you need to worry only if the vomiting is green in colour or bilious or there is abdominal distention or the baby is failing to thrive. None of this is happening in your baby.
But to be sure that this is not a hundred percent hypertrophic pyloric stenosis, we need to take an ultrasound scan. The other clinical finding which we can find is, there will be visible Gastric peristalsis near the stomach region in the abdomen, which the pediatrician can easily pick up.
As to the issue of passing stool immediately after feeds - this is called Gastrocolic reflex and you need not worry about it. I will explain you what it is.
It is quite common for babies of this age group t pass small amount of diarrhea or loose stools soon after feeds. This need not be treated as diarrhea and especially antibiotics are not indicated.
When the baby takes milk , the stomach expands - then when it is contracting it sets off a wave form which moves down the intestines and when that wave reaches the lower down rectum, a small quantity of the stool is evacuated out. This is the basis for gastro-colic reflex. Do not worry.
Unless the kid's having low urine output or very dull or excessively sleepy or blood in motion or green bilious vomiting...you need not worry.
I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link.
Once the page opens there will be an option below my image as – ASK ME A QUESTION – click on it.
In this way even in health care magic you can follow up always with a single doctor who knows the history of your kid completely. Please find the link below -
www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696
Regards - Dr. Sumanth
Suggestions on vomiting and passing stools after feeding
Detailed Answer:
Hi.... I understand your concern.
Your child is gaining almost 60 grams per day. Initially in the first 10 days of life babies lose 10% of their body weight and regain it again by 10th day. So in this manner it has been 25 days now and the baby is 4 kilos. That mean she has gained 1500 grams in 25 days which is almost 60 grams per day. This cannot happen if the child is having hypertrophic pyloric stenosis. The baby would have been not gaining appropriate weight and would have been feeling to thrive. Moreover hypertrophic pyloric stenosis is more common in male babies.
This is the reason why I am not considering hypertrophic pyloric stenosis.
Babies can vomit or regurgitate whole milk which has been fed. Even if it is regurgitation or vomiting, you need to worry only if the vomiting is green in colour or bilious or there is abdominal distention or the baby is failing to thrive. None of this is happening in your baby.
But to be sure that this is not a hundred percent hypertrophic pyloric stenosis, we need to take an ultrasound scan. The other clinical finding which we can find is, there will be visible Gastric peristalsis near the stomach region in the abdomen, which the pediatrician can easily pick up.
As to the issue of passing stool immediately after feeds - this is called Gastrocolic reflex and you need not worry about it. I will explain you what it is.
It is quite common for babies of this age group t pass small amount of diarrhea or loose stools soon after feeds. This need not be treated as diarrhea and especially antibiotics are not indicated.
When the baby takes milk , the stomach expands - then when it is contracting it sets off a wave form which moves down the intestines and when that wave reaches the lower down rectum, a small quantity of the stool is evacuated out. This is the basis for gastro-colic reflex. Do not worry.
Unless the kid's having low urine output or very dull or excessively sleepy or blood in motion or green bilious vomiting...you need not worry.
I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link.
Once the page opens there will be an option below my image as – ASK ME A QUESTION – click on it.
In this way even in health care magic you can follow up always with a single doctor who knows the history of your kid completely. Please find the link below -
www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696
Regards - Dr. Sumanth
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much doctor for the well-detailed answer. I will surely consider asking you directly through the link you gave me if i have any future questions, truly appreciate the link you provided me.
final follow up questions to my current case of my daughter, I took her to hospital today just for a quick checkup, regarding her vomiting the Doctor told me the same exact thing that you wrote above, and he said to get a peace of mind we will do ultrasound for her to rule out pyloric stenosis.
Regarding the cough he took a quick swab from her nose and it became positive for RSV, he said this is common at this season because many people get infected and they touch the baby. he gave me a prescription I attached above and some of them need nebulizer which i bought from the pharmacy. He told me to let her stay at hospital for 2 days but because it's very expensive and I'm not at home country I decided to give her the nebulizer and medications myself at home. please read the attached prescription he gave me and let me know what you think about it and if you agree with it. He also ordered me to give her 4 drops of Fentisil which does not include in the prescription.
her situation is ok now however I'm little concerned about her breathing i checked her breathing rate couple of times and it was 87/minute in the afternoon after we came back from the hospital and now it was 92 beats/minute. sometimes it drops to 63beats/minute .. but most of the time even when she is sleeping i can hear her breathing fast. When I read online in almost every website it says to watch for baby breathing rate and if it's fast breathing then go to emergency, that makes me quite worried. i tried to look at her abdomen to see retraction of ribs etc but i couldn't see, the breathing looks like similar to a fast labor breath that comes and goes.
She also sleeps a little more than before she just wakes up to feed and goes back to sleep or sometimes we wake her up every three hours to feed her because she might just continue sleeping.
questions.
1.what's your opinion about doctors prescription attached above?
2.is the fast breathing she has a cause of concern? should i take her back to hospital? or should i continue her medications and worry not about the breathing rate.
3.when can we say she is lethargic? it's hard to differentiate if she is just tired or lethargic because newborns usually always sleep alot
4.my wife (her mother) is also coughing, has sore throat and painful swallowing she developed yesterday.. we thought to get a mask to cover my wife face when she is holding her? is it good or unnecessary ?
thank you again
final follow up questions to my current case of my daughter, I took her to hospital today just for a quick checkup, regarding her vomiting the Doctor told me the same exact thing that you wrote above, and he said to get a peace of mind we will do ultrasound for her to rule out pyloric stenosis.
Regarding the cough he took a quick swab from her nose and it became positive for RSV, he said this is common at this season because many people get infected and they touch the baby. he gave me a prescription I attached above and some of them need nebulizer which i bought from the pharmacy. He told me to let her stay at hospital for 2 days but because it's very expensive and I'm not at home country I decided to give her the nebulizer and medications myself at home. please read the attached prescription he gave me and let me know what you think about it and if you agree with it. He also ordered me to give her 4 drops of Fentisil which does not include in the prescription.
her situation is ok now however I'm little concerned about her breathing i checked her breathing rate couple of times and it was 87/minute in the afternoon after we came back from the hospital and now it was 92 beats/minute. sometimes it drops to 63beats/minute .. but most of the time even when she is sleeping i can hear her breathing fast. When I read online in almost every website it says to watch for baby breathing rate and if it's fast breathing then go to emergency, that makes me quite worried. i tried to look at her abdomen to see retraction of ribs etc but i couldn't see, the breathing looks like similar to a fast labor breath that comes and goes.
She also sleeps a little more than before she just wakes up to feed and goes back to sleep or sometimes we wake her up every three hours to feed her because she might just continue sleeping.
questions.
1.what's your opinion about doctors prescription attached above?
2.is the fast breathing she has a cause of concern? should i take her back to hospital? or should i continue her medications and worry not about the breathing rate.
3.when can we say she is lethargic? it's hard to differentiate if she is just tired or lethargic because newborns usually always sleep alot
4.my wife (her mother) is also coughing, has sore throat and painful swallowing she developed yesterday.. we thought to get a mask to cover my wife face when she is holding her? is it good or unnecessary ?
thank you again
Dr i just checked her temperature now and it's 37.5 on one ear and 37.7 on the other ear. i hope it's just because it was too hot in the room.
should the fever more alarming condition to take her back to hospital immediately? or we can wait with it and continue the treatment
should the fever more alarming condition to take her back to hospital immediately? or we can wait with it and continue the treatment
Brief Answer:
Thanks for detailed description - suggestions given
Detailed Answer:
Hi...I understand your concern.
What your kid is having is RSV Bronchiolitis.
Coming to your queries -
1. RSV Bronchiolitis doesn't require any bronchodilator therapy as prescribed. Only humidified oxygen will do... which can be provided only at a hospital. At the most she might require hypertonic nebulization like 3% Sodium chloride nebulization.
2. I am concerned about her respiratory rate and anything above 60 at this age should not be ignored and she should be hospitalized.
3. We can say she is lethargic when she goes back to sleep immediately after waking up also.
4. Please use a mask for the mother.
5. 99.86 degrees Fahrenheit is not fever. We should treat fever only if it is above 100 degrees Fahrenheit.
Regards - Dr. Sumanth
Thanks for detailed description - suggestions given
Detailed Answer:
Hi...I understand your concern.
What your kid is having is RSV Bronchiolitis.
Coming to your queries -
1. RSV Bronchiolitis doesn't require any bronchodilator therapy as prescribed. Only humidified oxygen will do... which can be provided only at a hospital. At the most she might require hypertonic nebulization like 3% Sodium chloride nebulization.
2. I am concerned about her respiratory rate and anything above 60 at this age should not be ignored and she should be hospitalized.
3. We can say she is lethargic when she goes back to sleep immediately after waking up also.
4. Please use a mask for the mother.
5. 99.86 degrees Fahrenheit is not fever. We should treat fever only if it is above 100 degrees Fahrenheit.
Regards - Dr. Sumanth
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
OK Doctor thank you very much for the answers. I will take her to the hospital tomorrow for a check up.
now she is doing well, she was kind of very sleepy yesterday but was still waking up to feed but today she was playful and awake for 4 hours, she fed well and she didn't have projectile vomiting, she coughed couple of times something of them was hard others was slight cough.
My last questions before I close this discussion and rate .
1.it's been 3 days now since we took her to hospital is her having a better day then yesterday a good sign of improvement?
2.Doctor another thing i noticed is that her breathing rate gets shallow or increases mostly after i give her the nebulizer sometimes until after few hours, after sometime she is calmer and better and playful. Does ventoline and atrovent have side effects that i should watch for? is this a sign the medicine is not good for her?
3.the way the doctor told me to give her is to mix 2ml normal saline +atrovent 0.5ml + ventoline 0.6 ml, i mix them all together in the nebulizer and give it to her at once it takes just 5 to 7 minutes to complete.. is that ok?
4. Some friends suggested me to open hot shower in the bathroom and keep her there for few minutes so she can breathin moist air this will help clear mucus in her lungs.. is that a good method? i thought that's not good our bathroom is clean however i think the bathroom is possibly full of bacterias and viruses
Thank you and hope i see you again for other questions if i will have any concerns in the future.
Goodbye
now she is doing well, she was kind of very sleepy yesterday but was still waking up to feed but today she was playful and awake for 4 hours, she fed well and she didn't have projectile vomiting, she coughed couple of times something of them was hard others was slight cough.
My last questions before I close this discussion and rate .
1.it's been 3 days now since we took her to hospital is her having a better day then yesterday a good sign of improvement?
2.Doctor another thing i noticed is that her breathing rate gets shallow or increases mostly after i give her the nebulizer sometimes until after few hours, after sometime she is calmer and better and playful. Does ventoline and atrovent have side effects that i should watch for? is this a sign the medicine is not good for her?
3.the way the doctor told me to give her is to mix 2ml normal saline +atrovent 0.5ml + ventoline 0.6 ml, i mix them all together in the nebulizer and give it to her at once it takes just 5 to 7 minutes to complete.. is that ok?
4. Some friends suggested me to open hot shower in the bathroom and keep her there for few minutes so she can breathin moist air this will help clear mucus in her lungs.. is that a good method? i thought that's not good our bathroom is clean however i think the bathroom is possibly full of bacterias and viruses
Thank you and hope i see you again for other questions if i will have any concerns in the future.
Goodbye
Brief Answer:
Queries on respiratory illness answered
Detailed Answer:
Hi... coming to your queries directly -
1. The kid being playful and active is definitely a sign of good improvement.
2. Her respiratory rate increasing immediately after nebulization, signifies that she is better off with it. If she really requires then, then it is normal for respiratory rate to get better after nebulization.
3. No need to continue nebulization...stop it. But nebulization going on for 5-7 minutes is normal.
4. The side-effects of these drugs include faster heart rate, vomiting and nausea.
5. Putting in shower is not a good idea.
Regards - Dr. Sumanth
Queries on respiratory illness answered
Detailed Answer:
Hi... coming to your queries directly -
1. The kid being playful and active is definitely a sign of good improvement.
2. Her respiratory rate increasing immediately after nebulization, signifies that she is better off with it. If she really requires then, then it is normal for respiratory rate to get better after nebulization.
3. No need to continue nebulization...stop it. But nebulization going on for 5-7 minutes is normal.
4. The side-effects of these drugs include faster heart rate, vomiting and nausea.
5. Putting in shower is not a good idea.
Regards - Dr. Sumanth
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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