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Infant struggling with nausea and vomiting. Is this something other than stomach bug?

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My 5 month old son has been struggling with nausea for the past three weeks. It originally appeared to originate as the result of a stomach bug (vomiting) and has seemed to get better. However, now this much time as passed and he's still dealing with it. Is there anything that can be prescribed to treat nausea when it is really severe? Is is possible he has something other than a stomach bug?
Posted Sun, 24 Mar 2013 in Child Health
Answered by Dr. Y V Siva Sankara Murty 1 hour later

Thanks for writing to health care magic.

Vomiting of one or two days could be because of gastroenteritis.... but normally it subsides in a short duration.

So now we should think of other causes of nausea and vomiting.

One cause that comes to my mind is gastroesophageal reflux disease. In this the contents of the stomach come back into the esophagus (the food pipe). Some times in such a scenario the presentation can be like this. After confirming the diagnosis your doctor will prescribe prokinetics etc.

Other cause that comes to my mind is jaundice because of viral hepatitis. What is the color of stool? Does he have feeding difficulty? Is he feeding normally or not? What is the color of urine? Is there any associated fever? What is the color of his eyes? Are they yellow? After a physical examination your doctor may prescribe serum bilirubin levels if he thinks this could be the diagnosis.

Another remote probability is that he is having another episode of gastroenteritis. But this is unlikely.

Are you giving the medications at appropriate dosage? Is there any abdominal distension?

I would have felt happy and better if the baby was breast fed and not stopped breast milk for a MILD milk allergy. I am sorry to say this but you know the advantages of breast milk..... the protective value of breast milk from infections.....etc.

Hope this helps.
Let me know if I can assist you further.

Above answer was peer-reviewed by
Follow-up: Infant struggling with nausea and vomiting. Is this something other than stomach bug? 9 hours later
After giving his symptoms additional consideration, I think he might have a stomach ulcer. I didn't mention that we were giving him 1, sometimes 2 infant doses of ibuprofen daily, for over a month now because his teething pain was so bad. The description of his condition seems almost exactly as described in the following article.

If it is a stomach ulcer, non-bacterial in nature, how long would you expect to see improvement once removing the ibuprofen from his routine? We've stopped all dosage as of today.
Answered by Dr. Y V Siva Sankara Murty 12 minutes later

Thanks for writing to health care magic.

May be ibuprofen is responsible for all this. You are also giving him syp Ranitidine... so that will have some protective effect and prevent ulcer formation by decreasing acidity. Your pediatrician will know about this drug.

In my 15 years of medical experience I am yet to use Ibuprofen in less than 1year old infants. Therefore please do not use so many medications on your child. Some natural things will subside on their own.

I do not think it might have gone to the stage of ulcer; it might be just gastritis and it will improve rapidly. Ranitidine can fasten the recovery. Besides that babies normally show rapid response compared to adults.

Before using any further medication in your baby I request you to write to me so that I can be of some use. You may contact me with further details on the following URL...........
Hope this helps.
Take care

Dr Y V Siva Sankara Murty
Associate Professor of Pediatrics
Above answer was peer-reviewed by
Follow-up: Infant struggling with nausea and vomiting. Is this something other than stomach bug? 13 hours later
We're realizing that using Ibuprofen was a bad idea; we used it out of desperation and wishing now that we had not done so. We're completely removing the use of the drug and just relying on Tylenol as needed. His stool has been slightly dark which made me think it has progressed to the point of an ulcer. We've been giving him the Ibuprofen for six weeks, 1-2 times a day at 1.5ml dosages. Do you still think he is just having gastritis?
Answered by Dr. Y V Siva Sankara Murty 7 minutes later

Thanks for your reply.

How is he now? Did he show some signs of improvement over these 24hrs or so.

Dark colored stool may indicate some bleeding might have occurred which also suggest the possibility of gastritis.

Can you tell me exactly at what dosage was Ibuprofen given....? How much does that 1.5ml contain? (Each preparation varies in the content and varies between countries.

Not to worry if baby is showing signs of improvement.

If there is no improvement proton pump inhibitors like lansoprazole or omprazole may be required after consulting your doctor.
Rarely a endoscopy may be required.

You may contact me with further details on the following URL:
Hope this helps.

Take care

Dr Y V Siva Sankara Murty
Associate Professor of Pediatrics

Above answer was peer-reviewed by
Follow-up: Infant struggling with nausea and vomiting. Is this something other than stomach bug? 20 hours later
Well we're not sure how much better he is doing; the removal of the Ibuprofen has been a mixed result. I think it was helping so much with the teething that even though he is not suffering the stomach pain, he is dealing with the increase in teething pain.

His stool does seem to be improved and we'll be consulting his regular doctor tomorrow about a possible ulcer. If that continues, we'll be able to isolate it as a possible cause and contributor.

The dosage amount seems to indicate 50mg/1.25ml. We're still staying completely off it since is may be the reason why he ended up in this condition. If it is an ulcer, in addition to the Zantac can we use? We were initially instructed to use 1.5ml, twice daily.
Answered by Dr. Y V Siva Sankara Murty 2 hours later

Thanks for your reply.

Sorry that I could not give an early reply this time. I can see that there was a delay of 2 hrs.

One thing that can give a clue if there is gastrointestinal hemorrhage is stool for occult blood. (If the bleeding stops by the time you get it tested it may turn negative)
I personally do not recommend Ibuprofen in young infants less than 6 months. (This is only a personal and practical point. In my 15 years of medical practice I am yet to use it in that age group. We do use it in newborn period but that is altogether for a different issue of heart related conditions)

I start with Paracetamol and things improve with that. If you still want to use Ibuprofen please consult your doctor. In older kids and adults I normally prescribe addition of Ranitidine (Zantac) or Omeprazole etc to prevent the gastric complications of Ibuprofen. (With such addition I do not find much gastric complications in those older age group I tried)

By the way how is his nausea? Is there any improvement over time after stopping Ibuprofen?
Why are you thinking that teething is causing such a whole lot of problem to him that Ibuprofen should be used. Can you please explain in detail?
Are you using any gel rub?
Did you give him anything safe to chew on?

Please reply in detail.
Take care.
Above answer was peer-reviewed by
Follow-up: Infant struggling with nausea and vomiting. Is this something other than stomach bug? 1 hour later
I have taken your recommendation to heart and just completely removed the Ibuprofen and will not use it at all until he reach at least one year of age. I think the risks far outweigh the potential benefits.

His nausea has not worsened and really seems to be triggered by consumption of more than 2oz of formula; no other liquids or solids seem to set him off. I can only assume that it is due to the fact that it is harder to digest.

Our use of the Ibuprofen to start was just to have an additional relief of the teething pain. He was not eating at all to the point we were concerned and felt it was the last option for pain relief.

I think he is showing signs of a improvement as a result of removing it. We have also increased the Zantac from 1.5ml, 2 times a day to 3 times a day. Is that dosage increase safe?

We have found that giving him something to chew helps, but not much. The over-the-counter gels provided no relief. The only thing we found was the Hyland's teething tablets. WWW.WWWW.WW
That is really why we ended up using the Ibuprofen, because the traditional aids didn't seem to help. However, we will not be using it any more at the risk it could be causing additional problems. Give me your thoughts on the Ranitidine (Zantac) dosage increase if you please and let me know if that is safe.
Answered by Dr. Y V Siva Sankara Murty 40 minutes later

Thanks for your reply.

The appetite of a baby is very variable. Sometimes they may not like certain food items and sometimes they do not accept anything at all. This may last for few days. This need not be a cause of worry. (Particularly if they are playful, active etc). Why did you consider that it was just because of teething he was not accepting at all?

Is your baby breast-fed or not? This is the period in which a baby is supposed to be breast fed as per WHO guidelines. Exclusive breast-feeding is indicated until 6 months. I think you are well aware of the several advantages of breast-feeding. It helps in brain growth, prevents infections, a whole lot of advantages.

The dosage of ranitidine is 2 to 4 mg/kg/day. (The statutory warning stands. Use medications as prescribed by your doctor. This is only for informational purpose.)

Medications like ranitidine (Zantac) decrease the acidity of stomach. The acid in the stomach protects us from infections. The microorganisms consumed will be killed by this acid. Decreasing the acidity by proton pump inhibitors or ranitidine etc will result in more stomach infections.

Normally an infant does not need any medication at all. Particularly the under 6 month’s babies. (More so if they are breast-fed. I daily see so many under 6 months babies but I hardly prescribe them any medications. Some multivitamin drops only that too because the parents insist on something to be prescribed.)

Try to get rid of all the medications that your baby is having.

Hope this helps.
Take care
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