1 Is your baby less than 2 months old, and is he or she vomiting after all or most feeds?

2 Is milk brought up effortlessly?

3 Is only a small amount of milk brought up?

4 Is your baby's temperature 38°C (100°F) or above?

5 Does your baby have any of the following?

• Abnormal drowsiness
• Restlessness
• A high-pitched or abnormal cry
• Refusing feeds
• Flat, dark red spots that do not fade on pressure ( Checking a red rash)

6 Does your baby have a cough?

7 Does your baby have diarrhoea?

8 Is your baby's vomit yellowish-green?

9 Does the vomiting only occur during or after travel in a vehicle?

10 Was your baby playing energetically just before vomiting, or were you playing boisterously with him or her?

11 See your doctor within 24 hours

Possible cause Pyloric stenosis, in which thickened muscle narrows the outlet from the stomach, may cause forceful repeated vomiting. This can lead to dehydration.

Action Your doctor will examine your baby. If he or she suspects pyloric stenosis, your baby will be admitted to hospital. Dehydration will be treated and further tests, such as ultrasound scanning, may be carried out to confirm the diagnosis. Treatment involves surgery to widen the outlet from the stomach.

12

Possible cause and action Regurgitation, sometimes known as posseting, is common in babies and is a likely cause. It is not true vomiting and is seldom a cause for concern in an otherwise well baby. The condition is usually the result of trapped air in the stomach (see Dealing with wind). However, if you are concerned, consult your doctor.

13 See your doctor within 24 hours

Possible cause Gastro-oesophageal reflux, in which the stomach contents leak back into the oesophagus, may be the cause of your baby's symptoms.

Action Your doctor will examine your baby to exclude other causes. You may be advised to put your baby to sleep on his or her side with the head higher than the feet. If the baby is old enough, spending more time sitting in a baby chair may help. If your baby is bottle-fed, try thickening his or her feed with cornflour or a commercial thickener. Your doctor may also suggest a drug that helps gastro-oesophageal reflux. Most babies grow out of this condition by the age of 1 year.

14 Emergency! Call an ambulance

Possible cause Meningitis, inflammation of the membranes surrounding the brain due to infection, may be the cause of these symptoms.

Action If meningitis is suspected, your baby will be admitted to hospital immediately. He or she will be given urgent treatment with antibiotics and may need intensive care.

15

Possible cause In a baby, vomiting with a fever may be due to an infection.

go to Fever in babies

16 Call your doctor now

Possible causes Bronchiolitis, a viral infection affecting the small airways in the lungs, or whooping cough (pertussis), an infectious disease that causes bouts of severe coughing, may be the cause.

Action Your baby may be admitted to hospital, where his or her blood oxygen levels can be measured ( Measuring blood oxygen). If bronchiolitis is diagnosed, treatment may include bronchodilator drugs and oxygen. If whooping cough is diagnosed, he or she may need antibiotics to prevent the spread of the infection, although these do not always affect the severity of the symptoms.

17 Call your doctor now

Possible cause Gastroenteritis, an infection of the digestive system, is the most likely cause of these symptoms. In some cases, a baby may also develop a fever.

Action Your doctor will check whether your baby is dehydrated and will give you advice on preventing dehydration in babies and treating gastroenteritis in babies. To prevent future attacks, follow the advice for preventing gastroenteritis.

18 Emergency! Call an ambulance

Possible cause Intussusception, in which the intestine telescopes in on itself, causing an obstruction, is a possibility.

Action Your baby will probably be admitted to hospital, where he or she can be fully examined and an exact diagnosis made. Treatment for intussusception usually involves an enema to force the displaced intestinal tissue back into the right position. If the enema is not successful, surgery will be necessary.

19

Possible cause and action Travel sickness is probably the cause. Although uncommon in children under the age of 1 year, some babies are particularly susceptible. The condition may run in families. For self-help measures, follow the advice on coping with travel sickness.

20

Possible cause and action In babies, the muscles around the top of the stomach are relatively lax compared with those of older children, and enthusiastic playing may cause vomiting. This is no cause for concern and will be less of a problem as your baby grows older. In the meantime, try to avoid boisterous games, particularly after feeds.

21

An isolated attack of vomiting is unlikely to be a sign of a serious problem in an otherwise well baby. However, if your baby vomits more than once in a day or seems otherwise unwell, call your doctor.