Pyloric Stenosis: When Does Spitting Up Mean Something More?

Health & Wellness on 03.23.11
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Drowning in a Wave of Spit Up

Babies spit up. I was well aware of this going into parenthood. I thought all babies spit up a lot and am always stunned when a mother says anything to the contrary about their child. Like most new moms, I had visions of my beautiful new baby wowing our friends, family, neighbors, and let's be honest, even perfect strangers with his ridiculously cute outfits, not with said outfits being covered in vomit all day long. So while I knew that it was part of the territory, when my son was merely two weeks old and he and I were each going through five outfits per day because of the spit up, I knew something wasn't right.

The first thing I did was hit my "What to Expect the First Year" book where I read a lot about possible allergies to things such as to dairy or soy and Gastroesophageal Reflux Disease (GERD) which could be the cause of his problems. There was also the mention of something called pyloric stenosis which is essentially when the pyloric valve - located between the stomach and small intestine - grows at a very rapid rate, causing the opening to close up so that food can't get into the small intestine and works its way back the way it went in. But according to my book, that was a long shot prognosis so I wasn't too worried about it.

Expert Opinions

I took my son to his pediatrician for an expert opinion. He had been eating like crazy, but because of the regurgitation had lost weight. The doctor mentioned medicines for GERD and that there was such a thing as pyloric stenosis, but said she doubted he had it as she's only seen one case of it herself. We left with instruction to switch to a hypo-allergenic formula--a much pricier option, the smell of which made me want to join in on the puke parade. If it didn't get any better or got any worse, we were to come back in a week. My gut told me it was going to get worse, but again I convinced myself I was just over-reacting because all babies spit up.

After another week, a lot of guessing about what percentage of food he was actually digesting, and countless more outfits being attacked by entire feedings, we arrived at the walk-in hours of our pediatrician's office as the doors were being opened. After meeting with the on-call pediatrician, he decided to send us to Hasbro Children's Hospital for a scan to see if there was anything going on, and as he was on the phone with the hospital, my son did it. It was as if it was in slow motion. A giant arc of undigested formula came at us and doused every inch of the baby and his car seat that we had just gotten him nestled back into. His full morning feeding came right out of his mouth.

Immediately, the pediatrician said, "That's definitely pyloric stenosis. Head to the hospital now and they'll operate today."

I am a worrier by nature, but when something has to be done in an emergency all I care about is getting it done, so rather than turn into a puddle over the fact that my brand new baby needed surgery, all I could think is we better get there as soon as possible.

Under the Knife

We arrived at the hospital with our three week old baby to be told that he would need to go under general anesthesia and that they would be making a small incision above his belly button where they would go in and essentially filet the pyloric muscle. There is little comfort in hearing that anyone, even a well respected pediatric surgeon, is going to knock out your child and then cut into them, not just once, but twice. Even though his scar should be barely noticeable after the surgery, and he should never have another issue with it again, that didn't change the fact that all I could envision was my tiny, helpless baby on the operating table.

I was actually most nervous about the general anesthesia, and was completely taken aback when the doctor told us that he performed this operation several times daily.  What? I've never even heard of it! But knowing that alleviated at least a little bit of my anxiety about the procedure. Misery loves company.

We live in the smallest state in the union so if the doctors here are performing this operation on a daily basis, it can't be that uncommon. Sure enough, as we started telling people our "our poor baby" tale more and more people said that they knew someone that had suffered from pyloric stenosis. For some yet to be discovered reason, our doctors told us that this problem most commonly occurs in first born, white, middle class males in their first six months of life. According to my What to Expect the First Year book one in every two hundred boy babies are afflicted with this problem and one in every one thousand girls are diagnosed with it.

Many years ago, a lot of babies did not survive having pyloric stenosis because they had not yet developed a way to treat it, and because the babies were not getting the nutrition they needed, they didn't make it. Now, with a procedure that takes less than an hour, an infant can be cured of the problem.

The Aftermath

My son continued to spit up throughout his infancy, but never again was it comparable to those first three weeks of his life. Now at almost five years old, the diagnosis has had no effect on his growth or the rest of his health. In fact, that statement is laughable as he has been "off the charts" ever since. The only long-term effect is that his future children may be at higher risk for it.

While no one ever wants to have their child be sick or undergo surgery, we were sharing rooms and passing children in the hospital corridors that were suffering from much worse ailments, and I was thanking god that I was lucky enough to have a child who had something so treatable.

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