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What Is Causing Vomiting in a 5-Month-Old Infant?

    John W. Harrington, MD

    Director, Division of General Academic Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA

    Harrington JW. What caused vomiting in a 5-month-old infant? Consultant. 2022;62(6);
    e1-e3. doi:10.25270/con.2021.05.00011

    Received May 12, 2021. Accepted May 14, 2021. Published online May 26, 2021

    The authors report no relevant financial relationships.

    John W. Harrington, MD, 601 Children's Lane, Norfolk, VA 23507 (


    A 5-month-old infant was brought to the emergency department (ED) with vomiting and concerns for reflux. He was a full-term infant born by C-section due to failure to progress, with a birth weight of 3.3 kg. He had an uneventful nursery stay at the time of birth and has been to all well visits at his pediatrician’s office. The patient has been gaining appropriate weight.

    Physical examination. In the ED, he did not appear dehydrated and had a normal capillary refill of less than 2 s, a normal heart rate, and normal moist mucous membranes. The infant was given ondansetron and tolerated 3 oz of formula.

    His mother was concerned about pyloric stenosis, since it was diagnosed in her nephew at the same age as her son. Therefore, the attending physician in the ED performed an ultrasonography scan, results of which showed a normal pylorus. The infant was then discharged home.

    The following day, the infant and his mother followed up with the general pediatrician. The patient’s mother was still concerned, since the infant continued to vomit/reflux with no fever or diarrhea, has only had 2 wet diapers since the morning, and seemed a little tired.

    The pediatrician tried an oral feeding in the office, and the infant promptly vomited. The infant also had a slightly raised, bumpy rash with some reddish/purplish discoloration that blanch. The pediatrician administered a dose of ondansetron, and the infant tolerated 3 to 4 oz of formula.

    The mother felt that the infant looked much better after the feeding and took the infant home. Overnight, the infant was brought to the ED again with the same concern of vomiting/reflux and appeared mildly dehydrated.  




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