Newborn vomiting: when to get urgent help

What does the evidence show for newborn vomiting?

• Effortless milk coming back up after a feed may be reflux. Repeated vomiting, distress, or disrupted growth should not be dismissed as the same normal feeding event. Describe what actually happens rather than using spit-up and vomiting interchangeably. 1
• Green or yellow-green vomit, blood, abdominal swelling, dehydration, and breathing difficulty are warning signs. Record the timing and appearance if you can do so without delaying care. A photograph may help explain the event, but it cannot rule out a serious cause. 2
• Pyloric stenosis is one possible cause of repeated forceful vomiting in early infancy. A baby may want to feed again afterward. Other conditions can cause vomiting too, so continued hunger does not establish that the infant is well. 3
• A rectal temperature of 100.4°F (38°C) or higher in a baby younger than three months warrants immediate contact with the pediatric team. Do not assume fever with vomiting is simply a feeding intolerance or give medicine first to see whether the concern disappears. 4
• For routine feeding, hold the baby and allow pauses rather than propping a bottle or forcing the remainder. When vomiting is repeated or an infant is unwell, ask for a clinical feeding plan instead of repeatedly increasing the volume to replace every visible loss. 5

Questions to discuss with your care team

When should I call my provider about newborn vomiting?

Green or yellow-green vomit, blood, or a swollen abdomen: obtain urgent medical assessment.,Repeated forceful vomiting, inability to retain feeds, or markedly fewer wet diapers: seek prompt care.,Rectal temperature of 100.4°F (38°C) or higher before three months: contact a clinician immediately.,Blue color, breathing difficulty, collapse, or inability to wake the baby: call 911. When in doubt, call your obstetric team the same day. Early input almost always beats waiting, and the on-call line exists exactly for this.