Vomiting sign of GI problem/aerophagia?

Does anyone have experience w/ vomiting due to GI problems or aerophagia? I know there are many causes for vomiting: overfeeding, gagging, behavioral, reflux. My son has vomited for all those reasons, and I've gotten good at knowing which thing caused each episode. But, there are times when he'll vomit for no apparent reason. Usually those times immediately follow bottle-feeding and he'll vomit up his entire bottle. I'm fairly certain that on most of those situations, it's not due to overfeeding, gagging, reflux (which he gets Prilosec for), or behavior. I'm wondering if it may be due to a GI problem or possibly aerophagia. He doesn't have severe gas and he does burp well during feeds. But often times during these episodes the vomiting occurs immediately after a "deep" burp... meaning that I can literally hear it coming up through him! He doesn't ever appear to be in any pain. He does have a g-tube, but we don't really use it anymore other than to vent him on occassion. He leaks a lot from the g-tube, could air be getting in? We have an appt with a GI specialist next week, and I want to be prepared and educated! So any experience/thoughts you all may have would be greatly appreciated!

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Hi. DS also vomits at times for no apparent reason (other times we think there is a reason - gagging, reflux, too full). Our Neurodevelopmental ped. just doubled his meds and wants us to follow up in 4 weeks. If there is no change, he is recommending an upper GI. He also specializes in feeding issues so hopefully we will figure it out.

Our feeding therapist talked to us about liquids and solids. She sees some children not be able to handle liquids during meals well, like it makes a sloshy (sp?)mixture that easily comes back up. Is Henry throwing up the the bottle in coordiantion with food, or is he just taking a bottle?

The only other thing I can think of is that last year, DS was 5/2 months and had a lot of projectile vomit. They suspected "pyloric stenosis" (sp) and did an ultrasound - fortunately it came back negative. This has to do with the narrowing of part of the stomach. But, I am thinking this is diagnosed more in younger babies.

What type of bottles are you using? Has the frequency recently increased? Changed? How is Henry's weight gain in consideration of his throwing up - is he still gaining?

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Has this been going on since Henry had his g-tube put in or is this a new problem? The reason I am asking is because Kylies GI said that sometimes having a g-tube put in makes reflux worse. She said the reason the reflux get worse is because it changes the shape of their stomach. Just a thought.

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My daughter does not have a g tube, but she was throwing up alot. Not sure if it is the same problem you are having. Her doc said they are more like huge spit ups rather than throwing up.

anwyays we sit her up when we feed her. And give her some time to rest after each burp. After feeding her, I have her sit up for at least 10 min. This has helped alot.

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kyliesmommy1 - I wonder if its the g-tube. He never threw up/spit up prior to the g-tube. BUT, he also wasn't eating solids. But since these random vomits seem to occur only w/ bottle feeding, I can't help but wonder if its the tube. He doesn't appear to be bothered by reflux, so I'm not so sure I think that's the problem. I am also concerned about the leakage from the tube. The GI that placed it said that's normal, but he also placed it, so why would it be bad... not that I'm saying he wouldn't admit to there being a problem, but... He has also had 2 surtures surface from it. They did a dye study after the first b/c we demanded it be looked at. It was normal and they are not concerned. Henry has a bard tube. We have finally got the granulation tissue under control and everyone has kept telling me that the leakage would stop when that goes away. The chronic leakage has decreased, but we still get times where he'll wake up from his nap completely soaked. ???

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beckhamsmom - thanks for the response! Henry does vomit w/ food, but usually that's b/c of gagging w/ food textures. This random vomiting is usually just with a bottle. And often times it occurs at night, right before bed. So we usually limit his movement as it is time to settle and cuddle. So I don't think that its necessarily sloshing around, although I completely understand what you mean! Henry has had an upper GI and gastric emptying... both of which occurred almost a year ago and before the g-tube. He recently had a swallow study. No problems w/ any of those. I'll look into the "pyloric stenosis"... not sure what that is but wonder if it could be related to changes in the stomach structure from the g-tube placement as kyliesmommy1 suggested.

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That really sounds like reflux to me. My son does not have a tube, but he is a chronic vomiter. The vomiting is most often right after a bottle and after a nasty burp. My theory is that he has vomited for so long that a burp brings a little into his throat...it feels gross and he knows how to expell the rest with little effort. The Prilosec keeps the vomit from being acidic, but it does not stop the reflux.

As he never did it before the tube I would wonder if that has an effect...how long have you been able to avoid using it and do you think he can have it out soon?

I hope you figure it out! (and if you do, tell me! lol)

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BTW it is highly unlikely that it is pyloric stenosis. Kylie had this at 3 months actual and we were told that she was older than most babies when she got it. Not that it can't happen when they are old because I don't know if they can or not. From our experience if he had pyloric stenosis he would vomit his entire feedings at every feeding. When a baby has pyloric stenosis the opening between the stomach and intestines called the pyloris is so narrow that when the stomach tries to push the food through it opening is too small and all the food comes back up. Trust me if he has/had pyloric stenosis you would know. Major projectile vomiting EVERY feeding.

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That is interesting that it is at bedtime. B had started throwing up during his bedtime bottle about 6 weeks ago, more consistently (probably 2-3x per week). We addressed the vomiting (in general) at our NICU follow up and that is when his dose was upped. That was at the end of August - that night we started his upper dose and that night he had a major throw up at bedtime (looks like almost all of dinner, about 3/4 c. of volume - yuck). Two days later he did the same thing, so we decided to stop his bedtime bottle. This was when his meds were given too and we didn't know how much he was getting, throwing up. Since then, just about 10 days ago, he has not thrown up at bedtime (only during the day :) - which I attribute usually to texture / gagging. We were nervous to take away the bottle as his weight fluctuates between the 3-5 percentile for his adjusted weight. Yesterday we had feeding clinic and his weight has stayed steady so unless he has a small dinner, we are going to not offer him a bottle at bed. BTW, he usually had his bottle 1-1.5 hrs. after dinner (dinner, bath, books, bottle, bed was the schedule). We still do feed him around midnight, when we go to bed.

His fluid intake is 4ounces offered after every meal or snack (bfast, am snack, lunch, pm snack) and then at midnight. At dinner he is offered a small amount, usually between 1-2 ounces in a sippy cup.

How long after dinner is Henry's bedtime bottle? Does any undigested food come up or only liquid?

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kyliesmommy1, thanks... from your description, it doesn't sound like Henry has that. Did they have to do surgery to fix that? There's another mom on this site whose daughter just went through a bunch of tests and she mentioned something similar but I don't know that she gave it a name. Wonder if its the same thing? Thanks for the info!

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thunderstorm, that's a good point about a little bit refluxing and possibly causing him to vomit the entire thing due to the strange/uncomfortable feeling. I hadn't thought about it that way. Right, since he didn't vomit before the tube I also wonder if that might be part of the problem. We are actually planning to discuss having it removed at our visit next week. We have only used it a handful of times in the past 3 1/2 months, mostly when he was sick. We have many reasons... the vomiting, the leakage (which seems to negate any of the times we actually do use it). Since we don't really use it, comfort and ease play a role for both him and us!

I wish I could respond to more than one post in a discussion b/c this also ties into beckhamsmom's comment! I'll finish w/ her reply! :-)

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beckhamsmom - unfortunately, we cannot eliminate the bedtime bottle. Henry is FTT and isn't quite 17lbs at 18 months (16 corrected). His feeding schedule is 4oz bottle around 8am, breakfast at 10ish, lunch at 11:30ish w/ sippy or bottle (used to be bottle, but we are trying to cut out this bottle and move to sippy). Nap right after lunch. Snack around 3:30-4ish w/ sippy, dinner around 6:30ish w/ sippy, bottle at bedtime. Before trying to transition to a sippy at lunch, he would often take 7-8oz bottle. He has never thrown up at that time of the day. This throws me off b/c he will only take 6-7oz at the bedtime bottle and this is when he throws up. In addition, there is more of a break between meal and bottle at bedtime than there was at lunch. ?? Since we started giving him digestive enzymes several months ago, he does't usually throw up food w/ the bedtime bottle (maybe just a little). Prior to using digestive enzymes, there would be all kinds of completely undigested food (even from earlier in the day!).

Thanks ladies so much for all your replies!!

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Yes she did have surgery to correct the pyloric stenosis.

Congrats on Henrys eating and the possibility of having the tube removed. I'm jealous, maybe he can come teach Kylie how to eat. LOL!

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Just wanted to wish Henry lots of luck at his appt next week! Hang in there, Mama!! :)

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My son is 18 yrs.old now and from just a few months old he was projectile vomiting on a regular basis and in the drs.office also on a regular basis. They had no clue! I got stupid remarks like 'well, maybe he's just got a little bug'! Not many people keep a bug for 3.5 yrs. That's how long it took them to finally diagnose something. At that age, he only weighed 20 lbs. When I brought it to one drs. attention, he said 'he's skinny but he's healthy'. He was NOT healthy! Finally, they did decide that his stomach wasn't emptying and he had a pyloraplasty, gtube inserted, and Nissen done all at the same time. He got much better after that but has had GI problems his entire life. When he was 17 his appendix was removed which didn't help his problem any. And the next Nov. he had surgery to remove scar tissue, clear up two bowel blockages, and reroute his intestines. Finally, he is much, much better. I don't have a very high opinion of drs. when it comes to special needs kids. I'm going by our own experiences which a lot of them have been horrendous.Somehow he's managed to survive them for 18 yrs. but we've had more than one close call. I wish you all the best.:)

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Does Henry still have his G-tube? This posting may be late. My son had a bard...the leaking that you have been experiencing is it from the tube site or from the tube itself (the port that you plug the extension into)?

Our bard was defective from the get go. We had tons of leakage from the tube itself...turns out the valve inside the tube was defective. Everytime we would disconnect the extension fluid would pour out. At that time my son was fascinated with opening his port and we would often find him soaked in formula and stomach juices because he had opened it.

He gained weight rather quickly initially and we had to change out the bard sooner than the surgeon had initially thought. We changed to a mini one. We do occasionally get leakage from the tube site but we just check the fluid level in the balloon. We will also get leakage from the valve (they tend to stop working after time), when this happens we replace the tube at home.

Joyce

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Thank you Ladies for all your responses! Henry has gotten significantly better in the past month. We switched drs and changed from Duke to UNC. The drs there switched his reflux meds to Prevacid from Prilosec (and we increased the dose a couple of times). I thought his reflux was under control, but it obviously wasn't. He now ASKS for food and gets hungry!! It's amazing! He ate an entire McD's hamburger last night! He has gained over 1lb in a month! It's like he's another child! We still have room for improvement and there are still some things that need to be checked out (he gets an endoscopy this week and they are also going to take blood for several tests and genetic testing).

We did get a great explanation from a GI surgeon about how the g-tube can change the shape of the stomach and may be contributing to large vomits like we were seeing (although those are rare now). When they do his endoscopy he will also be getting his bard g-tube changed out to a mickey. We are not using the tube now as he regularly consumes enough calories in a day (hurray!). So we are hoping that in the spring after rsv/flu season we will get the tube removed.

I've been afraid to update with positive news for fear that things will turn back around for some reason. I really do hope this is our turning point and from now on things will only continue to improve! Thanks so much ladies!

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Wow! I'm so happy to hear some progress! So, the new Drs, they just changed the one med and that changed everything? I have never gone to GI cuz I feel like no one can help. Maybe I will go now...

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We changed from Prilosec to Prevacid as well and has greatly reduced the number of vomiting episodes (still on occasion, but it texture related). Our son also takes it much more easily.

Glad to hear about the good weight gain!

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29weekevan, It does seem that simple doesn't it! But yes, it seems like the Prevacid is what finally turned things around. There are definitely some other things that have resulted in improvements and I think all of them together is what finally made the difference. To me, the things that seem to matter are the Prevacid (first and foremost!), digestive enzymes, and probiotics.

We work w/ a team of specialists at UNC, but it is mostly w/ the GI nurse practitioner. There is also the GI dr, a surgeon, a feeding therapist (seen weekly), a nutritionist, and a geneticist. They all work together. It has been very beneficial. I think what really matters here is that they really do care, try to understand, and LISTEN to the parents. All of those things were significantly lacking over at Duke, even w/ the same types of specialists.

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Hi Henrysmom,
Would you mind sharing which digestive enzymes and probiotics you are giving DS? I would like to ask our feeding team about them (I liked to be prepared with specifics in case they have questions or resist the idea :)

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