Dr.Abhijit Misra MBBS(Cal),MD Pediatrics

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Vomiting in children: What to do? When to worry? #CauseAchatter

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Vomiting is a common problem in children and small babies. Parents become anxious and often rush to the Hospital for this problem. 

You should know that vomiting is a protective reflex of our body to let out harmful or excessive content in the stomach. 

In small babies letting out milk and curd is very common. But most of the time it is regurgitation and not vomiting. Babies swallow air while feeding, and it is responsible for regurgitation most of the time. Vomiting is forceful, throwing of stomach content. Whereas regurgitation is effortless passive coming out of stomach content into the esophagus and mouth. It is not associated with any distress in the baby, and infants are often hungry immediately after an episode. 

So it is not necessary to aggressively stop the vomiting always. Although it may be an indicator of underlying severe disease. 

What can mother’s do to minimize regurgitation in babies 

  1. Proper attachment at the breast to prevent swallowing of air 
  2. Proper burping after a feed
  3. Also positioning the baby approximately 30° towards head end helps to minimize regurgitation 

Parents don’t need to worry about regurgitation if the baby is passing urine regularly, is active, playful, and baby is gaining weight as expected. 

Vomiting can be due to something as benign as indigestion to as severe as an infection like meningitis.

Common causes of vomiting in children are:

  1. Food intolerance and indigestion 
  2. Excessive and forceful feeding by caregivers 
  3. Belly Infection likely gastroenteritis 
  4. Other acute infection like UTI, septicemia, and meningitis 
  5. Intestinal obstruction or blockage 
  6. Lesions in the brain like a brain tumor 

Complications of vomiting 

Complications can arise if vomiting is not treated properly :

  1. Dehydration
  2. Electrolyte abnormalities 
  3. Failure to thrive in case of chronic vomiting 
  4. Aspiration of vomitus leading to pneumonia and breathing problem
  5. Bleeding from the torn esophagus, if severe retching 

What to do if your child is vomiting?

  1. Wait for 20 to 30 minutes before giving anything to eat again 
  2. Give sips of ORS and water repeatedly 
  3. Give a small amount of easily digestible foods or milk more frequently 
  4. Ondansetron can be given as per doctor’s prescription. Remember not to give anything at least 20 to 30 minutes after giving this medicine to make it work
  5. Watch for signs of dehydration 
  6. Visit your doctor or Hospital if any of the danger signs present 

When to worry? ( Danger symptoms)

  1. Repeatedly vomiting and not able to hold anything 
  2. Not passing urine for more than 6 hours 
  3. Other signs of dehydration: like no tear, while crying, dry mouth and very irritable child
  4. Associated with fever
  5. Associated with abdominal distention 
  6. Green color vomiting or blood mixed vomiting 
  7. Baby is lethargic 
  8. Repeated episodes of intense vomiting 
  9. The child is not gaining weight as expected in case of chronic vomiting 

Always consult with your pediatrician if any of the danger symptoms is present in your baby. 

Take away message:

Vomiting in children is very common. Regurgitation in small babies should be differentiated from vomiting. Parents don’t need to worry If the child is active, playful, passing urine regularly, and have no danger symptoms.

Parents should watch for the signs of dehydration and visit the doctor as necessary.

drabhijitmisra.com Disclaimer: All health information provided on this blog is for general awareness and doesn’t in any way replace a doctor’s professional medical advice. Kindly consult your doctor in case of any decision regarding your health, and diet. The information provided is for awareness. This is not meant as professional medical consultation. Healthcare is an individual decision and needs careful discussion and professional consultation before taking any decision. The author is sharing his professional knowledge. This post is meant as educational and awareness information and all decisions to be taken at own risk after consulting their own doctor in person. Health information is constantly being updated and while the author tries his best to keep updated information, the author and the website shall not be held liable for any reliance placed on such content for any reason whatsoever.

Colic in babies: What to do? When to worry? #CauseAchatter

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Excessive cry in babies, especially when inconsolable, is a nightmare for parents and pediatricians.

A cry is a normal physiological response. It is an excellent indicator that a child is in need, but a very poor indicator of what actually they need.
The reason behind excessive cry can be as simple as diaper irritation to as dangerous as a brain infection like meningitis.

Whenever a baby cries, parents feel that either they are hungry or they are in pain.
What we have to remember that crying is a normal physiological thing. And a baby has a crying curve just like a growth curve.

What is colic?

As per updated ROME IV criteria:
An infant who is less than five months of age at the start and stop of symptoms. The infant has recurrent and prolonged periods of crying, fussing, or irritability reported by caregivers without a specific reason. Infant colic cannot be prevented or resolved by caregivers. There is no evidence of infant failure to thrive, fever or illness.

PURPLE Crying in Colic

Parents should know about the concept of P U R P L E crying in colic.
The peak of crying: a typical colicky baby starts crying at around 2 weeks and gets worse with time until 2 to 3 months. And then it gradually declines by the end of 5 months.
Unexpected: most of the time it is sudden
Resists soothing: it does not respond to usual baby calming methods
Pain like faces: baby will make pain like faces
Long-lasting: each episode can be as long as 4 to 6 hrs
Evening: it has a tendency to occur in the evening

Why should we know and manage excessive cry/colic better?

Although colic is considered to be benign

  1. It is a severe burden for families. Mentally and physically.
  2. The impossible burden on health professionals and the health system. Parents are anxious and visit health care facilities, fearing the worse. An overburdened system cannot cope with this. Repeated counseling helps in many cases. That’s why awareness is crucial.
  3. Colic is strongly associated with maternal depression, guilt, and disharmony in the family.
  4. It can lead to Doctor shopping, harmful medications.
  5. It is a common cause of early breastfeeding cessation.
  6. Crying beyond the usual colicky period can be linked to later sleep problems, allergic disorders, family dysfunction, and behavioral problems.

What is the suspected Etiology of colic?


Despite years of research, the etiology is still not clear, and there are many proposed theories :

  1. Postulated gastrointestinal mechanisms have included increased intraluminal gas, gut dysmotility, and visceral pain, but none is proven. Gastro-oesophageal reflux, cow’s milk protein allergy, lactose intolerance, and overload can also contribute.
  2. Mother related factors: Maternal age, smoking, alcohol consumption, antenatal maternal stress and anxiety, and poor feeding techniques
  3. Baby related factors: Difficult infant temperament, immaturity of the central nervous system, or an early form of migraine.
  4. Environment-related factor: Lack of family support, family stress, and altered parent-child interaction
    Perhaps infant colic can be best regarded as an exacerbation of normal infant behavior by a mixture of physiological and psychosocial factors.

When to worry about excessive cry?


If any of the underlying symptoms are noticed in a baby, then you should visit a doctor as soon as possible.

  1. Fever: most of the time, crying associated with fever is an indicator of infection with a few exceptions like fever after vaccination.
  2. Lethargic baby or not feeding well: if the baby is less active than usual and or not accepting feed as earlier there’s a strong possibility of a serious disease.
  3. Not gaining weight: if the baby is not gaining weight as per his / her age.
  4. Repeated vomiting or arching: which might indicate a GERD ( gastroesophageal reflux disease).
  5. Explosive diarrhea with perianal excoriation: suggests underlying lactose intolerance.
  6. Blood mixed stool with diarrhea and not thriving well: may indicate a Cow’s milk protein allergy.
    What to do? How to manage colic?
    There is no cure or definitive treatment of colic parents can do the following things
  7. Exclude other causes of excessive cry: before labeling it, colic parents must visit a doctor to ensure that it is colic and nothing else.
  8. Know in detail about the disease: parents and all caregivers must understand the nature of the disease and its course. PURPLE cry to be remembered
  9. Learn methods to deal with periods of excessive cry: various techniques, also known as “5S”, can be applied to calm the baby like swaddling the baby, side positioning, gently swinging, suckle(feeding the baby ), shh.. sound. Sometimes it might not help.
  10. Low allergy diet in exclusively breastfed baby: mothers excluded cow’s milk, eggs, peanuts, tree nuts, wheat, soy, and fish from their diet
  11. Switching to a hydrolyzed preparation in formula-fed babies after consultation with a doctor.
  12. Drugs/medicines: some probiotics, lactase drop supplementation, etc. can be tried with a doctor’s consultation.

Take home message:


• Infantile colic is a benign condition improving with time.
• There are no associated abnormality in most cases and no long term sequelae in both baby and mother.
• Learning about the disease and coping methods to deal with this temporary issue is the best way to manage it.

This is a series of posts to create awareness about common shild health concerns as a part of #CauseAchatter initiative by Blogchatter.

Green stools in babies: What to do? When to worry? #CauseAchatter

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Green stools in babies? In this post, I will be giving you a quick overview of the reason behind this common worry parents have.

In newborn babies and during early life, stools can be of varied colors. And amongst them, the green stool can be one of the types. When parents notice green stool in their kids, they tend to worry and rush to their pediatrician for advice. Green stool in babies can be a normal finding or can be an indicator of a severe intestinal infection.

Here is a guide about green stool in babies and when parents should need to worry about it.

Why green stool occurs?Normal physiology of stool color:

Stool color is influenced by what you eat and the amount of bile (a yellow-green fluid secreted by the gall bladder that digests fats) in your stool. It also depends on the travel time taken by the food in the digestive tract. When bile pigments travel through your gastrointestinal tract, they are chemically altered by enzymes, changing the pigments from green to brown.

Causes of green-colored stool

1) Decreased transit time of food in the gut: In other words, foods are passing faster through the digestive tract. It may be a normal phenomenon in breastfed babies or may be due to an infection like diarrhea.

2) Food with green pigment: like plenty of green leafy vegetables or food or drinks with green additive color.

When is green stool bad?

When to worry: if any of the underlying features are present, parents should visit the doctor/pediatrician.

  1. Associated blood in stool: stool is bright red or black. It may indicate any serious enteric infection like dysentery or severe food allergy. Please note that a dark green colored stool might look black in the naked eye. You may rub a little stool in a white cloth to see whether it is dark green or black.
  2. Not gaining weight: if there is growth faltering, there is a high possibility of underlying serious illness
  3. A decrease in urine output means the baby is not passing at least 4 to 6 times a day.
  4. Associates fever: may indicate an infection.
  5. Not accepting feed well: baby is not taking his or her usual feed.
  6. Significant abdominal distension: if the abdomen is distended and is tense
  7. Repeated vomiting: baby is not able to keep the usual feed

When green stool is not dangerous

When not to worry: if the baby is passing greenish stool and

  1. Active and playful as usual
  2. Feeding well
  3. Passing urine as usual
  4. Not having any of the above mentioned “to worry” complaints

How to cure Green-stool?

What mothers can do:

  1. Proper latching: This means baby is well attached to the breast. If a baby is bottle-fed, the baby should be kept in a semi-reclined position during feeding and bottle to be tilted upwards.
  2. Mother to take care of her heath and feeding: as mother’s health and digestion directly or indirectly affect the baby’s health.

drabhijitmisra.com Disclaimer: All health information provided on this blog is for general awareness and doesn’t in any way replace a doctor’s professional medical advice. Kindly consult your doctor in case of any decision regarding your health, and diet. The information provided is for awareness. This is not meant as professional medical consultation. Healthcare is an individual decision and needs careful discussion and professional consultation before taking any decision. The author is sharing his professional knowledge. This post is meant as educational and awareness information and all decisions to be taken at own risk after consulting their own doctor in person. Health information is constantly being updated and while the author tries his best to keep updated information, the author and the website shall not be held liable for any reliance placed on such content for any reason whatsoever.

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COUGH IN CHILDREN: WHAT TO DO? WHEN TO WORRY?

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Cough in children: what to do? When to worry?

Cough is one of the most common complaints children suffer. Not only it cause discomfort to the child, it also elicits stress and sleepless nights for their parents.

2 out of every 3-child aged 0 to 4 years visit their paediatricians at least once a year with cough.

Most of the time cough in children are results of acute viral infection and therefore self limiting and benign. Sometime it may be the indicator of a serious underlying problem. Overall most of the time cause is acute viral infection. 10 % of the time it is asthma . 1 to 3% of cases cause is a pneumonia and rest causes are very uncommon.

Cough is divided into acute or chronic depending on the duration of symptom.

Acute cough: less than 2 weeks

Chronic cough: more than 2 to 4 weeks

Most of the time acute cough is due to acute viral infection and they do not need any medication or any investigation. So if the child is active, playful and having undisturbed sleep at night you should not worry.

However if the cough is not decreasing by the 3rd week and becoming more severe in frequency and intensity, earlier investigation is warranted. 

When to worry?

  1. Cough in newborn or small babies
  2. Sudden onset cough
  3. Chronic cough( i.e. more than 2 weeks)
  4. Associated with fever, weight loss, night sweats, blood mixed sputum etc.
  5. Cough with feeding
  6. Continuous unremitting or worsening cough

What to do?

  1. Ensure adequate hydration: give more water
  • Saline nasal drops: to unblock the nose as needed
  • Don’t give antitussives(cough medicines) on your own: most of the times over the counter antitussive medications are not effective in children.  They can do more harm than good to your child.
  • Don’t give antibiotics on your own: which may be harmful .
  • Give paracetamol: if associated fever or severe pain in throat
  • Consult your doctor : it any of the above mentioned enlisted above in “when to worry” column present

So to conclude: cough in children is a very common symptom and most of the time it is self-limiting and do not need any treatment. You should not worry if your child is active, playful, feeding well, and having undisturbed sleep. But you must visit your pediatrician if any of the “when to worry” symptoms present.

This is part of the Blogchatter initiative #CauseAChatter.

See the other posts here

drabhijitmisra.com Disclaimer: All health information provided on this blog is for general awareness and doesn’t in any way replace a doctor’s professional medical advice. Kindly consult your doctor in case of any decision regarding your health, and diet. The information provided is for awareness. This is not meant as professional medical consultation. Healthcare is an individual decision and needs careful discussion and professional consultation before taking any decision. The author is sharing his professional knowledge. This post is meant as educational and awareness information and all decisions to be taken at own risk after consulting their own doctor in person. Health information is constantly being updated and while the author tries his best to keep updated information, the author and the website shall not be held liable for any reliance placed on such content for any reason whatsoever.

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