Ashwin Lewis
Dry heaving, also known as retching, is a common occurrence in newborns and children. It involves the contraction of the abdominal walls and diaphragm, mimicking the motions of vomiting without producing any vomit. While it can be distressing for parents, dry heaving is usually harmless and often resolves on its own. However, in some cases, it may be a symptom of an underlying medical condition or a side effect of certain medications. This is especially true for children with neurological or gastrointestinal issues or those who have undergone specific surgeries. If your newborn frequently dry heaves while sleeping, it is important to consult a doctor to rule out any serious causes and receive appropriate treatment or advice.
Why does my newborn dry heave while sleeping?
| Characteristics | Values |
|---|---|
| Dry Heaving | The contraction of the abdominal walls and diaphragm, which allows the lungs to expand while the stomach and esophagus relax. |
| Causes | A combination of factors, including vomiting, nausea, medical conditions, medications, and certain situations. |
| Risk Factors | Dehydration, neurological or gastrointestinal conditions, fundoplication surgery, sensitive nervous systems, motility problems, and more. |
| Treatment | Basic care, hydration, small and slow sips of water, ginger supplements, anti-nausea medications, and specific treatments for underlying causes. |
| Prevention | Holding the baby upright after eating, frequent burping, optimizing feeding schedule and amount, changing feeding methods, and seeking medical evaluation for persistent retching or vomiting. |
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What You'll Learn
Gastrointestinal conditions
Dry heaving, also known as retching, is the contraction of the abdominal walls and diaphragm, which allows the lungs to expand while the stomach and oesophagus relax. This results in the contents of the stomach and oesophagus being forced upward. When there is nothing left in the stomach to expel, the body may still go through the motions of vomiting, resulting in dry heaves.
Dry heaving is often a symptom of an underlying medical condition, and it is common in children with certain gastrointestinal or neurological issues. In particular, children with motility problems are susceptible to dry heaving. This includes spasmodic motility problems, such as spasms of the oesophagus or intestine. These spasms can be treated with anticholinergic drugs or anti-spasmodics, such as Bentyl (dicyclomine) or Levsin (hyoscyamine sulfate). In some cases, Botox can be used to relax sphincters that spasm persistently.
Children with delayed emptying of the gut or a lack of "housekeeper" contractions can be treated with prokinetic medications, such as Reglan (metoclopramide) or Sandostatin (octreotide). In addition, feeding methods can be altered to help manage dry heaving. For example, children who eat orally may benefit from consuming smaller, more frequent meals and snacks. If a child has a feeding tube, feedings can be slowed down, made more frequent, or switched to continuous drip feedings.
It is important to note that dry heaving can also be caused by factors unrelated to gastrointestinal conditions. For instance, it can be triggered by certain sights or smells, even when there is no reason to empty the stomach. Furthermore, dry heaving is often associated with nausea and vomiting, which can be caused by a viral infection of the stomach.
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Neurological conditions
Dry heaving, also known as retching, is a common occurrence in newborns and children. While it can happen due to various reasons, neurological conditions are one of the primary causes. Children with neurological disorders or an overly sensitive nervous system are more prone to dry heaves. This is often associated with an overactive vomiting reflex, where the brain triggers the vomiting response even to mild stimuli.
In some cases, neurological conditions such as cerebral palsy or hypersensitivity of the gut (visceral hyperalgesia) can lead to dry heaves. Visceral hyperalgesia causes the stomach to feel full or painful with even a small amount of food or fluid, resulting in discomfort and retching. This hypersensitivity can also extend to other parts of the gut, exacerbating the issue.
Neurologically impaired children may also experience post-fundoplication retching, which is dry heaving after a specific type of surgery. A study found that out of 14 toddlers with post-fundoplication retching, 11 had cerebral palsy, indicating a potential link between neurological disorders and this type of dry heaving. These children often present with motility or sensory problems, such as esophageal spasms or antroduodenal (stomach and small intestine) motility issues.
Treating dry heaving in newborns and children with neurological conditions can be challenging and usually requires sophisticated testing and evaluation by a skilled motility specialist. The specialist must have advanced knowledge of the intricate connection between the brain and the gut to diagnose and treat the condition effectively. Medications such as anticholinergic drugs or anti-spasmodics may be prescribed to manage spasmodic motility problems, while feeding methods may need to be adjusted to reduce the frequency and severity of dry heaves.
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Feeding methods
Dry heaving, also known as retching, can be caused by certain neurological or gastrointestinal conditions, an overly sensitive nervous system, or motility problems. It can be treated by changing feeding methods, and in some cases, surgery may be required.
If your newborn is experiencing dry heaving, it is important to consult a doctor, especially if it is persistent, as it could be a symptom of a more serious condition. In the meantime, here are some general feeding methods that may help:
- Oral Feeding: If your child is eating orally, it is recommended to give smaller, more frequent meals and snacks. This means that your child's stomach will not be overloaded, and the risk of vomiting is reduced.
- Tube Feeding: If your child has a feeding tube, feedings should be slowed down and given more frequently in smaller amounts. This will help to ensure that your child is not being fed too much or too quickly, which can cause discomfort and dry heaving.
- Venting: If your child tends to swallow air or burp frequently, venting the feeding tube with a Farrell bag, open syringe, or other venting system can help to release excess air and prevent dry heaving.
- GJ-tube: In some cases, switching to a GJ-tube may be beneficial. This tube allows for direct feeding into the intestine, bypassing the stomach, and includes a venting or draining feature.
- Clear Liquids: When your child is experiencing vomiting or diarrhea, it is important to focus on rehydration. Offer clear liquids, such as Pedialyte, flat soda, syrup from canned fruit, or diluted Gatorade, in small amounts every 5-10 minutes. This will help to prevent dehydration and give your child's stomach time to rest.
- Bland and Starchy Foods: After a period of vomiting or diarrhea, start with bland, starchy foods that are easy to digest, such as rice, crackers, bread, applesauce, strained bananas, or rice cereal mixed with water. Avoid solid foods for at least 4 hours initially, and gradually introduce them back into your child's diet.
- Soy Formula: If your child has been experiencing diarrhea, consider switching to a soy formula like Isomil or Isomil DF (diarrhea formula) to help manage the symptoms.
- Medications: In some cases, your child's doctor may recommend medications to treat motility problems or spasms. These could include anticholinergic drugs, anti-spasmodics, or promotility medications, depending on the specific condition.
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Dehydration
There are several reasons why your newborn may become dehydrated. One of the most common causes is excessive vomiting or diarrhea, which can be due to an infection or an intolerance to something in the mother's diet if breastfeeding. Prolonged fever or excessive sweating can also contribute to dehydration, as your baby loses fluids through their skin and breath. Insufficient fluid intake is another obvious cause, which may occur if your baby is not feeding enough due to illness or a lack of interest in feeding.
The symptoms of dehydration in newborns can include dry mouth, fewer wet diapers, sunken eyes or fontanelle (soft spot on the head), lethargy, and, in more severe cases, dry heaving and vomiting. If you notice any of these signs, particularly the more severe ones, it is important to seek medical attention promptly. Dry heaving while sleeping could be an indication that your baby is struggling to maintain adequate fluid levels and may need immediate rehydration support.
To prevent dehydration, ensure your baby is feeding regularly and adequately. Offer the breast or bottle frequently, and if your baby is formula-fed, prepare the formula correctly according to the instructions. If your baby is showing signs of dehydration, oral rehydration solutions (ORS) can be very effective. These solutions contain the right balance of water, sugar, and salts to replenish what your baby has lost. They are typically given with a syringe or spoon, and you should give small amounts frequently to help your baby absorb the fluids better. Always consult your pediatrician for advice and guidance on rehydration solutions and the appropriate course of action.
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Underlying medical conditions
Dry heaving, also known as retching, is the body's response to an attempt to vomit when there is nothing left in the stomach to throw up. It is often accompanied by vomiting and nausea and can be triggered by certain situations, medications, or underlying medical conditions.
Dry heaving in newborns may be indicative of certain neurological or gastrointestinal conditions. For instance, children with spasmodic motility problems, such as spasms of the esophagus or intestine, may experience retching. In such cases, anticholinergic drugs or anti-spasmodics may be prescribed to relax the sphincters that spasm persistently. Delayed emptying or a lack of "housekeeper" contractions in the gut can also cause dry heaving and may be treated with pro-motility medications.
Excessive gagging in newborns may be a sign of conditions like GER or GERD. Gagging is a natural reflex to protect the baby's airway, but if it becomes excessive or is followed by discomfort, panic, fear, or irritability, it may be a cause for concern.
Retching is also commonly observed in children who have had fundoplication surgery. In such cases, a knowledgeable motility specialist is required to treat the condition and improve the child's quality of life.
If your newborn is experiencing dry heaves, it is important to consult a healthcare professional to rule out any underlying medical conditions and receive appropriate treatment.
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