Pyloric Stenosis in Babies – Causes, Symptoms & Treatment

This condition is typically observed in infants, usually between 2 to 12 weeks of age, with most cases occurring around 3 to 5 weeks old. It is more common in first-born babies and male infants. Pyloric stenosis can be a distressing and serious condition because it leads to persistent vomiting, dehydration, and poor weight gain.

Symptoms Of Pyloric Stenosis in Babies

The symptoms of pyloric stenosis develop in infants between 2 to 12 weeks of age, but most commonly around 3 to 5 weeks old. The condition is more prevalent in first-born babies and is more common in male infants.

The signs and symptoms of pyloric stenosis include

1. Projectile Vomiting

This is the hallmark symptom of pyloric stenosis. The baby vomits forcefully and with some distance known as projectile vomiting.  This occurs shortly after feeding, and the vomit may contain mucus and curdled milk.

2. Persistent Hunger

Despite vomiting, the baby may seem hungry and eager to feed again shortly after vomiting.

3. Weight Loss Or Poor Weight Gain

Due to frequent vomiting, the baby may not be getting enough nutrition, leading to weight loss or inadequate weight gain. This can be concerning for parents or caregivers who notice that the baby is not growing as expected.

4. Dehydration

Prolonged vomiting can lead to dehydration in the baby. Signs of dehydration may include fewer wet diapers, dry mouth, sunken fontanelles (soft spots on the baby’s head), and lethargy.

5. Visible Peristalsis

In some cases, the wave-like contractions of the stomach can be seen through the baby’s skin, especially after feeding.

If you notice any of these symptoms in an infant, particularly frequent projectile vomiting and poor weight gain, seek immediate medical attention. Pyloric stenosis can lead to significant complications if left untreated, such as severe dehydration and electrolyte imbalances. However, with timely diagnosis and appropriate treatment, most babies recover fully.

Causes And Risk Factors For Pyloric Stenosis In Babies

The exact cause of pyloric stenosis is not fully understood. But it is believed to be a combination of genetic and environmental factors.

Several factors may contribute to the development of pyloric stenosis in infants.

a. Genetic Factors

There appears to be a genetic predisposition to pyloric stenosis, as the condition often runs in families. Infants with a family history of pyloric stenosis are at a higher risk of developing the condition themselves.

b. Abnormal Muscle Development

Pyloric stenosis occurs due to abnormal thickening and enlargement of the muscles in the pylorus (the outlet of the stomach). This leads to a narrowing of the passageway, making it difficult for food to pass into the small intestine.

c. Hormonal Factors

Some researchers believe that hormonal influences may play a role in the development of pyloric stenosis. For example, infants with pyloric stenosis have high levels of gastrin, a hormone that stimulates stomach acid production.

d. Birth Order

Pyloric stenosis is more common in first-born babies, suggesting that birth order might be a risk factor. However, the reason for this association is not entirely clear.

e. Age And Gender

Pyloric stenosis most commonly affects infants between 2 to 12 weeks of age, with a peak incidence around 3 to 5 weeks. It is also more common in male infants compared to female infants.

f. Medications Taken During Pregnancy

Some studies suggest a possible association between pyloric stenosis and certain medications taken during pregnancy, particularly macrolide antibiotics (e.g., erythromycin) and some antidepressant medications. However, the evidence for this link is not definitive.

It’s important to note that while these factors may increase the likelihood of pyloric stenosis, the condition can still occur without any apparent risk factors. Pyloric stenosis is relatively rare, and most babies born to parents with no family history of the condition will not develop it.

If you suspect that your baby is showing signs of pyloric stenosis or has risk factors for the condition, it is crucial to seek medical attention promptly. Early diagnosis and treatment are essential for the well-being of the baby and to prevent complications associated with this condition. A healthcare provider can perform a physical examination, review the baby’s symptoms and medical history, and conduct necessary tests to confirm the diagnosis and recommend appropriate treatment.

Diagnosing Pyloric Stenosis

Pyloric stenosis is typically diagnosed based on a combination of the baby’s clinical presentation, a physical examination, and diagnostic imaging.

If your baby is showing symptoms suggestive of pyloric stenosis, such as frequent projectile vomiting, poor weight gain, and signs of dehydration, a healthcare provider will conduct a thorough evaluation to confirm the diagnosis. The diagnosis is:

1. Medical History And Physical Examination

The healthcare provider will start by taking a medical history, including information about the baby’s symptoms, feeding patterns, and any family history of pyloric stenosis. The doctor will do a physical examination to check for signs of dehydration, observe the baby’s abdomen for any visible peristalsis (wave-like contractions of the stomach), and assess the size and mobility of the pyloric mass.

2. Ultrasound

An abdominal ultrasound is a key diagnostic tool for pyloric stenosis. During this imaging procedure, high-frequency sound waves are used to create images of the baby’s abdomen. The ultrasound can show the thickened pylorus and the characteristic “olive-shaped” mass, confirming the diagnosis.

3. Blood Tests

Blood tests may be performed to check for electrolyte imbalances and signs of dehydration, which can occur due to frequent vomiting.

4. Evaluating Vomit

In some cases, the doctor may analyze a sample of the baby’s vomit to rule out other possible causes of vomiting.

The combination of clinical evaluation and ultrasound findings is usually sufficient to diagnose pyloric stenosis. In some cases, other imaging tests, such as upper gastrointestinal (GI) series or barium swallow, may help further evaluate the condition. But these are less common today due to the widespread use of abdominal ultrasound.

It’s essential to seek medical attention promptly if you suspect that your baby may have pyloric stenosis or is experiencing symptoms such as frequent vomiting and poor weight gain. Early diagnosis and treatment are crucial to prevent complications associated with this condition.

Treatment Of Pyloric Stenosis In Babies

The primary treatment for pyloric stenosis is a surgical procedure called pyloromyotomy. A pyloromyotomy is a safe and effective surgery that aims to relieve the obstruction at the outlet of the stomach (pylorus), allowing the stomach to empty its contents into the small intestine normally. The procedure is typically performed as soon as the diagnosis of pyloric stenosis is confirmed.

a. Pyloromyotomy Procedure

During the pyloromyotomy, a surgeon makes a small incision in the muscles of the pylorus. The incision is carefully made to avoid damaging nearby structures, and once it is completed, the muscles of the pylorus are spread open. This release of the obstruction allows food and gastric contents to pass freely from the stomach to the small intestine.

A pyloromyotomy is usually performed using minimally invasive techniques, such as laparoscopy, which involves making small incisions and using a laparoscope (a thin, flexible tube with a camera) to guide the surgery. A laparoscopic pyloromyotomy is less invasive, and babies often recover more quickly with smaller scars compared to traditional open surgery.

b. Post-Surgery And Recovery

After the surgery, the baby stays in the hospital under constant monitoring to ensure a smooth recovery. In most cases, babies can start feeding again relatively soon after the procedure, and vomiting should cease or significantly improve.

The recovery period after pyloromyotomy is usually quick, and babies typically resume feeding well and begin to gain weight. The majority of infants recover fully from pyloric stenosis and experience no long-term effects from the condition or the surgery.

c. Feeding After Surgery

Since feeding patterns may have been disrupted due to pyloric stenosis, parents may need guidance from healthcare providers on resuming normal feeding practices after surgery. Gradual reintroduction of feeds and monitoring of the baby’s tolerance to feeding may be necessary.

d. Complications

While pyloromyotomy is generally safe, as with any surgery, there can be potential risks or complications. These could be an infection, hemorrhage, or a negative anesthetic reaction. However, serious complications are rare, and the benefits of surgery in relieving pyloric obstruction far outweigh the risks.

If your baby has been diagnosed with pyloric stenosis, the healthcare team will provide you with specific information about the surgery, the recovery process, and what to expect after the procedure. As a parent or caregiver, it’s essential to follow the medical team’s instructions and attend any follow-up appointments to ensure the baby’s proper healing and ongoing health.

Complications Of Pyloric Stenosis In Babies

Pyloric stenosis is a condition that requires prompt medical attention and surgical intervention to prevent potential complications. Without treatment, the obstruction at the outlet of the stomach can lead to various health issues.

Some of the potential complications of pyloric stenosis include

• Dehydration
• Electrolyte Imbalances
• Weight Loss and Failure to Thrive
• Metabolic Alkalosis
• Irritability and Discomfort
• Delayed Diagnosis and Treatment
• Malnutrition

Fortunately, pyloric stenosis is a treatable condition, and most infants recover fully after a surgical procedure called pyloromyotomy. Early diagnosis and timely intervention are essential to prevent complications and ensure the baby’s well-being.

If you suspect that your baby is showing symptoms of pyloric stenosis, such as frequent projectile vomiting, poor weight gain, and dehydration, it’s crucial to seek medical attention promptly. A healthcare provider can perform the necessary evaluations, confirm the diagnosis, and recommend appropriate treatment to prevent complications and support the baby’s recovery.

When To See A Doctor?

If you notice any concerning symptoms in your baby, it’s essential to seek medical attention promptly. Here are some specific signs and symptoms associated with pyloric stenosis and other conditions that should prompt you to see a doctor

• Frequent Projectile Vomiting
• Persistent Hunger
• Poor Weight Gain
• Signs of Dehydration
• Visible Peristalsis
• Fussiness or Irritability
• Abdominal Distension
• Change in Bowel Movements
• Unexplained Crying or Discomfort
• Concerns about Overall Health

Remember, as a parent or caregiver, you know your baby best. If you observe any worrisome symptoms or changes in behavior that raise concerns, do not hesitate to contact your pediatrician or seek urgent medical care.

Early detection and intervention can make a significant difference in managing any potential health issues, including pyloric stenosis in babies. Your healthcare provider can perform a thorough examination, diagnose the cause of the symptoms, and recommend appropriate treatment or further evaluation if needed. The hallmark symptom of pyloric stenosis is projectile vomits. Seeking medical help is essential.

FAQ’s

1. Can Babies Still Poop With Pyloric Stenosis?

Yes, babies with pyloric stenosis continue to poop as long as the food gets digested.

2. Can Overfeeding Cause Pyloric Stenosis?

No, overfeeding cannot cause pyloric stenosis. Genetic factors are considered to be the most common causes of pyloric stenosis in babies.

3. Do Babies Vomit Every Feeding With Pyloric Stenosis?

Yes. And the vomit style is different from normal babies. It will be with high pressure called projectile vomits.