Diagnosis

It is not only of psychological benefit to the parents to treat possetting, but it is also of significant benefit to the infant, since 1 in 10 babies left untreated may go on to develop more serious complications, such as dehydration and oesophagitis, due to the persistent exposure of the oesophagus to acid and other gastric contents. In most cases, although the condition is distressing, if the baby is developing and gaining weight as expected by the parents and health visitor, there is little cause for concern. In rare circumstances, however, infants may present with more sinister alarm symptoms that will necessitate GP referral (Table 1).

TABLE 1 – Alarm symptoms in infants necessitating GP referral

Symptom Comments
Signs of dehydration Listlessness, dark circles under the eyes, refusal to feed and dry nappies
Breathing difficulties Persistent vomiting and refluxed gastric fluids may be inhaled into the lungs resulting in chest infections, symptoms of asthma (eg, wheezing), or an interruption to breathing (apnoea)
Poor or no weight gain and failure to thrive Through excess loss of food due to regurgitation
Blood in the regurgitated food Oesophagitis is caused by prolonged or repeated reflux of the acidic stomach contents, which irritates the mucosal lining of the oesophagus and may cause inflammation. Infants may develop bloodstained vomiting, and occasionally experience difficulty in swallowing
Persistently unsettled, crying or fighting feeds  

If the infant is experiencing any of the above symptoms a GP should be consulted. Similarly, a baby who is vomiting severely, constantly or in a projectile manner should be seen by the health visitor or GP as soon as possible.

An approach to managing possetting in babies
FIGURE 1 – An approach to
managing possetting in babies
(click to enlarge)

Once the presence of these alarm symptoms has been ruled out, appropriate measures and treatment options can be recommended (Figure 1). [Click here to view pdf version]

bottom frame image