diet nurse anticipate week infant surgical repair hypertrophic pyloric stenosis hps

Which diet would the nurse anticipate for a 4 week old infant after surgical repair for hypertrophic pyloric stenosis HPS )?

Babies spit up all the time, but if your newborn is consistently vomiting forcefully, pyloric stenosis may have something to do with it. Fortunately, there's a fix that'll get your baby's digestive tract back on track.

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In This Article

  • What is pyloric stenosis?
  • Symptoms of pyloric stenosis
  • What causes pyloric stenosis?
  • Diagnosing pyloric stenosis
  • Treatments for pyloric stenosis
  • Prognosis for pyloric stenosis

If you have a newborn, it’s normal to find that often what goes down, comes back up again. You can chalk it up to new baby digestion, and most of the time, it’s something your little one will outgrow. 

But if your baby throws up so frequently and so forcefully that the vomit projectiles clear across the room, it could be another, more serious cause: pyloric stenosis. It’s important to diagnose pyloric stenosis early, as it can cause dehydration and malnourishment. But when it’s addressed promptly, pyloric stenosis is completely treatable, meaning your baby will eat normally, grow and thrive.

What is pyloric stenosis? 

Pyloric stenosis is a narrowing of the pylorus, the muscular valve at the bottom of the stomach. This prevents breast milk or formula from passing through the small intestine and causes forceful or projectile vomiting.

Pyloric stenosis occurs in about 3 out of every 1,000 babies in the U.S., and it’s the most common condition requiring surgery in the first few months of life.

Symptoms of pyloric stenosis 

If your newborn has pyloric stenosis, you’ll notice it usually within the first two months. Symptoms include:

  • Projectile or forceful vomiting. This is nothing like ordinary spit-up. Babies with pyloric stenosis will vomit within a half hour of eating, spewing milk or formula a foot or more. Sometimes the vomit may have blood in it. 
  • Constant hunger. Babies with pyloric stenosis aren’t digesting properly, so they’re ravenous. Often, they will want to eat again soon after vomiting. 
  • Wave-like stomach contractions. You may notice this phenomenon (called peristalsis) after feedings but before vomiting. It’s caused by the stomach muscles trying to force food through the narrowed pyloric sphincter.
  • Constipation. Since little or no food reaches the intestines, babies with pyloric stenosis have fewer, smaller poops. 
  • Dehydration. Because your baby can’t keep anything down, he’s not getting enough fluids. You may notice that he’s crying without tears and you’re not changing enough wet diapers. 
  • Weight loss. With insufficient nutrients, babies with pyloric stenosis struggle to gain weight and may even lose weight.

What causes pyloric stenosis?

The exact cause of pyloric stenosis is unknown, but some things can put a baby more at risk for the condition.

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  • Sex. It’s more common in boys, especially firstborn sons. In fact, pyloric stenosis affects about four times as many boys as girls.
  • Family history. There may be a genetic component to pyloric stenosis. It’s more frequent in babies who had a parent with the condition. If they already have a sibling with pyloric stenosis, they also have a 30 times greater risk than babies who don’t. 
  • Antibiotic use. There is evidence that taking certain antibiotics late in pregnancy, during breastfeeding or giving certain antibiotics to babies in the first two weeks of life is linked with an increased risk of pyloric stenosis.
  • Smoking during pregnancy. Babies of moms who smoked while pregnant have double the risk of developing this condition.
  • Hernias. Pyloric stenosis is seen more often in babies born with inguinal hernias, a condition where a part of the intestine pushes through a weakness in a baby’s belly.

Diagnosing pyloric stenosis

Pyloric stenosis can be confused with reflux (frequent spit-up) or gastroesophageal reflux disease (GERD), a condition in which the contents of the stomach come back up. GERD can also cause irritability and poor weight gain. 

To confirm pyloric stenosis, the first step is a physical exam. Your doctor may notice the following:

  • Signs of dehydration, such as dry skin, a lack of tears when crying and dry diapers.
  • A lump in the baby’s stomach from the enlarged pylorus.

Your doctor will then run imaging tests to confirm the diagnosis. These include:

  • Abdominal ultrasound. This can reveal whether the pylorus is thicker than normal. It can also show if milk isn’t passing from the stomach to the small intestine.
  • Barium X-ray. With this specific type of X-ray, your baby will drink a special liquid that lights up on the scan. If your baby does have pyloric stenosis, the test will show only a very small amount of fluid going through.
  • Blood tests to check for an electrolyte imbalance.

Treatments for pyloric stenosis

The standard — and most effective — treatment for pyloric stenosis is surgery, known as pyloromyotomy. The procedure, which is performed through a incision near the baby’s belly button, is done under general anesthesia. It will widen the passageway from the stomach to the intestines so your baby can get the food he needs. 

When babies are diagnosed with pyloric stenosis, they are often scheduled for surgery that same day in order to get nutrients moving through their systems as quickly as possible. If there is severe dehydration when a baby is diagnosed, doctors may give IV fluids first to restore electrolytes before going ahead with the surgery.

After surgery, babies often receive more IV fluids and can usually eat within a few hours. Expect to go home with your baby within a couple of days. There may be some vomiting at first that disappears after a few feedings.

Once home, keep the incision clean and dry for three days. After that, you can give your baby gentle sponge baths, but still try to keep the cut dry. The stitches will usually dissolve on their own. Your surgeon may also recommend that you give your little one infants’ acetaminophen if he seems uncomfortable.

At follow-up appointments, the doctor will make sure the incision is healing properly and your baby is eating well and gaining weight just as he should.

Prognosis for pyloric stenosis

Most babies with pyloric stenosis respond well to prompt treatment and go on to live fully normal lives with no long-term effects from it. But if you notice any unusual symptoms later on, it's never a bad idea to check in with your pediatrician.

From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You're Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.

  • What to Expect the First Year, 3rd edition, Heidi Murkoff.
  • WhatToExpect.com, Dehydration in Babies, January 2021.
  • WhatToExpect.com, Types of Vomiting in Babies and Toddlers, June 2020.
  • WhatToExpect.com, How Much Baby Spit Up Is Normal?, September 2021.
  • WhatToExpect.com, Infant GERD and Acid Reflux in Babies, April 2020.
  • American Academy of Pediatrics, Hypertrophic Pyloric Stenosis (HPS) - Help for Babies With Forceful Vomiting, December 2019.
  • Boston Children’s Hospital, Inguinal Hernia, 2021.
  • Children’s Hospital of Philadelphia, Pyloric Stenosis, 2021.
  • Johns Hopkins Medicine, Pyloric Stenosis, 2021.
  • KidsHealth From Nemours, Pyloric Stenosis, March 2017.
  • Mayo Clinic, Pyloric Stenosis, November 2020.
  • Mayo Clinic, Pyloromyotomy, 2021.
  • Mount Nittany Health, Pyloric Stenosis, After Your Child’s Surgery for Pyloric Stenosis, May 2021.
  • National Institutes of Health, National Library of Medicine, Pyloric Stenosis in Infants, September 2021.
  • Stanford Children’s Health, Inguinal Hernia in Children, 2021.

Was this article helpful?

Which nursing intervention would be the priority for a 4 week old infant with hypertrophic pyloric stenosis?

Option A: Infants with pyloric stenosis usually have some degree of dehydration; replacing fluids and electrolytes would be priority actions for this diagnosis.

What surgery is performed for a child diagnosed with hypertrophic pyloric stenosis HPS )? Quizlet?

Surgery called pyloromyotomy treats pyloric stenosis. After diagnosing pyloric stenosis, your surgeon will discuss the surgery with you.

Which clinical finding would the nurse expect to identify in an infant with hypertrophic pyloric stenosis?

The most common symptoms noted in a baby with pyloric stenosis is forceful, projectile vomiting. This kind of vomiting is different from a "wet burp" that a baby may have at the end of a feeding. Large amounts of breast milk or formula are vomited, and may go several feet across a room.

Why is the vomit of an infant with pyloric stenosis white rather than bile stained?

The vomited material does not contain bile because the pyloric obstruction prevents entry of duodenal contents (containing bile) into the stomach. The chloride loss results in a low blood chloride level which impairs the kidney's ability to excrete bicarbonate.

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