Introduction Neonatal bilious vomiting is a surgical emergency until proved otherwise, and requires prompt investigation. Health workers who are unfamiliar with the colour of bile may over or under recognise bile colour. While missed or delayed identifying of bile in newborn vomit can be catastrophic over-diagnosis means unnecessary & hazardous intervention in newborn babies with transfer to distant hospitals. Only 30–40% of all babies referred to surgical units because of bilious vomiting need surgery.

Objective To evaluate the ability of the neonatal staff, and newly delivered mothers to identify bilious vomit mothers to identify bilious vomit.

Design A total of 163 participants of both parents and health workers were asked to identify bile colours from a colour-chart of 8 green/yellow colour options.

Setting At the paediatric department in general District hospital, and over 3 months.

Main outcome measures Chi-Square goodness-of-fit tests and Kolmogorov-Smirnov two-sample tests were conducted to compare different groups and answers. Breakdown of the ability to recognise bile by gender to see whether colour blindness has any contribution to the ability to recognised bile.

Results Showed that the colour of bile was correctly identified by 95.5% of medical staff, 91% of nurses, midwives 72% and only 16.5% of parents. Whereas 16% of doctors, 30.5% of nurses, midwives 28% and 34% of parents wrongly identified the yellow colours as being that of bile

Conclusion Parents commonly think that bile is yellow and not green. Some health workers also make this confusion. Further education and using bile colour charts and posters for parents and health workers may be important in raising level of awareness of bile colour, screening for colour blindness among health workers may be of value as well. More than one person should check suspect vomit/aspirate to decide what the true colour is.