VOMITING

Symptom Definition

Vomiting is the forceful emptying (throwing up) of a large portion of the stomach's contents through the mouth.
Nausea and abdominal discomfort usually precede each bout of vomiting.

Causes

Main Cause: stomach infection (gastritis) from a stomach virus (eg Rotavirus). The illness starts with vomiting but diarrhea usually follows within 12-24 hours. If vomiting persists as an isolated symptom (without diarrhea) for more than 24 hours, more serious causes must be considered.

Return to School

Your child can return to day care or school after vomiting and fever are gone.

See More Appropriate Topic (instead of this one) If

Vomiting only occurs while coughing, see COUGH.
Child younger than 1 year old and spitting (reflux), see SPITTING UP.
Diarrhea is the main symptom, see DIARRHEA.

WHEN TO CALL YOUR DOCTOR

Call 911 now (your child may need an ambulance) if:

Unresponsive or difficult to awaken
Not moving or too weak to stand

Call your doctor now (night or day) if:

Your child looks or acts very sick
Confused (delirious)
Stiff neck or bulging soft spot
Headache
You suspect poisoning with a plant, medicine, or other chemical.
Signs of dehydration (e.g., very dry mouth, no tears and no urine in more than 8 hours).
Blood in the vomit that's not from a nosebleed.
Bile (bright yellow or green) in the vomit.
Abdominal pain is also present (EXCEPTION: abdominal pain or crying just before and improved by vomiting is quite common)
Fever above 105 F (40.6 C)
Age less than 12 weeks with fever above 100.4 F (38 C) rectally.(Caution: Do NOT give your baby any fever medicine before being seen.)
Age less than 12 weeks with vomiting 2 or more times.
Age less than 12 months old who has vomited Pedialyte (or other brand of ORS) 3 or more times and also has watery diarrhea.
Receiving Pedialyte (or clear fluids if age > 1 year) and vomits everything > 8 hours
High-risk child (e.g., diabetes mellitus, abdominal injury, head injury).
Vomiting an essential medicine.

Call your doctor within 24 hours (between 9am and 4pm) if:

You think your child needs to be seen.
Has vomited for more than 24 hours.
Fever present for more than 3 days.

Call your doctor during weekday office hours if:

You have other questions or concerns.
Vomiting is a recurrent ongoing problem.

Parent care at home if:

Mild vomiting (probably viral gastritis) and you don't think your child needs to be seen.

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HOME CARE ADVICE

Reassurance:

Most vomiting is caused by a viral infection of the stomach or mild food poisoning.
Vomiting is the body's way of protecting the lower GI tract.
Fortunately, vomiting illnesses are usually brief.

For Bottlefed Infants Offer Oral Rehydration Solution (ORS) for 8 Hours:

ORS (eg. Pedialyte or the store brand) is a special electrolyte solution that can prevent dehydration. It's readily available in supermarkets and drug stores
For vomiting 1 or 2 times, offer 1/2 strength formula for 2 feedings, then regular formula.
For vomiting over 2 times, offer ORS for 8 hours. If ORS not available, use formula. Spoon or syringe feed small amounts: 1-2 teaspoons (5-10 ml) every 5 minutes.
After 4 hours without vomiting, increase the amount.
After 8 hours without vomiting, return to regular formula.
For infants over 4 months old, also return to cereal, strained bananas, etc.
Normal diet OK in 24-48 hours.

For Breastfed Infants, Reduce the Amount Per Feeding:

If vomits once or twice, nurse 1 side every 1 to 2 hours.
If vomits over 2 times, nurse for 4 to 5 minutes every 30 to 60 minutes.
Spoon or syringe feed small amounts of ORS: 1-2 teaspoons (5-10 ml) every 5 minutes.
After 4 hours of ORS, return to regular breastfeeding. Start with small feedings of 5 minutes every 30 minutes and increase as tolerated.

For Older Children (over 1 Year Old) Offer Small Amounts of Clear Fluids For 8 Hours:

Water or ice chips are best for vomiting in older children.
(Reason: Water is directly absorbed across the stomach wall)
EXCEPTION: also has diarrhea. ORS: Vomiting with watery diarrhea needs ORS. If refuses ORS, use 1/2 strength Gatorade.
Give small amounts: 2-3 teaspoons (10-15 ml) every 5 minutes.
Other options: 1/2 strength flat lemon-lime soda, popsicles or ORS frozen pops.
After 4 hours without vomiting, increase the amount.
After 8 hours without vomiting, add solids:

Limit solids to bland foods for 24 hours.
Start with saltine crackers, white bread, cereals, rice, mashed potatoes, etc.
Normal diet OK in 24-48 hours.

Avoid Medicines:

Discontinue all nonessential medicines for 8 hours (reason: usually make vomiting worse).
Fever: Fevers usually don't need any medicine. For higher fevers, consider acetaminophen (Tylenol) suppositories. Never give oral ibuprofen; it is a stomach irritant.
Call your doctor if: vomiting an essential medicine.

Contagiousness: Your child can return to day care or school after vomiting and fever are gone.
Sleep: Help your child go to sleep for a few hours. (Reason: Sleep often empties the stomach and relieves the need to vomit). Your child doesn't have to drink anything if he feels very nauseated.
Expected Course: Vomiting from viral gastritis usually stops in 12 to 24 hours. If diarrhea is present, it usually continues for several days.
Call Your Doctor If:

Vomiting becomes severe (vomits everything) over 8 hours
Vomiting persists over 24 hours
Signs of dehydration
Your child becomes worse

And remember, contact your doctor if your child becomes worse or develops any of the "Call Your Doctor" symptoms.

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REFERENCES

Armon K, Elliott EJ. Acute gastroenteritis. In: Moyer V, Davis RL, Elliott E, et al, eds. Evidence Based Pediatrics and Child Health.London, England: BMJ Publishing Group; 2000. p. 273-286.
Atherly-John YC, Cunningham SJ, Crain EF. A randomized trial of oral versus intravenous rehydration in a pediatric emergency department. Arch Pediatr Adolesc Med. 2002;156:1240-1243.
Foley LC, et al. Evaluation of the vomiting infant. Am J Dis Child. 1989;143:660-661.
Fuchs S and Jaffe D. Vomiting. Pediatr Emerg Care. 1990;6:164-169.
Garcia VF and Randolph JG. Pyloric stenosis: Diagnosis and management. Pediatr Rev. 1990;11:293-296.
Gorelick MH, Shaw KN, Murphy KO. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997;99(5):E6.
Kuppermann N, O�Dea T, Pinckney L, Hoecker C. Predictors of intussusception in young children. Arch Pediatr Adolesc Med. 2000;154:250-255.
Murray KF and Christie DL. Vomiting. Pediatr Rev. 1998;19:337-34.
Porter SC, Fleisher GR, Kohane IS, Mandl KD. The value of parental report for diagnosis and management of dehydration in the emergency department. Ann Emerg Med. 2003;41:196-205.
Santucci KA, Anderson AC, Lewander WJ, Linakis JG. Frozen oral hydration as an alternative to conventional enteral fluids. Arch Pediatr Adolesc Med. 1998;152:142-146.
Steiner MJ, DeWalt DA, Byerley JS. Is this child dehydrated? JAMA. 2004;291:2746-2754.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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