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Vomiting
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 (e.g., 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.
When to Call for Vomiting
Call 911 Now (your child may need an ambulance) If- Unresponsive or difficult to awaken
- Not moving or too weak to stand
Call Us 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 under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen.)
- Age under 12 weeks with vomiting 2 or more times (EXCEPTION: spitting up)
- Age under 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 over 1 year old) and vomits everything over 8 hours
- High-risk child (e.g., diabetes mellitus, abdominal injury, head injury)
- Vomiting an essential medicine
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Call Us Within 24 Hours (between 9 am and 4 pm) If- You think your child needs to be seen
- Has vomited over 24 hours
- Fever present for more than 3 days
Call Us During Weekday Office Hours If- You have other questions or concerns
- Vomiting is a recurrent ongoing problem
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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 FOR VOMITING 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 ½ 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.
- If continues to vomit, switch to ORS for 4 hours.
- 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 can be used for vomiting in older children as well as ORS.
- EXCEPTION: also has diarrhea. ORS: Vomiting with watery diarrhea needs ORS. If refuses ORS, use ½ strength Gatorade.
- Give small amounts: 2-3 teaspoons (10-15 ml) every 5 minutes.
- Other options: ½ strength flat lemon-lime soda, gingerale, 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.
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.
Contagiousness: Your child can return to day care or school after vomiting and fever are gone.
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 develops any of the "When to Call Us" symptoms (including dry mouth, no tears, no urine output for 8 hours.
Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 7/15/2007 Last Revised: 11/18/2008
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