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.

Cause

  • Main Cause: stomach infection (gastritis) from a stomach virus (e.g., Rotavirus).

See More Appropriate Topic (instead of this one) If

  • Vomiting only occurs while coughing, see COUGH.
  • Child younger than 1 year old spits up a small amount, see SPITTING UP.
  • Diarrhea is the main symptom, see DIARRHEA.

 

WHEN TO CALL YOUR DOCTOR 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 Your Doctor Now (night or day) If:

  • Your child looks or acts very sick.
  • Stiff neck, severe headache or bulging soft spot. 
  • 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 (yellow or green) in the vomit.
  • Abdominal pain is also present (EXCEPTION: abdominal pain or crying just before and relieved by vomiting is quite common).
  • Fever above 104°F (40°C).
  • Age less than 12 weeks old with fever above 100.4°F (38°C) rectally.
  • Age less than 12 weeks with vomiting 2 or more times.
  • Age less than 12 months old who has vomited clear fluids 3 or more times and also has watery diarrhea.
  • Receiving ORS and vomits everything > 8 hours
  • High-risk child (e.g., diabetes mellitus, abdominal 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 problem.

Parent Care at Home If:

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

HOME CARE ADVICE FOR VOMITING

  1. Sleep:  Help your child go to sleep (reason: sleep often empties the stomach and relieves the need to vomit).  Your child doesn't have to drink anything if he feels nauseated.
  2. 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 once, offer ½ strength formula for 2 feedings, then regular formula.
    • For vomiting 2 or more times, offer ORS for 8 hours.
    • If ORS not available, use formula.
      • Spoon 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 older than 4 months old, also return to cereal, strained bananas, etc. Normal diet OK in 24-48 hours.
  3. For Breastfed Infants, Reduce the Amount Per Feeding:
    • If vomits twice, nurse 1 side every 1 to 2 hours.
    • If vomits more than 2 times, nurse for 4 to 5 minutes every 30 to 60 minutes.
    • If continues to vomit, switch to ORS for 4 hours.
    • Spoon feed small amounts: 1-2 teaspoons (5-10 ml) every 5 minutes.
    • After 4 hours without vomiting, return to regular breastfeeding.
  4. For Older Children (older than 1 Year Old) Small Amounts of Clear Fluids For 8 Hours:
    • Water or ice chips are best for vomiting in older children.  (EXCEPTION: severe diarrhea.)  (Reason: water is directly absorbed across the stomach wall.)
    • Give small amounts: 2-3 teaspoons (10-15 ml) every 5 minutes.
    • Other options: ½ 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.
  5. Avoid Medicines:  Discontinue all nonessential medicines for 8 hours (reason: usually make vomiting worse).  Call if vomiting an essential medicine.
  6. Contagiousness:  Your child can return to day care or school after vomiting and fever are gone.
  7. Expected Course:  Vomiting from viral gastritis usually stops in 12 to 24 hours. If diarrhea is present, it usually continues for several days.
  8. Call Your Doctor If:
    • Vomiting persists for more than 24 hours.
    • Signs of dehydration.
    • Your child becomes worse or develops any of the "Call Your Doctor"
^Back to Top

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.

Pediatric HouseCalls Online. Copyright © 2000-2004 Barton Schmitt, M.D. FAAP

Reviewed 8/2004

Revised 8/2004

See Other Topics:

View Anatomic Index of Topics