Vomiting

Vomiting (throwing up) is common in children. Babies often “spit up” (reflux) a little milk. Vomiting is different. It is forceful and causes food and liquid to come up from the stomach and out of the mouth or nose. Vomiting is a way to keep the body safe from harmful germs or substances but it can be harmful if a child looses too much fluid and salt from the body. This is called dehydration.

There are many causes of vomiting in children:

  • Stomach flu (gastroenteritis) – is the most common cause of vomiting in children over the age of one. Stomach flu may be caused by germs such as viruses, bacteria or parasites.
  • Food poisoning – caused by eating a food with a harmful germ (bacteria).
  • Medications
  • Infections
  • Problems in other areas of the body:
    • Inner ear
    • Head injury
    • Certain smells or sounds
    • Headaches
    • Becoming too hot (heat exhaustion, sunburn)
    • Bladder infection
    • appendicitis
  • Food allergies
  • Enzyme deficiencies (such as lactose intolerance)
  • Poisons – from eating something like household cleaners, etc.
  • Diseases or illness:
    • Hepatitis
    • Gallbladder disease
    • Pancreatitis
    • Inflammatory bowel disease like Crohn’s or Ulcerative Colitis
    • Kidney problems
    • Some forms of cancer
    • Diabetes.

Problems with esophagus, stomach, or intestines in children less than one year old:

  • GERD – Gastroesophageal Reflux Disease
  • Pyloric stenosis

Vomiting that lasts longer than 24 hours may be serious, and it is important for you to contact your doctor in this case.

Dehydration

Signs that a baby may be dehydrated:

  • If they have 5 or less wet diapers in a 24 hour period.
  • Dry mouth or cracked lips
  • Cry with no tears
  • Acts sleepier, weaker, or fussier than normal
  • Eyes and soft spot on top of the head sinks
  • Wrinkled skin and pale hands and feet.

Signs that a child is dehydrated:

  • Dry mouth
  • Cracked lips
  • Cries without tears
  • Dizzy
  • Sleepier, fussier, and weaker than usual
  • Very thirsty and will urinate less often

Other signs that require taking your child to the Emergency Room immediately include:

  • Fever over 103 degrees F (orally), or 104 degrees F (rectally)
  • Severe stomach pain
  • Blood in child’s stool or vomit
  • Child’s vomit is green or black or looks like coffee grounds
  • Child is difficult to wake up or seems confused
  • Child will not drink
  • Other symptoms that concern you as a parent

Testing

The doctor can usually find the cause of the vomiting based on asking questions like what foods were eaten, any contact with people with same symptoms, what medications were given. The doctor may collect a blood or urine sample for testing or have X-rays. If the child is vomiting a lot, the doctor may decide to do additional tests. Some of these tests include: Upper Endoscopy, Gastric Emptying Scan, CT Scan, and UPPER GI Series with SBFT.

Treatment

The best way to prevent dehydration is to give the child plenty of fluids, even if they still vomit a little. The best fluids contain a mixture of salt, sugar, minerals and nutrients in water. Many of these fluids can be bought at the store. Ask the doctor which ones to buy.

Give the child 1 to 2 ounces of clear fluids every half hour for 4 hours (avoid giving child more liquid than he or she wants as this can cause vomiting). If your child will not drink, give one spoonful of liquid every few minutes. If your baby will not drink from a bottle, use a syringe without a needle. A syringe may be purchased from a drug store.

-Clear fluids include:

  • Oral rehydration solution (ORS) such as Pedialyte MS, Rehydralyte, Lytren, Ricelyte, Reosol
  • Children over age 2 may also have the ORS solutions listed above, but also may have sports drinks such as: Gatorade, Gatorade Light, 10 K, Power Burst, and All Sport
  • Water
  • Popsicles
  • Sugar water

-If the child does not vomit, slowly give more clear fluids. After 8 hours of clear liquids and no vomiting, you may begin giving the child the below foods:

  • If you are breastfeeding your child, you may continue to do so.
  • If child is formula fed, provide 1 or 2 ounces less than normal at each feeding
  • Dry toast or crackers (saltines)
  • Non-sweetened cereals
  • Bland soups (chicken broth, or chicken noodle)
  • Rice (plain)
  • Mashed potatoes (plain)

-The child may normally return to a normal diet after 24 hours.

Prevention

Everyone in the family should be careful to wash hands frequently, especially after changing the child’s diaper, cleaning up vomit, and using the restroom. It is also a good idea to frequently wash the child’s bedding and toys, and prevent the child from sharing cups, pacifiers, bottles etc. with others.

When to contact the Doctor

See above “Precaution” section concerning dehydration. Also, DO NOT give your child any medication for vomiting without checking with your doctor first.

You should contact the doctor when:

      -Your child has started a new medication and begins vomiting       -Your child’s vomiting has lasted longer than 24 hours       -Your child’s fever has lasted more than 3 days       -Your child will not eat or drink.