Vomiting and Nausea
Vomiting is messy, uncomfortable, and exhausting. Fortunately it is rarely serious. With most illnesses involving vomiting our main goal is to prevent dehydration.
Why do children vomit?
Vomiting can be caused by illness, ingestions, or stress.
If your child has ingested something you should call the poison control center in your area or the national poison control helpline (800-222-1222) and/or proceed to your nearest emergency room.
Viral Gastroenteritis/Stomach Flu
In a child with a viral gastroenteritis (GE), or stomach flu, you will often see vomiting with or without fever, followed in a day or two by diarrhea. In a typical viral GE the vomiting will be intense for twelve to twenty four hours. The most common complication is dehydration, so treatment is geared toward preventing dehydration and minimizing the vomiting and diarrhea.
It is important to realize that when your child is vomiting and has a viral GE the body is trying to rid itself of an infection. The stomach becomes very sensitive and if you do not take things slowly you might increase the vomiting. A large quantity will stretch the stomach and it might reflexively contract – more vomiting. For this reason you need to wait at least thirty minutes after the last vomiting episode before giving your child a small amount to drink. Despite their thirst or protests, you must go slowly. Start with pedialyte, a 50/50 gatorade water solution, a caffeine free tea, sprite/7-up, popsicles or, if all else fails, use water. You can also use rice water – boil the rice with lots of extra water and then when the water is cool use it as your re-hydrating solution. If your child refuses anything other than milk/formula you can try soy –last resort would be dairy. Dairy might prolong the diarrhea and stomach upset, but if it doesn’t increase the vomiting in your child then go ahead and use it. Remember – your main goal is to prevent dehydration. Anti-vomiting medications are rarely used and are unsafe in children less than 2 years of age. It is unsafe to use anti-diarrhea medications in children of any age.
- Wait 30 minutes after the last vomiting episode
- Begin with one to two teaspoons of liquid. If you have a breastfeeding infant you can breastfeed for 1-2 minutes.
- Wait 5 minutes. If your child does not vomit, give another 1-2 tsp liquid.
- Continue this, increasing the amount of liquid as tolerated over time.
- If your child vomits, stop for thirty minutes then begin again.
- If your child hasn’t vomited for several hours, begin solids – mild foods are best—bananas, rice, apples, bread/toast. Again- Go slowly. Your child might not take solids for a few days. S/he will lose weight – that is to be expected. As long as s/he is drinking and urinating it is not cause for alarm.
After an episode of viral GE the stomach might be lactose intolerant. Dairy products should be avoided if possible to minimize vomiting and shorten the duration of diarrhea. Using a probiotic daily, such as acidophilus, might also help restore balance to the stomach more quickly and shorten the duration of diarrhea.
Should you be worried?
If your child has fever for more than 48 hours, pain on urination or a sore throat you should contact your physician. In young children urinary tract infections and strep throat can present with vomiting as a first, or only symptom.
If your child is vomiting and is/has any of the following you should contact and see a physician immediately:
- Less than 2 months old with repeated vomiting or forceful vomiting
- Vomiting more than once following a head injury
- Headache, high irritability
- Blood (red) or Bile (deep/dark green) in the vomit
- Signs of dehydration: dry lips, little urine output (no urine in an eight hour period of time, less than three urinations in 24 hours)
- Severe abdominal pain
- Bloody diarrhea
If you feel that something is just not right call your physician or head into an urgent care/emergency room. Remember, no one knows your child like you do!
Vomiting illnesses are among the most difficult of routine illness to experience. Just remember to take it slow. And hang in there.
-Monique Araya, MD, FAAP
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