Bringing up a large amount of stomach contents through the mouth and sometimes the nose
- The main concern is to watch for signs of dehydration.
- Vomiting is commonly seen with viral infections like the flu, stomach viruses (usually associated with diarrhea), and bacterial infections like strep throats, ear infections, and urinary tract infections. More serious infections like meningitis and bloodstream infections may also have vomiting symptoms.
- It may be triggered by a cough that causes the child to gag and then vomit.
- Newborns vomiting in the first few days of life after each feeding that is forceful, bright yellow or green may have an obstruction and need immediate evaluation.
- Blood in the vomitus with a nursing baby may occur when mother’s nipples are bleeding and the baby is swallowing blood. It is fine to continue to breast-feed in this situation.
- Babies under a year commonly spit up - this is usually a few mouthfuls of milk/food that is non-forceful usually with burping. The babies should be gaining weight and not be excessively irritable with feeding or after a feeding. If they are very fussy , discuss the possibility of gastroesophageal reflux with esophagitis with your doctor during office hours. This is a fancy name for what we commonly know as "heartburn" and makes for an uncomfortable baby. Your doctor may need to recommend medications like antacids.
- Pyloric stenosis is a problem that occurs in infants around 4 to 6 weeks of age because of an obstruction from the muscle at the outlet of the stomach. The baby will have projectile vomiting during or shortly after feeding. This needs immediate evaluation.
- Intussusception occurs typically in the 2 month to 6 year age range. This is caused by a "telescoping" of some small intestine within itself. There is an obstruction and the bowel will lose blood supply. The common finding is a bloody stool that looks like "red currant jelly". Other symptoms can include abdominal pain, and a very sleepy, hard to arouse child.
- Head injuries and abdominal injuries may cause vomiting.
- Blood in the vomited material (unless you have a breast-fed newborn and you are sure you have bleeding nipples
- Yellow or green vomit
- Abdominal distention
- Constant abdominal pain over 1 to 2 hours
- Signs of severe dehydration
- Decreased urination (more than 8 hours since last urination)
- Dry mouth or absent tears with crying, sunken eyes
- Mottled, pale skin with cool hands and feet
- History of recent abdominal injury
- Is difficult to arouse, confused or delirious
- History of significant head injury, especially with other symptoms like severe headache, unsteady gait, weakness, change in behavior
- Possibility of accidental ingestion of a poison (plant, medicine, chemical)
- Choking episode or ingestion of a coin or other foreign object
- Projectile, very forceful vomiting more than 2 or 3 times, especially in an infant under 6 months of age
- Blood in the stool, any stool that looks like "red currant jelly"
- See fever, abdominal pain, diarrhea for other associated symptoms
- If the child on medicine that may be making him vomit
- Signs of mild dehydration
- If the child less than 6 months and vomiting more than 12 hours
- If the child more than 6 months and vomiting more than 24 hours
- Associated symptoms that need evaluation such as an earache, sore throat, pain with urination, diarrhea
- Possibility of food poisoning (onset usually 2 to 3 hours after eating spoiled food)
Dehydration. The key to treating vomiting at home is to avoid dehydration. Unfortunately, it is impossible to give an exact number of times of vomiting that will cause dehydration. It depends on the size of the child, how much they are vomiting and if they are keeping some fluids down.
- Signs of severe dehydration include listlessness(very weak with no energy), dry tongue and mouth that is sticky or tacky, absent tears with crying, sunken eyes, mottled skin, no urination for more than 8 to 10 hours, and in babies a sunken fontanel (soft spot on top of the head). Sometimes, in quiet, healthy baby, the fontanel does appear slightly sunken, especially if the baby is in an upright position. If any of these symptoms of severe dehydration are occurring, the doctor should be contacted immediately.
- Signs of mild dehydration may include dry lips with a moist mouth inside, fussy behavior, but the child should be able to interact, babble or talk or intermittently play, and less urine when the child does urinate. It is often difficult to check urination when a child is having diarrhea. Children who are mildly dehydrated need to be watched closely and if they can keep some fluids down, tend to do well.
Medications. If the child is on any medications, they should be temporarily stopped, unless they are critical like anti-seizure or heart medications. The doctor should be contacted if the child is unable to keep down these type of medications. Antibiotics may need to be skipped with alot of vomiting, but call the doctor if more than one day's worth of medicine is missed. Tylenol may be given as a suppository to control fever if necessary and this is available over the counter. Medications to stop vomiting should not be used unless specifically instructed by your doctor.
Fluids. If the child is vomiting frequently, wait one hour after the last vomiting episode and then start with clear fluids in small, frequent amounts. Choices such as Pedialyte, Infalyte and Ricelyte in young infants and Gatorade in older children are preferable. Flat cola, ginger ale or 7-up may be given to older children. Popsicles or ice chips may also be used. Start with 1 teaspoon to 1 tablespoon every 15 to 20 minutes. Do not let the child take more initially even though they may feel thirsty. Too much fluids given too fast will often worsen the vomiting. The amounts may be increased every hour, if the child is tolerating what is offered. If you are breast-feeding, try initially to nurse small amounts of time, like 3 to 4 minutes and then increase. If the baby is still vomiting with breast milk, pedialyte may need to be offered instead.
For bottle-fed infants under one year, use Pedialtye at first and if this is tolerated, you may switch to diluted formula (try starting with 1/4 strength) and then gradually increase the strength.
Solids. In children who are on solids, do not offer any until they are tolerating fluids for at least 8 hours. Foods to start with include bananas, rice or rice cereal, applesauce, toast (BRAT diet); crackers, potatoes, bland soup. Do not worry if your child is not interested in solids for a few days as long as they are drinking and staying well hydrated.
