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
• Main Cause: stomach infection (gastritis) from a stomach virus (eg Rotavirus)

See More Appropriate Topic

• If vomiting only occurs while coughing, see Cough
• If infant spits up a small amount, see Spitting Up (Reflex)
• If Diarrhea is the main symptom, see Diarrhea

Call Your Doctor Now (night or day) If

• Your child looks or acts very sick
• Difficult to awaken, confused when awake or severe 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 > 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 and need not be seen)
• Fever > 104°F (40°C)
• Age less then 12 weeks old with fever > 100.4°F (38°C) rectally
• Age < 12 weeks with vomiting 2 or more times
• Age < 12 months old who has vomited clear fluids 3 or more times and also has watery diarrhea
• High-risk child (e.g. diabetes mellitus, recent abdominal injury)
• Vomiting an essential medicine

Call Your Doctor Within 24 Hours (between 9 and 4) If

• You think your child needs to be seen
• Fever present > 3 days
• Has vomited > 24 hours

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

Home Care Advice for

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
   • For vomiting 1 or 2 times, offer 1/2 strength formula for 2 feedings, then regular formula
   • For vomiting more then 2 times, offer ORS (Infalyte, KaoLectrolyte or Pedialyte) for 8 hours
   • Give small amounts (1 teaspoon) every 5 minutes
   • After 4 hours without vomiting, increase the amount
   • After 8 hours without vomiting, return to regular formula. For infants > 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 > 2 times, nurse for 4 to 5 minutes every 30 to 60 minutes
   • After 8 hours without vomiting, return to regular breastfeeding
4. For Older Children (>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)
   • Other options: 1/2 strength flat lemon-lime soda, Popsicles or ORS frozen pops
   • Give small amounts (1 Tbsp) every 5 minutes
   • After 4 hrs. without vomiting, increase the amount
   • After 8 hours without vomiting, add solids:
   • Limit 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: Stop 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 > 24 hours
   • Signs of dehydration
   • Your child becomes worse or develops any of the “Call Your Doctor” symptoms