Vomiting – Pediatric

WHAT IS VOMITING?

Vomiting is the forceful emptying of a large portion of the stomach’s contents through the mouth. Strong stomach contractions against a closed stomach outlet result in vomiting. Reflux is the effortless spitting up of one or two mouthfuls of stomach contents that occurs in babies. Several bouts of vomiting occurring at one time without a break is considered one instance of vomiting.

WHAT IS THE CAUSE?

Most vomiting is caused by a viral infection of the stomach or food poisoning from eating poorly refrigerated food. Usually, a child whose vomiting is caused by a virus also has diarrhea. If your child has vomiting without diarrhea and it lasts more than 24 hours, your child may have something more serious.

HOW LONG DOES IT LAST?

The vomiting usually stops in 6 to 24 hours. Changes in the diet can prevent excessive vomiting and dehydration. If your child also has diarrhea, the diarrhea will usually continue for several days.

TREATMENT / ADVICE TO TAKE CARE OF YOUR CHILD

Feeding breast-fed babies who are vomiting

The key to treatment is providing breast milk in smaller amounts than usual. If your baby vomits once, make no changes. If your baby vomits twice, continue breast-feeding but nurse on only one side for five minutes every 30 to 60 minutes. When four hours have passed without vomiting, return to regular nursing on both sides, starting with small feedings of five minutes every 30 minutes and increase as tolerated.

An oral rehydration drink such as Pedialyte is usually not needed for breast-fed babies. If
vomiting continues once you have tried lower volume feeding, however, switch to Pedialyte for four hours. Spoon feed one to two teaspoons (5 to 10 ml) of Pedialyte every five minutes. If your baby is urinating less frequently than normal, you can also offer your baby Pedialyte between breast-feedings for up to 24 hours.

If vomiting continues after four hours following this care advice, see a provider today and ASAP if your child seems really sick and/or dehydrated.

Caring for formula-fed or older children who are vomiting

  • Offer small amounts of clear fluids for eight hours
    Offer clear fluids (not milk) in frequent small amounts until eight hours have passed without vomiting.
    For infants less than one year old, always use an oral electrolyte solution (such as Pedialyte or  the store brand). Spoon feed your baby one to two teaspoons (5 to 10 ml) every five minutes. Until you get some oral rehydration solution such as Pedialyte, give formula by teaspoonful in the same way.
    Under six months of age, the goal is to provide 30 to 90 mL (one to three ounces) of oralrehydration solution every hour for four hours. At age six months to two years provide 90 to 125 mL (three to four ounces) of clear fluid every hour for the first four hours. After four hours without vomiting, double the amount. After eight hours without vomiting, start to introduce regular food as tolerated.
    For a child over one year old with vomiting but no diarrhea, the best fluid is water or ice chips because water can be directly absorbed across the stomach wall. If your child is two years old or older water is best, but half-strength apple juice, lemon-lime soda or Popsicles are also okay. Stir the soda with cold water until no fizz remains. However, if the vomiting continues for over 12 hours, switch to an oral rehydration solution drink such as Pedialyte.
    Start with one teaspoon (five ml) to one tablespoon (15 ml) of the clear fluid, depending on your child’s age, every five minutes. After four hours without vomiting, double the amount. If your child vomits using this treatment, rest the stomach completely for one hour and then start over but with smaller amounts. This one-swallow-at-a-time spoon fed approach rarely fails.
    If diarrhea is also present with vomiting the use of an electrolyte oral replacement solution, such as Pedialyte, is all the more important to replace electrolytes as well as fluid losses.
    If your child is not taking Pedialyte, try mixing it with cold water or apple juice or freeze it into a slushy texture – anything to get it in!
    Oral rehydration solutions taste better cold.
  • Avoid solid foods or table foods for children who are vomiting:
    After eight hours without vomiting, your child can gradually return to a normal diet.
    Infants can start with bland foods such as cereal. If your baby only takes formula, give one or two ounces less per feeding than usual.
    Older children can start with such foods as saltine crackers, cereals, white bread, bland soups, rice, and mashed potatoes.
    Usually your child can be back on a normal diet within 24 hours after recovery from vomiting.
  • Medicines:
    Do not give your child any medicines by mouth for eight hours. Oral medicines can irritate the stomach and make vomiting worse. If your child has a fever over 39°C (102°F), use acetaminophen rectal medication suppositories. Call your health-care provider if your child needs to continue taking an essential prescription medicine.

Common mistakes in the treatment of vomiting:

  • A common error is to give as much fluid at one time as your child wants rather than
    gradually increasing the amount. This almost always leads to continued vomiting.
  • There is no effective drug or suppository for vomiting, so avoid medication. Changing the diet is the best treatment. Vomiting alone (without diarrhea) rarely causes dehydration.

WHEN SHOULD I SEE A HEALTH-CARE PROVIDER?

SEE A HEALTH-CARE PROVIDER IMMEDIATELY if:

  • Your child shows signs of dehydration after following the clear fluids care advice (such as no urine for over 8 hours or over 12 hours if more than one year old, very dry mouth, no tears when crying).
  • Your child vomits up blood or something that looks like coffee grounds.
  • Your child vomits repeatedly AND also has watery diarrhea.
  • Your child has abdominal pain when not vomiting.
  • Your child is confused or difficult to awaken.
  • Your child starts acting very sick (unable to sit up or walk, not moving limbs, not awake and alert or able to speak, not taking any fluids).

SEE A HEALTH-CARE PROVIDER TODAY if:

  • The vomiting continues for more than four hours on clear fluids if your child is under one year of age or 48 hours if over age one and your child is ill, but managing, and not overly sick (can wake up and respond to you, can sit up, move limbs and walk, is taking fluids).

If you haven’t spoken to us yet, call Health Links – Info Santé to discuss your child’s symptoms with a nurse. Call back any time if your condition changes and you need assessment, or you have any questions or concerns.