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Treatment for Vomiting

Vomiting is a very common condition in babies and children. Vomiting happens when the stomach pushes food and liquid backwards, up the esophagus, or food tube. People vomit for many different reasons. Infections are a very common cause of vomiting in both infants and older children. When an infection is the cause of vomiting, diarrhea almost always follows shortly. Doctors call the combination of diarrhea and vomiting “gastroenteritis,” or “GE.” Children with GE or vomiting from an infection often complain of nausea (“don’t feel good”). They don’t usually have significant abdominal pain, however, until some time after the vomiting has started. You can read our Aftercare Instruction on Diarrhea.

People also vomit if they have swallowed a toxic, or poisonous, material. This is a natural and protective reaction. Vomiting from this cause usually does not last for long, unless the person has absorbed a lot of the material. Vomiting after drinking too much alcohol, for example, is a common cause of vomiting in teenagers.

If a child has a blockage of the intestines, this can cause material to back up and cause both abdominal pain and vomiting. Depending on the location of the blockage, and how severe it is, this kind of vomiting can include bile from the liver, which is yellowish-green in color. Prolonged vomiting, even without a blockage, can cause bile to appear in the vomit. Certain other kinds of bowel problems, such as appendicitis, can also cause vomiting. The hallmark of any kind of bowel problem, such as appendicitis or a blockage, is that pain comes first, followed later by vomiting. Please remember that infants and toddlers can’t really complain of abdominal pain directly, but if your baby or toddler seems fussy or irritable before vomiting, please let your doctor know.

People can also vomit for reasons that have nothing to do with their stomach or intestines. Children with diabetes may vomit during an attack of high blood sugar levels. Children or teens frequently vomit after a head injury or a concussion. You can read our Aftercare Instructions on Head Injury. In very rare cases, the pressure inside the skull increases because of bleeding or a tumor. That increased pressure can also cause vomiting.

What is the biggest concern?

There are several main concerns in vomiting. From the child’s standpoint, s/he simply wants it to stop so s/he will feel better. Parents and doctors have that concern too, of course, and they are also concerned to prevent the child from becoming dehydrated. Vomiting causes loss of water and some minerals from the body. Without replacement of fluid and minerals, the child can become dehydrated. Children often don’t want to drink when they have vomiting. They may be afraid that drinking will make the vomiting worse, or they may feel too nauseated to drink.

If a child has vomiting without diarrhea, particularly if there is abdominal pain or some other concerning condition, it is also important to try to discover what is causing the vomiting. If it persists, this may sometimes require blood tests, x-rays, CT or MRI scans, or other “imaging” tests.

Treatment for Vomiting

Usually the first thing to do for a vomiting child is to reassure him or her that s/he will feel better soon. Vomiting can make a person feel frightened and out of control, and children need to hear reassurance. This can be hard to do if you are worried yourself!

You can do some things that will help calm your child a little. You can use a cool damp washcloth as a compress, and another to help your child keep his or her face clean. Keep two basins or buckets in service, so that you can rinse one out and have the second one available if your child needs it. The less vomit you and your child have to look at or deal with, the better everyone will feel. If you give your child some clear water to rinse his or her mouth with as soon as an episode of vomiting is over, this will also help him or her to feel better. If at all possible stay at your child’s bedside, or have another family member do so, while your child is actively vomiting. There’s nothing more miserable than vomiting alone!

It is usually safe to give a vomiting child sips of liquid, such as half-strength juice, an oral rehydration solution such as Pedialyte®, or water, until you can speak with your doctor about how to proceed. The only time this is not true is if the child has severe abdominal pain that started before the vomiting, or if the child has had a serious head injury. In those cases, of course, it is best to go straight to the emergency room to get the correct diagnosis and treatment.

If your child has vomiting along with diarrhea, or if your doctor is fairly certain that s/he has GE or a “stomach bug,” you will be able to care for your child easily at home. Offer plenty of clear liquids in small sips, but very frequently. Please don’t allow a thirsty child with vomiting to gulp down a whole cup or glass of liquid. That will be too much fluid at once, and s/he will very likely vomit it right back up. If you can control the amount yourself, try to give just one teaspoonful (5 cc) every minute. In an hour you’ll have given 10 ounces (300cc) of fluid, and your child won’t have vomited much of it. Most children will stop vomiting after one to two hours of this treatment. If your child continues to vomit, or if s/he is still eager to drink after two hours of steady fluids at this rate, please call your doctor.

If your child has diarrhea, it is best to avoid high sugar liquids such as soft drinks, fruit punch, and full-strength fruit juices. These actually pull water out of the child’s body and into the intestines, where they will make the diarrhea worse. You may want to use a special “oral rehydration solution” such as Pedialyte® or Infalyte® and others. These have just the right amount of salt and sugar to help push water back into your child’s body. Please remember that children almost never vomit up as much as they have swallowed. This means that you can continue to offer fluids in small amounts even to a vomiting child. Please don’t give oral fluids to a child who is vomiting and has severe abdominal pain or a high fever.

Doctors who care for children have traditionally avoided prescribing anti-vomiting drugs such as prochlorperazine (proe-klor-pair-a-zeen, Compazine® and others). This is because of concerns that those drugs might make it harder to diagnose a more serious problem, like a blockage or appendicitis. More and more doctors today feel comfortable using these kinds of medicines, so long as parents can watch their children closely. Sometimes a single dose or two of such a drug can help a child get to a point where s/he can drink enough on his or her own to stay hydrated. It is important never to give one of these medications to a child with abdominal pain, however, unless the child is already in a hospital.

Some families traditionally use things like flat ginger ale or even Coke® syrup to try to calm an upset stomach. These things are not harmful to children except for the amount of sugar they contain, but there is no scientific evidence that they help stop vomiting. Please try to avoid using them in a child who has diarrhea, because the sugar will make the diarrhea worse.

In most cases, simple vomiting in children turns out to be the first sign of a stomach “bug,” or GE. If that is the case with your child, s/he will proceed to have diarrhea within a few hours or days. Please be sure to read our Aftercare Instruction on Diarrhea.

Dangerous Vomiting Symptoms

Although vomiting in children is most commonly just part of a fairly minor illness, it can be a sign of a more serious problem, or of worsening dehydration. Here are some things to watch out for:

  • Fever – infants and toddlers occasionally run a slight fever when they have GE, but any fever over 102.4 °F or 38 °C is of concern at any age
  • Significant abdominal pain – more than just occasional cramps
  • Vomiting after more than a few hours of abdominal pain
  • Vomiting without diarrhea that lasts more than 24 hours
  • Yellow or green material in the vomit
  • Blood or dark brown material like coffee grounds in the vomit
  • A swollen or distended abdomen
  • No stool output for 24 hours while vomiting
  • Abdominal or back pain while walking or with any bumping or jarring of the abdomen
  • Pain, burning, or stinging on urination
  • No appetite at all (many children will eat less when they have vomiting or GE, but they usually have at least some desire to eat and drink)
  • Signs of dehydration:
    • Sunken appearance of the eyes
    • Dry tongue and mouth (dry lips are common and are not a sign of dehydration)
    • A sunken fontanel (soft spot) in an infant
    • Less than normal urination, or dark or strong-smelling urine
    • Being too sleepy (lethargic) or being very irritable or fussy
    • Cold, pale hands and feet even if the room is warm

     

  • Severe headache or stiff neck
  • Blurry vision or trouble walking

If any of these occur, please be sure to call your doctor’s office right away. If your child has any of the items listed above in bold print, please go directly to the emergency room.

Other points of concern

Vomiting can be very forceful in children and teens. In some cases, children vomit so hard that they can tear the lining of their esophagus (food tube). These small tears are not usually dangerous, but they can cause blood to appear in the vomit. Please let your doctor know right away if you see red blood or dark, coffee grounds-like material (old blood) in the vomit. Sometimes children with forceful vomiting can break tiny blood vessels in their skin or eyes. On the skin this causes tiny red spots called “petechiae” (pa-tea-key -eye). Small areas of bright red blood on the white part of the eye may also appear with forceful vomiting. These are not dangerous, but of course they always cause concern when people see them. Please let your doctor know if your child develops any of these signs. Yellow or green material in the vomit may also just be a sign of very forceful vomiting, but it can also be evidence of a blockage of the intestinal tract. Your doctor will want to know if this occurs.

Other Conditions that Might Be Present with Vomiting

In children with very severe cough, as sometimes happens with flu, pneumonia, croup or asthma, vomiting may follow a prolonged episode of coughing. Sometimes the child has an easier time breathing just after the vomiting episode. Some of the medicines that children use for asthma, such as albuterol and others, can make vomiting more likely. In general, vomiting once or twice, no matter what the cause, is no reason for alarm. If a child continues to vomit or if the vomiting gets worse, please let your doctor know.