What is vomiting?
Vomiting is the forceful emptying ("throwing up") of a large
portion of the stomach's contents through the mouth. Strong stomach
contractions against a closed stomach outlet result in vomiting. In contrast,
reflux is the effortless spitting up of one or two mouthfuls of stomach
contents (which you may often see babies less than 1 year old do).
What is the cause?
Most vomiting is caused by a viral infection of the lining of
the stomach or if your child eats something that disagrees with him. 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, it will usually continue for several days.
How can I take care of my
child?
- Offer small amounts of clear
fluids for 8 hours (no solid food)
Offer clear fluids (not milk) in small amounts until 8 hours
have passed without vomiting. For infants less than 1 year old, always use
an oral electrolyte solution (such as Pedialyte or Kao Lectrolyte). Spoon or
syringe feed your baby 1 teaspoon (5 ml) every 5 minutes. Until you get some
Pedialyte, give formula by teaspoonful in the same way.
For a child over 1 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 2 years old or older water is
best, but half-strength lemon-lime soda or Popsicles are also acceptable.
Stir the soda until no fizz remains (the bubbles inflate the stomach and
increase the chances of continued vomiting).
Start with 1 teaspoon to 1 tablespoon of the clear fluid,
depending on your child's age, every 5 minutes. After 4 hours without
vomiting, double the amount each hour. If your child vomits using this
treatment, rest the stomach completely for 1 hour and then start over but
with smaller amounts. This one-swallow-at-a-time spoonfed approach rarely
fails.
- Offer bland foods after 8 hours
without vomiting
After 8 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 1 or 2 ounces less per feeding than usual.
Older children can start with such foods as saltine
crackers, cereals, white bread, bland soups like "chicken with stars," rice,
and mashed potatoes.
Usually your child can be back on a normal diet within 24
hours after recovery from vomiting.
- Diet for breast-fed babies
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 10
minutes every 1 to 2 hours.
If your baby vomits 3 or more times, nurse for 4 to 5
minutes every 30 to 60 minutes. As soon as 8 hours have passed without
vomiting, return to normal nursing on both sides.
Pedialyte and Kao Lectrolyte are rarely needed for
breast-fed babies. If vomiting continues, switch to Pedialyte for 4 hours.
Spoon or syringe feed 1 tablespoon (15 ml) of Pedialyte every 5 minutes. If
your baby is urinating less frequently than normal, you can offer the baby
an electrolyte solution between breast-feedings for a short time (6 to 24
hours).
- Medicines
Do not give your child any medicines by mouth for 8 hours.
Oral medicines can irritate the stomach and make vomiting worse. If your
child has a fever over 102°F (39°C), use acetaminophen suppositories. Call
your health care provider if your child needs to continue taking a
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. Diet
therapy is the answer. Vomiting alone (without diarrhea) rarely causes
dehydration unless you are giving your child medicine by mouth.
When should I call my child's
health care provider?
Call IMMEDIATELY if:
- Your child shows any signs of dehydration (such as no
urine in over 8 hours, very dry mouth, no tears when crying).
- Your child vomits up blood.
- Your child vomits repeatedly AND also has watery diarrhea.
- Your child is confused or difficult to awaken.
- Your child starts acting very sick.
Call during office hours if:
- The vomiting continues for more than 24 hours if your
child is under age 2 years or 48 hours if over age 2.
- You have other concerns or questions.
