›› The Perils of Parenting

The Vomiting Child—What to Do

Margaret Morris, MD
Chapel Hill Children’s Clinic

One of the most distressing illnesses that commonly strike children (and other humans) is vomiting.

No one likes to vomit, and no one likes to deal with someone who is vomiting. But like most physiologic responses that have been around (we assume) since the beginning of mammals, vomiting has important disease-fighting or life-sustaining functions. We mammals use it to empty a non-functioning GI tract, or to rid ourselves of things that we have eaten but cannot tolerate. Vomiting must be an important piece of our ability to exist, because there is even a “vomiting center” in the brain that when stimulated causes us to vomit.

But despite its helpful role, like other disease-fighting responses (such as fever and inflammation), vomiting can be dangerous if too extreme or too prolonged.

The most concerning negative effect of vomiting is the potential for dehydration. Other concerns are changes in the body’s balance of chemicals and little tears in the esophagus from the violence of the act of vomiting. Vomiting is also often a sign of disease in the vomiter, and it may accompany any number of illnesses from “stomach flu” to strep throat to ear infections to appendicitis to profound metabolic problems.

So your child has vomited. What should you do? What should you think about? Should you call the doctor? Should you go to the doctor? Can it wait till morning? Can it wait till Monday?

Vomiting is usually not an emergency. The most common cause is gastroenteritis or “stomach flu.” This can usually be managed at home.

The most important thing is to pause and assess. Don’t rush to replace the lost fluid or the vomited food. It won’t work. His stomach has just sent you a message: “I want to be empty!” Don’t try to give him anything by mouth for at least 30 to 60 minutes.

Ask yourself:
Is your child in pain? Does his stomach hurt? Does his head hurt? Does he have a fever? Is he normally “tuned-in” and aware for his age and the time of day?
As the day progresses and if the vomiting continues or is joined or replaced by diarrhea, start thinking about whether he has lost too much fluid, whether he is looking sicker.

Dehydration
The younger the child, the more quickly he can become dehydrated. A fever increases the potential for dehydration. But it takes hours at least to become dehydrated. A few vomiting episodes are not going to cause dehydration.

The signs to look for are: thirst, urinating smaller amounts and less frequently, dry mouth, no tears when crying, fontanelle sunken more than usual, sunken eyes, ill and washed out appearance, limpness and lack of energy.

Management
After giving your child’s stomach a chance to rest, start cautiously to give fluids. The best fluids are the electrolyte-containing fluids because they are the easiest to absorb.

Babies should be given ½ to 1 oz of oral electrolyte fluid (such as Pedialyte) every 15 to 20 minutes. If they vomit again, give them another 30 minute rest and then give 1 to 2 teaspoons every 10 minutes. If they tolerate an amount for an hour, they can get more the next hour, but go slow. After 8 to 12 hours without vomiting, you can let them breastfeed or formula feed small amounts. If appropriate, you can give food but keep the amounts small and the food bland. 

Older children can have oral electrolyte fluids as well as other clear liquids or ice chips. Start with small quantities (1 to 2 ounces) with 15 to 30 minute breaks. If they continue to vomit, again give nothing for 30 to 60 minutes and then try again with half the amount twice as often. After 12 hours without vomiting, cautiously introduce bland foods.

Sleep is a great anti-nausea agent. But keep a wastebasket or basin by the bed for further episodes.

Take your vomiting child to the doctor