Vomiting

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Why is my infant vomiting?

Some infants spit up. Vomiting is the forceful eruption of stomach contents out of the mouth and nose. Spitting up is an easy flowing of contents. Many healthy infants spit up. The infant who eats well, has normal bowel movements, and is gaining weight well is usually a well infant with "reflux" or spitting up. Before, during, and after the episode of spitting up the child is not in any distress and it is not a forceful vomiting. This starts the first few weeks after birth and continues for months. Avoiding overfeeding, burping the infant during feedings and keeping the head elevated for 30 minutes after a feeding usually will decrease reflux.

If your child is less than two months old and the episodes are repeated and a more forceful projectile vomiting, you should call our office. Some newborns can have an obstruction at the exit of the stomach due to a thickened muscle. This is called pyloric stenosis and can cause persistent projectile vomiting with every feeding. This condition requires immediately medical attention and usually surgery or the infant can become very ill. There are other conditions in infants that can be due to obstructions lower in their intestines. Any vomiting of bile in an infant can also be concerning. Click here to see reasons to call the office.

Infants that appear very ill and have vomiting as part of other symptoms may have a very serious infection. Most often diarrhea and vomiting go together with a low grade fever and only mild fussiness (abdominal pain) in an illness called viral gastroenteritis. This viral infection of the stomach or intestines is sometimes called a "stomach bug." Occasionally vomiting with or without diarrhea can be caused by infection from bacteria or parasites in the intestines.

Why is my toddler/child vomiting?

Vomiting is the forceful eruption of stomach contents out of the mouth and nose. Children that appear very ill and have vomiting as part of other symptoms may have a very serious infection. Most often diarrhea and vomiting go together with a low grade fever and mild abdominal pain in an illness called viral gastroenteritis. This viral infection of the stomach or intestines is sometimes called a "stomach bug." Occasionally vomiting with or without diarrhea can be caused by infection from bacteria or parasites in the intestines. Click here to see reasons to call the office.

What is the "stomach bug"?

The stomach bug is a viral infection of the stomach or intestines causing vomiting and diarrhea. Click here to signs of illnesses with vomiting that are not viral gastroenteritis. The stomach bug usually only has frequent vomiting for the first 4-6 hours. Over the first 24-48 hours the vomiting usually becomes less frequent followed by diarrhea and abdominal cramping. The child usually feels a little better once they have vomited. Click here to see suggestions on treating the stomach bug.

How do I treat viral gastroenteritis in my infant?

For infants under 12 months old who are hydrated, usually viral gastroenteritis can be treated at home. If you child has vomiting with no other symptoms but is alert and hydrated the first few hours just offer your child comfort measures. A cool washcloth and a calm environment is very helpful. We do not recommend any medicine to stop the vomiting or to ease the diarrhea. These medicines will sometime prolong an illness that usually will go away in 1-2 days. Sometimes they can cause bloody diarrhea or worsening symptoms. Occasionally Tylenol (acetaminophen) can be used to lessen pain or fussiness if your she is older than two months old. Other than acetaminophen, do not use any other medicine to treat nausea, vomiting, abdominal pain, or diarrhea without a physician’s direction. Ibuprofen products like Motrin or Advil sometimes can make abdominal pain worse.

Do not force fluids the first 2 hours your child begins to vomit. Usually the child will vomit everything you force right back. If your child drank/ate normally up to the first episode of vomiting your child will not get dehydrated the first few hours of vomiting.

After the first 2-4 hours of vomiting the episodes of vomiting or dry heaving are less frequent and you can start forcing small amounts of "clear liquid". Most infants are ready to start sipping fluids the first 2-4 hours of a vomiting illness. For infants offer ½ an ounce of breast milk or Pedialyte every 10-20 minutes. We consider breast milk a clear liquid and is well tolerated by infants with vomiting unlike formula. As your infant is able to tolerate more liquid you can increase the amount given at one time. Starting off with this small amount of liquid at a time allows the esophagus to absorb some of the liquid without overwhelming the stomach and causing more vomiting.

After 4-6 hours your infant should be able to tolerate some small amounts of liquid. This should keep your infant hydrated. Some children continue to vomit for 2-3 days, but usually just a few times each day. Watch for signs of dehydration or worsening symptoms. Click here for the signs of dehydration. Click here for reasons to call the office.

Once your infant’s vomiting has stopped, you may offer a bland diet or regular diet of breast milk or formula. Some infants on formula need ½ strength formula for the first 12-24 hours. If your child does not at first tolerate full strength formula you could try ½ strength. You can make ½ strength by taking your regular formula as you normally make it and adding an equal amount of Pedialyte. For example, 2 ounces of ready made formula to 2 ounces of Pedialyte.

If she is able to tolerate this challenge after 6-12 hours you may offer her regular food. If she vomits as you try to progress her diet go back to the type of diet she was on before she started vomiting again. For example if she tolerates Pedialyte or breast milk but vomits baby food or formula then offer her only Pedialyte or breast milk for another 6-12 hours. Usually within 24 hours infants can return to their normal diet.

Once the vomiting is completely over most children can return to their normal diet even if they still have diarrhea. Only a few children out of a hundred will develop a short term bout of lactose intolerance. If your child seems to be getting better but has worse diarrhea with regular formula you will want to discuss with our office if a special lactose-free diet is necessary.

How do I treat viral gastroenteritis in my TODDLER/CHILD (Over 12 months old)?

Children over 12 months old (toddlers and children) with viral gastroenteritis can be treated at home. If you child has vomiting with no other symptoms but is alert and hydrated the first few hours just offer your child comfort measures. A cool washcloth and a calm environment is very helpful. We do not recommend any medicine to stop the vomiting or to ease the diarrhea. These medicines will sometime prolong an illness that usually will go away in 1-2 days. Sometimes they can cause bloody diarrhea or worsening symptoms.

Occasionally Tylenol (acetaminophen) can be used to lessen pain. Other than acetaminophen, do not use any other medicine to treat nausea, vomiting, abdominal pain, or diarrhea without a physician’s direction. Ibuprofen products like Motrin or Advil sometimes can make abdominal pain worse.

Do not force fluids the first 1-2 hours your child begins to vomit. Usually the child will vomit everything you force right back. If your child drank/ate normally up to the first episode of vomiting, your child will not get dehydrated the first few hours of vomiting. Fluids offered when vomiting should replace the electrolytes and sugar lost by the body during the illness. "Clear liquids" are best. "Electrolyte Solutions" like Pedialyte are best to help your child get better faster. Plain water with no sugar or electrolytes is not a good idea. Gatorade, Sprite/7-UP, ginger ale, or even popsicles are considered clear liquids but often don't provide the best balance of electrolytes and glucose to offer during a vomiting illness.

After the first 2-4 hours of vomiting the episodes of vomiting or dry heaving are less frequent and you can start forcing small amounts of liquid. Most children are ready to start sipping fluids the first 2-4 hours of a vomiting illness. For toddlers offer 5-10mL of clear liquids (Pedialyte) every five minutes. As your child is able to tolerate more liquid you can increase the amount given at one time. As your child is able to tolerate more liquid you can increase the amount given at one time. Starting off with this small amount of liquid at a time allows the esophagus to absorb some of the liquid without overwhelming the stomach and causing more vomiting. Offering this small amount of fluid frequently should keep your child hydrated even if they keep vomiting the first 12-24 hours of their illness.

After 4-6 hours your child should be able to tolerate some small amounts of liquid. This should keep your child hydrated. Some children continue to vomit for 2-3 days, but usually just a few times each day. Watch for signs of dehydration or worsening symptoms. Click here for the signs of dehydration. Click here for reasons to call the office.

Once your child’s vomiting has stopped you may offer a bland diet (crackers, broth, etc.) If he is able to tolerate this bland food challenge after 6-12 hours you may offer regular food. If your child vomits as you try to progress his diet go back to the type of diet he was on before he started vomiting again. For example if he tolerate crackers and broth but vomits a hamburger offer him only a bland diet for another 6-12 hours. Usually within 2-3 days children can return to a normal diet.

Once the vomiting is completely over most children can return to their normal diet even if they still have diarrhea. Only a few children out of a hundred will develop a short term bout of lactose intolerance. If your child seems to be getting better but has worse diarrhea with regular milk or dairy products you will want to discuss with our office if a special lactose-free diet is necessary. Click here for reasons to call the office.

What are the signs of dehydration?

  • Dry mouth and mucus membranes
  • Dry or sunken eyes, no tears
  • A very depressed soft spot in infants
  • Decreased urine output :
  • Well children should urinate every 8 hours
  • Well toddlers should wet a diaper every 6-8 hours
  • Well newborns should have a wet diaper every 4-6 hours
  • "A slow capillary refill"
  • Depress your child’s fingernail or toenail and watch how fast the pinkness returns, if this takes more than 3-5 seconds your child may be dehydrated.
  • Not able to drink enough fluids.
  • Force fluids even if they don't want it - they need it!
  • Try offering small amounts every 5 minutes
  • Use a 5mL syringe or a teaspoon or just sips
  • Worsening signs of illness (Click here)

When is vomiting more than the stomach bug? Call our office if any of these are present:

When other symptoms are present like:

  • Severe headache
  • Stiff neck
  • Non-blanching Rash
  • Lethargic, unarousable or Drunk Appearing
  • Severe irritability or inconsolable
  • Not alert (Won’t make eye contact, won’t speak, can’t wake up)
  • Very ill appearing infant or child
  • Sore Throat
  • Red Sunburn-like Rash
  • Cough
  • Trouble Breathing
  • Burns with urination
  • Convulsions
  • Dehydration (Click here for signs of dehydration)
  • Newborns less than 2 months old with a fever (higher than 100.3)
  • Infants older than 2 months and children with fever for more than 48 hours

When the symptoms are more severe than the typical viral stomach bug like:

  • Projectile vomiting in an infant
  • Vomiting blood or bile (green colored material)
  • Bloody diarrhea
  • Severe abdominal pain
  • Swollen abdomen
  • Right lower sided abdominal pain
  • No diarrhea but persistent vomiting that lasts more than 12-24 hours
  • Vomiting that is getting worse after the first 24 hours
  • Strenuous repeated vomiting

When the symptoms last longer than normal:

  • Vomiting more than 3 times a day for more than 48 hours
  • Diarrhea getting worse after 7 days