Vomiting

Hilliard Pediatrics, Inc. - Dr. Tricia Lucin, MD

Introduction

Vomiting is your body's way to expel stomach contents from the body without going through the digestive tract. Commonly associated with nausea, or the unpleasant feeling of needing to vomit, vomiting is probably one of parents' and children's most dreaded sick symptoms. Vomiting can be caused by many things, both common and severe, which will be discussed further detail. Typically, treatment involves gut rest and slow, stead reintroduction of fluids and foods as vomiting slows and stops. Let's get into some details. Note: this is by no means an exhaustive list and you should call our office if you have concerns about your child.

Causes

Nearly everyone vomits at some point in their life, and commonly children vomit when they have a gastrointestinal (GI) bug or "stomach flu". This is one of the most typical reasons for vomiting in childhood. There are many viruses and a few bacteria that cause these - Norovirus, Rotavirus, Sapovirus, oh my! Often, this is coupled with nausea, diarrhea, abdominal cramping (but not severe pain), fatigue and potentially fevers. GI bugs are very contagious and spread like wildfire through classrooms and families. The best way to prevent these is good handwashing!

Another reason that children vomit is food and drink choices. Often children will vomit if they eat and then participate in heavy exercise activities. This is typically a "one and done" type of vomiting and the kids don't feel too bad. Another food-related cause of vomiting is food allergies. If a child has a food allergy, in addition to hives/rashes, he or she might vomit with each ingestion of that particular food item. Often these allergies can be readily identified by paying attention to symptoms after eating certain foods. Note that allergies act fast, and vomiting 6 hours after a meal is unlikely to be a food allergy. Of course, food poisoning can also cause vomiting, typically a few hours to a day after eating the improperly cooked or prepared foods. Food poisoning and GI bugs can be very difficult to tell apart in the right setting.

Motion sickness, when people get sick due to being in a car, boat, train, or plane, is another cause of vomiting, which typically occurs only in the car seat or other moving vehicle. After 1 or 2 episodes, this is pretty easy to identify - kids get sick in the car, then feel better when back on steady ground.

And yes, there are scarier causes of vomiting as well. Appendicitis, where a small structure off the intestine becomes inflamed, causes vomiting, typically along with severe right lower abdominal pain and fevers. Diabetes or poor glucose (sugar) control can cause vomiting, typically associated with abdominal pain, increased thirst and extra urination, weight loss, and lethargy. Surgical emergencies of the intestine (volvulus, obstruction, perforation, to name a few scary words) cause vomiting, with severe abdominal pain. Most of these scarier causes are luckily far less common than the others listed above, are usually not associated with diarrhea, and kids feel AWFUL.

Contagiousness/Prevention

If your child has a tummy bug, you can consider them contagious until AT LEAST 24 hours have passed from the last vomiting, and until diarrhea has slowed or stopped. This means, if your child has vomited after dinner last night, you probably shouldn't send them to school the next day, even if they slept fine. It is very likely that he/she will develop diarrhea and that isn't fun at school.

Wash. Those. Hands. Some tummy bugs are not killed with gel hand sanitizer, so good old soap and water is the gold standard. 20 seconds please!

Sanitize/bleach all bathroom surfaces and try to keep family member exposure contained. These bugs are tricky, so good luck!

Treatments

The biggest and best things we can do for our vomiting child is pay attention to hydration and pain level. Beware, if your kid just barfed her whole dinner, having her chug a water bottle is a bad idea! If we stretch that stomach while it is already upset, you can almost guarantee further trips to the bathroom. Instead, if your child has been vomiting, give him/her a good 20-30 minutes to let the tummy settle. If at that point the child is less nauseated, go ahead with small sips of clear fluids (water, Pedialyte®, Gatorade®, popsicles, breastmilk (ok it isn't clear, but it is very well tolerated by the tummy)). Start with a small volume, a few sips, or half a popsicle and then wait another few minutes. If that fluid comes back up, then wait another 20-30 minutes and start over. If your child tolerates those sips, then do some more. Continue until your child is feeling better and the vomiting has passed. After your child has tolerated fluids for an hour or two, you can consider some simple foods like applesauce, gelatin, or crackers. Again, GO SLOW!! Often kids don't want to eat while their tummies are upset and this is just fine for most kids. As long as they are drinking, that's what matters. Eating will return when kids feel better.

Milk, greasy foods, spicy foods, and most any fast-food can be tough to tolerate on an upset tummy and is best to be avoided until feeling all better. We often hear of kids who vomit, then 12 hours later are starving and want their favorite pizza, but then puke again, ugh! Best to give kids ample time before getting back to these foods.

If your infant is breastfeeding, you don't likely need to make any changes. Over 3 months of age, you can give Pedialyte® for a few hours if breastmilk is not tolerated. If your child is formula-fed and tolerating it fine, that's great! If he/she is having a harder time tolerating formula, you might give some Pedialyte® or cut the formula half and half with Pedialyte® (briefly!! Not more than 12-24 hours). If your infant cannot tolerate his/her regular breastmilk or formula after 24 hours, we need to know about it (sooner in younger infants).

We typically do not use medication for vomiting unless children are having trouble maintaining their hydration. How do you know if your child is well-hydrated? I'm glad you asked! A few good ways to know:

  • Tears when baby cries are a good sign. Tears are one of the first fluids to drop when hydration is poor. 
  • At least one wet diaper or trip to pee in the potty every 6-8 hours. That's a minimum of 3-4 per 24 hours.
  • Wet-looking tongue and mouth, not sticky or tacky.
  • Yes, baby soft-spots will get flatter or sunken, but this can be tricky to tell, so best to go with the first 3 when in doubt.

Fever reducers, Tylenol® (acetaminophen) and ibuprofen (Motrin®, Advil®) are typically not super useful treating the crampy pain that comes with vomiting, but they can be used to treat any associated fevers if needed. There are medications which can by prescribed to help slow or stop vomiting, but again, these are not used commonly with "regular" illnesses, and would need a trip to the office to have prescribed.

Most causes of vomiting, even the infectious ones, don't need any specific medication to get better. In fact, some bacteria if given antibiotics will actually get worse!

If your child is doubled over in pain, writhing in pain, or otherwise in severe pain for more than a brief moment, you should seek immediate medical care rather than trying to treat at home. Go immediately to the emergency room.

What to Do When

  • Your child is vomiting (with or without diarrhea) but is not in severe pain and is still hydrated (see above):
    • First, don't panic. It isn't fun, but it happens. Work on fluid intake.
  • Your child is vomiting with a fever:
    • If he/she is not in severe pain, this is probably ok. It is fine to give fever-reducers to help with the discomfort of fevers and keep going on hydration. It wouldn't be surprising if diarrhea developed too. See our fever protocol for more information on when to seek care.
  • Your child has been vomiting for more than 24-48 hours:
    • Call us during business hours, your child might need to be seen.  When you call, press option 1 and leave a message on our nurse line with your child's name, date birth, and a brief description of what is going on and a nurse will call you back to discuss further.
  • Your child vomits intermittently over more than a week ,but is otherwise well-hydrated and not in pain:
    • Call us during business hours for an appointment. When you call, press option 1 and leave a message on our nurse line with your child's name, date birth, and a brief description of what is going on and a nurse will call you back to discuss further.
  • Your child is showing signs of dehydration (no tears, poor urine output, having a hard time holding head up, etc) or is having a hard time keeping small amounts of fluids down:
    • You probably need to go to the emergency room. Your child might need IV fluids to help.
  • Your child vomits something that looks like blood, coffee grounds, or bright green liquid:
    • You need to call us or seek care in the emergency room. These can be signs of some of those emergencies we referenced a little bit ago.
  • Your child is vomiting and in severe pain:
    • You need to go to the emergency room. You can call us, and we will likely tell you the same. Severe pain can be a sign of a surgical emergency and needs to be seen by a medical provider immediately.