Springdale Mason Pediatrics

Vomiting (Age 6-21)

Definition

  • Vomiting is the forceful emptying (throwing up) of what is in the stomach
  • It's normal for nausea (upset stomach) to come before each bout of vomiting

Call or Return If

  • Vomits clear fluids for more than 8 hours
  • Vomiting lasts more than 24 hours
  • Signs of dehydration occur
  • Diarrhea becomes severe or contains blood
  • Pain occurs and becomes constant
  • You think your child needs to be seen
  • Your child becomes worse

About This Topic

Vomiting Scale

  • Mild: 1 - 2 times/day
  • Moderate: 3 - 7 times/day
  • Severe: Vomits everything, nearly everything or 8 or more times/day
  • Severity relates even more to how long the vomiting goes on for. At the start of the illness, it's common to vomit everything. This can last for 3 or 4 hours. Then often changes to mild vomiting.
  • The main risk of vomiting is dehydration.

Dehydration: How to Know

  • Dehydration means that the body has lost too much fluid. These are signs of dehydration:
  • Decreased urine (no urine in more than 12 hours) happens early in dehydration. So does a dark yellow color. If the urine is light straw colored, your child is not dehydrated.
  • Dry tongue and inside of the mouth. Dry lips are not helpful.
  • Dry eyes with decreased or absent tears
  • Fussy, tired out or acting ill. If your child is alert, happy and playful, he or she is not dehydrated.
  • A child with severe dehydration becomes too weak to stand. Can also be dizzy when trying to stand.

Causes

  • Main Cause. Stomach infection from a stomach virus (such as Rotavirus). The illness starts with vomiting. Watery loose stools follow within 12-24 hours.
  • Food Poisoning. This causes rapid vomiting and diarrhea within hours after eating the bad food. Caused by toxins from germs growing in foods left out too long. An example is Staph toxin in egg salad.
  • Coughing. Hard coughing can also cause your child to throw up.
  • Serious Causes. Vomiting alone (without diarrhea) should stop within about 24 hours. If it lasts over 24 hours, you must think about more serious causes. Examples are appendicitis or a kidney infection.

Prevention of Spread to Others

  • Careful hand washing after touching vomit or using the toilet.

After Care Advice

Overview:
  • Most vomiting is caused by a viral infection of the stomach. Sometimes, mild food poisoning is the cause.
  • Vomiting is the body's way of protecting the lower gut.
  • The good news is that most severe vomiting only lasts a few hours.
  • Here is some care advice that should help.
Clear Fluids For 8 Hours - Offer Small Amounts Frequently:
  • Water or ice chips are best for older children. (Reason: Water is easily absorbed).
  • Other clear fluids: Use half-strength Gatorade. Make it by mixing equal amounts of Gatorade and water. Can mix apple juice the same way. ORS (such as Pedialyte) is usually not needed in older children. Popsicles work great for some kids.
  • The key to success is giving small amounts of fluid. Offer 2-3 teaspoons (10-15 ml) every 5 minutes. Older kids can just slowly sip a clear fluid.
  • After 4 hours without throwing up, increase the amount.
  • After 8 hours without throwing up, return to regular fluids.
  • Caution: If vomits over 12 hours, stop using water. Switch to ORS or half-strength Gatorade.
Stop Solid Foods:
  • Avoid all solid foods in kids who are vomiting.
  • After 8 hours without throwing up, gradually add them back.
  • Start with starchy foods that are easy to digest. Examples are cereals, crackers and bread.
  • Return to normal diet in 24-48 hours.
Do Not Give Medicines:
  • Stop using any medicine that is over-the-counter and not important.
  • Fever. Mild fevers don't need to be treated with any meds. For higher fevers, you can use an acetaminophen (Tylenol) suppository. This is a form of the med you put in the rectum.
  • Call your doctor if: Your child vomits a med ordered by them.
Sleep:
  • Help your child go to sleep for a few hours.
  • Reason: Sleep often empties the stomach and removes the need to vomit.
  • Your child doesn't have to drink anything if his stomach feels upset.
What to Expect:
  • Vomiting from a viral illness often stops in 12 to 24 hours.
  • Mild vomiting and nausea may last up to 3 days.
  • Watery loose stools often follow vomiting within 12-24 hours. This can be normal. Diarrhea alone can last 1-2 weeks.
For Vomiting with Diarrhea:
  • If your child is having both vomiting and diarrhea, follow the advice for vomiting.
  • If your child cannot keep down fluids and diarrhea is bad, call your doctor. Reason: increased risk for dehydration.
  • If your child starts having diarrhea alone, keep on a regular diet. Also, give your child extra fluids.
Return to School:
  • Your child can return to school after the vomiting and fever are gone.

Author: Barton Schmitt MD, FAAP
Copyright 2000-2020 Schmitt Pediatric Guidelines LLC
Disclaimer: This health information is for educational purposes only. You the reader assume full responsibility for how you choose to use it.
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