VOMITING

Introduction
Most of the time, vomiting in children is caused by gastroenteritis, usually due to a virus infecting the gastrointestinal tract. (Gastroenteritis is sometimes called the "stomach flu," which can also cause nausea and diarrhea.) These infections often don't last long and are more disruptive than dangerous to your child. However, if kids (especially infants) are unable to take fluids adequately, and if there's also diarrhea, they could become dehydrated.
Your most important intervention may be a calm approach - vomiting is frightening for young children (and parents, too) and exhausting for children of all ages. Offering plenty of reassurance to your child and taking appropriate measures to prevent dehydration are key for a quick recovery.
What to Do When Your Child Is Vomiting?
For infants under 6 months:

• Avoid giving plain water to a young infant unless your child's doctor directly specifies an amount.
• Offer your infant small but frequent amounts - about 2 to 3 teaspoons, or up to 1/2 ounce (about 20 milliliters) - of an oral electrolyte solution every 15 to 20 minutes with a spoon or an oral syringe. Oral electrolyte solutions (available at most supermarkets or pharmacies and also called oral electrolyte maintenance solutions) are balanced with salts to replace what's lost with vomiting or diarrhea, and they also contain some sugar. It's especially important for young infants that any fluids given have the correct salt balance (unflavored electrolyte solutions are best for younger infants).
• Gradually increase the amount of solution you're giving if your infant is able to keep it down for more than a couple of hours without vomiting. For instance, if your little one takes 4 ounces (or about 120 milliliters) normally per feed, slowly work up to giving this amount of oral electrolyte solution over the course of the day.
• Do not give more solution at a time than your infant would normally eat - this will overfill an already irritated tummy and will likely cause more vomiting.
• After your infant goes for a period of time (more than about 8 hours) without vomiting, you can reintroduce formula slowly if your infant is formula-fed. Start with small (1/2 to 1 ounce, or about 20 to 30 milliliters), more frequent feeds and slowly work up to your infant's normal feeding routine. If your infant already eats baby cereal, it's OK to start solid feedings in small amounts again.
• If your infant is exclusively breastfeeding and vomits (not just spits up, but vomits what seems like the entire feed) more than once, then breastfeed for a total of 5 to 10 minutes every 2 hours. If your infant is still vomiting, then call your child's doctor. After 8 hours without vomiting, you can resume breastfeeding normally.
• If your infant is under 1 month old and vomiting all feeds (not just spitting up), call your child's doctor immediately.

For infants 6 months to 1 year:

• Avoid giving plain water to an infant under 1 year, unless an amount is directly specified by your child's doctor.
• Give your infant small but frequent amounts - about 3 teaspoons, or 1/2 ounce (about 20 milliliters) - of an oral electrolyte solution every 15 to 20 minutes. It's important that any fluids given to infants under 1 year of age who are vomiting have the correct salt balance (again, oral electrolyte solutions are balanced with salts to replace what's lost with vomiting or diarrhea).
• An infant over 6 months of age may not appreciate the taste of an unflavored oral electrolyte solution. Flavored solutions are also available, or you can add 1/2 teaspoon (about 3 milliliters) of juice to each feeding of unflavored oral electrolyte solutions. Frozen oral electrolyte solution pops are often appealing to infants in this age group; this approach also encourages the slow intake of fluids that's required.
• Gradually increase the amount of solution you're giving if your infant is able to keep it down for more than a couple of hours without vomiting. For instance, if your infant takes 4 ounces (about 120 milliliters) normally per feed, work slowly up to giving this amount of oral electrolyte solution over the course of the day.
• Do not give more solution at a time than your infant would normally eat - this will overfill an already irritated tummy and will likely cause more vomiting.
• After your infant goes more than about 8 hours without vomiting, you can reintroduce formula slowly to your infant. Start with small (1 to 2 ounces, or about 30 to 60 milliliters), more frequent feeds and slowly work up to your infant's normal feeding routine. You can also begin small amounts of soft, bland foods that your infant is already familiar with such as bananas, cereals, crackers, or other mild baby foods.
• If your infant doesn't vomit for 24 hours, you can resume your normal feeding routine.

For children 1 year or older:

• Give clear liquids (milk and milk products should be avoided) in small amounts (ranging from 2 teaspoons to 2 tablespoons, or up to 1 ounce or 30 milliliters) every 15 minutes. Clear liquids that are appropriate include:
• ice chips or sips of water
• flavored oral electrolyte solutions, or add 1/2 teaspoon (about 3 milliliters) of nonacidic fruit juice to the oral electrolyte solution
• frozen oral electrolyte solution pops
• If your child vomits, then start over with a smaller amount of fluid (2 teaspoons, or about 5 milliliters) and continue as above.
• If there's no vomiting for approximately 8 hours, then introduce bland, mild foods gradually. But do not force any foods - your child will tell you when he or she is hungry. Saltine crackers, toast, broths, or mild soups (some noodles are OK), mashed potatoes, rice, and breads are all OK.
• If there's no vomiting for 24 hours, then you can slowly resume your child's regular diet. Wait 2 to 3 days before resuming milk products.

When Should You Call Your Child's Doctor?
The greatest risk of vomiting due to gastroenteritis (the "stomach flu") is dehydration. Call your child's doctor if your child refuses fluids or if the vomiting continues after using the suggestions above. Call your child's doctor for any of the signs of dehydration listed below.
Mild to moderate dehydration:

• dry mouth
• few or no tears when crying
• fussy behavior in infants
• fewer than four wet diapers per day in an infant (more than 4 to 6 hours without a wet diaper in a younger infant under 6 months of age)
• no urination for 6 to 8 hours in children
• soft spot on an infant's head that looks flatter than usual or somewhat sunken

Severe dehydration:

• very dry mouth (looks "sticky" inside)
• dry, wrinkled, or doughy skin (especially on the belly and upper arms and legs)
• inactivity or decreased alertness
• appears weak or limp
• sunken eyes
• sunken soft spot in an infant
• excessive sleepiness or disorientation
• deep, rapid breathing
• no urination for more than 6 to 8 hours in infants
• no urination for more than 8 to 10 hours in children
• fast or weakened pulse

The following symptoms may indicate a condition more serious than gastroenteritis and indicate that you need to contact your child's physician:

• projectile or forceful vomiting in an infant, particularly a baby who's less than 3 months old
• vomiting in an infant after the infant has taken an oral electrolyte solution for close to 24 hours
• vomiting starts again as soon as you try to resume the child's normal diet
• vomiting starts after a head injury
• vomiting is accompanied by fever (100.4 degrees Fahrenheit, or 38 degrees Celsius, rectally in an infant under 6 months of age or more than 101 to 102 degrees Fahrenheit, or 38.3 to 38.9 degrees Celsius, in an older child)
• vomiting of bright green or yellow-green fluid
• your child's belly feels hard, bloated, and painful between vomiting episodes
• vomiting is accompanied by severe stomach pain
• vomit resembles coffee grounds (blood that mixes with stomach acid will be brownish in color and look like coffee grounds)
• vomiting blood

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Reviewed by: Barbara P. Homeier, MD
Date reviewed: April 2005