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Vomiting

Vomiting Without Diarrhea  
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  Does this describe your child's symptoms?
 
Definition
  • Vomiting is the forceful emptying (throwing up) of a large portion of the stomach's contents through the mouth
  • Nausea and abdominal discomfort usually precede each bout of vomiting

Causes

  • Main cause: stomach infection (gastritis) from a stomach virus (e.g., Rotavirus). The illness starts with vomiting but diarrhea usually follows within 12-24 hours.
  • Food poisoning from toxins produced by bacteria growing in poorly refrigerated foods (e.g. Staphylococcus toxin in egg salad or Bacillus cereus toxin in rice dishes).
  • Serious causes: If vomiting persists as an isolated symptom (without diarrhea) for more than 24 hours, more serious causes must be considered. Examples are appendicitis, kidney infection, meningitis, head injury, etc.
  • Vomiting can also be triggered by hard coughing. This is common especially in children with reflux.

Severity of Vomiting

The following is an arbitrary attempt to classify vomiting by risk for dehydration:

  • MILD: 1 - 2 times/day
  • MODERATE: 3 - 7 times/day
  • SEVERE: Vomits everything or nearly everything or 8 or more times/day
  • Severity relates even more to the length of time that the particular severity level has persisted. At the beginning of a vomiting illness (especially following food poisoning), it's common for a child to vomit everything for 3 or 4 hours and then become stable with mild or moderate vomiting.
  • The younger the child, the greater the risk for dehydration.

Return to School

  • Your child can return to child care or school after vomiting and fever are gone.
 If not, see these topics
  • Vomiting occurs with diarrhea (diarrhea means 2 or more watery or very loose stools), see VOMITING WITH DIARRHEA
  • Vomiting only occurs while coughing, see COUGH
  • Child under 1 year old and spitting (reflux), see SPITTING UP
  • Diarrhea is the main symptom, see DIARRHEA
  When to Call Your Doctor
  Call 911 Now (your child may need an ambulance) If
  • Unresponsive or difficult to awaken
  • Not moving or too weak to stand
  Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Confused (delirious)
  • Stiff neck or bulging soft spot
  • Headache
  • Signs of dehydration (e.g., very dry mouth, no tears and no urine in more than 8 hours)
  • Blood in the vomit that's not from a nosebleed
  • Bile (bright yellow or green) in the vomit
  • Abdominal pain is also present (EXCEPTION: abdominal pain or crying just before and improved by vomiting is quite common)
  • Appendicitis suspected (pain low on right side, won't jump, prefers to lie still, etc)
  • Diabetes suspected (excessive drinking, frequent urination, weight loss)
  • Poisoning with a plant, medicine, or other chemical suspected
  • Age under 12 weeks with vomiting 2 or more times (EXCEPTION: spitting up)
  • Receiving Pedialyte (or clear fluids if age over 1 year old) and vomits everything over 8 hours
  • High-risk child (e.g., diabetes mellitus, abdominal injury, head injury)
  • Weak immune system (sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids, etc)
  • Vomiting a prescription medicine
  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine
  • Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen.)
  • You think your child needs to be seen urgently
  Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen, but not urgently
  • Has vomited over 24 hours
  • Fever present for more than 3 days
  • Fever returns after gone for over 24 hours
  Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Vomiting is a recurrent chronic problem
  Parent Care at Home If
  • Mild-moderate vomiting (probably viral gastritis) and you don't think your child needs to be seen
  HOME CARE ADVICE FOR VOMITING WITHOUT DIARRHEA
  1. Reassurance:
    • Most vomiting is caused by a viral infection of the stomach or mild food poisoning.
    • Vomiting is the body's way of protecting the lower intestinal tract.
    • Fortunately, vomiting illnesses are usually brief.
  2. For Bottlefed Infants Offer Oral Rehydration Solution (ORS) for 8 Hours:
    • ORS (eg. Pedialyte or the store brand) is a special electrolyte solution that can prevent dehydration. It's readily available in supermarkets and drug stores.
    • For vomiting once, continue regular formula.
    • For vomiting more than once, offer ORS for 8 hours. If ORS not available, use formula.
    • Spoon or syringe feed small amounts: 1-2 teaspoons (5-10 ml) every 5 minutes.
    • After 4 hours without vomiting, double the amount.
    • After 8 hours without vomiting, return to regular formula.
    • For infants over 4 months old, also return to cereal, strained bananas, etc.
    • Return to normal diet in 24-48 hours.
  3. For Breastfed Infants, Reduce the Amount Per Feeding:
    • If vomits once, nurse 1 side every 1 to 2 hours.
    • If vomits more than once, nurse for 5 minutes every 30 to 60 minutes. After 4 hours without vomiting, return to regular breastfeeding.
    • If continues to vomit, switch to ORS (e.g., Pedialyte) for 4 hours.
    • Spoon or syringe feed small amounts of ORS: 1-2 teaspoons (5-10 ml) every 5 minutes.
    • After 4 hours without vomiting, return to regular breastfeeding. Start with small feedings of 5 minutes every 30 minutes and increase as tolerated.
  4. For Older Children (over 1 Year Old) Offer Small Amounts of Clear Fluids For 8 Hours:
    • Water or ice chips are best for vomiting in older children. (Reason: Water is directly absorbed across the stomach wall)
    • ORS: If child vomits water, offer Oral Rehydration Solution (e.g., Pedialyte). If refuses ORS, use ½ strength Gatorade.
    • Give small amounts: 2-3 teaspoons (10-15 ml) every 5 minutes.
    • Other options: ½ strength flat lemon-lime soda, popsicles or ORS frozen pops.
    • After 4 hours without vomiting, increase the amount.
    • After 8 hours without vomiting, return to regular fluids.
    • Caution: if vomiting continues over 12 hours, switch to ORS or half-strength Gatorade.
    • Solids: After 8 hours without vomiting, add solids:
      • Limit solids to bland foods. Starchy foods are easiest to digest.
      • Start with saltine crackers, white bread, cereals, rice, mashed potatoes, etc.
      • Return to normal diet in 24-48 hours.
  5. Avoid Medicines:
    • Discontinue all non-prescription medicines for 8 hours (reason: usually make vomiting worse).
    • Fever: Fevers usually don't need any medicine. For higher fevers, consider acetaminophen (Tylenol) suppositories. Never give oral ibuprofen; it is a stomach irritant.
    • Call your doctor if: vomiting a prescription medicine.
  6. Sleep: Help your child go to sleep for a few hours. (Reason: Sleep often empties the stomach and relieves the need to vomit). Your child doesn't have to drink anything if he feels very nauseated.
  7. Contagiousness: Your child can return to child care or school after vomiting and fever are gone.
  8. Expected Course: Vomiting from viral gastritis usually stops in 12 to 24 hours. Mild vomiting with nausea may last up to 3 days.
  9. Call Your Doctor If:
    • Vomiting becomes severe (vomits everything) over 8 hours
    • Vomiting persists over 24 hours
    • Signs of dehydration
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

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.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 11/15/2011

Last Revised: 11/15/2011

Content Set: Pediatric HouseCalls Symptom Checker

Copyright 1994-2012 Barton D. Schmitt, M.D.

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