Vomiting

Written By Dr. Fradkin

In babies and infants, it can be tough to distinguish between true vomiting and normal baby spit up and reflux. 

Babies are designed to spit up.  It’s nature’s pop off valve. If a kiddo spits up a few tablespoons onto their parent’s shoulder after every feed, that is totally within the realm of normal as long as the spit up is not painful and it does not contain any blood or bile.  If the spit up after meals is painful, the concern is that a kiddo may have too much stomach acid in their tummy, also known as reflux, and we may or may not need a change feeding schedules/patterns or add a small dose of a tummy acid medicine to help.  For more information on this type of “ok” vomiting see these sections: Spitting Up and Reflux

In older kiddos the vast majority of vomiting is due to stomach viruses they get from friends at school and is described in this section: Stomach Bugs

Anytime a kiddo has blood or bile in their vomit they should see a doctor to make sure everything is ok and to ensure we don’t need to prescribe anti-vomit medicine to stop the vomiting.  Also, if a kiddo is vomiting so much that they are unable to stay hydrated, we need to see that kiddo in clinic to help them retain fluids. If abdominal pain is accompanying the vomiting, we should see that kiddo in the emergency room where we can do an ultrasound or other imaging of the abdomen to make sure the stomach and GI tract are working like they should.

I really like this protocol from our friends at Schmitt Pediatric Guidelines LLC for keeping kiddos hydrated and slow reintroduction of fluids and solids after vomiting episodes:

What You Should Know About Vomiting Without Diarrhea:

  • 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 stomach illnesses last only a short time.

  • The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid.

  • Here is some care advice that should help.

Formula Fed Babies - Give Oral Rehydration Solution (ORS) if Vomiting Continues:

  • If your child vomits more than once, offer ORS. If you don't have ORS, use formula in smaller amounts until you can get some.

  • ORS is a special fluid that can help your child stay hydrated. You can use Pedialyte or the store brand of ORS. It can be bought in food stores or drugstores.

  • Spoon or syringe feed ORS in small amounts. Give 1-2 teaspoons (5-10 mL) every 5 minutes.

  • After 2 hours without throwing up, double the amount.

  • Return to Formula. After 4 hours without throwing up, go back to regular formula. Start with smaller amounts.

Breastfed Babies - Reduce the Amount Per Feeding:

  • If vomits more than once, nurse for 5 minutes every 30 to 60 minutes. After 4 hours without throwing up, return to regular nursing.

  • If continues to vomit, switch to pumped breastmilk. ORS is rarely needed in breastfed babies. It can be used if vomiting becomes worse.

  • Spoon or syringe feed small amounts of pumped milk. Give 1-2 teaspoons (5-10 mL) every 5 minutes.

  • After 4 hours without throwing up, return to regular feeding at the breast. Start with small feedings of 5 minutes every 30 minutes. As your baby keeps down the smaller amounts, slowly give more.

Older Children (over 1 Year Old) - Offer Small Amounts of Clear Fluids For 8 Hours:

  • Water or ice chips are best for older children. Reason: water is easily absorbed in the stomach.

  • 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, switch to ORS or half-strength Gatorade.

Stop All Solid Foods:

  • Avoid all solid foods and baby 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.

Do Not Give Medicines:

  • Stop using any drug that is over-the-counter for 8 hours. Reason: some of these can make vomiting worse.

  • Fever. Mild fevers don't need to be treated with any drugs. For higher fevers, you can use an acetaminophen suppository (such as FeverAll). This is a form of the drug you put in the rectum (bottom). Ask a pharmacist for help finding this product. Do not use ibuprofen. It can upset the stomach.

  • Call your doctor if: your child vomits a drug ordered by your doctor.

Try to 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 and he doesn't have any diarrhea.

Return to School:

  • Your child can return to school after the vomiting and fever are gone.

What to Expect:

  • For the first 3 or 4 hours, your child may vomit everything. Then the stomach settles down.

  • Vomiting from a viral illness often stops in 12 to 24 hours.

  • Mild vomiting and nausea may last up to 3 days.

Dr. Fradkin
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