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(See the separate article on diarrhea.)
What Is Vomiting?
- 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.
- If your child is vomiting after a head injury, you must contact your health care team immediately.
Is My Child's Amount of Vomiting Considered Severe?
Vomiting Scale
- Mild: 1-2 times/day
- Moderate: 3-7 times/day
- Severe: Vomits everything, nearly everything, or 8+ times per day. Severity relates even more to how long the vomiting goes on. 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.
How Do I Know if My Child Is Dehydrated?
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. If lips are dry but the tongue is moist, this does NOT signal dehydration.
- Dry eyes with decreased or absent tears
- Fussy, tired out, or acting ill. If your child is alert, happy, and playful, they are NOT dehydrated.
- A child with severe dehydration becomes too weak to stand. Can also be dizzy when trying to stand.
What Causes Vomiting?
- 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 of 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.
How Do I Prevent Spreading the Vomiting Illness to Others?
Careful hand washing after touching vomit, using the toilet, or changing diapers.
How Do I Care For My Child With Vomiting?
- 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.
Select a tab for recommendations on offering fluids:
Older Children
Clear Fluids For 8 Hours - Offer Small Amounts Frequently:
- Water often works best. Children over 5 years old can suck on ice chips. (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. Oral rehydration solution (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.
Formula Fed Infants
Give Oral Rehydration Solution (ORS) for 8 Hours:- If vomits once, keep on regular formula.
- If more than once, offer ORS (such as Pediatlye) for 8 hours. If you don’t have ORS, use formula 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 or drug stores.
- Spoon or syringe feed small amounts. Give 1-2 teaspoons (5-10 ml) every 5 minutes.
- After 4 hours without throwing up, double the amount.
- Return to Formula. After 8 hours without throwing up, go back to regular formula.
Breast Fed Infants
Reduce the Amount Per Feeding:- If vomits once, nurse 1 side every 1 to 2 hours.
- If 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 (such as Pedialyte) is rarely needed in breastfed babies. It can be used if vomiting becomes worse.
- Spoon or syringe feed small amounts of pumped breastmilk. 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.
Stop 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.
- 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 health care team 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 their 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.
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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 health care team. Reason: increased risk for dehydration.
- If your child starts having diarrhea, keep on a regular diet. Also, give your child extra fluids. For infants, if the diarrhea is more than mild, offer extra breastmilk or formula. For severe diarrhea, also give 1-2 ounces (30-60 ml) of Pedialyte for every large watery stool.
Return to Child Care or School:
- Your child can return after the vomiting and fever are gone.
Contact Your Healthcare Team If:
- Recent head injury
- Vomit appears green or bloody
- Vomits clear fluids for more than 8 hours
- Vomiting lasts more than 24 hours
- Signs of dehydration occur (see above)
- Diarrhea becomes severe or contains blood
- Pain occurs and becomes constant
- You think your child needs to be seen
- Your child becomes worse
Adapted from AAP Pediatric Education materials.
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