Clinical Reference Systems: Pediatric Advisor 10.0
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Description

Vomiting is the forceful emptying ("throwing up") of a large portion of the stomach's contents through the mouth. Strong stomach contractions against a closed stomach outlet result in vomiting. In contrast, regurgitation is the effortless spitting up of one or two mouthfuls of stomach contents (which you may often see babies less than 1 year old do).

Cause

Most vomiting is caused by a viral infection of the lining of the stomach or by eating something that disagrees with your child. Often, a child whose vomiting is caused by a virus also has diarrhea.

Expected Course

The vomiting usually stops in 6 to 24 hours. Changes in the diet usually speed recovery. If your child has diarrhea, it will usually continue for several days.

Home Care for Vomiting

1. Offer small amounts of clear fluids for 8 hours (no solid food)

   Offer clear fluids (not milk) in small amounts until 8 hours have passed without vomiting. For infants, you can also use an oral electrolyte solution (such as Pedialyte or Kao Lectrolyte). For vomiting without any diarrhea, the best clear fluid for a child over 1 year of age is water or ice chips because water can be directly absorbed across the stomach wall. If your child is 2 years old or older water is best, but half- strength lemon-lime soda or Popsicles are also acceptable. Stir the soda until no fizz remains (the bubbles inflate the stomach and increase the chances of continued vomiting).

   Start with 1 teaspoon to 1 tablespoon of the clear fluid, depending on your child's age, every 5 minutes. After 4 hours without vomiting, double the amount each hour. If your child vomits using this treatment, rest the stomach completely for 1 hour and then start over but with smaller amounts. This one-swallow-at-a-time approach rarely fails.

2. Offer bland foods after 8 hours without vomiting

   After 8 hours without vomiting, your child can gradually return to a normal diet.

   Older children can start with such foods as saltine crackers, white bread, bland soups like "chicken with stars," rice, and mashed potatoes.

   Infants can start with such foods as cereals and strained bananas. If your baby only takes formula, give 1 or 2 ounces less per feeding than usual.

   Usually your child can be back on a normal diet within 24 hours after recovery from vomiting.

3. Diet for breast-fed babies

   The key to treatment is providing breast milk in smaller amounts than usual. If your baby vomits once, make no changes. If your baby vomits twice, continue breast- feeding but nurse on only one side for 10 minutes every 1 to 2 hours.

   If your baby vomits three or more times, nurse for 4 to 5 minutes every 30 to 60 minutes. As soon as 8 hours have passed without vomiting, return to normal nursing on both sides. Pedialyte and Kao Lectrolyte are rarely needed for breast-fed babies. If your baby is urinating less frequently than normal, you can offer the baby an electrolyte solution between breast-feedings for a short time (6 to 24 hours).

4. Medicines

   Do not give your child any medicines by mouth for 8 hours. Oral medicines can irritate the stomach and make vomiting worse. If your child has a fever over 102ƒF (39ƒC), use acetaminophen suppositories. Call your physician if your child needs to continue taking a prescription medicine.

5. Common mistakes in the treatment of vomiting

   A common error is to give as much clear fluid as your child wants rather than gradually increasing the amount. This almost always leads to continued vomiting.

   There is no effective drug or suppository for vomiting. Diet therapy is the answer. Vomiting alone rarely causes dehydration unless you give drugs by mouth, milk, or too much clear fluid.

Call Your Child's Physician Immediately If:

• Your child shows any signs of dehydration (such as no urine in over 8 hours, very dry mouth, no tears when crying).
• Your child vomits up blood.
• Your child starts acting very sick.

Call Your Child's Physician During Office Hours If:

• The vomiting continues for more than 24 hours if your child is under age 2 years or 48 hours if over age 2.
• You have other concerns or questions.