Vomiting (Nausea and Emesis)

Think of vomiting as your child's way of purging the body of the ills it is encountering. Typically, viral gastroenteritis (aka "stomach bug" or "stomach flu") is the most common reason your child will vomit. And depending upon your child's age, there are certain guidelines that can be followed in order to hopefully maintain adequate hydration (see below for symptoms of dehydration), which is really the primary concern of vomiting. Because when dehydration becomes too severe, it can become serious and impact the body's ability to function efficiently. But bear in mind, most of the time, it really is no more than an aggravating experience for both you and your child.

So with the goal of maintaining adequate hydration and slowing down the vomiting process, here are some guidelines you can follow:

Infants Younger than 6 Months of Age:

  • Give about ½ ounce of an oral electrolyte solution (e.g. pedialyte) every 15 minutes or so. Try to avoid water unless we tell you otherwise, as the salts in the electrolyte solution help to replace what is being lost from the vomiting process.
  • Slowly increase the amount of solution your infant is taking if the vomiting has not reoccurred. For example, after two hours of tolerating the ½ ounce, it is okay to try maybe ¾ – 1 ounce every 15 minutes or so and then gradually increase throughout the day.
  • If after eight hours of this hydration process without any vomiting, it is okay to return to either formula and/or breastfeeding. But start slowly. If breastfeeding, stick to 5-10 minute feeds every two hours and if formula feeding maybe begin with no more than an ounce at a time.
  • If vomiting occurs during this rehydration process, wait about 30-60 minutes before beginning the process once again.
  • But with any infant under two months of age and back-to-back vomiting episodes, call us at Boulevard Pediatrics for immediate care and instructions.

Infants 6 Months to 1 Year of Age:

  • For the most part, pretty similar directions as for the younger infants, other than volume amounts can begin a bit higher.
  • What often is helpful in this age range are the flavored popsicles from the oral electrolyte solutions.
  • If after eight hours of this hydration process without any vomiting, it is okay to return to formula/breastmilk as mentioned above. Just remember to start slowly. And for infants who are on solids, it is okay to begin slowly with some of the bland foods — bananas, cereals and soft crackers.

Children 1 Year of Age and Older:

  • Same instructions as above, but larger initial volumes of clear fluids can be tolerated. Begin with ¾ ounces every 15 minutes and gradually increase from there. Some clear liquids include ice chips/water, flavored oral electrolyte solutions (e.g. pedialyte), or popsicles, as mentioned above.
  • After eight hours of no vomiting, it is okay to start the mild, bland foods listed above, as well as mashed potatoes, bland soups, and chicken broth.
  • Sometimes we will prescribe an anti-vomiting medication but only after being evaluated in the office.
  • And for those wondering about milk products, it is probably best to avoid them until a day or so after the vomiting ceases.

So what are some symptoms of mild to moderate dehydration?

  • Dry mouth
  • Decreased tears
  • Decreased wet diapers or no urination in an older child for 6-8 hours
  • Slightly sunken in soft spot on the infant's head
  • Fussier than normal

What are some symptoms of severe dehydration?

  • Drier mouth… even sticky-looking inside
  • Wrinkled or doughy skin
  • Decreased alertness
  • Sunken eyes or sunken in soft spot in an infant
  • More sleepy and even limp appearing
  • No urination in eight hours for an infant and 12 hours in a child

When should your child be seen?

If there is refusal of fluids or if vomiting continues, we want to see your child. Also, if there is any abdominal pain not consistent with a viral "stomach bug,” projectile vomiting in an infant less than 3 months of age, vomiting following head injury, vomiting bright green fluid, vomiting blood or coffee ground emesis, or anything else that concerns you about your child, please have your child be seen immediately.