Most of the time, vomiting in children is caused by
gastroenteritis
, usually due to a virus infecting the gastrointestinal tract.
(Gastroenteritis is sometimes called the "stomach flu,"
which can also cause nausea and
diarrhea
.)
These infections usually don't last long and are more
disruptive than dangerous. However, kids (especially infants) who
are unable to take in enough fluids and also have diarrhea could
become
dehydrated
.
It's important to stay calm - vomiting is frightening for
young children (and parents, too) and exhausting for kids of all
ages. Offering plenty of reassurance to your child and taking
measures to prevent dehydration are key for a quick recovery.
For Infants Under 6 Months
- Avoid
giving plain water to a young infant unless your doctor directly
specifies an amount.
- Offer your infant small but frequent amounts - about 2 to 3
teaspoons, or up to 1/2 ounce (about 20 milliliters) - of an oral
electrolyte solution every 15 to 20 minutes with a spoon or an
oral syringe. Oral electrolyte solutions (available at most
supermarkets or pharmacies and also called oral electrolyte
maintenance solutions) are balanced with salts to replace
what's lost with vomiting or diarrhea, and they also contain
some sugar. It's especially important for young infants that
any fluids given have the correct salt balance (unflavored
electrolyte solutions are best for younger infants).
- Gradually increase the amount of solution you're giving
if your infant is able to keep it down for more than a couple of
hours without vomiting. For instance, if your little one takes 4
ounces (or about 120 milliliters) normally per feed, slowly work
up to giving this amount of oral electrolyte solution over the
course of the day.
- Do
not
give more solution at a time than your infant would normally eat
- this will overfill an already irritated tummy and will likely
cause more vomiting.
- After your infant goes for a period of time (more than about
8 hours) without vomiting, reintroduce formula slowly if your
infant is formula-fed. Start with small (1/2 to 1 ounce, or about
20 to 30 milliliters), more frequent feeds and slowly work up to
the normal feeding routine. If your infant already eats baby
cereal, it's OK to start solid feedings in small amounts
again.
- If your infant is exclusively
breastfeeding
and vomits (not just spits up, but vomits what seems like the
entire feed) more than once, then breastfeed for a total of 5-10
minutes every 2 hours. If your infant is still vomiting, then
call your doctor. After 8 hours without vomiting, you can resume
breastfeeding normally.
- If your infant is under 1 month old and vomiting all feeds
(not just spitting up), call your doctor immediately.
For Infants 6 Months to 1 Year
- Avoid
giving plain water to an infant under 1 year unless your doctor
directly specifies an amount.
- Give your infant small but frequent amounts - about 3
teaspoons, or 1/2 ounce (about 20 milliliters) - of an oral
electrolyte solution every 15-20 minutes. It's important that
any fluids given to infants under 1 year of age who are vomiting
have the correct salt balance (again, oral electrolyte solutions
are balanced with salts to replace what's lost with vomiting
or diarrhea).
- An infant over 6 months of age may not appreciate the taste
of an unflavored oral electrolyte solution. Flavored solutions
are also available, or you can add 1/2 teaspoon (about 3
milliliters) of juice to each feeding of unflavored oral
electrolyte solutions. Frozen oral electrolyte solution pops are
often appealing to infants in this age group; this approach also
encourages the slow intake of fluids that's required.
- Gradually increase the amount of solution you're giving
if your infant is able to keep it down for more than a couple of
hours without vomiting. For instance, if your infant takes 4
ounces (about 120 milliliters) normally per feed, work slowly up
to giving this amount of oral electrolyte solution over the
course of the day.
- Do
not
give more solution at a time than your infant would normally eat
- this will overfill an already irritated tummy and will likely
cause more vomiting.
- After your infant goes more than about 8 hours without
vomiting, you can reintroduce formula slowly to your infant.
Start with small (1 to 2 ounces, or about 30 to 60 milliliters),
more frequent feeds and slowly work up to the normal feeding
routine. You can also begin small amounts of soft, bland foods
that your infant is already familiar with such as bananas,
cereals, crackers, or other mild baby foods.
- If your infant doesn't vomit for 24 hours, you can resume
your normal feeding routine.
For Kids 1 Year and Older:
- Give
clear liquids
(milk and milk products should be avoided) in small amounts
(ranging from 2 teaspoons to 2 tablespoons, or up to 1 ounce or
30 milliliters) every 15 minutes. Clear liquids that are
appropriate include:
- ice chips or sips of water
- flavored oral electrolyte solutions, or add 1/2 teaspoon
(about 3 milliliters) of nonacidic fruit juice to the oral
electrolyte solution
- frozen oral electrolyte solution pops
- If your child vomits, then start over with a smaller amount
of fluid (2 teaspoons, or about 5 milliliters) and continue as
above.
- If there's no vomiting for approximately 8 hours, then
introduce bland, mild foods gradually. But do
not
force any foods - your child will tell you when he or she is
hungry. Saltine crackers, toast, broths, or mild soups (some
noodles are OK), mashed potatoes, rice, and breads are all
OK.
- If there's no vomiting for 24 hours, then you can slowly
resume the regular diet. Wait 2 to 3 days before resuming milk
products.
When to Call the Doctor
The greatest risk of vomiting due to gastroenteritis (the
"stomach flu") is dehydration. Call your doctor if your
child refuses fluids or if the vomiting continues after using the
suggestions above. Call the doctor for
any
of the signs of dehydration listed below.
Mild to moderate dehydration:
- dry mouth
- few or no tears when crying
- fussy behavior in infants
- fewer than four wet diapers per day in an infant (more than 4
to 6 hours without a wet diaper in a younger infant under 6
months of age)
- no urination for 6 to 8 hours in children
- soft spot on an infant's head that looks flatter than
usual or somewhat sunken
Severe dehydration:
- very dry mouth (looks "sticky" inside)
- dry, wrinkled, or doughy skin (especially on the belly and
upper arms and legs)
- inactivity or decreased alertness
- appears weak or limp
- sunken eyes
- sunken soft spot in an infant
- excessive sleepiness or disorientation
- deep, rapid breathing
- no urination for more than 6 to 8 hours in infants
- no urination for more than 8 to 10 hours in children
- fast or weakened pulse
The following symptoms may indicate a condition more serious
than gastroenteritis; contact your doctor right away if your infant
has any of these:
- projectile or forceful vomiting in an infant, particularly a
baby who's less than 3 months old
- vomiting in an infant after the infant has taken an oral
electrolyte solution for close to 24 hours
- vomiting starts again as soon as you try to resume the
child's normal diet
- vomiting starts after a
head injury
- vomiting is accompanied by
fever
(100.4º Fahrenheit/38º Celsius rectally in an infant under 6
months of age or more than 101-102ºF/38.3-38.9ºC in an older
child)
- vomiting of bright green or yellow-green fluid
- your child's belly feels hard, bloated, and painful
between vomiting episodes
- vomiting is accompanied by severe stomach pain
- vomit resembles coffee grounds (blood that mixes with stomach
acid will be brownish in color and look like coffee grounds)
- vomiting blood
Reviewed by:
Steven Dowshen, MD
Date reviewed: September 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
© 1995-2009 The Nemours Foundation/KidsHealth. All rights reserved.