Vomiting

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, reflux 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).

Most vomiting is caused by a viral infection of the lining of the stomach or if your child eats something that disagrees with him. Usually, a child whose vomiting is caused by a virus also has diarrhea. If your child has vomiting without diarrhea and it lasts more than 24 hours, your child may have something more serious.

The vomiting usually stops in 6 to 24 hours. Changes in the diet can prevent excessive vomiting and dehydration. If your child also has diarrhea, it will usually continue for several days.

• 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 less than 1 year old, always use an oral electrolyte solution (such as Pedialyte or Kao Lectrolyte). Spoon or syringe feed your baby 1 teaspoon (5 ml) every 5 minutes. Until you get some Pedialyte, give formula by teaspoonful in the same way.
  
  For a child over 1 year old with vomiting (but no diarrhea), the best fluid 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 okay. 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 spoonfed approach rarely fails.

• Offer bland foods after 8 hours without vomiting 
  After 8 hours without vomiting, your child can gradually return to a normal diet.

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

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

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

• 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 3 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 vomiting continues, switch to Pedialyte for 4 hours. Spoon or syringe feed 1 tablespoon (15 ml) of Pedialyte every 5 minutes. 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).

• 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 102°F (39°C), use acetaminophen suppositories. Call your healthcare provider if your child needs to continue taking a prescription medicine.
   
• Common mistakes in the treatment of vomiting 
  A common error is to give as much fluid at one time 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 is the best treatment. Vomiting alone (without diarrhea) rarely causes dehydration unless you are giving your child medicine by mouth.

If you feel that your child needs immediate medical care.

• 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 or something that looks like coffee grounds. 
• Your child vomits repeatedly AND also has watery diarrhea. 
• Your child has severe abdominal pain. 
• Your child is confused or difficult to awaken. 
• Your child starts acting very sick.

• 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.

Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.