Unexplained Vomiting in a Child: A Doctor Offers Guidance

Vomiting is a common childhood complaint that occurs with a variety of conditions. It is most often self-limited, but in rare cases it can be a sign of a serious medical condition.

Vomiting is a symptom of many different gastrointestinal issues, but here at Boston Children's Hospital it can also be seen in disorders of other body systems including neurologic, endocrine, renal or psychiatric disorders. Important factors to consider when determining the cause and treatment of childhood vomiting include a patient’s age, its onset and duration and accompanying symptoms.

What is unexplained vomiting in a child?

Vomiting is the forceful expulsion of stomach contents through the mouth and/or nose. It is often preceded by nausea, or the sensation that a person is about to vomit.

What causes vomiting in children?

The most common cause of vomiting in children is gastroenteritis (inflammation of the stomach and intestines, most commonly caused by a viral infection) Vomiting is often followed by diarrhea within 12 to 24 hours and typically other close contacts are experiencing similar symptoms. Another common cause is food poisoning. Additional causes of vomiting include:

• Motion sickness
• Food allergy
• Other infections: pharyngitis (such as strep throat), ear infection, cough or UTIs
• Overeating
• Migraine headaches or concussions
• Emotional response
• Cyclic vomiting syndrome -- recurrent attacks of vomiting related to migraines and family history of migraines
• Cannabinoid hyperemesis syndrome -- chronic vomiting and nausea seen with marijuana use
• Serious causes: appendicitis, kidney infection, gallbladder disease, diabetes, head injury or intracranial mass. This also includes anatomic abnormalities of the GI tract, including bowel obstruction.

Symptoms of vomiting in children

These may include nausea, sweating, chills, fever, abdominal pain/cramps, diarrhea or dizziness/lightheadedness.

Repeated episodes of vomiting can lead to dehydration, when your body loses more fluid than what you take in, which can impact your body’s ability to function properly. Signs of dehydration to monitor closely include:

• Decreased wet diapers in infants, urinating less in older children, dark-colored urine
• Dry mouth and tongue
• Crying with few or no tears
• Dizziness or weakness upon standing, confusion
• Delayed capillary refill, greater than 2 seconds. This can be measured by touching your child’s fingernail to turn it pale. Then count the seconds it takes for the nail to appear pink.

Treatments for vomiting in children

The treatment for a child’s vomiting will depend on the cause. A medical provider may prescribe your child an antiemetic, which is a medication that can help with persistent vomiting. Giving oral rehydration solution (ORS) at home is one of the most effective ways to prevent dehydration in a child with vomiting. These are electrolyte-rich solutions (such as Pedialyte or a similar store/pharmacy brand) that help to rehydrate quickly. These solutions are more appropriate for use than other clear liquids such as soda or fruit juices because they contain the right amounts of water, salt and sugars to avoid dehydration.

Self-care tips for vomiting in children

When a child is actively vomiting or feels nauseous, it can be difficult to encourage them to take ORS. Start by giving the fluid in small, frequent amounts. It may be helpful to give via syringe, dropper or teaspoon every few minutes. If a child vomits, wait 10 to 15 minutes before trying again. For children under 20 pounds, aim for 2 ounces of ORS per hour for 4 to 6 hours. For children over than 20 pounds, aim for 3 ounces of ORS per hour for 4 to 6 hours. If your child is tolerating oral fluids without further vomiting, then you can continue to gradually increase fluids. In most cases, breastfeeding and formula feeding should continue in infants. When your child’s vomiting ceases and appetite returns, you can start to offer solid foods. It may help to start with bland, nutritious foods at first. Examples include toasts/breads, rice, bananas, mashed potatoes, pasta, yogurts or lean meats. Eating smaller meals and avoiding excessive dairy, spicy or fatty foods can also help when first starting solids. Contact your child’s doctor if they cannot continue to eat once symptoms have improved, as this may impact their nutrition and weight with time.

When to call a doctor

You should call your child’s doctor if they are less than 1 year of age with persistent vomiting, exhibit signs of dehydration as above, report persistent abdominal pain when not vomiting, have complex medical needs or a weakened immune system, have a persistent fever, are unable to keep necessary medications down, continue to vomit for longer than eight hours despite receiving ORS, or if you feel your child is looking or acting very sick. Seek immediate medical attention if vomiting appears red, green or brown in color, vomiting follows a head injury, they develop a severe headache or neck stiffness, or exhibit worsening irritability or confusion.