Vomiting

Why do children vomit?

Vomiting is the body's way of expelling material from the stomach, sometimes to get rid of something poisonous. Whatever the cause, your child's stomach muscles will contract forcefully, and food will come back up through his esophagus and out through his mouth and sometimes his nose.

What causes vomiting?

A stomach virus or "flu" is the most common reason for vomiting. The medical name for this illness is acute gastroenteritis (AGE), and it often includes diarrhea, fever, and abdominal pain. Serious bacterial infections from E. coli, salmonella, and shigella -- germs that cause food poisoning -- can result in similar symptoms.

Surprisingly, respiratory infections can also lead to vomiting. When children swallow a lot of phlegm, the excess mucus can irritate their stomachs and cause them to throw up. Coughing can trigger vomiting as well -- a reflex that's actually designed to reduce the cough.

Other common causes of vomiting:

• Toxins, such as poisonous plants, or herbs inappropriate for children, or medications.
• Overeating, particularly at birthday parties and on Halloween.
• Motion sickness. Traveling in a car, boat, or airplane makes some children queasy. Have your child eat a light snack before leaving, breathe fresh air, and focus on distant objects during travel.
• Food allergies. Some food allergies can cause diarrhea or loose stools and occasional vomiting.
• Appendicitis. Symptoms may seem indistinguishable from a stomach virus, but the illness can be much more serious, so watch for this pattern: With appendicitis, the abdominal pain usually begins around the belly button and migrates to the lower right side of the abdomen. Intestinal blockage causes vomiting that contains bile, a forest-green-colored stomach secretion.
• Urinary tract infections. If your child has vomiting along with frequent, painful urination, he may have a urinary tract infection. Your doctor will want to examine him and check his urine.
• Headache. When head pain accompanies vomiting, it can signal a viral illness. Severe headaches and vomiting, however, can be symptoms of migraine or meningitis, an infection around the brain. A stiff neck, fever, listlessness, and a bumpy purple or red rash are other signs of meningitis. Get emergency medical care immediately if your child shows these symptoms.
• Pregnancy. Once a girl enters puberty, nausea and vomiting can be an early sign of pregnancy.

When should I call the pediatrician?

Dehydration is the most common complication of vomiting. If your child shows any signs of dehydration, contact your doctor. Symptoms to watch for:

• No urine for eight hours
• Crying without tears
• Dry, sticky mouth
• Confusion
• Excessive sleepiness
• Dark urine
• Damp, mottled skin on hands and feet
• Muscle cramps
• Sunken eyes
• Sensation of cold in arms and legs

You should also call the pediatrician immediately if you see blood or bile in your child's vomit. Normally, vomit contains items recently eaten or drunk; once the stomach is emptied, frothy-yellow stomach secretions may be the only thing that comes up. The presence of blood, whether bright red or dark like coffee grounds, is a serious sign. Likewise, bile, a forest-green secretion, can signal intestinal blockage -- a potential surgical emergency.

Most children with vomiting have some stomach pain. But if your child's pain seems severe, lasts more than four hours, or is located in the right lower abdomen, contact your doctor immediately.

If you suspect that your child has ingested bad food, medicine, plants, or chemicals, call poison control or your pediatrician immediately.

How do I take care of my child when he's vomiting?

Change his diet. If he's throwing up, stop all solid foods for at least eight hours. If he's over 1 year of age and not dehydrated (see above), then give him Kool-Aid or clear liquids like broth or flat soda pop with no caffeine. (Avoid red Kool-Aid because it can cause the stools to look red and be confused with blood.) Avoid liquids that are cold or supersweet; they stimulate more stomach contractions and vomiting, making an uncomfortable child even more miserable. Don't give your child fruit juice or milk. Water and ice chips are okay as long as he doesn't have diarrhea.

If your child does have signs of dehydration, then use an electrolyte solution like Pedialyte, Infalyte, or Kaolectrolyte. Kids who are somewhat dehydrated will accept the salty taste of those liquids that are designed to replace important salts the body loses with vomiting and diarrhea. If your child has serious diarrhea, you need to replace those liquids with an electrolyte solution to keep him from getting dehydrated.

Give your child small amounts of fluid frequently; too much fluid too fast may further upset an already irritated stomach and he may vomit again. For children 1 to 6-years-old, start with one tablespoon of liquid every 10 minutes. (This works out to about one sip every commercial break.) Children over 6 should try an ounce every ten minutes. Double this amount when your child has gone four hours without vomiting. If vomiting persists, withhold all fluids for an hour and start again with smaller amounts.

Once your child has gone eight hours without vomiting, you can reintroduce bland solids like crackers, toast, soup broth with noodles, rice, and mashed potatoes. Resume a normal diet gradually, beginning 24 hours after the vomiting has ended. The vomiting that comes with a stomach virus usually goes away within 24 hours. (Don't push solid foods as your child recovers. His stomach will tell him when it's time to eat them.)

What if my child has a respiratory infection?

When your child vomits because of phlegm and cough, treat the vomiting by treating the other problems.

What about medications?

There are no effective medications for vomiting caused by a stomach virus -- and that may be a good thing. This kind of vomiting clears the body of infected material; it shouldn't be suppressed.

Anti-vomiting medications can be potentially dangerous when they slow the action of the intestines and mask symptoms. Don't use over-the-counter medications for nausea and vomiting without consulting your doctor first.

Over-the-counter medications include meclizine (Antivert), diphenhydramine (Benadryl), demenhydrinate (Dramamine), Emetrol (phosphorylated carbohydrate), Coca-Cola syrup, and Pepto Bismol (bismuth compounds). Meclizine is not recommended for children under 12 years old; the other medications should not be used for children under 2. Never give Pepto Bismol to children with influenza or chicken pox; it contains salicylates that have been associated with Reye's syndrome, a rare but potentially life-threatening condition.

Prescription medications for nausea and vomiting include prochlorperazine (Compazine), promethazine (Phenergan), chlorpromazine (Thorazine), trimethobenzamide (Tigan), and a scopolamine skin patch (Transderm Scop). These powerful medications all have side effects, and they are not recommended for common stomach viruses. If your doctor prescribes any of these medications, use them strictly according to directions, watch your child closely, and report any changes to your pediatrician promptly.

What are some home remedies?

For children over 1 year of age, these include tummy-friendly teas like chamomile and peppermint. Ginger can also soothe a sick stomach. If you choose to give ginger ale, make sure it has real ginger and not just ginger flavoring. And as with all carbonated liquids, de-fizz it first.

If your child (other than an infant) has a stomach virus accompanied by fever, acetaminophen suppositories are a handy way to reduce fever without having to give medicine by mouth to a vomiting child.

References

American Academy of Pediatrics, Caring for Your Baby and Young Child: Birth to Age 5. Bantam.

American Academy of Pediatrics, HealthyChildren.org. Treating Vomiting. http://www.healthychildren.org/English/health-issues/conditions/abdominal/pages/Treating-Vomiting.aspx

The Baby Book: Everything You Need to Know About Your Baby from Birth to Age Two, William Sears, Little, Brown & Co.