Vomiting is one of the more common symptoms of childhood illness. Most often just a smelly mess, it can be evidence or the cause of serious problems. What is the best approach to the vomiting child due to non-catastrophic illness, and when might we begin to worry more?
Vomiting caused by influenza(flu) or rotavirus (“stomach flu”–summertime) is caused by inflammation of the stomach and intestine from fever (“pyrogens”) in the bloodstream as well as primary irritation from the invading organsims into the lining (mucosa) of these organs. Besides nausea and pain, more serious problems may arise from inability to absorb fluids and increased fluid losses. Blood volume decreases, bloodflow to vital organs deteriorates and many metabolic derangements may develop.
Breaking the cycle of repeated vomiting is the goal we must address. But don’t be too anxious to “just do something.” The “magic formula” to settle the child’s upset stomach isn’t necessarily juice, broth, Pedialyte, or “just a sip of water” but time.
What can we do?
- Give a frequently vomiting child 3-4 hours of nothing consumed by mouth to allow his/her stomach to settle down a bit.
- Subsequently begin approximately 1/2 oz (3 tsp only) clear liquids every 20-30 minutes for 2-3 hours. As tolerated you may begin to gradually liberalize the amount taken up to “ad lib”–as much as desired over the ensuing 12-24 hours.
- Next you may progress to a “BRATT” diet–bananas, applesause, tea, toast ( no dairy, milk, or meat).
- You may give acetaminophen or ibuprofen for fever or discomfort when the child is more reliably able to hold down clear liquids. (Note that acetaminophen is available as a rectal suppository and can be administered via that route to a vomiting child).
Diarrhea is a lesser problem. Absent vomiting I rarely see a child become dehydrated from diarrhea alone(even a young infant). The above diet can be followed for diarrhea only but you should be aware that it can take a week or two(sometimes longer) for the stools to completely return to “normal.”
At what point should one worry?
- If the above regimen fails, of course.
- If your child vomits blood, blackish, or greenish material, that may warrent prompt medical attention
- Greenish and bloody(not greeen alone) stools
- Dry mouth, decreased urination, or altered “sensorium”(agitation or serious listlessness) lasting hours
Frequent vomiting in a young infant (under 6 months) is a special concern. it can be most serious, or, paradoxically, of comparatively little concern. With this, as with the aforementioned “curve balls” you should always contact me so I can help you differentiate serious from lesser problems.
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