Vomiting

What is vomiting?

Vomiting is when the contents of the stomach is rapidly or forceful emptied through the mouth. This takes place through a sudden contraction of the stomach muscles.

Regurgitation (also called "spitting up") occurs when small amounts of food come back up through the mouth.

Causes of vomiting

• For infants, regurgitation, or spitting up during and between meals is normal. However, if your child is regurgitating several times a day, he may not be gaining enough weight. If you suspect that your infant is regurgitating too often or is in pain when regurgitating, see a doctor. In these cases, the regurgitation can lead to reflux esophagitis, a condition where the stomach acid irritates the esophagus (the tube connecting the mouth with the stomach) and requires medical treatment. 

• Another serious cause of vomiting is pyloric stenosis, which leads to forceful "projectile" vomiting in infants less than 2 months old. It is caused by a blockage or narrowing in the opening between the stomach and the intestines. Without treatment, the blockage can lead to severe dehydration and weight loss. This is a very serious condition that should be considered an emergency. If you suspect that your child has pyloric stenosis, contact your doctor right away, sicne treatment for this condition usually involves surgery. 

• Many different types of infections can also cause vomiting and nausea. These include infections of the lungs, ear infections, and urinary tract, or stomach and intestinal (gastroenteritis) infections.

• Migraine headaches can also trigger vomiting in older children. A child who is vomiting, has stomach pains and a fever could have appendicitis. 

• Vomiting after a head injury could mean that your child has had a concussion or a brain hemorrhage (bleeding). This is a serious condition. 

• Motion sickness is a common cause of vomiting in children. 

• Eating poisonous substances may also lead to vomiting. If you suspect that your child has swallowed poison, contact 911 or your local poison control center immediately. 

• In rare cases, brain tumors or other problems with the brain can cause repeated headaches and vomiting.

Gastroenteritis

While there are many causes of vomiting, children who suddenly start vomiting will usually have gastroenteritis, an infection of the stomach and intestines. Other common symptoms of gastroenteritis may include diarrhea and a fever.

Gastroenteritis is usually caused by a virus, but can also be caused by bacteria. Viral infections of the intestinal tract tend to be milder and may be associated with respiratory symptoms (sore throat, congestion, or earache), but gastroenteritis caused by bacterial infections is usually more severe and can result in diarrhea that contains blood. Diarrhea that occurs while or after travelling to a foreign country is often caused by bacteria.

Most cases of gastroenteritis are self-limited, meaning that they do not require any specific treatment and the child will get better after a few days.

The most important thing you can do is to make sure your sick child drinks enough fluids to prevent dehydration. 

Home treatment

• Make sure that your child is drinking enough fluids, especially if he also has diarrhea. Drinking plenty of fluids is essential in preventing dehydration and replacing the fluids, salts, and calories your child loses when vomiting. Start giving your child fluids even if he is nauseous. If your child has just vomited, wait 30-60 minutes before giving fluids and then start with small amounts. 
• Avoid giving your child solid food for the first 24 hours after the vomiting starts. Instead, give him clear fluid in small, frequent doses (every 5 minutes) by spoon or bottle. You can also have your child suck on ice cubes or cold, wet washcloths. Older child can sip their drinks through a straw. If your child can keep fluids down, gradually increase the amount you give to him. 
• Children who are being breast-fed should continue to receive breast milk. However, your child should be fed more often than normal (every 1-2 hours), and be given smaller doses (breast feed for 5-10 minutes at a time). If your child will not take the breast, the mother can pump and give him milk by spoon, cup or bottle. 
• Infants who have been on a formula can continue having a regular, full-strength formula. 
• In addition to breast milk and formula, you can give your infant one of several specially prepared oral rehydration solutions (i.e. Pedialyte, Ricelyte or Kao Lectrolyte). These oral rehydration solutions (ORS) help to quickly replace the fluids and salts that are lost through vomiting, and can be bought in a variety of flavors. Older children can be given frozen popsicles made from these solutions. If your child is over 6 months and does not like the taste of plain (unflavored) Pedialyte, you can add half a teaspoonful of apple juice to each dose. 
• Older children can drink other fluids in addition to oral rehydration solutions. Children with diarrhea should avoid fruit juices and soft drinks because they have high sugar content which can make the diarrhea worse. If your child is vomiting but doesn't have diarrhea, he can try taking small sips of a clear fruit juice or water.
• If your child has been able to take in fluids without vomiting after the first eight hours, you can try to gradually reintroduce solid foods. For younger children, start bland foods such as applesauce, mashed bananas or infant cereal. Older children (over 1 year old) can be given saltine crackers, toast, mixed grain, soups, mashed potatoes or white bread. A normal diet can usually be continued about 24 hours after the vomiting has stopped.

When to seek medical advice

See the doctor immediately or call 911 if:

• Your child is showing signs of dehydration. These signs include: listlessness, lethargy, dry lips or mouth, or lack of urination for more than 4 to 6 hours in a baby or more than 6 to 8 hours in an older child. 
• Be aware that young children, especially infants less than 6 months old, will become dehydrated much more quickly than older children. 
• Dehydrated infants less than 1 year old will have a sunken fontanel (the soft spot on top of the head). 
• Your baby is less than 1 month old and vomits after every attempt to feed. Frequent, forceful vomiting in an infant less than 3 months old may be a sign of the disease pyloric stenosis. 
• Your child is vomiting and has severe stomach pains. 
• Your child is vomiting and complaining of a headache. You should always consider the possibility that your child has meningitis if he has fever and is vomiting, especially if he does not have diarrhea. Look for other danger signs of meningitis, such as a stiff neck and skin rashes.   
• Your childs is vomiting after a head injury. This may indicate that your child has had a concussion or a brain hemorrhage (bleeding). 
• The color of your child's vomit is green (bile-colored), and your child is having severe abdominal pain. Your child may have a blockage in his intestines. 
• Your child's abdomen feels hard and is tight and tender between episodes of vomiting. 
• Your child vomits up blood or the vomit contains a substance that looks like coffee granules. The latter may indicate that there is blood in the stomach. 
• The vomiting is accompanied by a dramatic change in your child's mental status (i.e. your child seems extremely tired or "out of it.") This may be a sign of an infection in the brain or spinal cord. 

 Make an appointment with your doctor if: 

• Your child is vomiting and has a fever (rectal temperature above 100.4ºF in children under 6 months or temperature above 101-102ºF in older children. 
• Your child is less than 2 years old and has been vomiting for more than 24 hours. In this case, call the doctor even if you have been giving your child an oral rehydration solution (i.e. Pedialyte). 
• Your child is over 2 years old and has been vomiting for more than 48 hours. 
• Your child starts to vomiting again when he begins to eat solid food. 
• Your child has stomach or abdominal pain that doesn't improve after vomiting. 
• You are unsure of the child's condition.