Vomiting

     Vomiting is a common childhood symptom, which must be distinguished from spitting up. Vomiting is the forceful ejection of a large portion of the stomach’s contents through the mouth. The mechanism is strong stomach contractions against a closed stomach outlet. By contrast, regurgitation is the effortless spitting up of one or two mouthfuls of stomach contents that is commonly seen in babies under 1 year of age. Most vomiting is caused by a viral infection of the stomach (viral gastritis) or eating something that disagrees with your child. Often, the viral type is associated with diarrhea.

     Generally speaking you should call us if your child is less than 12 months old and vomits multiple times or has other associated symptoms such as fever, headache, abdominal pain or distension, blood or green color, and you are unable to keep them hydrated (see “dehydration”). The vomiting usually stops in 6 to 24 hours. Dietary changes usually speed recovery. If diarrhea is present, it usually continues for several days.

     Treatment is mainly of a dietary nature.  In general you should:

1.     Stop milk and food of any kind. If breast feeding continue breast feeding, but stop any solids.

2.     Do not give anything by mouth for a brief period - 3 hours in infants, 6 hours in older children.

3.     After this, offer one ounce of clear liquids in small amounts (sips, not gulps) every 20 to 30 minutes. If less than 6 months old, give Pedialyte or Infalyte. Older children may also be given Gatorade, Kool-Aid, “flat” clear or lemon-lime soft drinks, or popsicles.

4.     After 4 hours without vomiting, you may increase the amount of fluid offered.

5.     Fluids at room temperature are best since an upset stomach is quite sensitive to hot or cold beverages.

6.     If the liquids have been tolerated for 24 hours:

·        Less than 6 months old begin ½ strength soy based formula for 24 hours, then go to full strength for one week. (If diarrhea is associated then use Isomil DF).

·        If breast feeding, continue on breast milk

Cont:

·        If older, begin rice cereal, applesauce, bananas and toast or any bland starchy food. After another 24 hours ease back into the normal diet.

7. Stop all oral medications for 8 hours. If fever is causing more discomfort and the child does not have diarrhea, Tylenol (acetaminophen) suppositories may be used.

8. Emetrol may be used for nausea once vomiting episodes have decreased. We DO NOT recommend use of Phenergan unless the child has been seen by a doctor. This can mask serious medical conditions like appendicitis that are associated with vomiting and cause a delay in diagnosis and treatment. Vomiting is also a way for the body to rid itself of the virus causing the symptoms. Stopping it may lead to prolonged illness.

9.  Sleep is encouraged. Sleep helps empty the stomach and relieves the need to vomit.

Diarrhea

     Diarrhea is also a common problem in children, which may be associated with vomiting. There are many causes of diarrhea. Most commonly it is due to a viral infection and is self – limited, lasts 24 to 72 hours sometimes longer. Treatment is essentially identical to that described for vomiting. Refrain from dairy products (especially milk). Soy formula (especially Isomil DF) is fine. DO NOT give PeptoBismol or other anti-diarrhea medication without first consulting a doctor.

Dehydration

Care must be taken to observe for dehydration any time your child has either vomiting or diarrhea. Signs of dehydration  include:

·        decreased urinary output (less than 1-2 episodes of urine in 24 hours)

·        dry skin

·        dry mouth

·        sunken eyes

·        listlessness or irritability

 You should call if you feel your child has developed any of these signs.