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Vomiting (0-12 Months)

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Definition

  • Vomiting (throwing up) stomach contents
  • Other names for vomiting are puking, barfing and heaving

Causes of Vomiting

  • Viral Gastritis. Stomach infection from a stomach virus is the most common cause. Also called stomach flu. A common cause is the Rotavirus. The illness starts with vomiting. Watery loose stools may follow within 12-24 hours.
  • Food Allergy. Vomiting can be the only symptom of a food reaction. The vomiting comes on quickly after eating the food. Uncommon in infants, but main foods are eggs and peanut butter.
  • Coughing. Hard coughing can also cause your child to throw up. This is more common in children with reflux.
  • Serious Causes. Vomiting alone should stop within about 24 hours. If it lasts over 24 hours, you must think about more serious causes. An example is a kidney infection. A serious cause in young babies is pyloric stenosis. See below for more on this.

Pyloric Stenosis (Serious Cause)

  • The most common cause of true vomiting in young babies.
  • Onset of vomiting is age 2 weeks to 2 months
  • Vomiting is forceful. It becomes projectile and shoots out.
  • Right after vomiting, the baby is hungry and wants to feed. ("hungry vomiter")
  • Cause: the pylorus is the channel between the stomach and the gut. In these babies, it becomes narrow and tight.
  • Risk: weight loss or dehydration
  • Treatment: cured by surgery.

Vomiting Scale

  • Mild: 1 - 2 times/day
  • Moderate: 3 - 7 times/day
  • Severe: vomits everything, nearly everything or 8 or more times/day
  • Severity relates even more to how long the vomiting goes on for. At the start of the illness, it's common for a child to vomit everything. This can last for 3 or 4 hours. Children then often become stable and change to mild vomiting.
  • The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid.
  • The younger the child, the greater the risk for dehydration.

Dehydration: How to Tell

  • The main risk of vomiting is dehydration. Dehydration means the body has lost too much water.
  • Vomiting with watery diarrhea is the most common cause of dehydration.
  • Dehydration is a reason to see a doctor right away.
  • Your child may have dehydration if not drinking much fluid and:
  • The urine is dark yellow and has not passed any in over 8 hours.
  • Inside of the mouth and tongue are very dry.
  • No tears if your child cries.
  • Slow blood refill test: longer than 2 seconds. First, press on the thumbnail and make it pale. Then let go. Count the seconds it takes for the nail to turn pink again. Ask your doctor to teach you how to do this test.
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When To Call

Call 911 Now

  • Can't wake up
  • Not moving
  • You think your child has a life-threatening emergency

Go to ER Now

  • Hard to wake up
  • Not alert when awake ("out of it")
  • Stiff neck (can't move neck normally)
  • Blood in the vomit that's not from a nosebleed
  • Bile (green color) in the vomit. Exception: stomach juice which is yellow.
  • Poisoning suspected
  • Swallowed object (such as coin) suspected

Call Doctor or Seek Care Now

  • Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
  • Stomach pain when not vomiting. Exception: stomach pain or crying just before vomiting is quite common.
  • Age less than 12 weeks old with vomiting 2 or more times. Exception: normal spitting up.
  • Vomited 3 or more times and also has diarrhea
  • Severe vomiting (vomits everything) more than 8 hours while getting Pedialyte (or breastmilk)
  • Head injury within the last 24 hours
  • Weak immune system. Examples are sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
  • Vomiting a prescription medicine
  • Fever higher than 104° F (40° C)
  • Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • All other infants (age less than 1 year) with vomiting. See Care Advice while waiting to discuss with doctor.
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Care Advice

What You Should Know About Vomiting:

  • Most vomiting is caused by a viral infection of the stomach.
  • Vomiting is the body's way of protecting the lower gut.
  • The good news is that stomach illnesses last only a short time.
  • The main risk of vomiting is dehydration. Dehydration means the body has lost too much fluid.
  • Here is some care advice that should help.

Formula Fed Babies - May Give Oral Rehydration Solution (ORS) for 8 Hours:

  • If vomits once, give half the regular amount of formula every 1 to 2 hours.
  • If vomits formula more than once, offer ORS for 8 hours. If you don't have ORS, use formula until you can get some.
  • ORS is a special fluid that can help your child stay hydrated. You can use Pedialyte or the store brand of ORS. It can be bought in food stores or drug stores.
  • Spoon or syringe feed small amounts. Give 1-2 teaspoons (5-10 mL) every 5 minutes.
  • After 4 hours without throwing up, double the amount.
  • Return to Formula. After 8 hours without throwing up, go back to regular formula.

Breastfed Babies - Reduce the Amount Per Feeding:

  • If vomits once, nurse half the regular time every 1 to 2 hours.
  • If vomits more than once, nurse for 5 minutes every 30 to 60 minutes. After 4 hours without throwing up, return to regular nursing.
  • If continues to vomit, switch to pumped breastmilk. ORS is rarely needed in breastfed babies. It can be used if vomiting becomes worse.
  • Spoon or syringe feed small amounts of pumped milk. Give 1-2 teaspoons (5-10 mL) every 5 minutes.
  • After 4 hours without throwing up, return to regular feeding at the breast. Start with small feedings of 5 minutes every 30 minutes. As your baby keeps down the smaller amounts, slowly give more.

Pumped Breastmilk Bottle-Fed Infants - Reduce the Amount per Feeding:

  • If vomits once and bottle-feeding breastmilk, give half the regular amount every 1-2 hours.
  • If vomits more than once within last 2 hours, give 1 ounce (30 mL) every 30 to 60 minutes.
  • If continues to vomit, give 1-2 teaspoons (5-10 mL) every 5 minutes. Only if not tolerating breastmilk, switch to ORS (e.g., Pedialyte) for every 5 minutes for a few hours.
  • After 4 hours without vomiting, return to regular feedings. Start with 1 ounce (30 mL) every 30 minutes and slowly increase as tolerated.

Stop All Solid Foods:

  • Avoid all solid foods and baby foods in kids who are vomiting.
  • After 8 hours without throwing up, gradually add them back.
  • If on solid foods, start with starchy foods that are easy to digest. Examples are cereals, crackers and bread.

Do Not Give Medicines:

  • Stop using any drug that is over-the-counter for 8 hours. Reason: some of these can make vomiting worse.
  • Fever. Mild fevers don't need to be treated with any drugs. For higher fevers, you can use an acetaminophen suppository (such as FeverAll). This is a form of the drug you put in the rectum (bottom). Ask a pharmacist for help finding this product. Do not use ibuprofen. It can upset the stomach.
  • Call your doctor if: your child vomits a drug ordered by your doctor.

Try to Sleep:

  • Help your child go to sleep for a few hours.
  • Reason: sleep often empties the stomach and removes the need to vomit.
  • Your child doesn't have to drink anything if his stomach feels upset and he doesn't have any diarrhea.

Return to Child Care:

  • Your child can return to child care after the vomiting and fever are gone.

What to Expect:

  • For the first 3 or 4 hours, your child may vomit everything. Then the stomach settles down.
  • Vomiting from a viral illness often stops in 12 to 24 hours.
  • Mild vomiting and nausea may last up to 3 days.

Call Your Doctor If:

  • Vomits everything for more than 8 hours
  • Vomiting lasts more than 12 hours
  • Blood or bile (green color) in the vomit
  • Stomach ache present when not vomiting
  • Dehydration suspected (no urine in over 8 hours, dark urine, very dry mouth, and no tears)
  • You think your child needs to be seen
  • Your child becomes worse

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Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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