Vomiting (0-12 Months)

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.

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 - Give Oral Rehydration Solution (ORS) if Vomiting Continues:

• If vomits once, keep on regular formula. Give smaller amounts per feed.
• If vomits formula more than once, offer ORS. If you don't have ORS, use formula in smaller amounts 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 ORS in small amounts. Give 1-2 teaspoons (5-10 mL) every 5 minutes.
• After 2 hours without throwing up, double the amount.
• Return to Formula. After 4 hours without throwing up, go back to regular formula. Start with small amounts.

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

Remember! Contact your doctor if you or your child develop any "Contact Your Doctor" symptoms.