Vomiting With Diarrhea

When To Call

Call 911 Now

• Can't wake up
• Not moving or too weak to stand
• You think your child has a life-threatening emergency

Go to ER Now

• Hard to wake up
• Acts or talks confused
• Not alert when awake ("out of it")
• Blood in the vomit that's not from a nosebleed
• Bile (green color) in the vomit. Exception: stomach juice which is yellow.
• Appendicitis suspected (pain low on right side, won't jump, wants to lie still)
• Poisoning suspected

Call Doctor or Seek Care Now

• Dehydration suspected. No urine in more than 8 hours, dark urine, very dry mouth and no tears.
• Blood in the stool
• 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.
• Age less than 12 months old and vomited Pedialyte 3 or more times
• Severe vomiting (vomits everything) for more than 8 hours while getting clear fluids
• 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

• Age less than 1 year with vomiting
• Has vomited for more than 24 hours
• Fever lasts more than 3 days
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Vomiting is a frequent problem
• You have other questions or concerns

Self Care at Home

• Mild or moderate vomiting with diarrhea

Care Advice

What You Should Know About Vomiting With Diarrhea:

• Most vomiting is caused by a viral infection of the stomach. Sometimes, mild food poisoning is the cause.
• Throwing up is the body's way of protecting the lower intestines.
• Diarrhea is the body's way of getting rid of the germs.
• When vomiting and diarrhea occur together, treat the vomiting. Don't do anything special for the diarrhea.
• 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 your child vomits 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 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.

Older Children (over 1 Year Old), Offer Small Amounts of ORS For 8 Hours:

• ORS. Vomiting with watery diarrhea needs ORS (such as Pedialyte). If refuses ORS, use half-strength Gatorade. Make it by mixing equal amounts of Gatorade and water.
• The key to success is giving small amounts of fluid. Offer 2-3 teaspoons (10-15 mL) every 5 minutes. Older kids can just slowly sip ORS.
• After 4 hours without throwing up, increase the amount.
• After 8 hours without throwing up, go back to regular fluids.
• Avoid fruit juices and soft drinks. They make diarrhea worse.

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.
• 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.

Return to School:

• Your child can return to school 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.
• Moderate vomiting usually stops in 12 to 24 hours.
• Mild vomiting (1-2 times per day) with diarrhea may last a little longer. It can continue off and on for up to a week.

Call Your Doctor If:

• Vomits all clear fluids for more than 8 hours
• Vomiting lasts more than 24 hours
• Blood or bile (green color) in the vomit
• Stomach pain present even when not vomiting
• Dehydration suspected (no urine in over 8 hours, dark urine, very dry mouth, and no tears)
• Diarrhea becomes severe or is bloody
• 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.