Vomiting (throwing up) is unpleasant but normally isn't harmful. Ongoing vomiting can lead to dehydration, so ensuring your child gets enough fluid is important.
|Call 111 for an ambulance or go to your nearest A&E department immediately if your child is vomiting and:
- has a headache, stiff neck and a rash (this could be meningitis)
- develops sudden and severe tummy pain (this could be due to ingesting something poisonous)
- it started after a head injury
- is floppy, irritable or not very responsive.
What causes vomiting in children?
The most common cause of vomiting in both adults and children is gastroenteritis, which is commonly known as 'gastro' or tummy bug. Other causes include food allergy, poisoning, reflux, meningitis, overeating, stress, infection or illness. Read more about causes of vomiting including other symptoms you may notice with each of them.
Ongoing vomiting can lead to dehydration which can be dangerous. The risk of dehydration is increased when the child has diarrhoea and vomiting at the same time.
The main sign of dehydration is not passing much or any urine, having fewer wet nappies, or urine being very dark and smelly. Other signs include dry mouth and tongue, sunken eyes, cold hands and feet, unusual sleepiness and/or lack of energy. Read more about dehydration.
When to see a doctor
Any baby under 6 months old with vomiting should be seen by a doctor urgently – babies become dehydrated and unwell quickly.
For older children with vomiting, see your doctor if you notice:
- signs of dehydration such as dry mouth and tongue, sunken eyes, cold hands and feet, unusual sleepiness or lack of energy, fewer wet nappies or not passing as much urine as usual
- blood or bile (greenish fluid) in the vomit
- severe tummy pain or a swollen tummy
- the child's skin colour or whites of the eyes have become yellowish.
How to care for a child who is vomiting
When your child is vomiting, sit them forward to prevent them from choking on the vomit. Keep a close eye on them and see your doctor straight away if you are worried.
Vomiting can be unsettling, and even frightening, for young children. Support your child by helping them stay calm and making sure they don't become dehydrated.
Allow your child to rest or play quietly if they feel up to it – keeping their minds busy will help distract them from their discomfort. Make sure the room is not too hot or stuffy.
If your child has stomach cramps, try a warm (not hot) wheat pack or hot water bottle on their tummy.
Children can easily become dehydrated if fluid lost by vomiting is not replaced. To prevent this, make sure your child is taking in enough fluid between vomiting episodes.
- Carry on breastfeeding or giving them milk feeds as normal.
- If they are younger than 6 months of age seek advice from your doctor; babies can quickly become dehydrated.
- If your baby becomes dehydrated, they will need extra fluids. Your doctor or pharmacist will advise you on the best oral rehydration solution to use.
- Offer your child small, regular sips of cool fluid. Water, clear soup, or watered-down fruit juice are good options.
- If your child doesn’t want to drink, offer ice to suck, use a novelty straw or try a timer to encourage them to have a small drink every 10–15 minutes.
- Avoid milk drinks, fizzy drinks and full-strength fruit juice.
- If vomiting lasts more than 24 hours, an oral rehydration solution such Gastrolyte or Pedialyte can be use. Try freezing the rehydration drink into iceblocks if your child doesn’t like the taste.
Your child probably won't feel like eating when they are vomiting.
- If your child is hungry let them eat small amounts. Otherwise, don’t worry about food.
- Try easily digested foods such as bananas, crackers, rice, pasta and bread.
- Avoid foods high in fibre such as whole fruits (except bananas) and vegetables, spicy or fatty foods, alcohol and caffeinated drinks.
- Go back to your child’s normal diet after 24–48 hours.
Adventures in vomiting WebMD, USA
Vomiting in children and babies NHS Choices, UK
Vomiting Ministry of Health, NZ
There are many things which can cause vomiting in children. Some of the causes, and the other symptoms you may see with them, are described below.
Vomiting + diarrhea + mild fever
- Also called gastro or tummy bug, it is the most common cause of vomiting and diarrhoea in adults and children.
- Gastroenteritis can be caused by viruses (such as rotavirus), bacteria (such as Campylobacter or E. coli which can cause food poisoning) or parasites (such as giardia).
- Read more about gastroenteritis.
Nausea + vomiting + rash
- Symptoms of food allergy can occur within minutes or hours of eating a certain food.
- Call 111 immediately if your child has shortness of breath or swelling of the mouth or throat. An extreme allergic reaction can be fatal if you don't act fast.
- Read more about food allergy.
Eating or drinking something poisonous
If you think your child has swallowed a poison, follow these steps:
- If they are awake, call the New Zealand National Poisons Centre on 0800 POISON (0800 764 766).
- If they are sleepy or unconscious, lie them on their side and dial 111 for an ambulance.
- Do NOT try to make your child vomit or give them food or liquid until you have been given advice.
Vomiting + high fever + piercing scream (babies) or stiff neck (older children)
- This is a potentially serious brain infection which since the development of the Haemophilus influenzae type b (Hib) vaccine is now rarely seen.
- See your doctor straight away if your baby is vomiting, running a fever, and irritable, or if your older child is vomiting and complains of a stiff neck or seems dizzy and confused.
- Read more about meningitis.
Reflux / spilling
Bringing up milk after a feed is sometimes mistaken for vomiting. The main difference is that vomiting is an effortful process while reflux or spilling is effortless. For babies less than 1 year old, spilling is a normal process that helps to relieve an uncomfortably full stomach. Read more about reflux.
Other causes include:
- Eating too much – especially rich food that they do not normally eat a lot of (for example sweet or fatty foods)
- Being very worried, anxious or stressed (this is more common in older children and adults)
- Having a gut obstruction - vomit in this case is usually greenish-looking
- Being sick with the flu or other illness
- Having an infection, such as appendicitis.
Assessment of dehydration
- The best way to find out if a child is dehydrated is to measure weight loss, however, a recent weight is seldom available.
- Clinical estimate of the degree of dehydration is unreliable. Doctors usually overestimate the deficit, and may underestimate it if there is hypernatraemia.
- As per the Gastroenteritis Starship guidelines 2006 (2), in the management of dehydration, it is much more important to observe a child closely over time (see table below) than it is to calculate and replace a hypothetical figure for percentage dehydration.
- slightly dry buccal mucosa
- dry buccal mucosa, absent tears
- sunken eyes & fontanelle
- decreased urine output
- altered skin elasticity
- signs of ketosis (rapid shallow breathing, smell of ketones)
- shock (tachycardia, poor volume peripheral pulses, cool peripheries)
- hypotension is late/ominous sign
- skin retraction time > 2 seconds
- capillary refill time > 3 seconds
|*As a rough guide, the child who is mildly dehydrated ("5%") may be considered to have a 50 mL /kg deficit, and the child who is severely dehydrated ("10 - 15%") may be considered to have at least a 100 mL / kg deficit.
Oral rehydration therapy (ORT)
The Starship Clinical Guideline on Gasteroenteritis states:
- ORT is intensive. It depends on a lot of input from the child's caregiver, or the use of a nasogastric tube.
- Pedialyte is the ORS of choice
- The treatment of gastroenteritis with ORS occurs in two phases: rehydration and maintenance. Except in hypernatraemia, ORT aims for full rehydration within 4 hours.
- The schedule suggested here for the rehydration phase is a standard rate of replacement for all dehydrated children who are not shocked, over 4 hours. The final volume given is determined by clinical assessment of when the child is rehydrated.
- During the rehydration phase, fluid is given at a rate of 5 ml per minute, by teaspoon or syringe. The small volumes decrease the risk of vomiting. The rate (1 teaspoon / minute) is easy to calculate and administer for a parent sitting at the bedside. 25 ml every 5 minutes can also be used. If oral rehydration not successful, then naso-gastric rehydration should be used.
- This rate of replacement is already maximal, and is not supplemented for ongoing losses. If the child's ongoing losses exceed an intake at this rate, the child will require nasogastric or intravenous fluids. This rate will rehydrate a moderately dehydrated 1 year old in 2 to 4 hours and a 2 year old in 3 to 5 hours (estimating diarrhoea at 0 -10 ml per kg per hour).
- An alternative rate is 25 ml / kg /hr, over 4 hours, in small aliquots frequently
- There must be frequent review (at least 2 hourly) in the rehydration phase.
- Vomiting is not a contra-indication. Most children with gastroenteritis who vomit, will still absorb a significant percentage of any fluid given by mouth or NG.
- Half strength apple juice has been shown to be a suitable alternative for children with mild gastroenteritis and minimal dehydration.
Regional HealthPathways NZ
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
Oral rehydration therapy (ORT) New Zealand Formulary for Children
Acute gastroenteritis in children BPAC, NZ
Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management NICE guideline April 2009
Gastroenteritis Starship Clinical Guidelines, May 2006
Assessment and management of infectious gastroenteritis BPAC NZ, 2009