Vomiting instructions

February 14, 2024

If your child is vomiting, you need to know what to do! Here are instructions, step by step, for you!

Vomiting

By Dr. Kerby Zeisloft, Advocare Fairmount Pediatrics

Vomiting is usually caused by a stomach virus. Antibiotics do not help. Some children will also have diarrhea.
The pattern you can expect is that the child feels poorly and wants to lie down. Next, they look pale. Finally, there is vomiting. There may be multiple vomits over the course of several hours. The diarrhea usually comes the second day, though it can be the first day. Vomiting will usually be for less than a full day, and then the child feels weak and does not have much appetite. They usually are a bit better on day 2 and then on day 3, they feel better enough that they eat normally. There is often more vomiting on day 3-4, as the child eats more normally before the stomach is quite ready.
The key to improvement is to go slowly! Preventing dehydration is the key.

FOR BABIES UNDER ONE YEAR OLD:

Wait 30 minutes after the child vomits before giving anything to drink.
I know you are worried about dehydration and you want to give something right away. But if you give fluids right away, your baby will vomit them. This will increase the risk of dehydration. Please wait after a vomit to allow the stomach to settle.

Now, give 5 cc of Pedialyte every 5 minutes about 3 times. Next, give 10 cc every 10 minutes, about 3 times. Next, give 15 cc every 15 minutes, about 3 times.
WHY PEDIALYTE? The pedialyte, or any oral rehydration fluid (even a home-made one, please see below for the recipe), has electrolytes in it. Giving just water will lead the child to vomit again, and will also cause the body's electrolytes to be watered down, leading to low levels of salt in the body. It's best to use an oral rehydration fluid.
Gerber Rehydralyte oral rehydration fluid is actually delicious, but is hard to find in the stores.

NEXT STEPS:
Next, every 5-15 minutes, give a small sip of half to one ounce of Pedialyte, Breast milk or Soy formula. If you are breastfeeding, you can try paced breastfeeding, allowing the infant to stay on the breast for 1-2 minutes at a time. If you have a forceful letdown, and rapid milk flow, you are better off pumping and feeding with a bottle at this point.

If there is no vomiting for 2 hours, go back to formula, if you are formula-feeding, or continue to breastfeed often, if you are breastfeeding

FOR CHILDREN OVER ONE YEAR OLD:

Wait 30 minutes after the child vomits before giving anything to drink.
BIGGEST MISTAKE? GIVING WATER RIGHT AWAY AFTER VOMITING.

Next, you can settle the stomach with a heavy sweet syrup. Years ago, people used Coke syrup for this. Today, you can use the syrup that peaches are canned in (buy the heavy syrup, not the light version), or a medication called Emetrol, which is just a heavy sweet syrup and not really a medication

Give the sweet syrup, 1 tsp (1/2 tsp for babies) every 10-15 minutes, three times. After that, the stomach should be somewhat better

Then, every 5-10 minutes, give a small sip of half to one ounce of Pedialyte, or

0.5 strength Gatorade (with water) and 3 saltines/glass

0.25 strength Kool Ade (with water) and 6 saltines/glass

Pedialyte popsicles

Regular popsicles (not the all-fruit kind, you want the cheap, sugary kind, since sugar can be digested with a stomach virus and fruit cannot)

CAN MY CHILD EAT FOOD THE FIRST DAY?
If there is no vomiting for 6-8 hours, you may give more fluids and gradually return to a normal diet. Take this very slowly. If you go too fast, the child will seem better on the 2nd day and then will relapse and vomit again on the 3rd day.

WHAT CAN THE CHILD EAT AS THE CHILD RECOVERS?
So, on day 2, try ginger ale, gatorade, salty broth, and jello. Later that day, try saltines, toast, salted noodles, and cheerios. Later still, try applesauce and bananas. The next day, boiled chicken, toast with jam, ice pops, dry cereal. Go slowly!

IF THE CHILDS BELLY DOES NOT HURT TO PRESS ON, AND THERE IS NO PAIN WITH JUMPING, WE CAN SEND IN ANTI-NAUSEA MEDS. Please schedule a telehealth visit for this. We usually use Ondansetron for this purpose. This drug is safe in young children as long as we can be confident that the belly is not tender or painful. Babies are sometimes given Ondansetron in the ER, but are not prescribed this drug without a physical exam first.

FOR ALL KIDS, ALL AGES:

REASONS TO CALL THE DOCTOR:
Call the doctor if: your child vomits more than 4-5 times, if you see blood or bile (bright green fluid) in the vomit, or if you see signs of dehydration.
What are the signs of dehydrations? Not enough wet diapers, less urination than usual, no tears when crying, a dry-looking mouth and tongue, a sunken soft spot.

WHEN IS IT AN EMERGENCY?
Call if the belly is hard and painful to touch, or if a baby has fluorescent green in their vomit, or go to the ER.
A great guide to recognize an emergency vomiting situation is to have the child jump up and down. If they are able to do this, you can probably stay home. If there is pain or the child is unable to jump up and down, you should head to the Emergency Department.
If there is no urine output for 6 hours, this is dehydration and it is time to go to the ER.

FREQUENTLY ASKED QUESTIONS:
WHAT IF MY CHILD GOES 20 MINUTES WITHOUT VOMITING AND THEN VOMITS AGAIN? This is a common question. Unfortunately, you are best off waiting another 30 minutes before feeding. If your child is very thirsty, you could try to shorten the time to 15 minutes and use less Pedialyte, 2.5 ml, when you start.

I DON'T HAVE ANY PEDIALYTE AT HOME, AND I CAN'T GO OUT!
Here is a recipe for homemade oral rehydration fluid. You don't have to go out to get it!
Homemade Pedialyte:
Please mix 2 cups water, 1/2 tsp salt, and either 1/2 cup instant baby rice cereal or 1 1/2 tablespoons sugar.
Mix this well, and then feed one tsp at a time every minute or two

MY BABY OR CHILD IS REFUSING FLUIDS. WHAT DO I DO?!
Try offering the fluids with a teaspoon.
Try turning on the television, even for an infant, to mesmerize them.
Try a dark room and cuddling the infant or child.
Try a syringe.
Try sugary fluids.
Try little bits of Pedialyte popsicles, or frozen pedialyte, and place the ice chips in the child's mouth.
Try singing while you offer the fluids.
If nothing nothing nothing works and there is no urine for 6 hours, please go to the ER for IV fluids.

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Working with Kids who have ADHD

By Alexis Lieberman • February 19, 2025

A few days ago, I had the chance to meet with a young patient I’ve known since he was born. Now seven years old, he came in to talk about his recent ADHD diagnosis. It was a big moment for him, but also a reminder of how important it is to really understand and support kids with ADHD. ADHD Symptoms and School Challenges Like many kids with ADHD, he was super outgoing and not at all shy about talking to me. He opened up right away about his relationships with his teachers, classmates, and how school was going for him. It was clear he was doing okay—he wasn’t crying at school or yelling at his teachers, which showed he had a pretty good handle on his emotions and impulses. That’s something kids with ADHD often struggle with, so it was nice to see that he had some self-control. Of course, like many kids with ADHD, he had trouble staying seated for long periods of time. It’s a common issue since kids with ADHD often have lots of energy and a hard time focusing for long stretches. This kid really struggled with staying in one spot for too long, which is a big problem in traditional classrooms where kids are expected to sit still and pay attention for hours. Creative Solutions for ADHD Kids: Thinking Outside the Classroom That got me thinking—what if there was a different kind of school for kids with ADHD? I’ve always wondered if programs like apprenticeships, where kids learn to be a woodworker or blacksmith, might work better. These types of hands-on jobs involve a lot of movement and learning by doing, which seems like it might be a better fit for kids who need to move around to stay engaged. Traditional school can feel like a tough fit for kids with ADHD, who often need to move and get their energy out in order to stay focused. I’ve also seen this firsthand with my own child, who has ADHD. My child had a math teacher who figured out that kids with ADHD need to move in order to stay engaged. Instead of sitting still at desks, the teacher had them stand up and use hand gestures to show math concepts. For example, they’d cross their arms to show multiplication and hold their arms parallel to show the equals sign. It wasn’t just fun—it worked! It helped the kids focus and made math a lot more interactive. That teacher understood that keeping kids with ADHD engaged meant thinking outside the box, and it made a huge difference for my child and the other kids. The Importance of ADHD Accommodations in School For the boy I saw recently, things at school were going okay, but we talked about the fact that he’d need support to keep thriving. Luckily, he already has a 504 Plan in place, which provides him with some important accommodations at school. Not all teachers are great at handling kids with ADHD, and some may not understand how important it is for kids to have room to move and get their energy out. But with his 504 Plan, he’s allowed to stand up and move around in class, which will help a lot. This kind of flexibility makes a big difference in helping kids succeed. ADHD Medication: A Tool for Focus and Success We also talked about the possibility of trying some medication to help with his ADHD. This is a topic that often brings up questions from parents. Just the other day, a mom asked me if giving her child a pill to help with ADHD might teach the child to look for pills as a way to solve problems in the future. It’s a good question, and I totally understand her concern. But research actually shows that kids with ADHD who take medication are less likely to develop substance abuse problems later in life. It’s a counterintuitive finding, but it makes sense when you think about it. Medication for ADHD helps improve focus, self-control, and overall functioning, which can actually make it less likely for kids to engage in risky behaviors. When ADHD is left untreated, kids may have a harder time with impulse control and regulating their emotions, which can sometimes lead to problems down the road. So, medication is just one part of a bigger picture—a tool in the toolbox, along with other strategies like therapy, lifestyle changes, and support at school. The Difference Between Drugs and Medication for ADHD The day before I met with this boy, I saw another child with ADHD. He was just as chatty and full of ideas, and I could’ve easily spent more time talking to him about his thoughts and creative ideas. He had a really interesting way of explaining the difference between “taking drugs” and “taking medication.” He understood that drugs are bad for you, but he also got that medication, when prescribed properly, can help you manage things like ADHD. It was a great reminder of how these kids, despite their challenges, often have a clear understanding of the world around them and how things work. The Joy of Working with Kids with ADHD Taking care of kids with ADHD is something I really enjoy. They’re often so smart, creative, and full of life—it’s impossible not to appreciate the way they see the world. These kids can be wildly inventive, and their way of thinking is often fresh and exciting. As a doctor, it’s incredibly rewarding to be part of their journey and to see how they grow and learn. For me, the most important part of this work is being a part of their team as they grow and helping them find the tools and strategies they need to become their best selves. It’s not just about treating a diagnosis—it’s about supporting them as they discover who they are and what they’re capable of. Building Strong Connections with ADHD Kids and Their Families But it’s also about the connections. Getting to know each child, understanding their unique strengths and struggles, is what makes this work so fulfilling. It’s not just about the medical side of things—it’s about the relationship, the trust, and the shared moments that come with working closely with these kids. Every child brings something special to the table, and it’s a privilege to witness their growth and to be there for them every step of the way. Helping these kids succeed is full of joy, laughter, and meaningful moments, and I wouldn’t trade it for anything. Conclusion: Supporting Kids with ADHD to Reach Their Full Potential In the end, my goal is to help kids with ADHD become the best versions of themselves. With the right tools and strategies—whether through hands-on learning, classroom accommodations, therapy, or medication—we can help them manage their challenges and succeed in school and life. It’s a privilege to be part of their journey, and I’m grateful for the opportunity to support these kids as they grow into their full potential.