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.