Like fever, there is considerable confusion over vomiting and I will attempt to resolve many of the myths with this post. First, let me remind you that the human race has survived for tens of thousands of years. Part of the credit for this amazing accomplishment is certainly due to the body’s ability to rid itself of those things that are harmful. Vomiting is one of the ways the body accomplishes this and in almost all cases it is GOOD. In otherwise healthy children, there is little reason to believe that vomiting is dangerous.
On the other hand, take your kid into the ER and you may expose them to real hazards. In the ER they will have to deal with other sick kids and unnecessary, painful, and potentially dangerous procedures. My opinion, avoid the ER if at all possible.
Myths & Facts
Myth #1: Vomiting causes dehydration.
This statement is FALSE. The stomach has a limited capacity to hold fluid and it secretes virtually no fluid. Thus a child who is vomiting will lose whatever is in their stomach when the vomiting begins, but little to no actual body fluid. The only substantial risk they have to dehydration is if they are unable to take in any fluids for more than 24 hours, they also have concurrent and profuse diarrhea, or they are very young (say less than 3 months).
Myth #2: If my child is vomiting they need an IV.
This is generally only true if you enjoy subjecting your child to torturous medical intervention. Vomiting alone rarely leads to dehydration and rarely requires an IV or IV fluids. This is not common practice though. If you go into the ER complaining that your child has been vomiting there is a good chance that your child will get an IV, not because they are dehydrated, but because most ER doctors feel compelled to DO something. Your child will then be held down while a nurse attempts to place an IV (which may take several attempts). All the while your child is crying and being stuck with needles, instead of resting at home and letting the body heal itself. The truth is that even in kids who have mild to moderate dehydration, rehydration can generally be accomplished orally and at home.
Myth #3: If my child is vomiting they need a medicine to stop the vomiting.
WRONG again. The body is protecting itself by vomiting. If your child ate some food and got food poisoning why would you want to keep that food in your child’s system? Remember, the body generally knows best and if left alone will generally heal itself much faster than if we start interfering.
You also must consider that many of the commonly prescribed medicines for nausea and vomiting have very common and serious side-effects. I would avoid these medications in almost all situations. They are generally a waste of money, probably prolong the overall illness, and may cause significant side-effects.
Myth #4: Vomiting means my child has a serious illness.
FALSE. Vomiting is generally caused by a stomach virus or food poisoning. Neither of these is dangerous in any way. Both generally last less than 24 hours and can easily be managed at home. The exceptions include vomiting blood or bile (dark green fluid) and vomiting associated with more worrisome symptoms like severe abdominal pain, high fevers, lethargy, and profuse water or bloody diarrhea. Click here to read more about other worrisome symptoms.
Fact #1: Oral rehydration is best.
True. True. True. This is less costly, involves no pain, and can easily be accomplished at home. Pedialyte is the fluid of choice but the actual choice of fluid is less important than the concept of providing some fluids orally (through the mouth).
Even though your child WILL continue to vomit most of what you give for the first 6-12 hours, some of the fluid that you give will get absorbed. The trick is to give small amounts of fluid frequently – like one ounce (or less) every 15 to 30 minutes. As the vomiting starts to slow down you can increase the amount of fluid that you give. Click here to read ore about ORT (Oral Rehydration Therapy).
Fact #2: Vomiting generally lasts 12 to 24 hours.
This is almost always the case and this is what you should expect. DO NOT call your doctor or run to the ER just because your child has thrown up 2 or 3 times. They will get sicker in the ER and probably be subjected to painful and unnecessary procedures. If the vomiting persists for more than 24 hours, this is not typical, and a call to your pediatrician is warranted. Also, vomiting associated with any of the more worrisome symptoms warrants a call to your pediatrician or a trip to the ER.
Fact #3: Vomiting is rarely caused by something dangerous.
True again. Most people worry about appendicitis and head (brain) problems. If your child has appendicitis they will also likely have fever and severe abdominal pain with the vomiting. If your child has a brain tumor the vomiting will not come on suddenly and is generally associated with headache or other neurological symptoms. Bleeding in the brain is almost always preceded by some sort of trauma – thus if your child has not just suffered some sort of trauma, they are very unlikely to have any bleeding in the brain.
The danger is that in some ERs the doctors are quick to order unnecessary and dangerous tests. CT scans, depending on age, can increase the life-time risk of cancer to a much as 1:1000. So use some caution – if you insist on a CT scan of the head because your child vomited a few times, you are unlikely to find a brain tumor on the scan, but there will now be a 1:1000 chance that there will be one some time in the future.
Of course there is always the chance that your child may have some very rare and serious illness, of which vomiting is the first sign. Most of these things are so uncommon that it is hard to even know how common they are (often less than 1 in a million children). Try to keep things in perspective though and understand risk… for most rare medical things, it is more likely that you will be involved in a fatal car accident on the way to the ER than your child will be diagnosed with one of these rare medical things.
Fact #4: Vomiting is GOOD.
This should be self-evident by now. Let the body do what it does best and rid itself of things that may cause it harm. Stay out of the way of this process, try to get in small amounts of fluids, and call your doctor if there is some sign that there is something more worrisome (lethargy, high fever, sever pain, etc.), the vomiting is dark green or bloody, your child is very young, or the vomiting has not resolved by 24 hours.
Fact #5: I am not YOUR doctor!!!
Some people mistakenly think that they can use the internet as a resource for the medical treatment of their children when they are acutely ill. Let me be clear that I am not your doctor and I am not dispensing medical advice for your child. I am simply providing you with useful information to use in collaboration with your own health care provider.
Since this Blog is about Smart Parenting, let me also be clear that attempting to take care of your sick child based solely on any internet information is a BAD idea. The information you will find here and other places is useful to educate yourself so your can have a more intelligent discussion with your own physician.