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.
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My 8.5 month old started vomiting tonight. She has had some head congestion all week (yellow runny nose) and it seems that she mostly vomited goo, for lack of a better word.
What can/should I do for her?
I replied at your other site as well.
I found this article painful to read. It was particularly harsh to read that the popular opinion is that I, and other moms like me, enjoy subjecting the children we love to torturous medical intervention.
“This is only true if you enjoy subjecting your child to torturous medical intervention.”
My daughter nearly died because of advice like yours. That advice came from a nurse practitioner at our pediatrician’s office years ago. Later, I sat outside in the parking lot of the hospital emergency room with a stop watch and syringe measuring out 5 cc’s at a time every twenty minutes only to watch it (and more) pour out of her mouth several minutes later. I was a wreck by the time I got into the er. I was crying and confused after being warned that the only reason to take her to the hospital would be for my comfort, not hers.
Eight days later we left the hospital.
Do not reassure yourself that your blanket statement “you know your child best” absolves you from all responsibility. After you, an authority figure, emotionally assault a parent for seeking help for their vomiting child, they may likely delay treatment for too long.
We have had many, many hospitalizations since that terrible night. Fortunately, none have been that long again.
My daughter had metabolic acidosis. For some unknown reason she is prone to it. I’m sure you are shaking your head going “yeah, whatever” by now. Another incident: six hours after being told by an er dr to follow up with primary in four days I took my unresponsive child to the emergency room a second time. Here are the results of her cmp:
bun, 25 H (7-18)
creatinine 0.5 L(0.6-1.3)
calcium 10.9 H(8.5-10.1)
sodium 129 L(135-145)
chloride 94 L(98-107)
co2 9.3 L(21-32)
Incidentally, she did not cry during the iv. In fact, she did not even respond during the spinal tap. I was holding her. I know.
Thankfully we no longer have to go to the hospital for mild acidosis. My daughter has a port now and I can start her iv at home when she needs it. Now that we have symptom control, I started reading tonight to find out why some kids do not respond favorably to ort. And this is the first answer I get? Because their parents don’t love them and enjoy torturing them. Are their doctors sadists as well as their parents? Our geneticist approves of the torture regimen. He even quizzes me on what signs mark a need to move from home infusion to inpatient treatment. (temperature below 95.5, kusmaul breathing(sp), tachychardia that doesn’t respond to iv within an hour…). and of course, if anything is out of pattern I call and ask if we need to go to the er.
If I were to show up at the er and find you as her doctor I don’t know how I would handle your accusations. Thankfully, she is treated very well in the er. We carry a protocol letter of course. Our geneticist is always notified en route. I don’t even have to cover her history at the er anymore. (sometimes to the nurses, but never to the doctors)
Your “vomiting is always good” may be true in many cases. I’m sure it’s true in most cases. In fact, I have four other children for whom it is true. But the one kid out there whose parent is fretting over “do I call the doctor?” doesn’t deserve to die or suffer permanent organ damage just because they don’t fit the norm.
I see that you understand the exception to the rule when it comes to phengergan. When it is YOUR child being the exception doesn’t really mean anything.
Not that you will care what a parent has to say…but I’m offering my two cents for other parents here. This is my version of vomiting protocol.
If you think your child’s vomiting may be pathological:
1) Failed ORT is an important sign. However, the er doctor will assume you did it wrong.
Document your attempts at ORT. Write the name of the liquid, the method of administration, and results. TAKE THIS WITH YOU to the emergency room. This is YOUR responsibility. Continue administering the failing ORT in the waiting room. Failure to take proof, including the liquid, the measuring device, and your records can endanger your child. You may also end up paying multiple er copayments per day.
2) Pathological vomiting differs from gi vomiting. In my experience, gi vomiting always smells bad. It is violent, gagging, hot, and very stinky. Acidosis vomting is not at all like that. When goes in comes back out quietly, without change, without emotion, and without smell. If this is your child, go to the emergency room. If at first they don’t do labs just sign back in and go back through. (Tip, try an adult er. Even though you will be transferred, your child will get labs that will identify the emergency. You will transferred to a hospital room, not to another waiting room.)
My heart goes out to any child suffering. I hope their parents find the strength to persevere for their child’s sake.
Thanks for your comments. I welcome all view points and perspectives here. It sounds to me that your child fell well within the worrisome symptoms that I mentioned in this post (like lethargy). Lethargy associated with vomiting always warrants evaluation. Since I was not the health care provider who saw your child I have no idea what the management strategy was for your child. A trial of ORT seems a reasonable place to start but a failed trial of ORT without improvement in symptoms is always an indication for escalation of care.
As for the comments about sadists and children deserving to die… this is just not useful discussion. An otherwise healthy child, without the worrisome signs mentioned in my post, who has a stomach virus… does not need IV fluids. Sure they can be given. It may well make the parent feel better but the long wait in the ER, the IV, the medical expense… it is not really what the child needs. The child needs to be cared for at home by their parents initially. In well over 99% of cases this is all the care that will be required.
In rare cases the vomiting is not caused by a stomach virus and it may be something more serious. It seems that this was the case for your child. This is the reason I have detailed the list of worrisome symptoms and what to expect with vomiting. As I have stated in my post, worrisome symptoms and atypical progression of symptoms requires a visit to the ER or a call to your health care provider. What happens in these cases is not the subject of this post. Obviously your child needs IV fluids when she is ill… she has a rare genetic disorder that predisposes here to life-threatening metabolic acidosis. The trauma associated with accessing her port is minor in the setting of her medical condition.
As for what I would have done for your child I can tell you because I do it all the time. If your child had vomited a few times but was running around the room and had no other worrisome symptoms (the vast majority of kids I see), I would have given her a trial of ORT along with parental education. I would have watched her for one hour. If she did not have any additional vomiting and still looked well, I would have sent her home with precautions to return for worsening symptoms.
If she was lethargic or had other worrisome symptoms I would have still given a trial of ORT and observed for an hour. If things were not better (or she failed ORT), she would have gotten additional work up.
Your comments in the end are especially useful. Thank you for them as many doctors and nurses do assume that ORT has not been given properly. Your advice is good advice for parents or children with pathological vomiting.
I am glad to hear that in the end the medical system was able to diagnose and treat your child.