It is not uncommon for parents to come into the ER after their child has had one or two episodes of vomiting requesting IV Fluids. This is simply not a good idea. Most children with a few episodes of vomiting do not need an IV. Especially since the process of getting an IV can be quite torturous for kids.
Other parents come into the ER requesting anti-nausea medicine for their kids. Historically, the most commonly prescribed medication for nausea in kids was Phenergan (promethazine). While there is some evidence that it might improve nausea and vomiting, for the most part, this medicine and others like it are often used in an irrational and unsafe way.
Understanding Vomiting
Vomiting is a good thing
When you are vomiting, this is generally a good thing. Your body generally does not start spewing out all of your stomach contents unless there is good reason. Most of the time, vomiting in kids is caused by one of two things:
- A stomach virus (The Stomach Flu)
- Food poisoning
Both of these things are bad for you. Thankfully your body is good at keeping an eye out for these things. If you happen to get one, your body will quickly help you rid yourself of the intruder with lots of vomiting. So if you understand why you are vomiting, then you also understand why it is not a good idea to stop the vomiting.
But what about dehydration
I see people in the ER all the time that are afraid their child may be getting dehydrated because they vomited one or two times. If it only took one or two episodes of vomiting to cause dehydration, we would not have lasted very long as a species. The truth is that it takes some time to get dehydrated simply by vomiting. When you vomit you do not lose much body fluid. You generally only lose what is in your stomach. Thus vomiting only causes dehydration because you are unable to drink fluids – not because you are losing lots of fluid. Thus for most kids over 6 months of age, it takes 24 hours or longer to get dehydrated simply from vomiting.
The good news
The good news is that most cases of vomiting will resolve in 12-24 hours. Generally your kid will have about 6 hours of frequent and often violent vomiting. After 4-5 episodes, most of what is in their stomach will be gone and the vomiting will turn into dry-heaves. Gradually between 6-12 hours the vomiting will start to slow and by 24 hours the vomiting is mostly gone.
When Should I be Concerned?
Vomiting bile
Bile is secreted by the gall bladder into the intestine. It is a dark green color. Now read this line closely – it is not a yellow-green color. Normally stomach juice is yellow-green. Bile looks like Christmas tree green – very dark. If your child is vomiting bile this may be a symptom of an intestinal obstruction. This is generally associated with a distended abdomen and severe abdominal pain. Mostly this kind of thing is seen in small babies or kids that have had a previous abdominal surgery.
This is a good example of Bile colored emesis (vomit). Notice it is dark green, not a yellowish green color.
Vomiting blood
This obviously is not normal. However, a streak or two of blood that happens after several episodes of vomiting is not a big deal. In fact, it is pretty common to have a few streaks of blood after several episodes of very forceful vomiting. The blood is the result of irritation to the lining of the esophagus. Copious amounts of bright red blood, on the other hand, is worrisome. I would suggest calling your doctor or visiting the ER if your child is vomiting lots of bright red blood.
Vomiting with severe pain
Kids that have a stomach virus or food poisoning will feel bad, but they should not have severe stomach pain. If your child is vomiting and having severe pain, a trip to the doctor is probably a good idea. A “tummy-ache” is not severe abdominal pain. Remember to assess your kid, do not succumb to fear and irrationality. If your child is simply saying that their tummy hurts but not in significant distress, then it is probably not severe pain. If, on the other hand your child is crying incessantly on account of the pain, then the pain may be severe.
Vomiting in small babies
Children less than 3 months of age are a bit more fragile than older babies. As such we generally recommend that parents err on the side of caution with smaller babies. A call to your doctor or a visit to the ER is always appropriate if you are concerned about your small baby. That said, you should again exercise some rational assessment of the situation. All babies have reflux or “spitting-up.” A trip to the ER for “spitting-up” that has been going on for weeks is unlikely to be a good use of your time as parent. However, projectile vomiting and large amounts of frequent vomiting in small babies may indicate something more serious and should generally be evaluated.
Vomiting lasting longer than 24 hours
It is not typical for the vomiting from a stomach virus or food poisoning to last more than 24 hours. In some cases it will, but generally the vomiting resolves between 12-24 hours. If your child is unable to keep any fluids down on account of recurrent vomiting for more than 24 hours a call to your pediatrician is warranted.
Vomiting with profuse diarrhea
Kids who have profuse, watery diarrhea can lose a fair bit of body water through their diarrhea. Generally this is not a problem because kids can compensate for the lost body water by drinking more. However, when vomiting and profuse watery diarrhea are going on at the same time, this can lead to dehydration. Fortunately, for most kids, the vomiting and diarrhea are either very short lived (6-12 hours), or the diarrhea does not start until the vomiting resolves. If your child is having profuse water diarrhea (and by this I mean blowing out their diaper 15-20 times per day) and having lots of vomiting, then they may need to be evaluated if things do not improve after 6-12 hours.
Vomiting with lethargy, high fever, or abnormal breathing
In rare situations vomiting may be a sign of a rare genetic condition or rare serious infection. It is normal for kids to have some fever but high fever generally warrants a call to your pediatrician. Likewise, kids may not be their typical energetic self when they are sick with a stomach virus… but lethargy , especially if it gets progressively worse, should be evaluated.
Some kids with diabetes or other rare disorders may have too much acid in their blood. This is called metabolic acidosis. These kids often develop vomiting and a very distinctive breathing pattern called Kussmal breathing. This breathing pattern consists of taking very deep breaths. It is very distinctive and often associated with a strange odor.
Other things to worry about???
Obviously if all it took to be a pediatrician was to read this web page… then why would anyone spend all that time and money on medical school and training. While this list covers just about very possible thing I can think of, there is an extensive list of things that may cause vomiting which I have not included. If it is not on this list it is probably sufficiently rare that I have never seen or even read about it.
The biggest thing you should worry about though is not these rare conditions. It is whether or not you are attempting to replace your doctor with this website or the internet. I am not your doctor and this website is not advice for your specific situation. This information is meant to educate you so that you can more effectively communicate with your own health care provider to decide on the optimal medical care of your children.
To Summarize…
Vomiting in most kids is usually no big deal. In most cases, it is the result of a stomach virus or food poisoning, neither of which is serious. In fact, vomiting is actually good for you since it eliminates the toxins of food poisoning or the stomach virus. In certain situations, there may be something more serious going on. However, this is the rare exception, not the rule. Do your best to use good parental judgment and try not to be overwhelmed with parental anxiety. Remember the ER is not always a friendly place for your child to hang out when they have a minor illness.
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