Vomiting Without Diarrhea

DEFINITION

• Vomiting is the forceful emptying (throwing up) of a large portion of the stomach's contents through the mouth
• Nausea and abdominal discomfort usually precede each bout of vomiting

• Main cause: stomach infection (gastritis) from a stomach virus (e.g., Rotavirus). The illness starts with vomiting but diarrhea usually follows within 12-24 hours.
• Food poisoning from toxins produced by bacteria growing in poorly refrigerated foods (e.g. Staphylococcus toxin in egg salad or Bacillus cereus toxin in rice dishes).
• Serious causes: If vomiting persists as an isolated symptom (without diarrhea) for more than 24 hours, more serious causes must be considered. Examples are appendicitis, kidney infection, meningitis, head injury, etc.
• Vomiting can also be triggered by hard coughing. This is common especially in children with reflux.

• MILD: 1 - 2 times/day
• MODERATE: 3 - 7 times/day
• SEVERE: Vomits everything or nearly everything or 8 or more times/day
• Severity relates even more to the length of time that the particular severity level has persisted. At the beginning of a vomiting illness (especially following food poisoning), it's common for a child to vomit everything for 3 or 4 hours and then become stable with mild or moderate vomiting.
• The younger the child, the greater the risk for dehydration.

• Your child can return to child care or school after vomiting and fever are gone.

See More Appropriate Topic (instead of this one) If

• Vomiting occurs with diarrhea, see VOMITING WITH DIARRHEA
• Vomiting only occurs while coughing, see COUGH
• Child under 1 year old and spitting (reflux), see SPITTING UP
• Diarrhea is the main symptom, see DIARRHEA

WHEN TO CALL YOUR DOCTOR

HOME CARE ADVICE FOR VOMITING

1. Reassurance:
   • Most vomiting is caused by a viral infection of the stomach or mild food poisoning.
   • Vomiting is the body's way of protecting the lower intestinal tract.
   • Fortunately, vomiting illnesses are usually brief.
2. For Bottlefed Infants Offer Oral Rehydration Solution (ORS) for 8 Hours:
   • ORS (eg. Pedialyte or the store brand) is a special electrolyte solution that can prevent dehydration. It's readily available in supermarkets and drug stores.
   • For vomiting once, continue regular formula.
   • For vomiting more than once, offer ORS for 8 hours. If ORS not available, use formula.
   • Spoon or syringe feed small amounts: 1-2 teaspoons (5-10 ml) every 5 minutes.
   • After 4 hours without vomiting, double the amount.
   • After 8 hours without vomiting, return to regular formula.
   • For infants over 4 months old, also return to cereal, strained bananas, etc.
   • Return to normal diet in 24-48 hours.
3. For Breastfed Infants, Reduce the Amount Per Feeding:
   • If vomits once, nurse 1 side every 1 to 2 hours.
   • If vomits more than once, nurse for 5 minutes every 30 to 60 minutes. After 4 hours without vomiting, return to regular breastfeeding.
   • If continues to vomit, switch to ORS for 4 hours.
   • Spoon or syringe feed small amounts of ORS: 1-2 teaspoons (5-10 ml) every 5 minutes.
   • After 4 hours without vomiting, return to regular breastfeeding. Start with small feedings of 5 minutes every 30 minutes and increase as tolerated.
4. For Older Children (over 1 Year Old) Offer Small Amounts of Clear Fluids For 8 Hours:
   
   
   • Water or ice chips are best for vomiting in older children. (Reason: Water is directly absorbed across the stomach wall)
   • ORS: If child vomits water, offer Oral Rehydration Solution (e.g., Pedialyte). If refuses ORS, use ½ strength Gatorade.
   • Give small amounts: 2-3 teaspoons (10-15 ml) every 5 minutes.
   • Other options: ½ strength flat lemon-lime soda, popsicles or ORS frozen pops.
   • After 4 hours without vomiting, increase the amount.
   • After 8 hours without vomiting, return to regular fluids.
   • Caution: if vomiting continues over 12 hours, switch to ORS or half-strength Gatorade.
   • Solids: After 8 hours without vomiting, add solids:
     • Limit solids to bland foods. Starchy foods are easiest to digest.
     • Start with saltine crackers, white bread, cereals, rice, mashed potatoes, etc.
     • Return to normal diet in 24-48 hours.
5. Avoid Medicines:
   • Discontinue all nonessential medicines for 8 hours (reason: usually make vomiting worse).
   • Fever: Fevers usually don't need any medicine. For higher fevers, consider acetaminophen (Tylenol) suppositories. Never give oral ibuprofen; it is a stomach irritant.
   • Call your doctor if: vomiting an essential medicine.
6. Sleep: Help your child go to sleep for a few hours. (Reason: Sleep often empties the stomach and relieves the need to vomit). Your child doesn't have to drink anything if he feels very nauseated.
7. Contagiousness: Your child can return to child care or school after vomiting and fever are gone.
8. Expected Course: Vomiting from viral gastritis usually stops in 12 to 24 hours. Mild vomiting with nausea may last up to 3 days.
9. Call Your Doctor If:
   • Vomiting becomes severe (vomits everything) over 8 hours
   • Vomiting persists over 24 hours
   • Signs of dehydration
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.