Patient education: Nausea and vomiting in babies and children (The Basics)

What are nausea and vomiting? — Nausea is the feeling your child has when they think that they might throw up. Your child might say that they have a "stomach ache" or feel "sick to their stomach." Vomiting is when they actually throw up.

Vomiting is different than spitting up, but, sometimes, people use these terms interchangeably. Babies often spit up with a burp after a feeding. This is known as "regurgitation" or "reflux."

What can cause nausea and vomiting? — Nausea and vomiting are common in children. They are usually part of a mild, short-term illness, often caused by a virus. The possible causes of vomiting depend on the child's age.

In newborns and very young babies (under 3 months old):

●Spitting up is common in babies and is normal. Vomiting is usually more forceful, and the baby might seem sick.

●Repeated vomiting with force, or having symptoms such as a fever of 100.4°F (38°C) or higher, can be a sign of a serious problem. Examples include a blockage in the stomach or intestine, or an infection.

In older babies, children, and teens:

●The most common cause is an infection of the stomach and intestines, usually caused by a virus. The medical name for this is "gastroenteritis." This infection is easily spread from person to person.

●Food poisoning can happen if your child eats food that has gone bad or that hasn't been washed or cooked enough. Food poisoning often also causes diarrhea.

●Other illnesses that can cause vomiting include an ear infection, strep throat, migraines, or inflammation or blockage in the intestines.

●Other things can also cause vomiting in teens. These include frequent use of marijuana or other substances, or pregnancy.

How is nausea and vomiting treated? — If your child's nausea and vomiting lasts for more than a day or so, the doctor might need to:

●Change your child's diet

●Give your child fluids through a thin tube that goes into a vein, called an "IV"

●Do tests to help find out the cause, such as:

•Blood or urine tests

•Imaging tests – These include X-ray, ultrasound, MRI, and others. These tests create pictures of the inside of the body.

What can I do to help my child feel better? — You can:

●Offer your child fluids, starting with small amounts. They can drink more as they start to feel better. If your child is vomiting a lot, you can try:

•For children less than 1 year old – Start by giving small amounts of fluids (1 to 2 teaspoons, or 5 to 10 mL) every 10 to 15 minutes. You can give breast milk, baby formula, or an oral electrolyte solution (sample brand name: Pedialyte). If you are breastfeeding, you can try to breastfeed more frequently and for a shorter amount of time. If you are not breastfeeding, you can give the fluids in a bottle, or with a spoon or syringe.

•For children over 1 year old – Have them sip small amounts of an oral electrolyte solution. If your child won't drink that, try a sports drink or juice mixed with an equal amount of water. For younger children, start by giving a few teaspoons (5 to 10 mL) every 10 to 15 minutes. Older children can start with a few sips and slowly increase how much they drink as they feel ready.

If your child vomits after drinking, wait 30 minutes and try again. If they can keep these small amounts down without vomiting, gradually increase the amount. If they do not vomit after 2 to 3 hours, you can go back to normal feeding.

●If your child has been vomiting, avoid giving them solid foods for a few hours. If they start to feel hungry and are able to drink fluids, offer foods that have a lot of fluid in them. Good examples are soup, gelatin, and ice pops. If this goes well, offer soft, bland foods if they feel ready. Foods that are high in carbohydrates ("carbs"), like bread or saltine crackers, can help settle the stomach. Other good foods to eat are noodles, rice, oatmeal, soup, soft vegetables, fruits, or lean meats. Avoid foods and drinks with a lot of sugar.

●Talk to your child's doctor or nurse before giving your child any over-the-counter medicines for diarrhea or vomiting.

When should I call the doctor? — Call for emergency help right away (in the US and Canada, call 9-1-1) if your child:

●Won't wake up

●Seems very sleepy, and has 1 or more of these signs of severe fluid loss:

•Skin is mottled and cool, and hands and feet are blue

•Eyes are sunken

•No urine for 24 hours

•The soft spot on their head is sunken (for babies)

Call the doctor or nurse for advice if your child:

●Has a severe belly ache

●Can't keep any fluids down, has not had anything to drink in many hours, or has trouble feeding normally

●Has vomit that looks green or has blood in it, or has bloody diarrhea

●Continues to vomit for more than 24 hours

●Is not as alert as usual, is very sleepy, is much less active, or cries all the time

●Hasn't needed to urinate in the past 6 to 8 hours (in older children), or hasn't had a wet diaper for 4 to 6 hours (in babies and younger children)

●Has dark-colored urine

●Has a dry mouth, or few or no tears when they cry

●Has a fever of 100.4°F (38°C) or higher that lasts more than 2 to 3 days

●Has diarrhea that lasts more than a few days, or has blood in their bowel movements

Can nausea and vomiting be prevented? — It depends on the cause. You can do things to lower the risk of getting or spreading an infection that causes nausea and vomiting:

●Wash your hands often with soap and water, and make sure that your child washes their hands (figure 1). This is especially important if you have been around someone who is sick. It's also important to wash your hands before you eat and after using the bathroom or changing diapers.

●Pay attention to food safety. This includes avoiding unpasteurized milk, washing fruits and vegetables before eating them, not eating undercooked food, and washing all cooking utensils. Wash hands thoroughly after touching raw food.

More on this topic

Patient education: Appendicitis in children (The Basics)
Patient education: Motion sickness (The Basics)
Patient education: Dehydration in children (The Basics)
Patient education: Pyloric stenosis in babies (The Basics)

Patient education: Acid reflux (gastroesophageal reflux) in babies (Beyond the Basics)
Patient education: Acute diarrhea in children (Beyond the Basics)
Patient education: Foodborne illness (food poisoning) (Beyond the Basics)
Patient education: Gastroesophageal reflux disease in children and adolescents (Beyond the Basics)
Patient education: Nausea and vomiting in infants and children (Beyond the Basics)