What To Do When a Baby or Toddler Vomits

By Laura Hunter (LPN) and Jennifer Walker (RN BSN)

Vomiting: large amounts of vomit, with forceful emptying of stomach contents, more than 2-3 times. Although there are various causes of vomiting, we see it most often associated with a gastrointestinal virus. These types of viruses usually start with vomiting every 30-45 minutes for the first 6-8 hours then maybe an isolated episode of vomiting on day two or three.

Treatment:

Try to wait about an hour after the child vomits. Then you can try one tsp of clear liquids (breastmilk, water, Pedialyte) every 10 minutes for the first 2-3 hours while awake, with an occasional teaspoon of heavy peach syrup. (Now you know why we mentioned the peaches in heavy syrup in the general shopping list! It coats the stomach and helps children keep the liquids down.) You can then begin to increase the amount of fluids by adding another teaspoon of fluids every ten minutes for the next 2-3 hours. (One teaspoon, wait ten minutes, two teaspoons, wait ten minutes, three teaspoons and so on.) Sucking on popsicles or a wet washcloth is a way of ensuring that they are not swallowing too much at one time. A teaspoon of jello would be good. You can sit on the couch and give sips of clear liquids from a medicine dropper if you need to as well.

If the child goes 6-8 hours without vomiting try to breastfeed a limited amount, increasing as tolerated or use 1-2 ounces of formula every 30 minutes for 2-3 hours as tolerated. If no vomiting after 12 hours, begin returning to a normal diet slowly.

If the baby vomits during any of above, return to step one.

Avoid giving medicines for 8 hours (with the approval of the pediatrician). If running a fever of 102 or more rectally, then use Fever-All® suppositories if permitted by your pediatrician.

If older than a year, no milk for 24 hours from the last time that they vomit. After no vomiting for 6-8 hours try starchy foods such as toast or crackers and gradually return to a normal diet.

Common Errors

  • -Giving too much fluid at one time.
  • -Not waiting the hour before beginning fluids.

Sometimes when a gastrointestinal virus is causing vomiting in a child, no matter what you feed them or how often you feed them, the vomiting will continue. If your child is crying for fluids and it has not been an hour after vomiting, it is okay to give it, just try to have them drink slowly. (We realize that you only have so much control over how quickly they drink.) When they are experiencing these symptoms, it is crucial to monitor for the following additional symptoms.

When to Seek Medical Care

Signs of dehydration:
Not urinating at least every 6 hours. (You may want to place toilet tissue in the diaper to check for wetness because the absorbent nature of today’s diapers makes it hard to tell if the baby has urinated at all.)

  • -When you run your pinky finger over the inside of their bottom lip it is dry and tacky as opposed to smooth and moist. tries to cry but cannot cry tears.
  • -Marked lethargy.
  • -Unable to hold down one tablespoon of fluid after 2-3 attempts. (Remember to wait 30 minutes to an hour after each vomiting episode.)
  • -Vomits blood
  • -Neck stiffness
  • -Rash
  • -Vomiting that continues > 24 hours
  • -Fever
  • -Vomiting bile – fluorescent yellow or green goo.
  • -Abdomen hard and tender at rest (hard like a table top, as opposed to soft like a really full balloon).
  • -Blood in stool (more than 1 tsp bright red blood) Call pediatrician if the child has a fever of 103.5 rectally or higher. (Or a baby under 3 months with a 100.4 or higher rectal temperature)

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