Vomiting

Vomiting, or throwing up, is the act of forcibly emptying the contents of the stomach through the mouth. It is often a symptom of an underlying disease or condition, but can also be a reaction to nausea caused by motion (as in car sickness), medication or an injury. Occasional vomiting is common in childhood, especially when a child is sick. Recurring or chronic vomiting may be a cause for concern, and any extended period of vomiting is a reason to see a primary care provider.

Vomiting is different from a baby’s spitting up, which is the easy flow of milk or other food from the stomach after eating, typically in small amounts and often accompanied by a burp. Spitting up does not usually make the baby uncomfortable. Vomiting is a more forceful ejection of food from the stomach, involving strong muscle contractions in the abdomen and diaphragm. A child who is vomiting is uncomfortable and does not feel well.

Vomiting is usually a symptom of another problem. How long the vomiting continues and the presence of other symptoms, such as fever, are indications of how serious that underlying problem might be and can guide parents in knowing when to call a primary care provider. Recurring vomiting can cause dehydration, especially when it occurs with diarrhea, and this can be a significant medical concern.

Parents should call their primary care provider if an infant or young child has vomiting that lasts for more than a few hours, or if a child over age six has vomiting that lasts for more than 24 hours. Parents of a child who is vomiting should contact their primary care provider or seek medical help right away if:

• The child shows signs of dehydration (dry lips and mouth, sunken eyes, rapid breathing, rapid pulse, decreased urination)
• There is blood in the vomit or the vomit looks like coffee grounds
• There is blood in the stool or the stool has a black, tarry appearance
• The child seems lethargic or confused
• The child has a severe headache or a stiff neck
• The child has severe abdominal pain
• The vomiting occurs after a head injury

A relatively rare form of vomiting, cyclic vomiting syndrome (CVS), is characterized by recurrent episodes of vomiting with periods of wellness in between.

Common causes of vomiting include:

• Infection or irritation in the gastrointestinal tract (as in a stomach bug)
• Food poisoning
• Nausea due to stimulation of or pressure on the middle ear (as in motion sickness or a middle ear infection)
• Overeating
• Emotional stress or fear
• Disturbing sights or smells
• Reactions to chemicals or medication

Chronic, recurring vomiting can be caused by:

• Food or milk allergies
• Gastroesophageal reflux (GER)
• Anatomical abnormalities, such as blocked intestine (small bowel atresia)
• Inflammatory bowel disease (IBD)
• Bulimia nervosa or another psychological illness

Vomiting can also be caused by:

• Concussion or head injury
• Migraine headaches
• Abnormally high or low blood sugar levels due to diabetes
• Appendicitis
• Accidental poisoning
• Brain tumors
• Some forms of cancer

Diagnosis starts with a physical examination and a careful history. The primary care provider will ask questions about when the vomiting began, how frequently it is occurring, and whether it is accompanied by other symptoms, such as fever, diarrhea or signs of an allergic reaction. The primary care provider will also look for signs of dehydration.

Based on information from the examination and history, the primary care provider may order tests and imaging. These may include:

• Blood tests
• Stool tests
• Urinalysis
• X-ray, ultrasound, CT scan or MRI
• Endoscopy or colonoscopy

Treatment for vomiting starts with addressing the risk of dehydration and calming the stomach to reduce feelings of nausea.

• A child who is vomiting should be given clear liquids to drink, in small amounts at first, then in gradually larger amounts. Water, Pedialyte, sports drinks with electrolytes, diluted fruit juice (but not orange or grapefruit juice), Jell-O, Popsicles and clear broths can all help to prevent dehydration.
• Solid foods should be avoided until the episode of vomiting has passed. When starting solid foods after an episode of vomiting, begin with bland foods, such as bananas, rice, applesauce and toast (the BRAT diet).
• It may help to have the child sit upright or lie with the head elevated on pillows.

Vomiting from motion sickness can be prevented by seating the child in the middle of the back seat, with a view out the front window, and by avoiding reading and video games in the car.

How to Treat Dehydration from Vomiting

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Medical treatment for more severe cases of vomiting may include:

• Intravenous fluids
• Anti-nausea medications (antiemetics)
• Treatments to address an underlying condition that is causing the vomiting
• Changes to medications, if these are found to be causing the vomiting or contributing to feelings of nausea