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Nausea and Vomiting, Age 11 and Younger
Vomiting occurs when a child's stomach contents are forced up the esophagus and out of the mouth. Although nausea may accompany vomiting in adults and older children, children younger than age 3 are usually not able to tell you if they are having nausea. Most of the time vomiting is not serious. Home treatment will often ease your child's discomfort.
Vomiting in a baby should not be confused with spitting up. Vomiting is forceful and repeated. Spitting up may seem forceful but it usually occurs shortly after feeding, is effortless, and causes no discomfort.
Causes of vomiting
A baby may spit up for no reason at all. Overfeeding, not burping your baby after feeding, intolerance to milk or formula, and exposure to tobacco smoke are other reasons why your baby may spit up.
Most vomiting in children is caused by a viral stomach illness (gastroenteritis). A child with a stomach illness also may have other symptoms, such as diarrhea, fever, and stomach cramps. With home treatment, the vomiting usually will stop within 12 hours. Diarrhea may last for a few days or more.
Vomiting can also be caused by an infection in another part of the body, such as strep throat, pneumonia, or a urinary tract infection. In rare cases, vomiting can be a symptom of a serious condition, such as a blockage of the digestive tract (pyloric stenosis), an infection (meningitis) of the fluid (cerebrospinal fluid) and tissues (meninges) that surround the brain and spinal cord, or Reye syndrome.
When a toddler vomits, it is important to make sure he or she has not swallowed medicines, household liquids, or other poisons. Look around the house for empty containers and spills. There may be pills in your child's vomit, or the vomit may have an unusual appearance, color, or odor. For more information, see the topic Poisoning.
A child who falls down and forcefully hits his or her head or belly may vomit because of an injury to those areas. Check your child's body for bruises and other injuries.
Babies and children younger than 1 year old need special attention if they continue to vomit. They can quickly become dehydrated. It is important to replace lost fluids when your child is vomiting. Watch your child carefully, and pay close attention to the amount of fluid he or she is able to drink. Look for early symptoms of dehydration:
- The mouth and eyes may be drier than usual.
- The urine may be less than usual.
- He or she may feel cranky, tired, or dizzy.
Also, be sure to notice the color of the vomit, and count the number of times your child vomits. If your child vomits so frequently that you can't get him or her to drink or vomits every time he or she takes a drink, the risk of dehydration is greater.
Check your child's symptoms to decide if and when your child should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
If you're not sure if a child's fever is high, moderate, or mild, think about these issues:
With a high fever:
- The child feels very hot.
- It is likely one of the highest fevers the child has ever had.
With a moderate fever:
- The child feels warm or hot.
- You are sure the child has a fever.
With a mild fever:
- The child may feel a little warm.
- You think the child might have a fever, but you're not sure.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:
- Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
- Steroid medicines, which are used to treat a variety of conditions.
- Medicines taken after organ transplant.
- Chemotherapy and radiation therapy for cancer.
- Not having a spleen.
Temperature varies a little depending on how you measure it. For children up to 11 years old, here are the ranges for high, moderate, and mild according to how you took the temperature.
Oral (by mouth), ear, or rectal temperature
- High: 104° F (40° C) and higher
- Moderate: 100.4° F (38° C) to 103.9° F (39.9° C)
- Mild: 100.3° F (37.9° C) and lower
A forehead (temporal) scanner is usually 0.5° F (0.3° C) to 1° F (0.6° C) lower than an oral temperature.
Armpit (axillary) temperature
- High: 103° F (39.5° C) and higher
- Moderate: 99.4° F (37.4° C) to 102.9° F (39.4° C)
- Mild: 99.3° F (37.3° C) and lower
Note: For children under 5 years old, rectal temperatures are the most accurate.
Babies can quickly get dehydrated when they lose fluids because of problems like vomiting or fever.
Symptoms of dehydration can range from mild to severe. For example:
- The baby may be fussy or cranky (mild dehydration), or the baby may be very sleepy and hard to wake up (severe dehydration).
- The baby may have a little less urine than usual (mild dehydration), or the baby may not be urinating at all (severe dehydration).
You can get dehydrated when you lose a lot of fluids because of problems like vomiting or fever.
Symptoms of dehydration can range from mild to severe. For example:
- You may feel tired and edgy (mild dehydration), or you may feel weak, not alert, and not able to think clearly (severe dehydration).
- You may pass less urine than usual (mild dehydration), or you may not be passing urine at all (severe dehydration).
Severe dehydration means:
- The baby may be very sleepy and hard to wake up.
- The baby may have a very dry mouth and very dry eyes (no tears).
- The baby may have no wet diapers in 12 or more hours.
Moderate dehydration means:
- The baby may have no wet diapers in 6 hours.
- The baby may have a dry mouth and dry eyes (fewer tears than usual).
Mild dehydration means:
- The baby may pass a little less urine than usual.
Severe dehydration means:
- The child's mouth and eyes may be extremely dry.
- The child may pass little or no urine for 12 or more hours.
- The child may not seem alert or able to think clearly.
- The child may be too weak or dizzy to stand.
- The child may pass out.
Moderate dehydration means:
- The child may be a lot more thirsty than usual.
- The child's mouth and eyes may be drier than usual.
- The child may pass little or no urine for 8 or more hours.
- The child may feel dizzy when he or she stands or sits up.
Mild dehydration means:
- The child may be more thirsty than usual.
- The child may pass less urine than usual.
Many nonprescription and prescription medicines can cause nausea or vomiting. A few examples are:
- Aspirin, ibuprofen (such as Advil or Motrin), and naproxen (such as Aleve).
- Medicines used to treat cancer (chemotherapy).
- Opioid pain medicines.
- Vitamins and mineral supplements, such as iron.
Starting a new medicine or increasing the dose can cause nausea and vomiting. Nausea and vomiting also may mean that there is too much medicine in your body, even if you took it properly.
Repeated vomiting: The child vomits nearly every time he or she tries to drink something. This type of vomiting makes it impossible to keep down any fluids or solid food, which greatly increases the chance of becoming dehydrated. The child has an even greater chance of dehydration if he or she also has diarrhea.
Occasional vomiting: Some young children vomit every once in a while for no clear reason. This usually does not increase the risk of dehydration or other problems as long as the child can keep down fluids between vomiting. The more time that passes between episodes of vomiting, the less serious it probably is. But if the vomiting continues, it may be important to find the cause.
Symptoms of serious illness in a baby may include the following:
- The baby is limp and floppy like a rag doll.
- The baby doesn't respond at all to being held, touched, or talked to.
- The baby is hard to wake up.
Symptoms of serious illness may include:
- A severe headache.
- A stiff neck.
- Mental changes, such as feeling confused or much less alert.
- Extreme fatigue (to the point where it's hard for you to function).
- Shaking chills.
An illness plan for people with diabetes usually covers things like:
- How often to test blood sugar and what the target range is.
- Whether and how to adjust the dose and timing of insulin or other diabetes medicines.
- What to do if you have trouble keeping food or fluids down.
- When to call your doctor.
The plan is designed to help keep your diabetes in control even though you are sick. When you have diabetes, even a minor illness can cause problems.
It is easy for your diabetes to become out of control when you are sick. Because of an illness:
- Your blood sugar may be too high or too low.
- You may not be able take your diabetes medicine (if you are vomiting or having trouble keeping food or fluids down).
- You may not know how to adjust the timing or dose of your diabetes medicine.
- You may not be eating enough or drinking enough fluids.
Colic is an extreme type of crying in a baby between 3 weeks and 3 months of age. All babies cry, but a colicky baby will cry for hours at a time, no matter what you do.
During a crying episode, a colicky baby may cry loudly and continuously and be hard to comfort. The baby may get red in the face, clench the fists, and arch his or her back or pull the legs up to the belly.
A baby that is extremely sick:
- May be limp and floppy like a rag doll.
- May not respond at all to being held, touched, or talked to.
- May be hard to wake up.
A baby that is sick (but not extremely sick):
- May be sleepier than usual.
- May not eat or drink as much as usual.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Newborns and babies younger than 1 year of age
Don't wait until you see signs of dehydration in your baby. These signs include your baby being thirstier than usual and having less urine than usual.
- If you breastfeed your baby, nurse him or her more often. Offer each breast to your baby for 1 to 2 minutes every 10 minutes.
- If you use a bottle to feed your baby, increase the number of feedings to make up for lost fluids. The amount of extra fluid your baby needs depends on your baby's age and size. For example, a newborn may need as little as 1 fl oz (30 mL) at each extra feeding, while a 12-month-old baby may need as much as 3 fl oz (90 mL) at each extra feeding.
- Ask your doctor if you need to use an oral rehydration solution (ORS) if your baby still isn't getting enough fluids from formula or the breast. The amount of ORS your baby needs depends on your baby's age and size. You can give the ORS in a dropper, spoon, or bottle.
- If your baby has started eating cereal, you may replace lost fluids with cereal. You also may feed your baby strained bananas and mashed potatoes if your child has had these foods before.
Children ages 1 through 11
- Make sure your child is drinking often. Frequent, small amounts work best.
- Allow your child to drink as much fluid as he or she wants. Encourage your child to drink extra fluids or suck on flavored ice pops, such as Popsicles. Note: Do not give your child fruit juice or soda pop. Fruit juice and soda pop contain too much sugar and not enough of the essential minerals (electrolytes) that are being lost. Diet soda pop lacks calories that your child needs.
- Cereal mixed with milk or water may also be used to replace lost fluids.
- If your child still is not getting enough fluids, you can try an oral rehydration solution (ORS).
- Gradually start to offer your child regular foods after 6 hours with no vomiting.
- Offer your child solid foods if he or she was eating solids before. Offer crackers, toast, broths, mild soups, mashed potatoes, rice, and breads to your older child.
- Avoid high-fiber foods, such as beans, and foods with a lot of sugar, such as candy or ice cream.
If your child also has diarrhea, try home treatment for diarrhea.
Symptoms to watch for during home treatment
Call your child's doctor if any of the following occur during home treatment:
- Dehydration develops. Signs include your child being thirstier than usual and having less urine than usual.
- Your child's vomiting returns or becomes severe.
- Blood or yellow or green liquid (bile) is present in your child's vomit.
- Your child's vomiting does not get better.
- Your child's symptoms become more severe or frequent.
It is normal for babies to spit up after a feeding. Vomiting after a single feeding may happen sometimes and does not mean your baby has a problem. Repeated vomiting after feedings is more of a concern. The following tips may help your baby spit up less often. If this advice does not help, talk with your doctor.
- Feed your baby smaller amounts at each feeding.
- Feed your baby slowly.
- Hold your baby during feedings.
- Do not prop your baby's bottle.
- Do not place your baby in an infant seat during feedings.
- Try a new type of bottle or use a nipple with a smaller opening to reduce air intake.
- Limit active and rough play after feedings.
- Try putting your baby in different positions during and after feeding.
- Burp your baby frequently during feedings.
- Consider talking to your doctor about starting your baby on hypoallergenic formula. About 1% of babies who spit up are allergic to milk protein.
- Do not add cereal to formula without first consulting your child's doctor.
- Do not smoke when you are feeding your baby. Children who are exposed to tobacco smoke are more likely to develop illnesses that cause vomiting. If you smoke, quit. If you can't quit, do not smoke when you are holding or feeding your baby or when you are in the house or the car. For more information, see the topic Quitting Smoking.
- Consider getting your child the rotavirus vaccine.
- Limit active and rough play after feedings.
- Teach your children how to wash their hands well, especially if there is an illness in the house.
If you use child care, talk to the caregivers about their program or policies for sick children.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:
- Did you have problems during your pregnancy or with the delivery of this child?
- What do you think might be causing your baby's vomiting?
- Has your child been exposed to someone with a similar illness?
- How long has the vomiting been going on?
- Does your child have any other symptoms, such as fever, belly pain, or diarrhea?
- Has your child had a recent fall or injury?
- How many times has your child vomited? How much fluid is lost each time?
- Is your child able to hold down fluids?
- What does the vomit look like?
- Is there any blood or yellow or green liquid (bile) in the vomit?
- Did you find any unusual liquids or pills in the vomit?
- What does the vomit smell like?
- What prescription or nonprescription medicines are in your home?
- Did your child's symptoms start after eating at a restaurant? Has anyone else who ate there with you become ill?
- Has your child recently eaten raw or undercooked seafood?
- Do you think your child may have eaten any contaminated food?
- Has your child recently visited a foreign country?
- Has your child recently drunk water from a lake, stream, or private well?
- Has your child had any known exposure to toxic materials, chemicals, or fumes?
- Does your child have any health risks?
Current as of: October 19, 2020
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine
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