3 Tips for Managing Vomiting in Infants and Children

It can be daunting for parents to see their child vomiting, especially when this occurs in the evening after the pediatrician's office may be closed.

It can be daunting for parents to see their child vomiting, especially when this occurs in the evening after the pediatrician’s office may be closed. Pharmacists are very accessible and can be a great resource to provide support and counseling tips for families. Parents may be overwhelmed with trying to determine the cause of the vomiting as well as management options. Vomiting in children is generally caused by gastroenteritis, which is an infection of the digestive tract.

Here are 3 tips for managing vomiting in infants and children:

Educate parents to stay calm.

Vomiting can be frightening for children and parents. Children will become exhausted, so rest along with replacing the fluids lost is extremely important. Reassure parents that their child will most likely feel better within 24 hours.1 Educate parents to wash their hands frequently with soap and water to avoid contracting the infection from their children. It can be challenging for parents to care for their children when they are sick themselves.

Prevent dehydration through oral rehydration therapy (ORT).

Sports drinks, sodas, and juices should be avoided in children since they contain inadequate sodium and too large a quantity of carbohydrates. After the child vomits, parents should wait about 30 minutes for the stomach to settle before initiating ORT. Recommend an ORT solution such as Pedialyte, which is available over-the-counter. The estimated electrolyte requirements are based on weight (Table 1).

Table 1: Estimated Electrolyte Requirements by Weight for Vomiting1

Body Weight (pounds)

Electrolyte Solution Requirements (ounces in 24 hours)

6-7

16

11

23

22

40

26

44

33

51

40

61

If an infant vomits an entire feeding more than once and is exclusively breastfeeding, then the baby should be breastfed for shorter periods of time (5 to 10 minutes at a time) every 2 hours.2 The feeding time can be increased as the infant is able to tolerate, and after about 8 hours the normal breastfeeding schedule can be resumed.2

Formula-fed infants should receive about 2 teaspoons (10 ml) of an unflavored electrolyte solution every 15-20 minutes with a spoon or an oral syringe.2 Juice (about 3 ml) can be added to the electrolyte solution for infants 6 months and older as a flavor enhancer.2 The solution amount can be increased once the infant can tolerate the solution without vomiting for more than 2 hours. Formula can be restarted after the infant goes more than 8 hours without vomiting.

Children 1 year of age and older should receive ORT in small amounts every 15 minutes.2 Other clear liquids include ice chips or sips of water, broth, and gelatin desserts.

Educate parents to watch for the following signs and symptoms of dehydration:2

  • Dry or sticky mouth
  • Few or no tears when crying
  • Sunken eyes
  • Sunken soft spot in babies
  • Urinating less frequently or fewer wet diapers
  • Dry, cool skin
  • Irritability
  • Drowsiness or dizziness

If children do not improve after receiving ORT, then they may need intravenous fluids in the hospital.

Keep children off of solid foods for 24 hours after vomiting.

Solid foods should be avoided for about 24 hours. The BRAT diet (bananas, rice, applesauce, and toast) is an effective way to reintroduce food after vomiting. These bland foods can help children ease into normal eating. Once these bland foods are tolerated, then a normal diet can gradually be reintroduced.

References

  • American Academy of Pediatrics. Treating vomiting. https://www.healthychildren.org/English/health-issues/conditions/abdominal/pages/Treating-Vomiting.aspx. Accessed December 10, 2017.
  • KidsHealth. Vomiting. http://kidshealth.org/en/parents/vomit.html. Accessed December 10, 2017.