What is vomiting?

Vomiting is the emptying (expulsion) of the stomach contents through the mouth. Vomiting is not a disease but is a symptom of many types of diseases. In children, vomiting is usually self-limiting and not dangerous unless it is caused by a serious underlying disease.

Are there various ways of vomiting?

Vomiting can manifest in different forms :

• Reflux – Reflux is when some amount of milk feeds comes back up from the stomach slowly. This is usually caused by the accidental opening of the valve separating the stomach from the oesophagus. This is very common during the first few months of a baby’s life and does not cause harm.
• Possetting/ regurgitation – Possetting occurs when a little bit of milk is regurgitated by your baby usually right after a feed.  This is very common in babies.
• Projectile vomiting – Projectile vomiting occurs when the baby’s stomach contents is brought up in a forceful manner through the mouth. The amount emptied out is usually larger.

What are the causes of vomiting?

Common causes of vomiting:

• Minor childhood infections such as viral infections or ‘stomach flu’.
• Food poisoning.
• Motion sickness.
• Overfeeding.

Uncommon but serious causes of vomiting :

• Brain infections (meningitis of encephalitis).
• Brain concussion/injury.
• Brain tumours.
• Blocked intestines (intestinal obstructions).
• Urinary tract infection.
• Diabetic ketoacidosis.
• Liver failure.
• Kidney failure.
• Metabolic disorders.
• Appendicitis.
• Pancreatitis.

What are the other important signs and symptoms to look for?

Besides the obvious vomiting, a child may develop other signs and symptoms if the vomiting is severe.

Dehydration occurs when the child vomits too much and is not getting enough replacement fluids.

Dehydration is graded as:

Mild to moderate dehydration

• Dry mouth / tongue.
• Cracked lips.
• No or few tears when crying.
• No urination for 4-6 hours (no wet diapers during that period).
• Soft spot on top of baby’s head looks sunken.
• Fretful behaviour.

Severe dehydration

All the signs above and additional signs such as :

• Dry, wrinkled skin.
• Child looks listless, very tired and inactive.
• Sunken eyes.
• Breathing seems laboured/difficult.
• Pulses feels weak and very fast.
• Child’s limbs feel very cold.
• Refusal to feed.

Danger signs

When these signs are present, the child may have a more serious underlying condition

• Projectile vomiting especially in infants less than 1 month.
• Fever > 38 degrees Centigrade.
• Vomiting out blood.
• Vomiting out greenish fluid.
• Vomiting after injury to the head.
• Disorientation, drowsiness.
• Pale looking.
• Yellow discolouration of the eyes.
• Breathing difficulties.
• Severe abdominal pain.
• Excessive bloating of abdomen.
• Persistent vomiting and unable to feed.

What are the complications that may arise from vomiting?

Complications are due to dehydration and other underlying serious conditions as mentioned above.

Other complications include:

• Organ dysfunction like kidney failure.
• Injury to oesophagus due to recurrent vomiting.
• Those related to child’s underlying disease.

How should vomiting be treated?

Whatever amount has been vomited out needs to be replaced so that your child does not get dehydrated.

For infants less that 6 months old:

• Give your baby small and frequent amounts of an oral rehydration salt (ORS) solution – give 2 to 3 teaspoons every 15 to 20 minutes.
• If your baby can keep down the solution, slowly increase the amount of solution you give (not more than what your baby would normally take in each feed).
• Do not give plain water or flavoured ORS solutions.
• If your baby is formula (bottle) fed, reintroduce the milk slowly to your baby if there is no more vomiting for 6-8 hours.
• If your baby is exclusively breastfed, breastfeed for 5-10 minutes on each side every 2 hours. Slowly increase your feeding time once baby has stopped vomiting for 6-8 hours.

For infants 6 months to 1 year:

• Give your baby small and frequent amounts of an oral rehydration salt (ORS) solution – give 3 teaspoons every 15 to 20 minutes.
• If your baby can keep down the solution, slowly increase the amount of solution you give (not more than what your baby would normally take in each feed).
• Do not give plain water.
• Flavoured ORS solutions may be used.
• If there is no more vomiting in the next 6-8 hours, slowly restart back your baby’s normal milk feeds.
• Begin the milk feeds with small amounts and increase gradually as your child is able to tolerate more.

For children older than 1 year:

• Give your child small and frequent amounts of oral rehydration salt solution (ORS) or other clear fluids – give 3 teaspoons every 15 to 20 minutes.
• Flavoured ORS solutions may be used.
• If your baby can keep down the solution, slowly increase the amount of solution you give (not more than what your baby would normally take in each feed)
• If there is no more vomiting in the next 6-8 hours, slowly try to feed your child some bland soup or mild food (bread, non-spicy rice or noodles)
• Do not force your child to eat.
• After 24 hours with no vomiting, slowly start back your child on his normal diet.

Caution

Seek medical attention if:

• Your child continues to vomit and refuses to feed.
• Your child has any of the danger signs mentioned above.

Can vomiting be prevented?

It is often difficult to prevent vomiting due to infections or other more serious diseases but there are a few basic things you can do to prevent motion sickness and posetting/regurgitation.

To minimize motion sickness:

• Do not give plenty of soft drinks and candy to your child in the car.
• Seat them in a car seat facing forwards and block the side-windows with car shades.

To minimize possetting/regurgitation:

• Do not feed your baby too much during one feed. Instead feed less each time but feed more frequently.
• Hold your baby upright and burp baby in the first twenty minutes after feeding.
• Avoid bouncing baby on your lap or placing them slouched in an infant seat after feeding.
• When laid down to sleep, place baby’s head end slightly higher than the foot end.