Vomiting is the forceful removal of milk and other stomach contents. In children, there are many causes of vomiting in conjunction with other symptoms, like abdominal pain, fever, and diarrhea. For kids whose symptoms are mainly vomiting, some possible explanations are pyloric stenosis, cyclic vomiting syndrome, migraines, food allergies, adverse drug effects, diabetes, and motion sickness. When treating your child’s vomiting, keep them well-hydrated and bring them to the doctor to rule out severe conditions.
Vomiting can be a symptom of illnesses like gastroenteritis or urinary tract infections.
Often there are other symptoms that go along with vomiting, which helps healthcare providers determine what illness or condition your baby might have.
But what if your child only has vomiting and no other symptoms and is completely fine for a few days before vomiting again? Is it a potentially serious concern?
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Let’s define vomiting first
What is vomiting?
It’s when food (and other contents) from your stomach are emptied out through the mouth with a lot of force.
This is different from spit-ups, also known as regurgitation, in younger kids. In regurgitation, milk comes out from the mouth effortlessly (without any force) in small amounts.
What causes vomiting?
There are many possible reasons for vomiting in children; the most common is a mild viral infection.
The Children’s Hospital of Philadelphia listed these conditions as some of the causes of vomiting:
- Migraines and cyclic vomiting syndrome
- Middle ear infection
- Food or milk allergies
- Gastroesophageal (acid) reflux
- High or low blood sugar level
- Inflammatory bowel disease
- Overeating and eating disorders
- Head injury
- Motion sickness
- Emotional stress
- Adverse effects of medicine or chemicals
- Accidental poisoning
While there may be cases when kids have only vomiting, most of the time, these conditions have other symptoms, such as nausea, fever, or diarrhea.
We will focus on several conditions where the main symptom is vomiting.
Newborns and infants who have intense vomiting episodes, but become hungry after each episode, might have pyloric stenosis.
In this condition, the passageway between the stomach and the intestines becomes narrower, making it hard for milk to pass through.
This is an urgent illness that is treated with surgery.
Cyclic vomiting syndrome (CVS)
Cyclic vomiting syndrome is a rare medical condition that is usually seen in kids at preschool age.
They vomit several times, usually at night, with no other symptoms of an infection. Often these vomiting episodes suddenly stop after a few hours or days.
There isn’t a clear cause for CVS, but studies have shown that there are certain triggers. These include infections, allergies, psychological stress, sleep deprivation, and even menses.
Because many vomiting episodes can lead to dehydration, some children need to have intravenous (IV) fluids at the ER.
CVS usually resolves during teenage years, but it makes affected kids prone to migraines as they grow older.
Because younger children may not be able to communicate properly, they might actually be experiencing symptoms other than vomiting — in this case, headache.
Migraines are throbbing headaches that involve only one side of the head.
According to the American Academy of Pediatrics, migraine headaches can happen in children, even those younger than 4 years old.
Allergic reactions can manifest in different ways: rashes and swelling are most frequently seen in kids.
Other signs and symptoms of food allergies include vomiting immediately after ingesting the food.
If you suspect a food allergy, it’s best to bring your child to the Emergency Department to be appropriately evaluated and to prevent the allergic reaction from worsening.
Yes, kids can also have diabetes. Type 1 diabetes mellitus (T1DM) is a type of diabetes more commonly seen in children because it can be inherited (compared to Type 2).
More often than not, children with T1DM are diagnosed when their blood sugar levels go so high that they exhibit symptoms needing urgent care.
This is called diabetic ketoacidosis (DKA).
In DKA, they may have body weakness, vomiting, abdominal pain, difficulty breathing, frequent urination, and even some weight loss.
Not all of these symptoms are present for each person — it is possible for kids with DKA to present with vomiting alone.
Adverse drug effects
If your child is currently taking medicine for another medical condition, vomiting may be a side effect. All medicines have side effects, but only a small number of people experience these.
Some common medicines that can cause vomiting (although this rarely happens, as medicines go through rigorous reviews before being introduced publicly) are ibuprofen, some antibiotics, and even some multivitamin supplements.
If you or your relatives have motion sickness, chances are your child might have it too.
Something as mild as quick car rides to something more intense, such as boat rides and amusement park rides, can cause motion sickness.
In this case, kids may also feel nauseated first before vomiting.
What initial treatment can we give?
Vomiting puts your child at risk for dehydration. The more they vomit, the higher the amount of fluids lost in the body, making them feel weaker.
Giving fluids at the start of vomiting episodes will lessen the chances of dehydration.
Children can be given water or oral rehydration solution. These drinks come with electrolytes, such as sodium, potassium, and chloride. A common example is Pedialyte.
Clear broths and popsicles may also help.
When you’re sure your child can tolerate fluids (typically a few hours), start with bland, solid foods. This is the BRAT diet, which consists of bananas, rice, applesauce, and toast.
If your child is in pain, you can give over-the-counter medications such as acetaminophen. Double-check with your healthcare provider if NSAIDs are safe for your child’s condition.
Some of the conditions listed above will definitely need in-hospital management. To be safe, it’s best to have your child seen by a healthcare provider to rule out serious conditions, such as T2DM and pyloric stenosis.
If your child has been taking in new food or medicines, consider an allergy or adverse reaction, respectively. Stop giving the suspected allergic trigger, and bring your child to an allergy specialist.
My child keeps on vomiting. When should I go to the ER?
Episodes of vomiting without fever or diarrhea for at least 24 hours are a signal to visit the ER.
If your child has any signs of bleeding (blood in the vomit or in their stool), intense abdominal pain, or stomachache, bring them to the ER.
If your child looks dehydrated, just had a head injury, is complaining of a headache or a stiff neck, or seems to be confused when spoken to, they should also be evaluated at the ER.
What are the signs of dehydration?
Some signs of dehydration are dry lips and mouth, sunken eyes, no tears when crying, and dark or low urine output.
If you know how to feel for your child’s pulse, a weak or thready pulse might also indicate dehydration.
Vomiting is the forceful expulsion of stomach contents.
For kids whose main problem or symptom is vomiting, some causes are pyloric stenosis, cyclic vomiting syndrome, migraines, food allergies, and diabetes, among others.
Vomiting is treated by hydration, and all kids should be evaluated by a healthcare provider to rule out serious concerns.