Vomiting

Dear Lisa,

My 2 ½ year old daughter was up all night vomiting. She doesn’t have any other symptoms. I tried giving her water, but she threw that up too. My doctor told me that she probably has a stomach virus. Is there any medication I can give her to make her stop vomiting? What should I give her to drink?

“Vomiting all night”

Dear “Vomiting all night”,

Unfortunately the anti-emetic medications that are prescribed for adults to stop vomiting are not recommended for children because of their side effects. Occasionally, these medications may be given to an older child, but there is a risk that the side effects can cloud the clinical picture. If a child becomes tired and listless on this medication you will not be able to decipher if it is due to worsening of her condition or if it is a side effect of the medication.

The best thing to give a 2 1/2 year old is ice in the form of Pedialyte pops, ice pops or homemade ice pops. The coldness of the ice will help take away the sensation of nausea. I do not recommend giving ice cubes to this age group because of the risk of choking. You can make your own ice pops from an ice cube tray using Pedialyte, Gatorade, sugar sweetened iced tea, sugar sweetened lemonade, or white grape juice. First pour the liquid into an empty ice cube tray. Next place aluminum foil over the ice cube tray. Take 7 straws and cut them in half with a scissor so that you end up with 14 short straws. Pierce the aluminum foil covering each small rectangular cube with the straw and leave the straw in the hole that you make. The straw should stand upwards because of the stiffness of the aluminum foil. Finish putting the rest of the straw pieces in each of the remaining cube spaces, each time piercing through the aluminum foil. When you are finished, put the ice cube tray in the freezer and wait 1 hour and 15 minutes. The homemade cubes will be frozen and ready to eat. Remove the aluminum foil and take out one cube at a time. The straw becomes a handle which perfectly fits a little child’s hand.

The child can lick the ice cubes slowly until the vomiting and nausea goes away. Licking ice cubes is a good way of intaking small amounts of fluid. If you give a child who is vomiting large amounts of fluids or if the child drinks the fluid too quickly she will probably just throw it up. Once your child stops vomiting you can advance to Pediatlye in a cup. Start out giving only 2 ounces at a time every 15 minutes, and if she doesn’t vomit you can continue to increase the amount slowly. Rehydration with oral electrolyte solutions such as Pedialyte is successful in 90% of children with dehydration from gastroenteritis. (1) Pedialyte is the preferred liquid to give to a child with vomiting or diarrhea because it contains the proper balance of fluid and electrolytes that are needed in order to rehydrate a child.

The problem I found is that many children do not like the taste of Pedialyte, regardless of the flavor purchased. If this is the case you can experiment with different brands of electrolye solutions. I have had some success with grape flavored Gerber electrolyte drink which is very similar to Pedialyte. Children who like grape juice or the taste of Dimetapp elixir tend to like this. For those children that won’t take these electrolyte drinks, the second choice would be Gatorade, sugar sweetened iced tea, sugar sweetened lemonade, white grape juice or pear juice.

I prefer not to use apple juice because it tends to cause diarrhea. Usually diarrhea follows the vomiting phase in children with gastroenteritis therefore the addition of apple juice may just worsen the situation. If your daughter refuses to take any liquids at all you can use a medicine dropper or syringe and squirt the liquid into her mouth. Instill one dropperful into the side of your daughter’s mouth between her cheek and gum every 5 to 10 minutes. This can prevent your child from becoming dehydrated and developing an electrolyte imbalance.

Water is not a good choice of liquids to give a child with vomiting or diarrhea. Water does not contain any of the essential electrolytes that are needed for body functions. When a child develops a fluid and electrolyte imbalance from vomiting, diarrhea or sweating; sodium, chloride, potassium and glucose need to be replaced. These electrolytes can be found in the correct proportions in Pedialyte, but are not found at all in water. Children who drink water alone as a means of replacing fluids during a stomach virus will remain dehydrated and may suffer the consequences of an electrolyte imbalance.

The vomiting phase of a stomach virus typically lasts 4 to 8 hours. If your child continues to vomit beyond this point and you can’t get her to drink any fluids she should be seen by a health care professional. Additionally, if the vomiting is associated with severe abdominal pain, headache, cough, rash or fever this may represent a problem other than a stomach virus. If this is the case your daughter should be evaluated by your Doctor or Nurse Practitioner. Other concerning signs include bilious vomiting (thick foamy greenish yellow vomit), vomiting with excessive coughing, a child with Asthma who vomits mucus, blood in the vomit, high fever, inconsolability, listlessness and signs of dehydration. If your daughter has any of these symptoms, she should be evaluated without delay.

Unfortunately there is always that small percent of children with a stomach virus whose symptoms are so severe that rehydration cannot be accomplished at home. Less than 5 % of children with gastroenteritis will need intravenous fluids and emergency treatment for fluid and electrolyte imbalance.(2) Signs that your child is dehydrated and rehydration attempts are not successful include; lack of voiding or urination, sunken eyeballs, sunken fontanel(soft spot), dry mucus membranes, non-elastic skin, decrease in tear production, listlessness, irritability, increased heart rate and inability to keep down liquids. If you notice these signs you should seek medical attention.

(1)The American Academy of Pediatrics. Practice parameter: The management of acute gastroenteritis in young children. Pediatrics. 1996; 97:424-435.
(2)Fonesca BK, Holdgate A, Craig JC. Enteral vs intravenous rehydration therapy for children with gastroenteritis. A meta-analysis of randomized controlled trials. Arch Pediatr Adolec Med. 2004;158:483-490.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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