Health Library Nausea and Vomiting, Age 4 and OlderFrom Healthwise

Nausea is a sick feeling in the pit of your stomach. When you are nauseated, you may feel weak and sweaty and have too much saliva in your mouth. You may even vomit. This forces your stomach contents up your esophagus and out of your mouth. Most of the time nausea and vomiting are not serious. Home treatment will often help you feel better.

Nausea and vomiting can be a symptom of another illness. Nausea and vomiting may be caused by:

• Illness caused by a virus, such as viral stomach illness (gastroenteritis).
• Food poisoning.
• Stress, nervousness, or a mental health problem, such as depression or an anxiety disorder.
• Medicines, such as antibiotics, birth control pills, or heart medicines.
• Pregnancy. "Morning sickness" may be one of your first symptoms.
• Problems with abdominal organs.
• Migraine headache.
• Heart attack.
• Stroke.
• Head injury.
• Alcohol or drug abuse or withdrawal.
• Overeating.
• Eating disorders, such as anorexia or bulimia.
• Disorders of the inner ear, such as labyrinthitis, Ménière's disease, or motion sickness.
• A side effect of radiation therapy.

Nausea or vomiting also may be a symptom of a problem or a disease, such as:

• Diabetes.
• Liver disease (hepatitis or cirrhosis).
• Inflammation of the pancreas (pancreatitis).
• Inflammation or irritation of the lining of the stomach (gastritis).
• Ulcer disease of the stomach or small intestine (peptic ulcers).
• Gallbladder problems (cholecystitis).
• Inflammation of the appendix (appendicitis).
• Kidney stones.
• Kidney disease (pyelonephritis or chronic kidney disease).
• Urinary problems, such as a urinary tract infection (UTI).
• Bowel problems, such as a bowel obstruction.
• Infection in or around the brain, such as meningitis, encephalitis, or a brain tumor.
• Infection of the pelvic organs (pelvic inflammatory disease).

Nausea and vomiting can quickly cause dehydration. Older adults have an increased chance of becoming dehydrated because they may:

• Not drink because they do not feel as thirsty as younger people.
• Have kidneys that do not work well.
• Choose to not drink because of the inability to control their bladders (incontinence).
• Have physical problems or a disease which makes it:
  • Hard to drink or hold a glass.
  • Painful to get up from a chair.
  • Painful or exhausting to go to the bathroom.
  • Difficult to talk or communicate to someone about their symptoms.
• Take medicines that increase urine output.
• Not have enough money to adequately feed themselves.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

• Breathing stops for longer than 30 seconds. After calling 911 , see the topic Dealing With Emergencies.
• Chest pain or other symptoms of a heart attack
• Severe dehydration
• Shock
• Moderate to severe difficulty breathing
• Symptoms of a stroke:
  • Unconsciousness that lasts for longer than 1 minute
  • Sudden, severe pain in the head ("the worst headache I've ever had")
  • Sudden onset of headache, nausea, and vomiting with an inability to walk or stand
  • Ongoing confusion or a change in level of consciousness or behavior
  • Sudden, persistent loss of movement or muscle weakness in one part or all of one side of the body
  • Sudden loss of vision in one or both eyes
  • Sudden, persistent difficulty speaking or understanding speech
  • Seizures. Protect the person from harm during the seizure.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• Abdominal pain: Go to the topic Abdominal Pain, Age 11 and Younger or Abdominal Pain, Age 12 and Older.
• Pregnancy: Go to the topic Pregnancy-Related Problems.
• Vomiting within 24 hours following a head injury: Go to the topic Head Injury, Age 4 and Older.
• Vomiting after ingestion of a known or suspected poison: Go to the topic Poisoning.

	Yes	Do you have blood in your vomit, or have you vomited material that looks like coffee grounds?
When to See a Doctor See significance of blood in vomit if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Before answering the following questions, rate the severity of the blood in your vomit. Call your health professional immediately if you answer "Yes" to any of the following questions. Note: Do not eat or drink anything until you have talked with your doctor. When you vomit blood, watch for blood in the stools, such as tarry, black, or maroon stools. This indicates a more serious amount of bleeding. Yes Do you have more than a streak of blood in your vomit? Yes Does your vomit contain material that looks like coffee grounds? Call your health professional today if you answer "Yes" to the following question. Note: Do not eat, and drink only sips of clear liquids until you have talked with your doctor. Yes Do you have a streak of blood in your vomit and you do not think the blood is coming from your nose or mouth? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes For the past 24 hours, have you had streaks of blood in your vomit but you are quite sure the blood is coming from your nose or mouth? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Has vomiting occurred with signs of a serious illness?
When to See a Doctor See significance of a serious illness if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Are you extremely sleepy or having a hard time staying awake? Yes Are you confused or having trouble thinking clearly? Yes Are you irritable, nervous, or restless? Yes Have you had a seizure? Yes Are you having trouble breathing? Yes Do you have severe headache? Yes Do you have a severe stiff neck? Yes Are you having vision changes, double vision, or severe sensitivity to light (photophobia)? Yes Are you so unsteady that you are having trouble standing or walking? Yes Do you have a new skin rash or bruises? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have vomiting and a fever?
When to See a Doctor See significance of vomiting and a fever if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need information on how to take a temperature, see the topic Body Temperature. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a fever of 104 °F (40 °C) or higher? Yes Do you think that you have a high fever, but you are unable to measure your temperature? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have a fever of 103 °F (39.4 °C) to 104 °F (40 °C)? Yes Have you had a fever of 101 °F (38.3 °C) to 103 °F (39.4 °C) for 12 hours? Yes Do you think that you have a moderate fever, but you are unable to measure your temperature? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had a fever of 100 °F (37.8 °C) to 101 °F (38.3 °C) for 24 hours? Yes Do you think that you have had a mild fever for 24 hours or longer, but you are unable to measure your temperature? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that you might be pregnant?
When to See a Doctor See significance of pregnancy if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Note: If you know or think you are pregnant, go to the topic Pregnancy-Related Problems. Call your health professional today if you answer "Yes" to the following question. Yes Are you having problems with nausea or vomiting, and you think you might be pregnant? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have severe or persistent vomiting?
When to See a Doctor See significance of severe or persistent vomiting if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you have severe vomiting? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild to moderate vomiting for 24 hours? Yes Have you had vomiting that comes and goes for longer than 2 days? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have vomiting with mild to moderate dehydration?
When to See a Doctor See significance of mild to moderate dehydration if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you have mild to moderate dehydration, and you are unable to drink enough to replace lost fluids? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had mild dehydration for 24 hours, but you are able to drink enough to replace lost fluids? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that your nausea or vomiting may be caused by a medicine?
When to See a Doctor See significance of medicine if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you think that your nausea or vomiting may be caused by a medicine? Note: If you answer is Yes: Call the doctor who prescribed the medicine to find out whether you should stop taking the medicine or take a different one. An appointment may not be necessary. If you are taking a nonprescription medicine, stop taking the medicine. Call your doctor if you feel you need to continue taking the medicine. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had persistent nausea?
When to See a Doctor See significance of persistent nausea if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Over the past 24 hours, has persistent nausea kept you from doing your usual activities? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you had nausea and a poor appetite for 1 week or longer? Yes Have you lost 10 lb (4.5 kg) or more in the past 3 months without trying? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Constipation: Go to the topic Constipation, Age 11 and Younger or Constipation, Age 12 and Older.
• Diarrhea: Go to the topic Diarrhea, Age 11 and Younger or Diarrhea, Age 12 and Older.
• Menstrual cramps: Go to the topic Menstrual Cramps.
• Urinary problems: Go to the topics Urinary Problems, Age 11 and Younger or Urinary Problems, Age 12 and Older.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home treatment may be all that is needed to treat occasional nausea.

• Watch for dehydration and treat it early. Older adults and young children can quickly become dehydrated.
• Use acetaminophen, such as Tylenol or Panadol, instead of aspirinor a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, if you need to treat a fever or abdominal pain.
• Take a nonprescription antinausea medicine, such as meclizine (Antivert or Bonine) or dimenhydrinate (Dramamine), or an antihistamine, such as Benadryl.
• Try acupressure:
  • Place the tip of your right index finger on the underside of your left wrist, about 1.5 in. (4 cm) from your hand. Acupressure points are very small, so you may need to try this method more than one time.
  • Apply moderate pressure for 2 to 3 minutes.
  • Repeat as needed.
  • Acupressure bands, which are available for motion sickness, may help reduce nausea.
• Suck on peppermint candy or chew a stick of peppermint gum. Peppermint may relax tight muscles in your stomach and help decrease the stomach contractions that may be causing your nausea.

If you are vomiting:

• Rest in bed until you are feeling better.
• Sip a rehydration drink to restore lost fluids and nutrients.
• After vomiting has stopped for one hour, drink 1 fl oz (30 mL) of a clear liquid every 20 minutes for one hour. Clear liquids include apple or grape juice mixed to half strength with water, rehydration drinks, weak tea with sugar, clear broth, and gelatin dessert. Avoid orange juice, grapefruit juice, tomato juice, or lemonade. Avoid apple or grape juice if you also have diarrhea. Do not drink milk products, alcohol, or carbonated drinks such as sodas.
• If you do not have any more vomiting, increase the amount of fluid you drink to 8 fl oz (237 mL) during the second hour. If you are not vomiting after the second hour, make sure that you continue to drink enough to prevent dehydration.
• When you are feeling better, begin eating clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Gelatin dessert, dry toast, crackers, and cooked cereal are good choices. Try to stay away from strong food odors, which can make nausea worse.

The acid in vomit can erode dental enamel and cause tooth decay (cavities). Rinse your mouth with water after you vomit. Brush your teeth if you can.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Dehydration develops.
• A stiff neck develops.
• Severe vomiting develops.
• Chest pain or other symptoms of a heart attack develop.
• Changes in mental alertness develop, such as extreme sleepiness, personality changes, confusion, irritability, or restlessness.
• Vomit contains blood or material that looks like coffee grounds.
• Vomiting with fever of 103 °F (39.4 °C) or higher occurs or fever lasts longer than 2 days.
• Belly pain develops or gets worse.
• Vomiting lasts longer than 2 days.
• Your symptoms become more severe or more frequent.

Food poisoning

Food poisoning is one of the most common causes of nausea and vomiting in adults. To prevent food poisoning:

• Follow the 2-40-140 rule. Don't eat meats, dressing, salads, or other foods that have been kept between 40 °F (4.4 °C) and 140 °F (60 °C) for more than 2 hours.
• Be especially careful with large cooked meats, such as your holiday turkey, which require a long time to cool. Thick parts of the meat may stay over 40 °F (4.4 °C) long enough to allow bacteria to grow.
• Use a thermometer to check your refrigerator. It should be between 34 °F (1.1 °C) and 40 °F (4.4 °C).
• Defrost meats in the refrigerator or the microwave, not on the kitchen counter.
• Wash your hands, cutting boards, and countertops often. After handling raw meats, especially chicken, wash your hands and utensils before preparing other foods.
• The U.S. Department of Agriculture (USDA) recommends you reheat meats to over 140 °F (60 °C) for at least 10 minutes to destroy bacteria. Even then the bacteria may not be destroyed.
  • Cook all meats to the recommended temperature. See cook foods to prevent food poisoning.
  • Cook hamburger well done. Cook chicken until the juices run clear.
  • Cover meats and poultry during microwave cooking to heat the surface of the meat.
• Do not eat raw eggs or uncooked sauces made with eggs.
• Keep party foods on ice.
• When you eat out, avoid rare and uncooked meats or seafood. Eat salad bar and deli items before they get warm.
• Discard any cans or jars with bulging lids or leaks.
• Follow home canning and freezing instructions carefully. Contact your county agricultural extension office for advice.
• If you think that food may have been stored in your refrigerator for too long, don't take the chance. Throw it out.

For more information, see the topic Food Poisoning and Safe Food Handling.

Viral illness

Increase your chance of staying healthy by:

• Washing your hands often, especially during winter months when viral illnesses like influenza are most common.
• Keeping your hands away from your nose, eyes, and mouth. Viruses are most likely to enter your body through these areas.
• Eating a healthy and balanced diet.
• Getting regular exercise.
• Not smoking. Smoking irritates the lining of your nose, sinuses, and lungs, which may increase your risk for problems from a viral illness.

You can help prevent influenza by getting immunized with an influenza vaccine each year, ideally in October or November. The "flu shot" is given by injection. This form of the vaccine prevents most cases of the flu.

Even if a flu shot does not prevent the flu, the vaccine can make your flu symptoms milder and decrease the risk of problems from the flu.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• Describe your nausea and vomiting:
  • When did it start?
  • How many times have you vomited?
  • When did you last vomit?
  • What does the vomit look like (blood, coffee grounds, bile, mucus, undigested food)?
• What prescription and nonprescription medicines are you taking?
  • Are you taking any new prescription or nonprescription medicines?
  • Have you recently increased the dose of a medicine?
  • Are you taking a medicine more frequently?
• Have you been under an unusual amount of stress at home, work, or both?
• Have you recently been exposed to someone with a similar illness?
• Did your symptoms start after eating at a restaurant? Has anyone else who ate there with you become ill?
• Have you recently eaten raw or undercooked seafood?
• Do you think you have eaten any contaminated food?
• Have you recently drunk any untreated lake, stream, or well water?
• Have you recently gone on a cruise or traveled outside the country?
• Have you had any known exposure to toxic materials, chemicals, or fumes?
• Do you think that your vomiting is caused by alcohol or drug use?
• What home treatment measures have you tried? How well have they worked?
• Do you have any other symptoms, such as diarrhea, fever, headache, urinary problems, or abdominal pain?
• Do you ever force yourself to vomit?
• Have you ever been diagnosed with an eating disorder, such as anorexia or bulimia?
• Does anyone else in your family have problems with vomiting?
• Have you or anyone else in your family been diagnosed with a mental health problem, such as depression or an anxiety disorder?
• Do you have any health risks?

• Abdominal Pain, Age 11 and Younger
• Abdominal Pain, Age 12 and Older
• Appendicitis
• Constipation, Age 11 and Younger
• Constipation, Age 12 and Older
• Dehydration
• Diarrhea, Age 11 and Younger
• Diarrhea, Age 12 and Older
• Food Poisoning and Safe Food Handling
• Gastroesophageal Reflux Disease (GERD)
• Head Injury, Age 3 and Younger
• Head Injury, Age 4 and Older
• Headaches
• Heartburn
• Irritable Bowel Syndrome (IBS)
• Menstrual Cramps
• Peptic Ulcer Disease
• Poisoning
• Pregnancy
• Shock
• Urinary Problems and Injuries, Age 12 and Older
• Vomiting, Age 3 and Younger

Author:	Jan Nissl, RN, BS	Last Updated: July 6, 2007
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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