Health Library Vomiting, Age 3 and YoungerFrom Healthwise

Vomiting occurs when a child's stomach contents are forced up the esophagus and out of the mouth. Although nausea may accompany vomiting in adults and older children, children younger than age 3 are usually not able to tell you if they are having nausea. Most of the time vomiting is not serious. Home treatment will often ease your child's discomfort.

Vomiting in a baby should not be confused with spitting up. Vomiting is forceful and repeated. Spitting up may seem forceful but it usually occurs shortly after feeding, is effortless, and causes no discomfort.

Causes of vomiting

A baby may spit up for no reason at all. Overfeeding, not burping your baby after feeding, intolerance to milk or formula, and exposure to tobacco smoke are other reasons why your baby may spit up.

Most vomiting in children age 3 and younger is caused by a viral stomach illness (gastroenteritis). A child with a stomach illness also may have other symptoms, such as diarrhea, fever, and stomach cramps. With home treatment, the vomiting usually will stop within 12 hours. Diarrhea may last for a few days or more.

Rotavirus is a virus that can cause severe vomiting and diarrhea. Rotavirus vaccine (What is a PDF document?) helps protect against rotavirus disease.

Vomiting can also be caused by an infection in another part of the body, such as strep throat, pneumonia, and urinary tract infections. In rare cases, vomiting can be a symptom of a serious condition, such as a blockage of the digestive tract ( pyloric stenosis), an infection ( meningitis) of the fluid (cerebrospinal fluid) and tissues (meninges) that surround the brain and spinal cord or Reye's syndrome.

When a toddler vomits, it is important to make sure he or she has not swallowed medicines, household liquids, or other poisons. Look around the house for empty containers and spills. There may be pills in your child's vomit, or the vomit may have an unusual appearance, color, or odor. For more information, see the topic Poisoning.

A child who falls down and forcefully hits his or her head or abdomen may vomit because of an injury to those areas. Check your child's body for bruises and other injuries.

Treatment

Babies and children younger than 1 year old need special attention if they continue to vomit. They can quickly become dehydrated. It is important to replace lost fluids when your child is vomiting. Watch your child carefully, and pay close attention to the amount of fluid he or she is able to drink. Look for early symptoms of dehydration, including:

• Less frequent and more concentrated urine or fewer diaper changes needed. Your child's urine will have a stronger odor or darker yellow color.
• Fussiness.
• Acting hungry most of the time.

Also, be sure to notice the color of the vomit, and count the number of times your child vomits. If your child vomits so frequently that you cannot get him or her to drink or vomits every time he or she takes a drink, the risk of dehydration is greater.

Review the Emergencies and Check Your Symptoms sections to determine if and when your child needs to see a doctor.

• Severe dehydration
• Shock
• Severe difficulty breathing
• Extreme sleepiness or very difficult to arouse

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 child's symptoms.

If your child has any of the following symptoms, evaluate those symptoms first:

• Abdominal pain: Go to the topic Abdominal Pain, Age 11 and Younger.
• Vomiting within 24 hours of a head injury: Go to the topic Head Injury, Age 3 and Younger.
• Vomiting after ingestion of a known or suspected poison: Go to the topic Poisoning.

	Yes	Does your child have vomiting with symptoms of serious illness?
When to See a Doctor See significance of vomiting with other symptoms of serious illness if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your child have severe neck stiffness, pain, and fussiness? Yes Is your child less alert than you would expect, very sleepy, or hard to wake up? Yes Does your baby have a bulging soft spot (fontanel) on the head when he or she is not crying? Yes Is your child breathing rapidly or having trouble breathing? Yes Does your child have increased drooling and trouble swallowing? Yes Does your child have new tiny purple or red spots (petechiae) on his or her skin? Yes Does your child have many new bruises (purpura), but he or she has not had an injury? Yes Do you think your child has a skin infection? Yes Does your child have new swelling, pain, redness, or warmth in one or more joints? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your child's vomiting may be caused by an injury?
When to See a Doctor See significance of vomiting caused by an injury if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Do you think your child's vomiting may be caused by a recent injury? Yes Do you think your child's vomiting may be caused by abuse? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Has your child vomited after 2 feedings or meals in a row?
When to See a Doctor See significance of vomiting after 2 feedings or meals in a row if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to the following question. Yes Has your baby younger than 3 months of age vomited after 2 feedings in a row? Call your child's health professional today if you answer "Yes" to the following question. Yes Has your child older than 3 months of age vomited after 2 or more feedings or meals in a row? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Has there been blood or yellow or green liquid (bile) in your child's vomit?
When to See a Doctor See significance of blood or yellow or green liquid (bile) in your child's vomit if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Is there any blood or yellow or green liquid (bile) in the vomit of a baby younger than 3 months of age? Yes Has your child older than 3 months of age vomited mostly blood, bile, or material that looks like coffee grounds? Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Are there streaks of blood in your child's vomit? Yes Has your child older than 3 months of age vomited bile occassionally? You may wait to see if your child's 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 your child occasionally vomited and had streaks of blood in the vomit some of the time? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child 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 child's symptoms. Note: All temperature guidelines listed in this topic are rectal temperatures. For information about taking accurate temperatures in babies and children, see the topic Body Temperature. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Does your baby younger than 3 months old have a rectal temperature of 100.4 °F (38 °C) or higher? Yes Do you think your baby younger than 3 months old has a fever, but you are unable to measure his or her temperature? Yes Does your child older than 3 months of age have a rectal temperature of 105 °F (40.6 °C) or higher? Yes Do you think your child has a high fever but you are unable to measure your child's temperature? Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Does your child older than 3 months of age have a rectal temperature of 104 °F (40 °C) or higher? Yes Has your child older than 3 months of age had a rectal temperature of 102 °F (38.9 °C) to 104 °F (40 °C) for 12 hours or longer? Yes Do you think your child has a moderate fever but you are unable to measure your child's temperature? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Has your child had a rectal temperature of 100.4 °F (38 °C) to 102 °F (38.9 °C) for 24 hours or longer? Yes Do you think your child has had a mild fever for 24 hours or longer but you are unable to measure your child's temperature? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have vomiting and belly pain?
When to See a Doctor See significance of vomiting and belly pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Note: Do not allow your child to eat or drink until you have talked with your child's doctor. Yes Does your child have severe belly pain? Yes Does your child have increasing pain that is clearly localized to one section of the belly? Yes Does your child have a new bulge around the belly button or in the groin that cannot be easily pushed back into the belly or groin? Yes Does your child have vomiting, belly pain, and dark red diarrhea? Call your child's health professional today if you answer "Yes" to any of the following questions. Note: Do not allow your child to eat and allow only sips of clear liquids until you have talked with your child's doctor. Yes Has your child had moderate cramping or persistent belly pain for 4 hours or longer? Yes Has your child's belly pain increased, and he or she has begun to vomit more frequently? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Has your child had vomiting that comes and goes and mild belly pain for longer than 48 hours? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Has your colicky baby had occasional vomiting? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have repeated vomiting (he or she has vomited many times and is unable to keep fluids down between vomiting)?
When to See a Doctor See significance of repeated vomiting if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional immediately if you answer "Yes" to any of the following questions. Yes Has your child had repeated vomiting of yellow or green liquid (bile)? Yes Has your baby younger than 3 months old forcefully vomited large amounts of breast milk or formula 2 or more times? Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Has your baby younger than 12 months old had repeated vomiting for 4 hours or longer? Yes Has your child age 1 year through 3 years had repeated vomiting for 8 hours or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your child have vomiting and dehydration?
When to See a Doctor See significance of dehydration if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Before answering any of the questions below, rate the severity of your child's dehydration. Call your child's health professional immediately if you answer "Yes" to the following question. Yes Does your child have moderate dehydration? Call your child's health professional today if you answer "Yes" to the following question. Yes Does your child have mild dehydration, and he or she is unable to drink enough to replace lost fluids? You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Has your child had mild dehydration for 24 hours or longer, but he or she is 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	Has your child had intermittent, ongoing vomiting without other symptoms?
When to See a Doctor See significance of intermittent, ongoing vomiting if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. You may wait to see if your child's symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Has your baby younger than 3 months of age had occasional vomiting for 1 to 2 days without other symptoms? Yes Has your baby age 3 months to 6 months had occasional vomiting for 2 days or longer? Yes Has your child age 7 months through 3 years had occasional vomiting for 1 week or longer? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Is your child's occasional vomiting becoming more frequent or more severe? Yes Has your colicky baby had occasional vomiting? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think your child's 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 child's symptoms. Call your child's health professional today if you answer "Yes" to the following question. Yes Do you think your child's vomiting may be caused by a medicine? Note: If your answer is "Yes": Call the doctor who prescribed the medicine the same day (before your child's next dose) to determine whether your child should stop taking the medicine or take a different one. An appointment may not be necessary. If you gave your child a medicine not prescribed by a doctor (nonprescription), stop giving the medicine. If you feel your child needs to continue taking the medicine, call your doctor. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Is your child having problems with spitting up?
When to See a Doctor See significance of spitting up if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your child's symptoms. Call your child's health professional today if you answer "Yes" to any of the following questions. Yes Has spitting up increased significantly in amount or frequency? Yes Does spitting up occur with other symptoms, such as diarrhea, constipation, or irritability? Your child needs an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Has spitting up without other symptoms increased over the past 1 to 2 weeks, and it has not improved with home treatment? Yes Has spitting up occurred for at least 1 month, and it has not improved with home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Does your child have any of the following symptoms?

• Diarrhea: Go to the topic Diarrhea, Age 11 and Younger.
• Ear pain or tugging on the ear and fever: Go to the topic Ear Problems and Injuries, Age 11 and Younger.
• Symptoms of a urinary tract infection: Go to the topic Urinary Problems and Injuries, Age 11 and Younger.
• Sore throat, headache, and fever: Go to the topic Sore Throat.

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

Newborns and babies through age 6 months

• Do not feed your baby for about 30 to 60 minutes after he or she has vomited. Be sure to watch your baby carefully for dehydration.
• If your baby is breast-fed, continue breast-feeding. Offer each breast to your baby for 1 to 2 minutes every 10 minutes.
• Do not give your baby plain water.
• If your baby is formula-fed, switch to an oral rehydration solution (ORS).
  • Offer 0.5 fl oz (15 mL) of the drink every 10 minutes for the first hour.
  • After the first hour, gradually increase the amount of ORS that you offer your baby.
  • When 6 hours have passed without vomiting, you may resume your child's regular formula feedings.
• Do not give your child any medicine—prescription, nonprescription, herbal, or home remedies—without your doctor specifically telling you to do so.

Children 7 months to 12 months

• When there has been no vomiting for 1 hour, give 0.5 fl oz (15 mL) of oral rehydration solution (ORS) every 20 minutes. Be sure to watch your child carefully for dehydration.
  • After the first hour, gradually increase the amount of ORS that you offer your baby.
  • When 6 hours have passed without vomiting, you may slowly resume your child's regular formula feedings.
  • Offer bananas, cereals, crackers, or other mild baby foods to your baby.
  • You can also offer ORS frozen pops to your child.
• Do not give your child plain water, undiluted fruit juice, or soda pop. Fruit juice or soda pop contains too much sugar and not enough of the essential minerals (electrolytes) that are being lost. Plain water or diet soda pop lacks calories that your child needs.
• Do not give your child any medicine—prescription, nonprescription, herbal, or home remedies—without your doctor specifically telling you to do so.

Children 1 year to 3 years

• When there has been no vomiting for 1 hour, give 1 fl oz (30 mL) of a clear liquid every 20 minutes for 1 hour. Be sure to watch your child carefully for dehydration. Increase the volume of clear liquids that you give by 3 fl oz (89 mL) an hour for each hour that your child does not vomit. For example, give your child:
  • 2 fl oz (59 mL) of fluid every 20 minutes during the second hour for a total of 6 ounces in the second hour.
  • 3 fl oz (89 mL) of fluid every 20 minutes during the third hour for a total of 9 ounces in the third hour.
  Clear liquids include fruit juice mixed to half strength with water, oral rehydration solution (ORS), clear broth, and gelatin dessert.
• You can also offer ORS frozen pops to your child.
• Do not give your child plain water, undiluted fruit juice, or soda pop. Fruit juice or soda pop contains too much sugar and not enough of the essential minerals (electrolytes) that are being lost. Plain water or diet soda pop lacks calories that your child needs.
• Gradually start to offer your child regular foods after 6 hours with no vomiting.
  • Offer your child solid foods if he or she was eating solids before. Offer crackers, toast, broths, mild soups, mashed potatoes, rice, and breads to your older child.
  • Allow your child to eat what he or she prefers—the type of food is not important.
  • Avoid high-fiber foods, such as beans, and foods with a lot of sugar, such as candy or ice cream.
• Do not give your child any medicine—prescription, nonprescription, herbal, or home remedies—without your doctor specifically telling you to do so.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your child's symptoms if any of the following occur during home treatment.

• Dehydration develops.
• Symptoms of a serious illness develop.
• New or increasing belly pain develops.
• Your child's vomiting returns or becomes severe.
• Blood or yellow or green liquid (bile) is present in your child's vomit.
• Your child's vomiting does not get better with home treatment or lasts longer than 4 days.
• Intermittent vomiting occurs more frequently or longer than 1 week.
• Your child is losing weight.
• Your child's symptoms become more severe or frequent.

Babies

You may be able to prevent spitting up and vomiting.

• Feed your baby smaller amounts at each feeding.
• Feed your baby slowly.
• Hold your baby during feedings.
  • Do not prop your baby's bottle.
  • Do not hold your baby in an extreme upright position.
  • Do not place your baby in an infant seat during feedings.
• Try a new type of bottle or use a nipple with a smaller opening to reduce air intake.
• Limit active and rough play after feedings.
• Try putting your baby in different positions during and after feeding.
• Burp your baby frequently during feedings.
• Consider talking to your doctor about starting your baby on hypoallergenic formula. About 1% of babies who spit up are allergic to milk protein.
• Do not add cereal to formula without first consulting your doctor.
• Do not smoke when you are feeding your baby. Children who are exposed to tobacco smoke are more likely to develop illnesses that cause vomiting. If you smoke, quit. If you cannot quit, do not smoke when you are holding or feeding your baby or when you are in the house or the car. For more information, see the topic Quitting Tobacco Use.
• Consider getting your child the rotavirus vaccine. (What is a PDF document?)

Toddlers

• Limit active and rough play after feedings.
• Teach your children how to wash their hands well, especially if there is an illness in the house.

If you use child care, talk to the caregivers about their program or policies for sick children.

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

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

• Did you have problems during your pregnancy or with the delivery of this child?
• What do you think might be causing your baby's vomiting?
• Has your child been exposed to someone with a similar illness?
• How long has the vomiting been going on?
• Does your child have any other symptoms, such as fever, belly pain, or diarrhea?
• Has your child had a recent fall or injury?
• How many times has your child vomited? How much fluid is lost each time?
• Is your child able to hold down fluids?
• What does the vomit look like?
  • Is there any blood or yellow or green liquid (bile) in the vomit?
  • Did you find any unusual liquids or pills in the vomit?
• What does the vomit smell like?
• What prescription or nonprescription medicines are in your home?
• Did your child's symptoms start after eating at a restaurant? Has anyone else who ate there with you become ill?
• Has your child recently eaten raw or undercooked seafood?
• Do you think your child may have eaten any contaminated food?
• Has your child recently visited a foreign country?
• Has your child recently drunk water from a lake, stream, or private well?
• Has your child had any known exposure to toxic materials, chemicals, or fumes?
• Do you or any other members of your household smoke?
• Does your child have any health risks?

• Abdominal Pain, Age 11 and Younger
• Colic
• Dehydration
• Diarrhea, Age 11 and Younger
• Ear Problems and Injuries, Age 11 and Younger
• Fever, Age 3 and Younger
• Head Injury, Age 3 and Younger
• Inguinal Hernia
• Nausea and Vomiting, Age 4 and Older
• Poisoning
• Reye's Syndrome
• Shock
• Sore Throat
• Urinary Problems and Injuries, Age 11 and Younger

Author:	Jan Nissl, RN, BS	Last Updated: July 12, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics
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