Vomiting Management in Children

Aka: Vomiting Management in Children

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II. Precautions

  1. This protocol assumes brief period of Vomiting
  2. This protocol is not for Pediatric Dehydration, which requires a more calculated replacement strategy
    1. See Oral Rehydration Therapy Protocol in Pediatric Dehydration
    2. See Pediatric Dehydration Management
  3. Infants with Vomiting who are discharged home should have close interval follow-up unless symptoms resolve
  4. Not all Vomiting is Gastroenteritis (consider other Vomiting Causes in Children)
    1. See Vomiting in Children
    2. See Vomiting Causes in Children

III. Management

  1. See Dehydration Management in Children with Oral Replacement
  2. Pause feeding for 30-60 minutes if Vomiting occurs
  3. Give 5-10 ml every 5 minutes
  4. May resume above Diarrheal replacement after no Vomiting for 30-60 minutes
  5. Consider Ondansetron (Zofran) 4 mg ODT tablets
    1. See Ondansetron for dosing
    2. Weight 8-15 kg (or under age 2 years): Ondansetron 2 mg (half tab)
    3. Weight 15-30 kg (or over age 2 years): Ondansetron 4 mg (one tab)
    4. Weight >30 kg: Ondansetron 4-8 mg (1-2 tabs); 4 mg is typical, but a second dose may be given
    5. Freedman (2006) N Engl J Med 354:1698-705 [PubMed]

IV. Management: First 8 hours after Vomiting

  1. Avoid solid foods and medications for 8 hours
  2. Keep child comfortable by lowering fever
    1. Cool compresses to forehead
    2. Tylenol Suppository
  3. Sweet drink for first hour (1-2 tsp every 20 minutes)
    1. Corn or coke syrup
    2. Honey (if age >1 year old)
  4. Clear fluids (see-through) after the first hour
    1. Fluids
      1. Pedialyte
      2. Gatorade
      3. Ginger ale or 7-Up (stir until bubbles dissipate)
      4. Ice chips for children older than 3 years old
    2. Amounts
      1. Start 1 teaspoon to 1 tablespoon every 20 minutes
      2. Double amount of fluid every hour
    3. Repeat Vomiting management
      1. Rest Stomach for one hour
      2. Restart fluid amount at 1 teaspoon to 1 tablespoon
    4. Pitfalls
      1. Avoid allowing children to drink ad lib
      2. Risk of repeat Vomiting from drinking too rapidly

V. Management: After 8 hours of no Vomiting

  1. Gradually transition to normal diet
    1. Infant
      1. Bananas
      2. Rice Cereal
      3. Applesauce
    2. Children
      1. Toast
      2. Soda crackers
      3. Honey on bread
      4. Bland soups (chicken with stars)
      5. Rice
      6. Mashed potatoes
  2. Normal diet may be resumed after 24 hours
  3. Medications should be given after meals

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