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Marlton Pediatrics

Vomiting (Baby on Breastmilk)

Definition

  • Vomiting is the forceful emptying (throwing up) of what is in the stomach
  • It's normal for nausea (upset stomach) to come before each bout of vomiting

Call or Return If

  • Vomits clear fluids for more than 8 hours
  • Vomiting lasts more than 24 hours
  • Signs of dehydration occur
  • Diarrhea becomes severe or contains blood
  • You think your child needs to be seen
  • Your child becomes worse

About This Topic

Vomiting Scale

  • Mild: 1 - 2 times/day
  • Moderate: 3 - 7 times/day
  • Severe: Vomits everything, nearly everything or 8 or more times/day
  • Severity relates even more to how long the vomiting goes on for. At the start of the illness, it's common to vomit everything. This can last for 3 or 4 hours. Then often changes to mild vomiting.
  • The main risk of vomiting is dehydration.

Dehydration: How to Know

  • Dehydration means that the body has lost too much fluid. These are signs of dehydration:
  • Decreased urine (no urine in more than 8 hours) happens early in dehydration. So does a dark yellow color. If the urine is light straw colored, your child is not dehydrated.
  • Dry tongue and inside of the mouth. Dry lips are not helpful.
  • Dry eyes with decreased or absent tears
  • In babies, a depressed or sunken soft spot
  • Fussy, tired out or acting ill. If your child is alert, happy and playful, he or she is not dehydrated.
  • A child with severe dehydration becomes too weak to stand. Can also be dizzy when trying to stand.

Causes

  • Main Cause. Stomach infection from a stomach virus (such as Rotavirus). The illness starts with vomiting. Watery loose stools follow within 12-24 hours.
  • Coughing. Hard coughing can also cause your child to throw up.
  • Serious Causes. Vomiting alone (without diarrhea) should stop within about 24 hours. If it lasts over 24 hours, you must think about more serious causes.

Prevention of Spread to Others

  • Careful hand washing after touching vomit, using the toilet or changing diapers.

After Care Advice

Overview:
  • Most vomiting is caused by a viral infection of the stomach.
  • Vomiting is the body's way of protecting the lower gut.
  • The good news is that stomach illnesses last only a short time.
  • Here is some care advice that should help.
Breastfed Babies - Reduce the Amount Per Feeding:
  • If vomits once, nurse 1 side every 1 to 2 hours.
  • If more than once, nurse for 5 minutes every 30 to 60 minutes. After 4 hours without throwing up, return to regular nursing.
  • If continues to vomit, switch to pumped breastmilk. ORS (such as Pedialyte) is rarely needed in breastfed babies. It can be used if vomiting becomes worse.
  • Spoon or syringe feed small amounts of pumped breastmilk. Give 1-2 teaspoons (5-10 ml) every 5 minutes.
  • After 4 hours without throwing up, return to regular feeding at the breast. Start with small feedings of 5 minutes every 30 minutes. As your baby keeps down the smaller amounts, slowly give more.
Pumped Breastmilk Bottle-Fed Infants - Reduce the Amount per Feeding:
  • If vomits once and bottle-feeding breastmilk, give half the regular amount. Do this every 1-2 hours.
  • If vomits more than once within last 2 hours, give 1 ounce (30 mL). Do this every 30 to 60 minutes.
  • If continues to vomit, give 1-2 teaspoons (5-10 mL). Do this every 5 minutes. If not tolerating breastmilk, switch to ORS (e.g., Pedialyte).
  • After 4 hours without vomiting, return to regular feedings. Start with 1 ounce (30 mL) every 30 minutes and slowly increase as tolerated.
Stop Solid Foods:
  • Avoid all solid foods and baby foods in kids who are vomiting.
  • After 8 hours without throwing up, gradually add them back.
  • Start with starchy foods that are easy to digest. Examples are cereals, crackers and bread.
  • Return to normal diet in 24-48 hours.
Do Not Give Medicines:
  • Stop using any drug that is over-the-counter for 8 hours.
  • Fever. Mild fevers don't need to be treated with any drugs. For higher fevers, you can use an acetaminophen (Tylenol) suppository. This is a form of the drug you put in the rectum.
  • Call your doctor if: Your child vomits a drug ordered by your doctor.
Sleep:
  • Help your child go to sleep for a few hours.
  • Reason: Sleep often empties the stomach and removes the need to vomit.
  • Your child doesn't have to drink anything if his stomach feels upset.
What to Expect:
  • Vomiting from a viral illness often stops in 12 to 24 hours.
  • Mild vomiting and nausea may last up to 3 days.
  • Watery loose stools may follow vomiting in 12-24 hours. This can be normal. Diarrhea alone can last 1-2 weeks.
For Vomiting with Diarrhea:
  • If your child is having both vomiting and diarrhea, follow the advice for vomiting.
  • If your child cannot keep down fluids and diarrhea is bad, call back. Reason: increased risk for dehydration.
  • If your child starts having diarrhea alone, keep on a regular diet. If the diarrhea is more than mild, offer extra breastmilk (or formula if needed). For severe diarrhea, also give 1-2 ounces (30-60 ml) of Pedialyte for every large watery stool.
Return to Child Care:
  • Your child can return to child care after the vomiting and fever are gone.
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