Tag Archives: bile

Vomiting without Diarrhea


* Vomiting is the forceful emptying (throwing up) of a large portion of the stomach’s contents through the mouth

* Nausea and abdominal discomfort usually precede each bout of vomiting


* Main Cause: Stomach infection (gastritis) from a stomach virus (eg, rotavirus). The illness starts with vomiting but diarrhea usually follows within 12 to 24 hours.

* Food poisoning from toxins produced by bacteria growing in poorly refrigerated foods (eg, Staphylococcus toxin in egg salad, Bacillus cereus toxin in rice dishes)

* Serious Causes: If vomiting persists as an isolated symptom (without diarrhea) for more than 24 hours, more serious causes must be considered. Examples are appendicitis, kidney infection, meningitis, and head injury.

* Vomiting can also be triggered by hard coughing. This is common, especially in children with reflux.

Severity of Vomiting:

Te following is an arbitrary attempt to classify vomiting by risk for dehydration:

* Mild: 1 to 2 times a day

* Moderate: 3 to 7 times a day

* Severe: Vomits everything or nearly everything, or 8 or more times a day

* Severity relates even more to the length of time that the particular severity level has persisted. At the beginning of a vomiting illness (especially following food poisoning), it’s common for a child to vomit everything for 3 or 4 hours and then become stable with mild or moderate vomiting.

* The younger the child, the greater the risk for dehydration

Return to School: Your child can return to child care or school after vomiting and fever are gone

Call 911 Now (Your Child May Need an Ambulance) If:

* Unresponsive or difficult to awaken

* Not moving or too weak to stand

Call Your Doctor Now (or in Alberta, canada call 780-408-LINK) If:

* Your child looks or acts very sick

* Confused (delirious)

* Stiff neck or bulging soft spot

* Headache

* Signs of dehydration (very dry mouth, no tears, and no urine in more than 8 hours)

* Blood in the vomit that’s not from a nosebleed

* Bile (bright yellow or green) in the vomit

* Abdominal pain is also present (EXCEPTION: Abdominal pain or crying just before and improved by vomiting is quite common)

* Appendicitis suspected (eg, pain low on right side, won’t jump, prefers to lie still)

* Diabetes suspected (excessive drinking, frequent urination, weight loss)

* Poisoning with a plant, medicine, or other chemical suspected

* Child is younger than 12 weeks with vomiting 2 or more times (EXCEPTION: spitting up)

* Receiving Pedialyte (or clear fluids if older than 1 year) and vomits everything longer than 8 hours

* High-risk child (eg, diabetes mellitus, abdominal injury, head injury)

* Weak immune system (eg, sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids)

* Vomiting an essential medicine

* Fever above 104°F (40°C) and not improved 2 hours after fever medicine

* Child is younger than 12 weeks with fever above 100.4°F (38.0°C) rectally (CAUTION: Do NOT give your baby any fever medicine before being seen)

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Has vomited longer than 24 hours

* Fever present for more than 3 days

* Fever returns after gone for longer than 24 hours

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Vomiting is a recurrent chronic problem

Parent Care at Home If:

* Mild to moderate vomiting (probably viral gastritis) and you don’t think your child needs to be seen

Home Care Advice for Vomiting:

1. Reassurance:

* Most vomiting is caused by a viral infection of the stomach or mild food poisoning

* Vomiting is the body’s way of protecting the lower intestinal tract

* Fortunately, vomiting illnesses are usually brief

2. For Bottle-fed Infants, Offer Oral Rehydration Solution (ORS) for 8 Hours:

* ORS (eg, Pedialyte, store brand) is a special electrolyte solution that can prevent dehydration. It’s readily available in supermarkets and drugstores.

* For vomiting once, continue regular formula

* For vomiting more than once, offer ORS for 8 hours. If ORS is not available, use formula.

* Spoon or syringe feed small amounts of ORS —1 to 2 teaspoons (5 to 10 mL) every 5 minutes.

* After 4 hours without vomiting, double the amount

* After 8 hours without vomiting, return to regular formula

* For infants older than 4 months, also return to cereal and strained bananas

* Return to normal diet in 24 to 48 hours

3. For Breastfed Infants, Reduce the Amount Per Feeding:

* If infant vomits once, nurse 1 side every 1 to 2 hours

* If infant vomits more than once, nurse for 5 minutes every 30 to 60 minutes. After 4 hours without vomiting, return to regular breastfeeding.

* If infant continues to vomit, switch to ORS (eg, Pedialyte) for 4 hours

* Spoon or syringe feed small amounts of ORS —1 to 2 teaspoons (5 to 10 mL) every 5 minutes

* After 4 hours without vomiting, return to regular breastfeeding. Start with small feedings of 5 minutes every 30 minutes and increase as tolerated.

4. For Children Older Than 1 Year, Offer Small Amounts of Clear Fluids for 8 Hours:

* Water or ice chips are best for vomiting in older children (Reason: water is directly absorbed across the stomach wall)

* ORS: If child vomits water, offer ORS (eg, Pedialyte). If child refuses ORS, use half-strength Gatorade

* Give small amounts —2 to 3 teaspoons (10 to 15 mL) every 5 minutes

* Other Options: Half-strength flat lemon-lime soda, popsicles, or ORS frozen pops

* After 4 hours without vomiting, increase the amount

* After 8 hours without vomiting, return to regular fluids

* CAUTION: If vomiting continues for more than 12 hours, switch to ORS or half-strength Gatorade

* Solids: After 8 hours without vomiting, add solids

– Limit solids to bland foods. Starchy foods are easiest to digest

– Start with saltine crackers, white bread, cereals, rice, and mashed potatoes

– Return to normal diet in 24 to 48 hours

5. Avoid Medicines:

* Discontinue all nonessential medicines for 8 hours (Reason: usually make vomiting worse)

* Fever: Fevers usually don’t need any medicine. For higher fevers, consider acetaminophen (eg, Tylenol) suppositories. Never give oral ibuprofen (eg, Advil); it is a stomach irritant

* Call your doctor if your child is vomiting an essential medicine

6. Sleep: Help your child go to sleep for a few hours (Reason: sleep often empties the stomach and relieves the need to vomit). Your child doesn’t have to drink anything if she feels very nauseated.

7. Contagiousness: Your child can return to child care or school after vomiting and fever are gone.

8. Expected Course: Vomiting from viral gastritis usually stops in 12 to 24 hours. Mild vomiting with nausea may last up to 3 days

9. Call Your Doctor If:

* Vomiting becomes severe (vomits everything) longer than 8 hours

* Vomiting persists longer than 24 hours

* Signs of dehydration

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt