Vomiting is very common during infancy and childhood and is usually caused by an illness or stomach upset. In infants it is important to distinguish between vomiting and “spitting up,” which is very typical in babies. Babies spit up if they are fed too fast or too much, and this is not considered to be a problem.

Mild vomiting in children likewise is not serious, but severe vomiting can strain the stomach and esophagus and may cause internal bleeding. Continual vomiting also can lead to dehydration, shock, or metabolic problems; if the vomited material is inhaled into the lungs it can cause PNEUMONIA. Intentional vomiting in teenagers (BULIMIA) can lead to tooth problems and electrolyte disturbances that can affect the heart’s function, and it can be fatal.

Causes of Vomiting
In infancy, spitting up can be caused by improper formula preparation, feeding too much or too fast,too much swallowed air, or improper handling after feeding. Infants who persistently vomit may have an infection, a physical problem, or an inborn error of metabolism. Vomiting during the second through the ninth week may indicate a narrowing of the passage between the stomach and the small intestine (pyloric stenosis).

Vomiting is a very common symptom in a range of infections, such as INFLUENZA, pneumonia, URINARY TRACT INFECTION, and MENINGITIS. It also may be caused by central nervous system disorders, accidents, ulcers, or food poisoning. Persistent vomiting without any apparent physical cause may be linked to excess stress or an emotional problem. It may be triggered by certain smells, sights, or sounds. Many medications also cause vomiting, including many antibiotics.

When to Call the Doctor
While an occasional vomiting bout is probably not serious, a parent should call the doctor if a child who is vomiting is under age six months, has vomited frequently within 24 hours, or has vomiting plus:

• abdominal pain
• diarrhea
• fever
• sleepiness
• blood in the vomit

Treatment
One of the biggest concerns with vomiting in children is the risk of dehydration, especially when it is accompanied by fever. For this reason, a child who is vomiting needs to restore the fluid levels in the body. Parents should give a vomiting child very small amounts of clear liquids (about half an ounce an hour). Small, frequent liquids are better than one big glass. Frozen or very cold liquids are often tolerated better than room-temperature fluids.

Parents may offer ice chips, Popsicles, tea, gelatin, chicken broth or chicken noodle soup, or flat gingerale or cola. As the vomiting subsides, children may gradually be given solid foods. While vomiting, they should not be given fatty or fried foods. Vomiting children should not be given antinausea medication, which may cause severe side effects.