Vomiting:
A Symptom Guide
Vomiting can signal anything from a 24-hour bug to a
food allergy to appendicitis. Here's how to figure out what's making your
child's stomach ache -- and how to treat it.
Vomiting can be a traumatic experience for child and parent alike. He's
upset and scared, and you have no idea whether this is just a minor stomach bug
or something that warrants a call to the doctor.
As unpleasant as it is,
vomiting does serve a purpose. "It either relieves pressure or gets a
toxin out of your system," says Susan Orenstein, M.D., chief of the
pediatric gastroenterology division at Children's Hospital of Pittsburgh. In
some cases, throwing up will make your child feel better instantly. In others,
vomiting is just one symptom among several that provide valuable clues to the
nature of your child's illness. Does he have a fever? Diarrhea? Is he
dehydrated?
Our symptom guide to common and not-so-common stomach illnesses will help you
distinguish a short-lived tummy virus from something more serious.
Vomiting +
diarrhea + mild fever
What
it could be: Gastroenteritis, often called the stomach flu, is
one of the most common stomach ailments in children 6 to 24 months old, though
it strikes kids of all ages. Gastroenteritis in young children is often caused
by rotavirus, which is easy to catch from other kids. According to the Centers
for Disease Control and Prevention, in Atlanta, four out of five kids will
become infected with rotavirus by age 5; the virus typically lasts three to
five days.
In children over 5, an
intense bout of gastroenteritis, particularly in the winter, could be caused by
any of a different group of bugs called caliciviruses. In this case, the
vomiting and diarrhea are usually short-lived. "Symptoms tend to last 24
to 48 hours," says John F. Modlin, M.D., acting chairman of the department
of pediatrics at Dartmouth-Hitchcock Medical Center, in Lebanon, New Hampshire.
Gastroenteritis can also come from bacteria, parasites, or mild food poisoning,
in which case other family members may also become ill.
Fast-action
plan: "The best remedy for an upset stomach of any kind is
to avoid drinking and eating for a few hours after the vomiting has stopped,
then slowly resume fluids and foods," says Cheston Berlin Jr., M.D., a
professor of pediatrics at Pennsylvania State University College of Medicine,
in Hershey. After your child has stopped throwing up, give him a teaspoonful of
milk or juice every few minutes for about an hour. If the fluid stays down and
your child is willing, encourage him to eat whatever appeals to him, Dr. Modlin
says.
If your child has repeated
bouts of vomiting or diarrhea and can't keep fluids down, try an
over-the-counter electrolyte-replacement solution such as Pedialyte, which can
help stave off dehydration. A dehydrated child may lose too many electrolytes
(salts in body fluids that help regulate the nervous system) and have a
seizure.
Call your doctor if fluids
don't stay down, your child has diarrhea for 12 hours, or he shows signs of
dehydration: dry tongue or lips; scant urination; or, in a baby, a sunken
fontanel (the soft spot on the top of the head).
When to Worry: Diarrhea
Persistent vomiting after nursing or bottle-feeding
What
it could be: Pyloric stenosis, a thickening of the valve muscle
between the stomach and the small intestine. The valve, normally the width of a
quarter, becomes the width of a pencil -- too small for stomach contents to
pass through. Pyloric stenosis is most often diagnosed in firstborn male babies
at 3 to 8 weeks of age, but it can occur in female infants too. The child may
also experience projectile vomiting.
Fast-action
plan: If your newborn vomits
after every feeding for a day or two, call your pediatrician. Once diagnosed,
the condition can be corrected with simple surgery to widen the muscle's
opening. Infants can usually go home within two
days.
Vomiting + rash
What
it could be: If your child vomits repeatedly after eating and
also has a rash around her mouth, on her neck, behind her knees, or in the
crook of her elbows, she may have an allergy to the formula or the milk she's
drinking, or to other common foods such as strawberries, chocolate, or peanuts.
Fast-action
plan: Call 911 immediately if your child experiences symptoms
such as shortness of breath or swelling of the mouth or throat. An extreme
allergic reaction can be fatal if you don't act fast. (It's a good idea to keep
an antihistamine such as Benadryl on hand; 911 might ask you to administer it.)
Otherwise, see your pediatrician. A rash signals inflammation in the gut, which
inhibits food absorption and proper weight gain. Overall, such reactions are
rare in babies because allergies are related to consistent exposure to a food.
"Eight- month-olds are less likely to have allergies than 8-year-olds, because
they haven't been exposed to the sugar, protein, or fat in food long enough to
develop an allergy to it," says Gail Gallemore, M.D., a professor of
pediatrics at East Tennessee College of Medicine, in Johnson City.
To minimize the risk of
allergy, introduce foods according to your pediatrician's recommendations and
timetable. Many doctors advise waiting until your child is 6 months old to
introduce solids and 12 months old before adding cow's milk to the menu. When you
do give your child a new food, watch for a reaction for several days before
introducing another food, Dr. Gallemore advises.
Vomiting + blood
What
it could be: Your child could simply have a stomach bug and a
broken blood vessel, or it could be a tissue tear in the stomach from the force
of the vomiting. In rarer instances, it might be caused by a bleeding ulcer
from bacteria called Heliocobactor pylori,
or from nonsteroidal anti-inflammatory drugs such as aspirin or aspirinlike
medication.
Fast-action
plan: Call your pediatrician immediately anytime your child
vomits blood. And don't give aspirin to children or teenagers. Besides upping
the risk of a bleeding ulcer, aspirin increases your child's potential for
developing Reye's syndrome, a serious brain-swelling disorder. "We
recommend that parents control fever with a nonaspirin pain reliever such as
acetaminophen," Dr. Orenstein says.
Vibrant greenish-yellow vomit
What
it could be: The bright-green color means your child is vomiting
bile, a liver secretion, which could indicate a gastrointestinal obstruction
due to a birth defect, a meconium blockage, or a twisted bowel (volvulus). A
meconium blockage and volvulus are most often diagnosed during the first month
of life, although school-age children can develop volvulus if their bowel is
congenitally susceptible to twisting.
Fast-action
plan: Call your doctor or go to the E.R. "Bile-stained
vomiting is an emergency," says Mike Farrell, M.D., chief of staff at the
Children's Hospital Medical Center of Cincinnati. Surgery is often necessary to
correct the problem.
Recurrent vomiting with no obvious cause
What
it could be: Cyclic vomiting syndrome, which affects 1 to 2
percent of school-age children. With this brain-gut disorder (often related to
migraine headaches), children experience an intense period of vomiting that
lasts from several hours to several days. Weeks or months then follow in which
they're symptom-free before the cycle starts again. Cyclic vomiting syndrome is
not as common as a viral stomach illness, but it's often mistaken for one.
"Not recognizing it is a big problem, because children may be treated
incorrectly for years," says Paul Hyman, M.D., director of the Pediatric
Gastrointestinal Motility Center at Children's Hospital of Orange County, in
Orange, California. Some kids develop migraines as adults; others simply
outgrow the condition.
Fast-action
plan: If your child has repeated intense vomiting episodes, keep
a log, noting how long they last and when they return. If you detect a pattern,
tell your pediatrician. A variety of medications can control, though not cure,
cyclic vomiting syndrome. If an episode can't be stopped, kids are often
hospitalized and sedated to ease their suffering.
Vomiting + fever + piercing scream (babies) or stiff
neck (older kids)
What
it could be: Bacterial meningitis, a potentially serious brain
infection. Fortunately, since the development of the Haemophilus influenzae
type b (Hib) vaccine, which is one of the well-baby shots, "we rarely see
meningitis, compared with 10 to 15 years ago," Dr. Berlin says. But it's
still possible for kids to contract it. Besides vomiting, symptoms of
meningitis in older children may include headache, stiff neck, and
disorientation.
Fast-action
plan: Call your pediatrician immediately if your baby is
vomiting, running a fever, and irritable, or if your older child is vomiting
and complains of a stiff neck or seems dizzy and confused.
Vomiting + severe abdominal pain
What
it could be: Your child may have appendicitis, an inflammation of
the small finger-shaped organ attached to the large intestine. It is more
common in children over the age of 10. At first, she may feel mild, constant
pain around the belly button, says Paul Sirbaugh, M.D., director of EMS for
Texas Children's Hospital. The pain is usually not too severe at the beginning,
but hours later it will migrate to the lower right side of her abdomen and
intensify as the infected appendix swells. If it ruptures, your child may feel
better because the painful pressure is gone. Six to eight hours after the
rupture, however, she'll feel ill again as toxins spread throughout the
abdominal cavity. A ruptured appendix is seldom fatal, but it is serious.
"If you suspect a rupture, you should get medical attention
immediately," Dr. Sirbaugh says.
Fast-action
plan: Call your doctor if your child is vomiting for several
hours and complains of stomach pain, especially around the belly button or on
the lower-right side of her abdomen. If she is diagnosed with appendicitis, her
appendix will need to be removed immediately. The good news, says Dr. Sirbaugh,
is that there's no need to change her diet or lifestyle as a result of this
operation.
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