Nausea and Vomiting

Introduction

Nausea and vomiting are not diseases, but rather are symptoms of many different conditions, such as infection (“stomach flu”), food poisoning, motion sickness, overeating, blocked intestine, illness, concussion or brain injury, appendicitis, and migraines. Nausea and vomiting can sometimes be symptoms of more serious diseases such as heart attacks, kidney or liver disorders, central nervous system disorders, brain tumors, and some forms of cancer.

Vomiting In Infants

It may be hard to decide if an infant is vomiting or spitting up. If the episodes occur shortly after feeding and only a small amount comes up, this may be spitting up.

  • Forceful vomiting: In the first two or three months, if the vomiting is forceful after eating (imagine it flying across the room), this may be a sign of pyloric stenosis, or an abnormal narrowing of the area at which the stomach empties into the small intestine. The vomiting is impressive, and if the healthcare provider suspects this diagnosis, it can be confirmed by ultrasound.The treatment is an operation to open the narrowing.
  • Vomiting associated with pain: if the infant cries uncontrollably, and if the stool is bloody or red, the diagnosis may be an intussusception (the pushing of one segment of the bowel into an adjacent segment). These infants should be evaluated by their healthcare provider.
  • Viral infection: If there is associated diarrhea that is not bloody, then a viral infection is a possibility. Alternatively, there may be an issue with intolerance to the type of baby formula. Infants and children are at greater risk of dehydration if the vomiting episodes last for more than 24 hours. Contact should be made with the healthcare provider for further advice in this situation.

When should you call the doctor?

The greatest risk of vomiting due to gastroenteritis (the “stomach flu”) is dehydration. Call your child’s doctor if your child refuses fluids or if the vomiting continues after using the suggestions above. Call your child’s doctor for any of the signs of dehydration listed below.
Mild to moderate dehydration:

  • dry mouth
  • few or no tears when crying
  • fussy behavior in infants
  • fewer than four wet diapers per day in an infant (more than 4 to 6 hours without a wet diaper in a younger infant under 6 months of age)
  • no urination for 6 to 8 hours in children
  • soft spot on an infant’s head that looks flatter than usual or somewhat sunken

Severe dehydration:

  • very dry mouth (looks “sticky” inside)
  • dry, wrinkled, or doughy skin (especially on the belly and upper arms and legs)
  • inactivity or decreased alertness
  • appears weak or limp
  • sunken eyes
  • sunken soft spot in an infant
  • excessive sleepiness or disorientation
  • deep, rapid breathing
  • no urination for more than 6 to 8 hours in infants
  • no urination for more than 8 to 10 hours in children
  • fast or weakened pulse