Patient's question:
How to treat frequent vomiting in childrenDoctor's answer:
Types of Pediatric Vomiting and CareVomiting is a symptom caused by the reverse peristalsis of the esophagus, stomach, and intestines, accompanied by strong spasmodic contractions of the abdominal and diaphragmatic muscles, forcing the contents of the esophagus and gastrointestinal tract to be expelled from the mouth. Vomiting is sometimes a natural defensive mechanism of the human body, which can expel harmful substances ingested and thus provide protection. Almost any infection or emotional stress can cause vomiting.
There are three types of vomiting:
1. Milk Reflux
Most common in infants under 6 months, especially newborns. This is related to a horizontal stomach, relaxed pyloric sphincter, tense pyloric sphincter, and improper feeding,. Generally, improving feeding methods or with age, it can resolve on its own. The second is regurgitation: due to increased lower jaw and pharyngeal muscle activity, stomach contents reflux into the mouth. This is more common in infants over 6 months and may be accompanied by abnormal mental states, leading to malnutrition and growth disorders.
2. Common Vomiting
Often preceded by nausea, followed by vomiting of one or several mouthfuls. Persistent or repeated vomiting is pathological and is more common in gastrointestinal infections, overeating, and recurrent vomiting.
3. Projectile Vomiting
Often without nausea, with a sudden expulsion of large amounts of stomach contents through the mouth or nose. This is usually caused by pyloric obstruction, gastric torsion, and intracranial hypertension.
Newborn Vomiting
Newborn vomiting is one of the common symptoms during the neonatal period:
1. Vomiting with curdled milk
Seen in improper feeding, gastric torsion, gastroesophageal reflux, and pyloric spasm.
2. Vomiting with bile
Seen in congenital annular pancreas, malrotation of the intestine, and gastrointestinal duplication.
3. Vomiting with abdominal distension
Seen in congenital megacolon, anorectal malformations, meconium ileus, and meconium peritonitis.
4. Vomiting with fontanelle bulging
Seen in hydrocephalus, neonatal hypoxic-ischemic encephalopathy, and intracranial hemorrhage.
5. Vomiting with physical abnormalities
Seen in congenital adrenal hyperplasia and galactosemia.
Acute Vomiting
Acute gastritis or enteritis is caused by viruses, toxic substances, or bacterial infections and is often accompanied by diarrhea and abdominal pain.
Periodic Vomiting (Recurrent Vomiting)
A persistent and refractory type of vomiting that often begins between 2–4 years of age and no longer occurs after puberty. The cause is not well-defined but is generally believed to be related to constitutional factors. Triggers include upper respiratory infections, emotional fluctuations, fatigue, and irregular eating habits. Its characteristics are repeated sudden attacks of frequent vomiting, lasting 1–3 days for relief.
Neurotic Vomiting (Psychogenic Vomiting)
A type of vomiting characterized by recurrent episodes without organic lesions and is often related to psychosocial factors. It is triggered by unpleasant environments or psychological stress, leading to repeated involuntary vomiting episodes, usually occurring after meals. Sudden projectile vomiting occurs without obvious nausea or discomfort, and appetite is not affected. Eating is possible after vomiting.
Vomiting Care Tips
Some children frequently vomit. For non-organic vomiting, parents should know how to care for their children to reduce recurrence. Here are some tips:
1. Feeding Methods
- Prefer holding the baby while feeding. If lying down, use a head-elevated position.
- For breastfeeding, warm water should be used to clean the nipples before feeding. The breast should be supported with four fingers and the thumb placed on the areola to slow milk flow.
- For formula feeding, milk bottles should be washed with boiling water before each feeding. The nipple should not be too large.
- After feeding, hold the baby upright and pat the back to expel swallowed air. Avoid changing diapers shortly after feeding.
2. Lying Position for Frequent Vomiting
- If organic lesions and gastrointestinal inflammation are ruled out, gastroesophageal reflux is likely. A head-elevated, side-lying position with the head raised 15° is beneficial.
- For gastroesophageal reflux, a lateral prone position for 20 minutes, 2–4 times daily, may help. However, during prone positioning, close supervision is necessary to prevent apnea. This can reduce reflux frequency, vomiting episodes, and aspiration, preventing aspiration pneumonia and suffocation.
3. Recurrent and Neurotic Vomiting
- Strengthen physical exercise to improve constitution, maintain a regular lifestyle, avoid overeating, and keep the mind calm.
- Avoid adding pressure to the child, as it may worsen vomiting.
- Arrange a reasonable lifestyle, including a feeding schedule, physical exercise, and increased sleep time.
- Avoid excessive attention to the child’s vomiting, as it may increase anxiety and reduce treatment confidence.
- Maintain a clean environment, promptly handle vomit, and change soiled clothes, bedding, and sheets to prevent further irritation.
- Stay by the child’s side during vomiting for emotional support. After vomiting, help rinse the mouth and bathe the child regularly to remove lingering odors.
4. Children Prone to Vomiting
- Strengthen nutrition and physical exercise to boost immunity. Consider taking colostrum or transfer factor to prevent colds.
- Maintain a regular diet, avoid overeating, ensure food is fresh and hygienic, and avoid spicy, smoked, or greasy foods.
5. Vomiting During Medication
- Medications should not be too hot or cold. For difficult-to-feed children, small, frequent doses can be used.
- After vomiting, clean the mouth, face, and neck skin, and change soiled clothes and bedding.
6. Sensitive Pharyngeal Reflex
Some children have a sensitive pharyngeal reflex, leading to vomiting with colds. Inform the doctor about this when seeking medical attention. Such children should eat easily digestible liquids or semi-liquids, avoiding overeating (usually half of their normal intake).
Special Reminder
Most vomiting is caused by gastritis or enteritis. Parents should monitor their child’s bowel movements and shape and seek medical attention promptly. Additionally, children should drink light saltwater. For mild vomiting, offer easily digestible fluids in small, frequent amounts. For severe vomiting, temporary fasting may be necessary.
Positioning During Vomiting
Keep the child in a side-lying or head-down position to prevent aspiration of vomit into the trachea.
Additional Notes
Pay attention to the vomiting pattern, frequency, vomit characteristics (shape, odor), relationship with eating, mental state, appetite, bowel and bladder conditions, and accompanying symptoms. This information helps doctors diagnose and treat effectively.
Vomiting is Not Always a Digestive Issue
Vomiting is only a symptom and may be caused by other diseases. While 80% of vomiting cases are related to gastrointestinal issues, persistent vomiting in children requires prompt medical attention to identify the cause.
What is Vomiting?
Vomiting is the forceful expulsion of stomach contents from the mouth. Severe, repeated vomiting can lead to dehydration, electrolyte imbalance, metabolic toxicity, and nutritional disorders.
Vomiting as a Reflex
Vomiting is a reflex action triggered by stimuli from the gastrointestinal tract, inner ear, vision, cerebral cortex, blood, or cerebrospinal fluid reaching the vomiting center in the medulla. Thus, while vomiting is a gastrointestinal symptom, it may not always stem from gastrointestinal diseases but can be a common symptom or precursor of many conditions.
Vomiting Causes by Age Group
While most vomiting cases are gastrointestinal, other causes include pharyngitis, post-cough vomiting, otitis media, neurological diseases, metabolic disorders, urinary tract infections, etc.
Greenish Bile in Vomit
Greenish bile in vomit may indicate a partial gastrointestinal obstruction, likely in the second part of the duodenum or beyond. However, bile in vomit may also result from severe vomiting without obstruction.
Diagnosing Vomiting Causes by Age Group
Neonatal Period
Before discussing vomiting causes in this period, distinguish it from milk leakage.
- Vomiting involves forceful expulsion of stomach contents, while milk leakage is an involuntary flow of esophageal or gastric contents from the mouth, especially during burping, passing gas, or active movement.
- Most normal infants under one year old have mild milk leakage due to poor control of the lower esophageal sphincter, leading to gastroesophageal reflux. This usually improves after starting complementary foods (around 5–6 months) and disappears by age 1 or 1.5.
- Improper feeding methods or swallowed air can also cause milk leakage. This is often mild and may be accompanied by symptoms like vomiting, anemia, malnutrition, or weight gain issues. Complications like aspiration pneumonia or esophagitis may occur.
- For mild cases, avoid lying the baby down immediately after feeding. Maintain an upright or semi-upright position for 20–30 minutes before gently placing them. Prone or right-side lying may also help, but avoid prone sleeping due to the risk of sudden infant death syndrome (SIDS).
- Small, frequent meals, adding shellfish to milk, or using low-spill formula can help. Medications like prokinetics or antacids may be used if needed.
- Statistically, 85% of cases resolve by 1.5 years, and 95% by age 4. Symptoms usually become milder with age, so parents of easily vomiting infants with normal weight gain should not be overly concerned.
- Severe, sudden, or accompanied by other discomforts requires medical evaluation to rule out causes like gastrointestinal malformations, meconium ileus, or congenital metabolic disorders.
Infant Period
- For infants with severe vomiting in the neonatal period, medication may be considered. If symptoms persist after treatment, further gastrointestinal evaluation is needed.
- Vomiting starting 2–3 weeks after birth, occurring 15–30 minutes after feeding, worsening, and becoming projectile may indicate hypertrophic pyloric stenosis (1 in 500 cases). Symptoms are usually mild at birth but worsen over weeks. The baby may still want to eat after vomiting, and symptoms persist despite medication. Dehydration is common, and ultrasound is used for diagnosis. Surgery is the primary treatment.
- As infants grow, putting objects in their mouths increases the risk of acute gastroenteritis-induced vomiting. Symptoms usually improve within 1–2 days and may be accompanied by fever. Diarrhea may follow.
- For infants under 6 months, dilute milk can be used. For those over 6 months, try rice water, porridge, rice, white bread, or buns.
- After 6 months, maternal antibodies decrease, and exposure to the outside world increases, raising colds. Vomiting may accompany otitis media or pharyngitis (gastrointestinal-type colds). Treatment of the underlying cause is key. If vomiting is accompanied by intermittent abdominal pain or currant-colored stools, intussusception may be suspected. Ultrasound is the best diagnostic tool. If intussusception is confirmed, barium enema may be used to reduce it. If unsuccessful, surgery is required.
Preschool Period
- The risk of vomiting caused by congenital abnormalities decreases (as most are diagnosed earlier), but occasional cases due to biliary cysts or malrotation may occur.
- Vomiting is more often caused by infectious diseases like pharyngitis, otitis media, sinusitis, pneumonia, acute gastroenteritis, urinary tract infections, and neurological diseases.
- Some vomiting is acute, while others are chronic and periodic. Periodic vomiting involves severe attacks at intervals, requiring hospitalization for intravenous fluids. Episodes last 3–5 days and resolve spontaneously. These cases often show normal results after extensive testing.
- Another chronic type is neurotic vomiting, common in 2–6-year-olds, especially sensitive or irritable children. Vomiting is triggered by minor issues and is psychological. For example, forced feeding by parents may lead to vomiting at the sight of food. While vomiting itself is not a concern, parents should improve feeding methods.
Home Dietary Care for Vomiting Children
1. Maintain Airway Patency
If vomiting is severe, vomit may spray from the nose. Clear nasal obstructions immediately to keep the airway open. If vomiting occurs while standing or lying down, keep the child in a forward-leaning or side-lying position to allow vomit to flow out and prevent aspiration.
2. Keep Mouth Clean
After vomiting, stomach acid, digestive enzymes, and undigested food residues remain in the mouth, causing unpleasant odors. For younger infants, use a damp cloth with warm water to clean the mouth. For older infants, use warm water to rinse.
3. Temporary Fasting, Then Light Diet
Parents may panic when their child vomits and rush to feed them again, leading to another wave of vomiting. The best approach is to fast for 4–6 hours after vomiting, avoiding water or milk. If the child demands water, use a cotton swab to moisten the mouth. Older children can have a lollipop. Once symptoms improve, offer small, frequent amounts of electrolyte solutions (sports drinks can be used but diluted if diarrhea is present). Gradually introduce light foods like porridge, rice, white bread, or buns, avoiding dairy or greasy foods for 2–3 days.
4. Taking Medications After Vomiting
Some antiemetics should be given 30 minutes before meals. Medications like cough syrup or nasal drops may be optional, while antibiotics must be taken as prescribed. If vomiting occurs within 30 minutes of medication, repeat the dose. Between 30 minutes and 1 hour, give half the dose. If vomiting occurs 2 hours after medication, most drugs have already entered the small intestine and will not be vomited, so no repeat dose is needed.
Seek Medical Attention Promptly
Vomiting is a symptom that may be a manifestation of many diseases. While 80% of vomiting cases are gastrointestinal, persistent vomiting in children requires prompt medical attention to identify the cause. In addition to replenishing electrolytes and fluids, watch for dehydration symptoms (e.g., rapid breathing/heart rate, weeping without tears, sunken fontanelle or orbits, decreased urine output, lethargy).
When to Return to the Doctor
- If vomit is greenish or coffee-colored.
- If abdominal pain worsens or severe diarrhea occurs.
- If symptoms do not improve despite medication.
Prompt medical evaluation and follow-up are essential to ensure proper diagnosis and treatment.