Vomiting in Children

Vomiting is common — but it is not always an infection

Vomiting is a symptom rather than a diagnosis. Viral gastroenteritis is a common cause, but children can vomit for many other reasons. The possible cause depends on the child’s age, associated symptoms and examination findings.

Common Causes

• Gastroenteritis — often accompanied by diarrhoea and/or fever
• Other infections — such as urinary tract infection, pneumonia or meningitis
• Food-related illness
• Reflux or feeding-related problems, particularly in infants
• Food allergy or intolerance
• Migraine or cyclic vomiting
• Motion sickness
• Coughing or respiratory illness
• Head injury or raised intracranial pressure
• Appendicitis or other abdominal conditions
• Bowel obstruction
• Metabolic conditions, including diabetic ketoacidosis

Vomiting without diarrhoea should not automatically be assumed to be gastroenteritis. Other causes should be considered, particularly when there are additional warning signs.

What Parents Can Observe

• When vomiting started and how often it occurs
• Whether the child can keep fluids down
• Urine output and wet nappies
• Fever, diarrhoea or respiratory symptoms
• Tummy pain or abdominal swelling
• Headache, unusual sleepiness or behaviour changes
• Recent head injury
• Colour and appearance of the vomit

Supportive Care at Home

• Offer small amounts of fluid frequently rather than a large volume at once.
• Continue breastfeeding or formula feeding, usually in smaller, more frequent feeds.
• Oral rehydration solution may be useful, particularly when vomiting occurs with diarrhoea.
• Once vomiting settles, allow the child to return to their usual age-appropriate diet as tolerated.
• Avoid giving anti-vomiting or anti-diarrhoeal medicines unless advised by a doctor.

Oral/enteral rehydration is generally preferred when the child can tolerate it.

When to Arrange a Paediatric Assessment

Arrange a medical review if vomiting:

• Persists or repeatedly recurs
• Prevents adequate fluid intake
• Is associated with poor feeding or reduced urine output
• Occurs with significant fever, abdominal pain or headache
• Is associated with poor growth or weight loss
• Occurs repeatedly without an obvious explanation

A child who is vomiting does not always need medication or investigations. The priority is to assess hydration and look for clues to the underlying cause. Most otherwise well children with isolated vomiting do not require extensive investigations.

What Happens During a Consultation?

The paediatrician will assess how long the vomiting has been present, how often it occurs, whether it is related to feeds or food, and whether there are associated symptoms such as fever, diarrhoea, tummy pain, cough or signs of dehydration.

Most cases of childhood vomiting can be assessed clinically. Blood tests, urine tests, imaging or other investigations are only needed when the history or examination suggests they may be helpful.