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Vomiting: A Symptom Guide

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).

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.