Vomiting Less than 1 yo
IF A PATIENT IS VOMITING BE SURE TO ASSESS FOR HEAD INJURY BEFORE GOING ANY FURTHER
 MODERATE vomiting (3-7 times/day) AND  age < 1 year old AND  present < 24 hours
* Formula Fed Infants - Give ORS
- For vomiting once, continue regular formula.
- For vomiting more than once within last 2 hours, offer ORS for 8 hours. If you don't have ORS, use formula until you can get some.
- ORS is Oral Rehydration Solution.
- ORS is a special electrolyte solution (such as Pedialyte or the store brand) that can prevent dehydration. It's readily available in supermarkets and drug stores.
- Spoon or syringe feed small amounts: 1-2 teaspoons (5-10 ml) every 5 minutes.
- After 4 hours without vomiting, double the amount.
- Formula: After 8 hours without vomiting, return to regular formula.
* Breastfed Infants - Reduce the Amount per Feeding
- If vomits once, nurse 1 side every 1 to 2 hours.
- If vomits more than once within last 2 hours, nurse for 5 minutes, every 30 to 60 minutes. After 4 hours without vomiting, return to regular breastfeeding.
- If continues to vomit, switch to pumped breastmilk. (ORS is rarely needed in breastfed babies but can be used if vomiting becomes worse).
- Spoon or syringe feed small amounts of pumped breastmilk: 1-2 teaspoons (5-10 ml) every 5 minutes.
- After 4 hours without vomiting, return to regular breastfeeding. Start with small feedings of 5 minutes every 30 minutes and increase as tolerated.
* Pumped Breastmilk Bottle-Fed Infants - Reduce the Amount per Feeding
- If vomits once and bottle-feeding breastmilk, give half the regular amount every 1-2 hours.
- If vomits more than once within last 2 hours, give 1 ounce (30 mL) every 30 to 60 minutes.
- If continues to vomit, give 1-2 teaspoons (5-10 mL) every 5 minutes. If not tolerating breastmilk, switch to ORS (e.g., Pedialyte).
- After 4 hours without vomiting, return to regular feedings. Start with 1 ounce (30 mL) every 30 minutes and slowly increase as tolerated.
* Stop Solid Foods
- Avoid all solid foods (or baby foods) in kids who are vomiting.
- After 8 hours without throwing up, gradually add them back.
- Start with starchy foods that are easy to digest. Examples are cereals, crackers and bread.
- Return to normal diet in 24-48 hours.
* Avoid Meds
- Discontinue all nonessential medicines for 8 hours. (Reason: usually makes vomiting worse.) (Avoid ibuprofen, which can cause gastritis.)
- Consider acetaminophen suppositories (same as oral dose) if the fever needs treatment (over 102 F or 39 C and causing discomfort).
- Call if child vomiting an essential medicine.
* Expected Course
- For the first 3 or 4 hours, your child may vomit everything. Then the stomach settles down.
- Vomiting from viral gastritis usually stops in 12 to 24 hours.
- Some children may develop diarrhea after the vomiting stops.
- Mild vomiting with nausea may last 3 days.
- Contagiousness: Your child can return to daycare or school after vomiting and fever are gone.
*Signs of Dehydration
-The main risk of vomiting is dehydration. Dehydration means the body has lost too much water.
-Vomiting frequently can lead to dehydration.
-Dehydration is a reason to see a doctor right away.
-Your child may have dehydration if not drinking much fluid and:
-The urine is dark yellow and has not passed any in over 8 hours. (over 12 hours if age over 1 year)
-Inside of the mouth is very dry and there are no tears if your child cries.
-Your child is irritable, tired out or acting ill. If your child is alert, happy and playful, he or she is not dehydrated.
* Reasons To Call Back
- Vomiting everything for over 8 hours
- Moderate vomiting persists over 24 hours
- Vomiting becomes worse
- Any abdominal pain becomes severe or constant
- Signs of dehydration occur
- Your child becomes worse