Adventures in Vomiting

When a child throws up -- or even an adult -- it can be scary if the person doesn’t understand what’s happening.

So what is going on? How can we help people we care about feel better?

Why We Vomit

In many cases, throwing up is a protective reflex to rid your body of viruses, bacteria, or parasites in your digestive system.

“If you were to eat something that was spoiled or poisoned, your body would get a signal that something was wrong,” says Bruno Chumpitazi, MD, of Texas Children’s Hospital. Then, you need to get rid of it.

This reflex can also be triggered by stress, anxiety, pregnancy, certain medications, and a disruption of the vestibular system, the parts of your inner ear that help control balance, he says.

Causes

The most common things that cause us to vomit aren’t usually serious, and they get better on their own. They include:

Gastroenteritis: Most people know this as the “stomach flu,” and it’s usually the result of a virus. Sometimes bacteria and parasites can cause it, too. It can also bring diarrhea. It typically goes away within 24 to 48 hours.

The best way to avoid it: Wash your hands -- a lot.

Food poisoning: This is more common in teens and adults eating a wide variety of food, says Lauren Middlebrooks, MD, of Children’s Healthcare of Atlanta. You may have diarrhea in addition to the vomiting, but episodes usually last a day or two.

Motion sickness: Experts aren’t sure why motion sickness affects some more than others. It’s thought to be caused by too much activity in the part of your inner ear that controls balance and eye movement. It may also happen when your brain gets conflicting messages from parts of your body that sense motion -- like your eyes and the nerves inside your muscles.

“Motion sickness is common in kids, although some grow out of it,” says Kenya Parks, MD, of the University of Texas McGovern Medical School. “Parents can help by teaching children how to focus on the horizon and making sure they get plenty of fresh air.”

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You can also try ginger, which Parks says acts a bit like an anti-inflammatory and may ease the nausea you get with motion sickness.

There are medicines that may help you feel better during travel. You can get a skin patch called a scopolamine patch by prescription, Chumpitazi says. Or there are over-the-counter remedies like Benadryl.

Ear infections: These are often accompanied by a buildup of fluid inside the ear, which can throw you off. They can cause nausea and vomiting the same way that riding in a boat or a car can cause motion sickness. Many ear infections will heal on their own. But if your child doesn’t get any better after 48 hours, see your pediatrician.

Pregnancy: One of the most common early signs of pregnancy is morning sickness. The name is a bit misleading, because the nausea and vomiting can happen not just in the morning, but any time. It's most common in the first trimester.

Reflux: Why do babies spit up all the time?

Scott Krugman, MD, at MedStar Franklin Square Medical Center in Baltimore, says it’s because infants don’t have good control of the muscle that keeps things in your stomach from coming up.

So parents may find themselves constantly wiping clear or milk-colored dribble from their babies’ chins.

Don’t sweat it.

“As long as your child is thriving and doesn’t seem bothered by it, you don’t need to worry,” Krugman says.           

Adults may have brief bouts of reflux after meals, too. This is normal, but if it happens a lot or is accompanied by heartburn, pain, trouble swallowing, cough, or sore throat, you may have something called gastroesophageal reflux disease (also known as GERD). It can be treated with lifestyle changes, medication, and -- in rare cases -- surgery.

Stress: Have you ever been so nervous -- say, before an important presentation -- that you threw up? Or maybe your child has vomited the morning of a big test? “Stress and anxiety can sometimes cause you to vomit,” Chumpitazi says. “It’s pretty common in kids, and not necessarily serious, but it’s worth bringing up to your doctor.”

He might be able to suggest strategies, like breathing exercises or guided imagery that can help manage stress.

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Red Flags

In rare cases, vomiting can point to a more serious health concern.

Here are signs that you need to see a doctor:

Dehydration: This is the most common issue doctors worry about, especially when the vomiting is accompanied by diarrhea, as with a stomach bug or food poisoning.

“In those cases, it’s very easy to become dehydrated,” Middlebrooks says.

To prevent it, give small amounts of water or an electrolyte solution like Pedialyte until they can keep more down. If your child isn’t urinating much, has dry, cracked lips or sunken eyes, or seems listless, call your doctor.

Strange colors: Vomit may look bright red or dark (like coffee grounds) if it contains blood. Meanwhile, bile -- a fluid made by your liver that helps with digestion -- can make vomit look bright green. Both are cause for concern. Blood could be a sign of an ulcer or an irritation in your GI tract. Bile could signal some kind of blockage in your digestive system. 

Belly pain: An intense pain in your abdomen that’s also accompanied by fever and vomiting, but not diarrhea, can be a telltale sign of appendicitis. In that case, contact your doctor or head to the ER.

Projectile vomiting in infants: Parents don’t need to worry about spit-up, so long as it’s not shooting out forcefully. That can be a sign of something called pyloric stenosis, says Parks, which is a blockage at the stomach that makes food’s journey harder.

Vomiting after an injury: If you’ve recently suffered a blow to the head or the belly, vomiting can be a sign of a concussion or trauma to your digestive organs.  

Waking up with vomiting: If your child begins throwing up soon after getting up in the morning and also has a headache, call your doctor.

“This is worrisome, because it could indicate the possibility of some kind of mass in the brain,” Parks says. “Lying down at night allows the pressure in the brain to increase, and that can lead to headaches and vomiting.”

Migraines and meningitis can also cause vomiting with headaches.

Vomiting that lingers: If you’re not getting better after 48 hours -- especially if you’re not able to hold down food at all, you don’t have any diarrhea, or you develop a high fever -- see your doctor.

“That’s when we start to become concerned that maybe it’s a chronic issue,” says Chumpitazi, rather than something passing like a stomach virus.

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Keeping Them Comfortable

Most of the time, “it’s a waiting game, unfortunately,” Chumpitazi says. That’s because in the case of a gastroenteritis infection or food poisoning, you vomit to get rid of what’s making you sick.

Anti-vomiting medications usually aren’t recommended in children because they can mask a more serious issue, Chumpitazi says. Even without drugs, though, there are things that you can do to help keep your kids comfortable:

Reassure them: Alexa Stevenson, a mom of two in Athens, GA, tries to remind her son that the awful feeling is temporary. “I know that just before I am going to throw up, I feel like I'm about to die,” she says. “I have to explain that he will feel so much better afterwards.”

Focus on hydration: Kids probably aren’t going to be interested in solid foods at first, and that’s OK. The most important thing is to keep up their fluids, Middlebrooks says. Doctors prefer water or things like Gatorade or Pedialyte, but some parents find that soothing treats can encourage their kids to stay hydrated.

Melissa Paez, a mom of three in Atlanta, offers Pedialyte Popsicles. Allison Sellers, of Waco, TX, says the nurse at her pediatrician’s office suggested syrup from canned peaches. “We gave a tablespoon of syrup every 15 minutes,” she says. “I thought it sounded crazy and only tried it because [my daughter] was close to hospitalization for dehydration. But it totally worked.”

Start with small food: If your child doesn’t eat anything for a couple of days, it can make it harder to bounce back from the illness, Krugman says. “Parents will say, ‘They don’t want to eat.’ But if you don’t try, it’ll make the whole course last longer.”

Try offering tiny amounts of bland foods like bananas, plain noodles, or toast. “Yogurt is great because it has probiotics,” Krugman says, “and the healthy bacteria in the gut can get disturbed” after a bout of stomach flu.

And that old advice to avoid dairy? You can ignore it, although keep in mind that “you want to avoid fatty foods, so maybe steer clear of something like whole milk,” Chumpitazi says. 

WebMD Feature Reviewed by Carol DerSarkissian on July 14, 2016

Sources

SOURCES:

Bruno Chumpitazi, MD, pediatric gastroenterologist, Texas Children’s Hospital.

Lauren Middlebrooks, MD, emergency medicine physician, Children’s Healthcare of Atlanta.

Kenya Parks, MD, assistant professor in pediatrics, McGovern Medical School at The University of Texas Health Science Center, Houston.

Merck Manual: "Motion Sickness."

U.S. National Library of Medicine: "Scopolamine Transdermal Patch."

Mayo Clinic: "Morning Sickness."

Scott Krugman, MD, chief, department of pediatrics, MedStar Franklin Square Medical Center, Baltimore; past president, Maryland Academy of Pediatrics

Up to Date: "Patient information: Acid reflux (gastroesophageal reflux disease) in adults."

Mayo Clinic: "Bile Reflux."

Alexa Stevenson.

Melissa Paez.

Allison Sellers.

© 2016 WebMD, LLC. All rights reserved.

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