Vomit (Pediatric)

Like most folks this season I’ve developed a hack, and a couple days ago my toddler Max joined along. He’s still super active, breathing, eating, peeing, pooping, so not too concerned. But last night before bed I thought his stomach looked a bit more plump than usual. He then added 10 ounces of uranium laced milk to the reactor. When fully topped up he coughed and spit up a bit. So I picked him up and tapped his back as you do. That’s when the cork blew.

Never in any ER have I seen such well distributed vomit. He soaked not only our bed and his pants and shirt, but the front and back of my shirt as well. We skated straight into the shower fully clothed, and Vanessa became hazmat director.

Why tell you this? Well it made me think of all the parents I’ve seen in ERs with vomiting kids. If vomit volume was a red flag then I too should have called 911. But it’s not. In fact, Max never even cried. He looked surprised, but then thoroughly enjoyed clothed showering and pushing undigested wagon wheel pasta (complete wheels!) through the strainer.

So here are other shades worth considering:

Red Flags:

• Abdominal pain
• Dehydration (not urinating or drinking and generally listless)
• Fevers
• Speaking/thinking/acting strangely
• New unusual headache
• Breathing problems
• Bright red blood with the first puke, and high volume. (Flecks of blood after the 5th heave, a bit less concerning.)
• “Projectile emesis” in an infant (Suggests pyloric stenosis or other obstruction downstream from the stomach. Picture a garden hose. Max was more like Niagara.)
• Accidental or intentional poisoning
• Recent abdominal surgery
• Not passing gas
• Bloody stools
• Diabetes, dialysis, cancers or other comorbidities

Happy Words

• Drinking, eating, peeing, pooping, playing properly again.
• Associated diarrhea absent pain, dehydration and ongoing vomiting. (The problem is the solution.)
• “Post tussive emesis” (What Max had.)
• “Jimmy eats Hot Cheetos three meals a day and his fingers are the color of his puke.”
• “My child vomited yesterday. He’s fine now, but I just want to get him checked out. And can I have a school note?”
• “My child bit a deodorant stick. I then stuck my fingers in his mouth to clear it and he puked all over daddy.” (My greatest soaking up to yesterday.)

Parents are often concerned that their kids won’t eat after a good round of vomiting. But really, hydration is what we care about. If kiddo only wants blue Otter Pops for three days, then so be it. Your gauge is urination. Food happens later.

For kids who land in the ER we often start with Zofran and Pedialyte, or Otter Pops. If we choose to get blood tests then we frequently run saline as well to limit the needle sticks. Oral or IV hydration can be remarkably effective. Kids in particular just seem to blossom.

If abdominal pain remains a component expect a CT scan, or ultrasound first if time permits. Head CT on occasion reveals surprises too if there are associated neurological problems. But we really try to limit the radiation.

Long story short, most vomiting resolves with TLC, +/- Zofran. It’s not the vomiting so much as the dehydration which causes concern. Feel free to give us a call to talk it through, or maybe for some IV fluids. Or head to an ER if you want to chase faster diagnostic testing and treatment.

As for Max, he’s well on the mend, but Zak has started sniffling. We’ll see. On the bright side, being soaked in someone’s vomit really helps gauge a relationship. Having not minded, I now realize how much I love those two.

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