What is the treatment for infant vomiting?

Treatment for Infant Vomiting

For infants with vomiting, oral rehydration therapy with small, frequent volumes (5 mL every minute) administered via spoon or syringe under close supervision is the cornerstone of treatment. 1

Initial Assessment and Management

Categorizing Vomiting

• Non-bilious vomiting: Often represents gastroesophageal reflux (GER) which is normal in infants and typically resolves with age 1
• Bilious vomiting or forceful vomiting: Requires urgent evaluation for possible obstruction 1

Immediate Management

1. Oral Rehydration Therapy (ORT):

   • Begin with small, frequent volumes (5 mL every minute)
   • Use a spoon or syringe with close supervision
   • Gradually increase volume as tolerated 1
   • Correction of dehydration often reduces vomiting frequency 1

2. Fluid Selection:

   • Use commercially available oral rehydration solutions (ORS)
   • Avoid inappropriate beverages like cola drinks (too little sodium, hyperosmolar) 2
   • Rice gruel can be a better alternative when ORS is unavailable 2

Feeding Recommendations

For Breastfed Infants

• Continue nursing on demand 1
• Breast milk reduces severity of diarrhea if present 2

For Formula-Fed Infants

• After initial rehydration, resume full-strength formula
• Consider lactose-free or lactose-reduced formulas if available 1, 3
• If using lactose-containing formula, monitor for signs of lactose intolerance (worsening diarrhea) 1

For Infants on Solid Foods

• Continue usual diet during illness
• Recommended foods: starches, cereals, yogurt, fruits, vegetables
• Avoid foods high in simple sugars and fats 1

Medication Considerations

Antiemetics

• Ondansetron may be considered for children >4 years with significant vomiting to facilitate oral rehydration 1
• Note: Ondansetron may increase stool volume as a side effect 1

Antimotility Agents

• Should not be given to children <18 years with acute diarrhea and vomiting 1
• Do not substitute medications for proper fluid and electrolyte therapy 1

Red Flags Requiring Urgent Medical Attention

Parents should seek immediate medical care if the infant:

• Becomes irritable or lethargic
• Has decreased urine output
• Develops intractable vomiting
• Has persistent diarrhea 1
• Shows signs of dehydration (delayed capillary filling, absence of tears, mucosal dryness, "sickly" appearance) 2
• Has bilious (green) vomit 1
• Shows signs of shock or severe dehydration 4

Home Management Instructions

1. Fluid replacement:

   • Replace vomit losses with appropriate volumes of ORS 1
   • Keep ORS available in the household (24-hour supply) 1

2. Monitoring:

   • Track urine output
   • Monitor for signs of worsening dehydration
   • Watch for red flags requiring medical attention 1

3. Hygiene:

   • Practice proper handwashing techniques
   • Maintain good diaper changing practices to prevent spread of infection 1

Common Pitfalls to Avoid

• Don't withhold feeding after rehydration is achieved - early refeeding shortens illness duration 2
• Don't substitute juice, soda, or sports drinks for proper ORS 2
• Don't administer antimotility medications to children under 18 years 1
• Don't delay seeking medical attention for bilious vomiting, which may indicate obstruction requiring surgical intervention 1
• Don't ignore persistent vomiting that prevents adequate oral intake, as this may require intravenous hydration 4

Remember that most cases of infant vomiting are benign and self-limiting, but proper rehydration is crucial to prevent complications 5.