How to manage vomiting in an infant?

Managing Vomiting in an 11-Month-Old Infant

For an 11-month-old infant with vomiting, start with small, frequent volumes of oral rehydration solution (5 mL every minute) administered via spoon or syringe, gradually increasing the amount as tolerated, while continuing age-appropriate foods once the child can keep fluids down. 1

Initial Assessment and Management

Determine Severity and Cause

• Assess for signs of dehydration:

  • Mild (3-5%): Increased thirst, slightly dry mucous membranes
  • Moderate (6-9%): Loss of skin turgor, skin tenting, dry mucous membranes
  • Severe (≥10%): Lethargy, prolonged skin tenting (>2 seconds), cool extremities 1

• Rule out red flag symptoms requiring immediate medical attention:

  • Bilious or bloody vomiting
  • Altered mental status
  • Severe dehydration
  • Inconsolable crying or excessive irritability 2

Immediate Rehydration Strategy

1. Start with small, frequent volumes of ORS:

   • Begin with 5 mL every minute via spoon or syringe
   • Gradually increase volume as tolerated 1
   • Replace ongoing losses with 50-100 mL ORS after each vomiting episode 3

2. Continue breastfeeding if the infant is breastfed:

   • Breastfeed on demand
   • Consider maternal exclusion diet for 2-4 weeks if intolerance is suspected 3

3. For formula-fed infants:

   • Consider temporarily diluting formula with equal parts water until vomiting subsides
   • Return to full-strength formula as soon as possible 3

Nutritional Management

• Resume feeding promptly after initial rehydration:

  • Continue age-appropriate diet
  • Focus on starches, cereals, yogurt, fruits, and vegetables
  • Avoid foods high in simple sugars and fats 1, 3

• For infants with suspected lactose intolerance:

  • Temporarily reduce or remove lactose from diet
  • Diagnosis is confirmed by worsening diarrhea when lactose-containing foods are introduced 1

Home Management Instructions for Parents

• Monitor for signs of worsening condition:

  • Decreased urine output (fewer wet diapers)
  • Increased lethargy or irritability
  • Intractable vomiting
  • Persistent diarrhea 1, 3

• Implement proper feeding techniques:

  • Careful spacing of feeds
  • Smaller, more frequent feeds
  • Proper positioning after feeding (slightly elevated) 3

• Practice infection prevention:

  • Proper handwashing
  • Appropriate cleaning of toys and surfaces 3

When to Avoid Medications

• Antibiotics are not routinely indicated unless:

  • Dysentery is present
  • High fever persists
  • Watery diarrhea lasts >5 days
  • Stool cultures indicate specific treatment is needed 1

• Nonspecific antidiarrheal agents are generally not recommended as they:

  • May not reduce fluid losses
  • Can cause side effects
  • Shift focus from appropriate fluid and nutritional therapy 1

When to Seek Medical Care

Instruct parents to contact healthcare provider immediately if the infant:

• Becomes irritable or lethargic
• Has decreased urine output
• Develops intractable vomiting
• Shows signs of dehydration despite home management
• Has persistent diarrhea 1, 3

Important Considerations

• Non-bilious, non-forceful vomiting in infants is most commonly due to gastroesophageal reflux (GER), which typically resolves with time and proper feeding management 3

• Vomiting in infants with normal weight gain and no other concerning symptoms is rarely due to obstruction 1, 3

• In cases of persistent vomiting despite appropriate management, ondansetron (0.2 mg/kg oral; 0.15 mg/kg parenteral; maximum 4 mg) may be considered, but this should be determined by a healthcare provider 2, 4