Is it normal to vomit?

Is Vomiting Normal?

Vomiting is normal in certain contexts but can also indicate underlying pathology requiring medical attention, depending on the frequency, severity, and associated symptoms. 1

Normal Vomiting Scenarios

• Infants: Mild regurgitation or non-bilious vomiting is common in infants, particularly in the first weeks of life, often due to gastroesophageal reflux (GER) and typically resolves with age 1
• Pregnancy: Nausea and vomiting of pregnancy (NVP) affects 30-90% of pregnant women, usually beginning at 4-6 weeks, peaking at 8-12 weeks, and subsiding by week 20 1
• Acute illness: Short-term vomiting (lasting up to 7 days) due to viral gastroenteritis, foodborne illness, or migraine headaches is common and typically self-limited 2

When Vomiting Is Not Normal

Red Flag Symptoms

• Bilious vomiting (green or yellow): Suggests obstruction distal to the ampulla of Vater, potentially indicating malrotation with volvulus in infants - a surgical emergency 1, 3
• Projectile vomiting in infants: May indicate hypertrophic pyloric stenosis, requiring prompt evaluation 3
• Persistent vomiting lasting more than 4 weeks: Defined as chronic and requires thorough evaluation 2, 4
• Hematemesis (blood in vomit): Requires immediate medical attention 3
• Vomiting with severe abdominal pain: May indicate obstruction or other serious conditions 5
• Vomiting with neurological symptoms: Headache, altered mental status, or lethargy may indicate increased intracranial pressure 1, 3

Special Populations

Infants

• Forceful or repeated vomiting should be evaluated for underlying obstruction 1
• Weight loss or poor weight gain with vomiting requires medical attention 1

Pregnant Women

• Hyperemesis gravidarum: Severe, intractable form of pregnancy-related vomiting causing dehydration and weight loss >5% requires medical intervention 1
• Early treatment of nausea and vomiting during pregnancy may prevent progression to hyperemesis gravidarum 1

Elderly

• Approximately every 2nd to 3rd elderly person experiences nausea/vomiting 6
• Physiological aging of the gastrointestinal tract alone does not cause vomiting 6
• Medication side effects are common causes in this population 6

Evaluation of Abnormal Vomiting

Initial Assessment

• Timing: Acute (<7 days) vs. chronic (≥4 weeks) 2, 4
• Pattern: Continuous, intermittent, cyclical, projectile 1, 3
• Content: Bilious, non-bilious, bloody 1, 3
• Associated symptoms: Abdominal pain, headache, fever, weight loss 5

Diagnostic Approach

• Infants with bilious vomiting: Upper GI series to rule out malrotation with volvulus 1
• Infants with projectile vomiting: Abdominal ultrasound to evaluate for pyloric stenosis 3
• Chronic vomiting: May require endoscopy, gastric emptying studies, or neurological evaluation 4, 5

Management of Normal Vomiting

• Infants with GER: Small, frequent feedings; upright positioning after feeding; avoiding car seats immediately after feeding 3
• Pregnancy-related vomiting: Diet modifications (small, frequent meals; BRAT diet); ginger (250mg four times daily); vitamin B6 (10-25mg every 8 hours) 1
• Acute vomiting: Fluid and electrolyte replacement; small, frequent meals; avoiding trigger foods 2

When to Seek Medical Attention

• Vomiting that persists beyond expected duration (>7 days for acute, >20 weeks for pregnancy)
• Signs of dehydration (decreased urination, dry mouth, dizziness)
• Inability to keep down any fluids for >24 hours
• Any red flag symptoms mentioned above

Remember that while vomiting can be normal in certain contexts, persistent or severe vomiting always warrants medical evaluation to rule out serious underlying conditions.