What medication would help a 6-month-old infant with vomiting?

Management of Vomiting in a 6-Month-Old Infant

For a 6-month-old infant with vomiting, oral rehydration therapy (ORT) with small, frequent volumes is the most effective first-line treatment. 1, 2

Initial Assessment and Rehydration

• Evaluate hydration status through physical examination looking for decreased skin turgor, dry mucous membranes, sunken eyes, altered mental status, tachycardia, and decreased urine output 2
• For mild to moderate dehydration, provide oral rehydration solution (ORS) as first-line therapy 1, 2
• Begin oral rehydration with small, frequent volumes (e.g., 5 mL every minute) administered via spoon or syringe under close supervision 1
• Gradually increase the amount as tolerated; simultaneous correction of dehydration often lessens the frequency of vomiting 1
• Replace ongoing fluid losses with ORS, with 60-120 mL ORS for each vomiting episode for infants <10 kg 2

Medication Options

• Ondansetron may be considered if the infant has persistent vomiting that prevents adequate oral rehydration 3, 4
  • However, ondansetron is typically recommended for children >4 years old 2
  • The dosage for infants would be 0.15 mg/kg if prescribed 5
• Avoid nonspecific antidiarrheal agents and antimotility drugs in infants this age, as they are not indicated and may cause harmful side effects 1

Nutritional Management

• Continue breastfeeding throughout the illness if the infant is breastfed 1, 2
• For formula-fed infants, resume full-strength formula immediately upon rehydration 1
• If lactose intolerance is suspected (worsening symptoms with formula), consider temporary use of lactose-free or lactose-reduced formula 1

Warning Signs Requiring Medical Attention

• Parents should seek immediate medical attention if the infant:
  • Becomes irritable or lethargic 1
  • Has decreased urine output 1
  • Develops intractable vomiting 1
  • Has persistent diarrhea 1
  • Shows signs of severe dehydration (>6% body weight loss) 2
  • Exhibits bilious or bloody vomiting (red flag sign) 5

Common Pitfalls to Avoid

• Do not use apple juice, Gatorade, or commercial soft drinks for rehydration as they contain too little sodium and excessive sugar, which may worsen symptoms 2, 6
• Avoid withholding food for prolonged periods as this does not improve outcomes 2
• Do not rely on nonspecific antidiarrheal medications or binding agents, as they may cause harmful side effects in infants 1
• Recognize that vomiting in infants can sometimes indicate serious conditions beyond gastroenteritis, such as intestinal obstruction, which requires prompt medical evaluation 5

Remember that most cases of vomiting in infants are self-limiting and can be managed with appropriate oral rehydration therapy. The primary goal is to prevent dehydration while the underlying condition resolves naturally 6, 7.