What is the management for a 17-month-old child who vomits after crying spells?

Management of Vomiting After Crying Spells in a 17-Month-Old Child

For a 17-month-old child who vomits after crying spells, the primary management approach should focus on providing small, frequent volumes of oral rehydration solution (ORS) to prevent dehydration, while continuing age-appropriate nutrition. 1

Initial Assessment

• Determine if vomiting is bilious (green) or non-bilious, as bilious emesis suggests intestinal obstruction requiring urgent evaluation 1
• Assess for forceful (projectile) vomiting which may indicate pyloric stenosis or other obstructive conditions 1
• Evaluate hydration status by checking skin turgor, mucous membranes, activity level, and urine output 2
• Crying-induced vomiting in toddlers is typically non-pathological but requires monitoring to prevent dehydration 1

Rehydration Approach

• Administer small volumes (5 mL) of ORS every minute using a spoon or syringe under close supervision 1, 3
• Gradually increase the volume as tolerated 3
• Replace each episode of vomiting with additional ORS (approximately 60-120 mL for a child this age) 2
• Continue with age-appropriate fluids between episodes 2
• Oral rehydration therapy is effective in over 90% of children with vomiting and is safer than intravenous therapy 1

Nutritional Management

• Continue the child's usual diet during episodes of vomiting 3, 1
• Recommended foods include starches, cereals, yogurt, fruits, and vegetables 3
• Avoid foods high in simple sugars and fats as these may worsen symptoms 3
• If the child is breastfed, continue nursing on demand 2
• For formula-fed infants, continue with full-strength formula if tolerated 1

Medication Considerations

• Medications are generally not indicated for vomiting associated with crying spells 3
• Antiemetics should only be considered after adequate hydration is established and only if vomiting is persistent and interfering with oral intake 2
• Ondansetron may be considered for children >4 years (not appropriate for a 17-month-old) with persistent vomiting 2, 4
• Avoid antimotility drugs (e.g., loperamide) in children under 18 years 2

Home Management Instructions for Parents

• Offer small, frequent sips of ORS rather than large volumes at once 3
• After a crying episode, wait 5-10 minutes before offering fluids 1
• Continue appropriate nutrition as tolerated 3
• Monitor for signs of dehydration (decreased urine output, lethargy, persistent vomiting) 3
• Return for medical care if the child becomes irritable or lethargic, has decreased urine output, develops intractable vomiting, or has persistent symptoms 3

When to Seek Emergency Care

• Bilious (green) vomiting requires emergency evaluation 1
• Projectile vomiting that persists requires emergency care 1
• Signs of severe dehydration not responding to oral rehydration require emergency care 1
• Abdominal distension or tenderness requires emergency care 1

Common Pitfalls to Avoid

• Don't withhold fluids or food for extended periods as this can worsen dehydration 2
• Don't offer large volumes of fluid at once, which may trigger more vomiting 3
• Don't use sports drinks, sodas, or juices as substitutes for proper ORS 2
• Don't assume all vomiting is benign; persistent or unusual patterns require medical evaluation 4