From the Guidelines
For a 7-year-old experiencing vomiting and stomach pain for two days, the most appropriate treatment is to start with oral rehydration using small sips of clear fluids like water, diluted juice, or pediatric electrolyte solutions (such as Pedialyte) every 15-20 minutes to prevent dehydration, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1.
The primary goal is to maintain hydration while the child's body fights the likely viral infection, as most childhood stomach illnesses are self-limiting viral conditions that need time and supportive care to resolve.
- Avoid solid foods initially, then gradually introduce bland foods like bananas, rice, applesauce, and toast (BRAT diet) once vomiting subsides.
- For pain relief, children's acetaminophen (Tylenol) can be given at 10-15 mg/kg every 4-6 hours as needed, but avoid ibuprofen as it may irritate the stomach.
- Monitor for warning signs including persistent vomiting, inability to keep fluids down, signs of dehydration (dry mouth, decreased urination, lethargy), high fever above 101°F (38.3°C), severe abdominal pain, or bloody vomit/stool.
- These symptoms would warrant immediate medical attention, as they may indicate a more serious underlying condition, such as a bacterial or parasitic infection, or a non-gastrointestinal illness, such as meningitis, bacterial sepsis, or pneumonia 1.
- Antinausea and antiemetic agents, such as ondansetron, may be given to facilitate tolerance of oral rehydration in children >4 years of age and in adolescents with acute gastroenteritis associated with vomiting, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1.
Most cases of gastroenteritis in children resolve within 3-5 days with supportive care, but if symptoms persist beyond 48 hours without improvement or worsen, consult a healthcare provider.
From the FDA Drug Label
Ondansetron tablets are indicated for the prevention of nausea and vomiting associated with: highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m 2. initial and repeat courses of moderately emetogenic cancer chemotherapy radiotherapy in patients receiving either total body irradiation, single high-dose fraction to the abdomen, or daily fractions to the abdomen. Ondansetron tablets are also indicated for the prevention of postoperative nausea and/or vomiting.
The FDA drug label does not answer the question.
From the Research
Treatment for Vomiting and Stomach Pain in Children
The treatment for a 7-year-old child with vomiting and stomach pain for 2 days may involve the following:
- Symptomatic relief with antiemetics, such as domperidone and ondansetron, if the vomiting is persistent and impedes oral intake 2
- Oral rehydration solution (ORS) to manage hydration status 3, 4
- Identification and treatment of the underlying cause of vomiting and stomach pain, which may include infections, gastrointestinal obstruction, or other systemic diseases 2, 5, 6
- Regular review and monitoring to ensure that more serious illnesses are not overlooked and that secondary complications of dehydration do not arise 6
Important Considerations
- Red flags, such as unstable vital signs, acidotic breathing, presence of bile or blood-stained vomitus, features of gastrointestinal obstruction, encephalopathy, and papilledema, should be recognized and addressed promptly 2, 5
- A detailed history and proper systemic examination are essential to determine the cause of vomiting and stomach pain 2, 5, 6
- Investigations, such as abdominal X-ray, may be necessary in some cases to rule out gastrointestinal obstruction or other serious conditions 5
Antiemetic Use in Children
- Ondansetron has been shown to reduce the risk of recurrent vomiting, the need for intravenous fluids, and hospital admissions in children with acute gastroenteritis 4
- However, the use of ondansetron in young children with gastroenteritis and persistent vomiting has been questioned due to the potential side effect of diarrhea 3