What can I use to treat vomiting in a 2-year-old?

Management of Vomiting in a 2-Year-Old Child

For a 2-year-old with vomiting, oral rehydration therapy (ORT) using small, frequent volumes (5-10 mL) of oral rehydration solution (ORS) every 1-2 minutes is the first-line treatment, gradually increasing the amount as tolerated. 1, 2

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 for decreased urine output, absence of tears, dry mucous membranes, and lethargy 3

Rehydration Approach

• For mild vomiting without significant dehydration:

  • Administer small volumes (5 mL) of ORS every minute using a spoon or syringe under close supervision 1, 2
  • Gradually increase the volume as tolerated 1
  • ORT is successful in more than 90% of cases, even in children with vomiting 1, 4

• For moderate dehydration:

  • Continue with small, frequent volumes of ORS 2
  • Replace ongoing losses (each episode of vomiting) with additional ORS 2
  • If vomiting persists despite proper administration technique, consider nasogastric administration of ORS 2

Nutritional Management

• Breastfed infants should continue nursing on demand 1, 2
• For toddlers on solid foods, continue their usual diet during episodes of vomiting once rehydration is complete 1, 2
• Recommended foods include starches, cereals, yogurt, fruits, and vegetables 2
• Avoid foods high in simple sugars and fats 2
• Resume age-appropriate usual diet during or immediately after the rehydration process 2

Medication Considerations

• Antiemetics should only be considered after adequate hydration is established 2
• Ondansetron (0.2 mg/kg orally or 0.15 mg/kg parenterally, maximum 4 mg) may be given to facilitate oral rehydration in children >4 years with persistent vomiting, but is not recommended for 2-year-olds 2, 5
• Antimotility drugs (e.g., loperamide) should NOT be given to children <18 years 2
• Avoid medications as a substitute for fluid and electrolyte therapy 2

Home Management Instructions

• Offer small, frequent sips of ORS rather than large volumes 2
• Beverages such as cola drinks are inappropriate for rehydration as they contain too little sodium and are excessively hyperosmolar 3
• Monitor for signs of worsening dehydration (decreased urine output, lethargy, persistent vomiting) 1
• ORS should be available in every household, and a 24-hour supply should be provided to parents of children with vomiting 2

When to Seek Emergency Care

• Bilious vomiting (green color) requires emergency care 1
• Projectile vomiting that persists requires emergency care 1
• Signs of severe dehydration not responding to oral rehydration require emergency care 1
• Bloody diarrhea accompanying vomiting requires immediate medical attention 2
• If the child becomes irritable or lethargic, has decreased urine output, or develops intractable vomiting 2

Common Pitfalls to Avoid

• Allowing a thirsty child to drink large volumes of ORS (ad libitum) from a cup or bottle can worsen vomiting; administer in small amounts via a spoon, syringe, or cup 2
• Delaying rehydration while waiting for vomiting to stop completely 3
• Using inappropriate fluids like sports drinks or sodas instead of proper ORS 3
• Administering antimotility medications to children under 18 years 2