What can I give to a 2-year-old to stop vomiting?

Management of Vomiting in a 2-Year-Old

For a 2-year-old with vomiting, the primary treatment is oral rehydration with small, frequent volumes of oral rehydration solution (ORS), starting with 5 mL every minute and gradually increasing as tolerated. 1

Immediate Assessment Priorities

Before treating, quickly assess for red flags that require emergency evaluation:

• Bilious (green) vomiting indicates possible intestinal obstruction and requires immediate surgical consultation 1, 2
• Projectile vomiting may suggest pyloric stenosis 1
• Signs of severe dehydration (lethargy, decreased urine output, sunken eyes, poor skin turgor) 1, 2
• Altered mental status or toxic appearance 2

Rehydration Strategy (First-Line Treatment)

For mild vomiting without significant dehydration:

• Give 5 mL of ORS every minute using a spoon or syringe under close supervision 1
• Gradually increase volume as the child tolerates 1
• Replace each vomiting episode with 60-120 mL of ORS 3

For moderate dehydration:

• Administer ORS 50-100 mL/kg over 3-4 hours 3
• Continue small, frequent volumes 1
• Replace ongoing losses with additional ORS 1

For severe dehydration:

• Intravenous isotonic fluids (lactated Ringer's or normal saline) are required 3
• This child needs emergency department evaluation 1

Feeding During Vomiting Episodes

Continue normal nutrition as tolerated:

• If breastfeeding, continue nursing on demand 3, 1
• If formula-fed, continue full-strength formula (do not dilute) 1
• For toddlers eating solids, offer starches, cereals, yogurt, fruits, and vegetables 1
• Avoid foods high in simple sugars and fats 1

Antiemetic Medications

Ondansetron is NOT recommended for a 2-year-old. The IDSA guidelines specify that antiemetics like ondansetron may only be given to children >4 years of age to facilitate oral rehydration 3. At 2 years old, this child is below the age threshold for ondansetron use in gastroenteritis. 2, 4

Do NOT give:

• Loperamide or other antimotility drugs—these are contraindicated in all children <18 years with vomiting and diarrhea 3

Common Pitfalls to Avoid

• Do not withhold food for 24 hours—this outdated practice has no supporting evidence 3
• Do not use diluted formula—full-strength formula is appropriate 1
• Do not give large volumes of fluid at once—this will trigger more vomiting; small frequent sips are key 1
• Do not use sports drinks, juice, or soda for rehydration—these have inappropriate electrolyte composition 3
• Do not routinely use antiemetics in young children—they are not a substitute for proper hydration 3

When to Seek Emergency Care

Return immediately if the child develops:

• Bilious (green) vomiting 1
• Persistent projectile vomiting 1
• Signs of severe dehydration (no urine for 8+ hours, extreme lethargy, sunken fontanelle) 1
• Abdominal distension or severe tenderness 1
• Inability to tolerate any oral fluids after proper ORS administration 1

Bottom Line

The treatment for a 2-year-old with vomiting is oral rehydration with small, frequent volumes of ORS, continued appropriate nutrition, and close monitoring for dehydration. 1 Antiemetics are not appropriate at this age. 3 Most cases are self-limited viral gastroenteritis that resolve with supportive care alone. 2, 5