What can I give to two pediatric patients under 10 years old with nausea and vomiting due to food poisoning?

Management of Nausea and Vomiting in Children Under 10 with Food Poisoning

For children under 10 with food poisoning-related nausea and vomiting, give oral rehydration solution (ORS) as the primary treatment, and consider ondansetron (0.2 mg/kg oral, maximum 4 mg) if vomiting is persistent and preventing oral rehydration. 1

Primary Treatment: Oral Rehydration

• ORS is the cornerstone of management for children with gastroenteritis-related vomiting, using reduced osmolarity formulation (65-70 mEq/L sodium, 75-90 mmol/L glucose). 1

• Give small, frequent amounts (5-10 mL every 1-2 minutes) using a spoon or syringe, gradually increasing volume as tolerated. 1

• Replace ongoing losses with ORS after each loose stool (10 mL/kg per watery stool, 2 mL/kg per vomiting episode) until symptoms resolve. 2, 1

• Even if vomiting occurs, over 90% of children can be successfully rehydrated orally when given small volumes frequently—do not give up on oral rehydration prematurely. 1

When to Add Ondansetron

Ondansetron should be considered when vomiting is persistent enough to hinder oral rehydration therapy. 1, 3

• Dosing for children: 0.2 mg/kg oral (maximum 4 mg single dose). 3

• Ondansetron is indicated specifically for children unable to take fluids orally due to persistent vomiting. 3

• Evidence shows a single oral dose reduces gastroenteritis-related vomiting and facilitates ORT without significant adverse events. 4

• Ondansetron may be given to children over 4 years to facilitate oral rehydration tolerance, though guidelines suggest caution in younger children. 1

Critical Contraindications

Never give loperamide (Imodium) or any antimotility drugs to children under 18 years—these carry risks of respiratory depression and serious cardiac adverse reactions. 1

• Avoid all antimotility medications regardless of symptom severity in pediatric patients. 1

Feeding During Illness

• Continue normal feeding throughout the illness, including breast milk without interruption. 1

• Resume age-appropriate diet immediately after rehydration is complete—early feeding reduces severity, duration, and nutritional consequences. 1

• Never withhold feeding, as this prolongs illness and worsens nutritional status. 1

When to Seek Emergency Care

Seek immediate medical attention if any of these develop: 1

• Signs of severe dehydration (sunken eyes, no tears, decreased urine output, lethargy)
• Bloody stools
• High fever >38.5°C (101.3°F)
• Inability to tolerate oral fluids despite small-volume administration
• Altered mental status or excessive irritability

Antibiotic Considerations

Do not give antibiotics for typical food poisoning gastroenteritis—most cases are viral and antibiotics are not indicated unless specific criteria are met (bloody diarrhea with high fever >5 days, documented bacterial pathogen). 2, 1

• Empiric antibiotics are not recommended in children with acute watery diarrhea. 5

Practical Algorithm

1. Start ORS immediately (5-10 mL every 1-2 minutes). 1
2. If vomiting prevents ORS intake, give ondansetron 0.2 mg/kg (max 4 mg). 3
3. Continue small frequent ORS 15-30 minutes after ondansetron. 1
4. Resume normal feeding as soon as child tolerates fluids. 1
5. Replace ongoing losses with additional ORS after each stool/vomit. 2, 1
6. Monitor hydration status every 2-4 hours (skin turgor, mucous membranes, urine output). 2