Home Management of Vomiting
For home management of vomiting, the most effective approach is to provide small, frequent sips of oral rehydration solution (ORS) every 5 minutes using a spoon or syringe, ensuring adequate fluid intake of at least 1.5 L/day, while implementing dietary modifications including small, frequent meals and avoiding trigger foods. 1, 2, 1
Immediate Fluid Management
- Administer oral rehydration solution (ORS) as first-line therapy, even when vomiting is present 1, 2
- Give small, frequent volumes initially (5 mL every minute) using a spoon or syringe to guarantee gradual progression 1
- Wait 10 minutes after vomiting episodes, then continue fluid administration more slowly in sips at short intervals 3
- Most fluid given is actually retained despite apparent vomiting, benefiting the patient 3
- Simultaneous correction of dehydration often lessens the frequency of vomiting 1
Dietary Modifications
- Plan 4-6 small meals throughout the day rather than large meals 1
- Eat slowly and chew food thoroughly (≥15 times per bite), with meal duration of at least 15 minutes 1
- Separate liquids from solids—abstain from drinking 15 minutes before meals and 30 minutes after meals 1
- Space meals at intervals of at least 2-4 hours 1
- For older children and adults, continue usual diet with starches, cereals, yogurt, fruits, and vegetables 1
- Avoid simple sugars, high-fat foods, and carbonated beverages 1
Hydration Targets and Monitoring
- Ensure adequate fluid intake of at least 1.5 L/day 1, 2
- Increase fluid intake during intense exercise, diarrhea, vomiting, pregnancy, fever, or fasting 1
- Vary beverage temperatures and flavors (adding herbs, lemon) to encourage consumption 1
- Monitor for signs requiring medical attention: decreased urine output, persistent vomiting, lethargy, or inability to keep fluids down 1
Important Nutritional Considerations
- Do not limit foods previously associated with vomiting—reintroduce them gradually over time 1
- Continue breastfeeding in infants throughout the illness 4
- For formula-fed infants, use full-strength, lactose-containing formulas unless true lactose intolerance develops (indicated by worsening diarrhea) 1
- Replace excess fluid losses from vomiting with ORS as outlined above 1
Critical Pitfalls to Avoid
- Never use antiemetic medications at home without medical evaluation, as they have undesirable side effects including drowsiness that can interfere with oral rehydration 3
- Do not use antimotility drugs (like loperamide) in children under 18 years or in anyone with fever or inflammatory diarrhea 4
- Avoid carbonated beverages and sugar-sweetened drinks 1
When to Seek Medical Care
- Contact a physician or return to clinic if the patient becomes irritable or lethargic 1
- Seek care for decreased urine output, intractable vomiting, or persistent symptoms 1
- Bilious (green) or bloody vomiting requires immediate emergency evaluation 5
- Severe dehydration, altered mental status, or inability to tolerate any oral fluids necessitates medical intervention 4