When to Seek Emergency Care for Your Child with Nausea, Vomiting, and Severe Abdominal Pain
If your child has severe abdominal pain combined with nausea and vomiting, you should go to the emergency room immediately, as this combination can indicate life-threatening conditions including appendicitis, bowel obstruction, intestinal ischemia, or in adolescent females, ectopic pregnancy. 1, 2
Critical Warning Signs Requiring Immediate ER Visit
Your child needs emergency evaluation if they have any of these danger signs:
- Severe abdominal pain that is constant or worsening – particularly if the pain is out of proportion to what you observe, which can indicate bowel ischemia 1, 2
- Signs of shock including rapid heartbeat, low blood pressure, pale or cold skin, confusion, or decreased urination 3, 1
- Fever combined with abdominal pain and vomiting – this triad suggests serious infection or surgical emergency 3
- Abdominal rigidity or extreme tenderness when you gently press on the belly, suggesting possible perforation or peritonitis 3, 1
- Vomiting that is dark brown, black, or contains blood – indicating possible upper gastrointestinal bleeding 2
- Bilious (green/yellow) vomiting – suggesting bowel obstruction requiring immediate intervention 1
- Inability to pass gas or have bowel movements combined with abdominal distension, indicating possible obstruction 1
- Rapid breathing or difficulty breathing along with abdominal symptoms 3
What to Monitor at Home Before Going to the ER
While preparing to go to the emergency room, observe:
- Vital signs changes – increased heart rate (tachycardia) is the most sensitive warning sign of surgical complications and should trigger immediate evaluation 3, 1
- Dehydration signs including dry mouth, decreased urination, sunken eyes, or dizziness when standing 1, 4
- Pain location and character – note if pain started around the belly button and moved to the right lower abdomen (classic for appendicitis), or if it's cramping/colicky versus constant 3, 1
- Timing of symptoms – whether vomiting started before or after pain onset (vomiting before pain makes appendicitis less likely) 3
What NOT to Do
- Do not give pain medications before medical evaluation, as this can mask important symptoms that help doctors diagnose the problem 1
- Do not give food or liquids if severe abdominal pain is present, as your child may need surgery 1
- Do not delay seeking care hoping symptoms will improve – early diagnosis significantly reduces complications and mortality 3, 1
Special Considerations for Adolescent Females
For females of childbearing age (typically 12+ years), always consider ectopic pregnancy as a potential cause of abdominal pain with nausea and vomiting, which is a life-threatening emergency requiring immediate surgical intervention. 5
What to Expect in the Emergency Room
The medical team will:
- Assess hemodynamic stability first by checking blood pressure, heart rate, breathing rate, and temperature 1
- Perform focused physical examination looking for abdominal distension, tenderness, rigidity, and bowel sounds 3, 1
- Order blood tests including complete blood count, electrolytes, kidney function, lactate levels, and blood gas analysis to detect bowel ischemia 1, 2
- Obtain imaging studies – CT scan of the abdomen and pelvis with IV contrast is the definitive test to identify obstruction, appendicitis, bowel ischemia, and other surgical emergencies 3, 1, 2
- Provide IV fluids for dehydration and place a nasogastric tube if obstruction is suspected 1
Home Symptom Management (Only for Mild Cases)
These recommendations apply ONLY if your child does NOT have severe pain or warning signs listed above:
- For mild nausea and vomiting, ondansetron or promethazine can be used under medical guidance 6
- Maintain hydration with small, frequent sips of clear fluids 1
- Avoid solid foods until vomiting resolves 1
However, if symptoms persist beyond 24 hours, worsen, or any warning signs develop, seek immediate emergency care. 4