What is the treatment for a 17-month-old child experiencing vomiting?

Treatment of Vomiting in a 17-Month-Old Child

Begin immediate oral rehydration therapy with small, frequent volumes (5 mL every minute) of oral rehydration solution (ORS) using a spoon or syringe, which successfully rehydrates over 90% of children with vomiting without requiring antiemetic medication. 1

Initial Assessment and Red Flags

Before starting treatment, rapidly assess for emergency conditions that require immediate intervention:

• Check if vomiting is bilious (green color) - this indicates intestinal obstruction and requires emergency surgical evaluation 1, 2
• Assess for projectile vomiting - may indicate pyloric stenosis or other obstructive conditions requiring urgent evaluation 1
• Evaluate hydration status through clinical signs: skin turgor, mental status, mucous membrane moisture, capillary refill, and vital signs 3, 4
• Look for altered mental status, toxic appearance, or severe dehydration - these require immediate emergency department evaluation 1, 5

Rehydration Protocol (First-Line Treatment)

The cornerstone of management is oral rehydration therapy, which should be started immediately:

• Start with 5 mL of ORS every 1 minute using a spoon or syringe under close supervision 1, 3
• Gradually increase volume as tolerated without triggering more vomiting 1, 3
• Replace ongoing losses: give 10 mL/kg (approximately 100-120 mL for a 17-month-old) of ORS for each vomiting episode 3
• Continue small, frequent volumes until clinical dehydration is corrected 1, 3

This approach is highly effective - ORS successfully rehydrates over 90% of children with vomiting, even those with concurrent diarrhea, and is safer and more physiologic than intravenous therapy 1.

Nutritional Management

Do not withhold food once the child tolerates fluids:

• Continue breastfeeding on demand if the child is breastfed 1, 3
• Resume age-appropriate solid foods immediately during or after rehydration - early refeeding reduces illness severity and duration 1, 3
• Offer starches, cereals, yogurt, fruits, and vegetables 1, 5
• Avoid foods high in simple sugars and fats (soft drinks, undiluted juice, high-fat foods) as these can worsen symptoms 1, 3

Antiemetic Considerations

Ondansetron should NOT be used in a 17-month-old child - it is only indicated for children over 4 years of age 1, 5, 2. The American Academy of Pediatrics and CDC guidelines are clear that:

• Antiemetics should only be considered after adequate hydration is established 1
• Ondansetron is indicated for children >4 years with persistent vomiting to facilitate oral rehydration 1, 5, 2
• For children under 4 years, focus exclusively on small-volume ORS administration without antiemetic medication 1, 3

This is a critical pitfall to avoid - many physicians inappropriately prescribe antiemetics for young toddlers when the evidence shows that proper ORS technique alone is successful in the vast majority of cases 1, 6.

Medications to Avoid

• Never give antimotility drugs (loperamide) to children under 18 years - serious adverse events including deaths have been reported 1, 3
• Do not use metoclopramide - it is ineffective and potentially harmful in gastroenteritis 3
• Antibiotics are not indicated unless there is evidence of bacterial infection (high fever, bloody diarrhea, symptoms >5 days) 1, 5

When to Seek Emergency Care

Instruct parents to return immediately if the child develops:

• Bilious (green) or bloody vomiting 1, 5
• Persistent projectile vomiting 1
• Signs of severe dehydration: severe lethargy, decreased consciousness, prolonged skin tenting (>2 seconds), cool extremities, decreased capillary refill 3
• Decreased urine output (no wet diapers for 6-8 hours) 1, 5
• Intractable vomiting despite small-volume ORS administration 1, 3
• Abdominal distension or severe tenderness 1, 5

Common Pitfalls to Avoid

• Do not give large volumes of fluid at once - this triggers more vomiting. Small, frequent volumes (5 mL every minute) are key 1, 3
• Do not use sports drinks, juice, or soda as primary rehydration - use proper low-osmolarity ORS 3
• Do not delay rehydration while awaiting diagnostic testing - start ORS immediately 3
• Do not unnecessarily restrict diet - resume normal feeding as soon as tolerated 1, 3
• Do not prescribe ondansetron for children under 4 years - it is not indicated in this age group 1, 5, 2