Can I give any medication, such as paracetamol, to my 2‑year‑old (≈10‑12 kg) child with vomiting, epigastric pain and low‑grade fever?

Medication Management for a 2-Year-Old with Vomiting, Epigastric Pain, and Low-Grade Fever

Do not give paracetamol (acetaminophen) or any other medication at this time; focus exclusively on oral rehydration solution (ORS) administered in small, frequent volumes (5–10 mL every 1–2 minutes), which successfully rehydrates >90% of children with vomiting and diarrhea without any medication. 1

Why Paracetamol Is Not Indicated

• Paracetamol does not stop vomiting, does not prevent febrile seizures, and does not treat the underlying gastroenteritis. 2
• The American Heart Association explicitly states that antipyretics such as paracetamol are not effective for stopping seizures or preventing subsequent febrile seizures in children. 2
• Low-grade fever in gastroenteritis is a protective response; treating fever alone is unnecessary unless the child is uncomfortable. 3
• Oral medications—including paracetamol—should never be given to a child who is actively vomiting or has decreased responsiveness, as they will be vomited back up and provide no benefit. 2

The Correct First-Line Treatment: Oral Rehydration Solution

• Begin ORS immediately at home using 5 mL every 1–2 minutes via spoon or syringe; this small-volume, slow technique prevents triggering more vomiting and achieves rehydration in over 90% of cases. 1
• For a 10–12 kg child with mild dehydration (3–5% fluid deficit), administer approximately 50 mL/kg (500–600 mL total) over 2–4 hours. 1
• Replace ongoing losses with 10 mL/kg (100–120 mL) for each watery stool and 2 mL/kg (20–24 mL) for each vomiting episode. 1
• The most critical error parents make is allowing the child to drink large volumes rapidly from a cup, which provokes vomiting and falsely suggests oral rehydration has failed. 1

When to Consider Ondansetron (the Only Medication That May Help)

• Ondansetron 0.15 mg/kg (maximum 4 mg) as a single oral dose may be given to children ≥4 years old when persistent vomiting prevents oral intake, but your 2-year-old is below the recommended age threshold. 1, 4
• Ondansetron reduces vomiting episodes, improves ORS tolerance, and decreases the need for IV fluids and hospitalization. 5, 6
• However, ondansetron should only be used after attempting proper small-volume ORS technique first, not as a replacement for rehydration. 1

Medications That Are Absolutely Contraindicated

• Loperamide (Imodium) and all antimotility agents are absolutely contraindicated in children <18 years with acute diarrhea due to risk of ileus and death. 1
• Metoclopramide has no role in gastroenteritis management and is explicitly not recommended. 7
• Adsorbents, antisecretory drugs, and toxin binders are ineffective and should be avoided. 1

Red-Flag Symptoms Requiring Immediate Medical Evaluation

• Bilious (green) vomiting suggests intestinal obstruction and requires emergency surgical assessment. 1, 4
• Bloody stools with fever indicate bacterial dysentery and possible hemolytic-uremic syndrome. 1
• Severe dehydration signs (altered consciousness, skin tenting >2 seconds, cool extremities, rapid deep breathing) require immediate IV fluids and hospitalization. 1
• Persistent tachycardia despite adequate ORS administration over 2–4 hours warrants medical evaluation. 8

Practical Home Management Algorithm

1. Stop all solid foods and milk temporarily; offer only ORS. 1
2. Give 5 mL of ORS every 1–2 minutes using a teaspoon or syringe. 1
3. Gradually increase volume as tolerated without triggering vomiting. 1
4. Continue breastfeeding if applicable. 1
5. Resume age-appropriate diet (rice, potatoes, bananas, crackers) immediately after rehydration is achieved. 1
6. Avoid apple juice, sports drinks, soft drinks, and caffeinated beverages—these worsen diarrhea. 1

When to Seek Medical Care

• Failure to tolerate ORS after 2–4 hours of proper technique 8
• No urine output for 6–8 hours 1
• Increasing lethargy or irritability 1
• Vomiting persists beyond 24 hours despite ORS 4, 9

The bottom line: Paracetamol will not help your child's vomiting or gastroenteritis. Focus on small-volume ORS rehydration, which is the only evidence-based treatment that works. 1