What can be given to a 5-year-old child for nausea and vomiting?

Management of Nausea and Vomiting in a 5-Year-Old Child

For a 5-year-old with nausea and vomiting, begin oral rehydration solution (ORS) immediately using small, frequent volumes of 5 mL every 1–2 minutes via spoon or syringe, and consider ondansetron 4 mg orally if vomiting persists and interferes with oral intake. 1, 2, 3

Initial Assessment and Fluid Management

Assess dehydration severity first by examining skin turgor, mucous membrane moisture, mental status, capillary refill, and urine output to classify as mild (3–5% deficit), moderate (6–9% deficit), or severe (≥10% deficit). 2

Oral Rehydration Strategy

• Start ORS immediately using the slow-administration technique: give 5 mL every 1–2 minutes with a spoon or syringe under close supervision. 1, 2
• This gradual approach succeeds in >90% of children with vomiting and prevents triggering additional emesis that occurs when children drink rapidly from a cup. 1, 2
• For mild dehydration, administer approximately 50 mL/kg of low-osmolarity ORS over 2–4 hours. 2
• For moderate dehydration, increase to 100 mL/kg over 2–4 hours. 2
• Replace ongoing losses with 10 mL/kg for each watery stool and 2 mL/kg for each vomiting episode. 2
• Reassess after 2–4 hours; if still dehydrated, recalculate the deficit and restart the protocol. 2

Ondansetron Use

Ondansetron may be administered to children ≥4 years when vomiting is significant and interferes with oral rehydration. 2, 3

• Dosing: Give 4 mg orally as a single dose 30 minutes before attempting ORS. 3, 4
• Benefit: Reduces vomiting episodes, facilitates oral intake, and decreases the need for intravenous hydration. 2, 5, 4
• Important caveat: Ondansetron may increase the number of diarrhea episodes, but this trade-off is acceptable when vomiting prevents rehydration. 4
• Monitor for QTc prolongation if the child has electrolyte abnormalities (hypokalemia, hypomagnesemia) or is taking other QT-prolonging medications. 3

Dietary Management

• Resume a normal, age-appropriate diet immediately during or after rehydration; do not withhold food. 1, 2
• Recommended foods include starches (rice, potatoes, noodles), cereals, yogurt, fruits, and vegetables. 1, 2
• Avoid high-sugar drinks (soft drinks, undiluted fruit juice, sports drinks) and high-fat foods, as they worsen diarrhea through osmotic effects and delayed gastric emptying. 1, 2

Medications to Avoid

• Never give loperamide or any antimotility agent to children under 18 years; serious adverse events including ileus and death have been reported. 2
• Do not use adsorbents, antisecretory drugs, or toxin binders; they are ineffective and divert attention from proper fluid therapy. 1, 2
• Antibiotics are not indicated for typical viral gastroenteritis; reserve them for bloody diarrhea with high fever, systemic toxicity, or confirmed bacterial pathogens. 1, 2

When to Seek Immediate Medical Care

Bring the child to the emergency department if any of the following develop:

• Severe dehydration signs: altered consciousness, prolonged skin tenting (>2 seconds), cool extremities, poor capillary refill, or rapid deep breathing. 2
• Bilious (green) vomiting, which suggests intestinal obstruction. 2
• Bloody stools with fever, indicating possible bacterial dysentery. 2
• Persistent vomiting despite ondansetron and proper ORS technique. 2
• Decreased urine output, severe lethargy, or irritability. 1, 2

Intravenous Therapy (Hospital Setting Only)

• Reserve IV fluids for severe dehydration (≥10% deficit), shock, altered mental status, or failure of oral rehydration. 2
• Administer 20 mL/kg boluses of lactated Ringer's or normal saline until pulse, perfusion, and mental status normalize, then transition to ORS. 2

Common Pitfalls to Avoid

• Do not allow the child to drink large volumes rapidly from a cup; this triggers vomiting and falsely suggests ORS failure. 2
• Do not use sports drinks or juice as rehydration fluids; they lack appropriate electrolyte balance. 2
• Do not withhold food or enforce fasting; early refeeding shortens illness duration. 1, 2
• Do not delay rehydration while awaiting diagnostic tests; start ORS based on clinical assessment. 2