Vomiting in children (ages one to five): what's normal and what's not

Why is my child vomiting?

Anything from car sickness (Lowth 2018) to indigestion (Tidy 2018a) can cause your child to be sick. Even a prolonged bout of crying (Mann 2015) or coughing (Sambrook 2017) can trigger this reflex. So you may see quite a bit of vomiting in your child's first few years.

In toddlers and young children, a sudden bout of vomiting is most commonly caused by a tummy bug (gastroenteritis) (NHS 2019). If your little one has gastroenteritis, he’ll probably also have diarrhoea (NICE 2017, Tidy 2018b).

A tummy bug is usually brought on by a virus, such as rotavirus or norovirus (NICE 2017, RCHM 2018, Tidy 2018b). It can also be caused by bacteria (NICE 2017, Tidy 2018b), for example from undercooked or out-of-date food (Tidy 2018b).

Less commonly, gastroenteritis can be caused by parasites (NICE 2017, Tidy 2018b), for example from drinking contaminated water when travelling or during a flood (Tidy 2018b).

Other causes of vomiting in children include:

• Food allergy (Harding 2018, NHS 2019). Common allergens include milk, eggs, fish, seafood, peanuts, sesame, tree nuts, soya and wheat. If your little one has a food allergy, his symptoms will probably come on soon after he's eaten the trigger food (Harding 2018).
• Infections other than a tummy bug. For example, your child may be sick if he has a urinary tract infection (UTI) or ear infection, or something more serious, such as pneumonia or meningitis (NHS 2019). See the section below for warning signs to look out for.
• Swallowing a harmful substance. If you think your child may have swallowed something he shouldn't, take him to the nearest hospital emergency department straight away (NHS 2019). If possible, bring a sample of whatever he's swallowed with you, along with any packaging or ingredients list. It will be easier for his doctors to treat him if they know exactly what he's swallowed.
• Appendicitis (NHS 2019). This condition can get worse quickly, so if your child has a sore tummy that's getting increasingly painful, seek medical advice straight away (NHS 2019). Appendicitis is most common in children over the age of 10, though, and less likely in younger children (NICE 2016).

Find out what to do if you think your child may have coronavirus.

Younger babies often bring up milk after a feed, which is known as reflux or posseting. This is completely normal in infants, but if your little one is more than a year old and still regularly bringing up milk after he feeds, talk your GP or child health nurse. There may be treatment available that can stop this happening (NHS 2016).

When should I call the doctor about my child vomiting?

An attack of vomiting will generally get better within a day or two, without any particular treatment (NHS 2019). Encourage your toddler to keep drinking small amounts of fluid often, so that he stays hydrated (NHS 2019). As long as he seems otherwise healthy, and like his usual self, there's usually no need to worry (NHS 2019).

But vomiting can sometimes be a symptom of other illnesses that may need treating (NHS 2019). If your child has other symptoms, or doesn't seem his usual self, seek medical advice:

Contact your doctor if your child:

• also has a fever (NICE 2017, Tidy 2018b)
• is vomiting so much that he can't keep fluids down (NHS 2019, RCHM 2018, Tidy 2018b)
• is showing signs of dehydration, such as a dry mouth, no tears when he cries, and weeing less often than usual (NHS 2019, RCHM 2018)
• is vomiting bile (green vomit) (NHS 2019, RCHM 2018)
• has been vomiting for more than two days (NHS 2019)

Call 000 for an ambulance or take your child to a hospital emergency department if he:

• has very bad tummy pain
• is throwing up blood
• has a headache, a stiff neck and a rash
• becomes drowsy, floppy and less responsive
  (NHS 2019)

If your child's vomit is a strange colour, or there's blood in it, you may want to take a photo so you can show your doctor. This can help her work out what may be causing it.

If you're in any doubt about whether your child needs medical attention, you can call Health Direct on 1800 022 222. Health Direct is a 24-hour, government-funded service. Some states and territories also provide a 24-hour nurse-on-call, parent helpline or maternal-and-child-health helpline. Find out whether there's one in your area on the Australian Institute of Family Studies website.

How can I help my child feel better?

Vomiting is usually nothing to worry about, and your little one should recover within a day or two. In the meantime, there’s plenty that you can do to help him feel better.

The most important thing is to keep him well hydrated. Vomiting (and diarrhoea) can cause your child to lose fluids quickly, so encourage him to drink regularly throughout the day (NHS 2019, NICE 2017).

Water or his usual milk are the best bets; steer clear of fruit juices and fizzy drinks, especially while he’s under the weather, because they could make his illness worse, especially if he has diarrhoea (NHS 2019, NICE 2017, RCHM 2018). If he won’t drink water or milk, though, you can offer him diluted apple juice (RCHM 2018).

If your child isn’t drinking much, or is being sick a lot, he could be at risk of dehydration. If you think your little one could be starting to become dehydrated – for example if he has a dry mouth or seems particularly thirsty – speak to a pharmacist. She'll be able to recommend an oral rehydration solution (ORS), which helps to replace the water and salts that are lost when your child is sick (NHS 2019). Some ORS products are available as an icy pole as well as a drink.

If your child is having trouble keeping down any fluids at all, or if you notice he’s weeing less often than usual or has any other symptoms of dehydration, see your GP (NHS 2019, RCHM 2018). And if he seems very dehydrated – for example if he’s drowsy and less responsive, is breathing fast or has a rapid pulse – take him straight to your nearest hospital emergency department (NHS 2019, NICE 2017).

As well as keeping your child well hydrated, the following tips may be helpful when he’s feeling sick:

• Offer him food as normal, but don’t worry if he doesn't feel like eating (NHS 2019, RCHM 2018). It’s normal for children to lose their appetite when they’re under the weather, and eating less for a few days won’t do him any harm. The only exception is if you’re giving him ORS, in which case you should stop offering food for a few hours until the treatment is complete (NICE 2017).
• Let him get plenty of rest if he wants it (NHS 2018), but if he’s happy playing around the house, that’s fine, too.
• If he has other symptoms and seems to be in pain, offer children’s paracetamol or ibuprofen (NHS 2018). Check the pack or ask your pharmacist if you’re unsure how much to give.

If your child is sick within half an hour of taking a dose of paracetamol or ibuprofen, it's fine to give him the same dose again. But if he's sick and it's been at least half an hour since his last dose, don't give it again – wait until the next dose is due (MFC 2012, 2014).

There are lots of natural remedies available that claim to help with nausea. Always talk to your pharmacist before trying any of these, as they may not be safe for your little one. Over-the-counter medicines that reduce vomiting and diarrhoea can also harm children, so don’t give your child any of these (RCHM 2018).

A few practical tips can help to make life easier when your child is under the weather:

• Encourage him to keep a bowl or bucket nearby at all times, and protect carpets and soft furnishings with towels, just in case.
• Consider layering his bedsheets with waterproof covers, so you can simply whip off a layer if he's ill in the night.
• If your little one has long hair, encourage him to keep it tied back!

Some toddlers and young children can find throwing up quite upsetting, so be ready with plenty of sympathy and cuddles. Just being there and stroking your little one's back is a powerful way to help him feel better.

Your child will probably have a bitter or unpleasant taste in his mouth after vomiting. But avoid brushing his teeth straight away. Stomach liquids in his vomit will temporarily soften the enamel on his teeth, so brushing soon after vomiting can damage his enamel (ADA nd, RCN 2015).

Instead, offer him a glass of water, or encourage him to rinse his mouth with water and spit it out. A little lemon in his water or sucking on an ice cube may help. He can brush his teeth after an hour or so.

How long do I need to keep my child away from childcare or preschool?

If you’re not sure what’s making your child sick, you’ll need to keep him home from childcare or preschool until at least 24 or 48 hours after his last bout of vomiting or diarrhoea (NHMRC 2012), depending on your childcare centre’s policy. The most common cause of vomiting in children, gastroenteritis, is contagious, so keeping your little one at home will help protect his classmates.

If you know that your child's vomiting was caused by something that's not contagious, such as a food allergy, he can probably go back sooner than this. But always call your childcare provider and let them know about your little one's symptoms before taking him in.

How can I prevent the rest of the family getting sick too?

The following tips can help prevent sickness bugs and other infections from spreading:

• Wash your child’s hands often (NHMRC 2012, RCHM 2018), and encourage the rest of the family to do the same, particularly after going to the toilet, handling nappies or potties, being near or touching vomit or diarrhoea, and before preparing, serving or eating food (RCHM 2018). Wash hands thoroughly with soap and water, and then dry them completely (NHMRC 2012). All his carers should also thoroughly wash their hands regularly.
• Don’t put your fingers near your mouth and encourage your family members to do the same.
• If your child has diarrhoea and is toilet trained, encourage him to use a flush toilet if possible. There are plenty of special seats and stools available to make this easier. If using a potty, flush the contents down the toilet and clean it thoroughly with soap and hot water after every use.
• Wash frequently touched areas in the bathroom at least daily, for example toilet seats, flush handles, taps, surfaces and door handles.
• Don’t let your child share face washers and towels with the rest of the family while he’s sick, and don’t let other children play with toys and books he’s touched.
• Wash your child's clothes and bedsheets on the hottest wash possible.
  (NICE 2017)

Keeping up to date with your child’s vaccinations will also help protect him from tummy bugs. The rotavirus is one of the main causes of gastro in children, and all babies are offered a vaccine against the virus when they’re about two months old, and another dose when they’re four months old (ATAGI 2018).

In most cases, your little one should be feeling better within a few days. But if you have any concerns about his symptoms, you can always see your GP for advice.

More on tummy troubles in toddlers and young children:

• Find out what to do if your little one also has diarrhoea.
• Learn when a fever could be a sign of something serious.
• Think your child could have a food allergy? Get the lowdown on allergies and intolerances.