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 2018) 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 2018a). If your little one has gastroenteritis, he'll probably also have diarrhoea (NICE 2017a, Knott 2014).

A tummy bug is usually brought on by a virus, such as rotavirus or norovirus (NICE 2017a, Knott 2014). It can also be caused by bacteria (NICE 2017a, Knott 2014), for example from undercooked or out-of-date food (Knott 2014).

Less commonly, gastroenteritis can be caused by parasites (NICE 2017a, Knott 2014), for example from drinking contaminated water when travelling (Knott 2014).

Other causes of vomiting in children include:

• Food allergy (Harding 2018a, NHS 2018a). 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 2018a).
• Infections other than a tummy bug. For example, your child might be sick if he has a urinary tract infection (UTI) or ear infection, or something more serious, such as pneumonia or meningitis (NHS 2018a). See the section below for warning signs to look out for.
• Swallowing a harmful substance. If you think your child might have swallowed something he shouldn't, take him to A&E straight away (NHS 2018a). If possible, bring a sample of whatever he's eaten 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 2018a). 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 2018a). However, this is most common in children over the age of 10, and less likely in younger children (NICE 2016a).

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

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 2018a). As long as your child seems otherwise healthy, and like his usual self, there’s normally no need to worry (NHS 2018a).

However, vomiting can sometimes be a symptom of other illnesses, that may need treating (NHS 2018a). If your child has other symptoms, or doesn't seem his usual self, seek medical advice:

Contact your GP if your child:

• also has a fever (Knott 2014, NICE 2017a)
• is vomiting so much that he can't keep fluids down (NHS 2018a)
• is showing signs of dehydration, such as a dry mouth, no tears when he cries, and weeing less often than usual (NHS 2018a)
• is vomiting bile (green vomit) (NHS 2018a)
• has been vomiting for more than two days (NHS 2018a)

Call 999 for an ambulance or take your child to A&E 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 2018a)

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

If you're in any doubt about whether your child needs medical attention, you can always call NHS 111 for advice (in Wales call 0845 46 47, and in Northern Ireland call your local GP surgery to find your out-of-hours service). If necessary, they can refer you to the right services for your child.

How can I care for my child while he's sick?

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 2018a, NICE 2017a). Water or his usual milk are the best bets; steer clear of fruit juices and fizzy drinks, especially while he's under the weather as they could make his illness worse (NHS 2018a, NICE 2017a).

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 2018a).

If your child is having trouble keeping down any fluids at all, or you notice that he's weeing less often than usual, see your GP (NHS 2018a). 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 A&E (NHS 2018a, NICE 2017a).

As well as keeping your child well hydrated, the following tips may help when he's feeling poorly:

• Offer him food as normal, but don't worry if he doesn't feel like eating (NHS 2018a). It's normal for children to lose their appetite while 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 2017a).
• Let him get plenty of rest if he wants to (NHS 2018b), but if he's happy playing around the house, that's fine too.
• If your child has other symptoms and seems to be in pain, offer infant paracetamol or ibuprofen (NHS 2018b). 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.

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.

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

If you're not sure what's making your little one sick, it's best to keep him at home until 48 hours after his last bout of vomiting (NHS 2018a). The most common cause of vomiting in children, gastroenteritis, is contagious, so keeping your little one at home will help to protect his classmates.

If you know that your child's vomiting was caused by something that's not contagious, such as a food allergy, your child 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 to prevent sickness bugs and other infections from spreading:

• Wash your child's hands frequently, and encourage the rest of the family to do the same, particularly after going to the toilet or handling nappies or potties, and before preparing, serving or eating food.
• 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 flannels or towels with the rest of the family while he's under the weather.
• Wash your child's clothes and bedsheets on the hottest wash possible.
  (NICE 2017a)

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.