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Child vomiting. Should I worry or just give plenty of fluids and diet food?

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Hi. My daughter is 2 years old and vomited twice today. In the early morning she hadn't digested dinner and when she got home after dinner time she vomited intact rice from lunch. She started nursery this week and I'm worried she picked something from another child. Should I worry or just keep giving her plenty of fluids and diet food? Thank you
Posted Fri, 14 Sep 2012 in Child Health
Answered by Dr. Michelle Gibson James 3 hours later

Having a 2 yr old myself, I can understand your concern.
The most common cause of vomiting in this age group is viral gastroenteritis with a virus called rotavirus being one of the most common pathogens. In rare cases it could bacterial as well but this is usually associated with high fever and blood in stool.

It is possible that she did pick it up from nursery, the pathogens are transmitted the fecal to oral route ( virus on hands from someone to your daughters food or drink).

You need to assess her hydration status because small children can quickly become dehydrated, use the following to check- (1)if she cries are there tears or is the crying dry, (2)how many wet nappies are you changing- is it less than usual,(3) does her skin appear dry, (4)does her mouth appear dry, (5)is she lethargic? (6) capillary refill - when you press on her finger nail bed till it turns white then remove your hand , how long before it returns pink? it should be less than 2 seconds (7) if you pinch the skin on her abdomen gently does the skin immediately go back like it should or does it stay up indicating dehydration?

If she does appear dehydrated you need to consider contacting her doctor.

Focus more on her drinking than eating, some foods may irritate her stomach and intestine and aggravate the symptoms.

If she will use them, try the oral rehydration fluids first because these contain the salts that she will need. If she won't use them, she can use liquids such as gatorade after the fizz is gone.

If she does not appear dehydrated then no immediate treatment is needed, she will need at least 1000ml/day (this called maintanence fluids because the body needs this amount to maintain itself), with an additional 2ml per kilogram in weight of fluid for every vomiting episode and an additional 10ml per kg for every loose stool if they occur. For example if she weighs 10 kg , everytime she vomits she needs an additional 20ml (4 teaspoons) of fluid added to her daily requirement.

She may want to drink large quantities at a time but in most cases this will actually aggravate the vomiting. Let her take sips (about a teaspoon), wait a few minutes ( about 1 or 2) if she doesn't vomit, give her some more etc.Once she is tolerating the fluids (after about 45mins to an hr ) then increase the amounts given slowly.

If she does appear dehydrated, again it is safer to speak to a doctor. What is usually recommended is 50 to 100ml of fluid per kg over 2 to 4 hours to replace what she has lost ( the same 2ml/kg given for each additional vomit and 10ml for every additional stool).
After the 2 hours then she goes onto the maintenance of 1000ml in a 24 hr period.
Again the fluids are given slowly as described before.

I hope this helps and I hope you little one feels better soon. Feel free to ask any other questions
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