FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

MOTHER PROBABLY TOOK RIGHT ACTION WITH SON’S VOMITING

Question: Last week my first-grader woke up for school feeling fine but began vomiting before the bus came. He threw up several times, then slept for a few hours, got up and felt fine. He was asking for food, but I only gave him clear liquids. He seemed to have a slight fever to the touch but was fine later in the day. Should I have taken him to the doctor?

Answer: Vomiting is a complex, coordinated reflex orchestrated by a specific part of the brain. It is involuntary and in most cases self-limiting. The triggering mechanism can be one of several causes. Vomiting can be a response to nerve signals coming from the mouth, stomach or intestines. Also, it can be triggered from the bloodstream in response to medicines or infections. Other times, the signal can come from the balancing system in the ear, as is the case with motion sickness. Finally, the signals can start in the brain itself as a result of unsettling sights, smells or thoughts. Generally, vomiting is preceded by a “sick to the stomach feeling” that we call nausea.

Of the possible causes, perhaps the most common is viral infection of the gastrointestinal tract. This is probably what your child experienced. This type of vomiting is often associated with diarrhea.

Since your child was ill for only a few hours, it was probably okay to not go to the doctor’s office. You also did the right thing by not allowing food too soon after the vomiting had stopped.

There are times when a child is vomiting, however, that you should get medical help. If the vomiting is forceful and frequent, you should contact your physician for advice and possible medication to slow down it down. Excessive vomiting can lead to dehydration, especially in very young children, or children who have an underlying medical condition.

There are certain times when vomiting should prompt an immediate call to your physician or a trip to the hospital emergency department. Here are three such cases: (1) if the vomiting is preceded by or associated with abdominal pain -- a possible sign of an appendicitis or another acute abdominal problem; (2) if the person vomiting also has a high fever or change in mental status; and (3) if it’s vomiting that’s associated with a concussion, or head injury.

So as you can see, figuring out the cause of the vomiting is the place to start. If it is determined that this is probably a viral infection, then your physician may want to prescribe medication to stop the nausea. It’s also a good idea to limit fluid intake to only small sips of clear liquid until the vomiting has subsided. Then gradually reintroduce solid foods and full liquids over a day or two. This can be difficult because many children bounce back very quickly and are ready to eat everything in 12 to 24 hours.

Though I think you did alright in this situation on your own, I always prefer to err on the side of caution. When in doubt about what to do, it is always best to call your physician.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.