Kid's Health topics

The technicolour yawn – vomiting in children

It has been a while since I have written anything for you all, but I can assure you that I have not been sitting back resting on my laurels.  In fact, the last couple of months have seen myself and my little family pack up our house in Brisbane and rent it out, squeeze our lives into a single shipping container, load the 3 kids into a car packed to the roof with gear, and drive 1700km up the QLD coast to Cairns, before jumping in a plane to fly another 1000km northward to reach our final destination at the very tip of Australia.  We have spent the last few weeks settling into our new home and new life here in the remote community of Bamaga. This means a new job for me (full time GP/hospital doc – eek!) and a new role of stay-at-home-dad for my husband (even more eek!)  You will hear some more about our adventures up here as we settle in, but so far so good.  Now that all the craziness is starting to settle, I thought I would dive back into writing to talk about a topic so familiar to us all as parents…. Vomit. 

Now I think I have a pretty strong stomach for most things medical, but I really dislike vomit.  Thankfully my husband doesn’t mind dealing with it, so I can usually palm it off on him.  We were lucky not to have too much experience with vomit in our household until my eldest was about 3 and his first vomiting bug declared itself with a strawberry milkshake deposited all over my husband 30 seconds after he walked in the door from work… thank goodness it wasn’t me!  That was a very expensive illness for us, as our darling boy was terrified of vomiting in a bowl or the toilet or anything vaguely sensible, and instead preferred the couch, the rug, his pillow, his doona and all of our towels…. sigh.  More recently our exciting trip up north started off with a bang when our middle child decided to vomit in the car on the very afternoon we left the house all packed tight to the roof.  Cue the first night spent unpacking all the gear, cleaning out the car, pulling out the car seat, washing the covers and hosing the seat out in the shower as there wasn’t a hose to be found.  Not exactly how I had planned the start of our adventure!  Vomiting is incredibly common for kids, so let’s talk about it.

Why do kids vomit so much?

Kids are more prone to vomiting than adults and partly this relates to the anatomy of their stomach and oesophagus and the tightness of the muscular ring that separates the two – the gastro-oesophageal sphincter.  In most adults this ring is pretty tight and only really loosens to let food pass through when you swallow.  In kids, and particularly babies, it is much looser and thus allows food and fluid to move back up the oesophagus as vomit more easily. 

Kids are also much more prone to the conditions that may cause vomiting; babies posset and may have reflux, some children experience urinary tract infections, and almost all kids have be exposed to viral infections at some point in their early lives.  Some children also seem to have a much lower threshold for vomiting and may do so after crying, with emotional stressors, with coughing, after a bump to the head, with a fever or sometimes even out of pure stubbornness (I may or may not have been the child who vomited on my plate in defiance instead of eating my vegetables!)

My child was diagnosed with ‘Gastro’. What does this mean?

Gastroenteritis or ‘gastro’ means inflammation in the stomach and bowel.  This may cause vomiting, diarrhoea, abdominal pain or a combination of these, sometimes associated with fever, runny nose or sore throat.  ‘Gastro’ is most commonly caused by a viral infection, but may occasionally be bacterial in nature.  It is generally highly contagious.   Childcare centres and schools often have ‘outbreaks’ of gastro and September/October is peak gastro season.  Thankfully most gastro infections are short and self-limiting.  The treatment is usually just to make sure that your child stays hydrated and as comfortable as possible, and to ride it out.  Most gastro will settle within a couple of days, though diarrhoea may persist for up to a week or so after the acute infection is over. 

What treatments are available?

If your child has a fever or is in pain then giving some Paracetamol or Ibuprofen can be helpful to make them feel more comfortable.  Also remember that you can buy Paracetamol suppositories from the chemist that are a fantastic option for children who may be feeling too sick to take oral medications.  They work very well and I’m a big fan of this underutilised form of medication.

The main goal is to maintain your child’s hydration.  How worried you need to be about this depends on how old your child is, how long they have been unwell for, how much fluid they are getting in, and any other medical conditions they may have.  Small babies can get dehydrated much more quickly than older children so it is always worth seeing your doctor if your <1yo baby is vomiting more than usual.  A good guide to your baby’s hydration is their number of wet nappies so it’s worth noting how many they have each day. Older kids have a bit more reserve and will generally be able to ride it out without getting dehydrated unless their illness is prolonged or severe. 

At home you can try to maintain your child’s hydration by giving more frequent small volume fluids – the smaller volume means they are less likely to vomit it back up.  This can be in the form of frequent short breastfeeds or bottle feeds for small babies, small volumes of juice, flat lemonade or cordial, ice blocks or frequent small volumes of oral rehydration liquids such as Gastrolyte or Hydralyte.  These are specially designed liquids available from the chemist which are gentle on the stomach, but contain a balance of sugars and electrolytes (salts) which is ideal for rehydration. 

If your child continues to vomit it may be worth a visit to your GP or local emergency department to assess their hydration.  Some children may be suitable for an anti-nausea medication which can help break the cycle of vomiting and allow them to orally rehydrate quicker. Some children may even require fluid rehydration through another means such as through a nasogastric tube or via and intravenous cannula.

When do I need to be worried about vomiting?

Though vomiting is frequently caused by viral gastroenteritis, there are some other causes that can be more serious.  These can include urinary tract infections, gastro-oesophageal reflux disease, and certain stomach and bowel conditions including surgical conditions such as appendicitis. It can sometimes be hard to tell the difference between a  viral gastroenteritis and some of these other causes, which is where a visit to your doctor may be worthwhile especially if your child is very young, seems quite sick, has protracted vomiting, or suffers from other medical problems, or if you have any concerns about you childs’ hydration. Although some of us don’t love vomit, we are only too happy to see your child and ensure that there are no more serious conditions at play and review their hydration.

Well that is probably enough about me least favourite topic for now.

Til next time.

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