When kids are sick in books or movies, they take to their (beautifully made up) beds and get rest. Actual kids, well, they tend to do something else. Mostly, they keep bouncing off the walls. When adults throw up, we tend to take that as a sign that something is really wrong and cancel plans, or at least take it easy for a bit. But toddlers can throw up and then continue on about their business, unperturbed. You’ve checked their temperature, and there’s no fever. So, what do you do, as a parent, when your toddler is vomiting with no other symptoms? How do you know whether it’s something you need to call the doctor about, or just a weird fluke that’s likely to pass?
Mainly, you’ll have to use your powers of observation. Even a seriously ill toddler might be more likely to tell you about the red truck he saw once than actually explain his symptoms. Figuring out if they’re too sick for school or daycare can be its own puzzle since, again, they’re not likely to tell you. To add to your list of worries, vomiting and gastrointestinal issues can be a symptom of Omicron in kids. Luckily, there’s some guidance. The medical professionals who work with kids have seen it all, and know when throwing up is an inconvenience, and when it’s something to take more seriously.
Why is my toddler vomiting with no other symptoms?
If your toddler is throwing up, but doesn’t have a fever or seem to have anything else wrong with them, there are a few things that could be going on, according to Dr. Steven Abelowitz, a pediatrician and director of Coastal Kids Pediatrics. The four main issues that doctors would point to in this case are:
- Acute gastroenteritis or gastritis. Basically, a stomach bug. “This is the most common cause of vomiting in toddlers, and although it's often accompanied by fever and diarrhea, it often can present as vomiting by itself,” Abelowitz explains.
- Food poisoning. Though you may aspire to serve your kids the same food as everyone else, that may not happen in practice. Think about what they’ve eaten in the last day or so and consider if there might be something that disagreed with them.
- Food allergies. Sometimes, a toddler’s body just gets rid of the foods they’re allergic to. This can be part of the reason that you want to avoid introducing a bunch of new foods at the same time — it’s easier to spot allergies when you introduce them slowly. If your toddler vomited after trying something new, to take any new foods and try them again “in small amounts, spaced four days apart, to be able to recognize any symptoms of upset,” says Paula Zindler, a pediatric nurse.
- Anxiety. Sometimes, a kid can cry so hard they vomit, or find a transition so upsetting — you’re going out and trying to leave them with a babysitter, for instance — that they throw up. That can be really frustrating for parents. In those situations, parents need to try to “root out the cause of the unhappiness that drives him to vomiting mode to keep you near him and get professional advice for tools to use in these difficult situations that are not linked to a digestion issue,” suggests Zindler.
Beyond these four big causes, the list of things that could cause your toddler to vomit runs the gamut from appendicitis to motion sickness. Kids can vomit after hard coughing, after taking medications on an empty stomach, and after a serious head trauma. You might have to mentally look back through the day to figure out the most likely explanation. If you’re worried at all, a quick call to your pediatrician’s office can put your mind at ease.
Dehydration: When to worry
Dehydration is always a potential concern when you have a vomiting toddler on your hands, and knowing the signs can help you feel prepared. The most common signs of dehydration in a young child, according to Abelowitz, are:
- Decrease in urination
- Dark or significantly yellow urine
- The inside of mouth and tongue become dry
- Mo tears when the child cries
A seriously dehydrated child may also become too weak to stand and lethargic.
Preventing dehydration isn’t always as easy as you might think, especially if your kid is throwing up frequently and can’t keep water down. Parents should wait twenty minutes after an episode of vomiting, Zindler says. Then, use a dropper to offer Pedialyte or Gatorade every fifteen minutes. If you try that twice, and your kid still can’t keep anything down, you should call your health care provider. If they keep that down, you can keep rehydrating them by offering an ounce of liquid every ten minutes. This method may avoid getting into a cycle where you can’t get them to keep anything down. “It’s common to continue to vomit once the belly is stressed from vomiting,” Zindler points out.
When to contact the doctor
It’s always OK to check in with your pediatrician if you’re worried, Abelowitz reminds, but you should absolutely phone your doctor right away if:
- If your child is under 6 months and is significantly vomiting.
- If your infant has been vomiting for more than twelve hours.
- If your child is under 2 has been vomiting for more than twenty four hours.
- If your child is over 2 and has been vomiting for more than forty eight hours.
- If the child is projectile vomiting.
- If your child is vomiting more than three times a day.
- If there is bile or blood in the vomit.
- If there are associated symptoms such as headaches or dehydration, or blood in the stool.
If your kid’s symptoms aren’t on this list, you can breathe a sigh of relief. But, even without other symptoms like a fever, you should keep a close eye on your kid if they’re throwing up. “Vomiting — although quite common in children — always needs to be taken very seriously,” Abelowitz notes. “Parents should be supervising children that are vomiting very closely.”
Hopefully, in a few hours, your kid will be feeling like themselves again and you’ll be able to collect a parenting merit badge for “unexplained vomit.”
Steven Abelowitz, M.D., Coastal Kids Pediatrics
Paula Zindler, BSN, RN, IBCLC