Causes of Vomiting in Children

Vomiting, also known as emesis, occurs as a reflex reaction triggered by the vomiting center in the brain, leading to strong contractions of the abdominal muscles and diaphragm, while the stomach relaxes. Various factors can stimulate this center, including:

Stimulation of nerves in the stomach and intestines due to irritation or inflammation of the gastrointestinal tract, often resulting from an infection or blockage.
Presence of chemicals in the bloodstream, such as certain medications.
Exposure to psychological triggers, including distressing sights or odors.
Stimulation from the inner ear, as seen in motion sickness.

Gastroenteritis

In many cases, vomiting in children is associated with gastroenteritis, commonly referred to as stomach flu. This intestinal inflammation is often caused by viral infections, with rotavirus and norovirus being the most prevalent culprits. Certain bacteria, such as E. coli and Salmonella, may also lead to this condition. Besides vomiting, gastroenteritis typically presents other symptoms, including nausea, abdominal pain, and diarrhea, which usually appear 12-48 hours post-infection. Typically, this condition is not long-lasting and often causes more discomfort than danger, with most children improving within 1-3 days. Norovirus may sometimes cause a slight fever, though this is not always the case. The virus is contagious and is usually transmitted to children through:

Contact with an infected individual.
Consuming contaminated food.
Touching the mouth or nose without washing hands after contact with contaminated surfaces.

Food Allergies

Symptoms of food allergies can manifest in children shortly after consuming specific foods, often within minutes to hours. These symptoms include nausea, vomiting, and skin rashes. Some severe allergic reactions can be life-threatening if not addressed promptly; hence, immediate medical attention is necessary if the child experiences difficulty breathing or swelling of the mouth or throat. Common allergenic foods include milk, eggs, fish, shellfish, peanuts, sesame, nuts, soy, and wheat.

Appendicitis and Other Infections

Vomiting not accompanied by diarrhea should typically cease within 24 hours. If it persists beyond this timeframe, it may indicate a serious health issue, such as a kidney infection, diabetes, or appendicitis. Appendicitis occurs when a small pouch protruding from the colon becomes inflamed, causing pain that generally begins near the belly button and then shifts to the lower right abdomen. The intensity of the pain worsens over time as inflammation progresses. Accompanying symptoms include nausea and vomiting. Although anyone can develop appendicitis, it most frequently occurs in individuals aged 10-30, and the standard treatment is surgical removal of the appendix.

Additionally, vomiting can be indicative of other infections, such as urinary tract infections (UTIs), middle ear infections, pneumonia, and meningitis. Parents should seek medical consultation if their child experiences vomiting alongside other infection symptoms, like fever or irritability. Here are some types of these infections:

Middle Ear Infection: A common condition in children, usually following a cold.
Pneumonia: This can be caused by viral or bacterial infections, with viral infections being more common. Distinguishing between them can be challenging due to similar symptoms, and children may develop pneumonia shortly after having a cold or flu.
Meningitis: An inflammation of the tissues surrounding the brain and spinal cord, most commonly viral meningitis, which occurs when a virus enters the body via the nose or mouth and then spreads to the brain. While bacterial meningitis is rare, it can be deadly and typically follows an illness resembling a cold. Common bacterial causes include pneumococcal and meningococcal infections. This condition is more prevalent in infants and young children.

Food Poisoning

Bacteria can enter a child’s system through the consumption of improperly cooked or preserved food, resulting in food poisoning. Common bacteria responsible for foodborne illnesses include Salmonella, Listeria, Campylobacter, and E. coli. Foods commonly associated with food poisoning include undercooked meats, poultry, eggs, shellfish, and unwashed vegetables such as lettuce. Children might begin vomiting a few hours after consuming contaminated food, although symptoms can occasionally develop one to two days later. Food poisoning typically presents additional symptoms like nausea, watery diarrhea, abdominal pain, and sometimes fever, with vomiting being the most common symptom without an accompanying fever. These symptoms can persist for several hours to a few days.

Ingestion of Harmful Substances

When a child begins to vomit, it is crucial to ensure they have not ingested any medications or cleaning products, or other toxic substances. Parents should thoroughly search the home for any empty containers or spilled liquids. It’s also important to evaluate the vomit, as it may contain pills or present unusual odors, colors, or appearances. If there is any suspicion that the child has ingested a harmful substance, immediate consultation with a healthcare professional or a visit to the emergency department is essential.

Other Causes

Vomiting in children can also be linked to various other causes, including:

Overeating, particularly foods high in fat or sugar that the child does not usually consume.
Bulimia in teenagers.
Bowel obstruction, often resulting in green vomit.
Influenza and other illnesses.
Concussion.
Severe coughing, which may trigger vomiting, especially in children who experience reflux.
Significant anxiety or stress, which is a more common cause in older children and adults.
Motion sickness, associated closely with genetics, including seasickness or dizziness from amusement park rides.
Migraine, which commonly afflicts children experiencing migraines.
Cyclic vomiting syndrome, characterized by repeated episodes of vomiting that begin and end suddenly, often correlating with later migraine occurrence.
Consuming certain medications on an empty stomach, where vomiting may indicate overdose of specific drugs. Common culprits include:

Codeine
Erythromycin
Iron
Certain asthma medications, like Theophylline
Acetaminophen
Ibuprofen

Causes of Infant Vomiting

It is important to distinguish between “spitting up,” or the reflux of milk into the esophagus, and vomiting. Spitting up typically represents a gentle expulsion of stomach contents in infants, often accompanied by burping, and is common in infants under one year of age. Conversely, vomiting involves a forceful ejection of stomach contents. Occasionally, it might be difficult to differentiate between spitting and vomiting in infants, as some spit up forcefully or in large amounts. However, trained professionals can usually ascertain the cause and identify the appropriate treatment. Persistent or forceful vomiting in infants under three months may indicate a serious issue and requires further evaluation. Potential causes of vomiting in infants can include pyloric stenosis, intestinal obstruction, or infections in the gastrointestinal tract or elsewhere in the body. Parents should also seek professional help if an infant under three months experiences a fever exceeding 38 degrees Celsius, regardless of whether vomiting is present.

Though pyloric stenosis is relatively uncommon, it can lead to significant vomiting in infants. It typically arises between two weeks and two months of age and involves an abnormal thickening of the pylorus, the muscular valve between the stomach and the small intestine, which obstructs the passage of food. This condition often leads to projectile vomiting, dehydration, and weight loss, along with persistent hunger in the affected infants. Surgical intervention is the standard treatment for this condition.

Tips for Managing and Preventing Vomiting

When a child vomits due to an infection, it is crucial for parents to take precautions, as these cases are highly contagious. To mitigate the spread of infection to parents, family members, or friends, the following steps should be followed:

Wash hands frequently, a highly effective method for preventing the spread of infection. This involves wetting hands with water and regular soap or antimicrobial soap, then rubbing hands together for 15-30 seconds, paying attention to nails, wrists, and between fingers. Afterward, rinse hands thoroughly and dry them with paper towels, disposing of them appropriately. Hand sanitizers containing alcohol can be an alternative when soap and water are unavailable, used by applying sufficient product to all surfaces of the hands until dry. These sanitizers come in convenient small sizes for portability, but hands should always be washed with soap and water if visibly dirty.
Keep the child out of daycare or school until at least 24 hours have passed since their last episode of vomiting, particularly if they have vomited twice or more within 24 hours.
Thoroughly clean surfaces using disinfectants and hot water.
Wash soiled bedding and clothing at high temperatures.
Clean or dispose of any cleaning tools used.
Never allow sick children to prepare food.
Ensure the sick child’s towels are not shared with others.

It is normal for a child to spit up after feeding or occasionally vomit once after feeding, which typically requires no concern. Therefore, parents should consider tips aimed at reducing reflux in infants. If these methods are unsuccessful, medical consultation is necessary. Recommendations include:

Feeding the infant smaller amounts at a time.
Feeding slowly.
Avoiding placing the child in a sitting position while feeding, and refrain from propping the bottle for independent feeding; holding the child during feeding is encouraged.
Using a different type of bottle or changing to a smaller nipple to minimize air intake during feeding.
Reducing play and vigorous activity after feeding.
Experimenting with varied positions for the child during and after feeding.
Burping the child frequently during feedings.
Avoiding smoking while holding or feeding the infant, and not smoking indoors or in the vehicle, as tobacco exposure can lead to various illnesses that may cause vomiting. Parents are advised to quit smoking altogether.

Video: Causes of Vomiting in Children

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