Test stress? One too many pieces of holiday candy and sweets? Playoff panic? Overindulged at dinner? Food allergy or food poisoning? A bad bug going around the class? Could it be something more serious?
When your young child complains of a tummy ache or has nausea and vomits, it can be difficult for parents to figure out the source of the often vague digestive complaint.
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Seek medical assistanceDr. Todd Zimmerman of CN EmergiKids, the pediatric emergency departments at Alexian Brothers Medical Center and St. Alexius Medical Center, advises parents to seek medical assistance immediately in the following conditions:
Ÿ Bile (green) or blood-tinged (reddish or black) vomit.
Ÿ Any episode of vomiting in a newborn, or vomiting that continues for more than six hours in an infant or child.
Ÿ If an infant refuses to eat or drink anything for more than a few hours.
Ÿ Dehydration: dry mouth, no tears when crying, not urinating or having a wet diaper in four to six hours (for babies and young children) or not urinating in six to eight hours (for older children).
Ÿ Abdominal pain that is moderate to severe, even if it comes and goes.
Ÿ Behavior changes, including lethargy or decreased responsiveness.
Nausea and vomiting are common in children, and are usually part of a mild, short-lived illness, frequently caused by a viral infection. For some, throwing up may be almost considered a rite of childhood passage, similar to a skinned knee. But for others, it can be much more serious.
Among the dozens of conditions which can lead to nausea and vomiting are gastroenteritis (stomach virus), food allergies and irritation, anxiety and stress, a viral flu bug, eating too much, headaches, concussion, food poisoning, and even appendicitis or intestinal intussusception.
For 9-year-old Maggie Hancock of suburban Carol Stream, it's test days that cause her tummy to quiver.
"It's usually nerves which lead to the nausea and occasional vomiting," says mom Judy, who works as a receptionist for a busy DuPage-area pediatric practice. "While she only gets sick once in a blue moon, test anxiety and sometimes eating too many sweets before bedtime can upset her tummy."
A playoff-type competitive sports event, speaking in front of the class, meeting people, or trying a new skill can do it for other kids.
"If it's a viral bug that I know is going around the classroom, we usually take it easy with food and I watch for dehydration," says Hancock, who carefully monitors for additional signs of a more severe illness.
Although most children recover from nausea and vomiting without any treatment, it is important to know when to seek help if the child does not get better, says Cara Long, of Western Springs, the mom to 17-year-old Maggie and a registered nurse.
"Maggie, who has a variety of special needs, suffers from reflux," says Long, who recalls trying to decipher early warning signs and clues to the inevitable spewing when her daughter was younger. "Sometimes it was as simple as her laying down and being crabby, other times refusal to eat. Whatever the sign, it's important to follow the child's lead. If they don't what to eat right then, don't make them."
As parent liaison at Easter Seals of DuPage and the Fox Valley Region, Long advises other parents to heed their own gut instincts when it comes to the seriousness of their own child's illness.
"If in addition to vomiting, your child's condition is getting worse, it's time to take action and call for help," she cautions. "No one knows your child as well as you do. If you think it's more than a simple bug, act on it."
Long's advice is on target, according to Todd Zimmerman, D.O., medical director of CN EmergiKids, the pediatric emergency departments at Alexian Brothers Medical Center, Elk Grove Village, and St. Alexius Medical Center, Hoffman Estates.
"Your child's history and the timing of your child's nausea and vomiting may give an indication of its cause," explains Dr. Zimmerman, whose EmergiKids pediatric emergency departments provide care for about 18,000 babies, kids and teens annually. "In nearly 95 percent of the cases, a child's personal history is the best diagnostic tool."
Dr. Zimmerman says while nausea and vomiting may be common to a number of illnesses, it's important to look for other symptoms like a sore throat, cough or runny nose which ultimately may lead to a flu diagnosis.
Food poisoning usually leads to nausea or vomiting a few hours after a meal. Vomiting also can be a sign of a more serious illness, such as appendicitis, meningitis, migraine headache, or a concussion.
Because young children and toddlers often have trouble describing pain or pinpointing an exact location, parents find some conditions like appendicitis and intestinal intussusception difficult to recognize in the earliest stages.
"I always tell parents if their child looks well and the vomiting isn't excessive, we first need to reset and monitor," explains Dr. Zimmerman, who recommends nothing to eat or drink for one hour after vomiting. "Then it's OK to try a Popsicle or small amount of liquid."
Dr. Zimmerman recommends keeping a close eye on your child and if they still look well, despite the vomiting, it may be OK to keep them at home. Because vomiting can quickly lead to dehydration, he cautions it is important to watch for signs of dry lips and mouth, sunken eyes, rapid breathing or pulse, decreased activity and/or urination.
If accompanied by significant belly pain or excessive vomiting, if their activity level changes and they look sicker than before, it's time to head to the emergency room.
For children under 6, if their vomiting coincides with diarrhea, dehydration, a fever over 100 F, or if the child hasn't urinated in six hours, it's also time to see the doctor.