Vomiting

Vomiting is the term for an active, sometimes powerful, return of stomach contents (and sometimes intestinal or esophageal contents) out of the mouth.  The reason for emphasizing the definition is because vomiting is different than reflux and rumination with different causes and mechanics.
With vomiting, the stomach is actively contracting, forcing the food and stomach juices up the esophagus and out.  It can be accompanied by nausea (a queasy feeling of discomfort that often feels like you might vomit, even when that doesn't happen).  It can occur repeatedly in waves over several minutes or hours until all of the stomach contents are emptied or in cycles where the pattern will happen intermittently.

Pain can come first, afterwards or not at all.
Diarrhea and / or fever can accompany the vomiting if there is an infection (gastroenteritis).
If there's no food in the stomach, the returned contents (emesis) are usually clear stomach acid.
Intestinal fluids (bile) can return as well.  If it is yellow, the bile is returning from the first portion of the small intestine.  Return of green bile is from lower in the intestine.

Red blood in the emesis that is present at the beginning of a vomiting episode often indicates a significant problem with an ulcer or other area that may be bleeding actively, and that may have caused the vomiting.  A brown substance that looks like coffee grounds may also indicate that blood is present and has been there long enough for the stomach acids to turn the blood into those brown grains.
If the person has had several forceful rounds of vomiting in a row, that force may tear a blood vessel where the stomach meets the esophagus.  This bleeding will usually stop when the vomiting subsides.

Vomiting and nausea can come from a number of causes

  • Intestinal infections, even kidney, sinus or other infections
  • Brain injury, swelling or pressure
  • Emotional upset or triggers (even the smell of food)
  • Gagging and swallowing problems
  • Narrowing in the esophagus
  • Ulcers and stomach disorders
  • Intestinal blockage
  • Food allergies
  • Hormone shifts (morning sickness in pregnancy)

Of concern:

  • Blood or green bile in the emesis
  • Dehydration (dry tongue, decreased tears)
  • Lethargy
  • High fever
  • Continued vomiting
  • Cycles of vomiting
  • Continued pain
  • Nutrition When Vomiting Is Present

  • The first need is to replace the fluids that have been lost with water and clear liquids (broths, popsicles and especially in children, the electrolyte replacement fluids.
  • Medicines may be needed to lessen the nausea and slow the vomiting--this and fluid replacement should be discussed with your primary care provider.  Medicines may also be needed to bring down a fever since higher temperatures do cause more fluid losses and greater replacement needs.
  • Food should be introduced as soon as the child is able to take it.  Crackers, rice, noodles and other easily tolerated foods often make good choices to begin with.
  • Ginger (ginger ale or ginger beer are often used to settle stomachs).  At times, flat sodas (the bubbles stirred out) can help.
  • Once stable, efforts should be directed to finding the cause and determining what else may need to be done.

Fortunately, intestinal infections are the usual cause of vomiting and they are often over within several days.

Further Reading

Diarrhea

Gastroesophageal Reflux