Management of Fever and Vomiting in Children
Initial Management
- For a child with fever and vomiting, appropriate management includes oral rehydration therapy with small, frequent volumes, acetaminophen for fever control, and continued age-appropriate diet once rehydration is achieved, as recommended by the Centers for Disease Control and Prevention (CDC) 1, 2
Fluid Management
- Oral rehydration should begin with small, frequent volumes (e.g., 5 mL every minute) using a spoon or syringe under close supervision, and gradually increase the amount as tolerated, according to the CDC 1
- Replace ongoing fluid losses from vomiting with appropriate volumes of oral rehydration solution, as suggested by the Infectious Diseases Society of America (IDSA) 3
Fever Management
- Avoid aspirin in children under 16 years of age due to risk of Reye's syndrome, as advised by the American Academy of Pediatrics (AAP) 2, 4
Dietary Recommendations
- Once rehydration is achieved, resume age-appropriate diet immediately, including starches, cereals, yogurt, fruits, and vegetables, and avoid foods high in simple sugars and fats, as recommended by the CDC 1, 3
Antiemetic Considerations
- Antiemetics are not routinely recommended for children under 4 years of age, but ondansetron may be considered in older children (>4 years) to facilitate oral rehydration when vomiting is persistent, according to the IDSA 3, 5
When to Seek Further Medical Care
- Indicators for referral to hospital include signs of respiratory distress, cyanosis, severe dehydration, altered consciousness, prolonged vomiting (>24 hours), drowsiness, and signs of septicemia, as indicated by the AAP and IDSA 2, 3, 4, 5, 6