When a child spits out a dose of syrup or throws it up soon after, parents wonder how much actually went in and whether to try again. This article covers the factors clinicians consider and ways to make dosing easier.
Why It Happens
Bitter taste, an unfamiliar texture and being held down for a dose are common reasons children refuse or spit out medicine. Squirting liquid straight to the back of the throat, or dosing a crying child, can trigger gagging or coughing. When a child already has a stomach bug or a bad cough, vomiting after a dose may simply be part of the illness.
How It Differs by Age and Stage
Young infants have a tongue-thrust reflex, so liquid often drips back out of the mouth. From around the first birthday to age 3, strong independence tends to show up as clamped lips or turned heads. Children in group care are sick more often, so a few bad experiences with medicine can make later doses harder.
What to Do at Home
The American Academy of Pediatrics (HealthyChildren.org) advises using the oral syringe, dropper or cup that comes with the medicine instead of a kitchen spoon, and describes an oral syringe as the most accurate tool for amounts under 5 mL. Sit the child upright, place the tip along the inside of the cheek, and push slowly in small amounts of roughly 0.5-1 mL so the child can swallow between squirts. Aiming at the back of the throat is discouraged. Pause to calm a crying child first.
Whether to repeat a dose depends on the medicine, the timing and how much came back up. A Canadian survey of hospital pharmacy practice found that the time between swallowing and vomiting was the factor clinicians weighed most, and many would consider a repeat dose if vomiting happened within about 30 minutes, but it also reported that clear guidelines were scarce. For fever reducers, antibiotics or any medicine where spacing matters, calling a pharmacist or the child’s doctor before giving more is the safer route. In the United States, Poison Control (1-800-222-1222) can also advise.
Common Misunderstandings
Many parents guess how much was lost and top it up, but the amount is hard to judge and a guess can lead to too much. Mixing medicine into a bottle or a bowl of food can seem safe, yet if the child does not finish it the dose is incomplete, and some medicines should not be mixed, so ask the pharmacist. Holding the mouth open to force a dose raises the chance of choking and often makes later refusal worse.
When to Seek Care
Call the doctor the same day if the child vomits after every dose, cannot keep down fluids, or shows signs of dehydration such as no urine for 8 hours or more, no tears and a dry mouth. Call promptly if a prescribed antibiotic or seizure medicine was vomited. Go to the emergency room right away if you think the child got more than the intended amount, has trouble breathing, has blue lips or is unusually limp. This information is based on U.S. and international sources; if you live elsewhere, check with a local pediatrician. This information isn’t a diagnostic tool and doesn’t replace advice from a medical professional.