Vomiting instructions

February 14, 2024

If your child is vomiting, you need to know what to do! Here are instructions, step by step, for you!

Vomiting


By Dr. Kerby Zeisloft, Advocare Fairmount Pediatrics


Vomiting is usually caused by a stomach virus. Antibiotics do not help. Some children will also have diarrhea.
The pattern you can expect is that the child feels poorly and wants to lie down. Next, they look pale. Finally, there is vomiting. There may be multiple vomits over the course of several hours. The diarrhea usually comes the second day, though it can be the first day. Vomiting will usually be for less than a full day, and then the child feels weak and does not have much appetite. They usually are a bit better on day 2 and then on day 3, they feel better enough that they eat normally. There is often more vomiting on day 3-4, as the child eats more normally before the stomach is quite ready.
The key to improvement is to go slowly! Preventing dehydration is the key.

FOR BABIES UNDER ONE YEAR OLD:


Wait 30 minutes after the child vomits before giving anything to drink.
I know you are worried about dehydration and you want to give something right away. But if you give fluids right away, your baby will vomit them. This will increase the risk of dehydration. Please wait after a vomit to allow the stomach to settle. 

Now, give 5 cc of Pedialyte every 5 minutes about 3 times. Next, give 10 cc every 10 minutes, about 3 times. Next, give 15 cc every 15 minutes, about 3 times.
WHY PEDIALYTE? The pedialyte, or any oral rehydration fluid (even a home-made one, please see below for the recipe), has electrolytes in it. Giving just water will lead the child to vomit again, and will also cause the body's electrolytes to be watered down, leading to low levels of salt in the body. It's best to use an oral rehydration fluid.
Gerber Rehydralyte oral rehydration fluid is actually delicious, but is hard to find in the stores. 

NEXT STEPS:
Next, every 5-15 minutes, give a small sip of half to one ounce of Pedialyte, Breast milk or Soy formula. If you are breastfeeding, you can try paced breastfeeding, allowing the infant to stay on the breast for 1-2 minutes at a time. If you have a forceful letdown, and rapid milk flow, you are better off pumping and feeding with a bottle at this point.

If there is no vomiting for 2 hours, go back to formula, if you are formula-feeding, or continue to breastfeed often, if you are breastfeeding


FOR CHILDREN OVER ONE YEAR OLD:


Wait 30 minutes after the child vomits before giving anything to drink.
BIGGEST MISTAKE? GIVING WATER RIGHT AWAY AFTER VOMITING.

Next, you can settle the stomach with a heavy sweet syrup. Years ago, people used Coke syrup for this. Today, you can use the syrup that peaches are canned in (buy the heavy syrup, not the light version), or a medication called Emetrol, which is just a heavy sweet syrup and not really a medication


Give the sweet syrup, 1 tsp (1/2 tsp for babies) every 10-15 minutes, three times. After that, the stomach should be somewhat better


Then, every 5-10 minutes, give a small sip of half to one ounce of Pedialyte, or


0.5 strength Gatorade (with water) and 3 saltines/glass


0.25 strength Kool Ade (with water) and 6 saltines/glass


Pedialyte popsicles


Regular popsicles (not the all-fruit kind, you want the cheap, sugary kind, since sugar can be digested with a stomach virus and fruit cannot)


CAN MY CHILD EAT FOOD THE FIRST DAY?
If there is no vomiting for 6-8 hours, you may give more fluids and gradually return to a normal diet. Take this very slowly. If you go too fast, the child will seem better on the 2nd day and then will relapse and vomit again on the 3rd day. 

WHAT CAN THE CHILD EAT AS THE CHILD RECOVERS?
So, on day 2, try ginger ale, gatorade, salty broth, and jello. Later that day, try saltines, toast, salted noodles, and cheerios. Later still, try applesauce and bananas. The next day, boiled chicken, toast with jam, ice pops, dry cereal. Go slowly!

IF THE CHILDS BELLY DOES NOT HURT TO PRESS ON, AND THERE IS NO PAIN WITH JUMPING, WE CAN SEND IN ANTI-NAUSEA MEDS. Please schedule a telehealth visit for this. We usually use Ondansetron for this purpose. This drug is safe in young children as long as we can be confident that the belly is not tender or painful. Babies are sometimes given Ondansetron in the ER, but are not prescribed this drug without a physical exam first. 


FOR ALL KIDS, ALL AGES:


REASONS TO CALL THE DOCTOR:
Call the doctor if: your child vomits more than 4-5 times, if you see blood or bile (bright green fluid) in the vomit, or if you see signs of dehydration.
What are the signs of dehydrations? Not enough wet diapers, less urination than usual, no tears when crying, a dry-looking mouth and tongue, a sunken soft spot.

WHEN IS IT AN EMERGENCY?
Call if the belly is hard and painful to touch, or if a baby has fluorescent green in their vomit, or go to the ER.
A great guide to recognize an emergency vomiting situation is to have the child jump up and down. If they are able to do this, you can probably stay home. If there is pain or the child is unable to jump up and down, you should head to the Emergency Department.
If there is no urine output for 6 hours, this is dehydration and it is time to go to the ER.


FREQUENTLY ASKED QUESTIONS:
WHAT IF MY CHILD GOES 20 MINUTES WITHOUT VOMITING AND THEN VOMITS AGAIN? This is a common question. Unfortunately, you are best off waiting another 30 minutes before feeding. If your child is very thirsty, you could try to shorten the time to 15 minutes and use less Pedialyte, 2.5 ml, when you start.


I DON'T HAVE ANY PEDIALYTE AT HOME, AND I CAN'T GO OUT!
Here is a recipe for homemade oral rehydration fluid. You don't have to go out to get it!
Homemade Pedialyte:
Please mix 2 cups water, 1/2 tsp salt, and either 1/2 cup instant baby rice cereal or 1 1/2 tablespoons sugar.
Mix this well, and then feed one tsp at a time every minute or two

MY BABY OR CHILD IS REFUSING FLUIDS. WHAT DO I DO?!
Try offering the fluids with a teaspoon. 
Try turning on the television, even for an infant, to mesmerize them.
Try a dark room and cuddling the infant or child.
Try a syringe.
Try sugary fluids.
Try little bits of Pedialyte popsicles, or frozen pedialyte, and place the ice chips in the child's mouth.
Try singing while you offer the fluids.
If nothing nothing nothing works and there is no urine for 6 hours, please go to the ER for IV fluids.

By Alexis Lieberman May 16, 2026
Traveling with a Baby or Toddler: Safety Tips for Flying, Sun Protection, Swimming, and International Travel Planning a vacation with a baby or toddler can feel overwhelming, but with the right preparation, family travel can be safe, enjoyable, and memorable. Whether you are flying with an infant, heading to the beach, or traveling internationally, understanding child travel safety is essential. This guide covers important tips for sun safety, airplane travel, water safety, and travel vaccines for babies and young children. Sun Safety for Babies and Toddlers Protecting babies and toddlers from the sun is especially important because young children have sensitive skin that burns easily. Choosing a Safe Sunscreen for Babies Sunscreen can be used at any age, including babies under 6 months old, as long as you choose a mineral or barrier sunscreen that primarily contains zinc oxide. Mineral sunscreens sit on top of the skin rather than being absorbed. When selecting sunscreen for children: Choose products with mostly zinc oxide Avoid oxybenzone, which may disrupt hormones Avoid retinyl palmitate, a form of vitamin A that may increase sun sensitivity Avoid spray sunscreens to prevent inhalation Parents can research sunscreen ingredients and safety ratings through resources such as EWG Skin Deep Cosmetics Database and look for products with a hazard score under 4. Safe Sun Exposure for Infants Even with sunscreen, babies should not spend long periods in direct midday sunlight. Safer sun habits include: Keeping babies and toddlers out of direct midday sun Allowing limited early morning or late afternoon sun exposure Using hats, rash guards, and shade whenever possible Short periods of sun exposure very early or very late in the day may be reasonable without sunscreen, but prolonged exposure should always be avoided. Flying with a Baby or Toddler Air travel with children requires planning, especially when it comes to safety and comfort. The Safest Way for Babies to Fly Although airlines allow children under age 2 to sit on a parent’s lap, the American Academy of Pediatrics recommends that infants travel in an FAA-approved car seat. Many car seats are approved for both motor vehicles and aircraft. Check: The sticker on the side of the car seat Your car seat manual Your airline’s measurement and seating requirements Older children may be able to use the CARES harness system on airplanes. Traveling with Car Seats If you are bringing a car seat to your destination: Ask your airline whether car seats count toward baggage limits Many airlines check car seats for free Car seats used on the plane with a purchased seat usually do not count as carry-on luggage Helping Babies with Ear Pressure on Airplanes Changes in cabin pressure can cause ear discomfort during takeoff and landing. To help reduce ear pain: Nurse, bottle-feed, or offer a pacifier during ascent and descent Older children can suck on lollipops If your child recently had diagnosed middle ear fluid or an ear infection, you can give ibuprofen about 30 min before take off. If more than 6 hours has passed, you can give a second dose 30 min before landing. Preventing Illness While Flying Airplane travel itself is generally safe for babies, but crowded public spaces can spread germs. Helpful travel hygiene tips include: Wash or sanitize your hands frequently Clean your hands before touching your baby Wipe down commonly touched surfaces if desired Can Benadryl Help Kids Sleep on Flights? Some parents consider using Benadryl during flights. However, children can occasionally have the opposite reaction and become hyperactive or irritable. If you want to try it: Test it at home first during nap time Be aware that effects may last about 6 hours Avoid routine use Entertainment Tips for Long Flights with Toddlers Older babies and toddlers can quickly become bored during travel. Helpful ideas include: Bring a bag of small toys your child has never seen before Borrow toys from friends specifically for travel Introduce a new activity or toy every 15 to 30 minutes And remember: if your child cries or fusses on the plane, most passengers understand. Many are parents themselves. Water Safety for Babies and Toddlers Pools, lakes, oceans, and bathtubs all require constant supervision around young children. Never Leave Children Alone Near Water Children can drown quickly and silently, even in small amounts of water. Important safety rules include: Never leave a child alone near pools, lakes, oceans, bathtubs, or buckets of water An adult who can swim should always remain within arm’s reach of infants and toddlers Supervision from a distance is not enough Water Safety and Alcohol Adults supervising children around water should avoid alcohol or other substances that impair judgment or slow reaction time. If it's a party, please arrange for a LIFEGUARD! Ocean Safety for Young Children If visiting the beach with babies or toddlers: Watch tide conditions carefully Stay alert for strong waves Learn how to recognize rip currents Keep young children at arm's length closeness to an adult at all times in the water Travel Vaccines and Medications for International Travel Families traveling internationally may need additional vaccines or medications depending on the destination. Please write on the portal to check in before international travel. Early Measles vaccine If your child is 6 months to 11 months, it is recommended by the American Academy of Pediatrics to get a measles vaccine prior to international travel. There is no specific recommendation for an early measles shot for travel within the US, but if you know you are going to a "measles hot spot," we DO recommend an early MMR. The measles vaccine given UNDER one year old does NOT count for the one year old vaccine, and it will need to be repeated. If your child already had their 1 year old measles vaccine, but has not yet had their 4 year old measles vaccine, you can get an early second MMR-V. This WILL count as the 4 year old vaccine and does NOT need to be repeated. Book a medical assistant visit to get this vaccine! Oral Typhoid Vaccine (Vivotif) Vivotif is approved for children ages 6 and older. Look at the CDC travel site for your destination to see if you need it. If you do, please book an appointment. If you have a recent weight, we can do that as a televist. Typical dosing instructions include: Take 1 capsule by mouth on days 1, 3, 5, and 7 Take capsules 1 hour before meals with a cold or lukewarm drink Complete the series at least one week before exposure Malaria Prevention with Malarone Malarone may be prescribed for travel to malaria-endemic regions. Look on the CDC travel site for your destination to see if you need it. Typical dosing recommendations: Start 1 to 2 days before entering the area Continue daily during travel Continue for 7 days after returning home Weight-based dosing: 11 to 20 kg: 1 pediatric tablet daily 21 to 30 kg: 2 pediatric tablets daily 31 to 40 kg: 3 pediatric tablets daily Over 40 kg: 1 adult tablet daily Book an appointment to get this prescribed. If you have a recent weight, we can do it as a telehealth visit. Travel Vaccine Clinics in Philadelphia Families in the Philadelphia area may consider the following travel medicine resources. General pediatricians cannot give Yellow Fever vaccine or injected Typhoid vaccine. Pennsylvania Hospital Travel Medicine Penn Presbyterian Medical Center Travel Medicine Passport Health Final Thoughts on Traveling with Young Children Traveling with babies and toddlers requires preparation, flexibility, and patience. Prioritizing sun protection, car seat safety, water supervision, and proper travel health precautions can help make your family vacation safer and less stressful. With thoughtful planning, traveling with young children can create wonderful family memories while keeping everyone healthy and safe.
By Alexis Lieberman June 12, 2025
Sunblock vs. Vitamin D for Kids: How to Protect Their Skin and Ensure Healthy Growth As parents, it’s essential to find the right balance between protecting your child’s skin from the sun and ensuring they get enough vitamin D. Too much sun exposure can lead to skin damage and even skin cancer, but not enough can result in vitamin D deficiency, which is crucial for bone health and the immune system. In this guide, we’ll break down the importance of sunblock for kids, the need for vitamin D in children, and how you can keep your little ones safe while they enjoy the outdoors. Why Sunblock Is Crucial for Protecting Your Child’s Skin Exposing your child’s skin to the sun can cause irreversible damage, especially when they are young. Ultraviolet (UV) radiation from the sun is the leading cause of skin cancer, and childhood sunburns can increase the risk of developing melanoma later in life. According to the American Academy of Dermatology (AAD), protecting your child's skin from UV damage is crucial for long-term skin health. Using sunblock for children is one of the most effective ways to prevent sunburns, premature aging, and skin cancer. It's important to apply sunblock regularly, even on cloudy days, as UV rays can still penetrate through the clouds and damage the skin. Be sure to choose a broad-spectrum sunscreen that protects against both UVA and UVB rays. Why Mineral Sunblock is the Best Choice for Kids When it comes to sunscreen, mineral sunblocks (also known as physical sunscreens) are often a safer choice for children. These sunscreens use zinc oxide and titanium dioxide, which create a physical barrier on the skin to block harmful UV rays. Mineral-based sunscreens are particularly effective for sensitive skin and are less likely to cause irritation or allergic reactions. Avoid sunscreens containing chemicals like oxybenzone and retinyl palmitate. Oxybenzone has been linked to hormone disruption, and retinyl palmitate may increase the risk of skin cancer when exposed to sunlight. You can refer to the EWG’s Skin Deep database to find safer sunscreen options. Also, it’s best to avoid spray sunscreens for kids. While they may seem convenient, they pose a risk of inhalation. The fine particles can be harmful to your child’s lungs, so stick with non-spray mineral sunblocks that are easy to apply and safer for their respiratory system. Vitamin D: Why Your Child Needs Sunlight Vitamin D plays an important role in your child’s health. It helps the body absorb calcium, which is essential for building strong bones. It also supports the immune system and can even have a positive impact on mood and overall well-being. The body naturally produces vitamin D when the skin is exposed to UVB rays from the sun. However, in today’s world, many children spend more time indoors, often engaging with screens rather than playing outside. This means they are not getting enough sunlight to maintain healthy vitamin D levels. The American Academy of Pediatrics (AAP) reports that vitamin D deficiency is becoming more common in children, particularly among those who don’t get enough time outdoors or live in regions with limited sunlight. Without adequate vitamin D, kids are at higher risk for bone problems and weakened immune systems. Balancing Sun Exposure: How to Get Vitamin D Safely You don’t need to expose your child to the sun all day, but it’s important to allow for short bursts of No-Sunblock time to let their bodies make vitamin D. During these short periods of sun exposure, your child will get a boost of vitamin D while minimizing the risk of sunburn. For babies, try No-Sunblock time before 9 am and after 5 pm. These hours provide weaker sun exposure, which reduces the risk of harmful UV rays. For older children, you can extend this window to before 10 am and after 4 pm. When you’re outside during peak sunlight hours (usually between 10 am and 4 pm), apply a non-spray mineral sunscreen to protect their skin from UV damage. This approach allows your child to get their daily dose of vitamin D without the dangers of sunburn and long-term skin damage. Best Practices for Sun Safety and Vitamin D Here’s a summary of key recommendations to balance sun protection with vitamin D production: Get outside early or late in the day—before 9 am for babies and 10 am for kids, and after 5 pm for babies and 4 pm for kids. These times offer weaker sun exposure, reducing the risk of sunburn. Use a mineral-based sunblock (zinc oxide or titanium dioxide) when spending extended time outside during peak sunlight hours. Avoid chemical sunscreens containing oxybenzone and retinyl palmitate. Avoid spray sunscreens—they can be harmful when inhaled. Stick to cream or lotion-based sunscreens. Check the EWG database to ensure you’re using a safe, effective sunscreen for your child. Conclusion: Keeping Your Kids Safe While Getting Their Vitamin D The key to keeping your child’s skin safe while ensuring they get enough vitamin D is to find a balance. Short, safe sun exposure allows them to produce the vitamin they need for healthy bones and immunity, while mineral sunblocks keep them protected from harmful UV rays. By following these sun safety guidelines, you can ensure your child enjoys the outdoors without compromising their health. With a little planning and a focus on safe sun practices, you can protect your child's skin and keep them healthy. Remember, sun safety for kids is about moderation and making smart choices when it comes to both sunscreen use and outdoor time. References American Academy of Dermatology (AAD). (2021). Sun Protection. Environmental Working Group (EWG). (2023). Skin Deep Cosmetics Database. American Academy of Pediatrics (AAP). (2023). Vitamin D on the Double.
By Alexis Lieberman March 3, 2025
Measles in Montgomery County: What Parents Need to Know About Vaccination and Protecting Your Family Over the weekend, there was a confirmed case of measles in Montgomery County, Pennsylvania, near Plymouth Meeting. As a pediatric practice in East Norriton, Montgomery County, this news is very concerning, and we want to ensure that our community has all the information they need to protect their families. The situation is especially alarming because there are already over 100 cases of measles in Texas, with one child tragically passing away. This shows that the threat is real, and it is important for all of us to be prepared. I immediately began looking at the Montgomery County Health Department website for updated information, and today I’m reaching out to them for further guidance. All of the doctors in our office are collaborating to determine the best way to manage this situation, given how close the case is to our East Norriton office. Why Measles in Montgomery County is a Concern Measles is a highly contagious virus that can spread quickly. This isn’t just a mild illness; measles can lead to serious complications like pneumonia, brain swelling (encephalitis), and even death. The fact that a case has been confirmed so close to home is a reminder that measles is still a threat. The outbreak in Texas and other recent cases highlight how important it is to make sure your child is vaccinated. We must all do our part to keep the disease from spreading further. Early Symptoms of Measles: What to Watch For If you think your child may have measles, it’s important to recognize the symptoms early. Here are the signs to look for: Fever: Often the first symptom, which can get worse over time. Cough: A dry cough that becomes more persistent. Runny Nose: A clear nasal discharge, much like a cold. Red, Watery Eyes: Known as conjunctivitis or pink eye. Koplik Spots: Small white spots that appear inside the mouth, usually before the rash. Rash: The rash starts on the forehead and behind the ears and spreads down the body a few days after the fever begins. If you notice these symptoms, it’s best to contact your doctor right away to prevent spreading the illness. The MMR Vaccine: Safe, Effective, and Long-Used The good news is that measles can be prevented through the MMR vaccine, which protects against measles, mumps, and rubella. The MMR vaccine has been used for over 50 years and has been shown to be very safe and effective in preventing measles. Most children receive the MMR vaccine in two doses: First dose: At age 1. Second dose: Between ages 4 and 6. One dose of the MMR vaccine gives about 93% protection against measles, and two doses provide about 97% protection. This high level of immunity is why the MMR vaccine has been so effective in preventing the spread of measles. Side Effects of the MMR Vaccine: What You Need to Know Like all vaccines, the MMR vaccine can cause some mild side effects, but these are usually short-lived and not serious. Here’s what to expect: Fever: A low-grade fever may occur for a few days. Rash: Some children may develop a mild rash, but this is not the same as the measles rash. Swollen Lymph Nodes: Swelling of the glands may happen, but it’s typically mild. Rare Side Effects: Severe allergic reactions are extremely rare, and any serious side effects are quickly treated. These side effects are far less concerning than the potential risks of measles itself, which can cause permanent damage like pneumonia and brain damage. The Wakefield Scare: Why You Shouldn’t Worry About the MMR Vaccine and Autism You may have heard that the MMR vaccine is linked to autism. This myth comes from a study published in 1998 by Andrew Wakefield, which was later found to be fraudulent. The study was retracted, and Wakefield lost his medical license for falsifying data. Since then, many large studies involving millions of children have shown that there is no connection between the MMR vaccine and autism. Both the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) have made it clear that the MMR vaccine is safe and does not cause autism. The fear around the vaccine is based on misinformation, and it’s important for parents to understand that the vaccine is safe and necessary to protect your child from measles and other dangerous diseases. Why Vaccination is So Important Measles is a highly contagious disease, and if enough people in a community aren’t vaccinated, outbreaks can occur. When more people get vaccinated, herd immunity is created, which helps protect those who cannot get vaccinated, such as infants or children with medical conditions. That’s why it’s important to make sure your child is vaccinated. The MMR vaccine doesn’t just protect your child—it helps protect everyone in the community. Our Plan of Action: What to Do If You Suspect Measles We’ve developed a detailed plan to keep everyone safe, especially given how close the measles case is to our office. Here’s what you need to do if you suspect your child has measles: If you suspect measles: Please do not come physically into the office. Instead, call us when you arrive, and we’ll come out to see your child in the car. This keeps everyone safe and minimizes exposure to other patients. For children 6 months to 1 year: If you want to get an early dose of the MMR vaccine, please book a Medical Assistant appointment online through our website. This will not replace the vaccine given at age 1, but it will help protect your child. Under the age of six months, the vaccine will not be effective. For children 1 to 4 years old: If you’d like to get your child’s second dose of the MMR vaccine early, you can book a Medical Assistant appointment online as well. This dose counts as the vaccine given at age 4. Check Your Child’s Immunization Record: You can check your child’s immunization record through our patient portal to see if they’re up-to-date on the MMR vaccine. You may see MMR or you may see MMRV. MMRV also protects against chickenpox. If your child is unvaccinated: If your child is not vaccinated and you choose not to vaccinate, we recommend keeping your child away from others who are sick. By following these steps, we can help limit the spread of measles and protect those who are most vulnerable. Conclusion: Protect Your Family from Measles with the MMR Vaccine The recent case of measles in Montgomery County shows how important it is to keep your child protected with the MMR vaccine. Vaccination is one of the best ways to prevent measles and protect your family from this dangerous disease. Don’t let misinformation scare you—vaccines are safe, effective, and necessary to keep our children healthy. If you have any questions about the MMR vaccine, feel free to reach out to our office. We are here to help.
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