Child Vomiting Without Fever: Common Causes and Red Flags

Vomiting without fever is common in children and usually self‑limited, but certain patterns warrant prompt evaluation.

Frequent Benign Causes

• Viral Gastroenteritis: Norovirus, rotavirus—often afebrile initially; diarrhea follows.
• Food Poisoning: Toxin‑mediated (S. aureus, B. cereus) – rapid onset, no fever.
• Motion Sickness: Car, boat, VR; resolves with cessation of motion.
• Food Allergy/Intolerance: IgE‑mediated (hives, wheezing) or non‑IgE (FPIES—profuse delayed vomiting).
• GERD: Effortless regurgitation, irritability, poor weight gain in infants.
• Anxiety/Stress: School avoidance, anticipatory nausea.
• Medication Side Effects: Antibiotics, iron, chemotherapy.

Surgical / Urgent Causes (Do Not Miss)

• Intussusception: Intermittent severe colicky pain, currant‑jelly stools, lethargy—peak 6–36 months.
• Pyloric Stenosis: Projectile non‑bilious vomiting at 2–8 weeks; palpable olive mass.
• Appendicitis: Periumbilical→RLQ pain, anorexia; vomiting follows pain.
• Intracranial Pressure: Head trauma, morning vomiting, neurologic signs.
• Cyclic Vomiting Syndrome: Stereotyped episodes, migraine association.

Home Management

• Oral rehydration solution (ORS) in small, frequent sips (5 mL every 5 min).
• Continue breastfeeding; offer usual formula if tolerated.
• Avoid anti‑emetics unless prescribed (ondansetron may mask surgical abdomen).

Red Flags – Seek Care Immediately

• Bilious (green) vomiting – surgical emergency.
• Signs of dehydration: dry mucosa, no tears, sunken fontanelle, <3 wet diapers/24h.
• Altered mental status, lethargy, irritability.
• Abdominal distension, tenderness, guarding.
• Blood in vomit or stool.
• Vomiting >24h (infants) or >48h (older children).
• Recent head injury.

When in doubt, call your pediatrician. Early assessment prevents complications.