Vomiting in older children is still often caused by a virus, but as kids get older the list of causes becomes broader. The key is identifying red flags and treating dehydration early.

Step 1: Red flags (Emergency now)

Seek urgent care if vomiting happens with any of the following:

  • Green (bilious) vomit
  • Blood in vomit or black coffee-ground material
  • Severe belly pain, worsening pain, or pain that localizes to the right lower belly
  • Stiff neck, severe headache, confusion, repeated vomiting after head injury
  • Signs of dehydration (very little urine, dizziness, fainting)
  • Persistent vomiting with inability to keep down fluids
  • Severe testicular pain (in boys) with nausea/vomiting
  • Suspected poisoning, drug ingestion, or severe alcohol exposure (teens)

Step 2: Common causes in older kids

1) Viral gastroenteritis

  • Still the most common
  • Often with diarrhea/cramps, sometimes fever

2) Appendicitis (important not to miss)

Clues:

  • Pain starts around the belly button then moves to right lower belly
  • Pain worsens with movement/jumping
  • Fever, reduced appetite, vomiting If you suspect appendicitis: seek urgent assessment.

3) Migraine / abdominal migraine

  • Episodes of vomiting with headache or sensitivity to light/sound
  • Some children have belly pain as the main symptom

4) Constipation

Can cause nausea/vomiting + belly pain + reduced appetite.

5) Reflux / gastritis

  • Burning upper belly pain, sour taste, nausea
  • Can be triggered by infection, ibuprofen, stress, spicy foods

6) Anxiety/stress

Stress can significantly affect the gut. Some kids vomit with school stress, performance anxiety, or panic.

Step 3: Home care (when no red flags)

  • Start oral rehydration solution or clear fluids in small sips
  • Avoid fatty foods while actively vomiting
  • Use a simple “sip schedule”: a few sips every 1–2 minutes
  • Rest, monitor urine output and energy

Step 4: When to call your doctor soon

  • Vomiting lasts > 24–48 hours
  • Recurring vomiting episodes (weekly or monthly pattern)
  • Weight loss, poor growth, chronic belly pain
  • Vomiting mostly in the morning, or vomiting with headaches

Quick summary

  • Most vomiting is viral, but older kids have more possible causes.
  • The big danger signs are green vomit, blood, dehydration, severe localized pain, or neurologic symptoms.