Child Vomiting at Night: Causes and When to Get Help

In our house the split is clear: when the child is being sick, it's my job. My wife can't do it. In return, fever and colds are hers.

If you are standing in the bedroom right now with a bowl and a clean pair of pyjamas, the question that matters most is whether this needs a phone call. So the answer to that comes first, and what to do over the next few hours comes straight after.

Is night-time vomiting in children dangerous?

Night-time vomiting in children is usually short-lived and stops within 1 or 2 days; diarrhoea, if it comes too, usually within 5 to 7 days. A stomach bug or food poisoning are the most common causes; reflux in babies, other infections such as a urinary tract infection, inner ear infections and medicines can also cause it. Danger comes from warning signs, and from fluid your child cannot keep down.

Those causes come from the NHS page on diarrhoea and vomiting. Diarrhoea alongside the vomiting points towards a tummy bug, and on those nights fluid becomes the whole job. If your child is sick at night without a temperature and fine during the day, the warning signs below still apply regardless of temperature.

Part of why it feels worse at night is the setting. You are pulled out of deep sleep, the room is dark and the duvet is soaked. The same episode at four in the afternoon would probably be filed under "ate too much, too fast".

When do you need help straight away?

Some signs mean you do not wait for the morning. Blood in the vomit, vomit that looks like ground coffee, green vomit or a sudden severe tummy ache all mean 999 or A&E.

A bang to the head is its own case. If your child has had a recent head injury and is being sick or feels dizzy, or has a condition or takes a medicine that thins the blood, get urgent advice from NHS 111. Call 999 if they have been knocked out and have not woken up, cannot stay awake, have a fit, fell from higher than 1 metre or 5 stairs, are under 1 year old with a bruise, swelling or large cut on the head, or their behaviour has changed, or if they show any of the other signs listed on the NHS head injury page.

One step below sits everything that needs NHS 111 now rather than tomorrow: your child seems drowsy, is breathing quickly or has a fast heart rate, has few or no tears when crying, has dark yellow pee or is peeing less than normal, feels dizzy when standing up and it does not go away, or a baby's soft spot (fontanelle) sinks inwards; you are worried about a baby under 12 months; your child stops breast or bottle feeding while ill; a child under 5 shows signs of dehydration such as fewer wet nappies, a dry mouth, sunken eyes, unusual thirst, a headache or feeling light-headed, or being drowsy or irritable; or your child keeps being sick and cannot keep fluid down, has been vomiting for more than 2 days or has had diarrhoea for more than 7 days, or has bloody diarrhoea or bleeding from the bottom. If a sign fits more than one list, act on the higher one: for example, fast breathing in a child who also has other signs of dehydration means 999.

If none of that applies, and your child is responsive between episodes, takes small sips and settles back to sleep, the night is exhausting, and you carry on at home and keep watching.

What do you do over the next few hours?

The order is simple, which helps when your head is still half asleep:

1. Sit them up. Keep your child upright while they are being sick so they do not choke and nothing goes the wrong way.
2. Child first, bed second. Wipe their face and offer a sip to rinse with. The pyjamas and duvet can wait five minutes. A spare fitted sheet within reach saves a surprising amount of energy if there is a second round.
3. Small sips of fluid. Give plenty of fluids, such as water or squash, in small sips rather than a full cup; avoid fruit juice, fizzy drinks and drinks with caffeine; juice and fizzy drinks can make diarrhoea worse. Offer food again once your child feels able to eat, and keep it plain rather than fatty or spicy. There is no fixed millilitre target; if you are unsure, ask a pharmacist or your GP. Ask a pharmacist early, too, if your child has a long-term condition or a weakened immune system that makes dehydration more likely.
4. Babies keep feeding. Carry on breast or bottle feeding, keep formula at its usual strength, and try small feeds more often than usual. If your baby has formula or solids, offer small sips of water between feeds; for a baby under 6 months, boil the water first and let it cool.
5. Stay within earshot. If your child has been sick more than once, stay close for the rest of the night. Do not adopt a particular sleep position on your own to prevent it; ask your health visitor or GP what suits your child's age.

If your child is sick again while drinking, wait a little and start small again rather than giving up on fluids for the night. If nothing stays down at all, call NHS 111 instead of experimenting further. Our guide on a tummy bug and fluids walks through what to try, and in what order.

How can you tell that your child is short of fluid?

Watch the nappies and the loo. In a child under 5, fewer wet nappies than usual is a sign of dehydration and a reason to call NHS 111. In a child aged 5 or over, dark yellow pee or peeing less than normal is also a reason to call NHS 111, as in the list above. A pharmacist can help with oral rehydration sachets alongside that call, and if signs of dehydration are still there after using them, call NHS 111 again. The younger the child, the less room you have to wait and see.

A baby who keeps being sick is not a case for waiting until the morning surgery opens: if you are worried about a baby under 12 months, call NHS 111 now. If a tummy bug is behind it, our article on norovirus and dehydration in children covers the drinking strategy in detail.

What should you note down for the GP?

A single night is different from a pattern over several days. Whether a pattern needs looking into is a decision for your GP, and they can only judge it as well as your answers allow. If your child is repeatedly sick at night or first thing in the morning, mention it.

The next morning brings four questions: When did it start? How often in the last few hours? Was there a temperature or diarrhoea? Did anything stay down? After the third episode at four in the morning, exactly that blurs together. The notepad on the bedside table tends to end up in the wash with the sheets.

In Mona you log each episode with a timestamp and every drink in seconds, even half asleep in a dark room. By morning the log answers those four questions, instead of you piecing the night together from memory.

Is night-time sickness in a baby just reflux?

It can be. Reflux is when a baby brings feeds back up, the "spitting up" most parents recognise, and the NHS lists it among the other causes of vomiting, after a stomach bug and food poisoning.

If your baby also has diarrhoea, a temperature or any of the warning signs above, treat it as illness rather than reflux: use the lists above, and if you are worried about a baby under 12 months, call NHS 111 now.

If your baby is repeatedly unsettled at night and bringing feeds back up, talk to your health visitor or GP rather than changing feeds on your own. If feeding has become a battle more generally, our guide on a sick child who will not eat may help.