Fever With Vomiting in a Child: What to Do and When to Get Help
A fever with vomiting is common, especially with viral infections, and usually settles on its own. The main things to manage are keeping your child hydrated and working out whether fever medicine is staying down. Here's what to do, how to handle medicine when vomiting gets in the way, and the signs that need urgent attention.
Why fever and vomiting often go together
Many common childhood infections cause both fever and vomiting at the same time. Viral gastroenteritis (a "stomach bug") is the most frequent cause, but vomiting can also come with throat infections, ear infections, and other illnesses where a high temperature upsets the stomach on its own.
A child who vomits once or twice but is still drinking, alert, and able to settle between episodes is usually managing the illness itself. The two things worth tracking are whether they can keep enough fluid down, and whether fever medicine is being absorbed.
Giving fever medicine when your child is vomiting
If your child vomits after a dose, do not give the same medicine again. You cannot tell how much was absorbed before it came back up, so count it as a dose given. Repeating it on top of a dose that was partly absorbed is how accidental double-dosing happens.
Note the time, wait about an hour, and check the temperature again. If your child is still uncomfortable or the fever is 38.5°C or above, you can give the other medicine (paracetamol or ibuprofen). It runs on its own schedule, so a partly absorbed dose of one does not count against the other.
Avoid ibuprofen if your child is vomiting repeatedly or not drinking well, because it is harder on the stomach and kidneys when fluids are low. It is also not suitable under 3 months, if dengue is suspected, or if your child has already had diclofenac. In those cases, stay with paracetamol and wait for its next dose. If you are unsure, call your pharmacist or GP.
→ How to give paracetamol and ibuprofen on separate schedules
If vomiting keeps getting in the way of later doses, a suppository is an option. It is absorbed through the back passage rather than the stomach, so it is not affected by vomiting in the same way. A paracetamol suppository is the gentler choice while your child is not keeping fluids down. If your child vomits straight after a suppository, you do not need to give another dose. The suppository still works.
→ Suppositories for a child's fever: what they are and how to give them
Watching for dehydration
Fever already increases fluid loss, and vomiting adds to it. Wait 15 to 30 minutes after a vomiting episode, then offer a teaspoon or two of fluid every 5 to 10 minutes, increasing the amount gradually as your child tolerates it. Trying to get them to drink a full cup at once often triggers more vomiting.
If diarrhoea is also present, oral rehydration solution (ORS) is useful because it replaces the salts lost as well as the fluid. Mix it exactly as the packet instructs.
→ Fever and dehydration: early signs, what to offer, and ORS guidance
Signs that need urgent attention
Call your GP or polyclinic the same day if vomiting continues for several hours but your child is keeping some sips down, or they have fewer wet nappies than usual. If your child cannot keep any fluids down, use the A&E list below.
Call 995 now if your child has a fever and any of these:
- !A seizure lasting more than 5 minutes (give rectal diazepam if a doctor has prescribed it, and still call)
- !Struggling to breathe (skin pulling in under the ribs, nostrils flaring, or grunting), pauses in breathing, or lips turning blue or grey
- !Cannot be woken, or floppy and not responding to you
- !A rash of small red or purple spots that does not fade when you press a glass on it
- !Swelling of the lips, tongue, or face, with any difficulty breathing
- !Cold, clammy, or mottled skin, with drowsiness or restlessness
Go to the nearest 24-hour A&E or children's emergency now if:
- !Blood, or what looks like coffee grounds, in the vomit
- !Severe or constant tummy pain
- !A baby under 3 months with a temperature of 38.0°C or above
- !A first febrile seizure, even if it has stopped
- !After a seizure: confused, still drowsy after 30 minutes, or more than one seizure in a day
- !A stiff neck, or crying in pain when bending the head forward
- !Unusually drowsy or hard to wake, but can be woken
- !Dengue warning signs as the fever comes down: tummy pain, repeated vomiting, bleeding gums or nose, or very tired
- !No urine or wet nappy for 12 hours or more
- !No tears when crying, sunken eyes, or a very dry mouth
- !Cannot keep any fluids down
- !Green vomit
- !A temperature above 40°C that is not coming down, and your child seems unwell
→ Toddler fever 39°C: when to monitor vs seek help
→ What happens when you take a feverish child to A&E
Frequently asked questions
My child vomited soon after I gave paracetamol or ibuprofen. Should I give another dose?+
Do not give the same medicine again. You cannot tell how much was absorbed before it came back up, so count the dose as given. Wait about an hour and check the temperature again. If your child is still uncomfortable or the fever is 38.5°C or above, you can give the other medicine (paracetamol or ibuprofen) on its own schedule. Avoid ibuprofen if your child is vomiting repeatedly or not drinking well. If you are unsure, call your pharmacist or GP.
Is vomiting with a fever normal?+
Yes, it is common, especially with viral infections such as gastroenteritis or even some throat and ear infections. A single vomit or a few episodes, with a child who is otherwise drinking and alert between times, is usually not a cause for alarm on its own.
When does vomiting with a fever need a same-day doctor visit or A&E?+
Call your GP or polyclinic the same day if vomiting continues for several hours but your child is keeping some sips down, or there are fewer wet nappies than usual. If your child cannot keep any fluids down, go to the nearest 24-hour A&E. Go to the nearest 24-hour A&E if there is blood or what looks like coffee grounds in the vomit, your child is unusually drowsy, has severe or constant tummy pain, or shows signs of dehydration listed below. Call 995 if your child cannot be woken, or is floppy and not responding to you.
Can I use a suppository if my child keeps vomiting oral medicine?+
Yes, a suppository is one of the main reasons it exists. If your child cannot keep oral paracetamol or ibuprofen down, a suppository of the same medicine bypasses the stomach. It still counts toward the same total dose and timing as the oral form of that medicine. If your child vomits straight after a suppository, you do not need to give another dose, because the suppository still works.
What if my child has both vomiting and diarrhoea with the fever?+
This points toward gastroenteritis, which is usually viral and settles within a few days. Fluid loss happens faster with both together, so focus on small frequent sips and watch for the dehydration signs below. Oral rehydration solution (ORS) is useful here, mixed exactly as the packet instructs.
How much fluid should I offer after a vomiting episode?+
Wait 15 to 30 minutes after vomiting, then offer a teaspoon or two of fluid every 5 to 10 minutes. Increase the amount gradually if it stays down. Trying to get your child to drink a full cup at once often triggers more vomiting.