# Pediatric nausea / vomiting

Treat dehydration, protect the airway, and use ondansetron only within its age-specific pediatric order.

Population: Pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/pediatric-nausea-vomiting/
Official source: [SO-P-090 — Nausea / Vomiting - Pediatric](https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-90%20vomiting.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- SO-P-090 does not supply an ondansetron dose below age 4 or a routine pediatric IV regimen.
- Use oral medication only when the child can safely tolerate it.

## Source documents

- [SO-P-090 — Nausea / Vomiting - Pediatric](https://www.ochealthinfo.com/sites/hca/files/2021-12/SO-P-90%20vomiting.pdf)

## Assess severity

- Assess hydration, perfusion, mental status, abdominal symptoms, duration, and ability to tolerate intake. Repeated vomiting can produce hypovolemia.
- Maintain the airway and suction when needed. Consider an underlying illness rather than treating the symptom alone.

## Fluid resuscitation

- If dehydration or poor perfusion is present, establish IV/IO and give saline 20 mL/kg, maximum 250 mL per bolus, with base contact.
- A pediatric-capable base is preferred. May repeat twice for three total boluses; reassess circulation and respiratory status between boluses.

## Antiemetic & glucose

- For ongoing nausea/vomiting in a child age 4 or older, give one 4 mg ondansetron ODT tablet to dissolve orally as tolerated. This is a fixed dose, not mg/kg.
- If altered or unresponsive, check glucose. Below 60 mg/dL, follow the source options: oral glucose only with intact airway reflexes, D10 5 mL/kg IV (maximum 250 mL), or glucagon 0.5 mg IM if IV cannot be established. IO dextrose requires the listed additional criteria.

## Reassessment & handoff

- Reassess vomiting, airway protection, hydration, mental status, glucose response, and treatment tolerance. Marked hyperglycemia with vomiting may indicate DKA; follow the full source rather than assuming gastroenteritis.
- Provide ALS transport to the nearest appropriate ERC and contact base as needed. Document age, weight, fluid totals, medication, and response.