A child who won’t eat and is throwing up is one of the most worrying situations a parent can face. Most of the time it’s a stomach bug, unpleasant, miserable, but resolving within a day or two. Sometimes it’s something more, and the difference matters because children dehydrate fast, deteriorate fast, and can’t always tell you how they feel.
When a child stops eating AND can’t keep fluids down, the math gets dangerous quickly. A toddler can go from “a little sick” to seriously dehydrated in under a day. Some specific causes, like appendicitis, an intestinal blockage, or a metabolic emergency, announce themselves first by making kids refuse food and vomit. Knowing what to look for, what counts as a warning sign, and when to come to the ER is what this article will give you.
If you’re reading this while your child is actively unwell, skip ahead to the red-flag section first. We put it upfront for a reason.
📍 ER of Dallas: 4535 Frankford Rd, Dallas, TX 75287
📞 +1 214-613-6694, open 24/7. We treat children every shift.
🚨 Come In or Call 911 Immediately If You See…
Any of these signs in a child who isn’t eating and is vomiting means don’t wait until morning. Call 911 if severe, or come straight to ER of Dallas:
Vomiting concerns:
- Vomiting blood or material that looks like coffee grounds
- Green or yellow (bilious) vomit, can indicate bowel obstruction
- Forceful, projectile vomiting in an infant under 3 months (possible pyloric stenosis)
- Vomiting after a head injury, especially repeated
- Vomiting for more than 24 hours with no improvement
Dehydration concerns:
- No wet diaper in 6+ hours (infant) or no urination in 8–12 hours (older child)
- No tears when crying
- Dry mouth and tongue
- Sunken eyes or sunken soft spot (fontanelle) on an infant’s head
- Cold, mottled, or grayish hands and feet
- Capillary refill longer than 2 seconds (press a fingernail, color should return quickly)
Pain or abdominal concerns:
- Severe abdominal pain, especially constant or localized to one area
- Pain that moves to the lower right side (possible appendicitis)
- Pulling knees up to chest in pain, especially in waves (possible intussusception, in children 6 months to 2 years)
- Stool that looks like red currant jelly (intussusception sign)
- A visibly swollen, hard, or tender abdomen
Behavior and responsiveness:
- Lethargy, unusually sleepy, hard to wake up, or not responding normally
- Limp or floppy body tone
- Confusion or unusual irritability that can’t be soothed
- Weak or quieter cry than usual (in infants)
- A child who just doesn’t “seem right” to you
Other warning signs:
- Fever above 100.4°F (38°C) in an infant under 3 months, regardless of any other symptoms
- High fever (above 102°F) in a child of any age with vomiting and lethargy
- Stiff neck, severe headache, or sensitivity to light (possible meningitis)
- Fast breathing, deep breathing, or fruity-smelling breath (possible DKA in a child with or without known diabetes)
- Suspected ingestion of medication, household chemical, or unknown substance, call Poison Control at 1-800-222-1222 immediately, then come in
- Severe pain, screaming inconsolably
- Seizure
- Difficulty breathing of any kind
Lower your threshold to come in for: infants under 3 months, premature babies, children with chronic medical conditions (diabetes, kidney disease, heart disease, immunodeficiency), children on long-term medications, and children with recent abdominal surgery.
Why Food Refusal + Vomiting Together Matters
Children stop eating when they’re seriously ill. That alone is a clinical signal we take seriously, well children almost always want food, even if they’re cranky. A child who refuses their favorite snack, won’t nurse, won’t take a bottle, or won’t drink anything is telling you something is wrong, even if they can’t explain it.
When food refusal pairs with vomiting, two problems compound quickly:
- Whatever caused the illness is severe enough that the child can’t tolerate food
- They can’t replace the fluids they’re losing through vomiting, because they can’t keep anything down
The result is rapid dehydration on top of whatever the underlying cause is. In adults, this is usually manageable over a day or two. In children, especially infants and toddlers, it can become an emergency in hours. That’s why the pairing of food refusal and vomiting in a child should lower your threshold to seek care.
Age-Specific Dehydration Signs, What to Look For
Dehydration looks different in children of different ages. Here are the signs to watch for, organized by age:
Infants (under 1 year):
- Fewer wet diapers than usual, a 6+ hour stretch without a wet diaper is concerning, more than 8–10 hours is a warning sign
- Urine that is darker yellow than usual
- No tears when crying
- Dry mouth and tongue (not just lips, which can dry from breathing through the mouth)
- Sunken soft spot (anterior fontanelle) on top of the head
- Sunken eyes
- Cool, mottled, or pale hands and feet
- Weaker or quieter cry than usual
- Lethargy or unusual sleepiness
- Skin that doesn’t bounce back quickly when gently pinched (skin tenting)
Toddlers and young children:
- No urination in 8–12+ hours
- Very dark or concentrated urine
- Dry, cracked lips and dry mouth
- No tears when crying
- Sunken eyes
- Unusual fussiness, irritability, or lethargy
- Dizziness or unsteadiness when standing or walking
- Skin that doesn’t bounce back when pinched
- Refusing all fluids
- Fast breathing or fast heart rate even at rest
Older children and teens:
- Decreased urination, dark urine
- Dry mouth, intense thirst
- Dizziness when standing up
- Headache
- Weakness or fatigue
- Mental fog or confusion (more advanced dehydration)
- Fast heart rate
Children pass through stages of dehydration faster than adults, and severe dehydration in a child is an emergency. IV fluids can correct it quickly, that’s a major reason kids come to our ER.
How to Quickly Estimate Your Child’s Hydration Status
While you’re monitoring at home or deciding whether to come in, these quick checks help you gauge how dehydrated your child is:
- Wet diaper / urination check. Count how many wet diapers (or trips to the bathroom) your child has had in the last 6–12 hours, and compare to their normal.
- Mouth check. Look inside the mouth. Is the tongue moist (good) or dry and tacky (concerning)? Are the lips cracked?
- Tear check. If your child cries, do they make tears? No tears suggests significant dehydration.
- Capillary refill check. Press lightly on a fingernail or toenail until it turns white, then release. Color should return within 2 seconds. Slower return suggests dehydration or poor circulation.
- Skin turgor check. Gently pinch a bit of skin on the abdomen or back of the hand. It should snap back immediately. Skin that stays tented up suggests significant dehydration.
- Fontanelle check (infants). Gently feel the soft spot on top of an infant’s head. It should feel flat or slightly soft. A noticeably sunken fontanelle is a warning sign.
- Behavior check. Compare your child to how they normally act. Lethargy, unusual quietness, or unusual fussiness are real signs.
If any of these checks are clearly abnormal, that’s a reason to come in. You don’t need to wait until multiple signs are present.
Common Causes, Usually Manageable
Many cases of child food refusal and vomiting come from causes that resolve on their own. Common patterns:
Viral gastroenteritis (stomach bug). The most common cause. Often spreads through families, daycares, and schools. Vomiting typically lasts 12–24 hours, followed by 1–3 days of decreased appetite and sometimes diarrhea. Children usually want fluids more than food at first.
Food poisoning. Acute onset 1–6 hours after eating contaminated food. Usually self-limited but can be severe.
Mild ear infection, throat infection, or respiratory illness. Children often refuse food when their throat hurts, their ear hurts, or they feel stuffy and miserable. May come with low-grade fever, cough, or pulling at the ear.
Post-viral effects. After many viral illnesses, appetite stays low for several days even after acute symptoms resolve. Persistent vomiting beyond the typical course, however, isn’t routine and deserves evaluation.
Motion sickness or recent travel. Self-limited, resolves with rest.
Anxiety or stress. Some children, especially older ones, can lose appetite and vomit from anxiety, school stress, or emotional upset. Should be a diagnosis after medical causes are considered.
Constipation. Severe constipation can cause poor appetite, nausea, and even vomiting in young children, sometimes without obvious bowel symptoms.
Reflux (infants). Spitting up after feeds is common in babies and usually benign. But projectile vomiting, vomiting that’s worsening, vomiting that interferes with weight gain, or vomiting paired with poor feeding should be evaluated.
Serious Causes, What We Worry About
Some causes of child vomiting and food refusal need urgent evaluation. The most important:
Appendicitis. Often starts with vague belly pain and decreased appetite. Pain typically shifts to the lower right abdomen, becomes more constant, and is accompanied by vomiting and sometimes low-grade fever. Appendicitis in young children can be atypical and harder to identify, but it’s one of the most common surgical emergencies in kids.
Intussusception. A part of the intestine slides into another part, causing obstruction and reduced blood flow. Most common in children 6 months to 2 years old. Classic presentation: episodes of severe abdominal pain (child pulls knees to chest, cries inconsolably) every 15–30 minutes, with intervals of looking tired or normal between. Vomiting, food refusal, and “currant jelly” stools (red, mucousy) are warning signs. Surgical emergency, needs same-day care.
Pyloric stenosis. Narrowing of the muscle between the stomach and intestine, usually presenting in infants 3–6 weeks old. Classic sign: forceful, projectile vomiting shortly after feeding, even though the baby seems hungry again right after. The baby may be losing weight or not gaining. Needs surgical evaluation.
Bowel obstruction. Can be caused by anatomical problems present from birth, scar tissue from previous surgery, hernias, or rarely tumors. Symptoms include vomiting (sometimes green or bile-stained), abdominal swelling, and inability to pass gas or have a bowel movement.
Diabetic ketoacidosis (DKA). A child with type 1 diabetes (sometimes new-onset and undiagnosed) can present with vomiting, food refusal, increased thirst, frequent urination, weight loss, fast/deep breathing, fruity-smelling breath, lethargy, and confusion. A life-threatening metabolic emergency that needs immediate IV care.
Severe gastroenteritis with dehydration. Some stomach bugs cause severe vomiting and diarrhea that overwhelm a child’s ability to stay hydrated. IV fluids in an ER can rehydrate and restore comfort within hours.
Urinary tract infection (UTI) or kidney infection. UTIs in young children may present without obvious urinary symptoms, instead with fever, vomiting, poor appetite, and irritability. Always considered in the workup of a young child with these symptoms.
Meningitis. Infection of the lining around the brain and spinal cord. Symptoms in children include fever, headache, stiff neck, sensitivity to light, vomiting, lethargy, and rash in some cases. A medical emergency.
Sepsis (severe infection). Children with severe infection can develop vomiting, food refusal, fast heart rate, fast breathing, fever or low body temperature, lethargy, and decreased urination. Needs immediate evaluation.
Head injury. A child who vomits after a fall, bump on the head, or car accident needs evaluation, especially if vomiting is repeated, the child is unusually sleepy, or there’s any change in behavior. Possible concussion or bleeding inside the skull. See our Concussion service page for details.
Ingestion / poisoning. Toddlers especially can swallow medications, household products, batteries, magnets, or other harmful items, sometimes without anyone noticing. Vomiting can be the first sign. Call Poison Control at 1-800-222-1222 and come to the ER.
Increased pressure inside the skull. Brain tumors, bleeding, or hydrocephalus can cause persistent vomiting (often morning vomiting), headache, behavior change, and balance problems. Rare but important to consider in unexplained persistent symptoms.
Concerns Specific to Each Age Group
Infants (under 1 year)
Lower threshold across the board. Concerns include pyloric stenosis (3–6 weeks of age), intussusception (especially 6 months and up), gastroesophageal reflux, severe formula intolerance, UTIs, sepsis, and any infection that prevents feeding. Infants under 3 months with ANY fever (100.4°F or higher) need ER evaluation regardless of feeding status.
Toddlers (1–3 years)
Most common cause is viral gastroenteritis, but this is also peak age for intussusception, foreign body ingestion, toddler’s fracture (limp + refusal to bear weight), and UTI. Watch carefully for dehydration; toddlers refuse fluids in addition to food when they feel sick.
Preschool and school-age children (4–12 years)
Stomach bugs remain common, but the differential broadens. Appendicitis becomes more typical in its presentation (vague pain that localizes to lower right). Streptococcal pharyngitis (strep throat) and ear infections can cause vomiting in this age group. Constipation and behavioral causes also become more relevant.
Adolescents
Mostly similar to adults, but with added considerations: pregnancy (in teen girls), eating disorders, substance use, depression presenting as somatic symptoms, migraine, and diabetic ketoacidosis (new-onset type 1 diabetes can present in adolescence).
What Concerning Timeline Patterns Mean
How long the symptoms have been going on, and how they’ve evolved, helps determine the urgency:
- Acute onset (within hours) with severe symptoms, think serious causes (appendicitis, intussusception, ingestion, intestinal obstruction)
- Gradual onset over days with low fever and other family members sick, typically viral, but watch for dehydration
- Persistent vomiting beyond 24 hours, deserves evaluation; usual viral illnesses are improving by this point
- Morning vomiting that’s persistent or worsening, consider increased pressure inside the skull (rare but important)
- Cyclical pattern (recurrent episodes over months), may suggest cyclic vomiting syndrome, abdominal migraines, or other recurring conditions; needs outpatient workup
- After a head injury, always concerning, especially repeated vomiting or worsening behavior
- After possible ingestion, always urgent, call Poison Control and come in
How an ER Evaluates a Child Who Won’t Eat and Is Vomiting
At ER of Dallas, evaluation of a sick child is gentle, child-friendly, and focused on identifying the cause while addressing dehydration in parallel. Here’s what happens:
- Triage and vital signs, heart rate, breathing rate, blood pressure, temperature, oxygen saturation, hydration assessment
- Detailed history, when symptoms started, last time the child ate or drank, last wet diaper or urination, character of vomiting, any associated symptoms, sick contacts, medical history, medications, possible ingestions
- Focused exam, abdominal exam, hydration assessment, ears and throat, neurological exam
- IV access and IV fluids when dehydration is present, the fastest way to restore hydration in a child who can’t keep fluids down
- IV anti-nausea care when indicated, to stop vomiting so fluids and food can stay in
- Lab work, complete blood count, basic metabolic panel (kidney function, electrolytes, blood sugar), urinalysis. Additional tests based on the working diagnosis.
- Imaging when indicated, abdominal ultrasound (often used in children to evaluate appendicitis or intussusception), X-rays for bowel obstruction, head CT after head injury
- Trial of oral rehydration in the ER, sometimes after anti-nausea care, a child can keep down small amounts of fluid, which is a good sign for discharge
- Observation, children often need a period of observation to be sure they’re responding to treatment
- Pediatric hospital transfer coordinated directly when surgical or specialized inpatient care is needed
Many children come into our ER for vomiting and feeding refusal and go home the same visit with IV fluids, anti-nausea care, and a clear follow-up plan. For surgical conditions (appendicitis, intussusception, pyloric stenosis) or other admissions, we stabilize and coordinate transfer directly to a pediatric hospital.
When to Come to ER of Dallas vs. Monitor at Home
| Situation | What to Do |
| Mild vomiting (a few episodes), child is taking some sips of fluid, normal urination, no fever or mild fever, alert and behaving close to normal, no red flags | Monitor closely at home. Offer small frequent sips of clear fluids. Recheck hydration status every few hours. |
| Vomiting beyond 12–24 hours, can’t keep down sips, decreasing urination, any dehydration signs developing, OR your child is in a special-population group (under 3 months, premature, chronic conditions) | Come to ER of Dallas. IV fluids and evaluation can prevent the situation from escalating. |
| ANY red flag from earlier in this article, blood in vomit, green/bilious vomit, severe pain, lethargy, no wet diapers, sunken eyes or fontanelle, fever in infant under 3 months, head injury, suspected ingestion, fast/deep breathing, fruity-smelling breath, signs of meningitis | 🚨 Call 911 (for severe distress) or come straight to ER of Dallas immediately. |
When in doubt with a child, come in. Children’s margins are smaller, and the cost of an unnecessary visit is far less than the cost of waiting too long with a serious cause.
What to Do While Monitoring at Home
If your child’s symptoms are mild and you’re monitoring at home, here’s safe guidance:
- Offer small, frequent sips of clear fluids, oral rehydration solutions are designed for this and are widely available at pharmacies. For infants, continue breastfeeding or formula in small frequent amounts.
- Don’t force food. Appetite returns when the child is ready. Forcing food often triggers more vomiting.
- When vomiting has stopped for a few hours, you can try small amounts of bland food (toast, rice, applesauce, banana for older kids).
- Avoid sugary drinks (soda, juice, sports drinks in large quantities) as the primary rehydration fluid, they can worsen diarrhea and slow recovery.
- Track every wet diaper or trip to the bathroom, this is the single most useful data point you can give a doctor.
- Recheck the hydration signs every few hours. Conditions can change quickly in children.
- Do NOT give any over-the-counter medications, including anti-nausea, anti-diarrheal, or fever-reducing medications, without specific guidance from a pediatrician or pharmacist. Many adult medications are not appropriate for children, and some can have serious side effects.
- Do NOT give honey to infants under 1 year (botulism risk).
- Trust your instincts. If your child seems off, even if you can’t name why, come in.
Frequently Asked Questions
(Implement FAQPage schema on this section)
Q: How long can a child go without eating?
A: Most healthy children can manage 24 hours without solid food as long as they’re drinking fluids, fluids matter much more than food in the short term. The bigger concern is hydration, which should not lapse. A child who isn’t drinking AND isn’t keeping anything down for more than a few hours, especially a young child, deserves prompt evaluation.
Q: Is it normal for my child to refuse food when sick?
A: Yes. Decreased appetite during illness is common and not concerning in itself. What matters is whether your child is drinking, urinating, and behaving close to normal. Persistent food refusal beyond the typical course of an illness, or refusal combined with vomiting and dehydration signs, deserves evaluation.
Q: How can I tell if my baby is dehydrated?
A: Look for fewer wet diapers (fewer than 6 wet diapers in 24 hours is concerning), no tears when crying, dry mouth, sunken eyes, a sunken soft spot on the head, cool or mottled hands and feet, lethargy, and a weaker cry than usual. Skin that doesn’t bounce back when pinched is a sign of moderate to severe dehydration.
Q: What is projectile vomiting and when is it dangerous?
A: Projectile vomiting is forceful vomiting that travels a significant distance, sometimes inches or feet from the child’s mouth. In an infant 3–6 weeks old, projectile vomiting after feeds is a classic sign of pyloric stenosis and needs urgent evaluation. In older children, it can indicate increased pressure inside the skull or other serious causes.
Q: My child has green vomit. Is that bad?
A: Yes. Green or bile-stained vomit can indicate a bowel obstruction, a surgical emergency. Come in immediately.
Q: Can stress or anxiety cause my child to refuse food and vomit?
A: Yes, in older children especially. But emotional causes should be a diagnosis after medical causes have been considered, not assumed first. School avoidance, anxiety disorders, and stress can cause real physical symptoms, but a doctor should rule out medical causes.
Q: Should I take my child to the ER or to the pediatrician?
A: For mild concerns during business hours, your pediatrician is a great first call. For evening, overnight, or weekend symptoms; for moderate-to-severe symptoms; or for any of the red flags in this article, come to the ER. Children with vomiting and feeding refusal benefit from rapid evaluation, on-site labs and imaging, and IV fluids that pediatrician offices don’t typically have.
Q: Will my insurance cover an ER visit?
A: Under the federal No Surprises Act, your insurance is required to process emergency visits at your in-network benefit level. ER of Dallas accepts most major insurance plans. We don’t accept Medicare, Medicaid, CHIP, or TRICARE.
Q: Do I need an appointment?
A: No. ER of Dallas is a 24/7 walk-in emergency room. Walk in or call +1 214-613-6694.
Q: Where is ER of Dallas located?
A: 4535 Frankford Rd, Dallas, TX 75287, Far North Dallas, easily reached from Carrollton, Addison, Plano, Frisco, and surrounding neighborhoods. Open 24/7.
Trust Your Instincts, We’re Open 24/7.
A child who won’t eat and is vomiting is not a small thing. Most of the time it’s a passing illness. Sometimes it’s a sign of something that needs urgent care. The threshold for bringing a child to the ER should be low, kids dehydrate fast, deteriorate fast, and can’t always tell you what’s wrong.
ER of Dallas is open 24/7 at 4535 Frankford Rd. We treat children every shift. Board-certified emergency physicians, on-site labs and imaging, IV fluids, and a calm, child-friendly setting. Walk in or call ahead.
🚨 Red-flag symptoms: Call 911 or come straight in.
📍 Address: 4535 Frankford Rd, Dallas, TX 75287
📞 Phone: +1 214-613-6694
🕐 Hours: Open 24/7, every day, every holiday
🌐 Website: https://erofdallastx.com/
