Some children and adolescents never experience any nausea or vomiting from cancer, its treatments, or other medicines. Others deal with one or both symptoms at different times in their illness, depending on which treatments they receive and how they react to them.

Your goals are to:

1. prevent dehydration and electrolyte imbalances,
2. call for help if it is needed,
3. make the best use of anti-nausea medicines, and
4. do what you can to ease the nausea and vomiting.

When To Get Professional Help

The first question you should ask is whether the patient needs help from medical professionals. You should call the clinic, doctor, or nurse immediately if any of the following are true:

If there is blood or material resembling coffee grounds in the vomit. Coffee ground material is actually old blood, and signals that some bleeding has occurred inside. This happens very rarely but it is important to report.

If vomiting occurs more frequently than you expect. Check the fluids chart. Ask the doctor or nurse about these times. For most children or adolescents, vomiting three times per hour for more than four hours is serious, but your situation may be different.

If the vomit shoots out for a distance (projectile vomiting). Projectile vomiting may mean that there are problems in the stomach or intestine that should be investigated by your doctor.

If your child skips taking two doses of any prescribed medicines or can't keep them down because of nausea or vomiting. Medicines will have to be given other ways until pills can stay down again.

If the child or adolescent takes a small amount of liquid and eats no solid food. (Check the fluids chart filled out by your doctor or nurse.) Also, check on urinary output. For a very young child, you should be concerned if there are no wet diapers in eight to 12 hours. For an older child, you should be concerned if he or she goes 12 to 16 hours without urinating. Ask the doctor or nurse about the number of cups of liquids. Without liquids, people become dehydrated after continued vomiting. Nutrition is needed to keep up your child's energy and to fight the illness. Most children or adolescents need to drink more than four cups in 24 hours. But your needs may be different, so check the fluids chart, which your doctor or nurse will fill out, to determine when to call about not eating or drinking.

If severe weakness or dizziness happen along with the nausea or vomiting. It is normal to feel a little weak or dizzy with nausea, but if a person can't get up, then you need to call a doctor or nurse.

If severe stomach pain happens while vomiting. Severe pain is always a reason to call the doctor.

If you are very worried and want information or advice immediately. If you're following this homecare plan and you're still worried, then call.

When you call, the doctor or nurse may ask you the following questions:

1. How long has nausea been a problem?
2. When does it begin and how long does it last?
3. How bad was the most recent nausea?
4. How much does the nausea interfere with normal activities?
5. Was medicine prescribed for nausea/vomiting? Name of medicine(s) How often should it be taken? How many doses at one time? How many doses were taken in the last two days? How much relief did it give? How long did the relief last?
6. In addition to nausea medicine, what did you do to help your child feel better and what were the results?
7. Was the nausea followed by vomiting?
8. What did the vomit look like? Was this vomit the same color as earlier vomit? If not, how was it different?
9. How often has vomiting happened in the past 24 hours?
10. What other symptoms are new since the nausea/vomiting began? (Answer questions below for each new symptom.)
    SYMPTOM:
    Where?
    How bad?
    When started?
    When does it happen?
    How long does it last?
    What relieves it?
    What doesn't help?
    
11. What and how much did your child eat in the past 24 hours?
12. What and how much liquid did your child take in the past 24 hours? Was his or her urine output normal?
13. How frequent were bowel movements in the past two days, and were they the same amount and color as usual?
14. What is the temperature of the child or adolescent with nausea?
15. When was the last cancer treatment?

Here is an example of what someone might say when calling:

"I am Eileen Dunn, Jennifer Dunn's mother. My daughter is Dr. Chang's patient. She is being treated for neuroblastoma. The homecare plan for nausea says that I should call if she vomited after taking the last two doses of her anti-nausea medicine."

What You Can Do To Help

There are three things you can do at home to deal with nausea or vomiting.

• Make the best use of nausea medicine
• Limit nausea and vomiting on your own
• Prevent dehydration

Make the best use of nausea medicine

Check to be sure you followed instructions on the label of the bottle and any instructions given by the nursing staff. Here are ways to get the most help from anti-nausea medicine, especially around the time of chemotherapy treatments.

• Give your son or daughter anti-nausea medicine on a consistent schedule. Give the prescribed anti-nausea medicine before chemotherapy treatment. Continue to give your child the medicine every four to six hours or as prescribed for at least 12-24 hours and continue as long as nausea or vomiting persists. The anti-nausea medicine must be taken on a consistent schedule to maintain adequate drug concentration in the blood.
• Give anti-nausea medicine before and after receiving chemotherapy treatments. For the medicine to be effective, your child needs to have enough of it in the bloodstream. That's why he or she should start taking it before chemotherapy and then keep taking it every four to six hours, or as directed by the doctor.
• Give anti-nausea medicines a half-hour before meals. Allow time for the medication to be absorbed before eating, usually 30 to 60 minutes. Liquids can be absorbed more quickly than pills. The anti-nausea medicine will ease a negative response to food and not let nausea get in the way of trying to eat.

Limit nausea and vomiting on your own

This is a list of ideas for what you can do on your own to help reduce nausea and vomiting. Start with those ideas that have helped in the past, but try new ideas, too. You can't be sure if an idea will help until you try.

Encourage the child or adolescent with cancer to do the following:

• Encourage him or her to eat three to four hours before treatment, but not just before treatment. This keeps something in the stomach and helps the body to get the nutrition it needs. Then serve frequent light meals throughout the day. Try to have your child's stomach empty just before treatments if you find that works best for you.
• Avoid serving fried foods, dairy products, and acids like fruit juices or vinegar salad dressings. These foods are hard to digest and may make nausea worse.
• Offer chewing gum or hard candy if your child is old enough to have them normally. Try peppermint or fruit flavors. These will cover up any unpleasant tastes during chemotherapy.
• Let fresh air into the house or, in good weather, have the child or adolescent go outside. Taking in more oxygen helps calm the feeling of nausea. Encourage mouth breathing for a few minutes, or open a window.
• Sleep through nausea. Some people find it helpful to lie down when they are nauseated. The anti-nausea medicine will sometimes make people sleepy, which helps them to sleep through their nausea.
• Offer sips of fluids or ice chips 30 minutes after vomiting. Let the vomiting pass and wait a while before offering food or liquids. For young children, try a teaspoon to a tablespoon of liquid. For older children or adolescents, try an ounce at a time. Let the fizz go out of sodas before drinking them because carbonation can upset the stomach again. Stir sodas vigorously with a spoon to release carbonation.
• Offer dry crackers. This often helps women who are pregnant and nauseated and helps many people with cancer, too.
• Avoid unpleasant or strong odors. Keep your child or adolescent away from the kitchen. Often breathing through the mouth can prevent nausea from odors.
• Encourage frequent mouth rinses (saltwater solution or tap water, not commercial mouthwashes). Frequent swishing and rinsing removes unpleasant tastes.
• Encourage rest. Allow short rest times between everyday activities like dressing or walking. Taking it easy can help to keep the nausea away.
• Distract your child's attention. Watching TV, reading, or playing games may help your child to not notice nausea as much. You can also ask the child life staff for suggestions.
• Encourage your child to relax. If the child or adolescent with cancer is tense, all physical symptoms seem more intense. Many people find that, by relaxing, the symptoms are not as bothersome. (See the home care plan for "Parents' Anxiety" for more explanation of how to practice relaxation.

Possible Obstacles

Think about ideas or attitudes that could stop you from carrying out your plan and how you will overcome them. Here is an obstacle that sometimes occurs.

"Why should I give my child an anti-nausea medicine when she hasn't vomited yet?"

Response: Chemotherapy often makes people nauseous, and it's important for your child to take the medicine in advance, and keep on taking it, to allow it to build up in the bloodstream and be distributed throughout the body. For it to be effective, your child should take it as prescribed and continue to do so for 12 to 24 hours. Waiting until nausea starts only aggravates the problem, because then the child or adolescent may have difficulty keeping down the very medicine that is supposed to help.

Carrying Out and Adjusting Your Plan

You can check on how well this homecare plan is working by keeping track of the number of times your child vomited, by asking how severe the feelings of nausea are, and by paying attention to how much fluid he or she is able to keep down and whether urinary output is affected.

If your plan doesn't work

If your child's problems with nausea are getting worse, review "When To Get Professional Help," and ask yourself if you're doing everything you can to reduce this symptom. If the child or adolescent is becoming anxious about getting nauseated or if the nausea is harder and harder to control, ask the doctor about alternative anti-nausea medicines.

Back