Q: My 6-year-old has recurrent vomiting, stomachaches, and is now very lethargic and not urinating. Is this Norovirus, and should we return to the ER?

Medically reviewed by Sang Hyun Ahn, MD

Content edited by Myeongchan Kim, MD

This post is a dramatization of a question and answer session experienced by our actual medical reviewers. Please note that this content is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.

Question:

My 6-year-old child frequently complains of stomachaches. Sometimes, when the vomiting starts, it doesn't stop unless they receive an injection at the clinic. Over the past few months, they have had three episodes of projectile vomiting about three weeks apart, even though their overall condition seemed fine beforehand. Two of those times, there was no fever, but this time there is a fever of 38°C.

The ER doctor suspected Norovirus. However, the blood test showed normal inflammation markers, and the vomiting has now stopped. Could this really be Norovirus? The other children in our home are perfectly fine. A recent X-ray showed no gas or stool buildup, and a recent abdominal CT scan only showed mesenteric lymphadenitis, with everything else being normal. Should we only be considering gastroenteritis for this frequent nausea, stomach pain, and vomiting?

Most worryingly, although today's blood test showed no dehydration, my child has now been sleeping for 5 hours straight. Even when I try to wake them, they just close their eyes again, and they haven't urinated at all. Do we need to go back to the emergency room?

Answer:

It is completely understandable to be deeply concerned about your child's recurrent vomiting and current severe lethargy. While a Norovirus infection is a possibility, other underlying conditions could be contributing to these symptoms.

The most critical and concerning issue right now is that your child has been sleeping for 5 hours, is difficult to arouse, and has not urinated. You need to immediately assess the following signs at home:

• Can the child fully open their eyes and respond to you clearly when awakened?

• Exactly how long has it been since their last wet diaper or trip to the bathroom?

• Are their lips or the inside of their mouth visibly dry?

If your child has not urinated for 8 hours or more, does not respond appropriately when you try to wake them, or has a severely dry mouth, you must return to the emergency room immediately. Lethargy and lack of urination are significant warning signs of dehydration or other systemic issues that require urgent in-person evaluation.

Regarding the pattern of recurrent vomiting:

Experiencing projectile vomiting every three weeks is a pattern that requires investigating causes beyond simple gastroenteritis. Once the current acute situation is resolved, you should consult your pediatrician or a pediatric gastroenterologist to evaluate for conditions such as:

• Cyclic vomiting syndrome

• Abdominal migraine

• Gastrointestinal motility disorders

While your child's previously diagnosed mesenteric lymphadenitis can cause recurrent abdominal pain, it is less likely to be the direct cause of this specific cyclic vomiting pattern.

For now, your immediate action plan should be:

1. Try to wake your child frequently (e.g., every 10 to 15 minutes) to carefully check their level of consciousness.

2. When they are awake and alert, offer 1 to 2 small sips of water frequently to help with hydration.

3. Carefully record their body temperature and the exact times they urinate.

Given the child's significant lethargy and lack of urination, please do not hesitate to seek immediate emergency medical care if they remain unresponsive or fail to urinate.

For extra peace of mind and clear guidance when tracking your child's symptoms, the FeverCoach app is always there to help.

https://fevercoach.us