Vomiting in children
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
Synonyms and keywords: Vomiting in kids
Overview
Vomiting in children is common and can range from benign condition to life-threatening condition. Most cases of vomiting are gastrointestinal in origin, most commonly gastroesophageal reflux disease and gastroenteritis. Vomiting, also known as emesis, is the oral expulsion of gastrointestinal content from the mouth due to the gut and thoracoabdominal wall muscles' contraction. At the same time, nausea refers to the need to vomit. Retching is used to describe the muscular event of vomiting with the expulsion of vomitus.
Historical Perspective
There is limited information about the historical perspective of vomiting in children
Classification
Vomiting in children may be classified according to content of vomitus into :
- Bloody and non-bloody
- Bilous and non-bilous
- Projectile and non-projectile
Pathophysiology
- The vomiting center is found in the medulla oblongata's reticular formation with muscarinic type receptor, which activates the vomiting center. The Signals then out to the abdominal muscle via the efferent pathway with the trigeminal (CN V), facial(CN VII), glossopharyngeal (CN IX), vagus(CN X), and hypoglossal (CN XII) to the upper GI tract, within vagal and sympathetic nerves to the lower tract, and within spinal nerves to the diaphragm and abdominal muscles. This vomiting center can also be triggered by the chemoreceptor trigger zone (CTRZ), which contains Dopamine 2 receptor, the CRTZ located outside the blood-brain barrier.
Causes
Common causes of Vomiting in children include
- Acute gastroenteritis
- Obstruction of the GI tracts
- Infantile hypertrophic pyloric stenosis
- Intussusception
- Indirect inguinal hernia
- Appendicitis
- Volvulus
- Inflammation of the GI tract including esophagitis, gastroenteritis, peptic ulcer disease, hepatitis, pancreatitis, cholecystitis or appendicitis, may cause vomiting
- Hepatitis
- Gall Bladder disease
- Pancreatitis
- CNS injury concussion/postconcussion syndrome, increased intracranial pressure (ICP), migraine headache and viral meningitis.
- Renal dx
- Drugs
Differentiating [disease name] from other Diseases
Vomiting in children must be differentiated from other diseases that cause vomiting in children such as Cyclic vomiting syndrome (CVS) Gastrointestinal disease (obstructive and inflammatory), Central Nervous System (CNS) disease, pulmonary disease, renal disease, endocrine/metabolic disorders, drugs (either as side effects or in overdosages), or psychiatric disorders.
Epidemiology and Demographics
Vomiting in children is very and there is no racial, gender, age, or race predilection to vomiting in children.
Risk Factors
There are no established risk factors for Vomiting in childdren.
Natural History, Complications and Prognosis
- The majority of children with vomiting is mostly due to gastroenteritis. Gastroenteritis ranges from asymptomatic to dehydration to death, it usually starts with mild fever and vomiting, followed by 1-4 days of non-bloody, watery diarrhea.
- Common complications of complication of vomiting in children is dehydration.
- Prognosis ranges from excellent to poor depending on the etiology of the vomiting (gastroenteritis to meningitis respectively)
Diagnosis
Diagnostic Criteria
- The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
- [criterion 1]
- [criterion 2]
- [criterion 3]
- [criterion 4]
Symptoms
- [Disease name] is usually asymptomatic.
- Symptoms of [disease name] may include the following:
- [symptom 1]
- [symptom 2]
- [symptom 3]
- [symptom 4]
- [symptom 5]
- [symptom 6]
Physical Examination
- Patients with [disease name] usually appear [general appearance].
- Physical examination may be remarkable for:
- [finding 1]
- [finding 2]
- [finding 3]
- [finding 4]
- [finding 5]
- [finding 6]
Laboratory Findings
- There are no specific laboratory findings associated with [disease name].
- A [positive/negative] [test name] is diagnostic of [disease name].
- An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
- Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
Electrocardiogram
There are no ECG findings associated with [disease name].
OR
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
X-ray
There are no x-ray findings associated with [disease name].
OR
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with [disease name].
OR
Echocardiography/ultrasound may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no echocardiography/ultrasound findings associated with [disease name]. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
CT scan
There are no CT scan findings associated with [disease name].
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
MRI
There are no MRI findings associated with [disease name].
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Other Imaging Findings
There are no other imaging findings associated with [disease name].
OR
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
Other Diagnostic Studies
- [Disease name] may also be diagnosed using [diagnostic study name].
- Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
- There is no treatment for [disease name]; the mainstay of therapy is supportive care.
- The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
- [Medical therapy 1] acts by [mechanism of action 1].
- Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
Surgery
- Surgery is the mainstay of therapy for [disease name].
- [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
- [Surgical procedure] can only be performed for patients with [disease stage] [disease name].
Prevention
- There are no primary preventive measures available for [disease name].
- Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
- Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].