- Home
- Medical books
- Pediatric pathology
- Paediatrics: Vomiting
Paediatrics: Vomiting
2021-03-04 12:00 AM
A common symptom in childhood.
Vomiting
A common symptom in childhood.
Three clinical scenarios are recognized:
- Acute: discrete episode of moderate to high intensity. Most commonand usually associated with an acute illness.
- Chronic: low-grade daily pattern, frequently with mild illness.
- Cyclic: severe, discrete episodes associated with pallor, lethargy +/–abdominal pain. The child is well in between episodes. Often there is a family history of migraine or vomiting.
Causes
- Acute: GI infection; non-GI infection (e.g. urinary tract infection); GIobstruction (congenital or acquired e.g. pyloric stenosis); adverse food reaction; poisoning; raised intracranial pressure; endocrine/metabolic disease (e.g. diabetic ketoacidosis).
- Chronic (usually GI): peptic ulcer disease; gastro-oesophageal reflux;chronic infection; gastritis; gastroparesis; food allergy; psychogenic (see Psychogenic vomiting); bulimia; pregnancy.
- Cyclic (usually non-GI cause): idiopathic; CNS disease; abdominalmigraine; endocrine (e.g. Addison’s disease); metabolic (e.g. acute intermittent porphyria); intermittent GI obstruction; fabricated illness.
Management
- Full history: e.g. early morning vomiting with CNS tumour, or familymembers with similar illness.
- Full examination:including ear, nose, and throat (ENT) and growth.
Assess for dehydration.
Treatment
- Supportive treatment as needed: e.g. oral or IV fluids.
- Treat cause: e.g. pyloromyotomy for hypertrophic pyloric stenosis.
- Pharmacological: antihistamines; phenothiazines (side-effects:extrapyramidal reactions); prokinetic drugs, e.g. domperidone. 5-HT3 antagonists, e.g. ondansetron, are increasingly being used for treating post-operative or chemotherapy induced vomiting. 5-HT1D agonists, e.g. pizotifen, are useful as prophylaxis and treatment for cyclic vomiting syndrome.
Complications
Dehydration, plasma electrolyte disturbance (e.g. ‘fall’ K+, ‘fall’ Cl–, alkalosis with pyloric stenosis), acute or chronic GI bleeding (e.g. Mallory–Weiss tear), esophageal stricture, Barrett’s metaplasia, broncho-pulmonary aspiration, faltering growth, iron deficiency anaemia.
Psychogenic vomiting
- Causes: anxiety; manipulative behaviour; disordered family dynamics. Afamily history of vomiting is common.
- Management: exclude organic disease. Refer to child psychologist.