Vomiting in children
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Adenike Eketunde
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 the content of vomitus, motion, and duration into :
- Bloody and non-bloody
- Bilious and non-bilious
- Projectile and non-projectile
- Acute and chronic. [1][2][3]
Pathophysiology
- The Vomiting center can be triggered by the gastrointestinal (GI) tract, the vestibular system, the chemoreceptor trigger zone, and higher centers in the Cortex and Thalamus.
- The Vomiting center is found in the medulla oblongata's reticular formation with muscarinic type receptor, which activates the Vomiting center. Signals are 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 causing vomiting.
- The Chemoreceptor Trigger Zone (CTRZ), which contains the Dopamine 2 receptor, is located outside the blood-brain barrier and can be activated directly by an irritant.[4]
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
- Gallbladder disease
- Pancreatitis
- CNS injury concussion/postconcussion syndrome, increased intracranial pressure (ICP), migraine headache and viral meningitis.
- Renal dx
- Drugs[5][6]
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)[7] Gastrointestinal disease (obstructive and inflammatory)[8], Central Nervous System (CNS) disease, pulmonary disease, renal disease, endocrine/metabolic disorders, drugs (either as side effects or in Overdose), 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 children.
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.[1]
- Common complications of complication of vomiting in children is dehydration.
- Prognosis ranges from excellent to poor depending on the etiology of the vomiting (include gastroenteritis to meningitis respectively)
Diagnosis
Diagnostic Criteria
- The diagnosis of Vomiting in children is made with both medical history and physical examination.
Symptoms
- Symptoms of vomiting in children include the following:
Physical Examination
- Physical examination may be remarkable for signs of dehydration:
Laboratory Findings
- There are no specific laboratory findings associated with vomiting in children. However, blood and urine test is helpful in diagnosis to check for infection and kidney function.
Electrocardiogram
There are no ECG findings associated with vomiting in children.
X-ray
There are no x-ray findings associated with vomiting in children.
Echocardiography or Ultrasound
There are no echocardiography/ultrasound findings associated with vomiting in children.
CT scan
There are no CT scan findings associated with vomiting in children.
MRI
There are no MRI findings associated with vomiting in children.
Other Imaging Findings
There are no other imaging findings associated with vomiting in children.
Other Diagnostic Studies
- There are no other imaging findings associated with vomiting in children.
Treatment
Medical Therapy
- The mainstay of therapy for vomiting in children is to treat underlying conditions and rehydration. Antiemetic can be used in the treatment of vomiting.[11]
Surgery
- Surgical intervention is not recommended for the management of vomiting in children.
Prevention
- There are no primary preventive measures available for vomiting in children.
References
- ↑ 1.0 1.1 Andrade, Gabriela Bonente Herculano de; Marin, Barbara Said; Medeiros, Daniela Nasu Monteiro; Yamanari, Mauricio Gustavo Ieiri; Troster, Eduardo Juan (2020). "Vomiting in newborns as a result of a duodenal membrane: two case reports". Einstein (São Paulo). 18. doi:10.31744/einstein_journal/2020RC4641. ISSN 1679-4508.
- ↑ Galea R, Said E (2018). "Infantile Hypertrophic Pyloric Stenosis: An Epidemiological Review". Neonatal Netw. 37 (4): 197–204. doi:10.1891/0730-0832.37.4.197. PMID 30567916.
- ↑ Tomasik E, Ziółkowska E, Kołodziej M, Szajewska H (2016). "Systematic review with meta-analysis: ondansetron for vomiting in children with acute gastroenteritis". Aliment Pharmacol Ther. 44 (5): 438–46. doi:10.1111/apt.13728. PMID 27401959.
- ↑ Becker DE (2010). "Nausea, vomiting, and hiccups: a review of mechanisms and treatment". Anesth Prog. 57 (4): 150–6, quiz 157. doi:10.2344/0003-3006-57.4.150. PMC 3006663. PMID 21174569.
- ↑ Andrade GBH, Marin BS, Medeiros DNM, Yamanari MGI, Troster EJ (2020). "Vomiting in newborns as a result of a duodenal membrane: two case reports". Einstein (Sao Paulo). 18: eRC4641. doi:10.31744/einstein_journal/2020RC4641. PMC 7687917 Check
|pmc=value (help). PMID 33263676 Check|pmid=value (help). - ↑ https://www.merckmanuals.com/professional/pediatrics/symptoms-in-infants-and-children/nausea-and-vomiting-in-infants-and-children
- ↑ Raucci U, Borrelli O, Di Nardo G, Tambucci R, Pavone P, Salvatore S; et al. (2020). "Cyclic Vomiting Syndrome in Children". Front Neurol. 11: 583425. doi:10.3389/fneur.2020.583425. PMC 7667239 Check
|pmc=value (help). PMID 33224097 Check|pmid=value (help). - ↑ Sullivan PB (2008). "Gastrointestinal disorders in children with neurodevelopmental disabilities". Dev Disabil Res Rev. 14 (2): 128–36. doi:10.1002/ddrr.18. PMID 18646021.
- ↑ Reust CE, Williams A (2016). "Acute Abdominal Pain in Children". Am Fam Physician. 93 (10): 830–6. PMID 27175718.
- ↑ Hoxha T, Xhelili L, Azemi M, Avdiu M, Ismaili-Jaha V, Efendija-Beqa U; et al. (2015). "Performance of clinical signs in the diagnosis of dehydration in children with acute gastroenteritis". Med Arch. 69 (1): 10–2. doi:10.5455/medarh.2015.69.10-12. PMC 4384849. PMID 25870468.
- ↑ Carter B, Seupaul RA (2012). "Update: antiemetics for vomiting associated with acute gastroenteritis in children". Ann Emerg Med. 60 (3): e5–6. doi:10.1016/j.annemergmed.2012.01.031. PMID 22424648.