Topic Resources
Vomiting is the uncomfortable, involuntary, forceful throwing up
of food. In infants, vomiting must be distinguished from spitting up.
Infants often spit up small amounts while being fed or shortly
afterward—typically while being burped. Spitting up may occur because
infants feed rapidly, swallow air, or are overfed, but it may occur for
no apparent reason. Vomiting is typically caused by a disorder.
Experienced parents can usually tell the difference between spitting up
and vomiting, but first-time parents may need to talk to a doctor or
nurse.
Vomiting can cause dehydration
because fluid is lost. Sometimes children cannot drink enough to make
up for lost fluid—either because they are continuing to vomit or because
they do not want to drink. Children who are vomiting usually do not
want to eat, but this lack of appetite rarely causes a problem.
Causes
Vomiting can be beneficial by getting rid of toxic substances
that have been swallowed. However, vomiting is most often caused by a
disorder. Usually, the disorder is relatively harmless, but occasionally
vomiting is a sign of a serious problem, such as a blockage in the
stomach or intestine or increased pressure within the skull
(intracranial hypertension).
Common causes
Likely causes of vomiting depend on the child’s age.
In newborns and infants, the most common causes of vomiting include
-
Gastroenteritis (infection of the digestive tract) due to a virus
In older children, the most common cause is
-
Gastroenteritis due to a virus
Less common causes
In newborns and infants, some causes, although less common, are important because they may be life threatening:
-
Narrowing or blockage of the passage out of the stomach (pyloric stenosis) in infants aged 3 to 6 weeks
-
A blockage of the intestine caused by birth defects, such as twisting (volvulus) or narrowing (stenosis) of the intestine
-
Sliding of one segment of intestine into another (intussusception) in infants aged 3 to 36 months
Food intolerance, allergy to cow's milk protein, and certain uncommon hereditary metabolic disorders may also cause vomiting in newborns and infants.
In older children and adolescents, rare causes include serious infections (such as a kidney infection or meningitis), acute appendicitis, or a disorder that increases pressure within the skull (such as a brain tumor or a serious head injury). In adolescents, causes also include gastroesophageal reflux disease or peptic ulcer disease, food allergies, cyclic vomiting, a slowly emptying stomach (gastroparesis), pregnancy, eating disorders, and ingestion of a toxic substance (such as large amounts of acetaminophen, iron, or alcohol).
Evaluation
For doctors, the first goal is to determine whether children are
dehydrated and whether the vomiting is caused by a life-threatening
disorder.
Warning signs
The following symptoms and characteristics are cause for concern:
-
Lethargy and listlessness
-
In infants, inconsolability or irritability and bulging of the soft spots (fontanelles) between the skull bones
-
In older children, a severe headache, stiff neck that makes lowering the chin to the chest difficult, sensitivity to light, and fever
-
Abdominal pain, swelling, or both
-
Persistent vomiting in infants who have not been growing or developing as expected
-
Bloody stools
When to see a doctor
Children with warning signs should be immediately evaluated by a
doctor, as should all newborns; children whose vomit is bloody,
resembles coffee grounds, or is bright green; and children with a recent
(within a week) head injury. Not every tummy ache counts as abdominal
pain (the warning sign). However, if children appear uncomfortable even
when not vomiting and their discomfort lasts more than a few hours, they
should probably be evaluated by a doctor.
For other children, signs of dehydration, particularly decreased
urination, and the amount they are drinking help determine how quickly
they need to be seen. The urgency varies somewhat by age because infants
and young children can become dehydrated more quickly than older
children. Generally, infants and young children who have not urinated
for more than 8 hours or who have been unwilling to drink for more than 8
hours should be seen by a doctor.
The doctor should be called if children have more than 6 to 8
episodes of vomiting, if the vomiting continues more than 24 to 48
hours, or if other symptoms (such as cough, fever, or rash) are present.
Children who have had only a few episodes of vomiting (with or
without diarrhea), who are drinking at least some fluids, and who
otherwise do not appear very ill rarely require a doctor’s visit.
What the doctor does
Doctors first ask questions about the child's symptoms and
medical history. Doctors then do a physical examination. A description
of the child's symptoms and a thorough examination usually enable
doctors to identify the cause of vomiting (see Table: Some Causes and Features of Vomiting in Infants, Children, and Adolescents).
Doctors ask
-
When the vomiting started
-
How often it occurs
-
What the vomit looks like (including its color)
-
Whether it is forceful (projectile)
-
How much is vomited
Determining whether there is a pattern—occurring at certain times of the day or after eating certain foods—can help doctors identify possible causes. Information about other symptoms (such as fever and abdominal pain), bowel movements (frequency and consistency), and urination can also help doctors identify a cause.
Doctors also ask about recent travel, injuries, and, for sexually active adolescent girls, use of birth control.
A physical examination is done to check for clues to possible
causes. Doctors note whether children are growing and developing as
expected.
Testing
Doctors choose tests based on suspected causes suggested by
results of the examination. Most children do not require testing.
However, if abnormalities in the abdomen are suspected, imaging tests
are typically done. If a hereditary metabolic disorder is suspected,
blood tests specific for that disorder are done.
If dehydration is suspected, blood tests to measure electrolytes
(minerals necessary to maintain fluid balance in the body) are sometimes
done.
Treatment
If a specific disorder is the cause, it is treated. Vomiting caused by gastroenteritis usually stops on its own.
Fluids
Making sure children are well-hydrated is important. Fluids are usually given by mouth (see Dehydration in Children).
Oral rehydration solutions that contain the right balance of
electrolytes are used. In the United States, these solutions are widely
available without a prescription from most pharmacies and from
supermarkets. Sports drinks, sodas, juices, and similar drinks have too little sodium and too much carbohydrate and should not be used.
Even children who are vomiting frequently may tolerate small
amounts of solution that are given often. Typically, 1 teaspoon (5
milliliters) is given every 5 minutes. If children keep this amount
down, the amount is gradually increased. With patience and
encouragement, most children can take enough fluid by mouth to avoid the
need for fluids by vein (intravenous fluids). However, children with
severe dehydration and those who do not take enough fluid by mouth may
need intravenous fluids.
Drugs to reduce vomiting
Drugs frequently used in adults to reduce nausea and vomiting are
less often used in children because their usefulness has not been
proved. Also, these drugs may have side effects. However, if nausea or
vomiting is severe or does not go away, doctors may give promethazine, prochlorperazine, metoclopramide, or ondansetron to children who are over 2 years of age.
Diet
As soon as children have received enough fluid and are not
vomiting, they should be given an age-appropriate diet. Infants may be
given breast milk or formula.
Key Points
-
Usually, vomiting is caused by gastroenteritis due to a virus and causes no long-lasting or serious problems.
-
Sometimes, vomiting is a sign of a serious disorder.
-
If diarrhea accompanies vomiting, the cause is probably gastroenteritis.
-
Children should be evaluated by a doctor immediately if vomiting persists or they have any warning signs (such as lethargy, irritability, a severe headache, abdominal pain or swelling, vomit that is bloody or bright green or yellow, or bloody vomit or stools).
Posts
0 Comments