Nausea and vomiting (peds)
This page is for pediatric patients. For adult patients, see: nausea and vomiting.
Background
- Broad differential: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, Behavioral
Clinical Features
- Assess general appearance and behavior
- Evaluate volume status
- Abdominal and genitourinary examinations are important for potential surgical causes
Differential Diagnosis
Nausea and vomiting (newborn)
Newborn | ' |
Obstructive intestinal anomalies |
|
Neurologic |
|
Renal |
|
Infectious | |
Metabolic/endocrine | |
Miscellaneous |
|
Nausea and vomiting infant (<12 mo)
' | |
Obstructive intestinal anomalies |
|
Neurologic |
|
Renal |
|
Infectious | |
Metabolic/endocrine | |
Miscellaneous |
Nausea and vomiting child (>12 mo)
' | ' |
Obstructive intestinal anomalies |
|
Neurologic |
|
Renal |
|
Infectious | |
Metabolic/endocrine | |
Miscellaneous |
Evaluation
Pediatric signs of dehydration
Significantly dehydrated if has 2 or more of the following (LR+ 6.1, CI:3.8-9.8):[1]
- Prolonged capillary refill (>2 sec)
- Dry mucous membranes
- Absence of tears
- Abnormal overall appearance
- Sunken fontanelle in an infant
Management
- Largely depends on etiology
- If ill appearing, establish rapid IV access, or if needed IO.
- Rapid finger stick blood sugar
- Point of care pH and electrolytes (iSTAT)
Pediatric acute gastroenteritis treatment
- Oral rehydration therapy
- Avoid IV fluids before doing a trial of oral rehydration therapy in uncomplicated cases of mild to moderate dehydration in children.[2]
- If fails, oral ondansetron as a single dose PO (>6 months of age)[3][4]
- If fails, IV fluids (e.g. normal saline)
Probiotics have NOT been shown to provide any benefit[5]
Disposition
Discharge
- Presumed self-limited etiology
- Well appearing
- Tolerating fluids
Admission and/or Observation
- All others
See Also
- Nausea and vomiting
- Abdominal pain (peds)
- Acute gastroenteritis (peds)
- Diarrhea (peds)
- Dehydration (peds)
External Links
Pediatric Emergency Playbook -- Vomiting in the Young Child: Nothing or Nightmare
References
- ↑ Gorelick MH et al. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997; 99(5):E6
- ↑ Choosing wisely ACEP
- ↑ Cheng A. Emergency department use of oral ondansetron for acute gastroenteritis-related vomiting in infants and children. Paediatrics & Child Health. 2011;16(3):177-179.
- ↑ A Cheng; Canadian Paediatric Society, Acute Care Committee. Paediatr Child Health 2011;16(3):177-9
- ↑ Freedman, et al. Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis. N Engl J Med 2018; 379:2015-2026 DOI: 10.1056/NEJMoa1802597