Here is a list of all the types of resources available on PedsCases, Categories.
Today I reviewed PedsCases Approach to Pediatric Vomitting Part 1. I’ll be reviewing Pediatric Vomitting Part 2 in an upcoming post. Here are the direct links:
- Approach to Pediatric Vomiting (Part 1)
by Erin Boschee Aug 25, 2014
- Approach to Pediatric Vomiting (Part 2)
by Erin Boschee Aug 25, 2014
- Link to the script [PDF]
- Link to Table 1: Common causes of pediatric vomiting by age of presentation [PDF]
- Here is the link to my post on Part 2, Links To PedsCases Approach to Pediatric Vomitting Part 2
Posted on May 11, 2020 by Tom Wade MD
Here are excerpts from Part 1:
Vomiting is a very common pediatric presentation, and the differential is extremely broad. While GI (gastrointestinal) causes tend to come to mind first, there are many non-GI causes for vomiting that have to be considered. The causes for pediatric
vomiting can be broken into categories including:
- toxin or medication-related
- psychogenic or behavioral.
Important causes of vomiting in the newborn period include:
- pyloric stenosis
- duodenal atresia
- intestinal malrotation
- a congenital anomaly in rotation of the midgut as it forms, presents as intermittent bilious vomiting, usually with significant abdominal distension
- It may be associated with severe abdominal pain if associated with midgut volvulus causing bowel ischemia.
- Since the bowel obstruction is often intermittent, the timing of presentation can be variable.
- Bilious or bile-stained vomiting should be treated as a potential surgical emergency [meaning get a stat pediatric surgery consult].
- tracheo-esophageal fistula.
- Necrotizing enterocolitis
After the newborn period, important gastrointestinal causes of vomiting include:
- gastroesophageal reflux disease (GERD)
- Gastroesophageal reflux disease (GERD) is associated with esophagitis, failure to
thrive and recurrent aspiration.
- Gastro-esophageal reflux (GER) is extremely common and typically presents in infants between 1-3 months of age. It is characterized by frequent small volume regurgitation of a milky substance, irritability with feeds orwhen lying supine, or back arching with feeds. Many infants are asymptomatic. Gastro-esophageal reflux is a normal physiologic process in infants and must be distinguished from gastro-esophageal reflux disease (GERD)
- intussusception and other causes of bowel obstruction
- intussusception involves invagination of a portion of the small bowel into another
portion of bowel.
- It is the most common cause of intestinal obstruction in children six to 36 months of age.
- In addition to vomiting, the classic triad of features includes intermittent, progressive abdominal pain, red currant jelly stools and a palpable sausage-like abdominal mass.
- Food allergies such as milk protein allergy in infants or celiac disease in older infants and children are other fairly common causes of vomiting.
- [See Management of Food Allergies
by caryma Jul 03, 2017]
- Eosinophilic esophagitis, a disease characterized by eosinophilic infiltrates in the esophagus is another cause of vomiting often found in older children or adolescents with a history of asthma, atopy and eczema, who complain of food sticking in the
- Appendicitis is a common GI cause of vomiting in children and adolescents that should not be missed. Usually, there will also be a history of fever and abdominal pain.
- Acute Gastroenteritis
- Meningitis and pyelonephritis classically present with vomiting and fever.
Neurologic Causes – Relate to Increased Intracranial Pressure
- The history should be suggestive of other symptoms of increased intracranial pressure, such as morning headaches, focal neurological deficits or changes in vision.
- Intracranial neoplasms
- Pseudo tumor cerebri in older children
Migraines can be another common cause for vomiting in children
Metabolic and Endocrine Causes
- Diabetic Ketoacidosis
- DKA can be the initial presentation of type 1 diabetes so always consider it as a cause of vomitting.
- A child in DKA may also present with abdominal pain, changes in respiratory pattern, and confusion or lethargy.
- Congential adrenal hyperplasia
- Inborn errors of metabolism
- Refers to post-tussive emesis, which is common in
- foreign body aspiration
- respiratory infections following prolonged and forceful coughing episodes.
- Iron poisoning
- Lead poisoning
- other medications
Less common categories of pediatric vomiting include psychogenic and behavioral causes, which includes overfeeding in infants and bulimia nervosa in adolescents.
Pregnancy must also be considered in adolescents.