The Indian Journal of Pediatrics

, Volume 80, Issue 4, pp 318–325 | Cite as

Management of a Child with Vomiting

  • Sunit C. Singhi
  • Ravi Shah
  • Arun Bansal
  • M. Jayashree
Symposium on pgimer management protocols in gastrointestinal emergencies


Vomiting is a protective reflex that results in forceful ejection of stomach contents up to and out of the mouth. It is a common complaint and may be the presenting symptom of several life-threatening conditions. It can be caused by a variety of organic and nonorganic disorders; gastrointestinal (GI) or outside of GI. Acute gastritis and gastroenteritis (AGE) are the leading cause of acute vomiting in children. Important life threatening causes in infancy include congenital intestinal obstruction, atresia, malrotation with volvulus, necrotizing enterocolitis, pyloric stenosis, intussusception, shaken baby syndrome, hydrocephalus, inborn errors of metabolism, congenital adrenal hypoplasia, obstructive uropathy, sepsis, meningitis and encephalitis, and severe gastroenteritis, and in older children appendicitis, intracranial mass lesion, diabetic ketoacidosis, Reye’s syndrome, toxic ingestions, uremia, and meningitis. Initial evaluation is directed at assessment of airway, breathing and circulation, assessment of hydration status and red flag signs (bilious or bloody vomiting, altered sensorium, toxic/septic/apprehensive look, inconsolable cry or excessive irritability, severe dehydration, concern for symptomatic hypoglycemia, severe wasting, Bent-over posture). The history and physical examination guides the approach in an individual patient. The diverse nature of causes of vomiting makes a “routine” laboratory or radiologic screen impossible. Investigations (Serum electrolytes and blood gases,renal and liver functions and radiological studies) are required in any child with dehydration or red flag signs, to diagnose surgical causes. Management priorities include treatment of dehydration, stoppage of oral fluids/feeds and decompression of the stomach with nasogastric tube in patients with bilious vomiting. Antiemetic ondansetron(0.2 mg/kg oral; parenteral 0.15 mg/kg; maximum 4 mg) is indicated in children unable to take orally due to persistent vomiting, post-operative vomiting, chemotherapy induced vomiting, cyclic vomiting syndrome and acute mountain sickness.


Children Vomiting Antiemetic 


  1. 1.
  2. 2.
    Taylor AT. Nausea and vomiting. In: DiPiro JT, Talbert RL, Yee G, et al., eds. Pharmacotherapy, a pathophysiologic approach. 4th ed. Stanford: Appleton & Lange; 1999. pp. 586–96.Google Scholar
  3. 3.
    Li BU, Sunku BK. Vomiting and Nausea in Pediatric Gastrointenstinal and Liver Disease. In: Wyllie R, Hyams JS, eds. Pathophysiology/Diagnosis/Management. 3rd ed. Philadelphia: Saunders; 2006. pp. 127–49.Google Scholar
  4. 4.
    Amarilyo G, Alper A, Ben-Tov A, Grisaru-Soen G. Diagnostic accuracy of clinical symptoms and signs in children with meningitis. Pediatr Emerg Care. 2011;27:196–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Hyman PE, Milla PJ, Bnenninga MA, Davidson GP, Fleisher DF, Taminiau J. Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenetrology. 2006;130:1519–26.CrossRefGoogle Scholar
  6. 6.
    Craig WR, Hanlon-Dearman A, Sinclair C, Taback S, Moffatt M. Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children under two years. Cochrane Database Syst Rev. 2004;4:CD003502.PubMedGoogle Scholar
  7. 7.
    Dunning J, Batchelor J, Stratford-Smith P, et al. A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Child. 2004;89:593–4.CrossRefGoogle Scholar
  8. 8.
    Brown F, Brown J, Beattie T. Why do children vomit after minor head injury? J Accid Emerg Med. 2000;17:268–71.PubMedCrossRefGoogle Scholar
  9. 9.
    Tack J, Blondeau K, Boecxstaens V, Rommel N. Review article: the pathophysiology, differential diagnosis and management of rumination syndrome. Aliment Pharmacol Ther. 2011;33:782–8.PubMedCrossRefGoogle Scholar
  10. 10.
    El-Mouzan MI, Al-Mofleh IA, Abdullah AM, Al-Rashed RS. Indications and yield of upper gastrointestinal endoscopy in children. Saudi Med J. 2004;25:1223–5.PubMedGoogle Scholar
  11. 11.
    Culy CR, Bhana N, Plosker GL. Ondansetron: a review of its use as an antiemetic in children. Paediatr Drugs. 2001;3:441–79.PubMedCrossRefGoogle Scholar
  12. 12.
    Alhashimi D, Al-Hashimi H, Fedorowicz Z. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database of System Rev. 2009;2:CD005506.Google Scholar
  13. 13.
    Yilmaz HL, Yildizdas RD, Sertdemir Y. Clinical trial: oral ondansetron for reducing vomiting secondary to acute gastroenteritis in children-a double-blind randomized study. Aliment Pharmacol Ther. 2010;31:82–91.PubMedCrossRefGoogle Scholar
  14. 14.
    Freedman SB, Powell EC, Nava-Ocampo AA, Finkelstein Y. Ondansetron dosing in pediatric gastroenteritis. Pediatr Drugs. 2010;12:405–10.CrossRefGoogle Scholar
  15. 15.
    Li BU, Balint J. Cyclic vomiting syndrome: evolution in our understanding of a brain-gut disorder. Adv Pediatr. 2000;47:117–60.PubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2013

Authors and Affiliations

  • Sunit C. Singhi
    • 1
  • Ravi Shah
    • 1
  • Arun Bansal
    • 1
  • M. Jayashree
    • 1
  1. 1.Department of Pediatrics, Advanced Pediatrics CentrePGIMERChandigarhIndia

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