VOMITING IN CHILDREN

Clinical Features

  • Vomiting in children may be due to a systemic infection or may accompany diarrhoea, as it often happens.
  • It should be noted that some normal babies regurgitate milk regularly and are clinically normal with normal growth. These are
    not considered to be having a vomiting problem.
  • Vomiting may also be due to upper gastrointestinal tract obstruction, and may be the primary presentation for
    this condition.

The common causes of vomiting include the following:

  • For early infancy
    • Gastro-oesophageal reflux disease (GORD), which initially presents as painless and persistent vomiting
    • Pyloric stenosis that presents with projectile vomiting and with a mass palpable in the right upper abdominal quadrant in the affected children.
    • Congenital upper gastrointestinal obstruction.
  • Later infancy/early childhood
    • Intussusception that presents with intermittent acute pains and blood in the stool. A mass may be palpable in the abdomen.

Investigations

  • Full haemogram
  • Serum electrolytes
  • Plain abdominal x-ray supine and erect or dorsal decubitus views
  • Abdominal ultrasound
  • Upper GI series
  • Endoscopy

Management

  • Avoid antiemetics.
  • Treat non obstructive causes appropriately.
  • Initiate rehydration according to degree of dehydration, using normal saline in the acute phase.
  • Arrange to transfer to surgical unit urgently all children suspected to have gastrointestinal obstruction and gastro-oesophageal reflux disease syndrome.

Reflux precautions:

  • Head up 30 degrees, side position to sleep
  • Upright after feeding for 30 minutes
  • Minimal handling after feeding
  • Small frequent feeds
  • Thicken feeds

Medications:

  • Acid suppression: Omeprazole 0.5 – 1.0mg/kg/day (maximum 30mg/day)
  • Prokinetic: Domperidone 0.1mg/kg/day
  • Refer if symptoms persist despite treatment.