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.