Vomiting, Pediatric

Vomiting, Pediatric is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Forceful, coordinated act of expelling gastric contents through the mouth; characterized by nausea, retching, and emesis, resulting from sustained contraction of abdominal muscles, diaphragm, pylorus, and antrum
  • Emesis results from activation of CTZ (chemosensitive trigger zone) which is located in the midbrain

Etiology

The causes of vomiting vary with age and range from very benign to serious life-threatening conditions:
  • Neonatal period (<2 mo):
    • GI causes include:
      • Feeding problems such as overfeeding, chalasia, sucking and swallowing difficulties, improper technique or position
      • Gastroesophageal reflux disease (GERD)
      • Other serious GI conditions include:
        • Meconium ileus, NEC, hypertrophic pyloric stenosis, malrotation with midgut volvulus, Hirschsprung disease, congenital obstructions (atresias, stenoses, and webs), incarcerated hernia
    • Non-GI causes:
      • Neurologic: CNS bleeding (often due to birth trauma), hydrocephalus, birth asphyxia
      • Infectious: Acute pyelonephritis, pneumonia, sepsis, gastroenteritis, meningitis/encephalitis, intrauterine infections (TORCHES)
      • Metabolic/endocrine: Inborn errors of metabolism (amino acidurias, galactosemia, fatty acid oxidation disorders, urea cycle defects), congenital adrenal hyperplasia, kernicterus
  • Infancy (2 mo–2 yr):
    • GI causes:
      • GERD, milk intolerance or milk allergy, posttussive emesis, viral gastritis or gastroenteritis, food poisoning
      • GI obstruction–pyloric stenosis, intussusception, malrotation with midgut volvulus and incarcerated hernia, foreign body/bezoar, trauma
    • Non-GI causes:
      • Metabolic/endocrine: Inborn errors of metabolism (amino acidurias, fatty acid oxidation disorders, urea cycle defects)
      • Neurologic: Increased intracranial pressure (ICP) from subdural hematoma, closed head injury, nonaccidental injury, hydrocephalus
      • Infections: Acute gastroenteritis, UTI, pneumonia, otitis media. Potentially serious infections such as sepsis, meningitis, or encephalitis
      • Chronic organ disease: Hepatobiliary disease, chronic renal disease, pancreatitis,
      • Other: Toxic ingestion
  • Childhood (3–12 yr):
    • GI causes:
      • Acute gastroenteritis, GERD. Serious causes include, foreign body in esophagus, eosinophilic esophagitis, and intestinal obstruction, e.g., intussusception, malrotation with midgut volvulus, adhesions from previous abdominal surgeries, incarcerated inguinal hernia, paralytic ileus, trauma
    • Non-GI causes:
      • Posttussive emesis from hyperreactive airway disease, pyelonephritis, strep pharyngitis, otitis media, and upper respiratory infections
      • Metabolic: Diabetic ketoacidosis (DKA)
      • Neurologic: Increased ICP from tumor, pseudotumor cerebri, subdural hematomas, severe head injury
      • Toxic ingestions: Accidental or intentional overdose
      • Cyclic vomiting
      • Other: Postchemotherapy
  • Adolescence (13–18 yr):
    • GI causes:
      • Acute gastroenteritis, peptic ulcer disease, appendicitis, intestinal obstruction, ileus, trauma
    • Non-GI causes:
      • Pregnancy, pseudotumor, substance abuse/withdrawal, eating disorders, psychogenic,
      • Underlying chronic organ diseases (chronic pancreatitis, end stage renal disease, hepatobiliary disease)
      • Substance abuse, drug induced, toxins, or overdose

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Basics

Description

  • Forceful, coordinated act of expelling gastric contents through the mouth; characterized by nausea, retching, and emesis, resulting from sustained contraction of abdominal muscles, diaphragm, pylorus, and antrum
  • Emesis results from activation of CTZ (chemosensitive trigger zone) which is located in the midbrain

Etiology

The causes of vomiting vary with age and range from very benign to serious life-threatening conditions:
  • Neonatal period (<2 mo):
    • GI causes include:
      • Feeding problems such as overfeeding, chalasia, sucking and swallowing difficulties, improper technique or position
      • Gastroesophageal reflux disease (GERD)
      • Other serious GI conditions include:
        • Meconium ileus, NEC, hypertrophic pyloric stenosis, malrotation with midgut volvulus, Hirschsprung disease, congenital obstructions (atresias, stenoses, and webs), incarcerated hernia
    • Non-GI causes:
      • Neurologic: CNS bleeding (often due to birth trauma), hydrocephalus, birth asphyxia
      • Infectious: Acute pyelonephritis, pneumonia, sepsis, gastroenteritis, meningitis/encephalitis, intrauterine infections (TORCHES)
      • Metabolic/endocrine: Inborn errors of metabolism (amino acidurias, galactosemia, fatty acid oxidation disorders, urea cycle defects), congenital adrenal hyperplasia, kernicterus
  • Infancy (2 mo–2 yr):
    • GI causes:
      • GERD, milk intolerance or milk allergy, posttussive emesis, viral gastritis or gastroenteritis, food poisoning
      • GI obstruction–pyloric stenosis, intussusception, malrotation with midgut volvulus and incarcerated hernia, foreign body/bezoar, trauma
    • Non-GI causes:
      • Metabolic/endocrine: Inborn errors of metabolism (amino acidurias, fatty acid oxidation disorders, urea cycle defects)
      • Neurologic: Increased intracranial pressure (ICP) from subdural hematoma, closed head injury, nonaccidental injury, hydrocephalus
      • Infections: Acute gastroenteritis, UTI, pneumonia, otitis media. Potentially serious infections such as sepsis, meningitis, or encephalitis
      • Chronic organ disease: Hepatobiliary disease, chronic renal disease, pancreatitis,
      • Other: Toxic ingestion
  • Childhood (3–12 yr):
    • GI causes:
      • Acute gastroenteritis, GERD. Serious causes include, foreign body in esophagus, eosinophilic esophagitis, and intestinal obstruction, e.g., intussusception, malrotation with midgut volvulus, adhesions from previous abdominal surgeries, incarcerated inguinal hernia, paralytic ileus, trauma
    • Non-GI causes:
      • Posttussive emesis from hyperreactive airway disease, pyelonephritis, strep pharyngitis, otitis media, and upper respiratory infections
      • Metabolic: Diabetic ketoacidosis (DKA)
      • Neurologic: Increased ICP from tumor, pseudotumor cerebri, subdural hematomas, severe head injury
      • Toxic ingestions: Accidental or intentional overdose
      • Cyclic vomiting
      • Other: Postchemotherapy
  • Adolescence (13–18 yr):
    • GI causes:
      • Acute gastroenteritis, peptic ulcer disease, appendicitis, intestinal obstruction, ileus, trauma
    • Non-GI causes:
      • Pregnancy, pseudotumor, substance abuse/withdrawal, eating disorders, psychogenic,
      • Underlying chronic organ diseases (chronic pancreatitis, end stage renal disease, hepatobiliary disease)
      • Substance abuse, drug induced, toxins, or overdose

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