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Chronic idiopathic nausea of childhood
Katja Kovacic1, Adrian Miranda1, Gisela Chelimsky1
1Center for Pediatric Neurogastroenterology, Division of Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI.
Insights
Children with chronic idiopathic nausea, often adolescent females, experience severe daily symptoms and comorbid conditions like migraines. This contrasts with secondary nausea in functional abdominal pain, highlighting chronic nausea as a distinct, disabling condition.
Area of Science:
- Pediatric Gastroenterology
- Functional Gastrointestinal Disorders
- Neurology
Background:
- Chronic idiopathic nausea in children is poorly understood.
- Distinguishing primary chronic nausea from secondary nausea in functional abdominal pain is crucial for diagnosis and management.
Purpose of the Study:
- To compare the clinical characteristics of children with primary chronic idiopathic nausea to those with secondary nausea associated with functional abdominal pain.
- To identify distinct features and comorbid conditions in each group.
Main Methods:
- Retrospective chart review of 45 children with primary chronic nausea.
- Comparison with prospectively collected data from 49 children with functional abdominal pain and comorbid nausea.
- Analysis of symptom severity, demographics, and associated medical conditions.
Main Results:
- The primary chronic nausea group comprised mostly adolescent Caucasian females with daily (88%) and constant (60%) nausea.
- This group reported significantly higher rates of migraines (62%), familial migraines (71%), postural tachycardia syndrome (36%), and cyclic vomiting syndrome (27%).
- Both groups experienced comorbid symptoms including anxiety, dizziness, fatigue, and sleep disturbances, with the chronic nausea cohort undergoing extensive negative medical workups.
Conclusions:
- Primary chronic idiopathic nausea in children is characterized by severe, daily symptoms and a higher prevalence of migraine features and dysautonomia.
- Chronic nausea represents a significant, disabling functional entity that warrants recognition as separate from functional abdominal pain.
- Future research should investigate the interplay of comorbid conditions like migraine and dysautonomia in pediatric chronic nausea.
Objectives:
To compare children with primary, chronic idiopathic nausea to those with secondary nausea associated with functional abdominal pain.
Study Design:
Retrospective chart review of 45 children with a primary complaint of chronic nausea several times per week. Comparisons were made to prospectively collected data on 49 children with functional abdominal pain and comorbid nausea.
Results:
The majority of those affected were adolescent Caucasian females. Subjects with chronic nausea had a more severe presentation with daily 88% (vs 26%) and constant 60% (vs 10%) nausea (P < .001), one-half with peak morning intensity. In the chronic nausea group, 62% had migraines, and 71% (vs 22%) had familial migraines (P < .001), 36% had postural tachycardia syndrome and 27% cyclic vomiting syndrome. Both groups suffered comorbid symptoms (anxiety, dizziness, fatigue, and sleep problems). The chronic nausea cohort underwent extensive, negative medical evaluations.
Conclusions:
Chronic idiopathic nausea of childhood is a poorly described symptom. Patients with primary (vs secondary) chronic nausea were more likely Caucasian, older adolescent females with severe, daily nausea and comorbid conditions such as anxiety, dizziness, and fatigue as well as significantly more migraine features. Chronic nausea is a major, disabling symptom that requires increased recognition as a separate functional entity. Future studies may need to focus on comorbid conditions including migraine and dysautonomia.
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