Child with Vomiting

Vomiting is a common problem in children for which parents seek health care consultation. It has a varied etiology encompassing many organ systems, ranging from a benign physiological behavior to a life-threatening systemic disease. Most often, it is benign and self-limiting. Infections within and outside the gastrointestinal tract are the commonest causes. A good history and meticulous physical examination can discern the cause and help in delineating the benign cause from the sinister. Red flags include unstable vital signs, acidotic breathing, presence of bile or blood stained vomitus, features of gastrointestinal (GI) obstruction, encephalopathy and papilledema. Blood pressure, hydration status, careful abdominal examination including genitalia and hernial orifices and fundus form important components of the physical examination. Signs of GI obstruction should prompt an abdominal X-ray and surgical consultation. Recognition and treatment of the underlying cause is important. Mere symptomatic treatment may delay specific diagnosis and therapy. If the cause is not apparent after initial assessment, observation and/or admission would be appropriate. Vomiting may need symptomatic relief with antiemetics, if it is persistent and impedes oral intake. Domperidone and ondansetron are the commonly used antiemetics. Since most causes are benign, parental reassurance with or without symptomatic treatment may suffice.