There are at least 4 known physiologic pathways that can trigger vomiting, 3 of which are extraintestinal. Understanding which pathway is causing a patient’s vomiting will help determine best treatment options, including which antiemetic is most likely to be helpful to mitigate symptoms. Bilious emesis in a newborn should indicate bowel obstruction. Cyclic episodes of vomiting may be indicative of a migraine variant.¹
Causing of Vomiting in Children, according to age group:
Neonatal
- malrotation with mid-gut volvulus
- meningitis / UTI / sepsis (fever, irritable)
- necrotising enterocolitis (usually premi)
- cerebral anoxia
- subdural haematoma
- hypoglycaemia
- systemic infection
- renal disease
- adrenal insufficiency
- inborn metabolic errors (afebrile)
- congenital intestinal atresia or webs
- small bowel obstruction: duodenal atresia
- large bowel obstruction: ileal atresia
- oesophageal atresia
- Hirschsprung’s disease
- meconium ileus
- severe GORD
Infancy
- infection
- surgical lesions of GIT (see childhood)
- gastro-oesophageal reflux disease
- rumination
- congenital hypertrophic pyloric stenosis
- pyelorospasm
- gastroenteritis
- malabsorption
- intestinal obstruction – intussusception, hernia
- accidental poisoning – toxins, drugs
- non-accidental (head) trauma
Childhood
- acute gastroenteritis – viral or bacterial
- infection – viral or bacterial
- meningitis / encephalitis
- pneumonia
- UTI
- sepsis
- migraine
- acute appendicitis (school aged)
- gut malrotation
- metabolic disorders
- diabetic ketoacidosis (toddler/preschool/early school)
- glycogen storage diseases
- inborn errors of metabolism
- non-accidental poisoning
- psychological
Don’t forget CNS causes:
- raised intracranial pressure
- intracranial neoplasm
- hydrocephalus
- meningitis / encephalomyelitis
- hypertensive encephalopathy – important to measure BP in children
- cerebral abscess
- lead poisoning
Downloads
- Headsmart Symptoms card
- Lead poisoning in children: case report – PanAfrican Medical Journal
- Neonatal Intestinal Obstruction – Vinocur, Lee, Eisenberg (AJR 2012; 198:W1–W10)
