Vomiting in Children: Reassurance, Red Flag, or Referral?

Abstract

1. Latha Chandran, MD, MPH* 2. Maribeth Chitkara, MD† 1. *Editorial Board 2. †Assistant Professor of Pediatrics and Emergency Medicine, Pediatric Hospitalist, State University of New York at Stony Brook, Stony Brook, NY After completing this article, readers should be able to: 1. Discuss the most common causes of vomiting in children of different age groups. 2. Understand the physiology behind the process of vomiting. 3. Recognize common causes of vomiting based on the pattern and nature of emesis. 4. Be familiar with the basic diagnostic evaluation and treatment strategies for different causes of vomiting. A 1-month-old boy who has had postprandial vomiting for 1 week is admitted from the emergency department. He was born at term with no complications and had regained his birthweight by the second week after birth, feeding on a milk protein formula. He has been vomiting curdled milk intermittently for the past week, and on the day of admission was noted by his pediatrician to have lost 4 oz in weight since his last check-up . On physical examination, the infant is slightly lethargic and has a sunken fontanelle. The rest of his physical examination findings, including evaluation of his abdomen, are normal. Abdominal ultrasonography shows normal width and length of the pylorus. However, no food movement past the pylorus is observed. An echogenic density in the prepyloric area is noted. An upper gastrointestinal (GI) radiographic series and endoscopy reveal an antral web, which is excised surgically . Vomiting involves the forceful expulsion of the contents of the stomach and is a highly coordinated, reflexive process. It is a feature of many acute and chronic disorders, including those causing increased intracranial pressure, metabolic diseases, and anatomic and mucosal GI abnormalities. Descent of the diaphragm and constriction of the abdominal musculature on relaxation of the gastric cardia force gastric contents back up the esophagus. The process is coordinated by the “vomiting center” in the central nervous system. The vomiting center receives sensory input from the vestibular nucleus (cranial nerve VIII), the GI tract …