Evaluation of vomiting in children

Vomiting is a frequently reported symptom in children and can be a presenting feature in both gastro-intestinal and non gastro-intestinal disease. Careful evaluation of all children with vomiting is essential in order to identify causes which require urgent management. Important aspects of the history include onset, frequency, duration and colour of the vomitus as well as associated gastro-intestinal, respiratory and neurological symptoms. Bilious vomiting at any age should always be taken seriously and any history of recurrent bouts of vomiting is important. A thorough examination is necessary to assess hydration status of the child and elicit other associated features such as congenital abnormalities, failure to thrive or neurological deficit. Definitive management will depend on the underlying cause and may include medical and surgical therapies. In all cases good supportive care is vital with adequate fluid and electrolyte replacement being paramount. ‘Red flag’ symptoms including early morning headache, signs of peritonism, lethargy, bulging fontanelle in infants, and persistent vomiting with poor growth or abnormal development, should point the clinician to the possibility of more sinister causes of vomiting.