Vomiting in Children: Clinical Scenarios

Purpose of Review: Vomiting is a common physiologic response in children. Although a defense mechanism against ingested toxins, it usually indicates an underlying disorder and at times can become maladaptive. It is crucial for the pediatrician to understand the differential diagnosis and management approach. We will review the topic of vomiting and present different clinical scenarios as a guide. At the end, the reader should feel comfortable with prudent evaluation and effective management of pediatric vomiting. Recent Findings: There is an ongoing research in development of novel medications for the treatment and prevention of vomiting. This has led to increased understanding of the circuitry and cellular mechanisms involved in nausea and vomiting, especially interactions between the enteric, central, and autonomic nervous systems. Receptor selective antiemetics that target specific emetic pathways are important to optimal management of vomiting. Summary: The approach to vomiting can be daunting to the front-line pediatrician given the broad differential diagnosis. This can be simplified through understanding of the emetic pathways and a focused history and physical examination. Vomiting characteristics, temporal pattern, and child’s age are keys to an accurate assessment. Treatment should be focused on the underlying disorder or mechanism and consist of appropriately targeted antiemetics.