From the Guidelines
Vomiting in children should be evaluated based on the presence of red flags, such as dehydration, bilious vomit, projectile vomiting, blood in vomit, severe abdominal pain, altered mental status, or vomiting that persists beyond 24-48 hours, and managed accordingly with oral rehydration therapy or medical attention as needed. Vomiting is a common symptom in pediatric patients, with numerous potential causes ranging from benign conditions like viral gastroenteritis to more serious issues such as intestinal obstruction, increased intracranial pressure, or metabolic disorders 1. For parents concerned about a child's vomiting, it's essential to monitor for warning signs and seek medical attention if any concerning symptoms develop or if the child shows signs of dehydration such as decreased urination, dry mouth, or lethargy.
Evaluation and Management
The evaluation of vomiting in children should start with a thorough clinical evaluation, including history and physical examination, to identify potential causes and red flags 1. In cases of mild vomiting, oral rehydration therapy using small, frequent sips of electrolyte solutions can be effective in managing symptoms and preventing dehydration 1. However, for children with severe vomiting or concerning symptoms, medical attention should be sought promptly.
Red Flags and Concerning Symptoms
Red flags that require immediate medical attention include:
- Dehydration
- Bilious (green) vomit
- Projectile vomiting
- Blood in vomit
- Severe abdominal pain
- Altered mental status
- Vomiting that persists beyond 24-48 hours These symptoms can indicate underlying conditions that require prompt medical evaluation and treatment 1.
Oral Rehydration Therapy
Oral rehydration therapy is a crucial component of managing vomiting in children, particularly in cases of mild to moderate dehydration 1. The use of antinausea and antiemetic medications, such as ondansetron, may be considered in children over 4 years of age and adolescents with acute gastroenteritis associated with vomiting 1. However, the primary approach should focus on oral rehydration and monitoring for red flags.
Gastroesophageal Reflux
Gastroesophageal reflux (GER) is a common condition in infants and children, characterized by the passage of gastric contents into the esophagus 1. While GER is generally considered a normal physiologic process, it can be associated with symptoms such as vomiting and regurgitation. Differentiating between GER and gastroesophageal reflux disease (GERD) is essential, as GERD may require further evaluation and treatment.
Conclusion is not allowed, so the answer will be ended here.
From the FDA Drug Label
Ondansetron tablets are indicated for the prevention of nausea and vomiting associated with: highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m 2. initial and repeat courses of moderately emetogenic cancer chemotherapy radiotherapy in patients receiving either total body irradiation, single high-dose fraction to the abdomen, or daily fractions to the abdomen. Ondansetron tablets are also indicated for the prevention of postoperative nausea and/or vomiting.
The question is about vomiting in children, but the provided drug label is for ondansetron, which is used to prevent nausea and vomiting in specific situations such as cancer chemotherapy, radiotherapy, and postoperative nausea and/or vomiting. There is no direct information in the provided drug label that specifically addresses vomiting in children. The FDA drug label does not answer the question.
From the Research
Causes of Vomiting in Children
- Vomiting can be caused by a variety of organic and nonorganic disorders, including gastrointestinal (GI) and non-GI disorders 2
- Acute gastritis and gastroenteritis (AGE) are the leading cause of acute vomiting in children 2
- Important life-threatening causes in infancy include congenital intestinal obstruction, atresia, malrotation with volvulus, necrotizing enterocolitis, pyloric stenosis, intussusception, shaken baby syndrome, hydrocephalus, inborn errors of metabolism, congenital adrenal hypoplasia, obstructive uropathy, sepsis, meningitis, and encephalitis 2
- In older children, causes of vomiting include appendicitis, intracranial mass lesion, diabetic ketoacidosis, Reye's syndrome, toxic ingestions, uremia, and meningitis 2
Evaluation and Management of Vomiting in Children
- Initial evaluation is directed at assessment of airway, breathing, and circulation, assessment of hydration status, and red flag signs (bilious or bloody vomiting, altered sensorium, toxic/septic/apprehensive look, inconsolable cry or excessive irritability, severe dehydration, concern for symptomatic hypoglycemia, severe wasting, Bent-over posture) 2
- Investigations (Serum electrolytes and blood gases, renal and liver functions, and radiological studies) are required in any child with dehydration or red flag signs to diagnose surgical causes 2
- Management priorities include treatment of dehydration, stoppage of oral fluids/feeds, and decompression of the stomach with a nasogastric tube in patients with bilious vomiting 2
- Antiemetic ondansetron is indicated in children unable to take orally due to persistent vomiting, post-operative vomiting, chemotherapy-induced vomiting, cyclic vomiting syndrome, and acute mountain sickness 2, 3
Role of Antiemetics in Vomiting Management
- Ondansetron has been shown to facilitate successful rehydration of under-5-year-old children suffering from acute diarrhea with vomiting and some dehydration 4
- A single oral dose of ondansetron, given before starting oral rehydration therapy (ORT), results in better oral rehydration, faster rehydration, lesser number of vomiting episodes, and better caregiver satisfaction 4
- Domperidone and ondansetron are commonly used antiemetics in the management of vomiting in children 3