Differential Diagnosis for Pediatric Vomiting

Single Most Likely Diagnosis

• Viral Gastroenteritis: This is the most common cause of vomiting in children, often accompanied by diarrhea, fever, and abdominal cramps. The high incidence and prevalence of viral gastroenteritis in the pediatric population make it the leading consideration.

Other Likely Diagnoses

• Food Allergy or Intolerance: Common in infants and young children, reactions to certain foods can cause vomiting. Symptoms can range from mild to severe and include other signs like rash or diarrhea.
• Gastroesophageal Reflux Disease (GERD): Especially in infants, GERD can cause frequent vomiting due to the reflux of stomach contents into the esophagus.
• Infections (e.g., Urinary Tract Infections, Otitis Media): In young children, infections elsewhere in the body can manifest with nonspecific symptoms like vomiting.
• Constipation: Though less obvious, constipation can lead to vomiting, possibly due to the body's attempt to expel contents or due to the discomfort and pressure constipation causes.

Do Not Miss Diagnoses

• Appendicitis: Although less common in very young children, appendicitis can present with vomiting and abdominal pain. Missing this diagnosis can lead to severe consequences, including perforation and peritonitis.
• Intussusception: A condition where a part of the intestine slides into an adjacent part, which can cause intestinal obstruction and ischemia. It's a medical emergency that requires prompt diagnosis and treatment.
• Pyloric Stenosis: Typically presents in infants with projectile vomiting, this condition is due to the narrowing of the pylorus, the passage linking the stomach to the small intestine. It requires surgical intervention.
• Diabetic Ketoacidosis: Especially in children with undiagnosed diabetes, vomiting can be a presenting symptom along with hyperglycemia and metabolic acidosis.

Rare Diagnoses

• Cyclic Vomiting Syndrome: A rare condition characterized by recurrent episodes of severe vomiting with periods of normal health in between.
• Congenital Anomalies of the Gastrointestinal Tract: Conditions like duodenal atresia or stenosis can cause vomiting in newborns.
• Increased Intracranial Pressure: Due to conditions like brain tumors or hydrocephalus, which can cause vomiting, especially in the morning.
• Adrenal Insufficiency: A rare condition where the adrenal glands do not produce enough cortisol and aldosterone, which can lead to vomiting among other symptoms.

Each of these diagnoses requires careful consideration based on the child's age, clinical presentation, and additional symptoms to ensure accurate diagnosis and appropriate management.