Differential Diagnosis for 2 yo F with Evening Vomiting

• Single most likely diagnosis
  • Gastroesophageal reflux disease (GERD): This is a common condition in toddlers, characterized by the reflux of stomach contents into the esophagus, often leading to evening vomiting due to increased pressure on the stomach after a day of eating and activity.
• Other Likely diagnoses
  • Viral gastroenteritis: Although this typically presents with diarrhea and vomiting throughout the day, some viral infections can cause intermittent vomiting, especially in the evenings.
  • Food intolerance or allergy: Intolerance to certain foods, such as lactose or gluten, or an allergic reaction to specific foods can lead to vomiting after consumption, which might be more noticeable in the evenings.
  • Constipation: In toddlers, constipation can sometimes lead to vomiting, possibly due to the body's attempt to expel the contents of the stomach in response to discomfort or pressure from the intestines.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Intussusception: A condition where a part of the intestine slides into an adjacent part, potentially cutting off blood supply. It's a medical emergency that can present with intermittent vomiting, among other symptoms like abdominal pain and bloody stools.
  • Pyloric stenosis: A condition where the pylorus (the passage between the stomach and small intestine) thickens, blocking food from entering the intestine. It typically presents with projectile vomiting after feeding but could be considered in any case of persistent vomiting.
  • Appendicitis: Although less common in toddlers, appendicitis can present with vomiting, fever, and abdominal pain. The pain often starts near the belly button and then moves to the lower right abdomen.
• Rare diagnoses
  • Metabolic disorders: Certain metabolic disorders can lead to episodes of vomiting, often accompanied by other systemic symptoms such as lethargy, seizures, or developmental delays.
  • Increased intracranial pressure: Conditions that increase pressure inside the skull, such as a brain tumor or hydrocephalus, can cause vomiting, often worse in the morning but can occur in the evenings as well.
  • Cyclic vomiting syndrome: A rare condition characterized by recurrent episodes of severe vomiting lasting hours to days, with periods of normal health in between episodes.