What are the treatments for vomiting (emesis) in pediatric patients?

From the Guidelines

To stop vomiting in children, it is recommended to use ondansetron, an antinausea and antiemetic agent, in children over 4 years of age and adolescents with acute gastroenteritis associated with vomiting, as it can facilitate tolerance of oral rehydration 1.

Key Recommendations

• Keep the child hydrated with small, frequent sips of clear fluids like water, diluted juice, or oral rehydration solutions such as Pedialyte.
• Avoid solid foods initially, then gradually introduce bland foods like crackers, toast, rice, or bananas once vomiting subsides.
• Ondansetron can be given to children over 4 years of age and adolescents to facilitate oral rehydration, as it has been shown to reduce vomiting and the need for hospitalization for rehydration 1.
• Home remedies like ginger tea (for older children) or peppermint aromatherapy may help settle the stomach.
• Keep the child resting in a cool, quiet environment, and position them on their side while sleeping to prevent choking if vomiting occurs.

Important Considerations

• Vomiting often results from viral gastroenteritis, which typically resolves within 24-48 hours.
• Seek immediate medical attention if your child shows signs of dehydration (dry mouth, no tears when crying, decreased urination), vomits for more than 24 hours, has a high fever, severe abdominal pain, blood in vomit, or appears unusually lethargic.
• Loperamide should not be given to children under 18 years of age with acute diarrhea, as it may increase the risk of complications 1.
• Antimotility agents and antimicrobial agents should be used with caution, as they may increase the risk of severe outcomes, including death, from diarrhea caused by certain pathogens 1.

From the FDA Drug Label

The safety and effectiveness of orally administered ondansetron tablets have been established in pediatric patients 4 years and older for the prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy In these trials, 58% of the 170 evaluable patients had a complete response (no emetic episodes) on Day 1 In 2 trials the response rates to ondansetron tablets 4 mg three times a day in patients younger than 12 years was similar to ondansetron tablets 8 mg three times daily in patients 12 to 18 years.

To stop vomiting in children, ondansetron tablets can be used in pediatric patients 4 years and older for the prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy. The recommended dose is 4 mg three times a day for patients younger than 12 years, and 8 mg three times daily for patients 12 to 18 years 2. However, it is essential to consult a healthcare professional for proper diagnosis and treatment, as the safety and effectiveness of ondansetron tablets have not been established in pediatric patients for other conditions, such as highly emetogenic cancer chemotherapy, radiotherapy, or postoperative nausea and/or vomiting 2.

From the Research

Causes of Vomiting in Children

• Vomiting in children can be caused by a variety of organic and nonorganic disorders, including gastrointestinal (GI) and non-GI disorders 3
• Acute gastritis and gastroenteritis (AGE) are the leading cause of acute vomiting in children 3
• Other life-threatening causes of vomiting in children 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 3

Management of Vomiting in Children

• Initial evaluation is directed at assessment of airway, breathing, and circulation, assessment of hydration status, and red flag signs 3
• 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 3
• Antiemetic medication, such as ondansetron, may be indicated in children unable to take orally due to persistent vomiting, post-operative vomiting, chemotherapy-induced vomiting, cyclic vomiting syndrome, and acute mountain sickness 3, 4, 5

Role of Antiemetic Medication

• Antiemetic medication, such as ondansetron, can facilitate oral rehydration therapy (ORT) and minimize the risk of dehydration and hospitalization 4, 5
• Ondansetron has been shown to be efficacious and superior to other antiemetic medications in the treatment of gastroenteritis-related vomiting 5
• The use of antiemetic medication should be considered in situations where vomiting hinders ORT, but a larger randomized, placebo-controlled trial is necessary before the medication can be routinely recommended for the treatment of gastroenteritis-related vomiting in children 5

Oral Rehydration Therapy

• Oral rehydration therapy is effective and successful in the majority of patients with acute gastroenteritis 6, 7
• Oral rehydration therapy takes advantage of the remaining intact absorptive cells in the intestine and is less invasive than intravenous rehydration 7
• Parents can be involved in their children's care by administering oral rehydration therapy 7