From the Guidelines
Vomiting in infants is most commonly caused by gastroesophageal reflux (GER), which is usually benign and resolves with age. According to a 2020 study published in the Journal of the American College of Radiology 1, GER is the most common cause of vomiting in infants, particularly in the first weeks of life. This condition is often due to overfeeding and typically resolves on its own with no definitive pathologic cause.
Common Causes of Vomiting
Other common causes of vomiting in infants include:
- Bilious emesis or repeated forceful vomiting, which should be evaluated for underlying obstruction
- Congenital GI tract abnormalities, such as malrotation with or without volvulus, atresia of the antropyloric region, and annular pancreas
- Hypertrophic pyloric stenosis (HPS), pylorospasm, formula intolerance, and gastroenteritis
- Medical causes, such as sepsis, enteritis, pneumonia, otitis media, meningitis, and metabolic disorders
Diagnostic Approach
A diagnostic workup should start with a thorough clinical evaluation, including history and physical examination, which can lead to the diagnosis in most instances 1. Viral gastroenteritis, systemic infections, and metabolic disorders may be diagnosed by clinical and laboratory criteria. It is essential to consider the clinical differentiation between vomiting and regurgitation, as well as the categorization of vomiting as nonbilious or bilious, to guide the diagnostic approach.
Key Considerations
Parents should seek medical attention if their infant's vomiting persists, contains blood, or is accompanied by severe abdominal pain, or if signs of dehydration develop. A study published in the Journal of the American College of Radiology 1 emphasizes the importance of a thorough clinical evaluation and laboratory criteria in diagnosing the underlying cause of vomiting in infants.
From the Research
Common Causes of Vomiting
- Gastrointestinal infections and food poisoning are the most common causes of acute nausea and vomiting 2
- Medication side effects and pregnancy should always be suspected as potential causes of vomiting 2
- Other potential causes of chronic nausea and vomiting include various underlying medical conditions, which require a comprehensive history and examination to diagnose 2
Treatment of Vomiting
- Ondansetron has been shown to be effective in managing vomiting in children with acute gastroenteritis, with higher efficacy rates compared to metoclopramide and domperidone 3, 4
- In adults, ondansetron and metoclopramide have been compared to placebo for the treatment of undifferentiated emergency department nausea and vomiting, with similar reductions in nausea severity 5
- A study comparing the effects of metoclopramide and ondansetron on emergency service observation times in acute gastroenteritis-related nausea and vomiting cases found that ondansetron resulted in shorter observation times and less recurrent admission to the emergency department 6
Comparison of Antiemetic Medications
- Ondansetron and metoclopramide have been compared in several studies, with varying results:
- A study in children with acute gastroenteritis found that ondansetron had higher efficacy rates compared to metoclopramide 3
- A study in adults with undifferentiated emergency department nausea and vomiting found similar reductions in nausea severity between ondansetron and metoclopramide 5
- A study comparing the effects of metoclopramide and ondansetron on emergency service observation times in acute gastroenteritis-related nausea and vomiting cases found that ondansetron resulted in shorter observation times and less recurrent admission to the emergency department 6