Can URTI Without Cough Cause Vomiting?
Yes, upper respiratory tract infections without cough can cause vomiting, particularly in pediatric influenza, COVID-19, and acute bacterial sinusitis, though the mechanism and presentation differ from the classic post-tussive vomiting seen in pertussis.
Primary URTI Causes of Vomiting Without Cough
Pediatric Influenza
- Young children with influenza frequently present with vomiting as a primary manifestation, even without prominent cough. 1
- Influenza in children commonly presents with otitis media, nausea, and vomiting alongside respiratory signs, but vomiting may dominate the clinical picture. 1
- Infants can initially mimic bacterial sepsis with high fever or febrile seizures accompanied by vomiting, making the respiratory component less obvious. 1
- When vomiting occurs with fever during influenza season—especially if the child appears systemically ill—consider influenza over isolated gastroenteritis, even without prominent cough. 1
COVID-19
- Gastrointestinal symptoms occur in 11–37% of COVID-19 patients, with nausea/vomiting reported in 3.7–25% of cases. 1
- GI manifestations can precede respiratory symptoms by several days, meaning vomiting may be the presenting complaint before any cough develops. 1
- The presence of vomiting or diarrhea raises the likelihood of a positive COVID-19 test by approximately 70%. 1
Acute Bacterial Sinusitis in Children
- Acute bacterial sinusitis often includes vomiting that occurs in association with gagging on post-nasal mucus, alongside irritability and prolonged cough. 1
- The vomiting mechanism in sinusitis results from gagging on drainage rather than post-cough paroxysms, so it can occur independently of active coughing episodes. 1
Critical Clinical Pitfalls to Avoid
Do not automatically attribute vomiting to gastroenteritis when any respiratory signs are present; include pertussis, influenza, and COVID-19 in the differential diagnosis. 1
Key Assessment Points
- In children with URTI-related vomiting, assess for dehydration and electrolyte disturbances, often requiring aggressive fluid replacement. 1
- Consider the timing: if vomiting precedes respiratory symptoms by days, COVID-19 becomes more likely. 1
- Evaluate for systemic illness severity: high fever with vomiting in a systemically ill child during flu season strongly suggests influenza. 1
- Check for post-nasal drainage: gagging on mucus can trigger vomiting in sinusitis without active coughing. 1
Distinguishing From Post-Tussive Vomiting
While post-tussive vomiting is a hallmark of pertussis with high specificity (approximately 78%), occurring specifically after coughing paroxysms, 1 the vomiting in influenza, COVID-19, and sinusitis operates through different mechanisms and does not require cough to be present. The distinction is clinically important because it broadens the differential diagnosis when evaluating a patient with URTI symptoms and vomiting but minimal or absent cough.