What are the treatment options for pediatric nausea?

From the Guidelines

For treating children's nausea, especially in cases of acute gastroenteritis associated with vomiting, an antinausea and antiemetic like ondansetron may be given to facilitate tolerance of oral rehydration in children over 4 years of age and in adolescents, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.

Key Considerations

• Non-medication approaches should be the first line of treatment, including offering small sips of clear fluids, serving bland foods, and ensuring the child rests in a cool, well-ventilated room.
• For children over 4 years and adolescents with acute gastroenteritis and vomiting, ondansetron can be considered to help with nausea and vomiting, based on guidelines from the Infectious Diseases Society of America 1.
• It's crucial to avoid using antimotility drugs like loperamide in children under 18 years of age with acute diarrhea, as per the guidelines 1.
• The evidence base for medication therapy in children and adolescents can be complex due to a high placebo response in clinical trials, making it essential to rely on the most recent and highest quality studies for guidance 1.

Treatment Approach

• Start with non-medication methods to manage nausea.
• Consider ondansetron for children over 4 years and adolescents with acute gastroenteritis and vomiting.
• Avoid antimotility drugs in children under 18 with acute diarrhea.
• Seek medical attention if nausea persists, is severe, or is accompanied by other concerning symptoms like fever, signs of dehydration, or if the child is under 6 months old.

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 For children, promethazine hydrochloride tablets, syrup, or rectal suppositories, 12.5 to 25 mg twice daily, may be administered. The usual dose is 0.5 mg per pound of body weight, and the dose should be adjusted to the age and weight of the patient and the severity of the condition being treated.

Children’s nausea treatment options include:

• Ondansetron: established safety and effectiveness in pediatric patients 4 years and older for prevention of nausea and vomiting associated with moderately emetogenic cancer chemotherapy 2
• Promethazine: may be administered to children at a dose of 0.5 mg per pound of body weight, adjusted to the age and weight of the patient and the severity of the condition being treated 3
• Metoclopramide: although there are insufficient reliable data to conclude whether the pharmacokinetics of metoclopramide in adults and the pediatric population are similar, it has been studied in pediatric patients with symptomatic gastroesophageal reflux (GER) or cancer chemotherapy-related nausea and vomiting 4

From the Research

Treatment Options for Children's Nausea

• Ondansetron is a selective serotonin (5-hydroxytryptamine; 5-HT) 5-HT3 receptor antagonist that has been shown to be effective in treating nausea and vomiting in children, particularly when combined with dexamethasone 5, 6, 7, 8.
• In children receiving chemotherapy, ondansetron has been found to be significantly more effective at reducing nausea and vomiting than metoclopramide or chlorpromazine 5.
• Ondansetron has also been shown to be effective in preventing postoperative nausea and vomiting (PONV) in children, with a single oral dose being significantly more effective than placebo 5, 9.
• In the treatment of gastroenteritis-related vomiting, ondansetron has been found to be efficacious and superior to other anti-emetic medications, with a single oral dose reducing vomiting and facilitating oral rehydration therapy (ORT) without significant adverse events 6, 7, 8.

Safety and Efficacy

• Ondansetron is generally well tolerated in children, with the most frequently reported adverse events being mild to moderate headache, constipation, and diarrhea 5, 9.
• The use of ondansetron in children has been supported by several studies, with enough evidence to define its clinical use as "off-label/on evidence" 8.
• The combination of ondansetron with dexamethasone has been shown to be significantly more effective than ondansetron or dexamethasone alone in preventing nausea and vomiting in children 5, 9.

Clinical Use

• Ondansetron should be considered as a first-line anti-emetic in children undergoing chemotherapy, radiotherapy, and surgery 5, 9.
• In the treatment of gastroenteritis-related vomiting, ondansetron may be useful in situations where vomiting hinders ORT, but a larger randomized, placebo-controlled trial is necessary before the medication can be routinely recommended 6, 7, 8.