Vomiting
Paediatrics
Introduction
Vomiting in children is a common symptom with various causes, including infections, gastrointestinal issues, and more serious conditions like intestinal obstruction. Taking a medical history involves assessing the onset, duration, frequency, and appearance of vomit, along with associated symptoms such as fever, abdominal pain, or dehydration. This helps identify the underlying cause and guide appropriate management.
WIPER
W – Wash/Sanitise hands.
I – Introduce yourself and establish patient demographics. Confirm the childs name and the relationship of the accompanying adult.
P- Permission, taking consent
E – Expose the patient (if needed)
R- Reposition
Presenting Complaint
Onset – When did he/she first start vomiting? What were they doing at the time? How much vomit did they bring up?
Character/colour – What colour is the vomit? Does it have any blood, mucus or bile in it? Is the vomiting projectile, posseting or regurgitating back?
– Does the child get reflux with or before vomiting?
Associated features
General health– Has the child been ill or irritable recently aside from the vomiting?
Bowels – Have you noticed any changes in their bowel movements? Is there diarrhoea or constipation?
Urine – Have you noticed any changes in their urine? Does the child complain of pain? Is the urine smelly?
Height and Weight– Have they lost any weight since the symptoms started?
Timing – How long does the episode last for? Is the vomiting associated with their eating and drinking time?
Exacerbating/relieving factors – Anything in particular that brings the vomiting on/makes it worse? Is it worse when the child is sitting or lying down? Has the carer tried any OTC medication (e.g. Gaviscon)
Subsequently– How does the child behave/feel after the vomiting episode? Are they hungry for more food? Are they drowsy?
Systems Review
Does the child have a fever/rash?
Any complains of pain anywhere else i.e. headaches?
Do they seem more drowsy/dizzy?
Are they sleeping okay?
Has their eating and drinking been affected?
Use this opportunity to elicit ideas, concerns and expectations
Be sure to summarise the history
Past Medical History
W – Wash/Sanitise hands.
I – Introduce yourself and establish patient demographics. Confirm the childs name and the relationship of the accompanying adult.
P- Permission, taking consent
E – Expose the patient (if needed)
R- Reposition
Medications
Are there any prescribed or OTC medications?
Family History
Anyone in the family have or have had similar symptoms?
Any conditions that run in the family such as coeliac disease and IBD.
Social History
Is there anyone else at home with similar symptoms? suspect gastroenteritis
Differential Diagnosis
Meningitis (when accompanied with non-blanching rash, photophobia and fever).
GORD - history of reflux, curving of spine, severe distress on feeding.
Pyloric stenosis - projectile vomiting in the first 10 weeks of life.
Intussusception - signs of bowel obstruction with swelling in the abdomen
Coeliac disease - vomiting, belching and skin changes.
Gastroenteritis - high temperatures, associated vomiting, travel history or eating from food from outside.
Management
Remember: Bedside --> Laboratory --> Imaging
Bedside:
Full physical examination of the child including height and weight
Laboratory:
WCC (meningitis/gastroenteritis), U&Es (check for dehydration)
Coeliac antibody testing
Imaging:
Abdominal ultrasound - to rule out pyloric stenosis or intussusception
Barium enema