Red flags: high fever, ↑HR/↓BP, neck stiffness/

photophobia, FTT/weight loss, bloody/biliary vomit,

Isolated vomiting in Children
projectile vomit, food refusal, (occult) blood in stool,
anemia, acute abdomen

Infectious/Inflammatory Gastroenteric Neurological Endocrine/

(r/o overfeeding) Metabolic
Food
Food Allergy (i.e.
poisoning
milk protein
allergy) Seizure dx Adrenal
Urinary Tract MS Inborn errors of
Infection Gastroenteritis metabolism insufficiency
(usually vomiting + Migraine (r/o uremia) (n/v + abdo
diarrhea +/- headache,
Labyrinthine dx
GI tract (fam hx may be +; pain + tanned
myalgials) Non-GI tract (If vertigo: motion
Appendicitis can trigger cyclic skin; ↓Na+,
Acute otitis sickness, Meniere
vomiting syndrome) ↑K+)
media GERD Crohn’s dx, etc) Diabetes
Meningitis/sepsis
(irritable, lethargic,
disease ↑ ICP (DKA, T1DM) Hyperthyroid
Bowel obstruction
poor feeding, Hiatus Malignancy,
+/- colicky pain
fever, petechial hernia hemorrhage, Hypo/hyper-
precedes vomiting, pain
rash) relieved w/ vomit.
infarction, abscess, parathyroid
Midgut Hepatitis Pancreatitis meningitis, congenital
Pyloric stenosis  Volvulus
“olive” mass in abdo. Cholecystitis malformation,
(bilious hydrocephalus, Workup:
NEC (in vomiting) pseudomotor cerebri -glucose (blood or urine)
Workup: premies)
-CBC Workup: -HbA1c
-Urinalysis Intussusception -ALT, AST, ALP, GGT -TSH, lytes
-Urine culture (abdo pain, bloody -Lipase Workup: -NH3
-CRP, ESR stool, + DRE) -CT head -Ca2+
-Blood cultures -EEG
-LP (if needed) Workup:
-Abdo x-ray Treatment:
-GI follow-through
• Rehydrate: oral, NG, or IV
-esophageal pH probe
(for GERD) Medications: • Diet: continue oral feedings, including
Psychiatric: -surgical exploration • Antibiotics, antivirals, analgesics (aspirin, NSAIDs, narcotics), breastfeeding, whenever possible.
• Anxiety/depression chemotherapy drugs, cardiovasc drugs (CCBs, BBs, anti- (frequent small meals, reduce fat intake,
• Eating disorder – anorexia, bulemia, NOS hypertensives), anticonvulsants, diuretics, hormonal agents eliminate carbonated liquids)
• Psychogenic vomiting (i.e. OCPs), GI tract tx (sulfasalazine, azathioprine), nicotine, • Antiemetics (oral, rectal, parenteral)
• Facticious disorder; Munchausen syndrome by proxy theophylline  consider doing drug levels