Vomiting in the pediatric age group
By Dr. Elvie Joy Atanque-Basa
During the summer season, many kids are brought to clinics or hospitals because of vomiting. Due to the heat, kids often want to drink too many fluids—cool refreshing drinks such as fruit juices or shakes—or, sometimes while at the beach, they can unconsciously put a foreign object in their mouth, such as a small toy, some nuts, or even a pebble, and eventually swallow it.
Why Vomiting Occurs
Vomiting is a highly-coordinated reflex process that may be anticipated by increased salivation and begins with involuntary retching. Both children and adults may experience it. Although the overall sequence of these processes is quite stereotypical, each can occur independently of the others.
The following is some information about vomiting, the most common causes of vomiting, and what to do in cases of vomiting.
It is accepted that the ability to vomit developed as a protective mechanism to rid the body of ingested toxins. Unfortunately, vomiting also frequently occurs in circumstances not related to the ingestion of noxious agents. Vomiting can be a sign of many different diseases, an adverse reaction to a certain medication, psychiatric disorders, pregnancy, or stress.
Vomiting during the first day of life suggests obstruction in the upper digestive tract or increased intracranial pressure. Vomiting may also be a nonspecific symptom of an illness such as septicemia. It is a common manifestation of overfeeding, inexperienced feeding technique, or normal reflux. Vomitus containing dark blood is usually a sign of serious illness, and the possibility of swallowed maternal blood should also be considered.
The most common cause for vomiting is often gastrointestinal (GI). It can be helpful to think of the GI tract as a long tube stretching from the mouth to the anus, with four buds sticking out in the middle: the liver, the gallbladder, the pancreas, and the appendix. Anything that either obstructs or inflames the tube or any of its buds may cause vomiting.
Acute gastroenteritis (AGE) is the most common cause of vomiting in the pediatric age group. Most cases of gastroenteritis are associated with some degree of vomiting. The child will develop a fever, vomiting, and abdominal pain followed by diarrhea after a few hours. Significant vomiting lasting longer than 48 hours needs to be evaluated for something other than AGE.
Appendicitis is the most common surgical emergency in childhood, and vomiting is the most common symptom, followed by fever and abdominal pain. If these signs and symptoms are seen in your child, bring him or her to the medical center for proper evaluation and assessment.
The most common foreign body (FB) ingestion in children worldwide is the swallowing of coins, which will usually result in vomiting. Fortunately, here in Vietnam coins are rarely used, so other small objects such as buttons, small toys and nuts are the more common culprits of FB ingestion.
Children who have ingested FBs are noted for drooling and may have difficulty breathing, and must be rushed to a nearby hospital for the removal of the FB by a specialist. If the child is neither drooling nor vomiting, he or she can be observed for 24 hours to see if the FB passes into the stomach spontaneously. If not, the child should be referred to a gastroenterologist for removal. In the case of ingested sharp FBs and button batteries, the child should be referred to a specialist immediately.
The most important consideration in assessing the child is the degree of dehydration. To prevent it, give small amounts of water or an oral rehydrating solution. No laboratory tests are needed in the vast majority of cases, except for random blood sugar or a set of electrolytes in cases of moderate or severe dehydration. Hypoglycemic children are commonly fussy and refuse to drink, and therefore will often need intravenous fluids and admission to a hospital. Owing to the self-limited nature of vomiting associated with gastroenteritis, no therapy is usually needed. If the child goes to daycare and if anyone in the family works as a food handler, the importance of good hand washing should also be stressed.
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