Nausea and vomiting are common symptoms in children and can result from various medical conditions. Nausea is the feeling of wanting to vomit, while vomiting is the forceful expulsion of stomach contents through the mouth. Approximately one in ten children experience episodes of nausea and vomiting each year. Understanding the causes and management of these symptoms is important for both parents and healthcare professionals to ensure prompt and effective treatment and to avoid potential complications such as dehydration.
Why do we vomit?
Nausea and vomiting are controlled by different parts of the body. The sensation of nausea is mainly mediated by the brain, particularly in an area called the chemoreceptor trigger zone (CTZ), located in the medulla. This area can be activated by various stimuli, including certain chemicals in the blood, signals from the gastrointestinal tract, and the inner ear’s vestibular system. Vomiting involves a more complex, coordinated response known as the vomiting reflex. This reflex begins when the CTZ or other parts of the brain receive signals indicating the need to expel stomach contents. The brain then sends signals to the diaphragm, abdominal muscles, and stomach to contract forcefully, causing vomiting. During vomiting, the stomach muscles contract while the diaphragm and abdominal muscles push upwards, creating pressure that forces the stomach’s contents out through the esophagus and mouth.
What is the most common cause of nausea and vomiting in children?
Viral gastroenteritis
The most common cause of nausea and vomiting in children is viral gastroenteritis, often called the stomach flu. Viral gastroenteritis is an infection of the stomach and intestines caused by various viruses, including rotavirus, norovirus, and adenovirus. Viral gastroenteritis typically affects children between six months and five years old. The pathogenesis involves the virus infecting the lining of the intestines, leading to inflammation and disruption of normal digestive processes.
Viral gastroenteritis is characterized by the sudden onset of nausea, vomiting, diarrhea, and abdominal pain. Fever may also be present. The diagnosis is usually clinical, based on the characteristic symptoms and a recent history of exposure to others with similar symptoms. Treatment focuses on maintaining hydration with oral rehydration solutions and managing symptoms. Most cases resolve within a few days without specific antiviral treatment.
Viruses that frequently cause gastroenteritis
- Rotavirus commonly affects infants and young children and is often associated with severe diarrhea.
- Norovirus can affect children of all ages and tends to cause outbreaks in group settings, such as schools and daycare centers.
- Adenovirus infections are less common but can also cause respiratory and gastrointestinal symptoms.
Is viral gastroenteritis contagious?
Yes, viral gastroenteritis is highly contagious. The viruses that cause viral gastroenteritis, including rotavirus, norovirus, and adenovirus, are easily spread from person to person. These viruses spread through contact with an infected person’s stool or vomit, as well as through contaminated food, water, or surfaces. Rotavirus is particularly contagious among infants and young children and can spread rapidly in daycare centers and other group settings. Norovirus is known for causing outbreaks in places like schools and cruise ships due to its ability to survive on surfaces for extended periods. Adenovirus can spread through respiratory droplets in addition to the fecal-oral route.
A child with viral gastroenteritis is typically contagious from the moment symptoms appear and can remain contagious for several days after symptoms resolve. Rotavirus can be shed in the stool for up to two weeks after recovery. To prevent the spread of viral gastroenteritis, it is important to practice good hygiene, including frequent handwashing with soap and water, disinfecting contaminated surfaces, and avoiding close contact with infected individuals.
Other common medical conditions associated with nausea and vomiting in children
Food poisoning
Food poisoning is caused by consuming contaminated food or drink. Symptoms include nausea, vomiting, diarrhea, and abdominal pain. Common microorganisms include Salmonella, Escherichia coli (E. coli), Staphylococcus aureus, and Campylobacter. Symptoms typically appear within hours to days of ingestion. Treatment involves maintaining hydration, and in some cases, antibiotics may be required for bacterial infections.
Motion sickness
Motion sickness is caused by conflicting signals from the inner ear and eyes during movement. It is more common in children aged 2 to 12 years and leads to nausea, vomiting, and dizziness. Treatment includes positioning the child to face forward, ensuring good ventilation, and sometimes using antihistamines like dimenhydrinate.
Food allergies
Food allergies can cause nausea and vomiting shortly after consuming the allergen. Additional symptoms may include hives, swelling, and difficulty breathing. Management includes avoiding the allergen and using antihistamines or epinephrine in severe cases.
Appendicitis
Appendicitis is inflammation of the appendix, a small, hollow, finger-shaped organ connected to the large intestine. Pain starting near the navel and shifting to the lower right abdomen is often the first symptom. Nausea, vomiting, and fever are common. Treatment is surgical removal of the appendix (appendectomy).
Urinary tract infection (UTI)
Urinary tract infections can cause nausea and vomiting, particularly in younger children. Symptoms include fever, abdominal pain, and painful urination. Treatment involves antibiotics based on the identified bacteria.
Migraine
Migraines can cause nausea and vomiting, often accompanied by severe headaches and sensitivity to light or sound. They typically affect older children and adolescents. Treatment involves rest, hydration, and medications such as ibuprofen or acetaminophen for pain relief and antiemetics for nausea.
Gastroesophageal reflux disease (GERD)
GERD occurs when stomach acid flows back into the esophagus, injuring the tissue inside the esophagus. Symptoms include nausea, vomiting, heartburn, and regurgitation. Treatment includes dietary modifications, positioning strategies, and medications like proton pump inhibitors or H2 blockers.
Less common but serious medical conditions associated with nausea and vomiting in children
Intestinal obstruction
Intestinal obstruction can be caused by various conditions, such as intussusception or volvulus. Symptoms include severe abdominal pain, vomiting, and abdominal distension. Intussusception typically occurs in children between six months and three years old and involves part of the intestine telescoping into itself, causing a blockage. Volvulus involves the twisting of the intestine, which can cut off blood supply and lead to necrosis. Treatment for both conditions may involve surgical intervention to relieve the obstruction.
Diabetic ketoacidosis
Diabetic ketoacidosis is a complication of diabetes characterized by high blood sugar and ketone levels, leading to nausea, vomiting, abdominal pain, and altered mental status. Nausea and vomiting can be the first signs of the disease. Precipitating factors include infections, missed insulin doses, and stress. Treatment involves fluid replacement, insulin therapy, and correction of electrolyte imbalances.
Pyloric stenosis
Pyloric stenosis is a condition where the muscles in the pylorus (the last part of the stomach) thicken, blocking food from entering the small intestine. It typically occurs in infants between three weeks and three months old. It causes forceful vomiting, dehydration, and weight loss. Treatment is a surgical intervention called pyloromyotomy.
Eosinophilic esophagitis
Eosinophilic esophagitis is an allergic condition where eosinophils, a type of white blood cell, build up in the esophagus. This leads to inflammation and difficulty swallowing, along with nausea and vomiting. Treatment includes dietary management, proton pump inhibitors, and sometimes corticosteroids.
Adrenal insufficiency
Adrenal insufficiency is when the adrenal glands do not produce enough hormones, leading to fatigue, abdominal pain, nausea, vomiting, and low blood pressure. Treatment involves hormone replacement therapy and managing any precipitating factors.
Poisoning
Ingestion of toxic substances such as medications, household chemicals, or plants causes nausea, vomiting, abdominal pain, and sometimes altered mental status. Treatment involves removing the toxin, administering activated charcoal, and supportive care.
Common poisons that cause nausea and vomiting in children include:
- Medications: Overdoses of acetaminophen, ibuprofen, or certain prescription medications.
- Household chemicals: Ingestion of cleaning agents, detergents, or pesticides.
- Plants: Consumption of poisonous plants like nightshade, oleander, or castor beans.
- Heavy metals: Lead or mercury poisoning from ingesting contaminated objects or substances.
Peptic ulcer disease
Peptic ulcer disease is the development of sores in the stomach lining or duodenum. These sores result in abdominal pain, nausea, vomiting, and sometimes bleeding. Causes include infection with Helicobacter pylori, long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), and stress. Treatment involves proton pump inhibitors, antibiotics for Helicobacter pylori infection, and lifestyle modifications.
Pancreatitis
Pancreatitis means inflammation of the pancreas. It typically presents with severe abdominal pain, nausea, vomiting, and sometimes fever. It can be caused by infections (such as mumps or viral hepatitis), medications (like certain anticonvulsants and chemotherapy drugs), trauma, gallstones, or genetic conditions. Treatment includes fasting, intravenous fluids, pain management, and addressing the underlying cause.
Meningitis
Meningitis means inflammation of the meninges, a specialized tissue that surrounds the brain and spinal cord. Most cases of meningitis are caused by infection leading to severe headache, neck stiffness, fever, nausea, and vomiting. Treatment involves prompt administration of antibiotics or antivirals and supportive care.
Brain tumours
Brain tumours can cause increased intracranial pressure, leading to nausea, vomiting, headache, and sometimes changes in vision or behavior. Treatment involves surgical removal of the tumor, radiation, and/or chemotherapy.
Sepsis
Sepsis is a severe infection causing systemic inflammation. It often presents with fever, nausea, vomiting, rapid breathing, and altered mental status. Sepsis occurs when an infection, such as a urinary tract infection, pneumonia, or skin infection, becomes disseminated in the blood. The body’s response to this widespread infection can lead to tissue damage, organ failure, and death. Treatment includes intravenous antibiotics, fluids, and supportive care in an intensive care unit if necessary.
Intracranial hypertension
Intracranial hypertension means increased pressure within the skull. It causes headaches, nausea, vomiting, and vision changes. Intracranial hypertension can result from various conditions, including hydrocephalus. Treatment involves addressing the underlying cause and sometimes surgical procedures to relieve pressure.
Hemolytic uremic syndrome
Hemolytic uremic syndrome is a potentially serious medical condition characterized by small blood vessel injury, kidney failure, and destruction of red blood cells. Most cases of hemolytic uremic syndrome are caused by infection with Shiga-toxin-producing Escherichia coli (E. coli) O157. The bacteria is typically acquired through contaminated food or drink or, less commonly, person-to-person contact. Symptoms include nausea, vomiting, diarrhea, and decreased urine output. Treatment involves supportive care and sometimes dialysis.
Intestinal pseudo-obstruction
Intestinal pseudo-obstruction is a rare condition where the intestines show blockage symptoms without any actual physical obstruction. Symptoms include severe abdominal pain, nausea, vomiting, and bloating. Treatment focuses on nutritional support, medications to enhance motility, and sometimes surgery.
Cyclic vomiting syndrome
Cyclic vomiting syndrome is characterized by recurrent, severe episodes of vomiting with no apparent cause, often occurring at regular intervals. Treatment includes hydration, antiemetic medications, and identifying and avoiding potential triggers.
Metabolic disorders
Metabolic disorders are genetic conditions affecting metabolism, leading to symptoms such as nausea, vomiting, lethargy, and poor growth. Examples include maple syrup urine disease and phenylketonuria. Treatment involves dietary management and sometimes specific medications.
Rare conditions associated with nausea and vomiting in children
Bartter syndrome
Bartter syndrome is a rare inherited disorder that affects the kidneys’ ability to reabsorb salt. This can lead to dehydration, muscle weakness, and growth delays. Electrolyte imbalances can also cause nausea and vomiting. Treatment involves managing symptoms with medications and dietary adjustments.
Porphyria
Porphyria is a group of rare genetic disorders affecting the production of heme, leading to symptoms such as abdominal pain, vomiting, neurological issues, and sensitivity to light. Treatment involves managing symptoms and avoiding triggers like certain medications and dietary factors.
Wilson disease
Wilson disease is a rare genetic disorder causing copper to accumulate in the body, leading to liver and neurological issues. Symptoms can include nausea, vomiting, jaundice, and tremors. Treatment involves medications to reduce copper levels and dietary changes.
Mitochondrial disorders
A group of genetic conditions affecting the mitochondria can lead to energy production issues. Symptoms can include muscle weakness, fatigue, nausea, vomiting, and neurological problems. Treatment focuses on managing symptoms and supportive care.
Scleroderma
Scleroderma is a rare autoimmune disease that causes the hardening and tightening of the skin and connective tissues. This can affect the gastrointestinal tract and lead to nausea, vomiting, and difficulty swallowing. Treatment involves managing symptoms with medications and supportive care.
Familial Mediterranean fever
Familial Mediterranean fever is a genetic disorder causing recurrent episodes of fever and inflammation, including abdominal pain, nausea, and vomiting. Treatment involves managing symptoms with medications like colchicine and supportive care.
Additional symptoms that can help identify the cause of nausea and vomiting in a child
- Abdominal pain: Sharp, localized pain may suggest appendicitis, while diffuse pain could indicate gastroenteritis or pancreatitis.
- Fever: The presence of fever suggests an infectious cause, such as viral gastroenteritis, meningitis, or urinary tract infection.
- Diarrhea: Commonly associated with viral gastroenteritis, food poisoning, or food allergies.
- Bloating: Can indicate conditions like gastroesophageal reflux disease or intestinal obstruction.
- Abdominal distension or swelling: This may suggest intestinal obstruction or severe constipation.
- Rash: Certain conditions, such as food allergies, meningitis, and viral infections, can be associated with skin rashes.
Advice for parents
If a child experiences persistent or severe nausea and vomiting, it is important to seek medical attention. Signs that warrant a doctor’s visit include dehydration (dry mouth, decreased urine output, sunken eyes), high fever, severe abdominal pain, lethargy, or vomiting accompanied by a rash, stiff neck, or severe headache. Treatment typically involves maintaining hydration, offering small amounts of clear fluids, and gradually reintroducing solid foods. Avoid giving over-the-counter medications without consulting a healthcare professional. In cases of suspected serious conditions, urgent medical care is necessary.
Summary
Nausea and vomiting in children are common symptoms with a wide range of causes, from viral gastroenteritis to more serious conditions like meningitis and brain tumors. Understanding the underlying mechanisms, recognizing associated symptoms, and knowing when to seek medical care are important for effective management and ensuring the child’s well-being.