Version May 2024
| Disorder | Typical clinical features |
| Infectious | |
| Gastroenteritis* | Sudden onset, usually with diarrhea and ill contacts. Most common cause of vomiting in all age groups. |
| Pharyngitis* | Sore throat, pharyngeal erythema. Vomiting is common with streptococcal pharyngitis. |
| Otitis media* | Ear pain, fever, often with vomiting. May include labyrinthitis, which tends to cause vertigo or ataxia. |
| Urinary tract infections | Urinary symptoms, fever. Vomiting is common, particularly in infants. |
| Gastrointestinal obstruction | |
| Intussusception | Intermittent, crampy abdominal pain and vomiting; may have lethargy, bloody stools, or palpable right lower quadrant mass. Most common between 6 and 36 months of age. |
| Malrotation | Can present at any age and with variable symptoms:
|
| Other intestinal obstructions | Incarcerated inguinal hernia, superior mesenteric artery syndrome, duodenal hematoma (post-trauma). |
| Other gastrointestinal causes | |
| GERD* | Vomiting is typically small volume, postprandial, and not forceful. |
| Peptic ulcer disease, gastritis* | Helicobacter pylori or chronic NSAID use may be implicated in both disorders. |
| Gastroparesis* | Vomiting tends to occur several hours after eating. May be postinfectious or related to underlying neuromuscular disorders or metabolic disturbances. |
| Appendicitis* | Abdominal pain and tenderness, migrating to the right lower quadrant. |
| Celiac disease* | Vomiting is more common in the younger child, along with growth failure. |
| Eosinophilic esophagitis or gastroenteritis | Epigastric pain, nausea and vomiting, and feeding aversion; older patients may present with dysphagia or food impaction. |
| Inflammatory bowel disease | Most common after 6 years of age but can present in any age group. Gastrointestinal symptoms often include diarrhea, hematochezia, and, occasionally, vomiting. |
| Pancreatitis | Epigastric, left upper quadrant pain radiating to back. Suggested by elevated lipase, with or without elevated bilirubin or liver transaminases. Uncommon in infants. May be viral induced or genetic (if recurrent) or associated with biliary obstruction (eg, biliary stones). |
| Functional gastrointestinal disorders | |
| Functional dyspepsia* | Persistent or recurrent pain in upper abdomen; often associated with postprandial nausea, vomiting, and early satiety. |
| Functional nausea and vomiting* | Nausea and/or vomiting without associated abdominal pain and with no underlying gastrointestinal cause. More common in individuals with underlying anxiety or depression. |
| Cyclic vomiting syndrome | Recurrent episodes of nausea and intense vomiting lasting hours to days, separated by symptom-free periods. |
| Cannabis hyperemesis syndrome | Episodes of vomiting that resemble cyclic vomiting syndrome, often with repetitive hot water bathing behavior. Associated with prolonged, excessive cannabis use in adolescents and young adults. |
| Rumination syndrome | Painless chewing and re-swallowing of regurgitated food within minutes of eating or during eating. |
| Endocrine/metabolic | |
| Diabetic ketoacidosis* | Polydipsia, polyuria, fatigue, sometimes with nocturia or enuresis. Nausea, vomiting, and acute weight loss are common. May present with vaginal or cutaneous candidiasis, especially in infants. |
| Adrenal crisis | Signs may include hyponatremia, hyperkalemia, hypoglycemia, and hypotension. Consider in infants with atypical genitalia or any child with known adrenal insufficiency or pituitary hormone deficiencies. |
| Neurologic | |
| Increased intracranial pressure (eg, mass, hemorrhage) | Causes include intracranial tumor, subdural hematoma from head trauma, or hydrocephalus. Vomiting tends to occur in the morning and with associated headaches. |
| Migraine | Episodic headache, nausea, vomiting, and abdominal pain, often with vertigo, relieved by sleep. Family history of migraines is common. |
| Miscellaneous | |
| Posttussive* | Causes include coughing related to asthma, infection, or foreign body. |
| Food allergy (anaphylaxis) | Vomiting, abdominal pain, and diarrhea, usually with urticaria, angioedema, and/or respiratory and cardiovascular symptoms. Onset within minutes to hours after ingesting an allergen. |
| Acute hydronephrosis | Can present with abdominal pain and vomiting (Dietl crisis) that may mimic a cyclic vomiting syndrome episode. |
| Pregnancy | Consider in any adolescent female presenting with nausea or vomiting, especially with complaints of menstrual irregularity. |
| Bulimia nervosa | Consider in a patient with concerns about body weight and shape. Most cases are in adolescent females. |
| Toxic ingestion | Refer to UpToDate content on the child with occult toxic exposure. |
| Medical child abuse (eg, poisoning, head trauma) | May present with frequent recurrent illnesses without a clear etiology; often requiring hospitalization. For details, refer to UpToDate content on medical child abuse. |
GERD: gastroesophageal reflux disease; NSAID: nonsteroidal antiinflammatory drug.
* Relatively common causes.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
