Persistent/recurrent vomiting

Persistent/recurrent vomiting

Reassure

  • Vomiting for less than two weeks
  • Corroborating findings of infectious cause
  • Responsive to therapy for gasto-oesophageal reflux
  • No associated worrying features

Review/refer

  • Vomiting for less than two weeks
  • No corroborating findings of infectious cause
  • Unresponsive to reflux therapy
  • Any worrying features

Scan

  • Persistent (occurring on most days over a two week period) vomiting
  • No corroborating findings of infectious cause
  • Unresponsive to therapy for gasto-oesophageal reflux
  • Any worrying features
  • Persistent vomiting with one or more other symptoms that may occur with a brain tumour

Diagnostic pitfalls

  • Vomiting is attributed to an infective cause without corroborating findings e.g fever, diarrhoea or contact with others with recent similar symptoms
  • Head circumference has not been monitored in a baby with persistent vomiting, where the vomiting was due to raised intracranial pressure

Examination/assessment

  • Determine duration and characteristics of nausea and vomiting
  • Assess hydration and need for oral or intravenous hydration
  • Ask specifically about associated symptoms and risk factors:
    • Personal or family history of a brain tumour
    • Leukaemia
    • Sarcoma and early onset breast or bowel cancer prior therapeutic CNS irritation
    • Neurofibromatosis types 1 and 2
    • Tuberous Sclerosis
    • Li Fraumeni Syndrome
    • Family history of colorectal polyposis
    • Gorlins Syndrome
    • Other familial genetic syndromes
  • Neurological examination (include assessment of vision (including acuity), gait and coordination
  • Plot growth in all children and pubertal status if applicable
  • Plot head circumference in children under two

Worrying features

  • Vomiting that wakes a child/young person from sleep or occurs on waking
  • Vomiting that is worse in the morning (exclude pregnancy where appropriate)
  • Vomiting with a headache
  • Vomiting with an increasing head circumference (crossing centiles)