Vomiting and Nausea in the Pediatric Patient

Nausea and vomiting are frequent symptoms among children, which are associated with both common and uncommon pediatric conditions. They may be due to primary gastrointestinal conditions such as anatomic anomalies, inflammatory conditions, and motility and functional disorders, but may also be secondary to conditions outside the GI tract. The latter includes metabolic abnormalities, drugs (e.g., chemotherapy, analgesics), central/peripheral/autonomic disorders, migraine headaches, and psychiatric/behavioral conditions. This chapter focuses on nausea and vomiting within the context of pediatric gastrointestinal disorders. It is divided into two main parts: vomiting, first, followed by nausea. We address primary gastrointestinal problems in children frequently associated with nausea and vomiting and elaborate on potential causes for nausea and vomiting in functional GI disorders. This will include the use of assessment tools such as symptom questionnaires aimed toward defining the role and significance of comorbid symptoms. The impact of coexisting psychological conditions such as anxiety are discussed as they relate to diagnosis as well as integrated treatment strategies. We emphasize mechanisms for nausea and vomiting for each of these conditions toward the goal of determining more focused diagnostic and evidenced-based treatment strategies.