VOMITING IN INFANTS AND CHILDREN

• As age advances, possibilities of vomiting as a symptom of congenital obstructive anomalies diminishes. Etiologic spectrum now widens and shifts to acquired conditions
• Vomiting is a common symptom of numerous underlying conditions for which children frequently present for healthcare. Although vomiting can originate from the gastrointestinal (GI) tract itself, it can also signal more generalized, systemic disorders. Vomiting in children is often benign and can be managed with supportive measures only. Still, clinicians must be able to recognize life-threatening causes of vomiting and to avoid serious associated complications, including electrolyte abnormalities, dehydration, or even bowel necrosis.

Obstructive

• ascariasis, paralytic ileus, cyst and tumours, intussusception, pyloric stenosis

Reflex vomiting

• occurs due to afferent stimulus arising from viscera and acting on the vomiting centre.
• Gastrointestinal tract: gastritis, enteritis, hepatitis, peritonitis, appendicitis
• Urinary tract: nephritis, pyelitis, cystitis, renal calculi
• Respiratory tract: tonsillitis, bronchitis, labyrinthitis, otitis media
• Metabolic causes: hyperglycaemia, uremia, acidosis
• Central- Raised intracranial pressure: meningitis, encephalitis, neoplasm, Epilepsies, migraine
• Miscellaneous: over feeding, emotional disturbance

Onset of vomiting and duration

Acute onset

• Usually associated with fever
• If there is diarrhoea- likely to be gastroenteritis
• If associated with headache- extra cranial or intracranial infection
• If associated with abdominal pain- hepatitis, pyelonephritis, cholecystitis
• High grade fever: acute bacterial or viral infection

Vomiting of long duration and recurrent with a completely normal interval period

• Migraine, cyclical vomiting, motion sickness or psychogenic

Colour of vomitus

• Bile stained: intestinal obstruction distal to ampulla of vater

Anorexia

• Severe anorexia with pain in abdomen is a feature of hepatitis

Abdominal pain

• Nature of pain: dull aching or colicky?
• Vomiting with abdominal dull pain indicates infective or inflammatory focus in the abdomen
• Colicky pain: spasm in ureter

Headache

• Persistent vomiting associated with severe headache- intracranial pathology

Stool pattern

• Constipation: possibility of intestinal obstruction
• Diarrhoea: intestinal infection

Colour of urine

• High coloured urine: hepatitis or concentrated urine
• If there is oliguria it indicates dehydration and would call for immediate resuscitation

Failure to thrive

• Pyloric stenosis, inborn errors of metabolism, chronic renal failure, Addisons disease

Examination

• Need to find following with Physical Examination
• Ill/ well/ lethargic
• Any signs of dehydration
• Changes in vital signs
• Assessment of growth
• Jaundice
• Skin pigmentation
• Systemic examination
• Guarding, rigidity, tenderness- intra abdominal inflammatory pathology
• Signs of meningeal irritation
• Presence of neurological deficit- intracranial pathology

Depending on provisional diagnosis:

Total and differential WBC count

• In majority of cases, vomiting is secondary to acute infection in respiratory tract, GIT
• Leucocytosis- bacterial infection
• Leukopenia- viral infection

Urine Examination

• Albumin, pus cells and bacteriuria if one suspects urinary tract infection
• Presence of bile pigments and bile salts indicates hepatitis
• Urine culture- In suspected urinary tract infection

Cerebrospinal fluid examination

• Done if meningitis is suspected

Blood biochemistry 

• Blood sugar examination: if diabetic ketoacidosis is suspected
• Blood urea nitrogen and serum creatinine: altered in chronic renal failure
• Serum calcium, phosphorous, alkaline phosphatase: altered in chronic renal failure
• Liver function test: raised in viral hepatitis
• Abdominal X ray in erect position
• USG Abdomen
• Barium meal 
• EEG: if vomiting appears to be due to epilepsy

• Treat according to cause
• Surgical correction if needed
• Immediate fluid replacement in dehydration
• Emergency care in neurological conditions

Ayurvedic Treatment

Vomiting due to indigestion and improper food

Toyas

• Oral fluids in small quantity, frequently as Lajamanda
• Toya with Deepana pachana and vata anulomana drugs –Shadanga Kashaya

Gutikas

• Dhanwantara gutika: with Jeeraka kashaya
• Vilwadi gutika with madhu or Ardraka swarasa
• Sudarsanam gutika with Seetha jala
  • Upto 6 years ¼ tab twice daily
  • 6-12 years- 1 tab bd
  • 12-15 years- 1 tab tds

Lehyas

• Vilwadi lehya
  • up to years: ¼ tsp tds
  • 6-12 years: ½ tsp freq
  • 12-15 years- 1 tsp freq