Merck Manual

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Some Causes and Features of Vomiting in Infants, Children, and Adolescents

Some Causes and Features of Vomiting in Infants, Children, and Adolescents

Cause

(listed from most to least common)

Common Features*

Tests

In infants

Usually with diarrhea (which rarely is bloody)

Sometimes a fever

Sometimes recent contact with infected people (as at a day care center), with animals at a petting zoo (where Escherichia [E.] coli may be acquired), or with reptiles (which may be infected with Salmonella bacteria) or recent consumption of undercooked, contaminated food or contaminated water

A doctor’s examination

Sometimes examination and culture of stool

Symptoms that occur after feeding, including fussiness, spitting up, arching of the back, crying, or a combination

Sometimes a cough when lying down, poor weight gain, or both

A doctor's examination

Sometimes treatment with drugs to suppress acid production (if symptoms are relieved, the cause is probably gastroesophageal reflux)

Sometimes x-rays of the upper digestive tract after barium is given by mouth (upper GI series)

Sometimes endoscopy

Pyloric stenosis (narrowing or blockage of the passage out of the stomach)

Forceful (projectile) vomiting that occurs immediately and after all feedings in infants aged 3–6 weeks

Signs of dehydration, an emaciated appearance, or both

In infants, appearing hungry and feeding eagerly

More common among boys, especially first-born boys

Ultrasonography of the stomach

If ultrasonography is unavailable or inconclusive, upper GI series

Birth defects that cause narrowing (stenosis) or blockage (atresia) of the digestive tract

Delayed passage of the first bowel movement (called meconium)

A swollen abdomen

Bright green or yellow vomit, indicating bile, during the first 24–48 hours of life (if the digestive tract is blocked) or somewhat later (if it is only narrowed)

More common among infants who have Down syndrome or whose mother had too much amniotic fluid in the uterus during pregnancy

An x-ray of the abdomen

Upper GI series or x-rays of the lower digestive tract after insertion of barium into the rectum (barium enema), depending on the suspected location of the problem

Intussusception (sliding of one segment of intestine into another)

Crying that occurs in bouts every 15–20 minutes, with children often drawing their legs up to their chest

Later tenderness of the abdomen when it is touched and bowel movements that look like currant jelly (because they contain blood)

Typically in children 3–36 months old

Insertion of air into the rectum (air enema)

Sometimes ultrasonography of the abdomen

Malrotation (abnormal development of the intestine, resulting in its being abnormally located and increasing the likelihood it will twist on itself)

Bright green or yellow vomit (indicating bile), a swollen abdomen, and blood in stool

Often in newborns

An x-ray of the abdomen

Upper GI series or barium enema

Fever and lethargy

A complete blood cell count

Culture of blood, urine, and cerebrospinal fluid

A chest x-ray if children have breathing problems

Diarrhea or constipation

Poor feeding

Weight loss, poor growth, or both

Blood in stools

Symptoms that lessen when the formula is changed

Possibly endoscopy, colonoscopy, or both

Poor feeding and not growing or developing as expected (failure to thrive)

Sluggishness (lethargy)

Other features depending on the disorder, such as

  • Jaundice

  • Cataracts

  • Unusual body and urine odors

Screening all newborns using a small sample of blood obtained by pricking the heel

Blood tests to measure levels of electrolytes (minerals necessary to maintain fluid balance in the body), ammonia, and glucose

Other tests based on the suspected cause

In children and adolescents

Usually with diarrhea (which rarely is bloody)

Sometimes fever

Sometimes recent contact with infected people (as at a day care center, at a camp, or on a cruise), with animals at a petting zoo (where Escherichia [E.] coli may be acquired), or with reptiles (which may be infected with Salmonella bacteria) or recent consumption of undercooked, contaminated food or contaminated water

A doctor’s examination

Sometimes examination or culture of stool

Heartburn

Pain in the chest or upper abdomen

Symptoms that worsen when lying down or after eating

Sometimes a nighttime cough

A doctor's examination

Symptoms that lessen or are relieved after treatment with drugs to suppress acid production

Sometimes upper GI series

Sometimes endoscopy

Gastroparesis or delayed gastric emptying (the stomach empties slowly)

Feeling of fullness after eating only small amounts

Sometimes a recent viral illness

A doctor's examination

Upper GI series or x-rays taken after formula or food is given by mouth (gastric emptying scan)

Vomiting that occurs immediately after eating certain food

Often hives, lip or tongue swelling, difficulty breathing, wheezing, abdominal pain, diarrhea, or a combination

A doctor's examination

Sometimes allergy testing

Avoidance of a particular food to see whether symptoms stop

Infections in parts of the body other than the digestive tract

Fever

Often symptoms that suggest the location of the infection, such as headache, ear pain, sore throat, swollen lymph nodes in the neck, pain during urination, pain in the side (flank), or a runny nose

A doctor’s examination

Sometimes tests based on the suspected cause

Initially a general feeling of illness and discomfort in the middle of the abdomen, followed by pain moving to the lower right part of the abdomen

Then vomiting, loss of appetite, and fever

Ultrasonography or CT of the abdomen

Increased pressure within the skull (intracranial hypertension), caused by a tumor or an injury

Waking up because of a headache during the night or waking in the morning with a headache

Headaches that become progressively worse and are made worse by coughing or bowel movements

Sometimes changes in vision and difficulty walking, talking, or thinking

CT of the brain

Recurring episodes of vomiting separated by periods of wellness

Often headaches associated with vomiting

Often a family history of migraines

A doctor's examination

Sometimes tests to rule out other causes of recurring episodes of vomiting

Purposefully eating too little to lose weight or eating too much (bingeing) followed by purposefully vomiting or taking laxatives (purging)

Erosion of enamel on teeth and scars on the hands from using them to trigger vomiting

A distorted body image

A doctor’s examination

No menstrual periods

Morning sickness, bloating, and tender breasts

Sexual activity (although many adolescents deny it) with no or inadequate use of birth control

A urine pregnancy test

Ingestion of a toxin such as large amounts of acetaminophen, iron, or alcohol

Various features depending on the substance

Often a history of taking the substance

Blood tests to measure levels of the substance

* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.

CT = computed tomography; GI = gastrointestinal.