Assessing nausea and vomiting

Assessing nausea and vomiting in a child

When assessing nausea and vomiting in a child you need to follow these steps:

  1. Take a full history, including all medication the child is receiving.
  2. Complete a clinical examination focusing particularly on the neurological and gastrointestinal systems.
  3. Identify the possible effects of the vomiting, e.g. dehydration.

Questions to ask when taking a history of the nausea and vomiting

To obtain a full history you would question the child, if they are old enough to give a history, as well as the caregiver (nursing staff and parents) about:

  • Whether they are experiencing feelings of nausea or not.

  • Timing, frequency, consistency and volume of the vomiting.

  • The stool habits e.g. constipation or diarrhoea.

  • Any factors that may be contributing e.g. certain food or medications.

  • Any factors that may help reduce vomiting e.g. eating before taking medication.

  • Any neurological problems that may be contributing e.g. swallowing problems.

  • Any gastrointestinal problems that may be contributing e.g. gastro-oesophageal reflux.

  • Any pain or anxiety that may be contributing to the nausea.

  • Any movement or positioning that may trigger nausea and/or vomiting.

  • Any history of allergies.

Signs and symptoms and possible causes

It is important that you identify the possible underlying cause of vomiting with a thorough history and examination before treating. Below is a table of common symptoms and their possible causes.

Symptoms and signs

Possible causes

Blood stained vomiting (haematemesis) Oesophagitis, swallowed blood, peptic ulcer, oesophageal varices
Coffee ground vomitus Upper gastrointestinal bleeding, stress ulceration, pre-terminal event, Disseminated Intravascular Coagulopathy (DIC)
Undigested milk/food Gastric outlet obstruction
Associated diarrhoea Gastro-enteritis
Projectile vomiting Raised gastrointestinal obstruction
Abdominal distension, decreased bowel sounds Ileus (a temporary lack of the normal muscle contractions of the intestines), electrolyte disturbances
Tender right upper quadrant, jaundice Hepatitis
Guarding and rebound tenderness Appendicitis, pancreatitis
Oliguria (low urine output), oedema  Renal failure
Chemotherapy, radiotherapy Toxicity, radiation enteritis
Bulging fontanelles, blurred disc margins, hypertension, bradycardia Raised intracranial pressure, hydrocephalus, space occupying lesion
Photophobia, meningism (neck stiffness) Meningitis
Smell of ketones, coma Diabetic ketoacidosis or other metabolic disorders
Associated headaches, blurred vision Migraines