Managing nausea and vomiting

Managing a child with nausea and vomiting

To manage nausea and vomiting correctly, an understanding of the physiology and the receptors involved in triggering the vomiting is essential. This is because different anti-emetic (anti-nausea) drugs work at different receptor sites. Aim to treat and correct any of the underlying causes or reversible factors such as pain, infection or constipation.

Non-pharmacological strategies for managing nausea and vomiting

Common strategies can include the following:

  • Explain and reassure the child and family about what the cause may be and how you will help manage it.

  • Offer small meals frequently and keep them bland and dry e.g. toast.

  • Avoid giving the child foods that may aggravate nausea and vomiting especially spicy, very sweet and fatty foods and remove any leftover food immediately.

  • Avoid exposing the child to strong odours as these can aggravate nausea. E.g., strong perfumes, deodorants and cooking smells.

  • Maintain hydration by giving frequent small amounts of liquid, including oral hydration solution if the child is already dehydrated. This may require cup and spoon or syringe feeding.

  • When an infant is feeding, try to avoid letting them drink too fast, as this may lead to them sucking in air which can cause more vomiting.

  • Position the child upright or use feed thickeners if gastro-oesophageal reflux disease is a concern.

  • Encourage the child to rinse out the mouth and brush teeth after vomiting.

  • Review the medication list for dosages or possible side effects that may be triggering nausea and vomiting.

  • Split medications dosages where possible if vomiting is associated with a certain medication.

  • Do what you can to address psychological issues like anxiety or fear through counselling, therapy and engaging in activities that are known to calm the child.

Pharmacological management of nausea and vomiting

Consider the most likely stimulus of nausea and vomiting as this will guide the choice of an anti-emetic. If the first choice of anti-emetic is only partially successful after 24 hours, increase the dose or use a different anti-emetic.

Commonly used anti-emetics are:

  • Prokinetics that work by stimulating contractions in the gastrointestinal tract e.g. domperidone or metoclopramide for conditions such as gastritis, gastric stasis and partial bowel obstruction.

  • Anti-emetics that work on the chemoreceptor trigger zone e.g. haloperidol or ondansetron. These are used for most of the chemical or metabolic causes of nausea and vomiting such as opioids, chemotherapy treatments, hypercalcaemia and renal failure.

  • Anti-emetics that work on the vomiting centre in the brain e.g. cyclizine for raised intracranial pressure and complete bowel obstruction.

  • Anti-emetics that have antispasmodic and anti-secretory effects e.g. hyoscine butylbromide for bowel colic or the need to reduce gastrointestinal secretions.

Choosing the best anti-emetic based on causes of vomiting

Causes of vomiting

1st Choice Anti-emetic

2nd Choice Anti-emetic

Metabolic Haloperidol Ondansetron
Drug-induced Haloperidol
Metoclopramide
Ondansetron
Radiotherapy, chemotherapy Ondansetron
Dexamethasone
Metoclopramide

Haloperidol

Raised intracranial pressure Cyclizine
Dexamethasone
Ondansetron
Bowel obstruction Cyclizine
Hyoscine Butylbromide
Dexamethasone
Ondansetron
Delayed Gastric Emptying Domperidone Metoclopramide