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, culture, or PCR testing 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), gastric emptying scan, or impedance probe 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 | Ultrasonography of the abdomen Sometimes insertion of air into the rectum (air enema) |
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
| 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, culture, or PCR testing 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, gastric emptying scan, or pH probe or impedance probe Sometimes endoscopy | |
Gastroparesis or delayed gastric emptying (the stomach empties slowly) | Feeling of fullness after eating only small amounts Sometimes a recent viral illness | 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 or MRI 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 or MRI 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 , iron, or alcohol | Various features depending on the substance Often a history of taking the substance | Blood tests to measure levels of the substance |
Alternating bouts of nausea and vomiting in frequent cannabis users | A doctor’s examination | |
* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. | ||
CT = computed tomography; GI = gastrointestinal; MRI = magnetic resonance imaging; PCR = polymerase chain reaction. | ||