symptoms in infants and children
children s health issues
Vomiting in Infants and Children
For doctors, the first goal is to determine whether children are dehydrated and whether the vomiting is caused by a life-threatening disorder. The following symptoms and characteristics are cause for concern: Lethargy and listlessness In infants, inconsolability or irritability and bulging of the soft spots (fontanelles) between the skull bones In older children, a severe headache, stiff neck that makes lowering the chin to the chest difficult, sensitivity to light, and fever Abdominal pain, swelling, or both Persistent vomiting in infants who have not been growing or developing as expected Bloody stools Bright green or bloody vomit Children with warning signs should be immediately evaluated by a doctor, as should all newborns; children whose vomit is bloody, resembles coffee grounds, or is bright green; and children with a recent (within a week) head injury. If children appear uncomfortable even when not vomiting and their discomfort lasts more than a few hours, they should probably be evaluated by a doctor. For other children, signs of dehydration, particularly decreased urination, and the amount they are drinking help determine how quickly they need to be seen. The urgency varies somewhat by age because infants and young children can become dehydrated more quickly than older children. Generally, infants and young children who have not urinated for more than 8 hours or who have been unwilling to drink for more than 8 hours should be seen by a doctor. The doctor should be called if children have more than 6 to 8 episodes of vomiting, if the vomiting continues more than 24 to 48 hours, or if other symptoms (such as cough, fever, or rash) are present. Children who have had only a few episodes of vomiting (with or without diarrhea), who are drinking at least some fluids, and who otherwise do not appear very ill rarely require a doctor’s visit. Doctors first ask questions about the child's symptoms and medical history. Doctors then do a physical examination. A description of the child's symptoms and a thorough examination usually enable doctors to identify the cause of vomiting (see table). Doctors ask When the vomiting started How often it occurs What the vomit looks like (including its color) Whether it is forceful (projectile) How much is vomited Determining whether there is a pattern—occurring at certain times of the day or after eating certain foods—can help doctors identify possible causes. Information about other symptoms (such as fever and abdominal pain), bowel movements (frequency and consistency), and urination can also help doctors identify a cause. Doctors also ask about recent travel, injuries, and, for sexually active adolescent girls, use of birth control. A physical examination is done to check for clues to possible causes. Doctors note whether children are growing and developing as expected. Doctors choose tests based on suspected causes suggested by results of the examination. Most children do not require testing. However, if abnormalities in the abdomen are suspected, imaging tests are typically done. If a hereditary metabolic disorder is suspected, blood tests specific for that disorder are done. If dehydration is suspected, blood tests to measure electrolytes (minerals necessary to maintain fluid balance in the body) are sometimes done. 