Vomiting in Children - An ED Approach.

Which of the following is a surgical emergency in a vomiting child?

• Bilious (green) vomiting

• Non-bilious vomiting with diarrhoea

• Vomiting after eating dairy/gluten

• Vomiting that resolves with ondansetron

What is the most likely cause of projectile vomiting in a 6-week-old male?

• Gastroenteritis

• Appendicitis

• Pyloric Stenosis

• Diabetic Ketoacidosis

Answer explanation

🔹 Neonates (<1 month)
– Pyloric stenosis
– Sepsis
– Malrotation/volvulus (bilious vomiting!)
– Inborn errors of metabolism

🔹 Infants (1 month – 1 year)
– Gastroenteritis
– Milk protein allergy
– Intussusception
– UTI

🔹 Children (>1 year)
– Gastroenteritis
– Appendicitis
– DKA
– Migraine
– Raised ICP

True or False: Vomiting without diarrhoea is reassuring?

• TRUE

• FALSE

Which of the following is NOT a red flag for vomiting in children?

• Watery diarrhoea with vomiting

• Bilious vomiting

• Vomiting with altered consciousness

• Projectile vomiting in an infant

Answer explanation

What is the first-line treatment for mild dehydration in gastroenteritis?

• Intravenous Fluids

• Ondansetron

• Nil by mouth

• Oral rehydration solution (ORS)

Answer explanation

Which investigation is MOST appropriate for suspected intussusception?

• CT Abdomen

• Abdomen Ultrasound

• Contrast / Gas Enema

• Stool MCS

Answer explanation

A 4-year-old has green vomit, abdominal distension, and lethargy. What should you do FIRST?

• Start IV fluids and escalate to surgery

• Give oral ondansetron and observe

• Trial of Fluids. Likely Discharge

• Paracetamol / Supportive Cares and observe

Which statement about ondansetron in kids is TRUE?

• It cures the underlying cause

• It helps reduce vomiting and admissions

• It should be avoided in gastroenteritis

• It replaces the need for rehydration

Which of the following is an example of functional vomiting?

• Vomiting due to intussusception

• Bilious vomiting in neonate

• Vomiting with fever and lethargy

• Cyclical vomiting syndrome

Acute infectious gastroenteritis in children is most commonly caused by:

• Viruses

• Bacteria

• Parasite

• Fungi