Vomiting (Paediatric) Flashcards
Sequence of events
Open question
Timeline
Symptom Analysis
Appearance- blood bile milky
Projection- does it hit wall, or is it just regurgitation
Timing- any particular time, relation to feeds, how do they feel afterwards, hungry for more food?
Exacerbating factors- does anything bring vomiting on, is it worse when child lies down or sits up, does anything help
Systems review
GIT- stools, tummy ache urine- smell, pain, blood Scales- growing normal, gaining or losing weight Traffic light Feeding history (eg. how much do you give them- overfeeding can be a cause of vomiting) Pregnancy and birth history Developmental history Immunisation history
Patients perspective
Feelings and effect on life
ICE
Background
PMH
DH
FH (coeliac and IBD)
SH- who is at home, how are things at school, anyone at school had similar symptoms
GORD
Common in first year of life
Related to feeds, relieved by sitting up
Child can be distressed after feeding
Pyloric stenosis
2-7 weeks
projectile vomiting after feed, child still hungry
Intussusception
5-10 months
Colicky abdominal pain every 10-20 minutes, child draws knees up and inconsolable crying
Redcurrant jelly stools
Coeliac disease
9 months-3 years (after weaning)
Meningitis
Vomiting- wont take feeds Fever irritable lethargic Non blanching purpuric rash cold extremities signs of increased ICP (eg. bulging fontanelle)
Gastroenteritis
D and V
fever irritable and unwell
history of recent travel
someone in family/school may have had similar symptoms
NB- hand hygiene, maintain fluids, oral rehydration solution (after each watery motion)
Investigations
NB- if satisfied it is GORD/gastroenteritis, may not need further tests (after physical exam and obs)
Bedside- observations, physical exam
Bloods- UE, coeliac antibodies, blood cultures (meningitis) , lactate
Specialist- USS abdomen, lumbar puncture (meningitis)
