ABSTRACT

Vomiting is a very common symptom in childhood. The causes are numerous but a good history and examination will often give an indication as to the underlying problem. The differential diagnosis will depend on the age of the child and the presence or absence of associated symptoms (e.g. fever, diarrhoea, headache). Posseting is the regurgitation of small amounts of milk in an otherwise well and thriving infant. Effortless regurgitation of larger volumes of milk may occur with gastro-oesophageal reflux. Bile-stained vomiting suggests an obstruction distal to the duodenum, although an older child who has vomited several times may then vomit bile in the absence of an intestinal obstruction. In an older child, vomiting first thing in the morning, particularly if associated with headache, is very worrying and raises the possibility of raised intracranial pressure.