​Symptoms and Signs - Differential Diagnosis of Emesis at  Pediatric Age
INFANCY
Gastrointestinal Tract
• Congenital
• Regurgitation: chalasia, gastroesophageal reflux
• Atresia: stenosis (tracheoesophageal fistula, prepyloric diaphragm, intestinal atresia)
• Duplication
• Volvulus (errors in rotation and fixation, Meckel’s
diverticulum)
• Congenital bands
• Hirschsprung’s disease
• Meconium ileus (cystic fibrosis [CF]), meconium plug
• Acquired
• Acute infectious gastroenteritis, food poisoning
(staphylococcal, clostridial)
• Pyloric stenosis
• Gastritis, duodenitis
• Intussusception
• Incarcerated hernia: inguinal, internal secondary to old adhesions
• Cow’s milk protein intolerance, food allergy, eosinophilic gastroenteritis
• Disaccharidase deficiency
• Celiac disease: presents after introduction of gluten in diet; inherited risk
• Adynamic ileus: the mediator for many nongastrointestinal causes
• Neonatal necrotizing enterocolitis
• Chronic granulomatous disease with gastric outlet obstruction Non–Gastrointestinal Tract
• Infectious: otitis, urinary tract infection (UTI), pneumonia, upper respiratory tract infection, sepsis, meningitis
• Metabolic: aminoaciduria and organic aciduria, galactosemia, fructosemia, adrenogenital syndrome, renal tubular acidosis, diabetic ketoacidosis, Reye’s syndrome
• CNS: trauma, tumor, infection, diencephalic syndrome, rumination, autonomic responses (pain, shock)
• Medications: anticholinergics, aspirin, alcohol, idiosyncratic reaction (e.g., codeine)
CHILDHOOD
Gastrointestinal Tract
• Peptic ulcer: vomiting is a common presentation in children younger than 6 years.
• Trauma: duodenal hematoma, traumatic pancreatitis, perforated bowel
• Pancreatitis: mumps, trauma, CF, hyperparathyroidism, hyperlipidemia, organic acidemias
• Crohn’s disease
• Idiopathic intestinal pseudo-obstruction
• Superior mesenteric artery syndrome
Non–Gastrointestinal Tract
• CNS: cyclic vomiting, migraine, anorexia nervosa, bulimia