Recurrent vomiting in children

　　1. Etiology

　　Children with recurrent episodes of vomiting often last for several years. There may be a family history, with siblings suffering from the same disease, which may be related to体质 factors. Overeating, excessive fat intake, constipation, upper respiratory tract infection, hunger, intense physical activity, fatigue, or emotional stress are common triggers. Especially before adolescence, girls often become ill due to anxiety or emotional fluctuations.

　　2. Pathogenesis

　　Vomiting is a complex reflex action. The vomiting center is located in the medulla oblongata, adjacent to the vagus nerve nucleus and respiratory center. The activity of the vomiting center is controlled by the cerebral cortex. The vomiting center receives impulses from the abdominal viscera via the vagus nerve and splanchnic nerve, as well as impulses from cranial nerves such as the glossopharyngeal, visual, olfactory, and vestibular nerves. It also receives impulses from the chemical sensory area at the bottom of the fourth ventricle. The impulses from the vomiting center are transmitted through the efferent pathways, namely the efferent nerves of the splanchnic nerve, spinal nerve, cranial nerve, and vagus nerve, which respectively reach the esophagus, stomach, diaphragm, abdominal muscles, intercostal muscles, and pharynx, palate, epiglottis, and other places. Through a series of complex and coordinated neuromuscular activities, vomiting is induced. Nausea, drooling, and dry heaves often occur before vomiting, that is, the diaphragm contracts strongly and descends, the mouth and glottis close, the pylorus contracts, the fundus of the stomach relaxes, the abdominal muscles contract more strongly, the esophagus opens upwards and opens, forcing the contents of the stomach to be expelled. Vomiting during gastrointestinal and extraintestinal infections is due to the reflex vomiting caused by inflammation stimulating the gastric and intestinal mucosa. Vomiting during gastrointestinal obstruction is due to the downward movement of esophageal, gastric, or intestinal contents being blocked, accumulating at the upper end of the obstruction due to retrograde peristalsis. Vomiting caused by intracranial lesions and intracranial hypertension is due to the vomiting center being directly stimulated by the lesion or pressure, causing central vomiting, or due to the stimulation of the cerebrospinal membrane causing reflex vomiting. Medications can also stimulate the medullary chemical sensory area and cause vomiting.

　　Due to the loss of a large amount of body fluid and electrolytes, and the excessive loss of acidic substances, metabolic alkalosis may occur, and the child may have clinical manifestations such as limb numbness. After the loss of electrolytes, hypokalemia may occur, which can inhibit myocardial tissue, causing a slow heartbeat or even cardiac arrest. At the same time, due to the loss of a large amount of fluid, dehydration and hypovolemic shock may occur.

　　Recurrent vomiting may occur several times a day to ten times a day, lasting for about 1-5 days, occasionally extending to one week, and then spontaneously recovering. It may occur several times within a year, with no discomfort between attacks. Vomiting is usually very severe, and food or water intake is completely vomited. Sometimes, blood or bile may be present in the vomit. Severe cases may vomit a large amount of coffee-like substance, often accompanied by thirst, headache, or abdominal pain. Those who vomit heavily may quickly become weak all over the body, spirits萎靡, some may become drowsy after vomiting, repeatedly vomit, and cannot eat, which may lead to dehydration and acid-base imbalance. The child's blood and urine ketone bodies increase, blood glucose decreases, blood chloride decreases, and those who vomit heavily are prone to hypokalemia.

　　1. Strengthen physical fitness and improve immunity: Pay attention to the combination of work and rest, participate in physical exercise more often, and eat more fresh fruits and vegetables rich in vitamins. Prevent eating too much greasy food.

　　2. Prevent factors that may induce vomiting.

　　3. Prevent upper respiratory tract infection, hunger, constipation.

　　4. Prevent overfatigue, intense physical activity, prevent anxiety and emotional fluctuations, etc.

　　5. Regular physical examination to achieve early detection, early diagnosis, and early treatment.

　　6. Good follow-up, prevent the deterioration of the disease.

　　Recurrent vomiting can cause water and electrolyte imbalance. According to the condition, serum sodium, chloride, potassium, blood pH value, blood urea nitrogen, blood glucose, urine ketone bodies, and other tests are performed; when suspected of intracranial diseases, cerebrospinal fluid routine examination is performed, and when necessary, the examination of vomitus and toxicological analysis is performed.

　　Abdominal X-ray透视或flat film, gastrointestinal barium meal透视或photography, endoscopic examination, etc., are helpful to understand gastrointestinal obstruction, abdominal inflammation, or congenital gastrointestinal malformation. When suspected of intracranial hemorrhage or intracranial space-occupying lesions, brain ultrasonography, cerebrovascular angiography, computed tomography of the brain, and magnetic resonance imaging can be performed.

　　Diet should be light and healthy, pay attention to hygiene, and rationally match the diet. Prevent overeating of greasy foods, prevent factors that may induce vomiting, prevent upper respiratory tract infection, hunger, constipation, and also prevent overfatigue, intense physical activity, and prevent anxiety and emotional fluctuations.

　　I. Treatment

　　Firstly, the cause should be sought and treatment for the removal of the cause should be carried out.

　　1. Diet

　　For stubborn vomiting, fasting for 4-8 hours at the beginning of treatment is recommended, during which small amounts of cool sugar water should be given multiple times. Gradually return to normal diet after vomiting is controlled.

　　2. Infusion

　　Most of these children have acidosis, ketonemia, ketonuria, and hypoglycemia. Glucose and alkaline solutions should be administered to correct hypoglycemia and eliminate ketonemia. Generally, the infusion volume is 30-50ml/kg, and 4:3:2 solution or 1:1 alkaline solution (i.e., 100ml of 10% glucose, 100ml of 0.9% sodium chloride, and 10ml of 5% sodium bicarbonate) can be used. Potassium should be added appropriately after urination. In case of severe dehydration and electrolyte imbalance, correction should be made according to the results of blood biochemical tests.

　　3. Medication

　　(1) Domperidone (Motilium): 0.3mg/kg each time, 3 times a day, taken orally 15-30 minutes before meals. For those who cannot take oral medication, suppositories can be used, with 10mg per suppository for infants, 30mg per suppository for children, and 60mg per suppository for adults, which can be used 2-4 times a day.

　　(2) Anisodamine (654-2): Can relax spasm, relieve pain, and stop vomiting, 1mg/kg each time, taken orally or by intramuscular injection, 3-4 times a day.

　　(3) Chlorpromazine: For severely ill children, intramuscular injection of chlorpromazine (usually compound chlorpromazine) 0.5-1mg/kg can have a calming and antiemetic effect. It can be used 2-3 times a day depending on the situation.

　　4. Acupuncture and Moxibustion Therapy

　　Common acupoints: Zhongwan, Tianshu, Neiguan, Zusanli, etc. Young children can use moxibustion, and older children can be treated with needles or moxibustion.

　　II. Prognosis

　　The prognosis is generally good, most of them recover in adolescence, and some may leave behind migraines.