The vomiting child--what to do and when to consult.

BACKGROUND Vomiting is a common, nonspecific sign of a range of childhood illnesses. It may be acute or chronic and the general practitioner has a key role in identifying whether a child needs further investigation and management. OBJECTIVE This article outlines the main differential diagnoses, investigation and management of children presenting with acute and chronic vomiting. DISCUSSION Viral gastroenteritis is the most common cause of acute vomiting but should only be made after careful consideration of other causes. Management of hydration status in a child with a self limiting case of vomiting is vital. Regular review in the early phases of an undifferentiated vomiting illness will ensure that more fulminant illnesses are not overlooked and that secondary complications of dehydration do not arise. Chronic regurgitation and gastro-oesophageal reflux in infancy are common presentations that require considered management and may be a presenting symptom of food allergy. Other chronic presentations of nausea and vomiting in the older child may require referral for specialist assessment.