And What To Do About It In Malaysia
Many different things can cause children to vomit. Things such as any forms of infections, intestinal blockage or even pain.
The most common cause of vomiting is usually due to a viral infection (tummy bug) and often this is accompanied by diarrhea.
Most children may have these symptoms for a couple of days but as long as they can drink and keep their fluids down and stay hydrated, they can usually be safely managed at home.
Infection is one of the most common causes of vomiting but it is CRITICAL that that you take your child to the local hospital Emergency Room (ER) if they are presenting any of the following symptoms:
Vomiting With Diarrhea
Cough And Persistently Vomiting
If your child presents ANY of the symptoms above it is critical you take them to your local hospital ER (Emergency Room) without delay.
Do NOT wait to schedule an appointment.
There are some rare occasions when your child vomits due to pain. He or she may have been injured from a fall and there may have been a significant injury, best seen by a doctor to rule out a bone fracture or any other soft tissue injury. Any child who vomits after a head injury needs to be assessed by a doctor.
When your boy has pain in his testis and is vomiting, you should take him to a child surgeon urgently, as he may have a twisted testis. There is risk of him losing his testis.
Type of vomit – non bilious (mostly milk feeds or mucus)
Hypertrophic Pyloric Stenosis
An Infant child (under 3 months old) who has projectile, forceful vomiting with every feed (large volumes), your child might have an obstruction to the stomach outlet (pyloric stenosis). With time your baby may become more dehydrated as none of the milk feed is kept down. You will have to take your child to see paediatrician at a hospital to assess. This is the only condition of bowel obstruction where the vomit does not contain bile.
Type of vomit – bilious (yellow or green)
Bile vomiting is usually indicative of an obstruction to the intestine therefore any child with bile vomiting should be taken to the hospital as soon as possible to be examined, ideally by a child surgeon.
These are blockages anywhere along the gastrointestinal tract from the oesophagus to the anus as the intestine is not in continuity. The child is born with this abnormality. Atresias of the intestine presents soon after birth with bile vomiting and if its further down stream, for example in the colon, there will be associated tummy distention. Surgery is the only option to repair the problem.
Malrotation happens when the intestine is not “arranged” in its rightful position and this predisposes it to twist (volvulus) on its own blood supply. When this happens it causes intestinal obstruction and more seriously it cuts off the blood supply to that part of the intestine. The intestine can die as a result. A child with green vomit and tummy pain needs to be urgently taken to hospital, preferably where there is a child surgeon. Other symptoms include blood in the poo.
This condition is identified at birth and can happen to both boys and girls. In some there is no visible opening for faeces to come through (usually in boys), in some others, the opening is tiny and slightly forward (towards the genitalia). The child will have difficulties opening bowels and hence the tummy will get distended if carried on feeding. A Child surgeon will decide if they can help to improve the faeces to come out till a definitive surgery is done or to perform a temporary stoma where the poo is diverted into a bag on the tummy.
In Hirschprungs disease, there is absence of nerve cells towards the bottom end of the bowel. The length of effected bowel can be variable but mostly no longer than 10 to 20 centimeters, from the rectum. The absence of nerve means that the effected segment of intestine does not relax and hence clamp shut. There is build up of pressure of faeces and gas upstream and these babies cannot open their bowels. Their tummies become distended and they will have bilious vomiting. The vast majority of children with Hirschprungs disease presents within the first month of life however some present within a year and very rarely beyond this period. Symptoms are infrequent opening of bowels with tummy distention and vomiting. Diagnosis is made by taking a small biopsy (sample) of the tissue from the rectum, which can be done in the child surgeon’s clinic.
These are a single finger like projections on the small bowel, which is present in 2% of the population. Only about 6% of all Meckels diverticulum will have symptoms. The inner lining of these may contain acid secreting cells and hence the acid can erode the adjacent lining of the small intestine causing bleeding. Other symptoms of intestinal obstruction are, due to inflammation or infection of the Meckels, or it can cause intussusception or obstruction when it is attached to the tummy wall inside and trap a loop of intestine (band obstruction)
The symptoms of these are tummy distention and pain, blood in the faeces or green vomit.
This condition happens when the intestine telescopes into an adjacent intestine usually the small intestine into the large. Occasionally as in Meckels diverticulum, the abnormal structure on the intestine can cause this to happen too. As the outer one is squeezing the intestine inside, this causes intermittent pain. The child often presents with pain, bloody jelly like poo, and bile vomiting.
The cause of bowel obstruction secondary to appendicitis, like in Meckels diverticulitis is the inflammation or even pus from a burst appendicitis causing the bowel movement (peristalsis) to stop. This is called paralytic ileus, secondary to inflammation or infection. With appendicitis, the predominant symptom would be tummy pain if it were severe enough to cause an ileus. The vomit here again is bile green. With tummy pain and all the symptoms suggesting appendicitis, its best to take your child to a hospital where there is a child surgeon doing keyhole surgery.
A tumour is any abnormal growth, which can be benign or cancerous. Any growth in the tummy can get large enough to push on the intestine and block it’s opening from the outside. A child with a tumour blocking the intestine will probably have a visible lump on the tummy. With a lump in the tummy and bile vomiting, the child needs to see a child surgeon immediately.
Dr Nada Sudhakaran is a consultant Paediatric Surgeon providing specialized children surgery and based in Kuala Lumpur Malaysia. He has extensive experience in reconstructive paediatric surgery, with a special interest in Minimally Invasive Surgery (keyhole surgery). He is on the specialist register to practice Paediatric Surgery in UK, Malaysia and Australia
MBBS University of Wales, UK, MRCS (Glasgow, UK), FRCS (Paediatric Surgery, Intercollegiate Board, UK), CCT Paediatric Surgery General Medical Council (UK), No: 4193546, FRACS Paediatric Surgery, Australia, No: 200030, National specialist Register Malaysia: No: 129809
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