Nausea in a baby

With such a symptom as nausea in a child, pediatricians and pediatric gastroenterologists encounter constantly, and this unpleasant sensation in the epigastric region (as a rule, presaging vomiting) in most cases is combined with other symptoms.

Causes of the baby nausea

As in adults, nausea in children can have toxic and infectious causes, can be caused by disorders of the gastrointestinal tract, central nervous system or mental health problems, as well as have iatrogenic origin, that is, associated with the administration of certain drugs.

Thus, nausea in acute respiratory viruses in children is the result of general intoxication of the body, in the clinical picture of which - along with headache, decreased appetite, nausea and muscle weakness - there are also respiratory symptoms in the form of runny nose and sore throat. [1] With respiratory viruses, the first thing that occurs is fever: hyperthermia, vomiting and diarrhea are initially manifested by rotavirus infection in children - rotavirus (Reovirida). [2]

Dyspepsia in infectious diseases [3] can also be caused by chickenpox (varicella zoster virus), the causative agent of which is the herpesvirus Varicella zoster virus. The body's immune system fights against it by activating T-cells and releasing cytokines, and their increased release into the systemic bloodstream is accompanied by the so-called cytokine release syndrome, among the many symptoms of which nausea is also observed. [4]

Bronchitis of viral or bacterial origin can also cause a similar reaction. However, you should be aware of the fact that some cough medicines - mucolytic agents (e.g. Bromhexine, Ambroxol, Milistan, Fluditec syrup for children with carbocysteine, etc.) may cause nausea as a side effect.

Nausea and diarrhea in a child can be symptoms:

• acute gastrointestinal diseases in children, including enterotoxigenic escherichiosis (intestinal lesions caused by bacteria of the genus Escherichia) or salmonellosis (caused by Salmonella enteritidis bacteria); [5]
• intestinal parasitoses (ascariasis, giardiasis, etc.); [6]
• catarrhal gastritis with increased acidity of gastric juice.

If a child has stomach pain and nausea, gastroenterologists may suspect gallbladder inflammation (cholecystitis) and biliary dyskinesia, dyspepsia or lazy bowel syndrome, and liver disease.

Epigastric pain of varying intensity with possible nausea may be caused by:

• functional gastric disorder in children;
• Gastric motility disorder - gastroparesis;
• duodenogastric reflux;
• inflammation of the pancreas - chronic pancreatitis in children.

Severe nausea in a child and repeated vomiting, which manifests food poisoning, in most cases is due to bacterial intoxication - the effect of toxins that are formed in food products as a result of the vital activity of bacteria (streptoi staphylococci, enterococci, clostridia, etc.). [7]

The combination of symptoms such as fever and nausea in a child, with complaints of lack of appetite and weight loss, as well as weakness and increased thirst, should cause the local pediatrician or family doctor to refer the patient to an endocrinologist, because this is how it can manifest itself hyperparathyroidism in children. [8]

But nausea in a child without fever may be a consequence of intolerance to any food products - food allergies in children. In the same cases appears on the skin urticaria - rash and nausea in a child of younger age groups, as well as runny nose and nausea. [9]

Nausea, vomiting and fever in a child may have nothing to do with gastrointestinal problems, but may be symptoms of inflammation of the brain membranes - meningitis, [10] particularly enterovirus. And in intestinal infections in children these symptoms are necessarily joined by diarrhea. [11]

Nausea and weakness in a child can be associated not only with infection with Giardia lamblia protozoa (which settle and multiply rapidly in the duodenum) - giardiasis in children, [12] but also with an autoimmune hematologic disease of a chronic nature such as Werlhoff's disease. [13]

Increased intracranial pressure, migraine, meningitis and encephalitis, and brain tumors cause headache and nausea in a child.

Nausea and dizziness in the child are characteristic of the clinical picture:

• Labyrinthitis (inflammation of the inner ear); [14]
• vertebral-basilar insufficiency; [15]
• vestibulo-atactic syndrome, risk factors for the development of which in children include birth trauma, traumatic brain injury, hydrocephalus, cerebrovascular disease, brain tumors, and complications of infectious diseases.

By the way, nausea in concussion in a child is part of the post-commotion syndrome, the symptoms of which are also headaches, sleep disorders, blurred vision, tinnitus, lethargy, memory and concentration problems. All of these are due to disturbances in signal transmission in the brain and regulation of the autonomic nervous system. [16]

If nausea after a meal in a child is not due to a simple nutritional error (for example, the child ate expired yogurt for breakfast) or overeating, then do not ignore the possibility of gastritis-induced postprandial gastric antral motility disorder, as well as increased BP or renal failure.

Nausea in a car in a child - motion sickness syndrome - can be explained by the fact that the sensitivity of the receptors of the vestibular apparatus, which respond to linear and angular accelerations, is increased in many children. There are many nerve connections between the vestibular system, the vomiting center, and the trigger zone of the medulla oblongata, and motion sickness (with nausea, vomiting, pallor, and sweating) when traveling is considered a physiological response to the mismatch between vestibular and visual information about the moving environment.

When nausea in a child without vomiting occurs without any obvious cause, neurologic or nervous nausea in a child may be defined as due to stress, anxiety, depression, or neurologic disorders. Anxiety and stress can increase the activity of the autonomic nervous system. In addition, psychogenic nausea in a child of adolescence appears in panic attacks and panic disorder. [17]

If there is often nausea in the morning in the child, its possible causes may be a feeling of hunger, dehydration, fluctuations in blood glucose levels, reflux of stomach and duodenal contents into the esophagus, associated with gastroparesis slow digestion, psycho-emotional state (when something in the upcoming day causes anxiety or fear in the child).

Possible reasons for a child complaining of persistent nausea (often with gagging), half of which occurs in the morning hours, may include migraines (often present in the family history), postural tachycardia syndrome, which may develop after infectious diseases, and the cyclic vomiting syndrome, risk factors for which include allergies to certain foods, fatigue, lack of sleep and hyperexcitability. cyclic vomiting syndrome, risk factors for the development of which include allergies, intolerance to certain foods, fatigue, lack of sleep and hyperexcitability.

So-called functional nausea in a child, which is not a manifestation of a recognizable underlying intestinal or extraintestinal disease, has recently been added to the pediatric list of gut-brain interaction disorders as functional gastrointestinal disorder or "gut-brain axis dysfunction": neural connections to many brain structures play an important integrative role in the functioning of the digestive system and GI tract. In domestic gastroenterology, this widespread condition is called functional dyspepsia in children.

A better understanding of its etiology is helped by a biopsychosocial model of the disease - psychosomatics of nausea in children, which is based on the complex interaction of genetic, physiological, psychological, emotional and environmental factors.

Pathogenesis

The pathophysiology of nausea and vomiting is related to the peripheral enteric (gastrointestinal) nervous system and is due to complex physiologic and neurobiologic mechanisms.

In the interaction between the brain and visceral organs, the leading role is played by vagus nerve (nervus vagus), which provides parasympathetic innervation of most abdominal organs and is responsible for contraction of the stomach and esophagus, relaxation of the lower esophageal sphincter, and motor control of retrograde peristalsis. Therefore, as in adults, the vagus nerve and nausea in children are inextricably linked by the autonomic nervous system and the CNS. [18]

Both vagus nerves (right and left), passing along the surface of the esophagus into the abdominal cavity, are located on the anterior and posterior walls of the stomach. Afferent (sensory) fibers of the nervus vagus transmit signals from sensory (sensitive) neurons of the thoracic and abdominal organs to the CNS - to such brain structures as the area postrema (a postrema located at the bottom of the fourth ventricle of the medulla oblongata), which is the chemoreceptor trigger zone (CTZ) of vomiting, and the nuclei of a single or isolated tract - nucleus tractus solitarius (NTS).

The CTZ monitors neurotransmitters and hormones involved in the sensation of nausea and vomiting, including dopamine, serotonin, acetylcholine, cortisol, histamine, vasopressin, and neurokinin1. This area also has receptors for various types of toxins and chemicals, including those in medications that may be present in the bloodstream.

The NTS integrates afferent signals from the vagus nerve and CTZ and together with it and the dorsal motor nucleus of the vagus nerve of the medulla oblongata forms the so-called dorsal vagus complex of the parasympathetic nervous system, which provides primary control and regulation of visceral organs, including the digestive tract.

The mechanism of nausea lies in the response of the enteric peripheral nervous system to the signals of afferent branches of the vagus nerve, after receiving and "processing" which its efferent fibers transmit from the brain structures a complex nerve impulse to the motor neurons of the corresponding parts of the GI tract. And nausea begins when motoneurons activate smooth muscles of the walls of the stomach and intestine, that is, increase myoelectric activity with the development of gastric arrhythmia (tachygastria) in the form of retrograde contractions of smooth muscle fibers, which are accompanied by increased saliva secretion, constriction of blood vessels of the skin and increased heart rate. [19], [20]

Diagnostics of the baby nausea

If a child has nausea, it is important to determine its underlying cause. An obligatory and very important stage of diagnosis in complaints of nausea in children is a detailed history and physical examination.

The same mandatory (except for nausea in acute respiratory viral infections) are the following tests: general and biochemical blood tests; blood tests for eosinophils and antibodies to intestinal helminths, glucose levels, creatinine and alkaline phosphatase, pancreatic enzymes and electrolytes; general urinalysis, coprogram (including analysis for helminth eggs); analysis of cerebrospinal fluid (in the presence of meningeal signs).

To establish the etiology of this symptom, instrumental diagnostics is used, in particular, chest X-ray, abdominal ultrasound, brain tomography, etc.

Note that depending on the results of the physical examination and laboratory tests, additional evaluation by subspecialists may be required.

Given the range of possible causes of nausea in children, the most important task is differential diagnosis, which helps to exclude not directly related to the GI etiology of this symptom.

Read also:

• Diagnosis of acute gastrointestinal diseases
• Diagnosis of functional dyspepsia in children
• Diagnosis of irritable bowel syndrome

Treatment of the baby nausea

Since nausea is a symptom, treatment depends on the underlying cause. What to do for nausea? What to give a child for nausea?

The appointment of this or that medicine from nausea for children is dictated by the established diagnosis with mandatory consideration of the age of the child.

D2 and 5-NT3receptor (dopamine and serotonin) antagonist, symptomatic antiemetic Metoclopramide or Cerucal for nausea in children - due to the high probability of side effects from the nervous and cardiovascular systems - can only be used to prevent nausea and vomiting after chemotherapy: in such cases, nausea shots are given at the end of the procedure (for five days). But for adults, there is no such limitation, and this drug in tablet form is prescribed to get rid of nausea and vomiting in many conditions, including migraine.

Related to D2-receptor antagonists prokinetic Domperidone from nausea in children is prescribed to eliminate symptoms of functional dyspepsia: 5 mg three times a day (half an hour before meals) - for children 5-11 years old, 10 mg - from 12 years old. This medicine (its other trade names are Motilium, Motilac, Motorix, Domrid) is not used in children under 5 years of age.

Syrup from nausea for children Motinorm as the main active ingredient also contains domperidone, but according to the instructions, it is allowed to use it in children from one year of age: 0.25 mg (ml) for each kilogram of body weight, up to three times during the day.

What other pills for nausea for children, more in the publication -Pills for nausea

In cases of nausea caused by motion sickness in transport, as well as in cases of morning sickness and labyrinthitis in children over 6 years of age, the H1-antihistamines Cyclizine hydrochoride (Medazine) and Meclosine (Bonine) may be used. The dosage for children 6-12 years of age is 25 mg (orally), not more than three times a day; for children over 12 years of age, 50 mg. In case of motion sickness, the tablet should be taken one hour before the forthcoming trip.

For more information, see:

• Motion sickness pills
• Pills for motion sickness and nausea.

In addition, there are:

• lollipops for nausea in children with motion sickness - Vitaton (with mint and ginger);
• nausea patch for children (over 10 years of age) - Scopoderm, which is applied to the skin in the behind-the-ear area five hours before the planned trip;
• Vomex (Vomex) with dimenhydrinate (an antihistamine) for nausea and vomiting in children;
• drops from nausea for children - simple mint (tincture of peppermint), Imbifem, Imbizan, Vertichochel (homeopathic).

Trimebutin or Trimedat for nausea in a child does not have a therapeutic effect directly on this symptom, but this myotropic antispasmodic can be prescribed to children over three years of age for dyspeptic disorders due to impaired motility of the GI tract - with epigastric pain and intestinal spasms. The single dose for children 3-5 years old is 25 mg, for children 5-12 years old - 50 mg; the drug is taken three times a day. In addition to allergic reactions, dizziness and headache, the list of possible side effects of this drug includes nausea, diarrhea or constipation.

The most representative example of pathogenetic treatment of nausea in poisoning is intracorporeal detoxification therapy with the use of intestinal adsorbents such as: activated charcoal (Carbolong, Ultrasorb), Smecta, Polysorb, Enterosgel and others.

Pathogenetic therapy can be attributed to the protection of the body from acid-base imbalance and dehydration - loss of water and electrolytes in vomiting and diarrhea, so to replenish it is recommended to use Regidron for nausea in a child in cases of vomiting and diarrhea in poisoning, acute gastrointestinal diseases or rotavirus infection.

In digestive disorders and dyspepsia associated with insufficient production of pancreatic enzymes, resort to enzyme replacement therapy with the use of enzyme preparations, including Pancreatin (Creon), Pancreasim, Panzinorm, Mezyme, etc., are used.

Folk remedies for nausea to a child - decoctions and water infusions of chamomile pharmacy, peppermint, melissa medicinal, basil fragrant, ginger root.

Nutrition and diet for nausea in a child require special attention, see more..:

• Diet for rotavirus infection
• Diet for poisoning
• Diet for intestinal infection

Also useful information on the topic in the materials:

• Treatment of food toxic infections
• Treatment of functional dyspepsia in children