What are the indications for additional evaluation when vomiting is the primary complaint in pediatric gastroesophageal reflux disease (GERD)?

Updated: Mar 14, 2019
  • Author: Steven M Schwarz, MD, FAAP, FACN, AGAF; Chief Editor: Carmen Cuffari, MD  more...
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Answer

Vomiting is a symptom associated with many disorders. Accordingly, gastroesophageal reflux cannot be assumed to be the primary problem in infants and children who present with a history of emesis. Warning signals that herald the requirement for additional evaluation include the following:

  • Bilious or forceful vomiting

  • Hematemesis or hematochezia

  • Vomiting with diarrhea

  • Abdominal tenderness or distention

  • Onset of vomiting after 6 months of life

  • Fever, lethargy, hepatosplenomegaly

  • Macrocephaly, microcephaly, seizures

The occurrence of any of these signs and symptoms indicates the need to consider a comprehensive metabolic, neurologic, and/or surgical evaluation, in addition to a gastroenterologic workup.


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