Abstract
Purpose of Review
Nausea is a common symptom in children for a variety of reasons ranging from intestinal, extraintestinal, and functional. Defining it is challenging as some children may not be able to verbalize the symptoms and it is often associated with functional gastrointestinal disorders (FGIDs). The burden of nausea amongst children has been demonstrated by its association with anxiety, depression, and impaired school performance. This review will discuss the pathophysiology of childhood nausea along with established and new treatment options.
Recent Findings
By exploring the biopsychosocial model, namely the interplay between peripheral chemoreceptors, central neuronal pathways, and the environment, we can improve diagnosis and management. The diagnosis of nausea is mainly clinical and it is important to identify alarm symptoms, such as weight loss, bilious emesis, and neurologic symptoms, that would prompt further evaluation. There are numerous causes of nausea to consider, including both intestinal and extraintestinal pathologies. A detailed history and physical exam frequently help to narrow the diagnosis. The treatment options for nausea are expanding and include pharmacologic and non-pharmacologic therapies, but further research is imperative.
Summary
This review focuses on the current treatment opinions in the management of pediatric nausea based on the biopsychosocial model and focuses on newer therapies and includes non-pharmacological approaches to childhood nausea.
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References and Recommended Reading
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Hasler WL, Chey WD. Nausea and vomiting. Gastroenterology. 2003;125(6):1860–7.
Saps M. High prevalence of nausea among school children in Latin America. J Pediatr. 2016;169:98–104.
Kovacic K, et al. High prevalence of nausea in children with pain-associated functional gastrointestinal disorders: are Rome criteria applicable? J Pediatr Gastroenterol Nutr. 2013;57(3):311–5.
Chitkara DK, Rawat DJ, Talley NJ. The epidemiology of childhood recurrent abdominal pain in Western countries: a systematic review. Am J Gastroenterol. 2005;100(8):1868–75.
Russell A, Sherman AL, Walker LS. 620 nausea complicating recurrent abdominal pain in childhood predicts functional GI disorders, disability, depression and anxiety in young adulthood: results of a prospective cohort study. Gastroenterology. 2015;148(4):S-122.
Hornby PJ. Central neurocircuitry associated with emesis. Am J Med. 2001;111 Suppl 8A(8):106S-112S.
Kovacic K, Di Lorenzo C. Functional nausea in children. J Pediatr Gastroenterol Nutr. 2016;62(3):365–71.
Kashyap P, Farrugia G. Diabetic gastroparesis: what we have learned and had to unlearn in the past 5 years. Gut. 2010;59(12):1716.
Pasricha PJ, et al. Characteristics of patients with chronic unexplained nausea and vomiting and normal gastric emptying. Clin Gastroenterol Hepatol. 2011;9(7):567-76.e1-4.
Chelimsky G, et al. Autonomic abnormalities in children with functional abdominal pain: coincidence or etiology? J Pediatr Gastroenterol Nutr. 2001;33(1):47–53.
Lacount L, et al. Dynamic cardiovagal response to motion sickness: a point-process heart rate variability study. Comput Cardiol. 2009;36:49–52.
Kim YY, et al. Characteristic changes in the physiological components of cybersickness. Psychophysiology. 2005;42(5):616–25.
Koppen IJN, et al. The pediatric Rome IV criteria: what’s new? Expert Rev Gastroenterol Hepatol. 2017;11(3):1–9.
Gershon MD. 5-Hydroxytryptamine (serotonin) in the gastrointestinal tract. Curr Opin Endocrinol Diabetes Obes. 2013;20(1):14–21.
Lummis SCR. 5-HT3 receptors*. J Biol Chem. 2012;287(48):40239–45.
Galligan JJ. Ligand-gated ion channels in the enteric nervous system. Neurogastroenterol Motil. 2002;14(6):611–23.
Loewen PS, Marra CA, Zed PJ. 5-HT3 receptor antagonistsvs traditional agents for the prophylaxis of postoperative nausea and vomiting. Can J Anesth. 2000;47(10):1008–18.
Niño-Serna LF, Acosta-Reyes J, Veroniki A-A, Florez ID. Antiemetics in children with acute gastroenteritis: a meta-analysis. Pediatrics. 2020;145(4). https://doi.org/10.1542/peds.2019-3260
Kovacic K, et al. Chronic idiopathic nausea of childhood. J Pediatr. 2014;164(5):1104–9.
Belkacemi L, Darmani NA. Dopamine receptors in emesis: molecular mechanisms and potential therapeutic function. Pharmacol Res. 2020;161:105124.
Sanger GJ, Broad J, Andrews PLR. The relationship between gastric motility and nausea: gastric prokinetic agents as treatments. Eur J Pharmacol. 2013;715(1–3):10–4.
Freedman SB, Fuchs S. Antiemetic therapy in pediatric emergency departments. Pediatr Emerg Care. 2004;20(9):625–33 (quiz 633-5).
Lau Moon Lin M, et al. The safety of metoclopramide in children: a systematic review and meta-analysis. Drug Saf. 2016;39(7):675–87.
Cristofori F, et al. Efficacy of the neurokinin-1 receptor antagonist aprepitant in children with cyclical vomiting syndrome. Aliment Pharmacol Ther. 2014;40(3):309–17.
Fahler J, Wall GC, Leman BI. Gastroparesis-associated refractory nausea treated with aprepitant. Ann Pharmacother. 2012;46(12):e38.
Gupta K, Walton R, Kataria SP. Chemotherapy-induced nausea and vomiting: pathogenesis, recommendations, and new trends. Cancer Treat Res Commun. 2021;26:100278.
Cangemi DJ, Kuo B. Practical perspectives in the treatment of nausea and vomiting. J Clin Gastroenterol. 2019;53(3):170–8. This article distinguishes between the pathophysiologies of acute and chronic nausea. It provides a comprehensive overview of the management of chronic nausea and vomiting, mainly in adults. There is a concise summary of the mechanisms, dosage, and side effects of current therapies used for nausea and vomiting.
• Arruda J, Yeh AM. Integrative approach to pediatric nausea. Pediatr Ann. 2019;48(6):e236–42. This article is one of few that outlines the emerging nonpharmacologic therapies for the management of pediatric nausea including mind-body modalities, botanicals and supplements, acupuncture, and aromatherapy. Each therapy is discussed along with a review of the study population, strength of evidence, side effects, and recommendations.
Kovacic K, Sood M, Venkatesan T. Cyclic vomiting syndrome in children and adults: what is new in 2018? Curr Gastroenterol Rep. 2018;20(10):46.
Viljoen E, et al. A systematic review and meta-analysis of the effect and safety of ginger in the treatment of pregnancy-associated nausea and vomiting. Nutr J. 2014;13(20):20.
Ernst E, Pittler MH. Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anaesth. 2000;84(3):367–71.
Bossi P, et al. A randomized, double-blind, placebo-controlled, multicenter study of a ginger extract in the management of chemotherapy-induced nausea and vomiting (CINV) in patients receiving high-dose cisplatin. Ann Oncol. 2017;28(10):2547–51.
Crichton M, et al. Efficacy of ginger (Zingiber officinale) in ameliorating chemotherapy-induced nausea and vomiting and chemotherapy-related outcomes: a systematic review update and meta-analysis. J Acad Nutr Diet. 2019;119(12):2055–68.
Kline RM, et al. Enteric-coated, pH-dependent peppermint oil capsules for the treatment of irritable bowel syndrome in children. J Pediatr. 2001;138(1):125–8.
Chumpitazi BP, Kearns GL, Shulman RJ. Review article: the physiological effects and safety of peppermint oil and its efficacy in irritable bowel syndrome and other functional disorders. Aliment Pharmacol Ther. 2018;47(6):738–52.
Mapp CP, et al. Peppermint oil: evaluating efficacy on nausea in patients receiving chemotherapy in the ambulatory setting. Clin J Oncol Nurs. 2020;24(2):160–4.
McParlin C, et al. Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: a systematic review. JAMA. 2016;316(13):1392–401.
von Arnim U, et al. STW 5, a phytopharmacon for patients with functional dyspepsia: results of a multicenter, placebo-controlled double-blind study. Am J Gastroenterol. 2007;102(6):1268–75.
Ottillinger B, et al. STW 5 (Iberogast®)—a safe and effective standard in the treatment of functional gastrointestinal disorders. Wiener Med Wochenschr (1946). 2013;163(3–4):65–72.
Morehead A, Salmon G. Efficacy of acupuncture/acupressure in the prevention and treatment of nausea and vomiting across multiple patient populations. Nurs Clin N Am. 2020;55:571–80.
Lee A, Chan SK, Fan LT. Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev. 2015;2016(11):CD003281.
Richardson J, et al. Hypnosis for nausea and vomiting in cancer chemotherapy: a systematic review of the research evidence. Eur J Cancer Care (Engl). 2007;16(5):402–12.
Haug TT, Mykletun A, Dahl AA. The prevalence of nausea in the community: psychological, social and somatic factors. Gen Hosp Psychiatry. 2002;24(2):81–6.
Palsson OS, Ballou S. Hypnosis and cognitive behavioral therapies for the management of gastrointestinal disorders. Curr Gastroenterol Rep. 2020;22(7):31.
Lembo A, et al. Relamorelin reduces vomiting frequency and severity and accelerates gastric emptying in adults with diabetic gastroparesis. Gastroenterology. 2016;151(1):87-96.e6.
Parkman HP, Carlson MR, Gonyer D. Metoclopramide nasal spray is effective in symptoms of gastroparesis in diabetics compared to conventional oral tablet. Neurogastroenterol Motil. 2014;26(4):521–8.
Teich S, et al. Efficacy of permanent gastric electrical stimulation for the treatment of gastroparesis and functional dyspepsia in children and adolescents. J Pediatr Surg. 2013;48(1):178–83.
Lu PL, Di Lorenzo C. Neurostimulation of the gastrointestinal tract in children: is it time to shock the gut? Curr Opin Pediatr. 2016;28(5):631–7.
Babygirija R, et al. Percutaneous electrical nerve field stimulation modulates central pain pathways and attenuates post-inflammatory visceral and somatic hyperalgesia in rats. Neuroscience. 2017;356:11–21.
• Krasaelap A, et al. Efficacy of auricular neurostimulation in adolescents with irritable bowel syndrome in a randomized, double-blind trial. Clin Gastroenterol Hepatol. 2020;18(9):1987-1994.e2. This randomized controlled trial assessed the impact of auricular neurostimulation on the severity of abdominal pain amongst patients with irritable bowel syndrome. The results demonstrated a significant improvement in abdominal pain severity among patients who received percutaneous electrical nerve field stimulation to the external ear as compared with those who received sham stimulation. This was a promising outcome for FGIDs, prompting a subsequent, pending trial in children with cyclic vomiting syndrome.
Kovacic K, et al. Neurostimulation for abdominal pain-related functional gastrointestinal disorders in adolescents: a randomised, double-blind, sham-controlled trial. Lancet Gastroenterol Hepatol. 2017;2(10):727–37.
Kovacic K. Efficacy of auricular neurostimulation for children and adults with cyclic vomiting syndrome: a pilot study. 2022. https://clinicaltrials.gov/ct2/show/NCT03434652.
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Liane Sadder declares that she has no conflict of interest. Rinarani Sanghavi declares that she has no conflict of interest.
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Sadder, L., Sanghavi, R. Pediatric Nausea—a Review of Current Management. Curr Treat Options Peds 8, 354–368 (2022). https://doi.org/10.1007/s40746-022-00254-x
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DOI: https://doi.org/10.1007/s40746-022-00254-x