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Differential diagnosis of vomiting and gastroesophageal reflux in infants and children

Differential diagnosis of vomiting and gastroesophageal reflux in infants and children
Gastrointestinal disorders
Obstruction
Intussusception* 
Hypertrophic pyloric stenosis* 
Foreign bodyΔ 
Hirschsprung disease 
Intestinal malrotation or volvulusΔ 
Duodenal or intestinal hematoma 
Esophageal, pyloric or intestinal stenosis, atresia, or web
Esophageal, gastric, or intestinal duplication
Gastric bezoar, volvulus, or tumor
Superior mesenteric artery syndrome
Intestinal pseudo-obstruction
Adhesions, including congenital adhesions
Incarcerated hernia
Tumors
Meconium ileus or equivalent
Imperforate anus
Other gastrointestinal disorders
Gastroesophageal reflux*
Gastritis, esophagitis*
Eosinophilic esophagitis/gastroenteritis 
Food intolerance or allergy* 
Gastroparesis (eg, postviral)
AppendicitisΔ
Cholecystitis, cholelithiasis 
Pancreatitis
Ulcerative colitis or Crohn disease 
Peptic ulcer 
Achalasia or chalasia
Tracheoesophageal fistula
Choledochal cyst
Genitourinary causes
Hydronephrosis
Urinary tract obstruction
Renal stones
Hydrometrocolpos
Testicular or ovarian torsion
Renal insufficiency
Toxic ingestions
Lead intoxication
Iron intoxication
Alcohol intoxication (ethanol or other toxic alcohol) 
Vitamin A or D intoxication
Organophosphate exposure
Medications (ipecac, digoxin, theophylline)
Cannabinoid hyperemesis syndrome (chronic cannabis use)
Infectious causes
Gastroenteritis*
Group A streptococcal infections* (including pharyngitis) 
Otitis media* 
Sepsis
Meningitis, encephalitis, or brain abscessΔ
Pneumonia
PyelonephritisΔ or other urinary tract infection
Hepatitis
Hepatic abscess
Endocrine and metabolic causes
Diabetic ketoacidosisΔ
Uremia (eg, from obstructive uropathy or renal insufficiency)
Renal tubular acidosis 
Hypercalcemia
Congenital adrenal hyperplasiaΔ
Diabetes insipidus
Inborn errors of metabolism, including: 
Disorders of carbohydrate intoleranceΔ (eg, galactosemia, hereditary fructose intolerance)
Amino acid and organic acid disordersΔ (eg, maple syrup urine disease)
Urea cycle defects
Fatty acid oxidation defects 
Mitochondrial disorders 
Neurologic causes
Migraine
Trauma (postconcussive)Δ
Increased intracranial pressure (eg, hydrocephalus, intracranial mass)Δ
Epilepsy
Subdural hematomaΔ
Intracranial hemorrhageΔ
Miscellaneous causes
Coughing (posttussive)* 
PregnancyΔ 
Falsely reported or induced illness (Munchausen syndrome by proxy)
Poor feeding technique
Improper formula preparation
Excessive air swallowing
Inappropriate handling after feeding
Psychogenic vomiting or bulimia
Rumination syndrome
Postnasal drip
Cyclic vomiting syndrome
Cricopharyngeal incoordination
Vestibular injury or inflammation
Heart failure
* Common causes.
Δ Important causes to remember because these disorders may not be obvious and prompt diagnosis affects outcome.
References: 
  1. Vomiting. In: Signs and Symptoms in Pediatrics, 3rd ed, Tunnessen WW Jr, Roberts KB (Eds), Lippincott Williams & Wilkins, Philadelphia 1999. p.491 and Pediatrics GE reflux clinical practice guidelines. J Pediatr Gastroenterol and Nutr 2001; 32:S1.
  2. Vandenplas Y, Rudolph CD, Di Lorenzo C, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2009; 49:498.
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