Rome IV Diagnostic Criteria for Child Functional Nausea and Vomiting
Official Rome IV criteria for the diagnosis of child functional nausea and vomiting.
Use in a child or adolescent with chronic nausea unrelated to meals, or vomiting in the absence of an eating disorder, of at least 2 months duration.
Patients with any of the following alarm features must be evaluated clinically for other diagnoses even though functional nausea or functional vomiting may be present:
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Severe nausea and vomiting.
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Vomiting occurs during the night or upon awakening.
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Headaches, visual disturbances, endocrine abnormalities or behavior changes along with the nausea or vomiting.
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Hematemesis.
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Bilious emesis.
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Abdominal distension.
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Severe abdominal pain.
If diagnosis not met (negative):
Current symptoms are unlikely to be related to functional vomiting. Consider further assessment as clinically indicated. Also, see pearls and pitfalls above.
If meets diagnosis (positive):
Likely diagnosis of functional vomiting. Consider initiating treatment.
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Supportive care.
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Cognitive behavioral therapy and hypnotherapy.
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Treatment of psychological or autonomic comorbidities such as emetophobia (psychotherapy) and postural orthostatic tachycardia syndrome (optimize salt and fluid intake).
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Pharmacologic interventions.
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Cyproheptadine.
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Antiemetics (e.g. Ondansetron).
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Antidepressants (e.g. Tricyclic antidepressants, SSRI).
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Pyloric botox.
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IB-Stim.
The choice of therapy is outside the scope of this calculator and will depend on clinical context.
This calculator should only be used in patients who do not have signs or symptoms suggestive of a structural, metabolic or other systemic cause of their symptoms based on clinical history, physical exam and initial work-up.