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    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:

    • Severe nausea and vomiting.

    • Vomiting occurs during the night or upon awakening.

    • Headaches, visual disturbances, endocrine abnormalities or behavior changes along with the nausea or vomiting.

    • Hematemesis.

    • Bilious emesis.

    • Abdominal distension.

    • Severe abdominal pain.

    When to Use
    Why Use

    Children and adolescents presenting with symptoms suggestive of functional nausea or functional vomiting for at least 2 months. The diagnosis of functional nausea and functional vomiting should be made by clinical history, positive symptom criteria, physical examination, and minimal diagnostic testing as clinically indicated.

    • The diagnoses of functional nausea (FN) and functional vomiting (FV) are positive symptom-based diagnoses. They should be evaluated and treated in the context of the biopsychosocial model. 

    • Overlap of symptoms between FN and FV is common. 

    • The absence of pain differentiates FN and FV from functional dyspepsia.

    • Rumination and functional vomiting can be difficult to differentiate and one may be misdiagnosed for the other. 

    • In some patients, symptoms occur only early in the morning and do not occur when they are able to sleep in.

    • The clinician’s judgment determines the extent of diagnostic evaluation. A (negative) upper endoscopy is not necessary to establish the diagnosis. 

    • In case of severe nausea and vomiting, diseases of the central nervous system, obstruction, anatomic abnormalities or mucosal diseases of the gastrointestinal tract and/or motility disorders should be considered and ruled out with appropriate diagnostic testing. 

    • Psychological evaluation is important as symptoms can be situational. 

    • Some patients experience concurrent autonomic symptoms such as sweating, dizziness, or pallor. Specifically postural orthostatic tachycardia syndrome can also cause nausea and vomiting and can be associated with FN and FV.

    • Used to establish the diagnosis of functional nausea and functional vomiting in children and adolescents.
    • Can be used to discuss the diagnosis with patients and their family.
    • Making a diagnosis will help minimize unnecessary diagnostic evaluations and allow early treatment. 
    Functional Nausea
    Must have the following:

    For ≥2 months prior

    Functional Vomiting
    Must have the following:

    For ≥2 months prior

    Diagnostic Result:

    Please fill out required fields.

    Next Steps
    Creator Insights
    Dr. Douglas Drossman

    About the Creator

    Douglas Drossman, MD, is professor emeritus of medicine and psychiatry at the University of North Carolina School of Medicine. He is founder, President Emeritus and Chief of Operations of the Rome Foundation. He is also the founder of the Drossman Center for the Education and Practice of Biopsychosocial Care and Drossman Consulting, LLC. Dr. Drossman has written over 500 articles and book chapters, has published two books, a GI procedure manual and a textbook of functional GI disorders (Rome I-IV), and serves on six editorial and advisory boards.

    To view Dr. Douglas Drossman's publications, visit PubMed

    Dr. Lin Chang

    About the Creator

    Lin Chang, MD is responsible for the oversight and coordination of the Rome IV calculators on MDCalc. She is a Professor of Medicine at the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA and is a member of the Rome Foundation Board of Directors.

    To view Dr. Lin Chang's publications, visit PubMed

    The Rome Foundation

    About the Creator

    The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of Disorders of Gut-Brain Interaction (DGBI), also known as functional gastrointestinal (GI) disorders. Their mission is to improve the lives of people with DGBI. Over the last 3 decades, the Rome organization has sought to legitimize and update our knowledge of the DGBIs. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of GI function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. Diagnosis is based on the use of symptom-based criteria which are used in clinical trials and daily practice. The list of Rome IV categories and the Chair and Co-Chair of each chapter committee are listed below.

    Committees Chair Co-Chair
    Esophageal Disorders Ronnie Fass, MD John Pandolfino, MD
    Gastroduodenal Disorders Nicholas J. Talley, MD, PhD, FRACP Vincenzo Stanghellini, MD
    Bowel Disorders Fermin Mearin, MD Brian Lacy, MD, PhD
    Gallbladder and Sphincter of Oddi Disorders Grace Elta, MD Peter Cotton, MD
    Centrally Mediated Disorders of Gastrointestinal Pain Peter J. Whorwell, MD Laurie Keefer, PhD
    Anorectal Disorders Adil E. Bharucha, MD, MBBS Satish S. C. Rao, MD, PhD, FRCP
    Childhood Functional Gastrointestinal Disorders: Neonate/Toddler Sam Nurko, MD Marc A. Benninga, MD
    Childhood Functional Gastrointestinal Disorders: Child/Adolescent Carlo Di Lorenzo, MD Jeffrey S. Hyams, MD

    Rome IV Diagnostic Criteria Chapters, Chairs and Co-Chairs

    Rome IV Editorial Board: Douglas A. Drossman, MD, Senior Editor, Lin Chang, MD, William D. Chey, MD, John Kellow, MD, Jan Tack, MD, PhD, and William E. Whitehead, PhD.

    To view The Rome Foundation's publications, visit PubMed

    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH