Nausea and vomiting (Paediatric Guidelines)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Nausea and vomiting may occur in the postoperative period and is often associated with the use of opioid analgesics. If this side effect is not treated it may be as unpleasant for the child as ongoing pain. Use of an assessment tool will also allow assessment of the efficacy of any anti-emetics given.

General management

  • Ensure adequate pain control, warmth and comfort.
  • Correct hypotension, hypovolaemia and hypoxia.
  • Ensure adequate hydration.
  • If there is a nasogastric tube, aspirate it.
  • If one anti-emetic fails, choose an alternative with a different mechanism of action and if ineffective, seek advice.
  • Check for any contra-indications to the use of any drugs in the “BNF for Children” publication.

Measuring nausea and vomiting

  • All children must have nausea scores measured at the same time as their vital signs, using the above scoring tool.
  • The post-operative nausea and vomiting guidelines within this manual will give advice on anti-emetic prescriptions and other factors which need to be considered.
  • A nausea score of 3 requires urgent treatment. 
0
 None
1
 Intermittent mild nausea
2

Constant nausea with/without some vomiting
3
 Significant, ongoing vomiting

Therapeutic options

Ondansetron

  • See BNFC
  • Oral or slow IV injection.
    MUST     be given slowly IV, over 2 to 5 minutes, as can cause prolonged QT interval.
  • Dose (by either route):
    • 0.15mg/kg up to a maximum of 4mg
    • Can be repeated 8 hours later, if necessary.
    • Also consider need for regular treatment.

OR Dexamethasone

  • See BNFC
  • Intravenously: 0.15mg/kg x 8 hourly

Avoid

  • Prochlorperazine / metoclopramide
  • These can cause extrapyramidal effects in children under 12 years of age, and in young people

Rescue anti-emetic:

  • Droperidol
  • See BNFC
  • 0.025mg/kg (maximum dose 1.25mg) in high risk children where dexamethasone is contraindicated.

Editorial Information

Last reviewed: 13/08/2024

Next review date: 30/09/2027

Author(s): Acute Pain Nurse Specialist.

Version: 2.1

Approved By: TAMSG of the ADTC

Reviewer name(s): L Reid, Clinical Nurse Specialist, Anaesthetics, C Wright, Acute Pain Nurse Specialist.

Document Id: TAM323