Nausea and Vomiting Assessment Tools (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. Refer to the Post-operative Nausea and Vomiting guidelines for assistance in management
0
 None
1
 Intermittent mild nausea
2

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

Therapeutic Options

Ondansetron
Can be administered orally or by intravenous injection. However, it must be given slowly intravenously over 2 – 5 minutes as can cause prolonged QT interval.
Dosing guidelines:
The dose by either route is 0.1mg/kg up to a maximum of 4mg and can be repeated 8 hours later if necessary. Also consider need for regular treatment.
OR
Dexamethasone
Intravenously: 0.15mg/kg x 8 hourly

Cyclizine
Cyclizine is available as 50mg tablets or intravenous form.

Dosing guidelines Orally/IV:
1month – 6 years 0.5 -1mg/kg, 8 hourly daily (max single dose 25mg)
Aged 6 to 12 years, give 25mg up to 8 hourly
Aged over 12 years, give 50mg up to 8 hourly

Avoid using Prochlorperazine/Metoclopramide These can cause extrapyramidal effects in children under 12 years of age, and in young people

See Post-operative Nausea and Vomiting guidance

Editorial Information

Last reviewed: 30/09/2021

Next review date: 30/09/2024

Author(s): Acute Pain Team.

Version: 2

Approved By: TAM subgroup of ADTC

Reviewer name(s): Acute Pain Nurse Specialist.

Document Id: TAM323