Nausea and vomiting are significant distressing symptoms among children receiving palliative or hospice care due to a variety of potential causes. In many situations children are unable to adequately express their specific discomfort. Most antiemetics block one or more of the receptors involved in the pathophysiology of nausea and vomiting, however no antiemetic blocks all possible receptors. Unfortunately, the first anti-emetic chosen is often inadequate to manage the patient's nausea and vomiting. In general, children have a higher risk of potential consequences of nausea/vomiting. 

Significant suffering from uncontrolled gastrointestinal symptoms can greatly impact quality of life. Therefore, patients must be evaluated, using age-appropriate assessment techniques, to determine potential etiologies and distinguish specific mechanisms involved in order to most effectively treat these symptoms. Management in children is complicated by medication restrictions, side effects, and lack of adequate literature supporting use. Although haloperidol may be first-line for chemoreceptor-trigger zone nausea and vomiting in adults, is it always appropriate in a child? While generally considered safe, is ondansetron the most cost-effective option? What is the role for cannabanoids in children? 

Through case examples, users will work through these questions and many others, applying their age-specific knowledge regarding mechanisms of nausea and vomiting to determine the most appropriate non-pharmacological and pharmacological interventions for the patient based on pathophysiology and patient-specific factors. 

Interdisciplinary providers will gain practical application experience to walk away with better confidence and understanding of how to safely and effectively manage nausea and vomiting in pediatric hospice and palliative care patients, even refractory symptoms.