Keeping It Down: A Case-Based Approach to Managing Pediatric Nausea and Vomiting
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.
Upon completion of this activity the learner should be better able to:
- Determine potential pathophysiological mechanisms of nausea/vomiting in children
- Evaluate treatments based on pathophysiology of nausea/vomiting in children
AAHPM endorses the Accreditation Council for Continuing Medical Education (ACCME) Standards for disclosure and commercial support and endeavors to ensure balance, independence, objectivity, and scientific rigor for all accredited products or programs. All who are in a position to control or influence the content of an educational activity must disclose any relevant financial relationships with ineligible companies.*Disclosure documents were reviewed for potential conflicts of interest and, if identified, they were resolved prior to confirmation of participation. Only those who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this activity.
All editors, faculty and staff have disclosed no relevant financial relationships.
*An ineligible company is defined as any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by, or used on, patients. (Exclusions at the time of this writing included 501-C not-for-profit organizations, government organizations, liability and health insurance providers, non-healthcare-related companies, group medical practices, for-profit healthcare providers, blood banks and diagnostic laboratories.)
Melissa Hunt, PharmD
Deborah Fisher, PhD PNP
Lisa Humphrey, MD FAAHPM
Continuing Medical Education (CME)
The American Academy of Hospice and Palliative Medicine (AAHPM) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American Academy of Hospice and Palliative Medicine (AAHPM) designates this Enduring material for a maximum of .50 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
CME credits expire October 13, 2024.
Maintenance of Certification (MOC)
“Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
- .50 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program; and
- .50 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program.
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM or ABP MOC credit.
ABIM or ABP MOC points expire on October 13, 2024.
Physicians certified with the American Board of Internal Medicine who wish to earn MOC points within the current calendar year must submit their MOC data no later than December 31 of the calendar year.
Physicians certified with the American Board of Pediatrics who wish to earn MOC points within the current calendar year must submit their MOC data no later than December 1 of the calendar year.
- 0.50 ABIM MOC
- 0.50 ABP MOC
- 0.50 CME (physician only)
- 0.50 Participation