Nausea, Reflux and Vomiting

Nausea, reflux and vomiting may come together but can also be separate complaints. The following possible remedies may help with all of these symptoms

Try a reduced feeding rate if the patient is pump fed.
If the patient is bolus fed give the boluses more slowly or reduce the size of the boluses and give them more frequently.
Check the volume and osmolality of the feed.
Consider an anti-emetic medication, for example metoclopramide.
Increasing mobility, if possible, can help.
Anxiety is likely to cause feelings of nausea.
Ensure the feed has not become contaminated.
With prolonged and severe nausea, reflux and vomiting, post pyloric (i.e. jejunual) feeding could be considered.
Be aware that constipation can cause nausea, reflux and vomiting.

Nausea:

Consider use of ginger containing products if oral intake permits.
Ensure patient is in a well-ventilated room, which is free from unpleasant smells.

Reflux:

Reflux is the effortless movement of stomach contents up the food pipe (oesophagus) and sometimes into the mouth/throat. This may be swallowed down. Reflux is especially concerning in patients with neurological impairment and an unsafe swallow and can lead to chest infections. In some patients reflux is silent, with no cough or vomit produced, so careful monitoring is required.

Positioning is especially important to help reduce reflux. When feeding patient should be at least 30o angle upright, and for 30 minutes afterwards. Do not feed lying down.
Trial slower, continuous feeding rather than bolus feeding.
Consider avoiding overnight feeding.
Anti-reflux medication may be required to protect the oesophagus from the stomach acid.
A lower fat feed can speed up gastric emptying and thus reduce reflux.
Consider trialling a peptide-based feed.

In some children a surgical procedure called a fundoplication may be considered by specialist teams. This prevents reflux and vomiting, but the patient must be carefully and fully assessed as to their suitability.

Vomiting:

Vomiting is effortful and may be caused by a patient's clinical condition. In severe vomiting feeding may need to be temporarily stopped and clear fluids given. Please liaise with the dietitian before stopping any feed.

Some common causes of vomiting may be acute infection, serious complication like an obstruction or disease progression. Please inform the doctor at the earliest if vomiting is severe and/or repeated episodes.

If you would like this information in another format, for example large print or easy read, or if you need help communicating with us, please contact:

First Community (Head Office)

Call: 01737 775450 Email: fchc.enquiries@nhs.net Text: 07814 639034

Address: First Community Health and Care, Consort House, 5-7 Queensway, Redhill, Surrey, RH1 1YB.