Management of Pediatric Cyclic Vomiting Syndrome (NASPGHAN, 2025)
Editorial Note: These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.
Guidelines on pediatric cyclic vomiting syndrome (CVS) were published in April 2025 by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition in the Journal of Pediatric Gastroenterology and Nutrition .[1]
Abortive Treatment
Antimigraine agents, such as triptans and nonsteroidal anti-inflammatory drugs, are strongly recommended for treating acute episodes of pediatric CVS in patients who have a personal or family history of migraine.
Other options for treating acute CVS episodes in children and adolescents are 5-hydroxytryptamine 3 and neurokinin 1 (NK-1) receptor antagonists.
Administration of intravenous fluids is suggested for patients who do not respond to outpatient abortive therapy.
Prophylactic Treatment
To prevent CVS episodes, suggested nonpharmacologic approaches are trigger avoidance and the use of dietary supplements, such as coenzyme Q10, riboflavin, and magnesium.
Medications that are suggested for prophylaxis include beta-blockers and NK-1 and 5-hydroxytryptamine 2A receptor antagonists. Tricyclic antidepressants may be considered for patients with frequent and severe symptoms.
Because of their adverse effects, anticonvulsants are generally not recommended for prophylaxis and should be reserved for patients who have refractory CVS.
For more information, please go to Cyclic Vomiting Syndrome.
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