If your child has repeated bouts of vomiting, please collect the
following information on three episodes of vomiting before you make
an initial or follow-up appointment. This information may be very
helpful to your physician in reaching a correct diagnosis.
Time and Place
Date:
Time of day:
Place (home, school, etc.):
People present:
Description of Vomiting
How much (ounces)?
Food or mucus?
For how long (minutes)?
What did it keep your child from doing?
Triggers for Vomiting
Thoughts or stresses before the vomiting (within 1 hour):
Feelings (for example, upset or afraid) before the vomiting (within
1 hour):
Activities before the vomiting (within 2 hours):
Food eaten before the vomiting (within 4 hours):
Treatment
What did you do to help your child feel better?
Your Observation
What do you think caused the vomiting this time?
Written by B.D. Schmitt, MD, author of "Your Child's Health," Bantam Books.
Published by
RelayHealth.
Last modified: 1995-11-07
Last reviewed: 2008-06-09
This content is reviewed periodically and is subject to
change as new health information becomes available. The
information is intended to inform and educate and is not a
replacement for medical evaluation, advice, diagnosis or
treatment by a healthcare professional.
� 2009 RelayHealth and/or its affiliates. All Rights Reserved.