Pediatric Guidelines Project
View the Updated Guidelines Here:
After years in the making and despite pandemic-related delays we are thrilled to announce that the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) has officially published the updated clinical practice guidelines for the management of pediatric cyclic vomiting syndrome (CVS)! Â
These groundbreaking guidelines replace the previous 2008 recommendations and mark a significant step forward in improving the care and quality of life for children affected by this often-misunderstood condition.
Why Are These Guidelines So Important?Â
Cyclic Vomiting Syndrome is a disabling condition with intense, recurring vomiting episodes and significant impacts on a child’s quality of life, often leading to emergency room visits, hospitalizations, and missed school days. Until now, management strategies have varied widely due to the lack of evidence-based direction.Â
These new evidence-based guidelines provide clarity and consistency for clinicians and families alike. Developed by a multidisciplinary panel of experts — including patient representatives — the recommendations are grounded in a systematic review of available evidence and structured using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) process. This ensures a transparent, rigorous, and patient-centered approach to care.
What’s Inside?Â
The guidelines provide evidence-based recommendations for managing pediatric CVS, including both abortive (acute) and prophylactic (preventive) strategies:Â
- Use of anti-migraine agents (e.g., triptans, NSAIDs) as first-line abortive treatments.Â
- Conditional recommendations for nonpharmacological interventions such as behavioral therapies and neuromodulation.Â
- Guidance on supplements like CoQ10, magnesium, and riboflavin.Â
- Frameworks for IV protocols, emergency care pathways, and multi-tiered treatment algorithms based on severity.Â
- Consideration of patient values, side effects, feasibility, and healthcare equity.Â
These tools will empower families and practitioners to make more informed decisions and support individualized treatment plans.
You Helped Make This PossibleÂ
This milestone was made possible through collaborative effort, volunteer dedication, and generous community support. CVSA is proud to have helped fund this critical project, but the costs associated with evidence reviews, GRADE methodology, publication, and dissemination were substantial.Â
If you value having open-access, expert-developed treatment guidance for CVS, please consider making a donation to help us continue this vital work: Support the Guidelines Project and more!
These guidelines are not just a document — they are a beacon of hope for patients, families, and clinicians navigating the complexities of CVS. They help shift treatment from fragmented to focused, from reactive to proactive.
Let’s keep the momentum going — share this announcement, educate your providers, and join us in celebrating this major step forward.Â
Hope Starts Here.
We also want to extend our deepest gratitude to the exceptional team of experts who made this monumental project possible.Â
A special thank you to Dr. Katja Karrento, who served as lead author and coordinator of the guidelines. Her vision, commitment, and coordination across multiple specialties were instrumental in bringing these guidelines to life.
We also want to recognize and thank the entire guideline panel:
- John M. Rosen, MD – University of Arkansas for Medical SciencesÂ
- Sally E. Tarbell, PhD – Northwestern UniversityÂ
- Robert M. Issenman, MD – McMaster UniversityÂ
- Amy A. Gelfand, MD – University of California, San FranciscoÂ
- Heidi Gamboa, MD – Nicklaus Children’s HospitalÂ
- Sumit Parikh, MD – Cleveland ClinicÂ
- Kathleen Adams, BSN – CVS patient representative and CVSA President-EmeritaÂ
- Wojtek Wiercioch, PhD – GRADE methodologist, McMaster UniversityÂ
- B. U. K. Li, MD – Vice Chair and Professor Emeritus of Pediatrics – Medical College of WisconsinÂ
- Katja Karrento, MD – Chair, Author, and Coordinator – Children’s Hospital WisconsinÂ
Thank you also to all the reviewers, NASPGHAN leadership, and the families of the Committee members, CVSA Leadership and patients who contributed input throughout this process.Â
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Did you know? Many experts consider cyclic vomiting syndrome to be known as "migraine of the stomach."
CVS causes recurring episodes of severe nausea and vomiting that can last hours to days, often with symptom-free periods in between. It shares many features with migraine, including triggers, family history patterns, and some of the same treatments.
Learn more about the relationship between cyclic vomiting syndrome and migraine through our comorbidity article, in partnership with the Cyclic Vomiting Syndrome Association.
đź”—https://www.migrainedisorders.org/cyclic-vomiting-syndrome/
CVS causes recurring episodes of severe nausea and vomiting that can last hours to days, often with symptom-free periods in between. It shares many features with migraine, including triggers, family history patterns, and some of the same treatments.
Learn more about the relationship between cyclic vomiting syndrome and migraine through our comorbidity article, in partnership with the Cyclic Vomiting Syndrome Association.
đź”—https://www.migrainedisorders.org/cyclic-vomiting-syndrome/
