A 9-year-old with abnormal neurologic signs during episodes of vomiting would warrant which course of action?

• A. Begin using anti-migraine medication to prevent headaches
• B. Prescribe ondansetron and lorazepam to help manage symptoms
• C. Reassure the parent that this is expected with cyclic vomiting syndrome
• D. Refer to a pediatric gastroenterologist for further workup

Answer: (B)

The key idea is to control the acute episode of vomiting and neurologic symptoms quickly. In children with episodic vomiting syndromes, addressing the current attack with targeted antiemetic and calming therapy can abort the episode and prevent dehydration or escalation. Ondansetron directly reduces nausea and vomiting, which helps stop the cycle of retching. Lorazepam, a benzodiazepine, provides anxiolysis and can dampen the autonomic and cortical arousal driving the episode, and it’s a commonly used option to abort CVS attacks. This approach focuses on stopping the current crisis rather than preventing future headaches or simply reassuring parents; while a gastroenterology referral is important for persistent or atypical cases, the most appropriate immediate management during the episode is the combination of ondansetron and lorazepam.