and medications Lifestyle modifications include avoiding triggers (similar to those known to trigger migraine headaches), such as fasting, chocolate, caffeine, and sleep deprivation Medications can be divided into those for acute symptoms and those used for prophylaxis Nausea and vomiting in acute episodes can be relieved with ondansetron, and intravenous fluids are frequently necessary Depending on the severity of the episode, sedatives such as diphenhydramine or lorazepam may be considered When CVS episodes occur frequently, prophylaxis can be provided with medications such as cyproheptadine, amitriptyline, and propranolol Symptomatic relief of vomiting can be provided with antiemetic medication, providing significant benefit for oral rehydration attempts In the past, many antiemetics were used with caution due to the possibility of dangerous adverse effects in children, including extrapyramidal symptoms However, ondansetron has emerged as an antiemetic with a low side effect profile Studies have shown that use of ondansetron does not mask symptoms of dangerous causes of vomiting, such as obstruction Although most commonly used to decrease nausea and vomiting in gastroenteritis, ondansetron has been used by practitioners for vomiting caused by a variety of conditions, including concussion, pneumonia, and appendicitis Suggested Readings and Key References General Shields TM, Lightdale JR Vomiting in children Pediatr Rev 2018;39(7):342– 358 Malrotation Adams SD, Stanton MP Malrotation and intestinal atresias Early Hum Dev 2014;90:921–925 Nagdeve NG, Qureshi AM, Bhingare PD, et al Malrotation beyond infancy J Pediatr Surg 2012;47:2026–2032 Strousse PJ Malrotation [review] Semin Roentgenol 2008;43(1):7–14 Hirschsprung Disease Haricharan RN, Georgeson KE Hirschsprung disease Semin Pediatr Surg 2008;17:266–275 Stensrud KJ, Emblem R, Bjornland K Late diagnosis of Hirschsprung disease— patient characteristics and results J Pediatr Surg 2012;47:1874–1879