Italian multidisciplinary delphi consensus on home management of nausea and vomiting in children with acute gastroenteritis (NoEmesi Project)

Introduction: Vomiting in pediatric acute gastroenteritis (AGE) is a major driver of distress, caregiver anxiety, and failure of oral rehydration, while guidance for home management and pediatric antiemetic use is limited and influenced by regulatory restrictions. Methods: We conducted a modified Delphi consensus in three phases (statement development after literature review, anonymous online rating, and final refinement) involving a national multidisciplinary panel of 70 Italian pediatricians. Results: Twenty-one statements addressing clinical aspects of vomiting in AGE and the pharmacology, safety, and use of commonly prescribed antiemetics (with emphasis on metoclopramide) were rated on a five-point Likert scale; consensus was predefined as ≥80% ratings of 4-5. All 21 statements met the consensus threshold (agreement 83%-100%; mean scores 4.2-4.9). The highest agreement concerned the clinical burden of vomiting in AGE, key mechanistic pathways, and practical safety considerations for metoclopramide (including dosing limits, age-related caution, and caregiver counseling). The panel agreed that, in selected children with persistent vomiting preventing oral rehydration, cautious antiemetic use, particularly metoclopramide, may support home management when safety precautions are followed, off-label requirements are respected, and parents are adequately counseled. Discussion: This Delphi consensus provides pragmatic, expert-endorsed recommendations for home management of nausea and vomiting in pediatric AGE. Oral rehydration solutions (ORS) remain the cornerstone of care; metoclopramide may be considered in carefully selected cases to quickly resolve symptoms, facilitate rehydration and reduce dehydration risk, provided that clinicians adopt strict risk-benefit assessment and good clinical practice safeguards.