Calculators & Tools

Rome IV — Cyclic Vomiting Syndrome

Stereotypical episodes of intense vomiting with well periods in between.

1 What is the Rome IV — Cyclic Vomiting Syndrome?

The Rome IV — Cyclic Vomiting Syndrome is a GI & Liver scoring tool used in paediatric practice. Stereotypical episodes of intense vomiting with well periods in between. It scores 4 criteria and interprets the total across 2 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in GI & Liver
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 4 criteria: ≥ 2 periods of intense, unremitting nausea and paroxysmal vomiting lasting hours to days, within a 6-month period; Episodes are stereotypical in each patient; Episodes are separated by weeks to months with return to baseline health; Symptoms cannot be attributed to another medical condition after appropriate evaluation. Totals are then banded: any score - Criteria not met: all four criteria are required for a Rome IV diagnosis of cyclic vomiting syndrome; 4 criteria or more - Criteria met: all criteria met - cyclic vomiting syndrome. Consider prophylaxis (cyproheptadine <5 y, amitriptyline ≥5 y, propranolol) and an abortive plan with early rehydration.
  • Source: Hyams JS et al. Rome IV - Functional disorders: children and adolescents. Gastroenterology 2016;150:1456-68.

4 Frequently asked questions

How many criteria does the Rome IV — Cyclic Vomiting Syndrome use?

4. They are ≥ 2 periods of intense, unremitting nausea and paroxysmal vomiting lasting hours to days, within a 6-month period; Episodes are stereotypical in each patient; Episodes are separated by weeks to months with return to baseline health; Symptoms cannot be attributed to another medical condition after appropriate evaluation.

What do the bands of the Rome IV — Cyclic Vomiting Syndrome mean?

The total is interpreted as: any score - Criteria not met: all four criteria are required for a Rome IV diagnosis of cyclic vomiting syndrome; 4 criteria or more - Criteria met: all criteria met - cyclic vomiting syndrome. Consider prophylaxis (cyproheptadine <5 y, amitriptyline ≥5 y, propranolol) and an abortive plan with early rehydration.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

Source: Hyams JS et al. Rome IV - Functional disorders: children and adolescents. Gastroenterology 2016;150:1456-68.

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.