Chronic vomiting in children is a common symptom, and many parents, including some doctors, tend to think that something is wrong with their child’s digestive system. Is that really the answer? No. Indeed, when we see such children in clinical work, most of them are found to have digestive problems, such as congenital malrotation, hypertrophic pyloric obstruction, annular pancreas, jejunal septum, intestinal stenosis, intestinal obstruction, etc. However, there are a small number of children who are not found to have problems after examination, treatment or even surgical exploration. So, where does the problem lie? It is diaphragmatic distension. As the name implies, diaphragmatic elevation means that one side of the diaphragm is elevated above the other side, which is most often found on the most common chest x-ray. Most often occurring on the right side, this type of disease in children is mostly congenital, but can also be acquired from acquired causes, such as breech birth or obstructed labor, frostbite, or heart surgery. The most common clinical manifestation is vomiting, in addition to recurrent respiratory infections, and vomiting often occurs as a single symptom. Therefore, if a child has such symptoms, it is important not to ignore the chest X-ray. Congenital diaphragmatic expansion 1. Definition Congenital diaphragmatic expansion is due to incomplete development of the diaphragm muscle fibers and the diaphragm becomes a thin membrane, when the abdominal pressure increases, part of the digestive tract rises into the thoracic cavity, so that the position of the diaphragm shifts upward, the lungs are compressed, and the respiratory distress. 2, type a. Primary diaphragm expansion: Intrauterine diaphragm muscle layer and collagen fiber dysplasia caused. b. Secondary diaphragmatic distension: phrenic nerve involvement due to different causes is a common cause of secondary diaphragmatic distension. For example, intrauterine infections and external injuries are common causes of phrenic nerve damage, birth injuries, direct cardiac surgery, and intraoperative frostbite. 3, clinical features a. Respiratory distress can occur in the neonatal period, manifested as shortness of breath and bruising after crying; partial diaphragmatic elevation symptoms can be reduced. Recurrent upper respiratory tract infections can occur due to the reduction of lung volume. b. Discomfort may occur after breastfeeding due to upward movement of the diaphragm, and the stomach is prone to gastric torsion due to poor fixation and occasional intestinal obstruction. c. The chest wall activity on the affected side is reduced during breathing, and breath sounds may decrease or disappear, and sometimes intestinal sounds may be heard.