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Vomiting is a common sympton in children with gastroenteritis, but its treatment remains controversial.To investigate potential beneficial effects of ondansetron, compared with placebo or no intervention, in treating vomiting during acute gastroenteritis in children.The following electronic databases were searched through August 2006: MEDLINE, EMBASE, CINAHL and The Cochrane Library; additional references were obtained from reviewed articles. Only randomized-controlled trials (RCTs) were included.Four RCTs involving 490 patients with vomiting during acute gastroenteritis were included. Combined data from three RCTs (n = 466) showed that ondansetron compared with the control significantly increased the chance for vomiting cessation soon after drug administration [relative risk (RR): 1.3, 95% confidence interval (CI): 1.2–1.5, number needed to treat (NNT): 5, 95% CI: 4–8], but this effect was not observed at 24 h (three RCTs, n = 144, RR 1.2, 95% CI: 0.9–1.7). Ondansetron significantly reduced the risk of intravenous rehydration (two RCTs, n = 359, RR 0.4, 95% CI: 0.3–0.7, NNT 7, 95% CI: 5–14). Outcome measures not significantly different after ondansetron treatment were the need for hospitalization and return emergency department visits.Despite some clinical benefits, there is insufficient evidence to recommend the routine use of ondansetron for vomiting during acute gastroenteritis in children.