Tuesday, December 26, 2006

Vomiting after Eating

Dear Lisa,

My name is Carrie and I have a 5 year old boy that he will eat supper and at times he will throw up. Usually it is his favorite food to eat. Can you help me understand why he is doing that?

“My boy vomits”

Dear “My boy vomits”,

There's a multitude of reasons why a 5 year old child vomits. Some children have a hyperactive gag reflex. A gag reflex is the normal response that everyone has when food or water touches the back of their throat. Children gag when something touches the back of the throat in order to protect their airway and prevent them from choking or aspirating. In some children this reflex is so overactive that the smallest amount of food can touch the back of the throat and cause such a forceful gag that it causes the child to vomit.

One of the most common causes of acute vomiting in children is Gastroenteritis or viral infection. (1) The symptoms of Viral Gastroenteritis include vomiting (which usually appears like undigested food), hyperactive bowel sounds, fever and abdominal pain.(2) Viral Gastroenteritis typically has a short course lasting approximately 1 to 5 days and many times is accompanied by watery diarrhea.

In most cases of Gastroenteritis, the vomiting phase lasts approximately 8 to 12 hours, subsides, and then is followed by diarrhea. Once the virus is over the vomiting should not return. Chronic or recurrent vomiting represents a different problem. Many times children who develop Gastroenteritis have a history of having contact with another person with the virus although the condition may also be spread through contaminated food or infected air droplets.(3)

A common cause of recurrent vomiting in childhood is Gastroesophageal Reflux (GER). GER occurs when the contents of the stomach travels up the food tube and in some cases shoots out of the mouth in the form of vomit. Older children with GER may present with new onset of recurrent vomiting, heartburn, anemia, chronic cough, recurrent pneumonia, non-seasonal Asthma, loss of appetite, difficulty eating or weight loss.(4) Anything that increases intra-abdominal pressure and intra-gastric pressure can exacerbate a child’s underlying Gastroesophageal Reflux disease.(1) Examples of conditions that increase intra-abdominal pressure include constipation, overeating or activities that apply force to the abdominal area.

A Food sensitivity cannot be overlooked as a possible cause of vomiting in children. Since your child’s symptoms seem to occur after a meal, this is a legitimate concern in your case. A Cow’s milk allergy is a common food sensitivity that presents with vomiting, diarrhea, gas and abdominal pain. (1) Anemia, malabsorption and failure to thrive may also occur in a child with a food sensitivity. Cow’s milk is present in many foods that may not be necessarily obvious to a parent so it is common for the correlation between the food and the symptoms to be overlooked.

Other food sensitivities such as a wheat intolerance can also cause similar symptoms. It is a good idea to keep a food and symptom diary for 2 weeks and bring it to your doctor’s office so that a food sensitivity in your child can be ruled out.

One of the less common causes of vomiting in a child is a Hiatal Hernia. A Hiatal Hernia is a condition where there is a prolapse of a portion of the stomach into the thoracic cavity. When this occurs, the top of the stomach slides through a weakened opening between the food tube and stomach. The symptoms of Hiatal hernia include regurgitation, vomiting, failure to thrive, intermittent colicky abdominal pain and GERD symptoms.

Certain respiratory conditions may also cause a child to vomit. Pneumonia, Asthma, Pertussis and Otitis Media (middle ear infection) are examples of conditions that can cause a child to vomit. (1) During a respiratory infection or Asthma, mucus is produced in the airways and can be swallowed by the child. As a result a stomach ache from the gastric irritation and vomiting develops. (1)

Cyclic vomiting is another cause of recurrent vomiting in childhood. Cyclic vomiting is defined as a cycle of vomiting that involves a high frequency of vomiting per hour during attacks with a few attacks ocurring per month.(5) The symptoms usually begin in the early morning hours.

Cyclic vomiting attacks usually occur every 2 to 4 weeks and the duration of each episode averages 24 to 40 hours. (5) The child then has a period free from vomiting for a few weeks and then the cycle begins again. The vomiting in this condition occurs on such a regular basis that many times parents can predict within a few days when the next episode will occur.(5)

The average age of onset for Cyclic Vomiting is 5 years old. It is considered an early childhood form of migraine which can evolve into abdominal migraine and later typical adult type migraine.(5) Even though a significant proportion of children will have symptoms through adolescence and young adulthood, many will outgrow their symptoms by age 10. (5)

Whenever a school age child develops vomiting on a regular basis it is a good idea to keep a record of the episodes. The child’s diet, activity, weight , time of day, duration, eliciting factors and associated symptoms should all be recorded and brought to the Pediatrician’s office for an evaluation. This way the doctor can make a determination if the vomiting is related to GER, a food sensitivity or another disorder.

Concerning symptoms include acute onset of vomiting with severe abdominal pain, intractable (continuous) vomiting , abdominal distention, projectile vomiting (vomit shoots outs forcefully), fever, bilious vomiting (greenish thick and foamy vomitus), blood in vomit, vomiting with excessive coughing, vomiting in a child with Asthma or vomiting accompanied with weight loss. (1) These symptoms can be related to more serious problems and require an evaluation by a Physician.

For information about topics discussed read other Pediatric Advice Stories:

Gastroesophageal Reflux



Fever and Vomiting

Failure to Thrive

(1)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990:353-355.
(2)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1419.
(3)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984:793.
(4 )Suwandhi E, Ton M, Schwarz S. Gastroesophageal Reflux in Infancy and Childhood. Pediatric Annals. 2006. 35(4)259-266.
(5) Lewis D, Pearlman E. The Migraine Variants. Pediatric Annals. 2005. 34(6):486-500.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Childhood Symptoms

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