Ask An Expert: Children Vomiting

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Ask An Expert: Children Vomiting

Question:

When should parents be concerned about their child vomiting? If the child, age 5 and a bit overweight, has what the parents think is a stomach bug that causes vomiting, and this happens for a couple days at least every two months or sometimes shorter periods in between, should they have tests done or should they just assume its a virus?

Answer:

It sounds like you think something more than a virus is the reason for these vomiting episodes in your child. In fact, there are many reasons why children vomit. Some are less cause for worry, while others could mean a more serious problem.

Gastroenteritis, an infection of the stomach and intestines (often called a "stomach bug"), is the most common reason for vomiting. A young child with this illness may have one or more of the following symptoms — vomiting, diarrhea, and fever — lasting a few days (occasionally longer). A child may get it more than once during the year, but getting it every two months or so would be somewhat unusual.

There are other infections that can cause vomiting, including strep throat, pneumonia (lung infection), urinary tract infection, and meningitis (infection of the lining of the brain and spinal cord). However, a child would have some more symptoms to go along with these infections, such as cough with pneumonia or a bad headache with meningitis. Like gastroenteritis, it would be unusual for these infections to occur every two months.

There are other things besides infection that cause repeated vomiting. These include stomach acid coming back up the swallowing tube (gastroesophageal reflux), stomach ulcers (peptic ulcer disease), and a twisting of intestines that are in the wrong position (malrotation). Food allergy or not being able to digest a food well (intolerance) can cause vomiting. This can be true of any food, but is most common with dairy products, wheat, soy products, and MSG (monosodium glutamate, often found in Chinese food).

Problems in or around the brain, such as migraine headaches or even a brain tumor, may have repeated vomiting. However, a child would complain of headaches and have more symptoms along with the vomiting. Abdominal "migraines" (also called cyclic vomiting syndrome or CVS) can cause repeated episodes of vomiting and abdominal pain. Diabetes also may cause repeated episodes of vomiting, but you would also notice things like weight loss, wanting to drink a lot, and needing to urinate all the time and even wetting the bed. Lastly, rare metabolic conditions that let toxins build up in the blood can cause vomiting.

Since your child is having repeated episodes of vomiting, I would check with her pediatrician about whether your child needs further evaluation. In the meantime, keep track of these episodes. Mark down each time your child vomits, including the date (and time of day), along with all of the details about the episode (for example, other symptoms she has at the time, when and what she ate that day, and what makes it better or worse). Your pediatrician will look at this information, closely examine your child, and then decide whether to order some tests, such as blood work, urine testing, or X-rays to look for less common causes of vomiting.

Leann M. Lesperance, M.D., Ph.D., is a lecturer on the Harvard Medical School faculty and a clinical assistant professor at SUNY-Upstate Medical University. She practices pediatrics in Binghamton, New York. She also holds a doctorate in medical engineering and is a research assistant professor in the Department of Bioengineering at Binghamton University.

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Last updated:	January 24, 2007