It’s never fun when your little one complains of a stomach ache, but even less fun when that ache becomes vomiting. Often, the culprit is a stomach bug or food that just didn’t sit well — so up it comes. But what else causes vomiting in kids and when should a parent worry?
It can be frightening for adults, too. As caregivers, we may struggle to determine whether our child’s vomiting is just a passing stomach illness or something truly serious. Trust your instincts, Dr. Elias encourages.
“At the end of the day, no one knows their child better than the parent. If they have a suspicion that something doesn’t seem normal, they should bring it to the attention of their pediatrician or subspecialist,” he says.
As a rule of thumb, Dr. Elias says, the presence of blood or green bile or truly forceful vomiting are red flags and require the attention of a pediatric gastroenterologist.
There’s a lot more to know about vomiting in kids. Read on to learn about common causes, when to worry, and next steps.
Vomiting in babies
For some young babies, spitting up is a daily occurrence and is relatively benign with some exceptions, says Dr. Elias. “Non-forceful spitting up is incredibly common and typically something a child will outgrow. But what can’t be overlooked is when a baby is not growing or their weight has gone down.”
Spit up that gets into the airway is also problematic, he says. “If a baby experiences aspiration or frequent lung infections, this is something you can’t overlook.”
Babies who spit up frequently have long been diagnosed with reflux, but in recent years, typical treatment has moved away from prescribed medication as a first line intervention and toward simply making sure the baby isn’t taking in too much too quickly. What’s difficult to tease out, says Dr. Elias, is a baby’s intolerance to cow’s milk protein ingested by the mom and makes its way into her breastmilk. But there are ways to retain the beneficial breastfeeding relationship and keep baby comfortable, Dr. Elias says.
“Nobody would ever suggest that mom stop breastfeeding and switch to formula, but now doctors may ask her to remove milk and sometimes soy from the maternal diet and see if that addresses the issue,” he says. “Ultimately, milk protein intolerance normally should resolve in most infants by age 1.”
Projectile vomiting in young babies is, however, a matter for concern and can indicate pyloric stenosis, a relatively rare condition that occurs when the muscular valve, or pylorus, blocks the entry of food from the stomach into the small intestine.
“Babies aren’t necessarily born with this issue. It can develop over time, but it does most often occur in very young children, within the first several months of life,” Dr. Elias says. Pyloric stenosis and congenital malrotation of the intestine are both surgical indications for young babies, he adds.
Vomiting in older kids
Most vomiting in older kids is caused by common viruses and they tend to resolve within a couple of days, but it’s a good idea to push fluids — even small sips — to avoid dehydration.
“If a child has a high fever and is vomiting nonstop, they could get dehydrated within 24 hours,” says Dr. Elias. “At this point, most parents call their pediatrician and get tips and decide whether they need to have the doctor evaluate the child urgently.”
When vomiting is accompanied by visual disturbances, a lack of coordination and/or odd behavior or speech patterns, parents should be concerned because it could indicate a problem with the central nervous system, Dr. Elias says.
Cyclic vomiting syndrome
Some kids experience a severe bout of vomiting — for several hours or even days — followed by grogginess, yet feel completely fine the next morning, “like a switch flipping,” Dr. Elias describes. Then the child has a period of several weeks or more with no problems, only to be followed by another episode of vomiting.
This is the hallmark of cyclic vomiting syndrome, or CVS, says Dr. Elias, and it’s notoriously difficult to diagnose when it first manifests, but GI docs see it often.
“The child will see a doctor who may consider the first instance as gastroenteritis. The second time it’s just darn your luck. Then when there is a third and fourth time, it’s becoming clear that there’s something more going on,” he says.
Occurring in kids from toddlerhood through adolescence, CVS can be triggered by anxiety, sleep deprivation or even extreme excitement.
“The worst situation is when the whole family has been planning a family vacation to Disney World and everyone is so excited and ready to pile into the airport shuttle and Billy is in the bathroom vomiting profusely,” Dr. Elias says. “This is where you feel really bad for the family because excitement or any extremes of emotional state can be the trigger.”
For the Disney vacation example, Dr. Elias recommends spending a week or two prior to the trip getting to bed early, eating well and generally taking excellent care of the whole family — especially Billy.
Families have choices regarding a variety of treatment options, but a holistic multidisciplinary approach can help the kid manage triggers to lessen the severity of CVS — and get to the root cause.
“These kids classically graduate to be migraineurs,” Dr. Elias says, adding that migraine can run in families. “For anyone with a significant migraine history, this is something to keep on your radar as a possibility for your child.”