Ask Dr. Marla: Toddler vomits constantly

Question:

My toddler vomits all the time but he doesn’t show any other signs of being sick. What is going on?

Answer:

You don’t report a fever, change in bowel movements, lethargy or signs of dehydration, which would take this answer in another direction. It is critical to make sure that vomiting is not a sign of another illness. Meningitis and other infections can present with the sudden onset of vomiting.

The timing of the event and the fact that your child is well are important. Does this happen when your child gets upset, is it related to food and if so, is it related to the same kind of food? Record the specific things, if any, that trigger your child’s episodes of vomiting. As with migraines, these triggers might include stress, excitement, infections, eating certain foods, hot weather, or motion sickness.

If there is a link to certain kinds of food, it could be a food allergy or gastroesophageal reflux, when the food refluxes back up the esophagus rather than propelled into the digestive system. Other possibilities include:

• delayed gastric emptying, a condition in which food sits longer in the stomach and eventually your child regurgitates or vomits the food back up.
• pyloric stenosis, a condition that occurs in young infants in which a narrowed pylorus (which connects the stomach to the small intestine) does not allow the food to be propelled out of the stomach, leading to projectile vomiting. This diagnosis is made with imaging and can require surgery.
• volvulus, a malrotation of the gut, which can be ruled out with diagnostic imaging.
• cyclic vomiting syndrome, a condition in which children have episodes of nausea that may last a few hours, or as long as a few days. Once the episode is over, children are usually symptom-free until the next time it happens. During the episode however, they might feel unwell and shows signs of dehydration. The cause of cyclical vomiting is unknown, but there is a link to a family history of migraines. Many experts believe the two are related. Some medications can be effective in treating this condition.

As always see your doctor for a complete examination to find a strategy to dealing with this situation.

Originally published in ParentsCanada magazine, February/March 2012.