Retching occurs when a child tries to vomit but can’t (as in children who have had a Nissen or fundoplication surgery), or when a child tries to vomit but has nothing to vomit. If retching is occurring, you may need to vent the stomach more often.
Retching with a Fundoplication
In theory, retching after a fundoplication occurs because the fundoplication stops the child from vomiting, meaning that any attempt at vomiting will lead to persistent retching since the gastric contents are not able to be released upwards out of the stomach and mouth. While this may be true for a child with a fundoplication who has a stomach virus, it does not explain why some children retch continuously after a fundoplication.
Doctors have begun to realize that persistent retching after a fundoplication may instead be the result of either a preexisting hypersensitivity or changes in the gut from the fundoplication. Children who vomit or retch before a fundoplication usually continue to retch afterwards. Most of these children have a hypersensitive emetic reflex or visceral hyperalgesia.
In some cases, a motility problem or other condition like eosinophilic esophagitis was mistaken for reflux pre-operatively, and was only discovered after the fundoplication failed to eliminate symptoms. Unfortunately, surgery not only does not improve symptoms in children with motility or hypersensitivity issues, but it also makes them worse in many cases.
Some children begin to retch after surgery even without pre-surgical vomiting. While this is not entirely understood, researchers have hypothesized that this retching may be due to sensitization of the emetic reflex from vagus nerve damage during surgery, or development of gastric dysrhythmia or uncoordinated gastric contractions as a result of surgery.
How to Vent
Using a Farrell Bag
Retching without a Fundoplication
Retching that occurs in a child with GI problems but without a fundoplication typically has one of two causes: a motility problem, or hypersensitivity of the stomach or other parts of the GI tract. In these children, retching is often followed by vomiting, though the two symptoms can happen separately as well.
Children who retch and have a motility problem often have abnormal motility of the esophagus, such as esophageal spasm or dysmotility, or a motility problem in their stomach or small intestine, such as a lack of contractions, spasmodic contractions, or the absence of “housekeeping” contractions in the stomach. See more information about Motility Disorders.
Other children may have a hypersensitive gut. The most common cause of hypersensitivity, often called visceral hyperalgesia, is reduced gastric volume capacity. In children with hypersensitivy, the stomach feels “full” and may even feel painful at a much lower volume than would be expected. This hypersensitivity may extend to other parts of the gut in some children, causing symptoms with even the smallest amount of fluid or food in the belly. The brain perceives the gut as painful or overfull, triggering discomfort, retching, and vomiting.
In other children, the emetic or vomiting reflex in the brain may be on a hair trigger, and almost anything, from a bad smell to 5ml of formula in the belly, may cause retching. It is very common for these problems to occur in tandem, and many children with motility problems have concurrent visceral hyperalgesia.
Venting the stomach can help retching tremendously. See the video in the sidebar or visit our Living with a Gastrostomy (G) Tube page for more information.
Farrell Valve bags allow for venting the stomach while feeding. Moreover, these bags gives formula a place to go until the stomach is better able to handle it. The food enters the bag and then is gravity fed back into the stomach.
Other treatments require treating the underlying cause. See Solutions for Retching from Complex Child for suggested treatments for various causes.