Vomiting occurs frequently in children who need feeding tubes. In many cases, the vomiting is caused by the same medical problems that require a child to have a feeding tube, but in some cases, vomiting may be due to how a child is being tube fed. Changes in formula, the feeding schedule, and the tube type can make a huge difference. See our page on Feeding Intolerance for more information on identifying ways you can adapt tube feeding to relieve vomiting and other symptoms.

There are many variables to consider. Of course, you will need to discuss your child’s situation with your doctors. It may take some trial and error to figure out the cause of the vomiting. More likely than not you have to adjust a number of different things. However, only change one thing at a time, so you know what is working and what isn’t.

What is the most common cause of vomiting in children with feeding tubes?

Feeding Intolerance.

Feeding intolerance, such as too fast a rate, too many calories, or using the wrong type of formula, is the most common cause of vomiting. Often, vomiting can be lessened or eliminated by changing the feeding regimen. See our page on Feed Intolerance for more information.

Causes of Vomiting

Illness

If vomiting only occurs occasionally, it may be due to illness. Young children get sick as frequently as once a month, and children who need feeding tubes are often more prone to vomiting during respiratory illnesses. Motility (meaning how food moves through the GI tract) slows down with illness, which can lead to increased vomiting even as a child is starting to get sick. It can remain slow for a week to 10 days (or more) after the illness has cleared, if the illness was significant. Coughs and congestion may also cause young children to vomit. For detailed information on handling illnesses, see our page on Illness.

Reflux Versus Vomiting

Often, vomit gets blamed on reflux or GERD. But, when you see a lot of vomit, it is likely that it is more than reflux going on. It is also important to try to determine if a child is actually refluxing (passive regurgitation of stomach contents) or vomiting. Air in the stomach needs to be expelled in the form of a belch, and the lower esophageal sphincter (LES) that serves as the gate between the esophagus and stomach must open up to allow air out. In some people, this sphincter opens too far, stays open too long, or opens too frequently, allowing stomach contents to be refluxed repeatedly and causing symptoms such as spitting up in babies or heartburn in older children and adults. While children with reflux do vomit occasionally, chronic and forceful vomiting, especially when accompanied by symptoms like paleness, sweating, salivation, or retching, is probably more than straightforward reflux.

While reflux is thought to be related to the belch reflex, in which stomach contents are expelled as if the body was going to belch, vomiting is triggered by the “vomiting center” of the brain, setting off a series of events involving muscles and nerves. Salivation in the mouth, narrowing of blood vessels, a fast heartrate, and paleness or sweating may occur. Then the muscles in the abdomen and diaphragm contract while the glottis (area where the vocal cords are) closes, creating retching. Finally, pressure inside the abdomen forces the contents of the stomach out through the mouth. Clearly, this is a much more complicated process than simple reflux, involving multiple body systems.

To complicate matters, reflux can sometimes trigger the gag reflex, which sets off vomiting. Children with neurological disorders may be extra sensitive, and may vomit as a result of gut hypersensitivity, an overactive gag reflex, an extra sensitive emetic or vomiting reflex in the brain, or motility problems in the gut.

For more information on the types of kids who tend to vomit, see Solutions for Vomiting from Complex Child.

Medical Conditions

Does your child have a condition that is linked with vomiting? Has she been tested for these conditions? Has his anatomy been checked for any abnormalities such as pyloric stenosis or a fistula? A lot of things mimic reflux or cause vomiting. Here are some of the chronic conditions that can cause repeated vomiting:

  • Motility Disorders, especially Esophageal Motility Disorders, Delayed Gastric Emptying or Gastroparesis, and Chronic Intestinal Pseudo-Obstruction
  • Anatomical or Structural Problems
  • Food Allergies and Intolerances
  • Autonomic Nervous System Issues or Dysautonomia
  • Celiac Disease
  • Cystic Fibrosis
  • Mastocytosis
  • Eosinophilic Esophagitisand other Eosinophilic Disorders
  • Endocrine Disorders
  • Cyclic Vomiting Syndrome
  • Abdominal Migraines
  • Functional Abdominal Disorders, such as Visceral Hyperalgesia, Dyspepsia, or Irritable Bowel Syndrome
  • Abdominal Epilepsy
  • Zollinger-Ellison Syndrome
  • Brain Tumor
  • Medications

Constipation

Constipation is one of the most common causes of vomiting in young children. Constipation backs up the whole GI tract, so that food that is coming in moves more slowly. It can cause the stomach to empty more slowly, and can lead to additional vomiting. Addressing constipation can improve feed tolerance considerably. See our page on Constipation for more information.

Addressing Vomiting

Medications

There are a variety of different medications that can help children who vomit. Here are a few options to consider:

  • Anti-reflux medications. While research has not shown anti-reflux medications usually improve vomiting, parents routinely see that a reduction in reflux often also brings a reduction in vomiting, probably because reflux triggers vomiting in many children. If possible, stick to the simpler medications like Pepcid or Zantac. Long term use of other reflux medications like Prevacid or Prilosec can have significant side effects.
  • Motility medications. These days most motility medications are banned due to side effects, and those still on the market have lots of potential side effects and black box warnings. For certain children, however, they may be worthwhile. Old-fashioned medications like low-dose antibiotics may be a good place to start.
  • Anti-emetics. In some children, quieting down the vomiting center in the brain makes a big difference. Anti-nausea medications, including Zofran, Phenergan, and Benadryl, may be helpful.
  • Medication for hyperalgesia. Children who have oversensitive guts sometimes respond very well to medications designed to blunt their nervous system overreactions. Common choices include Neurontin, Lyrica and Elavil.
  • Anti-spasmodics and anti-spasticity medications. These classes of medications often improve vomiting. Baclofen, a medication usually used for spasticity, is especially helpful in reducing both reflux and vomiting. These medications do tend to make kids sleepy, and some of them also slow down motility.

Improve Medical Conditions and Mechanical Issues

  • Treat underlying conditions. All underlying conditions should be treated as much as possible to reduce vomiting. This may include structural issues, gastrointestinal disorders, neurological conditions, respiratory problems, and endocrine disorders.
  • Get a handle on constipation. The GI tract cannot function if one end is blocked. Make sure that constipation is not causing problems. Treat constipation aggressively with laxatives and stimulants, if needed, in order to get things moving. See our Constipation page.
  • Improve swallowing.  If vomiting is triggered by a poor swallow and choking, swallowing therapy may be helpful. Both traditional speech therapy and newer electrical stimulation techniques may be helpful.
  • Eliminate problem textures and get feeding therapy in to help. Children who vomit due to feeding or sensory/texture issues often improve considerably with feeding therapy, which may be provided by an occupational therapist or a speech language pathologist. It takes time, but it can work.

Address Feed Intolerance

Our page on Feeding Intolerance presents many different methods to change tube feedings in order to improve symptoms. Some of the more relevant ones for kids who vomit include the following:

  • Slow down the feeding
  • Give smaller, more frequent feedings
  • Thicken feedings for older kids
  • Try a blended diet
  • Eliminate problem foods or formulas
  • Try a GJ or NJ tube that goes into the intestine
  • Try venting the feeding tube more often

Take Note of What Is and Isn't Working

Once feeding becomes so medical, parents are scared to do the wrong thing. We defer to medical professionals, which is understandable and expected. If you spent a lot of time in the hospital early on, you may not really trust your parenting skills at first.

However, take a step back and remember this is feeding your child and you are with this child day in and day out. You get the most immediate feedback on how feeds are going – vomit, retching, discomfort. Trust that parent instinct if you think that something is wrong, or if things are working well. Keep detailed notes of the changes you make and their impact. It will allow you to have a more informed conversation with your doctor, nurse or dietitian. Your input is important to the process and can help mold feeding plans that your child can better tolerate.