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 and Solutions for Retching from Complex Child for suggested treatments for various causes.
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
- 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
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.