Vomiting Health Article

Vomiting

Forcibly disgorging the contents of the stomach through the mouth.

Vomiting in children has a wide range of causes, from ordinary cases of stomach flu that spontaneously resolve within days to serious disorders of the digestive tract and other problems. The most common danger associated with vomiting is dehydration, especially when the vomiting is accompanied by fever and diarrhea. Severe, repeated vomiting can also strain the esophagus and stomach and cause internal bleeding or shock. If it becomes chronic, vomiting can also disrupt a child's metabolism and slow growth. Another concern is the danger that vomit will be aspirated into the lungs, which can lead to pneumonia.

Infancy

Vomiting should be distinguished from the spitting up (gastrointestinal reflux) that is common in infants. Unlike the forcible reverse peristalsis of vomiting, spitting up is a free discharge of the stomach contents resulting from rapid feeding or overfeeding, or simply from the fact that in the first six months the entrance to an infant's stomach isn't tight enough to keep all its contents down all the time. Unless there are other problems associated with it, spitting up does not pose any danger and is considered normal for infants under 15 months.

Infants with chronic vomiting may also have a condition that results when the esophogeal sphincter, the valve between the esophagus and stomach, allows the stomach contents to flow back into the esophagus. This problem, usually outgrown within the first year, can be alleviated by burping the infant frequently and by leaving the infant in an upright or semi-upright position for at least 30 minutes following a feeding. For bottlefed babies, thickening the formula with baby cereal may help.

In contrast, persistent vomiting in an infant may indicate a serious disorder, including some that require surgery. An example is pyloric stenosis, a narrowing of the passageway between the stomach and small intestine caused by a thickening of the surrounding muscle. (Abnormal narrowing of a digestive system passageway is known as stenosis; the pyloric sphincter connects the stomach and small intestine.) The hallmark of pyloric stenosis is projectile vomiting, usually within 15 to 30 minutes of feeding. Most infants with pyloric stenosis begin to exhibit projectile vomiting sometime between two weeks and four months. Pyloric stenosis is the most common surgically correctable cause of vomiting, occurring in approximately one out of every 250 births. (It is four times more common in boys than girls.) Similarly, anal Stenosis is the condition in which the anus is too small to allow the passage of fecal material.

Vomiting in infants and young children may also be caused by other congenital conditions that require surgery, including atresia, in which the esophagus or another part of the gastrointestinal tract fails to open properly; Hirschsprung's disease, in which some of the nerve cells that regulate normal bowel activity are missing; and intussusception, in which part of the small intestine "telescopes" onto itself, with one section sliding over another. Intussusception usually occurs between the ages of 6 months and 2 years.

The most common cause of vomiting in children is gastroenteritis (stomach flu), which is caused by a virus in over 90% of cases. In gastroenteritis, vomiting is usually accompanied by diarrhea, which increases the danger of dehydration, making it important for the lost body fluids to be replaced, preferably with a specially prepared oral rehydration solution. About one to two hours after the last vomiting episode, offer the child a few sips of cool water. Follow this every half hour with a few sips of water or other clear liquid such as sugar water or gelatin water (one-half to one teaspoon of sugar or flavored gelatin in about four ounces of water). Commercially prepared solutions, sold under such names as Naturalyte, Pedialyte, and Rehydralyte, contain a combination of water and electrolytes in the form of citric acid, potassium citrate, potassium sorbate, potassium benzoate, and sodium chloride, usually with fruit flavoring. These fluids are regulated by the Food and Drug Administration (FDA) as medical foods. Food can gradually be reintroduced when the vomiting starts to subside. In most cases of gastroenteritis, the vomiting lasts between 12 and 24 hours with moderate abdominal pain and little or no fever.

When an infant or young child is vomiting, it is important to keep his head turned to the side or face down over a basin or towel to minimize the possibility of inhaling the vomitus (material being vomited) into the lungs.

Two serious causes of chronic vomiting in children of any age are malrotation and volvulus. Malrotation (as its name suggests) refers to a congenital abnormality in the rotation which normally occurs in the fetus as the gastrointestinal tract develops. Malrotation allows portions of the intestine to become twisted, causing intermittent vomiting. This twisting can even destroy a portion of the intestine by cutting off its blood supply, a condition known as volvulus, characterized by abdominal pain and persistent vomiting. Both malrotation and volvulus require surgical treatment. (Volvulus is considered a surgical emergency.)

In addition to the flu, vomiting is associated with other infectious diseases, including pneumonia, meningitis, urinary tract infections, and intestinal infections—including food poisoning—caused by bacteria such as campylobacter, E. coli, shigella, and staphylococcus. Other medical causes of vomiting include migraine headaches, disorders of the central nervous system, brain tumors, hepatitis, appendicitis, ulcers, metabolic disorders, and food allergies.

An environmentally related cause of vomiting is motion sickness in response to travel by car, airplane, boat, or other form of transport. The symptoms—which include headache, pallor, and sweating in addition to vomiting—are believed to be triggered by the vestibular apparatus in the inner ear, which is responsible for balance and spatial orientation. Many physicians discourage the use of antinausea medications (antiemetics), especially for young children, because of possible side effects which can be intensified by dehydration.

After age five, abdominal pain and vomiting is also a common response to emotional upset—either distress or excitement. In children, vomiting may be triggered by any one or combination of factors such as anxiety, anticipation over an upcoming event, feelings of unhappiness, disappointment, or anger. In female adolescents, chronic vomiting can be sign of an eating disorder or pregnancy. If a child exhibits recurring abdominal pain and vomiting accompanied by change in behavior, emotional triggers for the digestive problems should be considered. A pediatrician, teacher, or child psychologist can provide insight into the root of the emotional upset if the problem persists.