Solutions for Vomiting
Vomiting is a common symptom of many diseases, disorders, and illnesses. While in many cases, the cause of the vomiting can be identified and addressed, sometimes children continue vomiting without an easy explanation. This article is for those persistent vomiters, in hopes that even without a perfect diagnosis, they can be treated.
Every child who is vomiting frequently should be thoroughly assessed by a physician. If that has happened and you have ruled out anything anatomical, fixable, or easily treatable, keep reading.
Common Types of Vomiters
While this list is not all-inclusive, it compiles some of the typical types of vomiters.
The Refluxer: Reflux and vomit are technically different. Refluxing is passive regurgitation, while vomiting is more forceful and usually starts with the triggering of the vomiting or emetic reflex in the brain. Despite this difference, reflux often leads to vomiting, as the process of regurgitating can cause children to gag, become nauseated, or otherwise trigger the vomiting center of the brain.
The Child with the Hypersensitive Gut: Certain children have really hypersensitive guts, sometimes diagnosed as visceral hyperalgesia. In these children, anything that ends up in the stomach feels incredibly uncomfortable, and kids with this problem often feel like they have a stomach bug all the time. The nerves in the child’s stomach are constantly sending messages to her brain that her stomach is in trouble, causing vomiting, cramping, pain, and other symptoms. This is more common in children with neurological or autonomic nervous system problems, as well as in children who have had lots of medical procedures, especially as babies.
The Slow or Irregular Digester: Kids who don’t digest quickly enough tend to get nauseated and may vomit. Food or formula literally sits in their stomachs for hours and even days. Since it can’t go down, it has no place to go but up. In some cases, motility is simply slow, while in others, the stomach contracts irregularly and ineffectively.
The Kid Who Won’t/Can’t Poop: If your child is constipated frequently, everything in the lower GI tract backs up everything in the upper GI tract. If constipation is severe enough, children may start to vomit.
The Kid with Motion Sickness: Some children are overly sensitive to motion, even very simple motion, including normal play or movement. These children may become nauseated and vomit frequently.
The Kid with Feeding Intolerance: Children with feeding tubes are often fed on schedules or at rates that may not work well with their bodies and digestive tracts. Some oral eaters also have trouble self-regulating for a variety of reasons. Feeding too fast, too frequently, too much, or with too rich of a formula may lead to vomiting, as the body becomes overwhelmed by the food or formula.
The Burper: Kids with a lot of air in their bellies may burp, leading them to gag, reflux, or vomit. Children who swallow a lot of air are particularly prone to this problem.
The Kid with Food Sensitivities or Allergies: Kids with food sensitivities or allergies may respond to the presence of those foods by vomiting. This response may be immune-related, or simply the body’s reaction to a certain food or type of food.
The Kid with the Oversensitive Mouth: Some kids really cannot deal with certain textures of food, tastes, or even the feel of food. These children may become nauseated or gaggy when they eat certain types of foods, causing them to vomit.
The Poor Swallower: Children who do not swallow well often choke and gag while eating, causing them to vomit.
The Cyclic Vomiter: Some children may have an autonomic disorder that causes frequent bouts of severe vomiting that are cyclical in nature. Other children may have abdominal migraines or seizures that lead to vomiting whenever they occur. These kids tend to vomit repeatedly for a period of time (hours to days), and then have symptom-free periods between cycles.
The Puker: Some kids just puke for no particular reason at all. It’s just what they do.
Sometimes it can be really hard to know why your child is vomiting, but if you keep track of each episode, you may be able to determine a simple cause. I suggest making a log of vomits, noting the specifics of each one, including the following:
- Time it occurred
- What the child was doing right before it happened
- Child’s response (fine after, crying, etc.)
- What the child was eating
- When the child last ate
- When the child last stooled
- How many times the child vomited
- Any other symptoms that occurred with the vomiting
Solutions for Vomiting
If your kid is a vomiter, you know how bad it can be. So what can be done to improve or eliminate vomiting? Here are some potential strategies:
- For tube feeders, slow down the feeding. Some children need to be fed continuously around the clock. Others may need frequent slow feedings, perhaps over one to two hours. Slowing down feedings may make a huge difference, especially for children with poor motility, children who tend to have early satiety (feel full), or children with hypersensitive guts.
- Give smaller, more frequent feedings. Whether your child eats orally or by tube, smaller, more frequent feedings can be very helpful. Children with poor motility, reflux, or hypersensitive guts find smaller findings especially helpful.
- Thicken feedings for older kids. While there has been a lot of attention on the injuries and deaths from thickened formula in babies, older kids can safely consume thickened formula or foods, as long as enough liquid is also being provided. Thicker food tends to stay down instead of coming up. Sometimes it can be as simple as using a thicker ready-to-feed formula. Other children may want to try a commercial food thickener. This technique works well for kids with reflux.
- Try a GJ or NJ tube. Sometimes the stomach just does not work well. In this case, bypassing the stomach and feeding directly into the intestine using a GJ or NJ tube might work. The stomach can even be vented or drained simultaneously.
- Try a blended diet. If your child has a feeding tube and is using regular formula, you might want to consider a trial of a blended diet, which uses pureed real foods instead of formula. The pureed foods tend to be thicker and have a wider range of unique nutrients, which sometimes improves vomiting for children.
- Try venting the feeding tube. If your child swallows a lot of air or burps a lot, venting the feeding tube before feeds (or even during feeds with a Farrell bag) can help reduce air-triggered vomits.
- Eliminate problem foods or formulas. Children who are sensitive to particular foods may want to try an elimination diet to try to identify and then eliminate foods that are problematic. Some children who are fed by tube may also want to switch to a different formula. Sometimes certain formula elements may be more difficult for children to digest. Predigested formulas, hypoallergenic formulas, or amino acid based formulas may be beneficial for these children.
- 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.
- Try a 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.
- Try an anti-emetic. 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.
- Try an anti-reflux medication. 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. 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.
- Try baclofen. Baclofen is a medication for spasticity, but it also can help reduce both reflux and vomiting. While it does tend to make kids sleepy, sometimes the improvement in vomiting is worth the drowsiness.
- Try a motility medication. 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.
- 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.
- 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 a super-specialist. If none of these simple techniques works, it might be time to see a super-specialist who can help you with sophisticated testing and treatments, including motility testing.