Cyclic vomiting syndrome

My son is now eight years old. Since he was three, he has had terrible bouts of vomiting. They happen only 2-3 times a year, but when it happens it really scares us. He can vomit up to every 15 minutes for a few days and by the end he throws up something that looks like blood. Also, he seems sort of “out of it” when he is vomiting. We have even put an old crib mattress in the bathroom so he can rest and throw up in there. In between times, he is perfectly healthy and an excellent student. He was hospitalized once and was given intravenous fluid. Can you help?

From your description, it sounds as if your son has cyclic vomiting syndrome (CVS), an uncommon and unexplained disorder of children (and some adults). The condition is characterized by recurrent prolonged attacks of severe nausea, vomiting and feeling unwell, without apparent cause. The vomiting happens frequently (even every 10 minutes at its peak) and can last for hours or a few days. The episodes tend to be similar and the child is well in between. Most affected children begin having symptoms between 3-7 years of age, and the episodes can continue to occur over a period of months or years. Affected children often have motion sickness and other family members may have migraine headaches.

The vomiting episodes may begin at any time, but often begin during the night or early morning. The child may also have abdominal pain, less often headache, low-grade fever and diarrhea. Prolonged vomiting may cause bleeding from irritation of the esophagus. The symptoms are frightening; they can be life-threatening because of the risk of dehydration. No blood test exists to diagnose CVS, but a pediatrician relies upon a careful history and physical examination to diagnose it. Because CVS is an uncommon condition, some pediatricians may seek the advice of a pediatric gastroenterologist (a pediatrician who specializes in the stomach and intestinal system).

Treatment involves early intervention with intravenous fluids. Some medications have been used that can prevent or shorten the episodes. Close collaboration and communication between the child, family and pediatrician are essential.

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