Overview Of Childhood Cyclic Vomiting
Childhood Cyclic Vomiting is synonymous with the term Cyclic vomiting syndrome. Cyclic Vomiting Syndrome is a disorder that causes recurrent episodes of nausea, vomiting, and tiredness (lethargy). This condition is diagnosed most often in young children, but it can affect people of any age.
The episodes of nausea, vomiting, and lethargy last anywhere from an hour to 10 days. An affected person may vomit several times per hour, potentially leading to a dangerous loss of fluids (dehydration). Additional symptoms can include unusually pale skin (pallor), abdominal pain, diarrhea, headache, fever, and increased sensitivity to light (photophobia) or to sound (phonophobia). In most affected people, the signs and symptoms of each attack are quite similar. These attacks can be debilitating, making it difficult for an affected person to go to work or school.
Episodes of nausea, vomiting, and lethargy can occur regularly or apparently at random, or can be triggered by a variety of factors. The most common triggers are emotional excitement and infections. Other triggers can include periods without eating (fasting), temperature extremes, lack of sleep, overexertion, allergies, ingesting certain foods or alcohol, and menstruation.
If the condition is not treated, episodes usually occur four to 12 times per year. Between attacks, vomiting is absent, and nausea is either absent or much reduced. However, many affected people experience other symptoms during and between episodes, including pain, lethargy, digestive disorders such as gastroesophageal reflux and irritable bowel syndrome, and fainting spells (syncope). People with cyclic vomiting syndrome are also more likely than people without the disorder to experience depression, anxiety, and panic disorder. It is unclear whether these health conditions are directly related to nausea and vomiting.
Cyclic vomiting syndrome is often considered to be a variant of migraines, which are severe headaches often associated with pain, nausea, vomiting, and extreme sensitivity to light and sound. Cyclic vomiting syndrome is likely the same as or closely related to a condition called abdominal migraine, which is characterized by attacks of stomach pain and cramping. Attacks of nausea, vomiting, or abdominal pain in childhood may be replaced by migraine headaches as an affected person gets older. Many people with cyclic vomiting syndrome or abdominal migraines have a family history of migraines.
Most people with cyclic vomiting syndrome have normal intelligence, although some affected people have a developmental delay or intellectual disability. Autism spectrum disorder, which affects communication and social interaction, has also been associated with cyclic vomiting syndrome. Additionally, muscle weakness (myopathy) and seizures are possible. People with any of these additional features are said to have cyclic vomiting syndrome plus.
Causes Of Childhood Cyclic Vomiting
Although the causes of cyclic vomiting syndrome have yet to be determined, researchers have proposed several factors that may contribute to the disorder. These factors include changes in brain function, hormonal abnormalities, and gastrointestinal problems. Many researchers believe that cyclic vomiting syndrome is a migraine-like condition, which suggests that it is related to changes in signaling between nerve cells (neurons) in certain areas of the brain. Many affected individuals have abnormalities of the autonomic nervous system, which controls involuntary body functions such as heart rate, blood pressure, and digestion. Based on these abnormalities, cyclic vomiting syndrome is often classified as a type of dysautonomia.
Some cases of cyclic vomiting syndrome, particularly those that begin in childhood, may be related to changes in mitochondrial DNA. Mitochondria are structures within cells that convert the energy from food into a form that cells can use. Although most DNA is packaged in chromosomes within the nucleus, mitochondria also have a small amount of their own DNA (known as mitochondrial DNA or mtDNA).
Several changes in mitochondrial DNA have been associated with cyclic vomiting syndrome. Some of these changes alter single DNA building blocks (nucleotides), whereas others rearrange larger segments of mitochondrial DNA. These changes likely impair the ability of mitochondria to produce energy. Researchers speculate that the impaired mitochondria may cause certain cells of the autonomic nervous system to malfunction, which could affect the digestive system. However, it remains unclear how changes in mitochondrial function could cause episodes of nausea, vomiting, and lethargy; abdominal pain; or migraines in people with this condition.
Other names of this disease.
- abdominal migraine
- cyclical vomiting
- cyclical vomiting syndrome
- periodic vomiting
The hallmark of childhood cyclic vomiting is recurrent episodes of severe nausea and vomiting. In children, these episodes usually last for several hours to a few days. In adults, episodes tend to occur less frequently but usually last longer for 8 days. These recurrent, characteristic episodes are extremely similar within each individual, often beginning at the same time of day, with the same severity, duration, and associated symptoms, as in previous episodes. Episodes often occur in the early morning hours or upon awakening in the morning. Affected individuals may only experience episodes several times a year or as frequently as several times a month. On occasion after years of cycling, episodes can “coalesce” together with daily nausea and mild vomiting between severe attacks such that there is no symptom-free period.
Nausea and vomiting that characterize these episodes are often quite severe. Nausea can be persistent and intense. Unlike most other gastrointestinal disorders, the vomiting in CVS does not typically relieve nausea. Affected children may experience bouts of rapid-fire, projectile vomiting as frequently as four or more times per hour with a peak pace of every 5-15 minutes. After the contents of the stomach are emptied, individuals may continue to dry heave. Symptoms can be so severe that affected individuals are unable to walk or talk and in some cases may appear unconscious or comatose. Episodes may cause affected individuals to withdraw from social interaction. The behavior of drinking water to dilute the bile and induce vomiting and hence reduce nausea is common, and should not be confused with a psychogenic cause. More commonly described in adults but also occurring in children, many take continuous prolonged hot shower or baths to alleviate nausea.
Additional symptoms may occur during an episode including paleness of the skin (pallor), lack of energy (lethargy), fever, and drooling. The emesis is typically bilious (green or yellow). Repetitive vomiting may cause loss of vital fluids (dehydration). Gastrointestinal symptoms such as severe abdominal pain, diarrhea, and retching (gagging) are not uncommon. Affected individuals have a reduced appetite and weight loss may occur. Some individuals may exhibit a variety of migraine-like neurological symptoms including headaches, abnormal sensitivity to light (photophobia), increased sensitivity to sound (phonophobia), and dizziness or vertigo.
Many affected individuals can identify a precipitating event or “trigger” that sets off an episode of CVS. In children, stress is the most trigger, more commonly excitement (birthdays, holidays) than negative stress. Additional triggers include infection, certain foods such as monosodium glutamate, chocolate or cheese, physical exhaustion, lack of sleep, motion sickness, and incoming weather fronts. In adolescents and women, menstruation may trigger an episode. Many adults with cyclic vomiting syndrome are prone to anxiety or panic attacks, which can trigger episodes.
Treatment Of Childhood Cyclic Vomiting
Some treatment options may include:
● Antiemetics: Some examples of these medications include metoclopramide and domperidone. These are anti-sickness medications that may help if a person is experiencing nausea or vomiting.
● Hydration therapy: This helps replace water lost through vomiting or diarrhea.
● Nonsteroidal anti-inflammatory drugs and acetaminophen: There is conflicting research regarding the efficacy of these medications for this purpose. However, they may help if a person takes them soon after the onset of symptoms.
● Triptans and ergotamines: These may help prevent the onset of abdominal migraine and treat the associated pain.
What triggers CVS?
Many people can identify a specific condition or event that triggered an episode, such as an infection. Common triggers in children include emotional stress and excitement. Anxiety and panic attacks are more common triggers in adults. Colds, allergies, sinus problems, and the flu can also set off episodes in some people.
Other reported triggers include eating certain foods such as chocolate or cheese, eating too much, or eating just before going to bed.
Hot weather, physical exhaustion, menstruation, and motion sickness can also trigger episodes.