Why does my two-year-old throw up almost daily?
September 28, 2009 8:21 AM   Subscribe

My 28-month-old boy throws up like Stan in "South Park," every 2 to 3 days. How can we help him keep his food down?

For the past three months or so, G. has thrown up at least a couple of times a week. For the past three weeks, it's been almost every day! We're seeing a GI specialist tomorrow.

I know sensitive gag reflexes and vomiting when upset are very common in toddlers. This particular toddler has always been a very enthusiastic eater, and he spat up a lot in his first year. He doesn't have a fever when he does it and he's still gaining weight. But...every day? If anyone else's kids did this at this age, what helped?

Triggers seem to be:
- coughing (if he has a cold)
- eating too fast and/or not chewing his food enough (which happens a lot; we tell him to take small bites and eat slowly, but we also end up cutting his food in very small pieces because he often tries to wolf it down anyway)
- being upset--such as on the first day of preschool, or after skinning his knee at the playground.

He's also reached way back into his mouth and then thrown up a few times; I think that was only when he had a molar coming in.

We've tried reducing or eliminating dairy products from his diet, since his dad has allergies and asthma which get worse when he eats dairy foods. It didn't seem to make any difference. There's no other family history of digestive problems or food intolerance that we know of. G. has a prescription for an albuterol inhaler which we've used a few times when he has a cold and starts to wheeze; that doesn't seem to affect the throwing up one way or the other, either.

Thanks for any advice you have. If you know of anything specific we should ask the doctor--actually, nurse practitioner--I'd appreciate that too.
posted by homelystar to Health & Fitness (14 answers total)
Possibly a valve issue (I'm not a doctor but my guess). Has he ever gone for a barium challenge test? It is easy at least--all he has to do is drink some barium and get an xray. They'll see the barium pass and see how the valves work.

The frequency IS a concern. Glad you're going to a specialist. Not sure if they'll also suggest an endoscopy (he'll be under anesthesia for that at least)

I"m sorry you're going through this.
posted by stormpooper at 8:41 AM on September 28, 2009

Acid reflux, for sure.

Food allergies - you don't have to have family history to have hugely irritating and/or dangerous food allergies or intolerances. One friend has finally been diagnosed with several weird food allergies at age 30 and her life has dramatically changed for the better. Your kid might be a barfer, but this sounds much worse than that.

Maybe some kind of stomach sphincter problem - the little opening at the top of his stomach.
posted by barnone at 8:44 AM on September 28, 2009

Can you find a common food or ingredient he's eating when he throws up? My son started throwing up occasionally at that age and we eventually found he had a peanut allergy. Suddenly, throwing up at a Chinese restaurant and after having a bite of my sundae (with peanuts) made sense. My wife and I have no history of food allergies in our families.
posted by bondcliff at 9:04 AM on September 28, 2009

We had the same issue as you, and the underlying cause in our case was the same as bondcliff's (egg allergy in our case though).
posted by forforf at 9:12 AM on September 28, 2009

IANAD, but I had similar symptoms throughout childhood, so I'm going to put a couple of suggestions out there. These are both conditions that I have - I wasn't diagnosed until well into adulthood. A childhood diagnosis would have made my life much easier!

A hiatal hernia can cause this, especially after eating too much, too quickly or both. This can be diagnosed by endoscopy, unfortunately not really a great thing to put a kid through.

So can other food intolerances than dairy. Lactose intolerance is widely known, but other intolerances such as fructose and gluten are less so. I have fructose intolerance - didn't learn about it until I was an adult, but it explains why almost any time I ate apples, most sweets, and most juices as a kid I faced bouts of nausea and vomiting. Testing for food intolerances is a lot less invasive than diagnosing a hiatal hernia, so this might be a good place to start.
posted by chez shoes at 9:53 AM on September 28, 2009

My husband vomited constantly as an infant and toddler and it wasn't until he was able to talk and complain that they realized he had a wide variety of food allergies. One of his allergies includes poultry which is considered a hypoallergenic food by most doctors so they didn't believe him (!). The vomiting can take a few hours to develop so it's not always obviously tied to the food.
posted by defreckled at 11:55 AM on September 28, 2009

Thanks very much to everyone so far! I mentioned family history because I was thinking of something like celiac disease, but he doesn't seem to have the abdominal/bowel-related problems that at least some celiac sufferers do. As defreckled's reply implies, G. isn't yet talking enough to be able to answer questions reliably such as whether his stomach hurts or what kind of snack he had at preschool. We don't feed him whole nuts, but he has had peanut butter and almond butter spread very thinly or mixed with other ingredients without an immediate reaction.
posted by homelystar at 12:14 PM on September 28, 2009

Sounds exactly like my husbands' mother's description of my husband's childhood reflux. Reflux is very treatable.

Don't expect him to learn quickly how to moderate his own food intake, from his perspective he's not really eating "too fast", he is eating a normal amount at a normal speed because he's hungry. His stomach is abnormal. Try to frame it like that in your mind so you don't get too frustrated with him.
posted by kathrineg at 12:31 PM on September 28, 2009

What's his eating schedule like? Maybe he needs a few more in between meal snacks so he's not so hungry. Less hungry, less likely to wolf down his meals.

Toddlers are weird.
posted by jrishel at 12:53 PM on September 28, 2009

jrishel, he typically has breakfast, lunch and dinner plus a midmorning and midafternoon snack.

And just in case sleep habits might affect this: about nine to ten hours per night plus a two- to three-hour afternoon nap. He hates to GO to bed at night but once he's asleep, he doesn't usually wake up until 7 am or so.
posted by homelystar at 2:06 PM on September 28, 2009

Remove gluten
posted by zentrification at 2:25 PM on September 28, 2009

This is just anecdotal.

When my daughter was a toddler (right around the age of your son, actually), she went through a stretch of vomiting at night. She'd be sleeping one minute and in a pool of vomit the next. It was scary. I worried about her choking. It started off being pretty rare, but then we had 3 nights in a row, so I took her to the doctor. The doc prescribed a week or two of acid reflux meds, I forget which now, and she's been fine ever since with the exception of a couple of food sensitivities that we've isolated.

She's 11 now and still has what I call a "touchy" stomach, but we have a history of that in the family. Some processed foods, especially anything from the Banquet brand, tend to set her off. Otherwise, she's energetic, smart, and growing like a weed. We tend to cook at home from scratch a lot. She knows what her allergies are and is good about avoiding things that will make her sick. We go out to eat as a family about once a week, and nothing from a restaurant has caused her trouble.

She'd also been a very, very colicky baby, which we figured out later was also probably from reflux, looking back on it. I spent many a night sleeping with her on my chest on the couch propped up at about 45 degrees. Her doctor at the time just shrugged and said that some babies were like that. I wish I'd have known more about reflux at the time.
posted by lilywing13 at 12:22 AM on September 29, 2009

After reading his medical history and asking a lot of questions, the GI nurse practitioner doesn't think G. is intolerant of or allergic to particular foods. She did suggest keeping track of what he eats just before this happens and to let her know if anything in particular seems to cause more of a problem. (Fructose malabsorption sounds very plausible to me. He loves fruit and fruit juices...we dilute them, but still.) She referred him for a barium challenge test--soonest available supposedly Nov. 4, we are lobbying for sooner--and prescribed a "Prilosec-like" medication in the meantime. If that helps, she said, it might be gastritis and they could do further tests if necessary.

I had completely forgotten that certain sugary drinks, popsicles and snow cones used to make me cough and gag as a kid. They were things my mom wouldn't buy, so I'd jump at the chance to eat them at friends' houses or the county fair. I'll look into what might have been in them (lots of weird synthetic flavors, no doubt) and whether we've been feeding G. something similar.

Thanks again!
posted by homelystar at 12:19 PM on September 29, 2009

One more update: G.'s doing very well with the "Prilosec-like" medication...the drug's name is omeprazole. He's thrown up maybe once per week since going on it, and seemingly only when he has a cold and is coughing heavily. We saw the nurse practitioner for a follow-up yesterday and she says she'll keep him on the omeprazole for one more month and then see if he does OK without it. Bacterial infections that cause gastritis can take up to two months to go away even with treatment, she explained. She added that this drug can have side effects of constipation or diarrhea but is unlikely to cause any lasting harm. G. also gained a pound in the month between appointments 1 and 2!

Thanks for the input, everyone.
posted by homelystar at 3:30 PM on October 28, 2009

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