Mystery Puking
December 12, 2012 10:24 AM   Subscribe

My daughter throws up after she showers. (And a few other times, too.) It's been going on for nine days. What could be causing my kid's mystery vomiting, and what can I do about it?

HELP HELP Dr. MeFi, I'm becoming panicky and don't know what to do.

On Monday Dec. 3, my 10-year-old daughter took a shower before bed, and unexpectedly threw up after she got out. She'd been fine all day up until that point. Since then, she's thrown up nearly every night. On a night when she showers (this is every other night), right after she gets out. Otherwise, she's woken up in the wee hours and been sick. She's had no vomiting at all on two nights. Oh, and she threw up once at the doctor after they did her strep swab.

We were operating under the assumption that it was just some passing virus. Aside from the puking, her head hurts, her throat hurts, her stomach hurts. After a while she started coughing, which turned into a distinct wheeze, which wound up in nebulizing her for a few days.

We've been to her pediatrician for this twice, now. On Saturday, they renewed her asthma meds and said to wait out the virus. All day Sunday she was fine until... shower time. All day Monday and through the night she was fine, too! We thought we had waited it out! So we sent her back to school yesterday. Then she threw up after her BATH, not shower (See? We were trying to change it up.) And then again after we woke her up this morning. Poor kid.

So today I took her BACK to the pediatrician, and they basically said, 'This is really weird, I guess talk to the gastroenterologist?' and gave me a prescription for Omnicef in case it was something like a sinus infection or pneumonia presenting in a nonstandard way. As loathe as I am to overuse antibiotics... we figure it can't hurt...? And maybe it will help...? But I haven't started it yet.

And she's, you know, mostly fine? You wouldn't look at her and think "That there is one sick kid." She's not perfect, but she's not exactly moaning in bed, either. She was coughing for a little while in the beginning, but that's over, and her lungs are clear as a bell now. No sneezing, no runny nose or congestion, no fever. She's eating well, no bowel problems. What she eats doesn't seem to matter. She's thrown up on chicken soup and kept McDonald's down just fine.

We have not started using new shower products. We've told her to take cooler showers, and again, one incident involved a bath. No new foods or laundry detergents or anything that we can think of. We have a new roof on our house, but it was put on *after* she got sick.

The child in question has a peanut allergy; history of asthma; a mild dairy allergy; and as we discovered after a lengthy investigative process for her two-year recurring stomach aches, fructose intolerance.

It bears noting that the gastroenterologist in question diagnosed her with IBS last year when we were trying to get to the bottom of her fructose-caused stomach aches. "Eat more fiber" was all we got from the gastro, but it just wasn't working (at least she confirmed no celiac, so there's that). In the end we had to take matters into our own hands and do a Serious Elimination Diet. This application of the scientific method led us to self-diagnose and actually find a way to make her feel better. Which she does! Though she misses smoothies a lot.

So basically: If you were her parent, would you give her the antibiotic? Is there anything we can try before we get in to see the gastro? Should we see the same gastro, or someone else? And have you ever, ever heard of an illness like this?! It's just... weird. Really weird.
posted by Andrhia to Health & Fitness (43 answers total) 1 user marked this as a favorite
Why would you administer an antibiotic if you did not know what the cause was? Besides, a 10-day bacterial infection would cause far more serious problems than you are experiencing now.

Anyway, could the vomiting be connected to asthma? As I recall, steam and water vapour (or perhaps chlorine if your local water is treated) can trigger asthma, which can maybe cause a pukey feeling (asthma can do that to me).
posted by KokuRyu at 10:29 AM on December 12, 2012 [2 favorites]

Plus, from my experience, doctors can be stumped by children and viruses (which can not be treated with antibiotics). At the age of 8, our son had this really, really weird rash that occurred each night at bedtime on his trunk, arms, legs and face, after having a bath. It disappeared during the day, and would always come back at night. It lasted for 3 or 4 nights.

We thought it might be an allergy or something, but the doctor said it was a virus. There are so many viruses out there, and kids tend to be less resistant to them than adults, that it's hard to tell what is going on.

Ten days seems a little long, though, and the rule of thumb is to go to a doctor if it lasts more than a week. It seems you have, though, so...
posted by KokuRyu at 10:32 AM on December 12, 2012

We have not started using new shower products.

Allergies don't have to be to something newly introduced. Could she have become allergic (sensitized) to something already present?
posted by Jahaza at 10:33 AM on December 12, 2012

I am not a parent, I am not a doctor, showers do not make me puke.

...Mold, maybe? In that specific bathroom wall? The only way I could think to test that is by trying to take a shower in a different bathroom, which...sounds like a cumbersome thing to set up, I'll admit.
posted by EmpressCallipygos at 10:34 AM on December 12, 2012 [5 favorites]

I'm not sure why you're going against the doctor's recommendation. Are concerned more about the overuse of anti-biotics, or about your daughter's health? Right now you are gambling that this isn't pnemonia or a some other anti-bacterial infection, but you have no other explaination of what it might be.

Seriously, the ramifications of overusing this anti-biotics this one time isn't going to kill her. You can't be quite so certain with a bacterial infection.
posted by nikkorizz at 10:34 AM on December 12, 2012

Poor kid, that sounds godawful.

When I was 11, the only noticeable symptom that I had of asthma was that, every day, I became extremely nauseated and vomited at around the same time . We didn't even know I had asthma until I was taken to the doctor for getting pukey every day around 2:00 p.m. Considering her health issues, maybe don't rule out asthma exacerbation yet? We never figured out what was making mine flare up at 2:00 p.m., so it might not be easy to figure out the trigger.
posted by Coatlicue at 10:39 AM on December 12, 2012 [3 favorites]

This is just me speculating and spitballing and I am not a doctor or a parent.

Does she wash her hair during the showers/baths? Could she be accidentally ingesting shampoo or even soap on her face while rinsing? I wash my face in the shower and one time gulped down some Cetaphil during a clumsy rinse and ... urk.
posted by kimberussell at 10:42 AM on December 12, 2012 [1 favorite]

Have her shower at a different time of the day (in the morning? not at all?) and see what happens? I'm thinking that might help you tell whether it's something about the time of day, or something about the bathroom, or something about the water? (maybe she's relaxing for the first time all day? Maybe its steamy and that's releasing mucus?)
posted by dpx.mfx at 10:45 AM on December 12, 2012 [5 favorites]

I may have had something similarish. I had a bad sinus infection without realising it steamy showers (and hot drinks) would make all the yucky infected stuff run and it went down into my stomach and I would feel nauseous as all get out after a shower and would have to lay down for a while. Antibiotics cleared it right up for me. IANAD in anyway shape or form and this is just my experience.
posted by wwax at 10:45 AM on December 12, 2012 [9 favorites]

I saw something really similar to this on Mystery Diagnosis. It was a seizure and it happened in the middle of the night. Perhaps a neurologist would be a good stop?

Arnold-Chiari Malformation is another thought. (or perhaps the same thought, it came up in the Google.)
posted by Ruthless Bunny at 10:46 AM on December 12, 2012

No answers here, but a few things to consider:
What is she eating for dinner that might have changed? Is dinner the last thing she eats before bedtime?
Have her hormones started to kick in, even a tiny bit? Could this mean a change in her senstivities and needs? Sorry to ask a sensitive question, but things do start moving right along and changing before very obvious changes show.
If she does take antibiotics, maybe consider probiotics to help recover. I give my kids (and myself) acidophilus. There are dairy-free brands available.
Take care of your daughter! Good luck!
posted by mamabear at 10:50 AM on December 12, 2012

When I had mono, I got so exhausted from taking a shower that I had to lay down on the floor for about 10 minutes to recover. I would also feel nauseous during this period, but I have a cast-iron stomach and only throw up about once a decade. I could see how people with more delicate stomachs might have this side effect from mono.
posted by jabes at 10:52 AM on December 12, 2012

Another person who finds showers vomit-inducing when she has a sinus or ear infection brewing chiming in.

I have a friend with persistent labrynthitis who can't shower because it gives her vertigo. Can your daughter try baths, not too warm, for a bit?
posted by Sidhedevil at 10:52 AM on December 12, 2012 [1 favorite]

I went through this in college--admittedly I was much older than 10--and it had to do with stomach acid. Basically, my doctor had me track all sorts of things (some of which will not be relevant to a 10 year old), including my period, my food intake, my alcohol intake, stress and lapse of time between food and any given activity and the vomiting. Came down to laryngopharyngeal reflux making me barf.

Vomiting is often associated with children who have gastro-esophageal reflux disease and my doctor said, that in her experience, it was not uncommon for people with reflux problems to reflexively vomit under some combinations of empty stomach, exertion, or moist heat (like a shower). Was your daughter very very drooly as an infant? That can be associated with reflux issues, too.

Oddly enough, a good friend had her problems with reflux misdiagnosed as asthma.
posted by crush-onastick at 10:52 AM on December 12, 2012 [8 favorites]

Seconding EmpressCallipygos - although I would take your daughter to someone else's house and have her shower there, maybe a relative who'll be understanding if your daughter gets sick. That may help rule out an environmental as opposed to endogenous cause.
posted by Currer Belfry at 10:52 AM on December 12, 2012 [3 favorites]

...gave me a prescription for Omnicef in case it was something like a sinus infection or pneumonia presenting in a nonstandard way. As loathe as I am to overuse antibiotics... we figure it can't hurt...?

In the absence of serious side-effects, I'd take this advice. I've had a couple of cases personally where a viral flu developed into an bacterial infection. In both cases, the bacterial infection took longer to get over and was much more serious. Even if this is prophylactic, to keep the opportunist bugs away while she gets over what ever this is, I think it's a good precaution for something that is more than a run of the mill bout of the flu.
posted by bonehead at 10:54 AM on December 12, 2012 [1 favorite]

Any incidence of dizziness/faintness/syncope? How is her blood pressure? Does she have anxiety?

I have low blood pressure, have experienced 'shower fainting,' and have had panic attacks triggered by shower faintness as well. Seems unlikely but something to consider.
posted by trunk muffins at 10:54 AM on December 12, 2012

One issue with antibiotics, however, is that they can cause nausea as well. Omnicef/cefdinir does list this as one of its side-effects, as expected. If she's having GI trouble, already suffering from IBS, this may be something to weigh in balance.
posted by bonehead at 11:00 AM on December 12, 2012 [1 favorite]

Just a thought - does your daughter grind her teeth when she sleeps? It could be a sign of acid reflux (teeth grinding stimulates saliva, which, when swallowed, can help alleviate acid reflux when sleeping).
posted by KokuRyu at 11:02 AM on December 12, 2012

Response by poster: Updates! She just took a midday shower -- when dpx.mfx suggested it she was already in there, hah. She said she felt pretty bad in the middle but it cleared up and she didn't actually throw up. Make of this what you will.

Other points of information: Last night's bath (not shower!) was in a different bathroom on a different floor of the house, using the same conditioner but a different body soap. She says the water was "barely room temperature."

Antibiotics: Not giving the antibiotic isn't going against the doctor's advice -- she was waffling on even giving it to me, it was "Humm, maybe this is a thing we should try, I don't know, maybe, but I don't think it'll help, and it might make her nauseous" and not "This is a thing you should do." But I think I will give it to her, as it's never upset her stomach before. The doctor suggested twice a day and not once to minimize it causing worse stomach problems.

Asthma: She's been on nebulized albuterol and pulmicort for the last few days, so even if it were initially caused by asthma, you'd think it would be clearing up ny now. She's definitely not wheezing anymore. And her bad asthma attacks -- the go-to-the-ER-overnight kind -- have never included vomiting before, so it's not one of my prime suspects.

Reflux: It's one of the paths they went down with her stomach aches. The reflux meds they gave us made her puke and didn't help. Heh. I suspect that sort of thing would've shown up on the endoscopy she had last year? And she was never a spitter-upper as a baby...

Puberty: She is also definitely Developing in That Way. So there is a solid chance this could be related somehow.

Dizziness: Come to think of it, she has reported some dizziness. Though not ongoing.

Anxiety: She is an anxious kid, yes. We've been keeping an eye on it.

Teeth grinding: Nope, not that we've ever noticed. She sleeps with her mouth wide open...

IBS: Not actually her prior problem. We resolved that entirely by limiting how much fruit she eats.

So it sounds like I might not be crazy in my speculation that this is an otherwise silent sinus infection? Even despite a runny nose or congestion?
posted by Andrhia at 11:13 AM on December 12, 2012

Nthing check for GERD. If you can't get in to see a doctor again anytime soon, start her on a BRAT diet and go from there. Moving her to beige bland foods can't hurt, and if it helps, you have at least a partial answer. If the medication she was on for reflux made her vomit, try another one, or give her a chewable acid controller like Rolaids Chews.

From a pragmatic point of view, I personally wouldn't bother to give a kid a medication that needs to build up in the system if she is likely to vomit it up.
posted by juniperesque at 11:14 AM on December 12, 2012

Cyclic vomiting syndrome? I haven't heard of a shower as a specific trigger, but I suppose it's possible?

Also, like jabes, I thought of mono. I threw up on a nurse myself once when I had mono.
posted by pie ninja at 11:30 AM on December 12, 2012 [1 favorite]

Ask her school if there's been a rash of any infections (pun intended) recently. And mono sounds possible too.

What temperature showers does she regularly take?
posted by I-baLL at 11:32 AM on December 12, 2012

It could absolutely be a mucus-from-cold-or-infection thing. Especially if she's prone to sniffling back nose drips rather than blowing them out, it's not too hard to end up with a bunch of swallowed snot. Which I am here to tell you, as an asthma-having sinus-infection-prone person, can definitely cause some really unpleasant pukiness, especially if loosened up by coughing or steam from a shower.

Has she complained of any headaches or anything? That and the vertigo/dizziness you note are the other symptoms I get a lot when bad things are brewing in my nasal cavities.
posted by badgermushroomSNAKE at 11:45 AM on December 12, 2012 [1 favorite]

Are you/is she using unscented shampoo, conditioner, soap? It's possible that fragrances could set off nausea, or a mysterious migraine-like condition.
posted by amtho at 11:46 AM on December 12, 2012

"In the end we had to take matters into our own hands and do a Serious Elimination Diet. This application of the scientific method led us to self-diagnose and actually find a way to make her feel better. Which she does! Though she misses smoothies a lot."

An elimination diet outside of direct medical supervision of someone who knows what they are doing, preferably a registered dietitian, is not actually as likely as you would think to produce meaningfully good results and can cause further harm. This is something that is very much worth asking your pediatrician about, who may refer you to the gastroenterologist who may refer you to a dietitian.

Your kiddo sounds like she has a really complicated medical history that we are in no way equipped to interface responsibly with, there has already been a significant amount of irresponsible/ignorant advice in this thread and I would strongly urge you to follow the advice given by your child's physicians as best you can. It is not entirely clear from your question, but have you given your pediatrician a heads up about the shower connection? If not that would very much be worth at least call to the office.
posted by Blasdelb at 11:56 AM on December 12, 2012 [1 favorite]

I used to vomit a lot after showers because they were really hot and I was really dehydrated. I was also on a sports team, and typically showering after my work out and then before bed.

What helped was drinking more water, and getting more electrolytes.
posted by spunweb at 12:11 PM on December 12, 2012 [2 favorites]

I read somewhere that sinus infection is a possible cause (mucous loosened up by warm steam and then dripping down).
posted by Dansaman at 12:28 PM on December 12, 2012 [1 favorite]

Is the bathroom well ventilated, with a window and/or door open if possible? Steam replaces breathable air, and having low oxygen obviously could make you sick.
posted by serena15221 at 12:39 PM on December 12, 2012

I used to vomit a lot after showers because they were really hot and I was really dehydrated. I was also on a sports team, and typically showering after my work out and then before bed.

I used to get dizzy and nauseous in the exact same circumstances - definitely seconding hydration. Also, ear infections will totally screw with your sense of balance and will make you nauseous.
posted by restless_nomad at 12:55 PM on December 12, 2012

You might want to try testing her hormone levels. An estrogen surge can cause what is essentially the equivalent of morning sickness. Which, of course, doesn't have to happen in the morning.
posted by Citrus at 1:24 PM on December 12, 2012

Does she have low blood pressure? I do, and as a kid I often felt nauseous after showering. Don't know why and it rarely went all the way to vomiting, but I saw it mentioned upthread and wanted to add some anecdata.

I want to join the chorus of suggestions that you not use the prophylactic antibiotic. We're just starting to understand how important gut bacteria are and how disruptive antibiotics can be, and the kid already has GI issues, and it was prescribed on just a hunch... so I would hold back.
posted by telegraph at 1:32 PM on December 12, 2012

Does she have low blood pressure? I do, and as a kid I often felt nauseous after showering.

Ooh, good point - I do too, and have to be really careful to eat enough salt, especially if I've been sweating (for any reason.) Hydrate with gatorate or pedialyte or coconut water as well as just water.
posted by restless_nomad at 1:39 PM on December 12, 2012

Is there any stress about bathing besides this new symptom?
posted by R2WeTwo at 2:21 PM on December 12, 2012

Response by poster: I think there's enough support for the sinus infection theory to start the antibiotic, so I have.

I do not know what her blood pressure is like; mine is on the low side, but her doctor has never commented.

The hormone theory is an interesting one. She's getting to be that age, and the Googles do say vomiting can be a side effect of emergent puberty... but I can't find anything about how exactly that vomiting would present. Tricksy.

The bathroom is not ventilated -- actually we're putting a fan in any day now. But again, she's also woken up in the middle of the night to puke, so environmental factors aren't the *only* thing going on here. For the same reason, I doubt dehydration or electrolyte imbalances are the culprit. Dehydration doesn't have you waking mommy up at 3am because your tummy hurts and you need a hug.

The elimination diet and conclusion were retroactively blessed by her pediatrician. I figured enough kids live on chicken nuggets and rice at her age; a couple of weeks of broiled chicken, rice, and re-introducing other foods once a day wasn't going to do her any permanent harm. The conclusion is pretty bullet-proof, too. You give the kid a spoonful of honey -- pure fructose -- and she has the worst stomach pain ever. No fructose, no stomach pain. And we were desperate at that point, she'd been missing on average one and a half days of school every week all year. Just letting her suffer and not trying everything we could seemed like the less responsible option.
posted by Andrhia at 2:35 PM on December 12, 2012

For the same reason, I doubt dehydration or electrolyte imbalances are the culprit

They may not be the only thing going on, but they could be contributory. She pukes for whatever reason, gets dehydrated from puking, hot shower makes her sweat and get dehydrated worse, pukes more, etc and etc. Basically if you're puking a lot you need to stay well ahead on the hydration front anyway.
posted by restless_nomad at 2:42 PM on December 12, 2012

Perhaps she bends her head in a certain way while bathing or showering, triggering vertigo? I have occasional problems with the "stones in the ear" moving around and the head position of hair washing is a trigger, for sure.

Amazing investigation here, MetaFilter!
posted by Riverine at 5:36 PM on December 12, 2012

Not to add to the stress and anxiety she's probably already going though, but are you sure she's sticking to her dietary constraints? I would always sneak candy or soda from my friends at school when I was that age. She may know that it makes her sick but might have a hard time resisting the temptation or peer pressure.
posted by arcolz at 7:20 PM on December 12, 2012

I had a similar issue when I was that age - went on for a few months as I vaguely remember - just always felt sick to my stomach after having the morning shower. I think the cause was definitely mold of some nature - either in the tracks of the shower, in the bathroom fan, or in the towel pile ( my parents kept bedding and towels in a linen closet within the bathroom, which had mold as I later found out). Hope you can source out the cause soon - mine went away over time.
posted by NorthernAutumn at 10:56 PM on December 12, 2012

About her age, until I was grown, I had several horrible bouts of stomach problems that looked pretty much like food poisoning but didn't appear to be that (no one who ate the same thing got sick, no other symptoms, etc.) I was hospitalized once when I stopped being able to keep anything down...they hydrated and tested me, sent me home, and never did figure out what was wrong. And I was fine 99% of the time.

But at that age, I also had horrible PMS cramps, some fainting, etc. And I still can't handle BC pill hormones and have to use other methods because I get sick. So maybe I have a hormone sensitivity that affected my stomach during puberty. Maybe she does too.

All speculation, I am no kind of doctor, but I have also been the one sitting in the doctor office when they shrug and look baffled by your stomach problems. It's possibly one of those things that just hasn't been labeled yet.
posted by emjaybee at 1:03 PM on December 13, 2012

Response by poster: An update: She was sick last night, but she's had a solid 24 hours now, and I'm optimistic for the night. She's reporting feeling bad, but not immediately need-to-hang-in-the-bathroom bad. This is... progress...?

Meanwhile the gastro was supposed to call me back today but did not. Sigh.

I am taking the dehydraiong angle seriously, though I am still unconvinced.

And thank you, everyone, for your input. It's comforting just to have a lot of minds turning the problem over. I'll keep you posted...
posted by Andrhia at 6:34 PM on December 13, 2012

Response by poster: And I think our final report: She started feeling better basically within a day of starting the antibiotic. Since then, her nose has been stuffy and runny, supporting that sinus infection theory -- all the yuck is draining out now, right?

Either way, she's feeling better and I regret nothing.
posted by Andrhia at 10:55 AM on December 18, 2012

Another thought which may support the "sinus infection" theory - I have a really, really strong gag reflex, and sometimes post-nasal drip aggravates it. I don't necessarily register the nasal or sinus congestion, but I definitely feel the drip down the back of my throat triggering my gagging.

If your daughter's gag reflex is also kind of strong, the steam could have been loosening things up in there, and they may have gone down the back of her throat and triggered gagging -- and from there, throwing up.

But sounds like this is progress. Yay!
posted by EmpressCallipygos at 11:27 AM on December 18, 2012

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