Calling Dr House...
July 31, 2017 3:38 AM Subscribe
Please help solve a medical mystery. My four year old daughter has started vomiting about half an hour after eating. Initially I thought it was a stomach bug (which she had three weeks previously) but she has no other symptoms. Before the gastro she also had bad bronchitis (winter in Australia) which was treated by antibiotics.
So the vomiting has been going on for two weeks, maybe three, now. Initially we thought it was because she was gorging her food or leftover from the gastro she had previously but now I think it's something else. Our local doctor has tested a stool sample for giardia and other exotic bugs and come up with nothing. She doesn't have diarrhoea, headaches, fever, congestion, stomach pain or anything else. She does have eczema (she's always had that) but it is much worse now.
So, what sets it off? I was leaning towards lactose intolerance as when I first noticed, it occurred straight after ice cream and hot chocolate, so we cut out milk products. (These are occasional treats so we weren't making the connection that there could have been a trigger there for a week or two.)
Eggs, toast and condiments in the morning don't set her off. Fruit, plain vegetables and sandwiches or wraps with salad are fine (large portions of her diet). Dinner is more of an issue. We went out for Chinese (mostly dumplings, no soy sauce or dairy) and that triggered it. For lunch she had sushi with tuna and avocado and for dinner she had veal tortellini (no sauce) and that triggered it.
When she vomits, it occurs about half an hour after. She doesn't completely purge her stomach, it's more like a baby's reflux, mainly saliva with a small amount of stomach contents, say 20ml, and she'll do this about six times.
I saw the doctor a few days ago - when I still thought it was lactose intolerance - and he has referred me to a pediatrician but I won't get to see them for another three weeks. I'm keeping a food diary now but I'm completely flummoxed and Dr Google, as to be expected, is throwing out all the scary things, celiacs, lactose intolerance, crohns, heck, brain tumours!
I'm sure this coming doctor will test for all sorts of things but in the meantime, does anyone have any ideas? I'm now thinking a food allergy of some sort, I'm even leaning towards the antibiotics we gave her might have upset her stomach flora and be causing this, even though I have her probiotics religiously at the time, but I just don't know. After tonight, I'm going to give her an even blander diet and see if that helps.
So the vomiting has been going on for two weeks, maybe three, now. Initially we thought it was because she was gorging her food or leftover from the gastro she had previously but now I think it's something else. Our local doctor has tested a stool sample for giardia and other exotic bugs and come up with nothing. She doesn't have diarrhoea, headaches, fever, congestion, stomach pain or anything else. She does have eczema (she's always had that) but it is much worse now.
So, what sets it off? I was leaning towards lactose intolerance as when I first noticed, it occurred straight after ice cream and hot chocolate, so we cut out milk products. (These are occasional treats so we weren't making the connection that there could have been a trigger there for a week or two.)
Eggs, toast and condiments in the morning don't set her off. Fruit, plain vegetables and sandwiches or wraps with salad are fine (large portions of her diet). Dinner is more of an issue. We went out for Chinese (mostly dumplings, no soy sauce or dairy) and that triggered it. For lunch she had sushi with tuna and avocado and for dinner she had veal tortellini (no sauce) and that triggered it.
When she vomits, it occurs about half an hour after. She doesn't completely purge her stomach, it's more like a baby's reflux, mainly saliva with a small amount of stomach contents, say 20ml, and she'll do this about six times.
I saw the doctor a few days ago - when I still thought it was lactose intolerance - and he has referred me to a pediatrician but I won't get to see them for another three weeks. I'm keeping a food diary now but I'm completely flummoxed and Dr Google, as to be expected, is throwing out all the scary things, celiacs, lactose intolerance, crohns, heck, brain tumours!
I'm sure this coming doctor will test for all sorts of things but in the meantime, does anyone have any ideas? I'm now thinking a food allergy of some sort, I'm even leaning towards the antibiotics we gave her might have upset her stomach flora and be causing this, even though I have her probiotics religiously at the time, but I just don't know. After tonight, I'm going to give her an even blander diet and see if that helps.
I should add, I'm not a doctor but I used to be a regular thrower-upperer and the things I mentioned were triggers.
posted by kitten magic at 4:07 AM on July 31, 2017
posted by kitten magic at 4:07 AM on July 31, 2017
Does she have anything stressful going on in her life? I get very nauseated when stressed, to the point of vomiting and can only eat bland small meals. This is combined with a history of reflux and a scarred throat, so I more easily vomit than most. Kids can express stress through not sleeping well or what look like skin allergies, and stomach upsets are pretty common, and it can be something that seems minor to an adult but huge from their perspective like a new childcare teacher or other changes.
The pediatrics gastro people I've dealt with for my kids have been very helpful for weird stuff, so I would push for a referral faster if you can. Allergies tend to have wider symptoms and this sounds more like something going on in her throat/oesophagus/tummy. It could just be like a tiny ulcer irritating her.
I would be methodical about trying textures of food (smoothies, porridge, dry foods) and quantities, and see if there's a pattern, and otherwise just keep her comfortable and fed until you get a specialist.
posted by dorothyisunderwood at 4:13 AM on July 31, 2017 [1 favorite]
The pediatrics gastro people I've dealt with for my kids have been very helpful for weird stuff, so I would push for a referral faster if you can. Allergies tend to have wider symptoms and this sounds more like something going on in her throat/oesophagus/tummy. It could just be like a tiny ulcer irritating her.
I would be methodical about trying textures of food (smoothies, porridge, dry foods) and quantities, and see if there's a pattern, and otherwise just keep her comfortable and fed until you get a specialist.
posted by dorothyisunderwood at 4:13 AM on July 31, 2017 [1 favorite]
A child has been vomiting for three weeks, and the pediatrician won't see her for another four? This seems unreasonable to me; children that small are very easily dehydrated. I don't know what your medical services are like there, but I would press this issue. Additionally, and not to frighten you unnecessarily, but there's a choking hazard here every time she vomits.
I would call them back. Be THAT parent. See if someone cancels an appointment, if you can take that slot. And look up the symptoms of dehydration, and watch her closely after these vomiting episodes. If you see signs of dehydration, emergency treatment is called for.
Consider sticking with the list of non-triggering foods you shared above until the appointment. It'll get repetetive, but you have nutritional variety in there. Vomiting is exhausting and risky, and I'm sure you're all ready for a break from it.
Sending you some good vibes. I know how stressful this is.
My own kid had a non-allergic sensitivity to animal proteins, a couple of food additives, and a non-food-related anxiety around social issues that caused his problems at around that age. It seemed very Big and Complex and Life-altering at the time (and it kind of was) but became our normal, and he's now a functioning independent adult who has found that ALL of his friends have some food thing or another. I'm hoping your family's problem is similarly manageable.
posted by Nancy_LockIsLit_Palmer at 4:25 AM on July 31, 2017 [8 favorites]
I would call them back. Be THAT parent. See if someone cancels an appointment, if you can take that slot. And look up the symptoms of dehydration, and watch her closely after these vomiting episodes. If you see signs of dehydration, emergency treatment is called for.
Consider sticking with the list of non-triggering foods you shared above until the appointment. It'll get repetetive, but you have nutritional variety in there. Vomiting is exhausting and risky, and I'm sure you're all ready for a break from it.
Sending you some good vibes. I know how stressful this is.
My own kid had a non-allergic sensitivity to animal proteins, a couple of food additives, and a non-food-related anxiety around social issues that caused his problems at around that age. It seemed very Big and Complex and Life-altering at the time (and it kind of was) but became our normal, and he's now a functioning independent adult who has found that ALL of his friends have some food thing or another. I'm hoping your family's problem is similarly manageable.
posted by Nancy_LockIsLit_Palmer at 4:25 AM on July 31, 2017 [8 favorites]
With getting a faster referral, one way is to call around a few to see the waiting times and then ask your GP to write a referral to that person. They'll often just refer you to the one they've used before but don't have objections to others, they are just going with what they know. Specialist's offices are usually fine with you getting the appointment and accepting the referral either by fax/email later or on the day (sorry if you know all this).
posted by kitten magic at 4:34 AM on July 31, 2017
posted by kitten magic at 4:34 AM on July 31, 2017
She doesn't have diarrhoea, headaches, fever, congestion, stomach pain or anything else.
I don't have a solution for you, but I'd be careful of taking a four year old's self-reporting regarding pain (or other symptoms that are not visible to you) at face value. At that age, kids don't always have a good sense of what 'normal' feels like. Ditto for anxiety - she may not be able to articulate that she feels anxious or scared. I was in my late teens before I was able to properly connect my bouts of nausea to certain types of stress.
This sounds awful for her and for you, I hope you get it resolved soon.
posted by une_heure_pleine at 4:35 AM on July 31, 2017 [3 favorites]
I don't have a solution for you, but I'd be careful of taking a four year old's self-reporting regarding pain (or other symptoms that are not visible to you) at face value. At that age, kids don't always have a good sense of what 'normal' feels like. Ditto for anxiety - she may not be able to articulate that she feels anxious or scared. I was in my late teens before I was able to properly connect my bouts of nausea to certain types of stress.
This sounds awful for her and for you, I hope you get it resolved soon.
posted by une_heure_pleine at 4:35 AM on July 31, 2017 [3 favorites]
If it is happening after gorging food it could be a hiatal hernia. If she is eating fast, see if she is having any discomfort or an odd feeling in her chest. It may feel the same as her bronchitis, or the bronchitis may be related.
posted by Short End Of A Wishbone at 5:05 AM on July 31, 2017
posted by Short End Of A Wishbone at 5:05 AM on July 31, 2017
I don't have a suggestion of what it could be, but I want you to take care of her teeth. DON'T BRUSH them right after she's refluxing/vomiting. Get her to rinse and chew half a Tums (Calcium heartburn relief chewable)- she doesn't have to swallow it, but it might help with any acid related burning in her esophagus. The Tums will neutralize the acid on her teeth and help prevent enamel damage. (My kids are/were pukers/refluxers)
I agree with others that you should call the pediatrician on a regular basis and check for cancellations. It is unfair to ask a 4 year old to continue vomiting on a daily basis for 4 more weeks. Best of luck.
posted by PorcineWithMe at 5:33 AM on July 31, 2017 [2 favorites]
I agree with others that you should call the pediatrician on a regular basis and check for cancellations. It is unfair to ask a 4 year old to continue vomiting on a daily basis for 4 more weeks. Best of luck.
posted by PorcineWithMe at 5:33 AM on July 31, 2017 [2 favorites]
Could it be cyclical vomiting syndrome or abdominal migraines?
I'm pretty sure I had something like this as a kid. I would get sick to my stomach in all kinds of situations, but especially ones I found stressful and wanted to get out of. The stress of vomiting itself seemed to compound my distress, which of course only made me vomit more. And while I wasn't being sick on purpose, I suspect that the stressful home environment around me - which often became more nurturing when I was sick - probably reinforced the pattern of vomiting in response to stress and caused me to be more ill, more often.
Has there been anything stressful happening at home? Assume a 4-year-old's definition of "stressful", which could include anything from the original bout of gastro, to changes to her routine, to caregivers being visibly distressed by her illness, etc, as well as more obvious sources like conflict in the home or at preschool. Anything you can do to increase her sense of predictability, normality and safety - even though you are probably (understandably!) distressed and worried yourself - might help ease her distress and settle her stomach.
But also, yes, I agree with others suggesting that you get her in to see a specialist sooner rather than later. Could your GP give you a referral to the local children's hospital?
posted by embrangled at 5:36 AM on July 31, 2017
I'm pretty sure I had something like this as a kid. I would get sick to my stomach in all kinds of situations, but especially ones I found stressful and wanted to get out of. The stress of vomiting itself seemed to compound my distress, which of course only made me vomit more. And while I wasn't being sick on purpose, I suspect that the stressful home environment around me - which often became more nurturing when I was sick - probably reinforced the pattern of vomiting in response to stress and caused me to be more ill, more often.
Has there been anything stressful happening at home? Assume a 4-year-old's definition of "stressful", which could include anything from the original bout of gastro, to changes to her routine, to caregivers being visibly distressed by her illness, etc, as well as more obvious sources like conflict in the home or at preschool. Anything you can do to increase her sense of predictability, normality and safety - even though you are probably (understandably!) distressed and worried yourself - might help ease her distress and settle her stomach.
But also, yes, I agree with others suggesting that you get her in to see a specialist sooner rather than later. Could your GP give you a referral to the local children's hospital?
posted by embrangled at 5:36 AM on July 31, 2017
Best answer: I agree, it sounds like acid reflux. You said she had the stomach bug not too long ago. If she was throwing up a lot this can mess with the stomach and acid reflux can linger for a few weeks afterwards. This happens to me. Just have her continue eating things that have been proven safe (and in smaller amounts) and hopefully she will be back to normal soon.
(Don't try to fight acid reflux with tums, they can actually prolong it)
posted by blackzinfandel at 6:18 AM on July 31, 2017
(Don't try to fight acid reflux with tums, they can actually prolong it)
posted by blackzinfandel at 6:18 AM on July 31, 2017
I wonder if she's eating too fast and packing food down and not giving it enough time to get into the stomach. Perhaps learning to slow down would help, such as putting the utensils down while chewing and swallowing, then pick them back up for the next bite. Just a thought but I seem to have heard this advice before for reflux-style vomiting. Good luck.
posted by MovableBookLady at 7:38 AM on July 31, 2017
posted by MovableBookLady at 7:38 AM on July 31, 2017
Response by poster: My husband corrected me on my choice of words - and he's right - it is actually reflux and not vomiting. I agree with you all that she needs to see someone sooner, however my original appointment was supposed to be mid October and I put my foot down at waiting that long, so the receptionist found another paediatrician (that I'm not referred to) which is why it's now mid August.
I've attempted other doctors already and this is the earliest I can get in. I will keep trying though. (And thank you for reminding me to check for cancellations, that was helpful). Seeing a specialist in a timely manner in this city is very difficult, I think it was an 8 month wait for an ENT (I actually went interstate to get my tonsils out as it was far quicker) and a year for some other specialists.
I am taking on board everyone's comments. My daughter has no anxiety that we know of, we have a stable boring family life (no changes in routine) with no family drama aside from occasional sibling squabbles. She's a pretty happy little girl. The more I think about it, my very non medical opinion is that this is acid reflux associated with the original gastro.
On the upside she had cereal this morning with almond milk and no reflux, so that was a win. We also focused on eating slowly. Maybe she is on the mend. I'm going to try and introduce different kinds of probiotics into her diet and see if it makes a difference and in the meantime, keep hammering the paediatricians. Thank you all!
posted by Jubey at 7:05 PM on July 31, 2017 [1 favorite]
I've attempted other doctors already and this is the earliest I can get in. I will keep trying though. (And thank you for reminding me to check for cancellations, that was helpful). Seeing a specialist in a timely manner in this city is very difficult, I think it was an 8 month wait for an ENT (I actually went interstate to get my tonsils out as it was far quicker) and a year for some other specialists.
I am taking on board everyone's comments. My daughter has no anxiety that we know of, we have a stable boring family life (no changes in routine) with no family drama aside from occasional sibling squabbles. She's a pretty happy little girl. The more I think about it, my very non medical opinion is that this is acid reflux associated with the original gastro.
On the upside she had cereal this morning with almond milk and no reflux, so that was a win. We also focused on eating slowly. Maybe she is on the mend. I'm going to try and introduce different kinds of probiotics into her diet and see if it makes a difference and in the meantime, keep hammering the paediatricians. Thank you all!
posted by Jubey at 7:05 PM on July 31, 2017 [1 favorite]
My oldest spent a couple months throwing up after every meal, starting when he was between 6-7 months old. His pediatrician kept telling me he was fine. When he started losing weight, I took him to the pediatric ER across town and told the nurse I wasn't leaving until somebody could tell me what was wrong with my son. A few hours later, a doctor looked him over, listened to his history, and said, "Well, heck, that sounds like acid reflux to me." He prescribed Zantac, and after the first dose, my son had no more problems.
You can't get kiddo-size Zantac over the counter, otherwise I'd be suggesting a pharmacy run. Everyone else's recommendations around food sound exactly right.
Hang in there!!
posted by The Almighty Mommy Goddess at 7:52 PM on August 3, 2017
You can't get kiddo-size Zantac over the counter, otherwise I'd be suggesting a pharmacy run. Everyone else's recommendations around food sound exactly right.
Hang in there!!
posted by The Almighty Mommy Goddess at 7:52 PM on August 3, 2017
So I've been down this path with 2 kids-one has a much worse case of GERD than the other. My severe GERD kid was on PPIs for a loooooong time. Long time. He ended up with SIBO which has been a complete fucking nightmare. What I'm really saying is that you may want to do some research into dietary changes and other symptom relief before jumping on board with whatever the doctor says. We used a pediatric GI for all of my child's life and he NEVER ONCE mentioned SIBO as a possible outcome of long term use. We are now exploring the Fast Tract Diet and doing less sugar but it's tough with a (now) seven year old. I hope you are able to get competent help for your child. Feel free to reach out via memail if you want to compare notes.
posted by PorcineWithMe at 10:42 AM on August 4, 2017
posted by PorcineWithMe at 10:42 AM on August 4, 2017
Response by poster: Just thought I'd update you. So the reflux cleared up a few days before I saw the paediatrician. She nevertheless sent me to get extensive testing (which I wanted because I was after an explanation for the eczema as well) which included blood tests, ultrasound and allergy prick tests. Everything came up negative.
At this point we have her off lactose and citrus as it seemed to exacerbate the reflux and eczema (intolerances rather than actual allergies). The doctor agreed with me that the original bout of gastro has probably made her lactose intolerant and brought this on, in the absence of any other explanation. She thinks my daughter's eczema is genetic rather than food/environment and in all likelihood she will grow out of it, and then gave me a bunch of creams and advice on how to manage it.
Both the allergist and paediatrician told me to start slowly bringing back these food in about six months and see if her system can handle it better then. Thanks for all the suggestions and while it wasn't fun, I'm also glad it seems to be resolving and isn't something more serious.
posted by Jubey at 9:43 PM on October 3, 2017 [1 favorite]
At this point we have her off lactose and citrus as it seemed to exacerbate the reflux and eczema (intolerances rather than actual allergies). The doctor agreed with me that the original bout of gastro has probably made her lactose intolerant and brought this on, in the absence of any other explanation. She thinks my daughter's eczema is genetic rather than food/environment and in all likelihood she will grow out of it, and then gave me a bunch of creams and advice on how to manage it.
Both the allergist and paediatrician told me to start slowly bringing back these food in about six months and see if her system can handle it better then. Thanks for all the suggestions and while it wasn't fun, I'm also glad it seems to be resolving and isn't something more serious.
posted by Jubey at 9:43 PM on October 3, 2017 [1 favorite]
This thread is closed to new comments.
Is she anxious about anything? It seems like it's after the evening meal - anything preceding dinner that's a common denominator? She's not spinning herself around like a whirlwind or anything like that while playing before dinner?
posted by kitten magic at 4:05 AM on July 31, 2017 [1 favorite]