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Cyclic Vomiting Syndrome

Cyclic vomiting syndrome (CVS) in children is a condition in which a child has repeated episodes, or cycles, of severe nausea and vomiting. In between these cycles, the child is generally healthy.

During a CVS cycle, the child will often vomit several times per hour; the cycle can last from a few hours to a few days. The symptoms can begin at any time of day, but often start late at night or in the early morning.

Each child’s cycles of CVS tend to be similar: they start at the same time of day, last about the same length of time, and have similar symptoms with the same intensity. On average, a child who has CVS has about 12 episodes per year. In most cases, CVS stops on its own without treatment.

How common is cyclic vomiting syndrome?

It is not known exactly how common CVS is, but it is estimated to affect up to 2.2 percent of children in the United States. It is slightly more common in girls than in boys.

Children in pre-school or early school years are at the greatest risk for CVS; the average age among children who get CVS is 5 years old. While CVS usually occurs in children, it can occur in adults as well.

What causes cyclic vomiting syndrome?

The cause of CVS is not known, but children who have it also often have migraine headaches and another disorder similar to CVS called abdominal migraine. Most patients with CVS have a family history of migraines, especially on the mother’s side of the family.

While experts are uncertain of a cause, there are certain things that can cause an attack of CVS. They include:

  • infections, especially colds, sinusitis, and the flu
  • situations that cause great excitement, such as birthdays and holidays
  • emotional stress
  • certain foods, such as chocolate and cheese
  • not eating for long periods
  • lack of sleep
  • motion sickness
  • overexertion (trying to do too much)
  • allergies
  • menstruation (monthly periods)

How do I know if my child has cyclic vomiting syndrome?

There are many conditions that can cause nausea and vomiting. When a child has CVS, he or she will have a pattern (cycle) of severe vomiting attacks that occur on a regular basis, followed by periods of normal health and no vomiting.

CVS may have four distinct phases:
  1. Prodrome – This is a "warning" phase that signals an attack is coming. Some patients have symptoms during this phase, such as nausea, stomach pain, headache, or anxiety. This is seen in up to 60% of patients.
  2. Vomiting – This is when the attack--vomiting or retching (gagging)--is taking place. This could last up to a day or more.
  3. Recovery – During this phase, the vomiting has stopped and the child is starting to feel better. Some children can eat solid food right away; some might need a couple of hours or need to begin with liquids and work up to solid food. Your child might also have muscle pain from the vomiting, and may be exhausted.
  4. Symptom-free – This is the time between attacks.
In addition to the nausea and vomiting, other symptoms of CVS include:
  • tiredness
  • pallor (pale skin)
  • abdominal (stomach) pain
  • diarrhea
  • headache
  • sensitivity to light and sound
  • low-grade fever
  • drooling

How does the doctor diagnose cyclic vomiting syndrome?

CVS may be difficult to diagnose because nausea and vomiting are symptoms of many disorders. Your child’s doctor will begin with a careful history and physical examination. It is helpful to fully describe the symptoms and how long the child has been having them.

The doctor will have to rule out other conditions before making a diagnosis of CVS. To do this, the doctor might use tests such as:

  • blood tests
  • upper GI series to examine the esophagus, stomach, and part of the small intestine. For this test, the patient swallows a contrast solution that contains barium and then has an X-ray.
  • imaging studies, such as X-rays, of various organs to rule out kidney disease, sinusitis, and other disorders

How is cyclic vomiting syndrome treated?

There is no cure for CVS. Treatment is designed to manage symptoms and offer support to the patient.

In most cases, when an episode of CVS begins, it is best to keep your child as calm as possible in bed in a dark, quiet room. Sleep is often the only way to relieve the vomiting. If he or she can keep it down, you might give your child an anti-nausea medicine or sedative to help him or her sleep.

If the nausea and vomiting are severe, your child might need to go to the hospital for intravenous fluids (injected directly into the vein) to prevent dehydration (dangerous loss of fluid). Symptoms of dehydration include:

  • thirst
  • decreased urination
  • paleness
  • exhaustion
  • listlessness
The doctor may prescribe various drugs to treat CVS, depending on the child’s age. Generally, treatment includes two approaches:
  • Abortive therapy - includes medication to stop or slow down the attack and includes anti-nausea medications, anti-anxiety medication, and sometimes sedatives.
  • Preventive therapies - includes medications that can help reduce or eliminate the attacks. The two commonly used medications are cyproheptadine and amitryptiline.

Stress management techniques and nutrition therapy can also be helpful for children.

What are the complications of cyclic vomiting syndrome?

Complications associated with CVS include:
  • dehydration
  • chemical imbalances (important minerals can be lost by vomiting)
  • tearing, burning, or bleeding of the esophagus (swallowing tube)
  • malnutrition (poor eating habits)

Can cyclic vomiting syndrome be prevented?

Since we do not know the exact cause of CVS, it cannot be prevented. However, you can learn how to manage its cycles and symptoms by learning what sparks your child’s vomiting. Keeping a diary of vomiting episodes can help you identify and then avoid or deal with the things that cause vomiting. Using preventive medicines might also help.

What is the outlook for children with cyclic vomiting syndrome?

Some children will outgrow CVS; the syndrome usually lasts between two and five years. Children with CVS tend to miss a great deal of school and often need tutoring and home schooling.

About 60 percent of children diagnosed with CVS will eventually develop migraines as they grow older.

When should I call my child’s doctor?

Whenever your child becomes severely nauseous and begins to vomit, you should contact your health care provider for advice. If your child shows any symptoms of dehydration, you should see a health care provider immediately.

References

Cyclic Vomiting Syndrome Association. Cyclic vomiting syndrome. www.cvsaonline.org/. Accessed October 5, 2011.

© Copyright 1995-2011 The Cleveland Clinic Foundation. All rights reserved.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 10/17/2011…#14894


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