A child vomits in his sleep or after sleeping at night, how can I help?

What happens during vomiting?

Vomiting is a protective reflex in which the contents of the stomach and initial parts of the intestines are returned through the mouth.
As a rule, it is preceded by nausea. It is caused by irritation of the receptors of the gastrointestinal tract (GIT) or a direct effect on the vomiting center, which is located in the brain stem. The gag reflex is realized by contracting the diaphragm, intercostal and abdominal muscles with the simultaneous opening of the lower esophageal sphincter, which normally prevents the return of food from the stomach into the esophagus. At the same time, the epiglottis closes and breathing stops, which prevents vomit from entering the respiratory tract.

As a result, the contents of the stomach, including enzymes and fluid, leave the body through the oral cavity. Also, due to the activation of the autonomic nervous system, salivation increases and sweating occurs. All this leads to loss of fluid - dehydration, which becomes a serious problem with prolonged vomiting.

Causes of vomiting in a child

Vomiting is one of the most common symptoms in children and can be associated with a wide variety of diseases and disorders of the gastrointestinal tract, nervous system, functional disorders and other reasons.

Intestinal infection in children

The most common cause of vomiting is gastrointestinal infections (video 1). As a rule, they occur when eating contaminated food or water, as well as when personal hygiene is not observed. Clinical manifestations may vary significantly depending on the specific disease.

The most common types of intestinal infections in children are:

• Intestinal flu (rotavirus infection), caused by viruses from the Reoviridae family. It is transmitted through contaminated water and through direct contact with a sick person.
• Viral gastroenteritis. In addition to rotaviruses, inflammation of the stomach and small intestine can also be caused by other viruses: adenovirus, norovirus, astroviruses.
• Salmonellosis, caused by Salmonella bacteria. Typical sources of infection are eggs, meat, poultry, milk and products prepared on their basis, for example, confectionery creams.
• Dysentery (shigellosis). The causative agent is bacteria of the genus Shigella. It can be transmitted through water, food (most often milk and dairy products), as well as through household items.
• Eschirichiosis (travelers' diarrhea), caused by bacteria from the genus Escherichia, often by Escherichia coli (E. Coli). Transmission factors include: water, dairy products, prepared meat products, drinks, as well as household items, such as toys.
• Listeroiosis. The causative agent is Listeria monocytogenes. Most often detected in semi-finished meat products and ready-to-eat meat products (canned food, sausages), soft cheeses and cold smoked fish products.

Infectious lesions of the gastrointestinal tract in children, in addition to vomiting, also cause other symptoms, such as diarrhea, fever, abdominal pain, slow weight gain, etc.

Video 1. What to do if you have an intestinal infection.

Diseases of the digestive organs

Another common cause of vomiting in childhood is diseases of the gastrointestinal tract. Most often this is:

• Gastritis is inflammation of the gastric mucosa.
• Duodenitis is inflammation of the duodenum.
• Pancreatitis is inflammation of the pancreas.
• Cholecystitis is inflammation of the gallbladder.
• Intestinal obstruction.

In infancy, constant regurgitation may be associated with pyloric stenosis and pyloric spasm. Pyloric stenosis is a structural deformation of the pylorus of the stomach, which prevents food from passing into the duodenum. With pylorospasm, similar changes occur, but they are temporary, since they are caused by increased tone of the stomach muscles.

What symptoms indicate problems with the gastrointestinal tract?

Common symptoms that suggest the development of gastrointestinal diseases in children are:

• Pain in various areas of the abdomen that occurs immediately after eating or after some time.
• Bowel disorders: diarrhea or constipation.
• Pathological impurities in feces, undigested food particles.
• Flatulence, belching sour or rotten.

Food poisoning in a child

Food poisoning, as well as infectious diseases of the gastrointestinal tract, are caused by eating contaminated food. However, in food poisoning, the key role is played not by the bacteria themselves, but by their metabolic products, released into the nutrient medium in which these bacteria have been present for a long time. Thus, a large amount of bacterial toxins enters the child’s body at once, which causes vomiting and other symptoms of poisoning.

Vomiting may be a sign of poisoning. Photo by Mac DeStroir from Pexels

The previously mentioned salmonella, as well as the bacteria Clostridium botulinum, which causes botulism, can release large amounts of toxins into products. The cause of the development of botulism is most often low-quality canned food, pickles, as well as insufficiently thermally processed meat and fish.

Important! Vomiting is one of the first reactions to eating foods unsuitable for food, for example, poisonous mushrooms, berries or raw meat.

Acute appendicitis

Acute appendicitis is an acute inflammation of the appendix (the vermiform appendix of the cecum). It is one of the most common surgical pathologies of the abdominal cavity.

Often, the first signs of appendicitis in childhood are constant acute pain in the abdomen, which later moves to the right iliac region, and an increase in body temperature up to 37.5 ° C (Fig. 1). In addition, nausea and vomiting once or twice often occur.

Acute appendicitis requires immediate surgical intervention - removal of the inflamed appendix of the intestine.

Figure 1. Classic symptoms of an “acute abdomen” that often accompany acute appendicitis. Source: Adobe Stock

Foreign body in the esophagus

A common cause of vomiting in childhood is the ingestion of foreign bodies, often small toys or their parts, for example, construction parts. Moreover, it is paroxysmal in nature, is in no way connected with meals, and the gag reflex may not be accompanied by evacuation of the stomach contents at all. In such cases, seeking medical help is indicated.

Acetone vomiting in children

Cyclic acetonemic vomiting syndrome is a set of manifestations that arise as a result of a sharp increase in the level of ketone bodies in the child’s blood plasma.

This condition may be the result of constitutional abnormalities (neuroarthritic diathesis) or prolonged fasting, the body's reaction in the postoperative period, or the manifestation of certain diseases and conditions: severe infections or endocrine pathologies (diabetes mellitus).

A characteristic feature of acetone vomiting in children is the cyclical nature of episodes that occur at regular intervals - from 15 to 60 minutes. Between them, the child, as a rule, feels satisfactory. Also noted: the smell of acetone from the mouth, increased body temperature and diarrhea.

Neurological disorders in children

The gag reflex can be provoked by a direct effect on the medulla oblongata, the part of the brain stem in which the so-called vomiting center is located. This occurs with concussion due to traumatic brain injury, with infectious lesions of the central nervous system (meningitis, encephalitis) and increased intracranial pressure due to hydrocephalus.

Neurotic or psychogenic vomiting in a child

In children of preschool and early school age, vomiting can be caused by strong emotional experiences, fear or stress. Associated phenomena are often surges in blood pressure, increased sweating, pallor, dizziness and general weakness.

Vomiting due to motion sickness

Children are more prone to kinetosis or motion sickness. It manifests itself with nausea and vomiting against a background of monotonous, prolonged fluctuations and occurs during long journeys by car, on buses and trains, or on a sea vessel. This pathology is also accompanied by dizziness, general weakness, pallor and sweating (video 2).

The mechanism for the development of motion sickness is the prolonged irritation of the vestibular apparatus located in the inner ear. Normally, he perceives the position of the body in space. However, when traffic is moving, the information received visually is often perceived by the brain as a static position, although some movement occurs. This heterogeneity of information received is what causes motion sickness.

Video 2. What to do if a child gets motion sickness.

Symptoms of intoxication in the presence of vomiting

In case of poisoning, infectious and inflammatory diseases, vomiting is accompanied by the so-called intoxication syndrome.
This is a set of symptoms caused by the entry into the blood of various toxins, tissue breakdown products, etc. Intoxication syndrome, in addition to possible nausea and vomiting, includes:

• General weakness, malaise and increased anxiety.
• Increased body temperature to 37-40°C and increased sweating.
• Loss of appetite.
• Headache, which at a young age is manifested by constant, sometimes monotonous crying.

What to do in case of vomiting?

The actions of parents depend on the causes of development and characteristics of the vomit. If vomiting is one-time and is not accompanied by other symptoms, no special action is required from parents. Otherwise, it is recommended to follow these recommendations:

• Constantly monitor the child. The baby should be held vertically in your arms; older children should be placed on their side or brought into a semi-sitting position. This will prevent you from inhaling vomit.
• After an attack of vomiting, rinse the baby's mouth with clean water using a bulb or a large syringe. Older children should be helped to rinse their mouths.
• Avoid using any medications on your own without knowing the cause of vomiting. At best, the pills will simply come out along with a new portion of vomit; at worst, they can cause harm and complicate diagnosis.

Excessive vomiting in children is accompanied by dehydration due to significant loss of fluid along with vomit. Therefore, it is important to restore losses with the help of mineral waters, special solutions, and in their absence - ordinary water.

If possible, the child should be given something to drink when vomiting. Photo: AndrewLozovyi / Depositphotos

What not to do

When vomiting occurs only once in the evening or at night, you can help the child and put him to sleep. Wherein:

• do not self-medicate and give your baby any medications other than sorbents and antipyretics;
• do not leave the baby alone, even for a few minutes, without adult supervision;
• do not feed your toddler dairy products or juices;
• Do not let your child sleep in anticipation of the next bout of vomiting.

If vomiting occurs only once at night, then you don’t have to worry and watch the patient until the morning. When the condition is steadily worsening every minute, there is no point in taking risks; only a doctor should treat the baby.

It is strictly forbidden to perform gastric lavage on a young child at home! This will bring nothing but harm.

In what cases should you consult a doctor?

If vomiting is persistent and accompanied by other alarming symptoms, you should seek medical help as soon as possible. You should call a doctor at home if:

• Vomiting appeared immediately after a traumatic brain injury.
• Vomiting is accompanied by an increase in body temperature.
• The vomit is bright green or yellow-green in color and contains blood or brown vomit that resembles coffee grounds.
• Vomiting is accompanied by severe abdominal pain.
• Rashes appeared on the child's body.
• There is a suspicion of ingestion of foreign bodies.
• There is a suspicion of ingestion of toxic substances.

There are signs of severe dehydration: lack of urination for more than 3 hours, dry skin, tongue and mucous membranes, crying without tears, pathological drowsiness and irritability, “recession” of the abdomen and cheeks.

Rash and vomiting are a reason to call a doctor. Photo: natulrich/Depositphotos

What to do in the morning

Sometimes it happens that the baby vomits once at night and in the morning does not remember anything at all. In this case, parents should provide the baby with enough fluids and adhere to a diet for a couple of days. You can give the following dishes:

• vegetable soups with a second chicken broth;
• porridge made from buckwheat, oatmeal or rice;
• mashed potatoes;
• steamed chicken balls;
• bread croutons;
• banana and applesauce.

Infants continue to be breastfed on demand, but no new foods are introduced into the diet for the next couple of days. Fruit jelly, which has an enveloping effect, is a good drink to drink. If nothing reminds you of the night incident for about two days, you don’t have to worry, it means the cause of the vomiting was not serious.

When your baby is still bothered by constant nausea and there is a cutting pain in the stomach, you need to consult a doctor. It is quite possible that there is a foreign body in the digestive tract that should be removed.

Every child experiences vomiting at night at least once. The cause most often is the use of harmful products. To prevent such a problem from happening, the child’s diet should consist only of natural and healthy foods.

Treatment of vomiting in children

The general treatment of vomiting depends on its origin. For example, in case of food poisoning, the main role in first aid is played by gastric lavage as soon as possible and the use of enterosorbents (activated carbon).

Treatment of vomiting, in addition to eliminating the main cause of its occurrence, includes restoring water and electrolyte balance. This is especially important in case of severe, prolonged and frequently repeated vomiting, due to which the body loses a large amount of fluid.

To compensate for the loss of fluid, ordinary mineral waters, slightly sweetened tea or special solutions are used, powders for the preparation of which can be purchased at the pharmacy. In severe cases, intravenous drip therapy is also used.

If it is impossible to determine the cause of vomiting or eliminate it, the use of antiemetics is indicated. Depending on the situation, the following can be used:

• Anticholinergics (scopolamine).
• Neuroleptics (chlorpromazine, haloperidol).
• H1 blockers (clemastine, promethazine).
• Dopamine receptor blockers (metoclopramide and domperidone).

Diagnostics

After arrival, the doctor conducts a survey to find out the cause of the attack. The following points need to be clarified:

• Frequency of repetition of vomiting.
• Volume of erupted masses.
• When did the first attack occur?
• What food did the child eat during the day?
• Whether the baby was sick during the previous 14 days.
• How the baby behaved before bedtime.
• Quality of sleep before vomiting began.

Examination of the child allows you to determine whether the temperature is elevated, signs of dehydration, the appearance of a rash, seizures, the appearance of symptoms of food poisoning, and the presence of rotavirus infection.

Sources

1. Novikova V.P., Gurova M.M., Khavkin A.I. Functional nausea and vomiting in children. Questions of children's dietetics. 2020; 18(4): 36–44
2. Dubrovskaya M.I., Mukhina Yu.G., Shumilov P.V., & Volodina I.I. (2007). Regurgitation and vomiting syndrome in children of the first year of life: differential diagnosis and management tactics. Pediatrics. Journal named after G.N. Speransky, 86 (6), 18.
3. Forbes D., Fairbrother S. Cyclic nausea and vomiting in childhood // Aust. Fam. Physician. - 2008. - 37(1-2).
4. Boles R., Powers A., Adams K. Cyclic Vomiting Syndrome Plus // J. Child Neuro. - 2006. - 21(3).
5. Muminova D.A. “Nosoological structure of recurrent vomiting in children” FORCIPE, no. Appendix, 2022, pp. 269-270.