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My son wokeup with vomiting without fever. Cause?

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My son is two and a half years old and tonight he woke up vomiting. Just a small amount. He has no fever and is acting normal. This is the third time in the past 3 or 4 months that this has happened. What could cause this?


Category: Pediatrician

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Category: ICU/ Critical Care Specialist
Dr. Saptharishi L G is online now

Expert:  Dr. Saptharishi L G replied 4 Days.

Dear Parent,
Thank you for your query at DoctorSpring.com
I can understand your concerns. Children in this age group could have vomiting due to multiple reasons depending on associated clinical problems.
1. Does he have any change in bowel habits or consistency of stools around these episodes of vomiting?
2. Does he complain of abdominal pain around these episodes of vomiting? If yes, where does he localize the pain in his tummy? Upper, middle or the lower portion?
3. Does he wake up from sleep with a vomiting every time?
4. Is there any association with particular kind of foods or over-eating?
5. Is there any similar history in the family?
6. What is his height and weight? Is his growth appropriate?
7. How is his appetite and overall activity?
Kindly clarify these points so that I can guide you in the right direction.
Regards
Dr. Saptharishi L G


Patient replied :

He has had no changes in bowels. He does not complain of pain. He has woken up the 3 times vomiting. He is "intolerant" to eggs and dairy with a grain but we steer clear of those things. No family history of this. He is 95 percentile for height and weight and has a great appetite. He is very hyper active. Always moving.


Expert:  Dr. Saptharishi L G replied 3 Days.

Dear parent,
Thank you for providing the above information. It has definitely clarified a number of things. On the face of it, there could be a component of gastro esophageal reflux. The fact that he has been having these episodes at night in recumbent position is suggestive. Again the small volume of vomitus is suggestive.
Try the following measures:
1. Let him have his dinner at least four hours before going to bed
2. Do not let him drink too much of water after dinner. Small sips may be allowed
3. Encourage him to sleep in left lateral position
4. Avoid spicy foods at dinner
5. If the above measures do not work, give him a trial of Lanzoprazole 15 mg tab once daily for two weeks
If he continues to have vomiting, we could get a GER scan to confirm his reflux.
Regards
Dr. Saptharishi L G


Patient replied :

Just a follow up. My son woke up again this morning at 4am throwing up. He again has no fever and not bad gas just really stinking gas just like last time. He will continue to no eat and throw up over the next 24 hours. He pukes everytime he tried to eat. There's no way this is a stomach bug. I'm starting to fear something more serious may be the problem.


Expert:  Dr. Saptharishi L G replied 2 Days.

Dear parent,
Your assessment that there is an underlying problem and that it is not a stomach bug is correct.
The history provided would be consistent with one of the following:
1. Gastroesophageal reflux
2. Hiatal hernia
2. Gastritis
3. Cyclical vomiting syndrome
All these disorders are possible and there are points for and against each of these diagnoses. I would strongly recommend that you book an appointment with a pediatric gastroenterologist so that further investigations such as endoscopy, esophageal pH studies can be planned.
The child may subsequently be considered for a two-week course of proton pump inhibitors..
Regret the delay in response. I was travelling by flight.
Regards.


Dr. Saptharishi L G
Category: ICU/ Critical Care Specialist
Experience: 
Senior Residency: DM,  Pediatric Critical Care, PGIMER

Residency: MD, Pediatrics, Postgraduate Medical Education & Research (PGIMER), Chandigarh, 2013

Internship: JIPMER, 2009

Medical School: MBBS, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, 2008
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