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night time vomitting in a 2year old
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night time vomitting in a 2year old

I have a 2 year old little girl who for the past 3 weeks has had one episode of vomiting each night. (there has been a couple of nights when she has not vomitted)She has lost weight and her apeptite has been diminished. She was admitted into hospital due to her lethergy and diminished apeptite where a head ct scan was normal, 3 urine cultures where negative. She had a raised crp which was not significant a hb of 10.7 and platelets graeter than 600 u&e's where normal. She has been constipated has now has daily lactulose. I am very concerned about her and awaiting to go back to hospital to see the consultant. There does not seem to be a link to food that makes her vomit, in the day she can have milk(cow's)and not vomit.She can have no food
after 4pm and still vomit her dinner, it is undigested food. Up until now she has been fit and well she has no allergies that I am aware and she has reached all her milestones. However during my pregency I suffered from gestational diabetes and was insulin for a short time. I then developed obstetric cholestasis and due to the rise in bile salts she was born prematurely at 35 weeks. She was in scubu for 10 days where initally she had a very low blood sugar and was on cpap ventilation,she was 7 10lb but lost wait very quickly down 6.5lb within days, she was breast fed and has never been ill since. Please can you advice me as to what I can do to help her
I have tried various different methods like watering down her night milk, not given it, no food after 4pm and in the end she still vomits, I am now just givig her what she will eat as she is losing weight
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There are various causes for refractory vomiting in children.  This can include GERD, metabolic abnormalities or anatomic abnormalities (i.e. pyloric stenosis).  

I would consider a referral to a pediatric gastroenterologist.  The barium study you mentioned would be a reasonable first step.  If that is not revealing, I would consider an upper endoscopy for a more comprehensive evaluation.  

Another consideration would be food allergy causing the vomiting - a referral to an allergy specialist should also be considered if the GI route is not revealing.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.
3 Comments
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You don't list investigations of her GI tract in the evaluation during her hospitalizations. Were any done? It sounds like she needs a consultation with a pediatric gastroenterologist, and some studies of her GI tract.
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The paediatricain has talked about doing some bareum studies but as of yet none have been done.
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Hi there.  My son was 2 years old when he started vomiting nightly.  He would start coughing, and that would alert us to his vomiting.  He was also losing weight, lethargic and would take several naps a day, on top of loose, foul smelling stools several times a day.  We were desperate to find out what was wrong with him.

Eventually, he became so sick that we had to take him into the ER.  They ran some tests after taking a medical history and tested him for a number of ailments.  They ran a celiac panel on him to check for Celiac disease, and one of the tests came back positive.  They sent us to a pediatric GI and he did a small bowel biopsy which revealed that he had damage to his small intestine consistent with Celiac disease.

Now that we have a diagnosis, and he has started the gluten free diet, he has improved significantly.  If you ped has not yet tested your daughter for Celiac, I would push for testing.  New studies have found that 1 out of 133 people in the US have Celiac, yet 97% remain undiagnosed.  It was once thought to be a rare condition, therefore many physicians don't think to test for it.  Please join us at the website below for any questions you have about Celiac and testing.  We are always welcoming new visitors who are looking for help and can steer you in the right direction. Just copy and paste link below into your web browser.  Other sites to check out include www.celiac.com Good luck and keep us posted on your daughter's progress.

http://forums.delphiforums.com/celiac


rhyanen :)
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