Recuring Vomiting in Toddler PLS HELP

[SilverSagess]

I am hoping someone can please help me.  I have been taking my son to a pediatric gastroenterologist for 9 months or more now because he was refusing to eat and had periods of recurring vomiting (not cyclic vomiting) and very low weight.  He was diagnosed with Noonan Syndrome (via genetic testing) and the Gastro put him on 30mg Prevacid for GERD.  Nevertheless, the vomiting and not-eating continues.  He will go for months with no vomiting, and after a while he starts to eat a little more normally.   Then he goes through a period where he will vomit 1-2 times per day for about 10-14 days straight.  Sometimes he vomits because he gags on food... foods that should not cause a person to gag.  I have seen him gag on mashed potatoes, yogurt, oatmeal, lots of things.  Other times, he vomits after he is completely finished eating.  Other times, he vomits because he's crying or excited or laughing.  This all goes on for a couple of weeks, then he goes again for months without problems.  During the non-vomiting phase the gagging stops, for the most part.  He may gag on a large piece of food that hasn't been chewed well enough, but it won't cause vomiting.  He can laugh, play, cry without vomiting, etc.  He gradually starts eating again after a month or so.

It doesn't seem to cause him any discomfort, surprisingly.  He throws up and then goes right about his business.  We don't usually have any warning or sign that he's feeling nauseous.  He doesn't get upset about it or seem to be in any pain.  His weight has increased since being on the Prevacid.  He went from not even registering on the growth percentile charts to being at approximately the 13th percentile, so that's great.  But I am concerned about the unexplained vomiting.  I worry he will damage his esophagus or that the vomiting could be a sign of something else that the doctors just aren't catching.  And it concerns me that he seems to NOT want to eat because he might gag or throw up.  He KNOWS that it happens.  He sometimes tells me, "I choke" even when he's not really gagging.  So, there are already psychological effects from this recurring vomiting.

I don't know what else I can do at this point.  No one seems to have any suggestions as to why this is happening or what we can do to find out what the cause might be.  I think they all just want to blame it on the Noonan Syndrome and hope that he outgrows it as he gets older, but Noonan Syndrome itself doesn't cause vomiting.  I want to know what is causing it and what we can do to minimize or stop it from happening.

Does anyone have any suggestions or ideas for me?  I am desperate and frustrated and I hate to see my child in this state.  Please help.

[boron]

http://www.bdfnewlife.co.uk/docs/pubs/BDF_Noonan_Feb06.pdf

QUOTE:
"Children with Noonan Syndrome may experience feeding problems from birth.
Difficulties can include:
• Projectile vomiting during or after feeding. This appears to have no definable
cause and normally resolves with time."

This seems to be a rare disorder, I believe you can find more info on some Noonan syndrome support site:
http://www.familyvillage.wisc.edu/lib_noon.htm

More links here:
http://ghr.nlm.nih.gov/condition=noonansyndrome

[SilverSagess]

It is not projectile vomiting, and he had no feeding problems for the first 15 months of his life.  I've read all the info on Noonan Syndrome, believe me.  I understand that feeding problems are common with Noonan Syndrome, but again I don't think the syndrome itself causes the vomiting.  ie.  babies who have problems nursing have these problems because of high arched palates or weak muscle tone, as stated as an example in the particular article you sited (which I have read before).  The palate or muscle tone is what causes that problem.

[boron]

As I've understood you, he was diagnosed for Noonan syndrome by genetic testing. So he has this syndrome, and vomiting may be a part of it. There may be several variations of this syndrome.

One of possibilities is hiatus hernia - loose entrance of the stomach doesn't prevent regurgitation of acid and food into esophagus. This may be diagnosed by pH measurements and manometry of esophagus, and possibly by contrast x-ray. I don't know what is apropriate for his age. All what I'm writting here is from my understanding of bowel physiology, but I have no experience with Noonan syndrome.

You don't need to worry if vomiting is connected with Noonan syndrome or not. You just need to find out which particular mechanism causes vomiting - and this may be then treated. But that article says, that vomiting eventually goes away with time. They are allergies and other diseases which go away with time. I believe other parents of kids with this disorder may give you more reliable info.

[SilverSagess]

Yes, I want to know "which particular mechanism causes vomiting" as you put it.  That's the thing; the Doctors are not making any suggestions as to what might cause it.  They simply attribute it to Noonan Syndrome in general.  That is why I posted here... in hopes of discovering possible causes... ie. the hiatal hernia you mentioned.  I read a bit about early this morning and made a note of it to ask his doctor about it.

[boron]

Occasional vomiting may be due to:
STOMACH DISORDER:
- hiatus hernia
- pylorostenosis
- gastroparesis

BILIARY TRACT DISORDER:
- gallbladder inflammation or gallstones
- stones in biliary tract
- biliary dyskinesia or sphincter of Odi dysfunction
- all above may cause biliary reflux

SMALL INTESTINE:
- intususception - would probably go with pain and mucus in the stool...or
...other blockage from intestinal stenosis, adhesions.

LARGE INTESTINE:
- Ogilvie's syndrome
http://www.emedicine.com/med/TOPIC2699.HTM

You've said it's not cyclic vomiting, well...
http://digestive.niddk.nih.gov/ddiseases/pubs/cvs/index.htm
http://www.mayoclinic.com/health/cyclic-vomiting-syndrome/DS00835

If the boy looks healthy, has no diarhea, pale or grey stools, I'd say the problem is within the stomach or biliary system. Most of possible causes are hard to detect with classical imaging (x-ray, CT), so contrast imaging and functional tests are needed (gastric emptying test, gallbladder function test - HIDA scan etc).

[SilverSagess]

Thank you Boron!  These are very helpful.  The biliary disorders seem to make sense... and the gastroparesis.  At least this gives me a few things to research and discuss with the doctor.  Thank you again.

[FLTurtle]

My son has the exact same symptoms.  He is two years old.  His pediatrician doesn't act like there's anything wrong.  Have you gotten anywhere with your research?