Pediatric Cyclic Vomiting Syndrome (CVS)

Q: What are the complications of cyclic vomiting syndrome?

A child who vomits repeatedly for a long period of time is at risk for dehydration. Acid from the vomited stomach contents can damage the esophagus and erode tooth enamel. CVS can negatively affect a child’s quality of life, leading to missed school days and activities.

Q: Can a child outgrow cyclic vomiting syndrome?

CVS can persist for years or decades. But it often improves as a child grows older. It’s rare for the condition to continue into adulthood. However, a child who has CVS is more likely to have migraine headaches as an adult.

Q: What mimics cyclic vomiting syndrome?

Other conditions increase the risk of CVS or cause similar symptoms, such as: Eosinophilic gastritis Food allergies Gastroesophageal reflux disease (GERD) Gastroparesis Irritable bowel syndrome (IBS) Pancreatitis

Q: What triggers cyclic vomiting syndrome in children?

Certain things may bring on a vomiting episode, such as: Anxiety, stress or excitement Colds or viral infections Foods like chocolate, cheese and those with monosodium glutamate (MSG) Lack of sleep Menstruation

Cyclic vomiting syndrome (CVS) causes episodes of severe vomiting that last for hours or days. Afterward, a child may be fine for weeks or months until the vomiting starts again. Doctors diagnose 3 out of every 100,000 children in the U.S. with CVS each year. If your child has this rare digestive disorder, you want experts who know how to help. At the only Pediatric Neurogastroenterology and Motility Disorders Program in North Texas , we offer advanced tests and treatments for children with CVS.

Overview

What is pediatric cyclic vomiting syndrome (CVS)?

Cyclic vomiting syndrome (CVS) occurs when a child has unexplained, sudden and severe episodes of vomiting followed by weeks or months with no symptoms. The condition typically appears when a child is between 3 and 7 years old, but it can occur at any age.

Types

What are the different stages of pediatric cyclic vomiting syndrome?

Cyclic vomiting syndrome symptoms occur in a cycle or pattern of four stages.

Symptom-free stage (well phase)

Your child has no symptoms and appears healthy. They’re eating, drinking, playing and thriving without stomach pain or other symptoms. This stage can last for several weeks or months.

Prodromal stage (early signs)

Your child starts to show early signs that the vomiting stage is about to occur. They may say they feel nauseous or queasy and complain that their stomach hurts. Their skin may look pale and feel clammy. This stage can last for several minutes or hours.

Vomiting stage

Your child vomits several times an hour for several hours or days. They may also retch (dry vomit). Your child may moan with stomach pain and may not be able to respond to you. This stage is exhausting and can make your child very lethargic.

Recovery stage

Your child stops vomiting and doesn’t feel as nauseous. Their appetite, skin color and energy level start to return to normal.

Signs and Symptoms

What are the signs and symptoms of pediatric CVS?

A child with CVS experiences hours or days of extreme nausea and vomiting. The symptoms come on suddenly for no apparent reason. Once nausea and vomiting stop, your child may feel fine for weeks or months until the cycle of symptoms starts again.

The vomiting phase tends to follow the same pattern each time it occurs. For instance, the symptoms come on during the same time of day (morning or evening), last for about the same length of time (hours or days) and occur with the same severity as previous episodes.

Cyclic vomiting syndrome in a child may also cause:

Abdominal pain
Diarrhea
Dizziness
Drooling or spitting
Dry vomiting (retching)
Extreme thirst
Headache
Loss of appetite
Fever
Sensitivity to light or sounds
Unusual sleepiness

Diagnosis

How is pediatric cyclic vomiting syndrome in children diagnosed?

Because CVS is extremely uncommon, it’s important to see specialists who have experience diagnosing it. At Children’s Health, your child receives care at one of the nation’s top-ranked Pediatric Gastroenterology (GI) Programs, as rated by U.S. News & World Report.

We start by reviewing your child’s symptoms and medical history, including how often the vomiting episodes occur and how long they last. This information helps us determine what digestive disorders may be causing your child’s symptoms.

To help us make a diagnosis, your child undergoes advanced diagnostic tests in our state-of-the-art Pediatric GI Lab. We have the region’s only certified pediatric motility studies lab for the diagnosis of GI movement disorders.

Your child may get one of these tests:

Abdominal ultrasound to look for problems with the kidneys, gallbladder or other organs.
Esophagogastroduodenoscopy, an upperendoscopic procedure that examines the esophagus (food pipe), stomach and the first part of the small intestine (duodenum).
Gastric emptying study (scintigraphy), a nuclear medicine test thattracks a food mixed with small, safe amounts of a radioactive substance as it moves through the digestive tract.
Upper GI series using fluoroscopy (moving X-rays) to monitor the passage of barium (a safe, drinkable liquid that coats the intestine through the esophagus, stomach and small intestine.

Causes

What causes pediatric cyclic vomiting syndrome in children?

There isn’t a known cause for cyclic vomiting syndrome in children. The condition is more common in kids who get migraines. Researchers are investigating whether it may be a type of abdominal migraine. There’s also some evidence that it’s a neurogastroenterology issue, which means there's a miscommunication problem with nerve signals that travel between the digestive tract and brain.