Child nausea without vomiting

Nausea & GI Distress in Teens

My 16-year old daughter has a similar problem. We’ve determined (after many tests and trips to the gastroenterologist’s office) that the nausea is a stress reaction, increase in epinephrine, drop in blood glucose, feeling nauseated and faint, even shakey at times. It’s all stress. We have found three things that help: 1) Taking a Calcium Tums tablet or Prilosec at bedtime, 2) immediately upon rising (or even before getting out of bed) starting the morning with an ounce of protein — chocolate SILK soy milk, 1 tsp of peanut butter, a little piece of meat, cheese, 1/2 cup of yogurt — to give the stomach acids something to digest. Regular milk, though rich in protein, sometimes adds to my daughter’s nausea. And 3) if nausea persists after taking above measures, we find that a fingertip of ginger paste used in oriental cooking does the trick beautifully! These need not progress in any particular order, though this is the sequence we have found most helpful. In my daughter’s case, the stress of a private AP-level high school was too much, so we’re homeschooling now, and she’s loving it. Far less drama in the mornings! A dietitian and MOM

I remember that when I was a teenager I had an 8 am dance class and once or twice had to excuse myself so I could throw up. I was just not physically able to be up and active so early. I was always a kid who needed a lot of sleep — still am.

There’s lots of research on how much sleep teens need and how their circadian rhythms adjust in these years — everyone knows that school should start later for this age group, but unfortunately no one is willing to modify the school day.

I’d have her checked out by a doctor just to make sure nothing else is going on, but I would consider the possibility that she just feels sick from lack of sleep and too early of a morning. Talk to her about the importance of sleep so that she can make the connection between how she feels in the morning and when she goes to bed. Then see if she can get to sleep earlier. Also make sure she’s not using any screens (cell phone, computer, TV, gaming system) an hour before bed as research shows that these devices can also disrupt sleep patterns. Still need 9 hours when I can get it.

Hi, First of all if you haven’t already done so I would like to suggest that you make an appointment for her to see her doctor for an exam.

You say that she looks forward to going to school and likes school but it’s curious that on school days she is more prone to feeling nauseous. Might her symptoms be related to some underlying anxiety about school? Or a situation that is troubling her that she has not voiced to you?

If you feel that there may be some truth to what I am saying and her doctor doesn’t pinpoint something physical you might want to seek the help of an alternative health practitioner who can work with your daughter to alleviate her symptoms and improve her well being. My daughter has an alternative MD who subscribes homeopathy and herbs to help her with her anxiety and she has responded very well to this approach. Unfortunately, her doctor is in Southern California but there are some fine practitioners in our area as well. If you are interested I think that the Berkeley Parents Network has some pretty good leads for alternative practitioners. Best of luck to you and your daughter. Hope this helps.

My 15-year-old daughter has had very similar morning stomach problems (nausea, indigestion, no appetite), that then go away later in the morning. She will have these symptoms for several weeks and then they will go away for awhile and later return. She also never has the problem on days when she is able to sleep in. I don’t really have a solution, just some thoughts:

1. Last spring when my daughter was having her most severe morning stomach issues, she was shortly afterward diagnosed with an ovarian cyst. Ovarian cysts are very common and usually go away on their own after a couple of menstrual cycles. Stomach problems are one of the symptoms of ovarian cysts.

2. I also think there may be a stress component to my daughter’s morning stomach problems. It seems to increase during exams.

3. Stomach problems are super common in kids, and not easy to identify the cause of. I know of many, many children and teens who have had mysterious stomach ailments that ebb and flow, and almost always are nothing serious (but still painful and real). teen parent

In my mid-20s I suffered from chronic reflux which manifested as nausea and not heartburn. Could night time acid reflux be part of the problem? Also when I was younger I hated to wake up early because, beside feeling really really groggy, I would feel sick as well although not as extreme as you describe. (I used to be a very heavy sleeper but now that I’m older and have been sleep trained by two babies, I can be instantly awake at any time.) I would look at diet, getting enough sleep, and stress (which makes any underlying condition worse). Good luck! Brenda

It’s so long ago….but my boyfriend in high school had this problem. In his case, it turned out to be that his stomach digested food at a different pace than other stomachs, and he awoke nauseous every morning. He and his family experimented and found solutions based on when and what to eat. Another person I knew had similar issues and was helped by consulting with Nori Hudson, Berkeley nutrition expert, who helped figure out what was going on–it was a different problem but they found a solution. sympathetic

First, get to a doctor for a full workup. Items to check – cardiology workup, since children have different symptoms than adults, e.g. instead of classic angina kids often experience nausea (Lucile Packard at Stanford is quite familiar with this area). Other items include checking thyroid (hypothyroidism often manifests itself at this age) – the treatment in this case is a simple pill. There are other very less likely possibilities like tumors and such, but those are very rare. A thorough health exam will alleviate your worries and put you on quantitative ground.

BTW, I’m hypothyroid and I’ve often found it extremely difficult to get up rapidly (note, not ”early” – ”rapidly”). I get dizzy and nauseated and can’t eat. Too little sleep also is difficult when your thyroid levels are off, and they are at the lowest in the early morning – that’s why you’re supposed to take your thyroid pill first thing in the morning without fail.

One thing to consider if she has some physical limitations at this time – why not start school later? My daughter had a 2nd-7th period schedule for junior year. It can be done if you push for it.

Finally, make sure you do a pregnancy test. Now I know and you know and she knows that she’s not pregnant, but do it anyway, because the doctor’s office will insist on it. Assure them you have done one yourself, but they are free to do one as well. This gets this issue off the table fast and allows you to get talking about other medical issues.

Good luck. Lynne

Your post does not mention if your daughter has been to a doctor. Also it may take more than one pregnancy test to know if someone is pregnant. Nausea can indicate many things: http://tinyurl.com/3b698t

Since she needs to sleep in on weekends and then the symtoms go away could mean she is really stressed at school. I don’t think any adults today have a reasonable idea of the stresses in school today – even carefully chosen school environments are a mixed bag. If this is the case please seek counseling. Being stressed can lead to many long term physical changes in the brain and organ systems that are real, debilitating, and potentially life threatening. Not sure why society is not supportive as a whole to this option in this day and age, but change is often ”a long time coming”.

I would really support your making a doctor’s appt, or if your medical office has a nurse practioner or a physician’s assistant if this gets her in sooner. Rule out medical causes, and at the same time check out counseling. Counseling (IMHO) should be seen more as as something that keeps us well, or makes us better, than as a last ditch unwelcome resort. Hope things improve

Hypoglycemia can cause nausea in the morning–I have had this. She should try eating a small meal w/ protein & no sugar just before bed, and see if she feels better. Hope this helps. por

Is she taking birth control pills (maybe without telling you)? They can cause symptoms of pregnancy, including ”morning sickness” and nausea.

Lack of sleep could also be the culprit. My daughter, who has a sensitive system, feels nauseous when she doesn’t get enough sleep or if she has to get up drastically early in the morning. That would fit why your daughter is OK on the weekends.

Good luck figuring it out!

I know this is a long shot, but I know my teen was getting morning nausea when we switched our brand of daily vitamins. I didn’t figure it out until I started taking them and had the same experience. Now I am sure we take them on a really full stomach and there’s no problem. mom of teen

There are many causes for morning nausea. Have your daughter checked for food allergies, seasonl allergies, lactose intolerance, sinus infection. The sinus infection can go undetected for a long period of time. The infection is toxic to your body and causes nausea. Hope your daughter feels better soon, Cecilia CC

I wonder if this could be an inner ear problem from rising early or from interrupting a sleep cycle. Or an acid stomach/reflux issue, from anxiety, diet, eating disorder. etc. In any case, I hope she goes to her doctor to check out all possible physical causes. Without any disrespect, it is possible to get a false negative on a home pregnancy test. I’d be worried too

I’ve always felt a bit nauseous upon awakening early. As a girl, I remember horrid egg breakfasts before church on Sundays. Now, when I’m readying for work at 7:00 a.m., the smell of eggs or onions cooking is too much! I can handle a bit of toast and tea. My appetite comes into full force at about 11:00 a.m. Weekends I wake up later, and have no problem! I think my body is telling me it’s just not quite awake yet. I usually bring a mid-morning snack with me if I have to leave early. I don’t see this as a problem — I’ve always been amazed at anyone who can actually eat so early! Fit & Healthy Mom

Are you sure she is (1) getting enough sleep and (2) not stressed by school? I’ve known of kids who got nausea when faced with a situation that stressed them – including a day at a summer camp that ”should” have been fun. At 16 she could be trying really hard to fit in, to assure herself and you that she’s not being a baby, and just having stress. High school is full of really good reasons for anxiety.

Try waking her up at the school time on the weekend and see if that makes her nauseated. If she is sick on the weekend you should take her to the doctor. Good luck, it sounds stressful to YOU! sympathetic mom

I have the same concern with my 15 year old daughter. She is out of school today for the same problem, wakes up at 7, often feels nausea and has a light amount of vomiting and then states she does not feel well enough to go to school. She usually likes school and is doing ok but I fear that missing so much school is affecting her grades. I think that part of the problem is fatigue, not getting enough sleep and it affects her physically. My advice is to make sure she eats and drinks well in the evening and then goes to sleep early enough to get at least 9 hours of sleep. I am trying this and have suggested counseling but my daughter is resistant. She seems to have more of this problem when she returns from staying with her Dad, we have joint custody. RN Mother

It could be stress, dehydration, food sensitivities…. Probably a good idea to have a doctor rule out pinworms, ulcer, or worse. Good luck

Abdominal Pain in Kids: Anxiety-Related or Something More?

It’s not uncommon for kids to complain of abdominal pain around the start of the school year, before a big test, sports game or performance — when their stress and anxiety levels can be at an all-time high.

While this may not be a cause for immediate concern for some parents, others may feel uncertain on how to address their child’s pain, or may not know that there could be more to it than just a few ‘butterflies’ fluttering in their child’s stomach.

Dr. Nicole Sawangpont Pattamanuch, a gastroenterologist at Seattle Children’s, breaks down the symptoms of abdominal pain related to stress and anxiety, recommends coping techniques for kids to alleviate their discomfort, explains how parents must check out Neuropathy Relief Guide for more information for tested and approved medications and shares red flags to help families determine if there is something more concerning to their child’s symptoms.

Breaking down the differences in symptoms

According to a study in PLOS One about pediatric functional abdominal pain disorders, chronic abdominal pain is a common problem in childhood, with prevalence rates ranging from 0.3–19% in school-aged children in the United States and Europe. However, in almost 90% of these children, there is no diagnosable disease tied to their symptoms.

“People with functional abdominal pain have a hypersensitive nervous system, due to early life adverse events, previous surgeries, acute infections or food intolerances,” said Pattamanuch. “If we think of the brain as a stereo receiver and speakers, it helps us understand how the gut-brain axis works. The gut reports pain to the spine, which relays the pain signals to the brain. Children under stress, whether it be physical or emotional, will often have the volume dial turned up on their stereo receiver. How the brain receives and interprets the pain signal is highly tied to our emotional state.”

In Pattamanuch’s practice, she sees many children with functional abdominal pain.

“These kids are still eating and gaining weight normally. They may experience pain, but overall they are functioning well, going to school and sleeping at night.”

In an initial visit with a child who is facing abdominal pain issues, with symptoms such as constipation, diarrhea, and nausea and/or vomiting, Pattamanuch always starts by asking parents if they think stress is a factor. This includes home, school and social stressors.

“Around half of the parents I meet with are usually aware that their kids are undergoing a lot of stress but are simply doing their due diligence to make sure they’re not missing any underlying medical issues their child may have,” said Pattamanuch. “The other half may not have a sense that their child’s pain is connected to stress, even though I’m concerned there are indeed psychological issues present. In these cases, it’s important that we further investigate and consider getting a counselor involved to screen for stressors.”

While not as common, Pattamanuch says the red flags that may signal there is an underlying disease present involves children presenting symptoms such with weight loss, persistent vomiting and diarrhea, or blood in their vomit or stool.

“Symptoms that are causing severe dysfunction are a huge cause for concern,” said Pattamanuch. “At this point, it’s very clear that they need to be medically evaluated as soon as possible.”

Coping techniques and resources to help kids thrive

With functional abdominal pain, there isn’t necessarily a definite treatment or medication that will cure kids’ discomfort.

“It’s more about helping these kids learn coping techniques and identify the triggers that exacerbate their symptoms,” said Pattamanuch. “Children may need more screening for depression or anxiety from a mental health professional. There are helpful clinics at Seattle Children’s for this.”

Some kids may be referred to the Biofeedback Clinic, where they can learn relaxation techniques to decrease the intensity of their pain. They may also be referred to the Pain Medicine Clinic where they could undergo an in-depth assessment to help manage their pain.

Aside from these resources, Pattamanuch often works with kids on simple techniques they can practice at home and implement into their daily lives to alleviate their recurring abdominal pain and discomfort. These include:

  • Peppermint: Brewing a cup of peppermint tea can help soothe the stomach and alleviate feelings of nausea.
  • Practicing mindfulness: Laying down in a quiet room and listening to the sound of their heartbeat and breathing can allow kids to tune out stressors that are running through their head. It can also help bring down their blood pressure and heartrate.
  • Regular exercise: It’s common for kids to withdraw from being active due to discomfort. If they become more isolated, it could make them feel worse. Pushing through their symptoms and continuing their physical activities are important. Daily exercise can help kids release their stress, be more alert during the day, perform better in school and sleep better at night.

While all kids have unique needs, some may require medication to help with their symptoms. However, Pattamanuch says there’s careful consideration when offering this treatment.

“When needed, we have some medications we can prescribe to help relax the gastrointestinal tract, but often they aren’t useful because they’re not addressing the root cause of the issue,” said Pattamanuch. “It’s most beneficial for kids to learn how to get in-tune with their psychological triggers and try to address those issues first and foremost.”

As the start of the school year is fast approaching, Pattamanuch says it’s likely she will see more kids coming in with abdominal pain. To assist in properly evaluating patients, she recommends parents do the following:

  • Keep a food diary: Logging the food their child eats, along with the times their child feels discomfort, can help troubleshoot whether it’s related to things like too much dairy intake or unhealthy eating, among other factors.
  • Think about the psychological stressors: This could be anything from school and academic work to bullying or changes in the family structure.

“I don’t think we talk enough about the important connection of our minds to our ‘bellies,’” said Pattamanuch. “The more we educate families on how it works, the better the chances of kids being able to learn the coping skills needed for them to live happy and healthy lives.”

Resources:

  • Should Your Child See a Doctor? – Abdominal Pain – Female, Abdominal Pain – Male
  • Biofeedback: Patient and Family Resources
  • Treatment Helps Kids and Teens Control Anxiety
  • Seattle Children’s Gastroenterology and Hepatology

Morning Vomiting in Children

It can be scary for both you and your child if she begins to vomit. Nausea is never a pleasant feeling, and it can be even more difficult for a young child. Morning vomiting can be a sign of several different conditions, some more serious than others. If your child is vomiting and develops a fever or intense abdominal pain or vomits blood, you should seek immediate medical attention.

Vomiting

When your child vomits, his abdominal muscles and diaphragm contract while his stomach muscles relax. This allows the contents of the stomach to be forcefully pushed out of the stomach, up the esophagus and out of the mouth. Vomiting is almost always preceded by feelings of nausea and excess saliva. Other symptoms present around the time your child vomits can provide clues to the cause.

Food Poisoning

Food poisoning almost always causes a certain amount of vomiting. Vomiting from food poisoning can begin as early as eight hours after eating contaminated food. If your child consumed food infected with bacteria for dinner, she may begin showing signs of food poisoning, like vomiting, in the morning. It is often difficult to distinguish food poisoning from a stomach virus, because:

  • the symptoms are similar
  • including fever
  • vomiting
  • diarrhea
  • headache

If your child’s symptoms are severe or persistent, her doctor might take a stool sample to determine what bacterium is causing her illness.

Virus

A stomach virus is by far the most common cause of vomiting in children and adults alike. Called gastroenteritis, any virus that infects your child’s stomach and intestines can cause vomiting for several days. The symptoms of gastroenteritis are very similar to those of food poisoning and can include fever, chills and abdominal pain. Gastroenteritis is usually not a serious condition, but you should make sure your child is consuming plenty of fluids to avoid dehydration.

Cyclic Vomiting Syndrome

Cyclic vomiting syndrome, or CVS, is a condition that causes bouts of uncontrollable vomiting. According to the Children’s Hospital of Wisconsin, a CVS episode usually begins between 2 a.m. and 6 a.m.. At the peak of a CVS episode, your child could be vomiting every five minutes. Though the cause of CVS isn’t clear, it usually resolves itself when your child reaches puberty. It is important to consult your child’s doctor if you believe he is suffering from this syndrome, because there are medications that can help treat or prevent episodes.

Brain Tumor

In rare cases, vomiting in the morning can be a symptom of a brain tumor. Brain tumors can be benign or malignant. Benign tumors do not contain cancer cells, while malignant tumors are cancerous and often spread. Other symptoms of a brain tumor include frequent headaches, vision or speech changes, depression, fatigue and seizures. If your child is displaying some or all of these symptoms, you should seek medical attention immediately. Almost all brain tumors require surgical removal.

What to know about nausea after eating

Causes of how nausea develops after eating include:

Hormonal

Hormonal changes often occur during pregnancy, which induce feelings of nausea at any time of day, frequently in the morning.

Some pregnant women will experience nausea before eating a meal. Others will feel nauseated immediately after eating. Sometimes this continues throughout the day.

Feelings of nausea will typically start during the second month of pregnancy. Nausea during pregnancy is not harmful to either the baby or mother and will usually resolve by the fourth month of pregnancy.

Elevated hormone levels in pregnancy can cause changes to the digestive system and the body, which means food spends longer in the stomach and small intestine. It is possible that this may also contribute to nausea after eating in pregnancy.

The hormones of pregnancy can relax the connection between the esophagus and stomach, causing an increase in acid reflux, which can contribute to nausea. A heightened sense of smell during pregnancy can also make nausea worse.

Infection

Food can become contaminated through not being cooked thoroughly or stored incorrectly. Consuming contaminated food can cause food poisoning.

Bacteria (or in some cases, viruses) are usually the cause of contamination. Either can induce feelings of nausea within hours of eating.

Viral infections of the digestive tract, such as “stomach flu,” can also cause nausea after eating.

People can get these viruses from:

  • close contact with another person infected with the virus
  • eating contaminated food and drinking water

These viruses are highly contagious and cause inflammation to the stomach and intestines. They can lead to:

  • fever
  • nausea
  • vomiting
  • diarrhea
  • abdominal pain and cramps

Food intolerances or allergies

Some people have an intolerance to certain foods, which means that the body has difficulty digesting them.

Share on PinterestSome food intolerances can cause a person to feel nauseated after eating.

Food intolerances do not involve the immune system but can cause nausea hours after the food is eaten. Common sources of food intolerances include:

  • foods that contain lactose, such as dairy products
  • gluten, such as most grains
  • foods that cause intestinal gas, such as beans or cabbage

Food allergies occur when the body mistakenly identifies proteins found in certain foods to be a threat, triggering an immune system response.

Nausea caused by a food allergy can occur seconds or minutes after eating. It is often accompanied by a host of other symptoms, such as swelling to the face or lip and difficulties breathing or swallowing. These types of reactions are emergencies and require immediate medical attention.

Gastrointestinal problems

Nausea after eating and other gastrointestinal problems may occur when an organ within the digestive system stops functioning properly.

For example, gastroesophageal disease (GERD) occurs when the ring of muscle between the esophagus and stomach malfunctions, causing stomach acid to enter the esophagus.

GERD causes a burning sensation throughout the esophagus known as heartburn and may be a cause of nausea after eating.

The gallbladder is responsible for releasing bile to aid in digesting fats. Gallbladder diseases impair the proper digestion of fats and can cause nausea after eating meals high in fat.

The pancreas releases proteins and hormones necessary for digestion. If this organ becomes inflamed or injured, known as pancreatitis, nausea often occurs along with other intestinal symptoms and pain.

Irritable bowel syndrome (IBS) is a chronic condition that can cause bloating and increased gas. In some people, this can also lead to nausea after eating.

Vascular

Nausea after eating could also be a sign of arteries in the intestines narrowing. This narrowing of blood vessels restricts blood flow. Nausea after eating can be accompanied by intense stomach pains and may indicate a condition known as chronic mesenteric ischemia. This condition can suddenly worsen and become life-threatening.

Headache syndromes

Migraines can also cause nausea after eating, which can be accompanied by intense stomach pain, vomiting, and dizziness.

Cardiac

In some cases, nausea after eating can be a warning sign of a heart attack.

Psychiatric or psychological

Anorexia nervosa and bulimia nervosa are the most common eating disorders characterized by abnormal eating habits.

Anorexia nervosa can cause nausea due to excess stomach acid or starvation. Bulimia nervosa can cause nausea after eating from a compulsion to vomit any food consumed.

Anxiety, depression, or intense stress can also result in a loss of appetite and nausea after eating.

Motion sickness

Some people are highly sensitive to particular movements or motion, which can make them feel nauseated. Eating food before or after experiencing motion can intensify nausea in individuals with motion sickness.

Medications

Nausea is a common side effect of several medications including antibiotics, pain relief drugs, or chemotherapy drugs. Nausea should subside once the treatment is completed or stopped.

Eating made her sick, but it took doctors years to figure out why

“It was a freaking nightmare,” Kaplow recalled of those years. She said she never believed her daughter was exaggerating or faking her symptoms. And each time a new diagnosis was made, Kaplow said, she felt elated that a doctor had figured out the cause of Maddie’s pain, which would turn into crushing disappointment when it recurred.

It was only after she landed in a college infirmary 400 miles from her Northern Virginia home that doctors finally determined what was wrong and treated Maddie for the illness that dominated her adolescence.

Now that her pain has been relieved, Maddie Kaplow can eat whatever she likes. (FAMILY PHOTO)

“It was years of total frustration,” said Maddie, now a 22-year-old college senior. “It got to the point that I almost felt at times that I was making it up.”

Shooting pains

Maddie remembers when the episodes started: in February 2003 during French class at a Fairfax County middle school. The sharp pain, often accompanied by nausea, was concentrated on the upper right quadrant of her abdomen, close to her rib cage, and extended to her back between her shoulder blades. When it didn’t go away, her mother took her to the pediatrician.

“She couldn’t find anything,” recalled Kaplow, the education services manager of The Post. The pain disappeared after a few days, then recurred about six weeks later. The pediatrician suggested that Maddie keep a food log to see what might be triggering it. When that didn’t reveal anything, she referred her to a pediatric gynecologist in the District. The gynecologist found nothing and sent Maddie to a pediatric gastroenterologist, whom she saw that May.

The gastroenterologist decided her problem was constipation and gave her a diet to follow, along with a recommendation to avoid wheat in case she had a sensitivity to gluten. Although the constipation cleared up, the pain, which was sometimes accompanied by diarrhea and chills, did not. Avoiding gluten didn’t seem to make a difference.

The gastroenterologist then recommended an endoscopy and colonoscopy, procedures for inspecting her upper and lower intestines. The colonoscopy found nothing, but the endoscopy revealed duodenal ulcers in the spot where the pain seemed concentrated. Maddie began taking medicines, including Nexium, a drug that blocks the production of excess stomach acid, but they did little to affect the pain, which seemed to be triggered by eating.

When the pain became too severe and needed to be treated with narcotic painkillers, Maddie would wind up in a Northern Virginia emergency room, an event that would occur about 18 times over a six-year period. Kaplow said Maddie’s pediatrician didn’t seem overly concerned, because she wasn’t losing weight. “The doctors kept saying, ‘Well, it’s not like she’s wasting away.’ ”

During one visit, an ER doctor thought he had found the culprit: A CT scan showed a possible ruptured ovarian cyst. No treatment was required, and the hope was that once it went away, so would her pain.

By May 2004, a surgeon consulted at the suggestion of Maddie’s gastroenterologist decided to remove her appendix. If nothing else, the doctor told her mother, removal of the organ would enable doctors to rule out appendicitis as the cause of any future episodes. “I just don’t know what else to do,” Kaplow said he told her.

Initially, it looked like a good call: Although the surgeon thought the appendix looked healthy, a pathologist said it showed early signs of disease. “We were thinking, ‘Okay, now we’ve got it,’ ” Kaplow recalled.

But their relief was short-lived. Three months later, Maddie was back in an ER with intense pain. This time, an ER doctor, citing her extensive work-up and recent appendectomy, proposed that Maddie’s illness was psychological.

Kaplow said she was furious at the suggestion that her daughter’s problem “was all in her head. I thought the pain was causing her anxiety, not the other way around.”

In 2005, Maddie began seeing a new gastroenterologist. He seemed attentive and concerned and decided she had IBS, a common but ill-defined malady characterized by bouts of abdominal pain, nausea and diarrhea. He switched medications and performed a second endoscopy and colonoscopy: Both were normal, and her ulcers had healed.

“We were hopeful that maybe IBS was the problem” her mother recalled.

A fresh perspective

But over the next few years, Maddie’s condition worsened as the episodes became more frequent and the pain sometimes grew unbearable. The family alternated between two emergency rooms. “Each time, we kept hoping that a new set of eyes would get to the bottom of it,” Kaplow recalled.

Maddie flatly refused to see the pediatrician who had repeatedly made it clear she thought the teenager was exaggerating. “She was so skeptical, she would say in this singsong voice, like a kindergarten teacher, ‘What is it today, Maddie?’ ” her mother said.

The pain became something she just learned to live with. “It was odd, because I was hungry but nauseous,” Maddie recalled. “And if I pushed my stomach out, it felt better.” Somehow she got through a demanding curriculum in high school, despite frequent absences due to illness.

In April 2008, while a freshman at the University of Rhode Island, Maddie had an episode while she was home on break and decided to seek help at an urgent care center in McLean. A doctor there suggested her problem might be related to her gallbladder and recommended further testing.

Kaplow said that when she told the pediatrician about the recommendation, the doctor was unimpressed. Kaplow had previously told the pediatrician and other doctors that she and her three sisters had all had their gall­bladders removed before they were 40 because they had gallbladder disease, which can run in families. The pediatrician said that Maddie’s tests showed no gallstones and that gallbladder problems would be rare in a teenager. She declined to order a gallbladder scan and instead recommended a third colonoscopy and endoscopy, both of which were normal.

In January 2009, Maddie experienced her most severe attack two days before she was due to fly back to Rhode Island from home. Earlier that week, she had seen a prominent gastroenterologist in Baltimore, hoping he could provide an answer. The doctor prescribed an anti-anxiety drug but decided a gallbladder scan could wait until summer. He ordered a test for celiac disease, which produces abdominal pain and diarrhea and is caused by an inability to digest gluten, although a previous wheat-free diet hadn’t helped.

“I thought, ‘Hey, maybe it’s celiac,’ ” Kaplow recalled.

Panicked by the severity of the episode — Maddie was in so much pain that she was unable to get out of bed — Kaplow made a flurry of frantic phone calls over the Martin Luther King holiday weekend. A Northern Virginia gastroenterologist prescribed pain medication, and “somehow she got on that plane,” her mother recalled.

Two days later, still in intense pain and unable to eat, Maddie went to the university’s student health center. A doctor there ordered a HIDA scan, an imaging test that uses radioactive dye to track the flow of bile through the digestive system and is used to detect gallbladder diseases.

A definitive result

The result left little doubt about what was wrong and what needed to be done. The scan showed that Maddie had profound biliary dyskinesia, also called acalculous cholecystopathy; the condition, which is marked by pain in the upper right quadrant of the abdomen and the absence of gallstones, is uncommon.

The test measured the ejection fraction of her gallbladder, an assessment of how well the organ is squeezing out bile; at 3 percent, it was abnormally low. People with an ejection fraction below about 40 percent are candidates for surgery to remove the gallbladder, according to the American Pediatric Surgical Association, which notes that biliary dyskinesia occurs mostly in older children and adults.

Although surgery does not guarantee that the pain will disappear, it appears to be effective in 70 to 80 percent of cases.

“We don’t understand much about this entity,” said Umberto Capuano, the general surgeon in Wakefield, R.I., who made the diagnosis. Once thought to be rare, particularly in children, doctors are seeing more cases, he said.

“She’s just one of a number of young ladies who’ve struggled for years” whom Capuano has treated, he said. “Every one of them got better after surgery.”

The surgeon said he is not sure why nearly all of the many doctors who treated Maddie failed to consider that her gallbladder might be the problem.

“There are regional differences in health care,” he said. But her significant family history of gallbladder disease “would certainly alert you.”

When Kaplow heard about the scan results and the plan to remove her daughter’s gallbladder, she burst into tears. “I thought, ‘Oh, my God, there’s going to maybe finally be an end to this.’ ”

Although laparascopic surgery was scheduled for late February, Capuano operated several weeks earlier, soon after Maddie was hospitalized with another severe gallbladder attack.

For Maddie, who has since transferred to Tulane University, the operation ended her pain. “I haven’t missed a class, and I can eat whatever I want,” she said.

Her mother said the experience has made them both wary of doctors and angry that Maddie was too often regarded as a hysterical teenager.

“As stupid as this sounds,” Kaplow said, “I was raised that if a doctor tells you something, it’s gospel, like the priests: They know better than we do. Now if I suspect something, I’m definitely more proactive.”

When she told Maddie’s former pediatrician what had happened, she said the response was not what Kaplow had hoped. “She said, ‘I’m so glad it’s been taken care of,’ ” Kaplow said, “not, ‘I’m sorry for all those years.’ ”

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What Causes Chronic Nausea?

Nausea is not a disease itself, but can be a symptom of many disorders related to the digestive system, including:

  • Gastroesophageal reflux disease (GERD)
  • Peptic ulcer disease
  • Problems with nerves or muscles in the stomach that cause slow stomach emptying or digestion (gastroparesis)
  • Discomfort in your upper stomach that is not related to an ulcer (nonulcer dyspepsia)
  • A condition that occurs when nerves and brain signals prevent food from passing along your digestive tract, even though there is no physical blockage (bowel obstruction)
  • Problems with the area of your brain that controls the digestive processes (autonomic dysfunction)
  • Migraine headache
  • An abnormal change in heart rate when you change your posture (postural orthostatic tachycardia syndrome)

Problems in certain areas of your body, your entire body, such as cancer or infection, and some medications can lead to nausea. Issues in these body regions commonly cause nausea:

  • Abdominal or pelvic organs
  • Balance centers in your inner ear
  • Brain or spinal fluid
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Many different things can make kids throw up, including illnesses, motion sickness, stress, and other problems. In most cases, though, vomiting in children is caused by gastroenteritis, an infection of the digestive tract.

Gastroenteritis, often called the “stomach flu,” usually is caused by common viruses that we come into contact with every day. Besides causing vomiting, it also can cause nausea, belly pain, and diarrhea.

Gastroenteritis infections usually don’t last long and are more disruptive than dangerous. But kids (especially infants) who cannot take in enough fluids and also have diarrhea could become dehydrated. This means that their bodies lose nutrients and water, leading to further illness.

It’s important to stay calm — vomiting is frightening to young children (and parents) and exhausting for kids of all ages. Reassuring your child and preventing dehydration are key for a quick recovery.

Giving kids the right fluids at the right time (called “oral rehydration”) is the best way to help prevent dehydration or treat mild fluid loss.

What Is Oral Rehydration?

When fluids are lost through vomiting or diarrhea, it’s important to replace them as soon as possible. The key is drinking small amounts of liquid often to replace water and nutrients that have been lost.

The best liquids for this are oral rehydration solutions — often called oral electrolyte solutions or oral electrolyte maintenance solutions. They have the right balance of fluids and minerals to replace those lost to vomiting and help kids stay hydrated.

Most electrolyte solutions are available at supermarkets or drugstores. If you think your child is at risk for dehydration, call your doctor. He or she might have specific oral rehydration instructions and can advise you on which solution is best for your child.

Note: Over-the-counter medicines to treat nausea, vomiting, and diarrhea are not recommended for babies and children. In some situations, doctors might recommend medicines for nausea or vomiting, but these are available only by prescription.

Rehydration Tips: Babies (Birth to 12 Months)

  • Do not give plain water to an infant unless your doctor tells you to and specifies an amount. Plain water by itself can disrupt the balance of nutrients in your baby’s blood.
  • If your baby is younger than 2 months old and vomits (not just spits up, but vomits what seems like an entire feeding) at ALL feedings, call your doctor right away.

For Breastfed Babies

  • If your infant is exclusively breastfeeding and vomits (not just spits up, but vomits what seems like the entire feeding) more than once, breastfeed for shorter periods of time (about 5 to 10 minutes at a time) every 2 hours. Increase the amount of time your baby feeds as he or she is able to tolerate it.
    If your baby is still vomiting on this schedule, call your doctor. After about 8 hours without vomiting, you can go back to your normal breastfeeding schedule.

For Formula-fed Babies

  • Offer small but frequent amounts — about 2 teaspoons (10 milliliters) — of an unflavored oral electrolyte solution every 15–20 minutes with a spoon or an oral syringe. Check with your doctor about which type of solution is best.
  • A baby over 6 months old may not like the taste of a plain oral electrolyte solution. You can buy flavored solutions, or (only for babies over 6 months) you can add ½ teaspoon (about 3 milliliters) of juice to each feeding of unflavored oral electrolyte solution.
  • If your baby can keep an electrolyte solution down for more than a couple of hours without vomiting, slowly increase the amount you give. For instance, if your little one normally drinks 4 ounces (about 120 milliliters) per feeding, slowly work up to giving this amount of oral electrolyte solution as the day goes on.
  • Sometimes very thirsty babies will try to drink a lot of liquid quickly but can’t tolerate it. Do not give more solution than your baby would normally drink in a sitting — this will overfill an already irritated tummy and likely cause more vomiting.
  • After your baby goes for more than about 8 hours without vomiting, restart formula slowly. Start with small, frequent feedings of half an ounce to 1 ounce, or about 20–30 milliliters. Slowly work up to the normal feeding routine. If your infant already eats solids, it’s OK to start solid feedings in small amounts again. If your baby doesn’t vomit for 24 hours, you can return to your normal feeding routine.

Rehydration Tips: Kids & Teens (Ages 1+)

  • Give clear liquids (avoid milk and milk products) in small amounts every 15 minutes. The amount you give at one time can range from 2 teaspoons (10 milliliters) to 2 tablespoons (30 milliliters or 1 ounce), depending on the age of your child and how much your child can take without vomiting.
    There are many good choices for clear liquids, including:
    • ice chips or sips of water

    • flavored oral electrolyte solutions, or add ½ teaspoon (about 3 milliliters) of fruit juice (like orange, apple, pear, or grape juice) to unflavored oral electrolyte solution

    • frozen oral electrolyte solution popsicles

    • broth

    • gelatin desserts

  • If your child vomits, start over with a smaller amount of fluid (2 teaspoons, or about 10 milliliters) and continue as above. Make sure to avoid straight juices and sodas, both of which could make things worse. Kids may ask for commercial sports drinks, but be careful with these — they have a lot of sugar and could make things worse.
  • After no vomiting for about 8 hours, introduce solid foods slowly. But do not force any foods. Your child will tell you when he or she is hungry. Your child might want bland foods — saltine crackers, toast, mashed potatoes, mild soups — to start out with.
  • If there’s no vomiting for 24 hours, slowly return to your child’s regular diet. There’s no need to leave out milk products unless they seem to be making vomiting or diarrhea worse.

Vomiting due to gastroenteritis is caused by viruses that can spread to others. So keep your child home from school or childcare until there’s been no vomiting for at least 24 hours. And remember that washing hands well and often is the best way to protect your family against many infections.

When Should I Call the Doctor?

If your child refuses fluids or if the vomiting continues after you try the suggested rehydration tips, call your doctor. Also, call for any of the signs of dehydration below.

In babies:

  • few or no tears when crying
  • dry lips
  • fewer than four wet diapers per day in a baby (more than 4–6 hours without a wet diaper in babies under 6 months of age)
  • fussy behavior
  • soft spot on an infant’s head that looks flatter than usual or somewhat sunken
  • appears weak or limp
  • not waking up for feedings

In kids and teens:

  • no peeing for 6–8 hours
  • dry mouth (might look “sticky” inside), cracked lips
  • dry, wrinkled, or doughy skin (especially on the belly and upper arms and legs)
  • inactivity or decreased alertness
  • excessive sleepiness or disorientation
  • deep, rapid breathing
  • fast or weakened pulse
  • sunken eyes

Also contact your doctor if you notice any of the following, which could be a sign of an illness more severe than gastroenteritis:

  • if your infant is under 2 months old and vomiting (not just spitting up)
  • projectile or forceful vomiting in an infant, particularly a baby who’s younger than 3 months old
  • vomiting after your baby has taken an oral electrolyte solution for close to 24 hours
  • vomiting that starts again as soon as you try to resume your child’s normal diet
  • vomiting that starts after a head injury
  • vomiting accompanied by fever (100.4°F/38°C rectally in an infant younger than 6 months old or more than 101–102°F/38.3–38.9°C in an older child)
  • vomiting of bright green or yellow-green fluid, blood, or brownish vomit resembling coffee grounds (which can be a sign of blood mixing with stomach acid)
  • your child’s belly feels hard, bloated, and painful between vomiting episodes
  • very bad stomach pain
  • swelling, redness, or pain in a boy’s scrotum
  • pain with peeing, blood in the pee, or back pain
  • headache or stiff neck

Reviewed by: Joanne Murren-Boezem, MD Date reviewed: May 2019

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