Pediatric Cyclic Vomiting Syndrome (CVS)

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.

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.

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

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.

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.

How is pediatric cyclic vomiting syndrome treated?

Our digestive disease specialists develop a customized treatment plan to help prevent the onset of vomiting episodes and ease symptoms when they occur. This treatment approach for cyclic vomiting syndrome is similar to what our doctors use to help kids who have migraines. There is no cure for cyclic vomiting syndrome.

Your child’s treatment may include:

Medications

Your child may take:

• Daily oral preventive (prophylactic) medications, such as anti-anxiety and migraine medications, to keep a vomiting episode from occurring.

• Abortive medications like antinausea drugs to ease or stop nausea and vomiting.

Mental health support

Because anxiety and stress can trigger cyclic vomiting syndrome (and CVS is a stressful condition to live with), your child may see one of our specially trained GI psychologists. Our experts help your child learn relaxation methods to prevent or manage symptoms. This therapy also helps your child cope with the stress of having the disorder.