An Often Overlooked Cause of Vomiting

An Often Overlooked Cause of Vomiting

Most parents don’t realize that not getting enough food can be the cause of unexplained vomiting in the middle of the night or first thing in the morning.

Where there is no fever, stomach flu, or any other common cause of vomiting in younger children, vomiting is often caused by low blood sugar. Most typically, this happens to children between 8 months and 4.5 to 5 years of age.

The official diagnosis for this scenario is ketotic hypoglycemia. Vomiting induced by ketotic hypoglycemia usually happens in the middle of the night or first thing in the morning, and typically when there’s been a longer-than-normal stretch of not eating – missing dinner is a common cause for those who are predisposed to this.

The child will typically feel some nausea and/or abdominal discomfort just prior to vomiting, and will usually be subdued for about a half hour after vomiting, but will otherwise appear normal.

Vomiting caused by ketotic hypoglycemia is often misdiagnosed as the stomach flu. The distinguishing feature of ketotic hypoglycemia is that the child quickly returns to normal; if vomiting occurs in the middle of the night, after a short period of malaise, the child will typically sleep comfortably for the rest of the night; if vomiting occurs first thing in the morning, within about 30 minutes, he or she will be ready to eat and go about everyday activities.

Vomitus is typically bubbly and tinged with a bit of yellow color – this is distinctly different from vomitus that accompanies the stomach flu, which usually includes incompletely digested food.

Normally during night-time sleep, the body uses blood glucose and some stores of glycogen in the muscles and/or liver to generate energy needed to carry out basic metabolic activities. Ketotic hypoglycemia tends to occur in young children who either miss dinner or eat a smaller-than-usual dinner and are in a rapid phase of growth where their need for fuel is greater than what a small meal in the late afternoon or early evening plus glycogen stores in the muscles and liver can provide; this is why vomiting from ketotic hypoglycemia typically only occurs in children who have a leaner-than-average build.

How to Prevent Vomiting Caused by Ketotic Hypoglycemia

Where ketotic hypoglycemia is identified as the cause of a child vomiting at night or in the morning, treatment is simple: Just ensure that your child has a healthy bedtime snack to avoid having his or her body go more than 10 hours without food intake.

Differential Diagnoses

There are many causes of hypoglycemia, as well as causes of vomiting at night that are not related to hypoglycemia, so in cases where it’s not obvious that lack of food intake in the evening is causing ketotic hypoglycemia-induced vomiting, it’s prudent to have your physician fully evaluate the situation to rule out other potential causes.

Stomach flu, food “poisoning,” severe coughing, a bladder infection (will be accompanied by a fever), and some type of intestinal obstruction are the main differentials to rule out.

Almost all children that experience vomiting caused by ketotic hypoglycemia grow out of it as their body mass increases with age and their ability to fast during bedtime sleep improves.

Please consider sharing this information with parents, grandparents, and elementary school teachers in your life. Being aware of this potential cause of vomiting in younger children makes it natural to understand that having them miss dinner isn’t a good choice in punishment for misbehavior – it’s wise to have other effective consequences ready in mind where some form of discipline is indicated, as vomiting is always best avoided for its negative effects on overall health.

By Dr. Ben Kim



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Posted By Dr. Ben Kim

Originally published on August 17, 2010

They say that you can learn a lot about yourself from your own children. I’d say that they’re absolutely right.

Our older son Joshua, now four and a half years old, is sweeter and more gentle than we could have wished for. These days, he lives to experience new and exciting things with his family. Things like riding the subway in Toronto for the first time, discovering the magic of helium balloons, and meeting new characters and worlds through trips to our library.

When I watch Joshua in silent slumber, I often think that it wouldn’t be such a bad thing to have my lips permanently sealed in a kiss with one of his softer-than-marshmallow cheeks. Ditto that for his younger brother, of course.

Despite the enormous love that I have for Joshua, there are times when I’m short and impatient with him. If, for example, I’ve had a rough day and he and his brother are making it painfully difficult for us to get them ready for bed, I sometimes end up hollering and threatening some form of punishment.

Our younger one tends to shrug off my occasional outbursts of frustration. He’ll even provide objective commentary, saying something like “You angwee at me? Noah angwee at you because… because… because you angwee at me!”

But Joshua, our highly sensitive and gentle son, will often retreat to his mattress, bury his head in his pillow, and remain still. This makes me feel horrible, to see how my lack of patience hurts him. I feel terrible for not having more self control, for once again breaking my vow to never to raise my voice with our boys.

When I take him into my arms, tell him that I’m sorry for yelling, try to explain why I lost my temper, and tell him that I love him more than anything, he often cries. Not with sadness, but with relief. I can almost feel a wave of relief resonate through his little body, restoring peace that comes from knowing that he is still loved more than anything.

I experience something similar with Noah from time to time when he feels particularly rejected by me or Margaret. I can feel the relief that accompanies his whimpers as I hold him tight. I guess deep down, even rugged little boys are highly sensitive.

Sensing the palpable relief that our boys feel whenever our love for them is reaffirmed in their hearts is all the proof that I need to believe that by nature, one of our greatest emotional needs is to feel accepted and loved.

I believe that the truth for all of us is that rejection hurts. No matter how we respond outwardly to various forms of rejection, inwardly, each episode of rejection creates a new wound that requires time and care to heal.

When freshly rejected in one of the millions of ways that we can feel rejected by others, I think many of us are conditioned to retaliate. Sometimes, we retaliate by trying to return the hurt. Sometimes, we retaliate by silently attributing rejection to the other person’s lack of maturity or outright idiocy.

Clearly, there are times when we shouldn’t fret for long; sometimes, there’s nothing more to contemplate than to realize that someone is engaging in ill-intentioned, toxic behavior, and though in need of help in some form, doesn’t deserve too much of our consideration.

But generally, I think there’s a lot to be gained from thinking about why someone has rejected us, and to avoid vilifying that someone to make ourselves feel better in the moment.

When we vilify someone who doesn’t accept us for whatever reason, I believe that we dampen our natural instincts to crave and give love. By turning rejection into an us versus them scenario, we walk down a path that likely leads to us becoming grumpy and paranoid men and women.

Outwardly or silently labeling someone who rejects us as being a jerk might be comforting in the moment, but ultimately, I believe taking on this mindset hardens us and leaves us less willing to give fully to the next person who could be a wonderful, life-long friend.

Rejection always hurts, even when we do our best to pretend that it doesn’t. There’s no quick fix for it. The passing of time, thinking about deficiencies that we have that might have contributed to us being rejected, perhaps talking it through with a trusted friend – all of these things can help. And as we heal, if we can avoid covering up our hurt feelings by mentally trashing the person who hurt us, I believe we preserve and even grow our capacity to revere and be revered.

I have our sons to thank for helping me recognize that rejection hurts every time. By embracing this reality and remembering that vilifying others only hurts my potential as a human being, my hope is that over time, I can become better at healing with grace.