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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.

 
 

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childhood vomiting

My two girls both had this when they were little and I put it together that it was probably low blood sugar. Now as teens they refuse to eat in the morning - they still feel like they want to throw up. I have let it slide because how do you make someone eat who feels nauseous? I never thought to try a before bedtime snack. I will give it a try. Thanks for the article.

Don't Look Over

If your child is vomiting without an explanation, don't look over neurological issues as well. My son had a cancerous brain tumor. I'm not trying to be a pessimist here, but for parents to be aware these things can happen. He vomited for months inexplicably, pediatricians prescribed migraine meds, until I finally realized it was something bigger and insisted on a CT scan. I always wonder, if I would have figured it out sooner, would it made any difference (such as size of the tumor being smaller and easier to resect). I'll never know.

My son also had a cancerous

My son also had a cancerous brain tumor. I too cringe everytime I read or hear about morning vomiting. I wish that it was more well known that this could be a symptom of something serious. If you don't feel the doctors are right...push for a CT...you are your childs best advocate.

My son will be 3 next month,

My son will be 3 next month, he also started vomiting late at nite or early mornings, he could eat at 8am and be perfectly fine, but then always 12 hours later vomit , Dr ruled out blockage and said it was a virus ( stomach bug .... I said he has no fever or other symptoms, and this has been going on for a month.... )I'm now pushing for CT scan since reading your story, thank you .

other symptoms with tumor?

My daughter has had a few episodes of early morning vomiting. Occurred a couple of months ago, lasted for a couple of weeks, stopped for 2 1/2 months. It has started again this past week. She has no other symptoms (headache, blurred vision, etc.) that I can tell. Did your sons have any other symptoms besides the vomiting?

Interesting... this is true,

Interesting... this is true, but I didn't know that it was due to low blood sugar. I always thought that it was wind in the stomach (all that rumbling!). When wind tries to push itself up, you feel nauseous. A little food settles the stomach quickly.

me too!

My 3 year old has been vomiting/complaining of upset stomach for three days now. It's winter break, and all my kids' sleep and eating schedules have been crazy. I just now made this connection, as I too used to not eat in the morning because of my stomach. The only difference is he's having his issues in late afternoon, but he's used to afternoon naps and snacks that we've been skipping. I'm going to try going back on schedule tomorrow. Hopefully that does the trick, or we're off to the Dr.

I didn't know people still

I didn't know people still used this type of punishment!

Sometimes my 4 year old will not eat her dinner because she does not like it or is too distracted to eat. I've often been conflicted on how to handle this. I do not believe in making another special meal as I believe that sends the wrong message. I have told my child that this is what we're having for dinner and that's all there is. I will however offer some yogurt or small snack closer to bedtime if she's eaten nothing at all. I have a hard time sending her to bed with no food in her belly.

Your comment gives me a

Your comment gives me a chance to ask a question I've had for a long time:
Do parents who require their kids to eat foods they don't like prepare and eat foods that they themselves don't like to eat as well?
My parents always asked my brother and I to give a little taste to everything on the plate but didn't require us to eat things we found distasteful. Today I have no problems trying new foods or eating a variety of meals. Honestly, there isn't a taste I find disgusting. (And I grew up in Asia, haha)
Conversely, my husband was forced to eat foods he couldn't stand when he was a child and now refuses to eat many kinds of foods. For instance, he never makes himself eat liver and onions now (even when it's served as dinner at his mom's) because he couldn't stand it when he was a kid.
So yeah, I've long wondered if parents make themselves eat foods they don't like because they're "healthy" or they want the kids to be thankful for what they have. My kids are now grown but once they were old enough to be active participants in the kitchen, they've had a say in what we eat and helped prepare meals. They've always been welcome to get in the fridge and grab things like carrot sticks and homemade hummus or an apple. Today they eat a variety of whole foods mindfully. I think it's good that you give your little one a chance to have a snack if she doesn't eat dinner.

picky eaters could have allergies, don't punish them

This breaks my heart as a child who was a picky eater and probably drove my mother insane... I was sent to bed without supper regularly and cried myself to sleep because my mother would not let me eat a peanut butter sandwich for dinner instead of her lousy cooking. No offense to moms, I am now a mother of a picky eater myself, and it drives me crazy too! But I won't put my kid to bed hungry.
I have severe hypoglycemia now which is partly from my addiction to candy as a child, but I'm sure being sent to bed without dinner three nights a week could have played a hand in it as well.

Anyway long story short, it turns out gluten intolerance runs in my family and out of us six kids, only one has not been tested and the other 5 of us are all gluten intolerant. Now that I know that and I look back on my child I realize the foods I didn't want to eat for dinner were things like my dad's special breaded chicken (I always hated the floury coating), and anything my mother cooked because to be honest she was a horrible cook.

So if your kid is that picky that often, maybe you should have a look at their diet and see if there is something affecting their appetite. My daughter always gets pickier when her father buys her yogurt cups at the store. I would prefer she was dairy free but it is hard when your husband is a pushover to his little girl...

Anyway, don't punish your kids by starving them. I have suffered from my mother doing that to me.

This Article put the pieces together for me.

THANK YOU FOR THIS ARTICLE!

My daughter had a seizure 3 weeks ago which included a vomiting episode at 5 AM in the morning. Took her to the ER and they checked everything ... blood, urine, CT scan, EKG .. everything was normal. Only problem was that with the blood test ... we had given her orange juice on the way to the ER at the recommendation of an EMT that came to our house that morning. So the blood sugar test would have been skewed.

The weeks following the seizure she began randomly vomiting at about 2-3 AM. I thought, initially, that maybe it was a touch of a bug but she had not one other symptom, no fever, nothing.

About two mornings ago she woke up at 3 AM and said "I'm hungry." and then a few moments later she vomited. I couldn't go back to sleep so I began googling and found this article. Everything clicked into place. She is very slender and I had a feeling she was going through a growth spurt in the past few weeks as she has been eating "like a horse".

I just got back from the pediatrician's office where we confirmed she had a fasting blood glucose level of 44. Low. Doctor is now testing insulin and other things.

But I just wanted to say that this article really made a HUGE difference for me and my daughter. A life saver I would say. I don't think I would have made the connection otherwise.

Does your daughter have a

Does your daughter have a seizure disorder also? Or was the seizure brought on by the blood sugar level? I could have written your post word for word describing our scenario. VERY interesting! What was the solution? Any information you have to share would be VERY helpful!

children vomiting

My two girls suffered from this but like another poster - only in the mornings. They are now 20 and 15 and still will not eat breakfast before 9am very often. I had read about the low blood sugar connection but couldn't get them to eat anything in the mornings even tho we knew the cause. My oldest turned out to have a very strong insulin response as we had a oral glucose test done and it was flat - her fasting BG was 85 and didn't deviate more than 5 points over the two hour test. She subsequently has to eat frequently and eat lower carbs to control the nausea and weight gain. Doctors told us if she didn't do more to control her insulin she'd be diabetic at an early age. 7 years later no diabetes but she did develop PCOS which is also related to insulin problems. The bedtime snack should help most kids.

vomitting

My son will be 4 this year. I started realizing the late night. And early morning vomiting as well. But my take is hes always eating he loves his food or even if I don't give him cook food he will have his hawlicks tea before Bed. He drinks slot off juice and water. He not much of a fan for snacks. But yet when I too him to the doctor I was told that he has infected diarrhea. Including off when vomiting all I see is foam or he had dinner late so he vomitted up some of it. But other night when he have just his tea all I see is foam. It's like while he's vommiting he.shacks while he forceing something to come out and all I see is foam. He uses the bath too often to and he cries for his belly alot.

 

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