A Ten Year Old with Vomiting In The Middle Of the Night

1/22/2008

I was asked to evaluate a child with a history of vomiting virtually every night approximately two to three hours after falling asleep. He had no other complaints such as headaches, dizziness, and clumsiness or school difficulties. There is no history of behavioral changes, no family history of migraines, recent weight loss, inappropriate weight gain, or frequent urination. After vomiting, he would immediately return to sleep and go through the rest of the night without incident.

I asked mom to bring him in for a complete history and exam. His neurological exam was completely normal. The mom pointed out that he has a habit of eating a significant “snack” just before bedtime. She very astutely suggested to him that this is a bad habit. On the few nights that he resisted and did not have a meal before bedtime, he did not vomit.

I simply confirmed to the mom what she had already suspected and that his vomiting was simply a response to going to sleep shortly after eating. While this habit is clearly a bad idea from a metabolic stand point often resulting in weight gain, it very likely was responsible for the vomiting. I was able to offer reassurance to the mom that there was very likely no neurological problem. Any child who awakens to vomit in the middle of the night needs a thorough history and examination to assure the family that there is no neurological basis for the vomiting. Children with lesions in their brain (such as brain tumors) often have increased intracranial pressure and vomiting which awakens them from sleep as well as nighttime headaches. Children with serious neurological headaches of the more serious type usually have progression of the headaches once they appear.

Another cause of nighttime headache and vomiting is carbon monoxide poisoning. I have seen on rare occasion a child who has “middle of the night headaches” and nausea from  carbon monoxide exposure. These poisonings usually occur when a gas heater leaks this deadly gas. The gas can also originate from some older versions of space heaters. All homes should have carbon monoxide and smoke detectors especially in areas where the family sleeps as this gas is often a silent killer as levels rise over time.

The child described here did not appear to have a neurological basis for the vomiting. The mom reported to me that the issue has resolved with her suggestion at eliminating the late night snacking. She was instructed to follow up with me if things change or if vomiting returns despite not eating late at night.