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Recurring and prolonged abdominal pain and vomiting are, unfortunately, not uncommon in kids. Often, they occur together, although a child may have pain without vomiting.

What are Cyclic Vomiting Syndrome and Abdominal Migraines?

The terms Cyclic Vomiting Syndrome (CVS) and Abdominal Migraines (AM) refer to two different conditions that have a lot in common, including recurring pain and possibly vomiting. Another thing they share is that they both often occur in children of migraine sufferers.

If your child vomits in the absence of illness with any sort of regularity, it might be CVS. If your child complains of abdominal pain with any sort of regularity, with or without vomiting it might be AM.

In either case, it is extremely important that your child see a health care provider qualified to give an accurate diagnosis. The symptoms of vomiting and abdominal pain can be caused by a number of serious conditions that must not be missed.

(A few) other conditions that may cause recurrent vomiting and / or abdominal pain: (This list is not exhaustive)

  1. Food allergies or food sensitivities – see this post and this one for more information on food reactions.
  2. Medication side effects – see the doctor who prescribed the medication for more information.
  3. Constipation
  4. Intestinal blockage
  5. Crohn’s Disease
  6. Stress
  7. Functional Abdominal Pain
  8. Chronic Infection (less common in the developed world).

How are CVS and AM diagnosed?

Both of these are diagnoses of exclusion. In other words, your doctor will seek to eliminate other causes, like those listed above, before giving a diagnosis of CVS or AM. Your child’s doctor will ask questions to determine the nature of the pain, the presence of associated symptoms, and family history. He or she may also use blood work and or imaging (e.g. ultrasound or X-ray) to confirm the diagnosis and rule out other conditions.

I have a diagnosis, now what?

Both of these conditions can be approached similarly to migraines, especially if there is a family history of migraines.

Primary goal = identify and eliminate triggers.

Keep a detailed diary of:

  • Symptoms – include duration, severity (scale of 1-10), location of pain
  • Diet – empower your child to do this with you; if your child is in school, enlist the teacher’s help
  • Stressors – make sure you give your child ample opportunity to communicate with you; use questions like “what did you like today” and “what did you not like today”
  • Life events – anything from having a visitor in the house to going to the mall

How long the diary must be kept depends on how often the migraines occur, and how soon you notice possible triggers.

Just as chocolate and foods high in nitrites (think hot dogs and some lunch meat) or MSG (think Chinese food) may trigger migraines in adults, you may notice the same in your child.

You may also find that your child has an intolerance to a certain food(s). For instance, if your child has abdominal pain every time she eats almonds, she is likely intolerant of almonds.

Lastly, you may notice your child has abdominal pain every time he has gym class, or every time he has to speak in front of a group, or every time he experiences anything he considers stressful. Then his pain is triggered by either specific stressful situations or by stress in general.

You may not know for sure what the actual triggers are after keeping the diary. But keep the diary long enough to identify possible triggers. Once you’ve identified all of the possible triggers, you can narrow it down to the actual triggers.

Eliminate triggers:

Once you’ve kept the diary and identified possible triggers, you have to stop all of those possible triggers. This can be easier said than done when you’re talking about major food groups that have to be eliminated (like gluten or dairy for example) or worse, when your child is reacting to everyday stressors. In either case, you’re going to need guidance.

If you need help with an elimination diet, seek the guidance of a naturopathic physician, or another practitioner skilled at monitoring a child on an elimination diet. It can be extremely difficult to get enough food into a kid on an elimination diet!

If you need help eliminating everyday stressors, enlist the help of the school counselor to start with. Explain what’s going on, and hopefully the counselor will agree to meet daily, or at least weekly, with your child to help teach stress management skills. Ideally, add in biofeedback.  Add to that any number of stress coping approaches like yoga, acupuncture, talk therapy, meditation, guided imagery, martial arts, exercise, etc.

When can we challenge?

You’ll know you’ve eliminated all triggers if all the symptoms disappear.  If symptoms persist, you then have to determine whether you’ve missed a trigger, or if the elimination has not been complete. For example, if your child is reacting to dairy, and you eliminate dairy completely at home, your child may still be eating dairy at school or play dates.  Furthermore, if the trigger is stress, since you can’t eliminate stress, it would be more realistic to strive to achieve a significant decrease in severity and frequency of symptoms. Finally, identifying triggers is no small job in many cases. Sometimes the culprit is something you would never dream of, like red grapes and vinegar, or green beans.  The hunt can turn you into quite the detective.  Starting to see why you’ll want an experienced health care provider guiding you through this?!

You don’t want to start challenging foods until you’re sure you’ve eliminated all triggers.

What is a challenge?

In the “challenge” phase you add the possible triggers back in to determine which ones are actual triggers.  You must do this systematically, one by one, to determine the true offenders.  Again, you’ll want to follow the guidance of an experienced health care practitioner for this, but following are some tips and references to help you get your mind around this process.

How to challenge:

You’ll want to introduce one trigger at a time.  Choose a relatively stress free time to start.  (If you introduce a food at the same time as your child has a big presentation at school, you may get confused about which one is the trigger).  Introduce the food; let your child eat it as much as he likes.  Now for the tricky part; how long you continue to challenge this one food depends on your child.  If you introduce it and symptoms begin immediately, then that food is pretty clearly a trigger.  However, if your child eats it for 4 days and does not get any symptoms, that food is probably not a trigger.

For more detailed instructions, reference our ebook on Elimination Challenge Diets here.  For great recipes that are elimination diet friendly, check out Nourishing Meals.

For more support:

In the event that you need support beyond eliminating triggers for the symptoms, there are some supplements and herbs that are often used to treat adult migraines; they may be helpful here too.  Consult a qualified health care practitioner for dosing advice for these supplements, and for an individualized treatment plan (and for purchasing information).

  • Magnesium – nice because it’s easy to find as a powder for kids who don’t take pills
  • Riboflavin – aka Vitamin B2
  • Feverfew and Butterbur – both are available as a tincture for those kids who don’t take pills
  • There are products that combine these products (and sometimes more) into a single capsule
  • Body work: Craniosacral Therapy, Visceral Manipulation and others.  For more information on abdominal massage check out our blog post Tummy Massage for Every Body
  • Traditional Chinese Medicine: acupuncture or acupressure with the possible addition of Chinese herbs.
  • Homeopathic Medicine: controversial as it is, practitioners and patients alike swear by it.  For more information about the controversy in Homeopathy check out our blog post What Is Homeopathy? (Insert Controversy Here)
  • Pharmaceuticals: there are a variety of drug classes that may be considered, if all else fails.

Resources:

This great cookbook has lots of elimination friendly recipes, and so does this one

This is a reference book all about the elimination diet

For support groups, help navigating school attendance, and other great resources, check out CVSA.

Learn about natural alternatives to Tylenol and Ibuprofen.

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Teresa Neff
Teresa Neff

Dr. Teresa specializes in pediatric and adolescent medicine and women’s health. After earning her doctorate from Bastyr University, she spent over two years at The Kids Clinic, in north Seattle, first as a medical resident, and then as a staff physician. At The Kids Clinic, she became comfortable managing urgent acute matters as well as chronic health concerns. Dr. Teresa loves combining her life long love of teaching children with her passion for natural medicine.

As a primary care provider, she offers well child exams, well woman exams, sports physicals, lab studies, vaccines and vaccine education. In addition, she uses the various tools of naturopathic medicine, including Craniosacral Therapy, Visceral Manipulation, and Classical Homeopathy, among others, to build healthy foundations and to promote health and empower her patients.

Dr. Teresa also studied breastfeeding and lactation with the Simkin Center and holds a certificate as a Certified Lactation Educator (CLE). Having experienced the struggles and the joys of breastfeeding herself, she is happy to help moms establish or continue breastfeeding. Dr. Teresa sees patients at Seattle Nature Cure Clinic in Seattle, Washington. Schedule an appointment with Dr. Neff in Seattle, Washington

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