Cyclic Vomiting Syndrome Program
The Cyclic Vomiting Syndrome Program at Children's Hospital of Wisconsin is the largest program of its kind in the U.S. with experts who treat children experiencing severe, recurrent vomiting episodes.
What is CVS?
Cyclic vomiting syndrome (CVS) is one of the more unrecognized and misdiagnosed childhood diseases. Children with CVS experience severe, recurrent vomiting episodes but remain completely free of symptoms for weeks or even months at a time before and after the episodes. Over the course of 24 to 48 hours, a child may have more than 30 vomiting attacks.
Doctors commonly mistake CVS for gastroenteritis (irritation or infection of the stomach and intestines), food poisoning, gastroesophageal reflux disease (GERD) and even bulimia
“With gastroenteritis, once the stomach is empty, the vomiting stops,” says B Li, MD, a pediatric gastroenterologist who leads the CVS program at Children’s Hospital of Wisconsin. “However, children with CVS will continue dry heaving long after the stomach is empty. The drive to vomit is relentless.”
Vomiting episodes often begin in the early morning. The child may be nonresponsive, pale and curled in a fetal position.
Other warning signs
A child with CVS may also experience one or more of these symptoms during vomiting episodes:
- Abdominal pain
- Sensitivity to light
In addition, vomiting can cause severe dehydration that can be life threatening. Signs of dehydration include thirst, exhaustion, decreased urination, paleness and listlessness. A child with any symptoms of dehydration should see a health care provider immediately.
Who has CVS?
CVS can begin at any age, but in children it typically begins between ages of 3 and 7. Some research suggests that it affects 2 percent of school-aged children. Sixty percent of those with CVS are female.
Most children will outgrow CVS around puberty, but they often then begin developing migraine headaches. The specific causes of CVS are unknown. However, Dr. Li’s research indicates that 83 percent of CVS sufferers have at least one family member who has migraine headaches.
On average, a child has been misdiagnosed for 2½ years before coming to Dr. Li. “If an episode takes place every one to two months, that is about 15 attacks or more, in which the child is suffering and the parents are unsure of the reason,” says Dr. Li.
Pediatricians should consider the possibility of CVS in children who experience:
- Vomiting episodes that start with severe vomiting — several times per hour — and last less than one week
- Three or more separate episodes of vomiting in the past year
- No nausea or vomiting between episodes
Dr. Li is one of the world-renowned experts in treating and researching CVS and has seen more than 1,000 cases in his career — more than any other health care provider in the world.
Before a child visits the CVS program, an interdisciplinary team of psychologists, neurologists, researchers and nurses spends hours reviewing medical records, a standardized questionnaire and a diary of vomiting episodes (including a narrative summary from parents). After they review this information, the team members meet with the child and parents to discuss how to help the child.