Cyclic Vomiting Syndrome in Children

Your pediatrician may have diagnosed your child with cyclic vomiting syndrome, or you may have wondered if he has something going on beyond frequent "stomach viruses." What do you need to know?

Child throwing up in bucket
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How It Differs From a Virus

While many younger children can get two to three episodes of viral gastroenteritis ("stomach flu") each year, having vomiting every month or two is more than you would usually expect a child to have.

Still, if a child has typical viral symptoms, such as vomiting and diarrhea and contact with other children with similar symptoms, then it is possible that he is just getting one virus after another.

But if his main symptoms are nausea and vomiting, especially if it is something that recurs every few weeks or months with normal times in between, it's likely that something else is going on, with cyclic vomiting syndrome being on the top of the list of possibilities.

The most common age at which this vomiting begins is between the ages of 3 and 7 and there are equal numbers of boys and girls who are affected.

Cyclic Vomiting Syndrome Symptoms

Children with cyclic vomiting syndrome usually have episodes or cycles of nausea and vomiting which may last a few hours or a few days. During these episodes, children may also have decreased activity and a decreased appetite and they may even become dehydrated.

Other symptoms include:

  • Abdominal pain
  • Headache
  • Fever
  • Pallor

Once the episode is over, children are usually symptom-free and well until the next time it happens.


Although the cause of cyclic vomiting syndrome is not known, most children with this condition have a family history of migraines and many experts believe the two are related.

The other factor that links migraines with cyclic vomiting syndrome is that they can often both be prevented with the same medications, namely Periactin (cyproheptadine) and Elavil (amitriptyline).


Cyclic vomiting syndrome is classified as one of the functional gastrointestinal disorders. The symptoms are due to the function of the digestive system instead of any structural problems. As such there aren't any specific tests done to diagnose the condition.

Most testing is done to rule out the possibility of other conditions—what physicians call organic disorders—or problems that do have a structural basis. The diagnosis is made by the typical pattern of symptoms, especially the fact that there are long periods without any symptoms at all.

Tests that may be done include:

  • A head computerized tomography (CT) scan or magnetic resonance imaging (MRI)
  • Metabolic tests
  • Abdominal ultrasound
  • Upper gastrointestinal X-ray with small bowel follow-through (UGI-SBFT)

Sometimes the diagnosis and treatment of this condition go hand in hand, as a response to treatments helps to confirm the diagnosis. Conditions which can cause symptoms that are somewhat similar (but not often with the periods of being normal between episodes) include:

  • Inborn errors of metabolism
  • Malrotation of the intestine with volvulus, a condition where the bowel moves around and becomes tangled


Proper treatment depends on whether the episode is acute or chronic.

Acute Treatment

During an acute episode of vomiting, treatment is aimed at making your child as comfortable as possible. Treatments may include:

Chronic Treatment

The best treatment for cyclic vomiting is prevention. The first step is to make sure nothing else is responsible for the vomiting. If your child is diagnosed with cyclic vomiting, you may want to attempt to identify triggers that stimulate these episodes.

Medications that are used for preventing cyclic vomiting—often with very good results—include:

  • Periactin (cyproheptadine)
  • Inderal (propanolol)
  • Elavil (amitryptylline)

Identifying Triggers

Just as there are common migraine triggers that appear to precipitate headache symptoms in those with migraines, it seems there may be triggers for some episodes of vomiting with cyclic vomiting syndrome.

Common Triggers

Triggers for cyclical vomiting episodes include:

  • Stress
  • Excitement
  • Infections
  • Eating certain foods
  • Hot weather
  • Motion sickness.

Keeping a vomiting journal just as some people keep a headache journal to keep track of migraine triggers, may help you identify any of these factors in order to avoid them, if possible, in the future.

The Role of Riboflavin

It's still too early to say, but using the B vitamin riboflavin may play a role in the prevention of cyclic vomiting in the future. It's known that riboflavin is sometimes helpful in the prevention of migraine headaches. Riboflavin is found in whole grains as well as almonds, spinach, and mushrooms.

A small European study in 2016 found that treating children with cyclical vomiting with riboflavin for 12 months helped to improve the condition. While this study is far too small to guide treatment at this time, it may be helpful to ask your pediatrician if the addition of this vitamin to your child's treatment plan could be beneficial.


The main complication of cyclic vomiting is dehydration which sometimes results in the need for hospitalization and IV fluids. Children with cyclic vomiting also appear to have a somewhat increased risk of anxiety disorders.

Very rarely, a complication called a Mallory Weiss tear may occur. This is a tear in the esophagus (after which children cough up blood) which can be the result of violent vomiting episodes.


Most children with cyclic vomiting syndrome do very well, and basically outgrow their symptoms. There have not been any recorded deaths from the syndrome, though children do sometimes end up needing hospitalization for dehydration.

One study found that over half of children who outgrew the symptoms of cyclic vomiting went on to have migraine headaches.

Make a point to learn more about migraine headaches in children, as they are often different from those in adults. And while your child is coping with the syndrome, make sure you are familiar with the symptoms of dehydration in children and how to manage vomiting and diarrhea in children.

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