Cyclic nausea and vomiting in childhood.

BACKGROUND: Cyclic vomiting syndrome (CVS) is an under-recognised functional gastrointestinal disorder of childhood. Despite failure of recognition by many health practitioners, it is relatively common and frequently disabling.
OBJECTIVE: This article describes the clinical features, differential diagnosis, treatment and outcomes of CVS. DISCUSSION: Cyclic vomiting syndrome is a functional disorder in childhood with a prevalence of around 2%. It consists of recurrent paroxysms of severe nausea and vomiting separated by symptom free periods. Associations include migraine, genetic factors, autonomic dysregulation, neuromuscular disorders and a tendency to anxiety. Cyclic vomiting syndrome may be triggered by stress and anticipatory anxiety as well as infection, exercise, trauma, menstruation and foods. Diagnosis requires exclusion of other causes of nausea and vomiting. Management focuses on the phases of the illness: prevention of attacks, termination of vomiting, sedation and prevention of complications. Children may outgrow symptoms, develop migraine or continue to have episodes into adulthood.