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Children's Health

Vomiting and persistant coughing and hacking

10/28/2008

Question:

My nine year old son has been vomiting off and on for about a week now. Sometimes he can keep food down, sometimes he can`t. Sometimes he coughs then vomits and then vice versa. He has no other symptoms other then blowing his nose a lot. He has been to his doctor and has had a whooping cough test done and a stomach x-ray. They both came back negative. She said he had some constipation though and told me to give him a stool softener. What else can we do? Would else could it be?

Answer:

From your description this could be

  1. a GI virus,
  2. constipation,
  3. reflux,
  4. sinus infection,
  5. or a cold.

1.) Viral stomach (GI) complaints are usually self limited, meaning they take care of themselves. Often they are accompanied by diarrhea, not in this situation. Some less common viral complaints last longer and require medical intervention. Usually not associated with a cough.

2.) Constipation is very common in this age group, as you have had an examination and x-ray to back up the examination, and this is the diagnosis that you physician has given you, this is the very likely at least a part of the complaint. With constipation if you become "backed-up" enough you can begin to vomit. The longer constipation is present, the longer it takes to truly get the problem under control. With constipation the bowel is stretched, sometimes to the point that the nerves which let you know the bowel is full and needs to be emptied are "stretched out" and stop functioning. So, you end up with a colon full of stool, stretching beyond normal until the sensation receptors are not functioning to let you know you need to go! This can be a vicious cycle! A good "clean out" of the intestinal track is essential followed by a long term bowel program to allow the bowel return to it's normal size and regain sensation. Constipation is usually not associated with a cough and true constipation requires more intervention that a stool softener.

3.) Reflux is when stomach contents (acid, food) back up into the esophagus (food pipe between the mouth and stomach). This is associated with a cough is some individuals with asthma. (the cough a part of asthma in this circumstance).

4.) A sinus infection with a large amount of post nasal drip can cause both vomiting (especially when first up from lying flat) and a cough. This is usually diagnosed by the child's history (symptoms for longer than 10 days, or symptoms worsening after 5-7 days, often with a fever), symptoms (by examination), and at times at CAT scan of the sinuses.

5.) A cold would account for all the symptoms your son is having. Without significant weight loss, fever over 102.5 F, bilious vomiting (green vomit), cough with color change (blueness around the mouth), I would strongly consider this possibility. The constipation issue would something found "along the way", but still needs attention.

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Response by:

Sarah Sauntry, RN, MS, CPNP-PC
Assistant Professor of Clinical Nursing
College of Nursing
University of Cincinnati