Parental Guidance For Children With Cyclic Vomiting Syndrome (CVS)
Quick Answer
Cyclic Vomiting Syndrome (CVS) is frightening to witness, but it IS manageable and most children outgrow it! If your child has episodes of severe, repeated vomiting that come and go with normal periods in between, they may have CVS. While scary during episodes, CVS doesn't cause long-term damage, and with proper management, episodes can be reduced or prevented. You're not alone - this guide helps you understand and manage your bachcha's CVS.
What Is Cyclic Vomiting Syndrome? (CVS Kya Hai)
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Understanding CVS
CVS is a pattern of:
Severe, repeated vomiting episodes
Episodes last hours to days
Completely normal between episodes
No other cause found (not infection, obstruction, etc.)
Key features:
Episodes are predictable (same pattern each time)
May be triggered by specific factors
Often related to migraines
Usually starts between ages 3-7
The Episode Cycle
Four phases:
Phase
What Happens
Duration
Prodrome
Early warning signs (nausea, pallor, sweating)
Minutes to hours
Vomiting
Intense, repeated vomiting (6-12 times/hour)
Hours to days
Recovery
Vomiting stops, appetite returns slowly
Hours to days
Well interval
Completely normal
Days to months
Signs and Symptoms (Lakshan)
During an Episode
Main symptoms:
Severe, forceful vomiting
Vomiting 6+ times per hour at peak
Pale, sweaty skin
Extreme fatigue/lethargy
Stomach pain
Loss of appetite
Sensitivity to light and sound
Headache
Low-grade fever (sometimes)
Drooling or spitting
Each episode:
Starts similarly (child may recognize warning signs)
Follows same pattern
Lasts about the same time
Between Episodes
Completely normal!
No symptoms
Normal eating
Normal activity
Normal energy
What Causes CVS?
The Connection to Migraines
Important: Up to 80% of CVS children have family history of migraines!
CVS is considered a "migraine variant"
Same brain pathways involved
Similar triggers
Many children develop migraines later
Common Triggers
Category
Specific Triggers
Emotional
Excitement, anxiety, stress, anticipation
Physical
Exhaustion, illness, lack of sleep (neend ki kami)
Food
Chocolate, cheese, MSG, caffeine
Other
Travel, motion sickness, fasting, periods (in older girls)
Learning your child's triggers is KEY to prevention!
When to Worry (Red Flags)
Seek immediate medical care if:
First episode ever (need to rule out other causes)
Blood in vomit
Severe dehydration (no urine 6+ hours, very dry mouth)
Severe abdominal pain
Confusion or unusual behavior
Episode longer than usual
Can't keep anything down
Call doctor during episode if:
Child looks very ill
Episode differs from usual pattern
Vomiting blood or bile
Signs of dehydration
Diagnosis
CVS is diagnosed by:
Pattern of episodes (Rome criteria)
At least 3 episodes in 6 months
Normal between episodes
No other cause found
Tests to rule out other causes:
Blood tests
Urine tests
Imaging (ultrasound, CT if needed)
Upper GI study
Possibly endoscopy
What You Can Do (Ghar Pe Kya Karein)
Identify and Avoid Triggers
Keep a diary of:
What child ate before episode
Sleep pattern (kitni neend li)
Stress/excitement level
Any illness before
Physical activity
Travel or events
Common preventable triggers:
Ensure regular, adequate sleep
Don't skip meals
Avoid known food triggers
Manage stress and anxiety
Treat infections promptly
Managing an Episode at Home
Early phase (prodrome):
If you recognize early signs, EARLY intervention helps!
Dark, quiet room
Anti-nausea medication (if prescribed)
Sometimes stopping the episode is possible if caught early
During vomiting phase:
Quiet, dark room
Don't force food or drink
Small sips of water/ORS if tolerated
Cool cloth on forehead
Prescribed medications
Monitor for dehydration
Recovery phase:
Gradual return to eating
Start with clear fluids
Progress to bland foods (khichdi, toast, banana)
Rest
Don't rush normal activity
Preventing Dehydration
Signs of dehydration:
Decreased urination (less than 3-4 times/day)
Dark urine
Dry mouth and lips
No tears when crying
Sunken eyes
Lethargy
If dehydrating:
May need IV fluids
Don't hesitate to go to hospital
Treatment Options
Preventive Medications
For frequent episodes, doctor may prescribe:
Cyproheptadine (common in younger children)
Amitriptyline
Propranolol
Others based on individual needs
Goal: Reduce frequency and severity of episodes
Treatment During Episodes
Medication Type
Purpose
Anti-nausea (ondansetron)
Stop vomiting
Sedatives
Help child sleep through episode
IV fluids
Prevent dehydration
Pain medication
For headache/abdominal pain
Lifestyle Measures
Regular sleep schedule
Regular meals (no fasting)
Stress management
Avoid known triggers
Coenzyme Q10 supplements (sometimes recommended)
Prognosis (Kya Hoga Aage)
Good news:
Most children outgrow CVS by puberty
Episodes typically decrease with age
Quality of life between episodes is normal
Treatment helps reduce episodes
Note: About 75% develop migraines later in life
Coping Strategies for Parents
During Episodes
Stay calm (your stress affects child)
Trust the process if pattern is known
Have action plan ready
Know when to seek help
Between Episodes
Focus on normal life
Don't overly restrict child
Work on trigger prevention
Connect with other CVS families
School Management
Inform school about condition
Provide action plan
May need flexible attendance policy
Teacher should recognize warning signs
Frequently Asked Questions
Q: Bachche ko baar baar ulti ho rahi hai, kaise pata chalega CVS hai?
A: CVS pattern: severe vomiting episodes that start and end suddenly, last hours to days, then completely normal in between. Episodes are similar each time. Must have 3+ episodes in 6 months with no other cause. Doctor will do tests to rule out infection, obstruction, etc. If pattern matches and tests normal - likely CVS. Don't self-diagnose - see specialist.
Q: Episode ke time kya khilana chahiye?
A: During active vomiting: nothing! Don't force food or drink - it won't stay down and causes more vomiting. Once vomiting slows: small sips of water/ORS, electral. Recovery: start with bland foods - khichdi, plain rice, toast, banana. Gradually return to normal diet. Force-feeding during episode makes things worse.
Q: CVS theek ho sakta hai?
A: Most children OUTGROW CVS by puberty! While there's no "cure," preventive medicines can reduce episodes significantly. Identifying and avoiding triggers helps. As child grows, episodes typically become less frequent and less severe. Many children are episode-free by teenage years (though may develop migraines later).
Q: Hospital le jaana padega har baar?
A: Not always, once you know the pattern. Mild episodes may be managed at home with rest, darkness, prescribed medications. BUT go to hospital if: first ever episode, severe dehydration, blood in vomit, can't keep any fluids down, episode longer/different than usual, or child looks very sick. When in doubt, seek medical care.
Q: Stress se CVS hota hai?
A: Stress is a common TRIGGER, not the cause. Both emotional stress AND excitement can trigger episodes. Other triggers: lack of sleep (neend ki kami), skipping meals, certain foods, infections. The underlying cause is likely related to migraine pathways in brain. Managing stress helps prevent episodes but stress alone doesn't cause CVS.
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This article was reviewed by a pediatrician. Last updated: January 2025
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