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 Table of Contents  
Year : 2021  |  Volume : 5  |  Issue : 1  |  Page : 96-97

Recurrent episodes of cyclical vomiting in a 12 year old child

1 Department of Paediatrics, Providence Hospital, Alappuzha, Kerala, India
2 Department of General Medicine, Mysore Medical College, Karnataka, India

Date of Submission17-Jun-2020
Date of Decision13-Jul-2020
Date of Acceptance30-Aug-2020
Date of Web Publication06-Jan-2021

Correspondence Address:
Dr. Jayasurya Suresh
Department of Paediatrics, Providence Hospital, Alappuzha, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aip.aip_53_20

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How to cite this article:
Suresh J, Chandran R N. Recurrent episodes of cyclical vomiting in a 12 year old child. Ann Indian Psychiatry 2021;5:96-7

How to cite this URL:
Suresh J, Chandran R N. Recurrent episodes of cyclical vomiting in a 12 year old child. Ann Indian Psychiatry [serial online] 2021 [cited 2021 Aug 5];5:96-7. Available from: https://www.anip.co.in/text.asp?2021/5/1/103/318682


Cyclical vomiting syndrome is characterized by multiple repeated episodes of gastrointestinal symptoms such as nausea, vomiting, and abdominal pain which leads to multiple hospital presentations prior to the definite diagnosis.[1] Majority of cases of cyclic vomiting syndrome can be reversed by recognizing the underlying risk factors and starting on appropriate management.[1] As abdominal pain and vomiting symptoms associated with cyclical vomiting syndrome can be managed by tricyclic antidepressants and lorazepam, it suggests manifestation of a central nervous system etiology.[1] Cyclic vomiting syndrome in children can lead to multiple hospitalizations, various comorbidities, and deteriorating quality of life.[2] The management includes lifestyle modifications, drugs, and anxiety reduction therapies.[2]

Cyclical vomiting syndrome include prodromal, visceral, and recovery phases during which the child can show a wide range of neuropsychiatric symptoms.[3] Pathophysiology of cyclical vomiting syndrome is slightly obscured and has multifactorial origin.[4] Cyclical vomiting syndrome can often lead to diagnostic and treating dilemmas to the physician.[5]

A 12-year-old female child was admitted with complaints of recurrent episodes of cyclical vomiting and abdominal pain. The child had 14 episodes of cyclical vomiting symptoms in the previous year. She started getting her symptoms from the age of 5 years. The girl was extensively worked up and treated for the same but the symptoms kept recurring. The child psychiatry consultation was done and it was found that the child was getting symptoms when she was stressed about her school exams and her parents used to scold her when she used to get low marks in school exams. Later, cognitive behavior therapy (CBT) along with counseling sessions was tried along with amitriptyline prophylaxis to which the child responded well. The child received ten sessions of CBT which included stress inoculation training. In the first session, basic awareness about the child's condition was briefed to her and she was given confidence that she can fight this condition if she made certain behavior modifications. In the later sessions, she was given imaginary situations which invoked anxiety in her and she was trained to track her thoughts and behavior during the episode. She was taught to practice relaxation techniques like diaphragmatic breathing and was asked to inculcate positive healthy behavioral changes on a daily basis. Child practiced relaxation techniques, breathing exercises, involvement in group play and hobbies, writing up her fears, and their solutions. Cognitive rehearsal sessions helped her to bring positive thoughts into her mind and thereby change her thought process during stress. Systematic positive reinforcement and self-instructional methods helped her to fight her fears immensely and thereby to get rid of her cyclical vomiting syndrome. Parents were also given psychiatric guidance and were advised not to stress the child about academics. Symptoms frequency of the child significantly came down after addressing the child's anxiety disorder.

Here, in the index case, the child started getting symptoms of intractable cyclical vomiting syndrome from an early age of 5 years which was not responding well to pharmacological treatment and later a psychological approach was tried to which there was good response. This proved the role of anxiety disorder as an etiological factor for cyclical vomiting syndrome and importance of CBT in the treatment of intractable cyclical vomiting syndrome.

CBT and psychological interventions should be given a trial in intractable cyclical vomiting syndrome along with pharmacological treatment for better prognostic outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

  References Top

Herlihy JD, Reddy S, Shanker A, McCallum R. Cyclic vomiting syndrome: An overview for clinicians. Expert Rev Gastroenterol Hepatol 2019;13:1137-43.  Back to cited text no. 1
Li BUK. Managing cyclic vomiting syndrome in children: Beyond the guidelines. Eur J Pediatr 2018;177:1435-42.  Back to cited text no. 2
Kovacic K, Sood M, Venkatesan T. Cyclic vomiting syndrome in children and adults: What is new in 2018? Curr Gastroenterol Rep 2018;20:46.  Back to cited text no. 3
Donnet A, Redon S. Cyclic vomiting syndrome in children. Curr Pain Headache Rep 2018;22:30.  Back to cited text no. 4
Slutsker B, Konichezky A, Gothelf D. Breaking the cycle: Cognitive behavioral therapy and biofeedback training in a case of cyclic vomiting syndrome. Psychol Health Med 2010;15:625-31.  Back to cited text no. 5


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