Cyclical Vomiting vs stomach bug????

Published

Specializes in 12 years as a school nurse.

Help me understand this, please? 2nd grader with previous diagnosis of cyclical vomiting syndrome, Zofran Rx kept at school, but has never needed it. . . until today. Student visits nurse's office about 10 complaining of a headache, stomach ache, and reports being sick over the weekend with same, but no vomiting or diarrhea. Temp is 99.1, student appears pale, acts quiet, subdued. Reports eating no breakfast because didn't feel well. I gave some crackers and water while I attempted to call parent to inquire if any Tylenol or motrin was given this morning, left msg. After 20 minutes, student reports feeling some better and parent has not returned call, so was sent back to class. Teacher accompanies student back to nurse's office 10 minutes later with trashcan/vomit. I called mom again to send student home as per school policy, (she answered this time) but refused to pick up, said give Zofran and motrin and thinks it's the cyclical vomiting. Teacher is not going to be happy to get this kid back in class today. Have any of you had students with cyclical vomiting Dx? How do you know if that's why they vomited or if it's just a regular stomach bug. (We've had plenty of that lately here!)

Up Vote Up Vote ×
Specializes in School Nursing, Ambulatory Care, etc..

Wow...I have no answers. This is one of those "between a rock and a hard place" issues.

How long has it been since the child last had an episode of CVS? Typical frequency is q2-4 weeks. If it's been longer then kiddo may have a viral GI issue. Any chance mom is will to let you talk with the pediatrician's office to get some guidelines?

Up Vote Up Vote ×
Specializes in 12 years as a school nurse.

To my knowledge, student has not had issues at school in the past year of attendance here. They move around a lot, not sure which Dr made initial diagnosis of CVS, but it wasn't the local Dr that prescribed the Zofran. I'm not sure how helpful it'd be to speak to the prescriber? I told mom student could stay today, as symptoms improved after meds, but if any fever or additional vomiting tonight, should stay home tomorrow. Seems like a bogus diagnosis to me, a way to not have to be inconvenienced to pick your sick kid up from school. (Unfortunately seeing a lot of that lately in my district. Parents just don't want to be bothered)

Up Vote Up Vote ×

I would suggest the doctor that wrote the order for Zofran also write that the student may remain in school after vomiting episode in absence of fever. That will trump your school policy. Mom will likely assist as she obviously wants the child to remain in school. I have had great results with this notation from the doctor for my frequent vomiters due to excessive mucous, anxiety, or just that child who seems at will to cough and vomit. This will also help with teacher if you have a physicians note as well. Not all vomiting is due to illness and not necessarily a reason to exclude.

Up Vote Up Vote ×
Specializes in School nursing.
I would suggest the doctor that wrote the order for Zofran also write that the student may remain in school after vomiting episode in absence of fever. That will trump your school policy. Mom will likely assist as she obviously wants the child to remain in school. I have had great results with this notation from the doctor for my frequent vomiters due to excessive mucous, anxiety, or just that child who seems at will to cough and vomit. This will also help with teacher if you have a physicians note as well. Not all vomiting is due to illness and not necessarily a reason to exclude.

See, I just got them to change the policy. Now a 1 time vomit kid is up to my discretion to evaluate. I love this, but realize that I'm lucky to have admin that support my assessment skills ;).

Up Vote Up Vote ×
Specializes in school nurse.

Hadn't heard of CVS before, thought it might be related to JSMC (Just Sampled My Cooking), but it turns out it wasn't.

Seriously, though, with the other symptoms presented it certainly sounds like it could have been viral...

Up Vote Up Vote ×

I had an adult in my family with CVS (rare for an adult). I really could not tell the difference between a stomach virus or a CVS episode. Upon the first occurrence we thought he ate something bad. He saw SEVERAL physicians, was seen in different various EDs, and had dozens of hospitalizations. It is a baffling syndrome, even to gastroenterologists.

You will not be able to distinguish a CVS episode from a virus, and the school will need education about it. I hope this poor kid grows out of it. I am so sorry.

Up Vote Up Vote ×
Specializes in IMC, school nursing.

CVS is also "abdominal migraine", a very important detail. Headache can also be present. In light of afebrile presentation I would have treated as CVS. Teachers do not want any vomiting in the classroom, period. The reason is very selfish, they don't want to get "it", well you can't "get" CVS. This is a case where consent from the parent to discuss CVS with the teacher would prove beneficial.

Up Vote Up Vote ×

Vomiting is really the bane of a school nurses's existence. It really does take a lot of education to staff, parents, students that not all vomiting is created equal. I have had so many students with chronic vomiting that are not contagious. Reflux, anxiety, migraines, strong gag reflex,pushed too hard in PE/athletics etc. Then there are the '"was it even actual vomiting scenario" - in the restroom toilet with no evidence, at home 7 times but didn't tell parents, spit up phlegm, acid indigestion. Every single day, the reports I get from athletics alone - you would think the gyms and locker rooms would be coated in vomitus but rarely is it ever seen or witnessed.

So, if I do have a kid that has an actual diagnosis, I do try to have physician write something on a letterhead or even a RX pad - just something in writing I can show to staff to get them to calm down a little.

Up Vote Up Vote ×
Specializes in Cardiology, School Nursing, General.

I have one student with dx of CVS. Basically as everyone said, it's usually accompanied with headaches. And it's non-stop, sometimes stress induced. When we noticed something was wrong was it wasn't just a few days and it went away, it was always a constant thing. He would get vomiting episodes around when a project was due or there was a test and it would last a week and then go away and start again another time. I thought it was a migraine and asked the mother to maybe visit a doctor or a specialist and she did, and found out he has CVS. He has no medication here since he takes it at home and he goes to see a therapist every once in a while about his stress and how to control it, because also comes to find out he has anxiety and needs medication for that too.

Lately though, we had a scare, a new symptom, where he fell asleep in class and would not wake up. He said he felt super dizzy and he went home after that. I haven't heard much after that and he seems fine now. I wonder, is that part of CVS too?

Up Vote Up Vote ×
Specializes in kids.
CVS is also "abdominal migraine", a very important detail. Headache can also be present. In light of afebrile presentation I would have treated as CVS. Teachers do not want any vomiting in the classroom, period. The reason is very selfish, they don't want to get "it", well you can't "get" CVS. This is a case where consent from the parent to discuss CVS with the teacher would prove beneficial.

This!!!!

Up Vote Up Vote ×
+ Join the Discussion