As a parent, you try to create a bedtime routine that enables your toddler to transition easily and peacefully to sleep. But your child might have other ideas. Many toddlers, even those who could fall asleep easily as babies, have difficulty falling asleep at bedtime. Whether your toddler is suddenly throwing up at bedtime for the first time or seems to be making a habit of bedtime illness, you need to determine the cause so you can prevent the problem and make bedtime peaceful again.
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Vomiting Because of Illness
Illness can strike your toddler at any time of day, including bedtime. If his vomiting is accompanied by other symptoms, such as fever, pain or diarrhea, it might be caused by a virus or infection. Although this vomiting is upsetting for both of you, it actually helps get the infection out of your toddler's system. Watch for signs of dehydration and give him clear liquids as soon as he's able to tolerate them. Anti-nausea medications are not recommended for toddlers, so there's little you can do for an infection but wait it out. Most infections that cause vomiting are over within 24 hours.
Vomiting Because of Reflux
Vomiting or spitting up because of reflux is more common in babies than toddlers. However, reflux can cause a toddler to vomit, even if he doesn't have other symptoms of this condition. Lying down on a flat surface is a common trigger for reflux, so if he throws up every night as soon as he lies down, reflux might be the cause. Your pediatrician can evaluate your toddler's symptoms to see if he has reflux. If so, then medication can help the problem disappear quickly. Make sure he has plenty of time to digest his food before lying down and raise the head of his mattress slightly so he's lying on a slight slant instead of completely flat in bed.
Vomiting Because of Food or Poison
Simple overeating can cause vomiting at bedtime, especially if your toddler recently ate a big meal. If he ate more than usual at dinner or had a large snack just before bed, then threw it up undigested food, he might have simply eaten too much. If the vomiting happens once, this can be the cause.
However, vomiting after eating also can be caused by food poisoning or other toxic substances. If your toddler seems to be in severe pain or if you have reason to think he ate something poisonous, call poison control. Describe all his symptoms as well as all the information you have about what he might have eaten.
Vomiting Because of Crying
If you are sleep training your toddler, and being left alone causes him to cry excessively at bedtime, then he could vomit as a result. Several sleep training experts, such as pediatrician Dr. Richard Ferber, acknowledge that your child could cry to the point of vomiting if he is very upset by being left alone in bed during sleep training. If your child vomits regularly at bedtime and this pattern began after you started sleep training, then consider whether you want to continue with sleep training or try another method. Many parents do not feel comfortable with allowing their child to become so upset at bedtime; unless you are strongly committed to a particular method of sleep training, try a gentler method to see if it works better for your child.