Question: My 2 year old gags and throws up when he is actively playing for more than a few minutes. What causes this and is it normal?
Answer: It is definitely not normal to have frequent vomiting with exercise or activity. If that happened only occasionally it wouldn't worry me as much but if that is happening frequently, something is not right.
The gag reflex happens for all people when something stimulates receptors on our palette and tongue which then causes our epiglottis to close. This protects the airway from whatever is in the area. As this happens, the muscles of the stomach and esophagus contract, attempting to clear the area of whatever substance is in the area. This is what can cause the vomiting.
Some kids have a more sensitive gag reflex than others do. In the scenario you asked about, activity seems to bring on this response. Something must be triggering the gag reflex that is released or produced during the activity. The two most likely factors would be a release of mucus from the nose and sinus area or stomach contents if the child is refluxing. Many things can cause the mucus buildup that would then be released during activity, i.e., allergies, colds, sinus infections, etc.
In either of these scenarios, it would be a good idea to have your pediatrician check the child to look for signs of those possibilities. It is possible that your child has a very sensitive gag and normal secretions produced during activity are causing the vomiting, but I would suggest getting your child checked out to see about any of the other potential problems. We want to promote activity in our children so this should be looked into in hopes of improving the situation.
If the child does some coughing and then vomits it is possible to see some exercise-induced asthma symptoms like this but it is less likely in this age group, usually in older children.
Craig H. Collison, MD, is a pediatrician with Mount Nittany Physician Group. He treats patients from the Physician Group's Boalsburg and Bellefonte locations. Read more about pediatric care at www.mountnittany.org/pediatrics.