Your little one is tucked into bed after a rambunctious day and you’re finally settling into the sofa to catch up on your favorite series. Just as you get comfortable, you hear a loud wail from the bedroom. Your child who seemed fine all day long has woken up from their slumber — throwing up.

Any time is a bad time for vomit. It can seem worse, though, when your cranky, sleepy child throws up at night. But it can happen for a number of reasons.

Often it’s just a temporary (and messy) situation for both you and the kid. Your child may feel better after vomiting — and being cleaned up — and go back to sleep. Throwing up may also be a sign of other health issues. Let’s take a look at what might be going on.

Along with throwing up after bedtime, your child might have other signs and symptoms that appear at night. These include:

  • stomachache or cramps
  • coughing
  • headache pain
  • nausea or dizziness
  • fever
  • diarrhea
  • wheezing
  • difficulty breathing
  • itching
  • skin rash

Food poisoning

Sometimes vomiting is simply the body saying “nope” for all the right reasons. Your child — or anyone — may consume something (through no fault of their own) that they shouldn’t have eaten, as far as the body’s concerned.

Cooked and uncooked food can both cause food poisoning. Your child may have eaten food that was:

  • left out too long (for example, at a friend’s outdoor birthday party in the summer)
  • wasn’t cooked properly (we’re not talking about your cooking, of course!)
  • something they found in their backpack from a few days ago

It can be hard to find out exactly what the culprit food was because your child may not have any symptoms for hours. But when it hits, vomiting is likely to happen at any time — even at night.

Along with vomiting, food poisoning can also cause symptoms like:

  • stomachache
  • stomach cramps
  • nausea
  • dizziness
  • fever
  • sweating
  • diarrhea

Stomach flu

The stomach flu is a common and contagious illness for kids. And it can strike at night, when you least expect it.

The “stomach bug” is also called viral gastroenteritis. Vomiting is a hallmark symptom of the viruses that cause the stomach flu.

Your child may also have:

  • mild fever
  • stomach cramps
  • headache pain
  • diarrhea

Food sensitivities

A food sensitivity happens when your child’s immune system overreacts to a (normally) harmless food. If your child is sensitive to a food, they may not have any symptoms for up to an hour after eating it. Eating a late dinner or a bedtime snack might lead to nighttime vomiting in this case.

Check to see if your child might have eaten anything they may be sensitive to. Some of these might be hidden in processed snacks like crackers. Common food sensitivities include:

  • dairy (milk, cheese, chocolate)
  • wheat (bread, crackers, pizza)
  • eggs
  • soy (in lots of processed or boxed foods and snacks)

A food allergy, which is more serious, would usually cause other symptoms — like rash, swelling, or breathing problems — and can be a medical emergency.

Cough

Your child might only have a slight cough during the day. But a cough can sometimes get worse at night, triggering your child’s gag reflex and making them vomit. This can happen whether your child has a dry or wet cough.

A dry cough might get worse if your child is a mouth breather. Breathing through an open mouth while sleeping leads to a dry, irritated throat. This causes more coughing, which in turn, causes your child to throw up dinner in bed.

A wet cough — usually from a cold or flu — comes with lots of mucus. The extra fluid trickles into the airways and stomach and can collect as your child sleeps. Too much mucous in the stomach causes waves of nausea and vomiting.

Acid reflux

Acid reflux (heartburn) can happen in babies as well as children from the age of 2 years and up. Your child may have it once in a while — this doesn’t mean they have a health problem necessarily. Acid reflux can irritate the throat, setting off coughing and vomiting.

This can happen in the wee hours of the night if your child ate something that may trigger acid reflux. Some foods make the muscles between the stomach and mouth tube (esophagus) relax more than usual. Other foods trigger the stomach to make more acid. This can cause occasional heartburn in some little ones and adults.

Foods that might give your child — and you — heartburn include:

  • fried foods
  • fatty foods
  • cheese
  • chocolate
  • peppermint
  • oranges and other citrus fruits
  • tomatoes and tomato sauce

If your child has acid reflux often, they may have other signs and symptoms that don’t seem linked:

  • sore throat
  • coughing
  • bad breath
  • frequent colds
  • repeated ear infections
  • wheezing
  • raspy breathing
  • rattling noise in the chest
  • loss of tooth enamel
  • dental cavities

Asthma

If your child has asthma, they might have more coughing and wheezing at night. This is because the airways — lungs and breathing tubes — are more sensitive at night while your child is sleeping. These nighttime asthma symptoms sometimes lead to throwing up. This can be worse if they also have a cold or allergies.

Your child may also have:

  • chest tightness
  • wheezing
  • whistling sound when breathing
  • difficulty breathing
  • trouble sleeping or staying asleep
  • tiredness
  • crankiness
  • anxiety

Snoring, with or without sleep apnea

If your little one sounds like a freight train while snoozing, pay attention. Children can have light to pretty serious snoring for a number of reasons. Some of these causes go away or get better as they get older. But if they also have significant pauses in breathing (usually while snoring), they might have sleep apnea.

If your child has sleep apnea, they might have to breathe through their mouth, especially at night. This can lead to a dry throat, coughing — and sometimes, throwing up.

In some children even without sleep apnea, snoring can make it hard to breathe. They might wake up suddenly feeling like they are choking. This can set off panic, coughing, and more vomit.

Kids who have asthma or allergies may be more likely to be snorers because they get stuffy noses and congested airways more often.

Remember that throwing up is usually a symptom of something else not quite right. Sometimes — if you’re lucky — one vomiting episode is all it takes to correct the problem, and your child goes back to sleep peacefully.

At other times, night vomiting may happen more than once. Treating the underlying health cause can help reduce or stop this symptoms. Soothing a cough might help get rid of the vomit. Home remedies include avoiding:

  • foods and drinks before bedtime that may trigger acid reflux
  • allergens such as dust, pollen, dander, feathers, animal fur
  • secondhand smoke, chemicals, and other air pollution

If the vomiting seems to be associated with eating certain foods, talk to the pediatrician to see if these are foods your child should avoid.

Give your child sips of water to help them stay hydrated after vomiting. For a younger child or baby, you may be able to get them to drink a rehydration solution like Pedialyte. This can be especially helpful for babies who have vomiting or diarrhea lasting longer than overnight.

You can try a rehydration solution from your local drugstore or make your own. Mix:

  • 4 cups water
  • 3 to 6 tsp. sugar
  • 1/2 tsp. salt

Popsicles can be a good hydration source for older children.

Vomiting is occasionally linked to breathing problems. Some children with sleep apnea have a smaller jaw and other mouth problems. Dental treatment or wearing a mouth retainer can help end the snoring.

If your child has asthma, talk to your pediatrician about the best medications and when to use them to reduce symptoms at night. Even if your child hasn’t been diagnosed with asthma, talk to their doctor if they frequently cough at night. Some children with asthma seem mostly fine during the day and their primary — or even only — symptom is a nighttime cough, with or without vomiting. Your child may need:

  • bronchodilators to open up the breathing tubes (Ventolin, Xopenex)
  • inhaled steroid drugs to reduce swelling in the lungs (Flovent Diskus, Pulmicort)
  • allergy medications (antihistamines and decongestants)
  • immunotherapy

Too much vomiting can lead to dehydration. This is especially a risk if your child also has diarrhea. Vomiting along with other symptoms may also be a sign of a serious infection. Call your doctor if your child has:

  • persistent cough
  • a cough that sounds like barking
  • a fever that is 102°F (38.9°C) or higher
  • blood in bowel movements
  • little or no urination
  • dry mouth
  • dry throat
  • very sore throat
  • dizziness
  • diarrhea for 3 days or longer
  • extra tiredness or sleepiness

And if you child has any of the following, an emergency trip to the doctor is warranted:

  • severe headache
  • severe stomach pain
  • difficulty waking

Sometimes the only reaction to a food sensitivity or allergy is vomiting. Your child might feel better after throwing up because the food is out of their system. In other cases, food allergies can trigger serious symptoms that need urgent medical care.

Look for symptoms like:

  • swelling of the face, lips, throat
  • difficulty breathing
  • hives or skin rash
  • itching

These can be signs of anaphylaxis, a serious allergic reaction that requires immediate medical attention.

If your child has asthma, check for signs that show they’re having a lot of difficulty breathing. Get emergency medical attention if you notice that your child:

  • isn’t speaking or has to stop speaking to catch their breath
  • is using their stomach muscles to breathe
  • is breathing in short, rapid breaths (like panting)
  • seems overly anxious
  • raises their rib cage and sucks in their stomach when breathing

Your child might vomit at night even if they seem fine during the day. Don’t worry: Vomiting isn’t always a bad thing. Throwing up is a symptom of some common health ailments that can crop up at night while your little one is sleeping. Sometimes, the vomiting goes away by itself.

In other cases, nighttime vomiting may be more of a regular thing. If your child has a health issue like allergies or asthma, throwing up can be a sign that more treatment is needed. Treating or preventing the underlying problem can stop the vomit.