IN MOST cases, we have seen young kids who go to bed or sleep without super and in the night complains of nausea or vomit.When we eat, food, especially carbohydrates, are converted into glucose in the body that provides energy. Glucose in blood is glycemia and in case there is low glucose, then the situation becomes hypoglycemia.The situation whereby kids develop low blood glucose or hypoglycemia and vomit is known as ketotic hypoglycemia.Some parents might not realise that not getting enough food can be the cause of unexplained vomiting for their young ones and this usually happens in the middle of the night or morning.Children who are seemingly health and vomit during the above mentioned times then vomiting is often caused by low blood sugar. However, this problem is often seen amongst children aged nine months and five years.The child will typically feel some nausea or abdominal discomfort just prior to vomiting, and will usually be subdued for about 30 minutes after vomiting, afterwards will otherwise appear normal.Vomiting caused by ketotic hypoglycemia is often misdiagnosed as the stomach flu. The distinguishing feature of ketotic hypoglycemia is that the child quickly returns to normal; if vomiting occurs in the middle of the night, after a short period of general weakness, the child will typically sleep comfortably for the rest of the night. But if vomiting occurs in the morning, the child has to eat before he or she goes for daily activities.Vomits caused by ketotic hypoglycemia differ from those caused by other problems such as the stomach flu. In ketotic hypoglycemia, the Vomitus appears typically bubbly and tinged with a bit of yellow color whereas in stomach flu the vomits are incompletely digested food.Why so common in the middle of the night? During sleeping, the body uses blood glucose and some stores of glycogen stored in the liver and muscles to generate energy needed to carry out basic metabolic activities. When there is insufficient nutrients in the body, regulatory mechanisms of the body will stimulate centers in the digestive system for urgent need of replacement.This is why this problem commonly occurs in children are in a rapid phase of growth where their body need for glucose is high. It also commonly occurs in children who eat less food or miss night meals.Other diseases that could be judged or present same problems like ketotic hypoglycemia include food poisoning, stomach flu, bladder infection and intestinal obstruction though the later occurs in under severe circumstances.Many children who experience vomiting caused by ketotic hypoglycemia grow out of it as their body mass increases with age and their ability to fast during bedtime sleep also improves.Awareness of this problem in children will make parents develop natural understanding that will enable them help young kids not to miss super or dinner.In this case, parents understand effective consequences of missed meals at night to take preventive and supportive care for their children.Dr Joseph Kamugisha is a resident oncologist in Jerusalem, Israel