Taking vomiting to a new level

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Do your kids 1) refuse to eat or 2) throw up when they do? I'm so sick (pun intended) of the puking. My son admits that he intentionally throws up. It looks like obvious melodrama, but I'm worried about anorexia. He says he sometimes can't breathe when he eats. He's been tested for allergies so we know he doesn't have any. He does have an enzyme defficiency and mild acid but both issues are controlled with meds. He's very sensitive to tastes and textures but he is actually refusing to eat even his favorite foods. We've gotten to the point that I don't know what to feed him anymore. What do you do????

get him to the drs asap

I don't know, Ster. This is a behavior issue, so who do we see?

That would be of serious concern to me, since you say it is happening even with his favorite foods. My son lives on air, I swear, but he doesn't vomit unless he is sick. We've never forced him to eat. Our doctor always told us he would eat when he got hungry enough, and so he does. Its just hopelessly erratic and I wish we knew where his energy came from given how little he usually eats. He has had many issues with constipation, even though he was pooping every day, he doesn't get it all out, and it backs up to the point where he gets severe cramps. Apparently digestion issues are common with AS, so definitely look into that.

I know many AS are extremely sensitive to smells and textures so do double check that absolutely nothing has changed in those areas. A different cleanser on the table could affect him; I'm always amazed at what can bother our kids that we would never in a million years consider.

To sum it up, I wouldn't consider this normal, so you need to find a trigger. Either sensory, medical, or emotional.

If it is a behavior issue, there is something driving it. You have to find the trigger, what weird concept he has in his head about what he gains this way.

Even if he admits it is sometimes intentional, it could be nausea driven.

Are you FORCING him to eat?

DW, when he was 1 year old, his pediatrician insisted we stop feeding him baby food. But when we introduced table food, he stopped eating altogether. He was a preemie, so he was small already and when he stopped eating, he lost weight. He wouldn't even eat baby food. We had to take him to a feeding therapist and I can tell you that they will force children to eat. We've NEVER forced him to eat. His diet is extremely limited and he eats like a bird. Two chicken nuggets but no fries. Or the center of a PBJ. Or three one-sided pb crackers. Five bites of rigatoni. I don't mean to say it's the same number every time, but that's an example of the tiny amount he eats. He often brings home his lunch (1 pbj sandwich) and his snack (1 chocolate granola bar) which means he's only had juice all day at school. Of course he will eat the centers out of two oreo poptarts for breakfast. He will eat 1/2 individual serving bag of M&Ms. A scoop of ice cream.

The vomiting is concerning. Like I said, he's enzyme defficient and has an acidic stomach. But he's on meds for that. He's had both chronic constipation (a behavior issue when potty training) and chronic diarreah in the past, but that's much better. He's been tested for chrones, cholitis, etc. I'm believe he has a tiny stomach, a finicky palate, and control issues. He hiccups and coughs until he vomits and everyone fusses over him and the school sends him home. He gets offended if anyone says he's too thin, so I don't think it's a self-image problem. I don't know (sigh). . . .

i'd still take him to the docs........repeated vomiting can cause a whole host of other problems. the doc could also rule out any specific medical cause for the vomiting.........if there aren't any specific medical causes for the vomiting, then you should get a behavioral consultant involved & work on a behavioral support plan. right now, it seems he's getting alot of attention for the vomiting- i know it's hard to not react,but perhaps reacting less to it would help- ie: don't have a conversation about it with him- just calmly make him pick up his mess. ( he should know prior to an episode that this will be the consequence for him vomiting)

My son vomited constantly til he was about 2 years old. After many diagnostic tests they just said it was completely sensory. Either the occupational therapy or getting older helped him stop. He will occasionally gag while trying a new food but we always make sure a garbage is nearby. I agree with previous posters that vomiting on his normal, favorite foods would be an indication of a physical problem, not a sensory problem. Take him to the doctor again.

I used to feel this way as a kid eating certain foods. Usually cooked vegetables. Sometimes it was the smell (carrots) or the texture (broccoli, cauliflower). I think the anticipation was the worst part - you start holding your breath or nose and by the time you try to force the food down you're gagging and unable to breathe.

You said your son will go all day only drinking juice - have you tried moving him to a more liquid diet? I'm no expert on kids and their daily needs, but I'm wondering if he'd drink a supplement or diet shake to get some additional nutrition. We have a couple elderly relatives in our care and that's how we help to keep weight on one of them.

agrees/.
am have a mostly liquid diet partly due to severe sensory problems and partly due to changes that constantly affect eating [dont have any intake most days other than drinks].
am prescribed a special milkshake by the doctor-ensure plus [in bottle form],it tastes disgusting/very nutty so its easy to add extra milk or drinking chocolate powder,but it's a smooth liquid and there isn't a massive pile of it to get down.
Dieticians can also get the GP to prescribe build up soups instead of build up milkshakes,and some areas have access to more brands than others [here,there's only two to choose from].

Am recommend making an appointment with a childrens dietician and they can assess his problems and whether special milkshakes or soups would be good for him,normal dieticians are not good with autism related problems with food so an aut. specialist alongside would help.

Just some ideas,but could it be a loss of tolerance for the foods he was able to tolerate [has he not eaten them for a while],or is he affected by change-as his level of eating could be affected by this as well.

jaelb, it sounds like he eats like my kids. I still haven't figured out what they live on. We've pulled most of the sugar, though, because it ends up being way too high a percentage of calories, and they eat better overall if there is no sugary food or drink served at all. But it's a tricky issue, because neither of my kids (and that includes the NT one) has a huge range of foods they are willing to eat, and they make it worse by quickly getting "tired" of the same thing.

ANYWAY, IF, and that is just IF there is a voluntary element here, your son might respond to a super factual presentation of what forced vomiting does to one's body. If your son is like mine, science is God, and something worth listening to. If he understands all the negative ways it affects his health and STILL does it, you will KNOW that the driving factors are deep and in need of attention.

If I recall, your son is facing a lot of stress at school, and that no doubt is playing into it. That, and some very real food sensitivities. You will probably have to deal with multiple pieces in multiple different ways.

I'm sorry I don't have any concrete answers. But I am thinking of you.

Thank you all. He sees his GI specialist soon and we'll bring it up at the appt. Saw the behavior analyst today and will be working on a token reward system at home and at school, including his eating habits. He will receive a token as a reward for eating without 'refunding.' At home, he'll also be required to clean up the mess. The school says he sometimes eats a snack during sensory break and are considering giving him a sensory break during lunch. I think removing him from the cafeteria may help since he doesn't like the smell. Of course, this interferes with much-needed socialization, so we have to weigh the benefit. Also, the school will notify me when he vomits, but he will not have the option to go home (unless he's running a temp or vomits more than once).

My son is also an extremely picky eater, who seems to get his nutrition from the air!

I can really sympathise with the difficulties in getting your son to eat, and I would agree with others here in saying that you really have to raise this with health professionals. There could be a variety of reasons behind this, and probably a variety of aproaches to take.

My son has a chocolate flavoured Complan drink for his breakfast and sometimes in the evening as well. He used to vomit from time to time, but now he tends either to refuse food altogether, or spit out what he doesn't like.

We had the same problem here (mine was born at 28 weeks), I tried table food and he refused it, pediatrician insisted, he stopped eating, I fired the pediatrician, we went to pedisure, re-introduced baby food, then slowly mixed in table food processed in the blender making it less and less smoother as time went by.

My son is also a very picky eater (he's 9, going on 10), but when he likes something now look out.

I had a friend that has a son 2 years older than mine, also born premature, same issues. Preemies seem to have alot of problems with acid reflux, he may be intentionally throwing up because it doesn't "feel right" after he eats. Mine had a preference for bland foods for quite some time, certain things like anything with tomato sauce, or alot of meat, would make him hiccup and cough from acid reflux and not "feel right", but luckily we didn't have a problem with vomiting, when he did on very few occasions it was normally due to the acid reflux and was very forceful as a result.

Good luck, and I hope you find an answer to your problem soon.

What is helping us with our eating issues here is some advice from a "feeding clinic".

First they say that there are steps to eating and the child should be encouraged if only the first one is taken.

They call it the "steps" and have a stair case with words on it.

1. Tolerate food: in room, at table, on plate.
2. Smells food: in room, at table, on plate.
3. Touches food (not going to happen with my kid...) with fingers, hands, with mouth.
4. Tastes food: licks food, bites food.
5. Eats food: chews and swallows independently.

The paper also goes to say that typically developing children may need 10 or more exposures before they will eat it, and that children with autism who are especially sensitive to tastes, textures, smells, or new things may need even more exposure.

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Basically what they told me is that if it tolerated at the table then it's a step. The next time you eat it as a family move the bowl of it a little closer to his spot. That type of thing.
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Another thing that is helping us GREATLY! is that we have started a "taste-testing" game.
We have a sheet, numbered 1-10. 1 has a frown, 5 has a ehhhh (being that it's not good but I could eat it again) face and 10 has a smiliey face. (we added 0 after brocolli, 0 is the things that you HAVE to spit out or you throw up. My child made a really nice picture face to accompany it. haha) (it would also be a reference for future meals when you want an "easy" evening! or for child care/grand parents)

You write down what you are trying that day, then have your child make a prediction about how it will smell, taste, feel and then they have to (on first exposure with my child) lick it enough to get a taste. If it wasn't horrible then they have to put it in their mouth and rate it by looking at the numbers and faces.

I always have the "trial" food as an extra. I make sure there is a grain, a fruit or veggie and a protein that he will eat (and he drinks chocolate milk.) He will get to pick between them and as long as we have one of each on his plate then he may eat, and has to eat a little of each.

We mainly went because he is in the lower percentile weight/height for his age and was LOSING weight. So I figure if he can learn to choose a grain a fruit/veggie or a protein each time he eats (within reason) then it's really a life skill. If somehow everything turns out to be low numbers for us (face chart) there is a fall back of PB@J on whole wheat. (which is about a 7 on his list).

Peanutbutter on Graham crackers was our grain and protein the night before. haha

[edit] someone mentioned the liquid diets, my son is also on 2 of those boost (well generic equivilent) a day. One WITH breakfast and one WITH after school snack at 4:00.[/edit]

From the biological side of your child's situation, a swallow study might help to determine if there is anything amiss. Another possibility for the vomiting is a weak sphincter at the top of the stomach.