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Ask the Mental Health Expert Archives 2001-2004

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Unusual Vomiting

Q. My friend's son is 3 years old. For over a year and a half now he has been vomiting almost every day. He usually does it when he starts coughing from running around too much or when he gets upset or when he's in trouble and is being punished.

He even vomits when he doesn't want to eat something he's told to eat. For dinner last night he was supposed to eat steak, corn, and fruit, but decided to throw up because he didn't want to eat it. As soon as he put the food onto his tongue he would start to gag and then continue to throw up until his parents told him he didn't have to eat it. Then he quit vomiting.

Could you lead me in a direction that would help me explain to my friend why her son should not be vomiting like that and that it is not normal? I've tried to get her to take him to a doctor and she told me it was just his asthma that was doing it. Does asthma cause a child to vomit in this way?

A. First of all, please understand that the differential diagnosis of vomiting is really the purview of gastroenterologists and internists, not psychiatrists! That said, I certainly agree that getting your friend to take her son to a good pediatrician is very important. (Frankly, some might consider a failure to do so under these circumstances as a form of child abuse or neglect--but that is a legal determination).

Persistent vomiting in children may stem from many psychological and physical causes, which requires a careful medical and psychological evaluation. It is true that severe coughing can bring on fits of vomiting. Allergic reactions, if very severe, can also trigger both coughing and vomiting. Some medications used to treat asthma (such as those containing theophylline) can also trigger nausea and vomiting if the blood level gets too high.

From the description you give, though, it may be that this child has learned to use vomiting as a way of manipulating others or getting his way--but this doesn't eliminate other causes, including serious physical ones, such as bowel obstruction.

You might try referring your friend to a good website, http://www.lpch.org/HealthLibrary/ParentCareTopics/ AbdomenGISymptoms/Vomiting.html, which is associated with Lucille Packard Children's Hospital.

Failing that, you might try persuading the boy's father, if he is available. Persistent daily vomiting can be a very serious condition, leading to dehydration, low potassium levels, and other problems. This child definitely needs to see the doctor.

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September 2003

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