So the other day on Facebook, one of my college friends posted that her almost two year old son had thrown up for the first time! I was impressed as Evan has it down to a science…or a hobby….
Before watching a Jon and Kate Plus Eight episode where one of their daughters could throw up to get her way, I never knew that throwing up could be a toddler behavioral issue versus a medical one! For Evan, this is a multi-faceted issue. He has a sensitive gag-reflex, gets full really easily, but also uses throwing up as a maladaptive coping skill (nice mental health language) when he is really upset or as a strategy to get his way. Many an outfit, crib sheet, and blanket have been washed repetitively due to this hobby of his. Evan is a really smart boy too. He knows it’s not something that we enjoy dealing with so he will also threaten to throw up if things aren’t going the way he wants them too! He will milk this power or control for all he can!
Prior to Evan’s surgery, we had seen the behavior completely go away and we were so thankful! But since the surgery, it has returned in full force….i.e. it was a daily occurrence. I guess it makes sense that he’d revert back to something he found comfort or power in after going through something traumatic. Some of the vomit episodes revolve around eating, but most of them are because Evan works himself up so much that he’ll throw up or because he wasn’t getting what he wanted in the moment.
So how have we handled this behavior?
1.) We have teased out what could be connected to his gag reflex and stomach emptying issues (with the help of professionals and trial and error). This means that we have worked to continue to head towards eating solids in a way that we try to minimize triggering the gag reflex. And we have done TONS of exercises with the speech therapist and feeding therapist to desensitize Evan’s mouth and gag reflex. We have also spread out his meals as much as we can so his stomach does not feel full going into the next meal.
2.) When he behaviorally throws up, he does not get out of his current situation because of it. For example, if he throws up in his crib, we change him and the crib sheet without him getting out of his crib (this is pretty comical to watch if you’re an outsider—and are plugging your nose). If he throws up in his eating chair, we change him next to it and clean up the chair, but then he goes right back in. We want to do all we can to make sure Evan doesn’t get something he wants from this behavior (i.e. more attention, a bath, getting out of a crib or chair, avoiding eating, etc.). If he throws up during a meal, he has to eat again (at times we adjust the amount or what he ate, but he still has to do over what was just thrown up).
3.) When he mentions that he might throw up or when he does throw up, we connect a negative consequence to the behavior. Lately that has been that he has to spend some time in his bed because throwing up means he’s “sick so he needs to have extra rest”. We’ve also had an incident when he threw up while friends were over—they had to leave.
4.) We also try to attach positive incentives to him not throwing up. He has gotten a bath for not throwing up but we’ve had to clean him up with washcloths and wipes when he’s thrown up. I know it sounds gross and odd to not give him a bath after vomiting, but it was one of the things that Evan loves and back when he would get an extra bath after throwing up, he tended to do it intentionally to get another one if there was a night he wasn’t scheduled for one.
This issue has been a difficult one, especially as is directly affects his weight gain and loss. Now that I’m home with the kids, it’s just one more reason why I am so thankful for Evan’s former daycare provider, Erin, who took care of Evan for almost two years. She repeatedly cleaned up after this hobby of his and didn’t complain! She was also very adept at discerning when it was a behavioral issue and when it meant he was sick and needed to go home. There were times I was surprised we weren’t told he needed to find a new daycare! It’s one thing to clean up vomit from your own child, it’s a whole other ball game to clean up after someone else’s little one.
Like any other issue, the moments when I get frustrated, I really need to remember to focus on the progress and baby steps made rather than the fact that we’re still dealing with the same behavior! And maybe Evan will become a child behavioral psychologist, pediatrician, or pediatric surgeon in the future, with unusual insight into the behavioral quirks of little ones!