ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Thursday, April 10, 1997 TAG: 9704100084
SECTION: NEIGHBORS PAGE: N-10 EDITION: METRO
SOURCE: BEVERLY MILLS
CHILD LIFE COLUMN Release Date: Week of April 6
Q: What should you do about a young child who has a habit of sticking her fingers down her own throat and gagging - spitting up? Sometimes, when she's agitated, bored or has just eaten, she brings her bottle right back up. We don't know what to do.
-Mattie Rogers
Baltimore
A: First, have the child examined by the family doctor to eliminate any serious problems. However, you can take heart in the fact that in most cases children who make themselves throw up will stop on their own if parents don't make a big deal out of it.
Rumination is the term doctors use for this. A very small percentage of children, less than 1 in 100, have stomach problems, says Dr. Alan Leichtner, director of clinical gastroenterology at Children's Hospital in Boston.
In the majority of cases, the throwing up can be traced to a problem in the child's surroundings, says Dr. D. Richard Martini, a child psychiatrist at Children's Memorial Hospital in Chicago.
"Often, there's a variety of environmental and psychological circumstances that lead to this," Martini says. "It could be a problem with the child's relationship to the caregiver. If a child is being ignored, rumination can result."
On the other hand, children who receive too much stimulation will sometimes react by inducing vomiting, Leichtner says.
Children who do this will usually start between the ages of 3 and 12 months, Martini says. Most normal children older than 2 years do not force themselves to throw up. The behavior can last anywhere from several days to several months.
"In a fair number of cases, it just goes away on its own," Martini says.
The best way parents can help ensure that the vomiting doesn't last long is not to pay a lot of attention to it.
"Give the child a lot of attention when she's not doing this," Martini says. "When she starts, don't say anything and walk away."
One reader, a speech pathologist from Tacoma, Wash., has seen this behavior in some of her clients.
"My suggestion is to give her only half a bottle at a time and make sure she has something that she likes to do immediately after feeding," April Hochstrasser says. "I would also change the timing of the bottle. If she gets it directly before going to bed, there's little else to do in bed."
Reader Carolla Ault of Libertyville, Ill., suggests distracting the child with finger-play games immediately after eating.
If the child gets lots of attention right when she throws up, even if it's negative attention, that can act as a reward for the behavior, and it's more likely to continue.
"If you get angry or yell, that's negative attention and it will actually make it worse," Martini says.
One parent who went through this says it's hard not to react.
"That's easier said than done when the child is getting ready to make a mess of your sofa or car," A.Z. Rose says.
She ended up covering the back seat of her car with a plastic sheet from the hardware store.
When children continue to force themselves to throw up for longer than two weeks, a thorough medical examination is advised because the child's nutrition can be affected, Martini says.
"In deciding when to seek help, you need to consider whether the child might become dehydrated," he says. "If the child is often irritable or smells bad or if this is impacting your relationship, you should seek help."
The most common medical cause, which doctors call gastroesophageal reflux, occurs when there's a backward flow of food from the stomach into the esophagus. In adults, this is the same action that causes heartburn.
Some children who have severe problems such as Down syndrome or who are developmentally delayed will do this. Parents who have any reason to suspect severe problems should not wait to seek medical help.
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THE BIG LIE: "I have a 10-year-old stepson who is constantly lying," says L.R. of Fresno, Calif. "We also have a 5-year-old son who is picking up on this. A lot of the lies are causing other kids to get into trouble. What should we do?"
- COPYRIGHT 1997 BY BEVERLY MILLS, CHILD LIFE
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