“He gets so excited he throws up”

“My son is 7 years old, and whenever something exciting happens, he throws up. We’re supposed to go to the amusement park today if the weather clears up, and he’s afraid — and so am I — that if we go, he’ll throw up while we’re there.

“I don’t know what to do anymore. On the first day of school, he throws up. On the last day of school, he throws up. Waiting in line for a roller coaster, he throws up. If he gets really happy for any reason, he throws up. And he throws up because he throws up and worries that he’s going to throw up again.

“Is there anything I can give him so he stops throwing up?”

Straight Face held firmly in place — with superhuman effort — I stopped to think about the problem.*

And lest you think me an insensitive clod, I can assure you that I did (and still do) feel awful for this kid. I wonder what his home life is like. I wonder if he’s chemically imbalanced. I wonder if it’s a phase he’ll grow out of. I wonder how to help him in the short term, today, hopefully without robbing him entirely of the excitement that an amusement park brings. I wonder about abuse, too. I wonder if this behavior is conditioned in some way, and if it might be self-reinforcing, not unlike that destructive positive feedback loop that plagues those with panic disorder. I wonder if he’ll grow up with anxiety problems. I wonder if he’ll end up a well-adjusted adult, hopefully without the need to be on long-term psych meds.

Most of all, right now, I hope mom has a talk with the pediatrician about it.

Given that my options are severely limited by a lack of prescribing powers, the best solution OTC would be Benadryl to blunt the edge, with the side effect of probably making him very sleepy. Not optimal, for sure, but better than puking before you get on the ride, no? Some would think Emetrol, maybe, but that’s a poor solution because that’s not going after the actual problem. If the child is overexcited, better to take that down a notch than merely cover the side effects of being in that condition in the first place.

What do you guys think? What would you have done?

* When I was in junior high, my friends and I used to talk about the worst, most absurd “super power” to have. We decided it would be the superhuman ability to crap your pants every time you got excited. “Haha! Yay!… ohhhh….” This is where I coined the phrase “My bowels are aquiver with excitement.”

I’d say this child’s difficulty ranks right up there…

5 thoughts on ““He gets so excited he throws up”

  1. I sympathize with the kid, since i have a similar affliction.

    Whenever I get stressed, as you said, “my bowels are aquiver”. Whenever I go on a long trip I have no idea where to find a loo. Hence, anxiety and thus more stress. Having to hold it in adds more stress, and so on. It sucks and it’s all psychological.

    I could very well be that for that kid it started out exactly the way it did for me: while doing big activity X he was feeling ill and seriously needed to puke (or in my case “move my bowels”). Unfortunately he didn’t have a comfortable option to let it go, so he tried to keep it down. Eventually he -did- explode, which can feel rather traumatic. Luckily, I “exploded” right after finding a loo, so I was at least relatively safe.

    For me, that was over six years ago and my mind+bowels haven’t been the same ever since. Unfortunately there’s not so much you can do: most of it would be in his head and thus it’s something he (like me) needs to get over.

    Maybe “taking the edge off” will help a little… :)

  2. My differential would depend on when the emesis started.
    If it has been chronic and ongoing, then I would think that the kid has some sort of lower esophageal sphincter problem and needs to see a pedi GI doc. My half sister had this scenario as a child. She is now about 30 and has Barrett’s due to years of undiagnosed reflux.

    If it is a new onset sx, then not sure, but would think it was anxiety based. But I agree, she needs the kid to be seen by his doc.

    Do they have rapidly dissolving ativan to go along with the Fentanyl pops? :)

  3. Well Ativan’s the only benzo that can be taken sublingually. I find it dissolves pretty quickly and doesn’t taste particularly bad. :)

    It hits quicker, in my experience, than Klonopin wafers as well, and is, for lack of a better word, smoother.

    This was a *small* child. I wouldn’t even know where to begin dosing a benzo for someone ~5-6 years old. :scared: I mean, sure I could look it up, but I’d rather defer to someone with actual experience in something like this rather than something I read out of a book. (Though I have called on scripts before only to be told my the physician that they had no experience with it and had looked it up in the PDR. :eek: )

    Interesting thought on the gastric emptying… I hadn’t considered that. (Though I did wonder if maybe some Gaviscon liquid was in order for the short term.)

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