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caryl

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Reply with quote  #1 
My 11 yr old s diagnosed AN in April. Weight restored and eating well although still having some tantrums but not as many. The problem he has is stopping mouthfuls of food coming back up in between meals and snacks. I have replaced any mouthfuls with an extra yoghurt or by putting something extra on his plate which means no calories are being lost. We are monitoring him 24/7 to ensure we can supervise all mouthfuls. I am sure this is all anxiety related but just wondering if anyone is having the same problem?
Kali

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Reply with quote  #2 
Hi Caryl,

So sorry you have had to join us here and experience this horrible illness.

Have you had your s. evaluated by a gastroenterologist to make sure that there is no medical reason for the food coming up again? I am not a dr and cannot give medical advice but my understanding is that there are medical conditions which can cause food to come up spontaneously after eating.

Kali





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martican

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Reply with quote  #3 
Hello Caryl. We have been struggling with this as well. My d is not wr yet though. Before I knew more about all the tricks AN can play, I went to a GI specialist. Actually, two of them, for two opinions. My d had an endoscopy done and it was determined by both that she has an Eosinophilic Esophagitis (EoE) (almost identical symptoms as AN). Her esophagus had way too many white blood cells (eosinophils). I kept questioning, on several occasions whether it could have been caused by constant regurgitation or vomit. I kept hearing "no", given the amount of eosinophils from her biopsy (normal range is under 25, she had 150). Apparently, it is allergy caused. She was put on acid reflux meds and steroid gel. Despite, she still experienced a lot of mouthfuls. I noticed that when she felt nauseous after a meal, she just kind of quickly crunched her stomach (standing up) and the food came out. This behaviour was eliminated with the same strategy as you are doing. But it came back after 3 months, and we doing the same thing again - 24/7 monitoring, refilling lost cals. She is still on those meds, but I think it is more behavioural, AN related with her. Sometimes, we do 4 rounds of mouthful - refill - mouthful - refill until she gets to keep it in. It doesn't happen that often anymore as it used to. I have zero tolerance towards that now, knowing AN better, and knowing EoE is under control now (with steroid gel and dairy/soy free diet). Deep down I am hesitant about the allergy verdict but I guess we will eventually find out when GI dr.lets her go on full diet.
I realize, everyone is different and this doesn't have to be the case of your boy, but I am still sharing our experience for you to consider. 
jsrachels

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Reply with quote  #4 
I agree with the other post in that it my be something physical. Constipation is very common when the eating is restored and can can cause vomiting. Has he been going #2? Might try a laxative.
galanick

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Reply with quote  #5 
Another thing to think about is rumination syndrome. Both my ed kids had what they call rumination syndrome.

They developed a bad habit of letting there food come back up. They really did not realize they were doing it, but they did learn how to stop it. The our gi doctor was not much help. There is no test or procedure for it. Diagnoses was just based on some questions.

The treatment was stopping acid blockers (Prilosec) so when the food came back up they were uncomfortable and they noticed it. Also diaphragm breathing exercises and cbt. You can't vomit when your diaphragm is busy doing something else. So it is helpful if ED habit also.

Refeeding is so hard on the gi,so it's hard to know how much is ed, how much is refeeding, or if something else going on.

Best of luck. Hope you son feels better soon.

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qtgirl

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Reply with quote  #6 
Hi All,
I am a new parent to the group, but my daughter is in her 3rd hospitalization for anorexia since last October and the regurgitation that you describe sounds like one of my daughter's behaviors.  For her it is more like rumination syndrome, although one therapist said she technically doesn't have RS because it didn't start in early childhood.  Regardless the behavior is the same, so the treatment is the same.  They are treating her for it with behavior replacement at the facility she is in right now.  Basically, she can't regurgitate while her mouth is open, so she has to engage in activities the require her to talk or have her mouth open after she eats.  I will be going out for PHP in about a week and we will see how she does outside of structured treatment.  We checked everything first, GI, reflux, etc. so you should definitely do that but as soon as our GI doctor heard what was happening he said it was behavioral and now that the behavior is being treated she is stopping.  Also, I know this sounds totally gross, but at the treatment facility she is in right now if she regurgitates in her mouth she has to swallow it - no spitting out.  I hope this helps.

martican

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Reply with quote  #7 
qtgirl - thank you for sharing how they deal with rumination syndrome. This actually helps me, and I will try to reinforce swallowing. Sounds more of a motivation for my D to quit the behavior bc it is so gross. What do they do if she'd spit it on the floor if there is nowhere else to spit it? (My D has done it few times when I blocked the bathroom and garbage can). This doesn't happen for her often and it is unpredictable. ... thanks


NELLY_UK

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Reply with quote  #8 
My d who is bulimic had the rumination syndrome. After a while she stopped it herself. No
Song and dance just supportive comments and motivation to stop it.
Wish the bulimia was as simple for her to regain control of.

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NELLY D 18 bulimic since age 12, diagnosed in 2011. 20 months useless CAMHs,7 months great IP, home March 14..... more useless CAMHs.now an adult & no MH services are involved. I reached the end of my tether, tied a knot in it and am hanging on. Bulimia treatmentis in the dark ages in West Sussex.
berry75

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Reply with quote  #9 
I have never heard of rumination syndrome but i will be reading up on it very soon.My daughter is about a year and a half into an ed we are weight restored but seem stuck on phase 2.She was doing very well but all of a sudden anxiety went to an all time high and for the first time she started to bring up her food not by sticking her finger down her throat luckily she has never done that.The vomiting was projectile,literally across the room and she could not stop it.I freaked out as all i have learnt so far is get the food in nothing about what to do if it cant stay down.We started her on anxiety meds and just ate painfully slow after a few months it seems to have settled which leads me to believe it was phycological not physiological.
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