F.E.A.S.T's Around The Dinner Table forum

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We’re making some progress with getting weight back on my 9 year old son but after each meal/ snack he is a little bit sick 5/6 times which Can’t be helping with weight gain! He isn’t physically forcing himself to be sick and he had issues with reflux for a year or so which were being investigated medically prior to ED being diagnosed. He’s still taking Omaprazole which he had previously and seemed to help reduce sickness but I don’t think it’s making much difference now.
Anybody been in a similar situation and have any advice? He sits with us after each meal but will just sit there with sick in his mouth if we don’t let him go and spit it out so that’s not stopping it just allowing us to monitor.
Could it now be a habit and not physiological? Does a psychological assessment sound reasonable to you?
Does he have some gastroparesis and need something to enhance gut motility? Does he eat too fast or slow?
Those would be the first things I would look at.
We did not have that and I am sure others that do will be here shortly.
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
Is there something he is really keen on you could offer him to get if he leaves purging just for ONE meal? I would be curious if he is able to stop it...
Did you tell him you will add the lost energy to his next meal so he sees that it is senseless to purge?
Often it is a habit after some time and really hard to stop.
Keep feeding. There is light at the end of the tunnel.
Hi Needinghelp,

While we are not medically qualified to diagnose anything, this sounds very much like rumination syndrome.  There is a good description of this on the Mayo Clinic website which is worth looking at.

Is this definitely ed or has the weight loss been caused by eating difficulties?  There sounds to be a lot going on here - although at the same time eds can cause digestive difficulties.  

I once asked a well respected ed psychiatrist what purpose rumination served and she said that it can alleviate anxiety because it stimulates the vagus nerve.  So I am wondering if anxiety could be a feature too.

I hope you can get the specialist support you need to address all these difficulties - but ultimately weight needs to go on and you seem to be doing well with that, so well done you!  
Believe you can and you're halfway there.
Theodore Roosevelt.
Thanks for thoughts. It’s def ED now although not sure if it started that way.

He does have gastropareis as that was tested over the summer and he eats v fast now (trying to get it over and done with!) so maybe his system just isn’t able to cope - hadn’t thought of that but will query with doctors if there is anything that could help.

I hadn’t heard of rumination syndrome so will investigate that too.

I have tried saying that he is going to have to eat more if he continues to be sick but he says he can’t control it and I am not convinced enough that he is lying to follow him through on threat. Might try the incentive approach though and see if that has any impact...
If he is for example keen on a video game that he really wants to have and you offer that for being not sick after lunch tomorrow (for example) and that works you know that it is a psychological thing and you can work on an incentive system (you cannot offer a game for ALL meals so you will be poor next week but some parents worked with a point system).
Keep feeding. There is light at the end of the tunnel.
My daughter went through something similar.  We had to slow down her eating and go for packing calories into as little food as possible.  She has horrible reflux and meds have helped with that.  We had to be careful of what she did after eating i.e. she would bend over and vomit without any control over it so she couldn't lay down for a while after eating and we elevated the head of her bed to help control the reflux.  Ultimately it did get better but for a while she had to keep swallowing what came back up.  We also tried not to overload her with fluids when eating too i.e. she would eat and drink whatever she needed to in order to eat but tried to avoid meals that were all liquid.  We also went for foods that didn't come up as easily as some like instead of having oatmeal for breakfast which was liquidy already, we'd go for a muffin and bagel with fruit for example.
I agree with Mjkz, making meals smaller (but with the same calories). My d also complains about feeling nauseous while/after eating and even I can't bend over after a meal. Some food make me feel worse more than other. Are there some foods your son seem to handle better than others? Maybe avoid citrus fruit/juices (even tomatoes) and add high energy density food such as nuts. Does he take medication on an empty stomach? I have to take ALL medication after a meal otherwise I feel green afterwards. I also need to avoid mint and green tea as well (on an empty stomach, fine after a meal). I give my daughter aloe vera juice as well and it seems to reduce the nausea. 
D became obsessed with exercise at age 9 and started eating 'healthy' at age 9.5. Restricting couple of months later. IP for 2 weeks at age 10. Slowly refed for months on Ensures alone, followed by swap over with food at a snails pace. WR after a year at age 11 in March 2017. View my recipes on my YouTube channel: https://www.youtube.com/channel/UCKLW6A6sDO3ZDq8npNm8_ww
One of the other parents here also had a young child with these problems. They worked on diaphragmatic breathing to help things. I agree also that smaller meals and eating more slowly may be helpful. I would actually work hard at stopping him from eating overly quickly - again a not very helpful way to eat in the long term. 

It may be worth looking at these threads. https://www.aroundthedinnertable.org/post/involuntary-regurgitation-breathing-exercises-7297270#gsc.tab=0

D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
Thanks useful threads. Trying to persuade him to try breathing exercises as it sounds like they might help!
Our daughter (16, diagnosed with ARFID in early December 2018) has this issue. Since a young age she reported issues with reflux.  The first weeks of re-feeding, regurgitation (which is completely different from vomiting) was especially frequent, but it seems to be slowly getting better. She was prescribed Prevacid, which seems to help. We encourage slow diaphragmatic breathing and try not to make a big fuss when it happens. I have also noticed that while she eats ridiculously slowly, she tends to drink beverages (milk and shakes) too fast, which I think makes it worse.