Fear of Throwing Up: Emetophobia-suggestions for school

1. If the child does not feel you understand how hard and scary it is to have this fear, he/she will not listen to anything else you have to say. This fear can be extremely distracting for those children struggling with it and it definitely feels very real to them. So we want to validate the feeling, even if we don’t agree with the child about what to do about it.
2. Unfortunately, answering the constant reassurance seeking questions such as “Do you think I am going to throw up?” provides only momentary relief at best. And likewise, frequent phone calls home are not typically helpful. But to wean the child off this reassurance seeking, incremental steps are needed. Otherwise all you will get is unproductive panic. So in the classroom a manageable first step might be that when the child asks to go the nurse, a teacher could say, “Would you consider waiting 10 minutes to see if this feeling goes away, and pretend to put your worries into this stress ball while you are waiting.” The language needs to clearly communicate to the child that this is a choice. The hope is that by not leaving immediately for the school nurse’s office, the child might give the fears a chance to dissipate. Likewise, if frequent phone calls to home are occurring, it is important to work on cutting them down, perhaps by starting with putting a limit on the amount of phone calls during the school day.
3. A distinction can be made between a “sick stomach” and an “anxious stomach.” A “sick stomach” is an indication of a flu or bad food, whereas an “anxious stomach” is the result of some stress or worry. The problem is that both types of stomachs feel pretty much the same and they certainly grab the child’s attention. The solution is not to focus on the unpleasant sensation, which typically amplifies the discomfort. On a boat or in a car, when you feel nausea, the common suggestion is to look at the horizon. In doing this, turn the focus away from the sensation and onto your surroundings. In a similar manner, we want to enlist the child in thinking about the context in which the stomach discomfort developed. Of course, the school nurse has to make a determination about whether the child might have a “sick stomach.” But if it seems more like an “anxious stomach,” the nurse might ask questions such as “when did your stomach begin to freak out?” or “has there been any point today where you were feeling better?” or “I wonder what was going on when you decided you needed to come see me.” Although it is a challenging endeavor for children, we want to help them see a connection between their reactive stomach and the various stresses that they encounter every day.
4. Basic concepts caregivers need to know to deal with Emetophobia include: problem with reassurance (see Reid Wilson and Lynn Lyons, Anxious Parents, Anxious Kids), what I term a two part sentence or connect and redirect (in Siegel and Bryson, The Whole-Brain Child, personifying worry, covered in all books on anxiety, distinction between anxious stomach and sick stomach, capacity to think in incremental terms, and of course creative ways of facing the fear. And of course these topics are covered in my blog and podcast: edwardplimpton.com and on itunes “Your Anxious Child: 5 minute solutions”.