Your anxious child

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”.

From Your Anxious Child: Emails to Parents by Edward H. Plimpton, PhD

The Fear of Throwing Up

Vomiting has got to make the list of one of the most unpleasant experiences that can happen. Your body is momentarily out of your control and what comes out is just disgusting. Seeing someone else throw up, which happens to children in school, is equally unpleasant and can induce a nauseous feeling that can make you wonder whether you are going to throw up. A fear of throwing up is not uncommon. The folk singer Joan Baez from the 60’s described in her autobiography and more recently, Sara Blakely, the inventor of Spanx, has stated that she has had a fear of throwing up.  For some children, either throwing up or seeing someone throw up can have a traumatizing effect and they will go to great lengths to avoid anything that might give them germs. This fear can be part of many worries a child has or can be a stand alone fear.

 The fact that most people vomit infrequency is not actually a very helpful fact for those struggling with this fear. It certainly deserves to be mentioned, but that fact by itself does little to dislodge the fear. Likewise, the fact that vomiting is relatively unusual also makes it harder to allow experience teach the child that they can survive such an occurrence, however unpleasant it may be. The sense of not being in control and the violent aspect of vomiting all create that dramatic memory of the event that is a feature of psychological trauma. But there is also another powerful factor having to do with the experience of disgust, an emotion has not always been sufficiently appreciated. Disgust is an important self-protective emotion, wired into us from years of evolutions, that protects us from food poisoning and getting too close to something that could make us sick.

So what to do? First, in the moment and aftermath of a vomiting incident, the child needs big time reassurance and comfort. Later, providing some information about the facts of vomiting to your child is important because in the absence clear information, the child will invent their own explanations about what is happening and that will most likely make the situation worse.  However, “the facts” by themselves will not dislodge this powerful fear.  Practical nauseous prevention strategies should be reviewed, so in the car looking down will more likely lead to nausea than picking a spot of the horizon to focus on.  Then look for ways to desensitize this topic by activities such as making fake vomit at home. Just getting used to seeing fake vomit around that you either make or buy from a joke/novelty store can help desensitize this issue.  The two-part sentence referred to elsewhere can help as in “yes it is awful to barf, but you survived” “yes it is disgusting, but your stomach just had to do it”. Because of the very wired in nature of this fear, it can require some patience to deal with it effectively.