DEAR DR. GOTT: My healthy and smart 8-year-old daughter vomits in restaurants. When she was 3, she had a spell of vomiting over the course of a couple of weeks that we could not explain. Her pediatrician suggested keeping track of what she ate to see if there was a pattern with certain foods, because there was no abdominal pain and it was not consistent with motion sickness. We discovered that the vomiting often occurred after she consumed dairy products, so after another doctor visit, we limited dairy and used Lactaid tablets. The vomiting did not occur as often; however, we noticed it was still a problem in restaurants. Then our daughter revealed something: She got nervous in restaurants. She was afraid she would vomit and be embarrassed and got herself so worked up she got sick. Back to the doctor we went. The doctor said kids usually grow out of lactose intolerance as she probably had but “some kids just barf a lot.” He said she would grow out of that, too.

She still has the problem. It does not happen at home or school, or in the homes of others. We are at a loss. Eating out is not enjoyable because everyone is on edge wondering if she will get sick. We have had her talk with our pastor. We have tried rewards, praying, breathing exercises and distractions. Some things work for a little while, maybe even months, but then it will suddenly and unexpectedly happen again. Could a medical issue be the cause?

Please, Dr. Gott, any suggestions you have would be greatly appreciated. My husband and I are desperate to help our daughter get over this. Thank you!

DEAR READER: You certainly appear to have covered many of the bases but still have not hit a home run in resolving the problem. I do not believe the stress and anxiety your daughter undergoes is related to an underlying medical condition, nor do I feel she does it for attention, but I don’t know her. Speak with her physician to be assured of her medical well-being. Vomiting can be the result of fear or emotional stress but can also represent a viral infection, milk allergy, a blocked intestine, tumor, gastritis and the reaction to specific smells or odors. These potential conditions are relatively easy to rule out with the assistance of laboratory work and X-rays. Again, because she doesn’t complain of pain, fever, diarrhea, headache and other common symptoms, my guess is that her testing will be normal. However, her pediatrician would be remiss if he or she did not consider the big picture. If her tests fail to reveal anything and she is an otherwise normal, physically healthy child, request a referral to a child therapist with whom she feels comfortable and can see regularly.While you might give the therapist a heads-up, she should be allowed to speak freely without a parent sitting nearby coaching her. Then back off as much as possible when an 8-year-old is involved. Allow your daughter to establish a relationship with the therapist, one she feels will help her now and in the future when other issues could come to light. Everything may be stress related, but it may be difficult to understand why she only reaches her limit when in a restaurant. This should be investigated and dealt with.You have indicated that you are on edge when dining out, expecting a repeat of her normal pattern. Whether you express it outwardly or not, I am sure she is perceptive enough to sense how you feel. And she picks up on that, no matter how well you think you are concealing your feelings.A step you may or may not have considered is to stay away from restaurants. From my perspective, it doesn’t appear worth putting your daughter through the trauma of public embarrassment. If there are compelling reasons for eating out, perhaps you can pick a corner table away from the hub of activity. Consider allowing her to bring a friend along so they can talk and giggle to reduce the tension level. Select a “restaurant” that has outdoor tables, and weather permitting, eat out of doors. Allow her and her friend to bring a hand-held game board to divert her attention away from her surroundings.Rule out potential medical conditions, assure her that she can speak frankly with a professional therapist and see what transpires.To provide related information, I am sending you a copy of my Health Report “Eating Disorders.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com.

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