Dear Dr. Gramma Karen,
My wife and I would like your help regarding Katy, our seven-and-a half-year-old daughter, who is very intelligent, extremely sensitive, and takes everything to heart.
Two years ago Katy went through a very emotional and difficult time when my mother (Katy’s grandmother) died from cancer; Katy and her grandmother were extremely close. To this day Katy still has problems falling asleep when she thinks about her grandmother. Sometimes her anxiety is so bad that she throws up.
In fact, her throwing up has gotten worse in the past couple of weeks. I worked with a woman who had multiple sclerosis. Katy used to read to her at her group home. Sadly, this woman recently died and Katy took her death very hard. I should point out that this woman and Katy’s grandmother were around the same age when they died.
We have tried different things to help Katy sleep, such as having her read before her bedtime in hopes that this would change her train of thought. We also bought her a journal so when she’s having troublesome thoughts that are bothering her, she can write them down to help get them off her chest. Doing these things has helped maybe a little.
A few months ago we took Katy to a therapist, but this isn’t working out. The therapist didn’t really know Katy, and she is located is a long drive away — she was seeing Katy for free as a favor to my father-in-law. I’m wondering if you have any advice on how to help Katy stop throwing up because of her anxiety.
Dr. Gramma Karen’s Response
I am so very sorry for Katy’s suffering. My heart also goes out to you and your wife as you try to alleviate her suffering.
The underlying cause of Katy’s frequent throwing up at bedtime may indeed be anxiety or stress related. However, for your piece of mind and to leave no stone unturned, I urge you to work with Katy’s pediatrician to determine if some physical issues are triggering these bouts. Your pediatrician and/or other specialists to whom he/she refers you can help rule in and rule out possible physical causes of the vomiting.
If the main cause of Katy’s throwing up is anxiety-stress related, your pediatrician can help you locate a therapist who is specifically trained to work with children who present with Katy’s symptoms. I am not a medical doctor and I am not qualified to make any kind of physical or psychological or psychiatric diagnoses, but I suggest that you might want to explore if Katy is dealing with post-traumatic stress disorder (PTSD). We assume that PTSD applies only to adults, but children can also suffer from it. To learn more about this, you may want to read “Post-tramuatic Stress Disorder in Children,” published by the CDC (Centers for Disease Control and Prevention).
You will note that one of the five causes of PTSD is “serious illness or death of a close family member or friend.” In the past two years, Katy has dealt with the illness and death of her grandmother (a close family member) and the death of a friend, someone who may have been a grandmother figure to her. Katy may be experiencing this as losing two “grandmothers.” This is a lot of loss for anyone, and especially so for a little girl.
In this same article, you may find it helpful to read about the general process used to help a child with PTSD.
- The first step to treatment is to talk with a healthcare provider to arrange an evaluation. For a PTSD diagnosis, a specific event must have triggered the symptoms. Because the event was distressing, children may not want to talk about the event, so a health provider who is highly skilled in talking with children and families may be needed.
- Once the diagnosis is made, the first step is to make the child feel safe by getting support from parents, friends, and school, and by minimizing the chance of another traumatic event to the extent possible.
- Psychotherapy in which the child can speak, draw, play, or write about the stressful event can be done with the child, the family, or a group. Behavior therapy, specifically cognitive-behavioral therapy, helps children learn to change thoughts and feelings by first changing behavior in order to reduce the fear or worry.
- Medication may also be used to decrease symptoms.
Again, I suggest you start with your pediatrician, as he/she is a good first resource to help determine the specific help Katy needs, and to help locate the resources with the right kind of training to work with Katy (and you and your wife).
Finally, the article includes other possible resources to find a healthcare provider familiar with treatment options:
- Psychologist LocatorExternal, a service of the American Psychological Association (APA) Practice Organization.
- Child and Adolescent Psychiatrist FinderExternal, a research tool by the American Academy of Child and Adolescent Psychiatry (AACAP).
- Find a Cognitive Behavioral TherapistExternal, a search tool by the Association for Behavioral and Cognitive Therapies.
- If you need help finding treatment facilities, visit MentalHealth.govExternal.
I know my readers join me in hoping that Katy finds relief from her suffering soon. You and your wife are obviously devoted parents and Katy is indeed fortunate to have you in her corner working on her behalf.
Ask Dr. Gramma Karen is published every other Tuesday.
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