The most important thing to remember is counter-intuitive to parenthood: don’t reassure the child if they ask questions. Reassurance, when it comes to anxiety disorders, is a real no-no. It’s called a “safety behaviour” and it makes the phobia worse. Think about it like this: if a child asks whether or not you think they might be sick, and you reassure them they won’t be, then the child feels better/calmer. So the kid’s brain goes “wow – I feel so much better when I’m reassured – I’ll ask for reassurance a lot now.” Reassurance also subconsciously tells the child that vomiting really is dangerous.
So if the child asks “will I be sick?” answer honestly: “I don’t know.” Shrug it off like it’s nothing. If you’ve been offering reassurance up until now, the child is going to freak out. That’s ok. Their freak-out won’t last forever. Remain calm – don’t get angry – just explain to them that nobody knows when somebody else will throw up, and besides it won’t hurt you – it’s just yucky and nobody likes it. Be completely nonchalant like it’s not a big deal (because it isn’t)!
I can’t possibly write everything you need to know about kids and emetophobia in one blog, so I’ll try to hit the highlights and give you a few tips to save your sanity. First of all, the best thing you can do is to order the Turnaround Anxiety Program (associate link) along with the Emetophobia Supplement of which I am an editor. It’s written by Chris McCarthy and my good friend and writing partner Dr. David Russ. David and I are busy writing a book to help therapists treat emetophobia. Anyway, check it out!
Very young kids are naturally afraid of vomiting. Unless they’ve been vomiting steadily since a baby, they may not experience it again until they’re two or three at which time they must wonder what the hell is wrong with the universe that this can happen! Parents normally comfort them and tell them that they’ll be ok. They teach them to vomit in the toilet or in a bowl/bin/bucket (the three B’s of not-on-the-carpet). If nothing else happens in that child’s life they may just forget about it, or tell you the next time how much they hate it. However, if there’s any kind of stressor (even a “good” stressor like a new baby or a new room/house) then they can start to channel all their anxiety in vomiting’s direction. You may not be able to identify the stressor but that’s ok because the treatment is the same anyway.
Reassurance-seeking can be tricky. They may ask “is it ok to eat this?” “do you think I’ll have a good day today” or “do I look pale to you?” and other such sneaky questions. Be suspicious of all questions. If repetitive questions are asked, explain to the child that you will answer any question only once. Use the Perry Mason, “asked and answered!” if you have to.
Without reassurance from parents (and clue in the teachers as well), the child will need some strategies to calm themselves down. You’ll find these in the Turnaround Anxiety Program, but briefly they will be such things as breathing more slowly, relaxing your body, art, music, or busying oneself with playing or schoolwork.
One final tip I have is the use of the “Get Out Of Jail Free Cards.” Except not about jail. Let’s take the example of a child missing a lot of school because of emetophobia or always feeling unwell/stomach aches. Decide what’s an acceptable amount of school to miss for an anxious child. Let’s say it’s 4 days per month. So make up 3 cards that say “Get out of school free.” Give them to the child and let THEM decide (no negotiating by you) when to use the cards. If they need to miss school they give you a card and you allow them to stay home, no questions asked (NO questions asked!). I had one client that was afraid to take the school bus so she got 3 “Get a ride to school with mom” cards. Another young boy asked his parents and teacher several times PER HOUR to feel his forehead to see if he felt hot. He got 5 “feel my forehead” cards for the month. In each of these cases both their parents and I were amazed at how well this strategy worked. Before using a card, the child had to decide for themselves if it were worth it to “waste” a card that day. Maybe they didn’t feel so bad after all. Maybe they could make it all day. Maybe they could feel their own forehead. In short, the child learns to solve their own problems and comfort themselves.
As a final word, I want to point out something that may be obvious to most of you: when a child has problems, you must address them in priority order. First, is the child actually sick or in pain? They must be taken to a doctor and be checked out that there’s nothing physically wrong with them. Don’t diagnose anxiety right off the bat. Are they eating? Losing weight? This is a medical emergency. Are they sleeping properly and for long enough? If not, this needs to be addressed, even with medication. Lack of sleep is serious. Are they going to school every day? If not, you must address this with their teachers and perhaps look at alternatives for their education, at least until their anxiety is under control. Are you seeking professional help for them for their phobia/anxiety? You must – anxiety disorders are not something a child just “outgrows” – they need help in coping with it. Finally, are they socializing with other kids such as playing sports, music, dance, or just hanging out with them? This is important for children. Hopefully, you find good therapeutic help for them to lessen their anxiety so that they can participate in life again, and enjoy their childhood.