Q: My son is now 2.5 years old. He was born at 37 weeks, healthy but underweight. His appetite has always been small. The same continues when he now grows into a toddler. But the real problem is, he has been very prone to throwing up all this time: first, milk, and now all kinds of solid food. Most of the time, he likes the food I’m offering him. But sometimes even without a sign or reason, he would throw up during a meal. He can easily throw up when he laughs, cries, screams, coughs, runs or plays hard. He is weak in terms of chewing: he seems to be selective in what to chew and what not to. But generally, he doesn’t eat hard or chunky food. My son’s weight has always been under average since day one.
A: You’re wise to be concerned about your son’s tendency to throw up while he’s eating and afterwards. There are at least a couple of reasons that could be contributing to your son’s vomiting. It could be that he has a very sensitive gag reflex. The gag reflex is the natural, instinctual contraction of the throat muscles to something touching the soft palate at the back of the throat except during normal eating and swallowing. This reflex helps protect our airways and keeps us from choking. In some children, this reflex is so very sensitive that it’s active even during eating, and when food touches the soft palate it can trigger such a forceful gag that it causes the child to vomit.
Another cause of recurrent vomiting in children is gastroesophageal reflux. This occurs when the contents of the stomach travel back up the esophagus, and in some cases can cause the child to vomit. Gastroesophageal reflux can be worsened by higher intra-abdominal pressure, or anything that causes the pressure to increase in the abdomen. This in turn puts more pressure on the stomach and makes the stomach contents more likely to travel the wrong way up the esophagus. So the fact that your son is more likely to vomit when he’s engaged in activities that increase intra-abdominal pressure, such as coughing, laughing crying, screaming, running, or playing hard, might be an indication that he’s suffering from reflux.
Your son’s pediatrician can help figure out what’s making your son throw up during and after eating. Once you know the cause of the vomiting, your doctor will be able to help you find the best solution. If a hypersensitive gag reflex is to blame, a speech and language therapist can help. This professional can also help your son overcome his tendency to be a “weak” chewer by working with him to better develop and use the muscles of the mouth, tongue, and throat properly. If your son has gastroesophageal reflux, the pediatrician might prescribe medications that help prevent the reflux. By addressing the problem and finding the right solution, your son will undoubtedly get better nutrition and have an easier time gaining weight.