Is Your Child Scared of Puking?
An extreme fear of vomiting, also known as emetophobia, is one of the most common types of phobias in childhood. An extreme fear of puking may affect as many as one in 10 people. A fear of puke is much less recognized relative to fears involving themes such as the dark, spiders, airplanes, and lightning - yet it can create more disruption in a child’s life than any of the better recognized phobias.
For people who have emetophobia, the condition typically starts in childhood. The fear can develop after a dramatic experience of vomiting or after witnessing someone else throw up. However, emetophobia can develop even without a notable puking event. Most children with emetophobia are more generally prone to anxiety and worry. They tend to be more vigilant about sensations in their body and misread signals in their body as meaning that they are about to throw up. They may also be more likely to experience gastrointestinal symptoms (such as nausea) when anxious. Many children with emetophobia have other worries about their health and bodies.
Signs that your child might have emetophobia:
Frequent questions about food such as: “could this make me sick?”
Overconcern with expiration dates on food.
Eating too little out of a fear of feeling full.
Excessive hand-washing.
Preoccupation with body sensations (especially in the tummy).
Frequent requests for anti-nausea medicine or antacids.
Avoidance of words such as “vomit,” “puke,” and “throw-up.”
Avoidance of long car rides, or any other situation that might be associated with puking.
In severe cases, a child may lose weight and even cease eating and drinking all together. Emetophobia can be easily mistaken for an eating disorder, but it is an anxiety disorder - not an eating disorder.
For children with emetophobia, it’s common for them to rope their parents into their coping efforts. Parents may find themselves repeatedly reassuring their child that the food is safe, that their tummy is fine, that they aren’t going to throw up, etc. Parents may agree to follow their child’s “rules” about forbidden words that are associated with puke. Parents may also end up preparing special meals or avoiding certain restaurants to accommodate their child’s need to eat only those foods that feel “safe.”
Do children grow out of emetophobia?
Emetophobia tends to persist into adulthood and can be quite debilitating. It’s common for adults with emetophobia to delay pregnancy (out of a fear of morning sickness), and to avoid certain places, travel, and experiences in an effort to avoid throwing up.
What can be done about emetophobia?
Avoidance is the core problem that creates the disruptions in life caused by emetophobia. Children with emetophobia avoid situations that they associate with a chance of throwing up. It’s the avoidance that derails the child’s ability to thrive. Avoidance can lead to missed experiences and activities. The more a child avoids situations that they associate with puke, the more entrenched the fears become and the smaller the child’s world becomes.
Although treatment studies are limited, the same cognitive-behavioral (CBT) strategies that we use to treat other phobias seem to help. When it comes to anxiety, a central aspect of CBT involves countering avoidance with “exposure therapy,” or simply, “exposure.”
Exposure is the opposite of avoidance. Exposure involves asking the child to engage in situations that they would normally avoid. Although challenging for the child, exposure can be done in a playful, gradual, and supportive manner. Parents play a central role in their child’s recovery from emetophobia as they themselves move toward “breaking the rules” that they have followed to avoid distressing their child.
Exposure is a powerful yet nuanced intervention that is best conducted with the guidance of a trained professional. If you think that your child may have emetophobia, reach out to your pediatrician for trusted referrals. You can also schedule a consultation with a member on our team to see if exposure therapy could be right for your child.
