Why does he vomit?

With the entries on Truman's testing and vomiting, some of you have asked me exactly what goes on with Truman. Here is a basic summary of Truman's vomiting:

Truman's issues are primarily physical. It is clear that the vast majority of his vomiting is involuntary and that once the process begins he cannot stop it, regardless of whether it started voluntarily or involuntarily. Virtually all food that is not completely pureed or a very narrow category of crunchy things causes him to vomit. Clear liquids cause him to vomit. Too much volume of anything causes him to vomit, and his max capacity seems to be between 7 and 8 ounces. He also has other vomits that don't have a clear source that we attribute to reflux. Additionally, he has a strong gag reflux, so strong crying, coughing, or drainage causes spontaneous vomiting as well.

However, because of the frequency of involuntary vomiting, he has learned how to voluntarily do it as well. We have made huge strides with the voluntary vomiting with a behaviorial feeding therapist, and it now only occurs when he is very upset, which I think makes it somewhat beyond his control. Before, he would begin retching or sticking his fingers down his throat to avoid eating, going to bed, etc.

Vomiting is not necessarily a daily occurrence, but it often is and sometimes multiple times in one day. Also problematic is that a single vomit always erases at least one entire meal, sometimes more. Considering that he does not want to eat most of the time and is miles away (and getting further) from even his adjusted growth chart, Truman doesn't have "extra" meals in him to lose.

However, if we can have a day with (1) only "safe" food (which isn't necessarily a consistent target since the thickness of the purees he can tolerate seems and the variety of crunchy textures is inconsistent), (2) without too much volume (this is assuming his stomach fully emptied from the last feeding, which we have no way of knowing since he may ask for / accept more food than he handle), (3) without him getting a drink of bath water, pool water, or the water hose before we can stop him, and (4) without him getting too upset or stressed about anything, we have a vomit-free day. We regulate what he eats so much that we do have vomit-free days, but not with any frequency or regularity.

We have a follow-up with the pediatric GI specialist at the end of the month to see if the meds or Benecalorie have done anything with regard to growth and to go over the calorie counts. I think that since neither med has reduced the vomiting by any measurable level, I anticipate an endoscopy and stomach biopsy will be scheduled soon. It's such a fine line to walk between accepting his slow growth responding with therapy and considering aggressive treatment to ensure that he grows and that slow growth does not impede cognitive development.