Behavioral Vomiting at Bedtime

My son is almost 22 months old.  He has been diagnosed with eosinophilic esophagitis.  We believe at the moment his esophagus is NOT inflamed (i.e., not causing the vomiting).  Prior to the endoscopy that showed the inflammation had subsided and since then, my son has been vomiting (during the day mostly) and we have not found a medical reason.  We strongly suspect behavioral causes for at least some of the vomiting particularly because he has sensory issues and is undergoing feeding therapy.  Because of his history of medically related vomiting my husband and I are very concerned when he vomits--a response that he has observed countless times.  A couple of weeks ago he vomited on two separate nights within 10 minutes of being put to bed, which was unusual for him despite the fact that he had been consistently vomiting during the day.  Until that point, my son was very comfortable with the nighttime routine and was fully capable of putting himself to sleep.  After the two vomits, he started calling for my husband and me.  To avert the vomiting we would go back in and soothe him as soon as we feared he would vomit.  If we didn't get to him in time, he would vomit.  I believe going in to soothe him set up a new habit as he understood that if he vomited he would elicit an immediate response from my husband and me.  My plan was to not go in and soothe him after he was down for the night and cried out for us.  However, if he vomited, I would go in and calmly change him in a matter of fact manner without either scolding him, yelling at him or coddling him.  Any advice you have on how to deal with this would be very appreciated.

[Kevin Kennedy, Ph.D.]

You are likely correct about the nature of some, but not all, of the episodes. It is too risky to adopt the stance that the nighttime episodes are solely behavioral in nature. They key is to reach the point (medically) when he not vomiting. For now I would approach this as more of a medical phenomenon than a behavioral phenomenon.