Q&A: 18-month-old vomiting every night before bed

Jess writes:

"I am really at my wit's end with this one.  My 18 month-old has neverbeen a good sleeper.  For the most part, he has been going to sleep by himself at night (for the last 3 or 4 months anyway) with about 10 minutes of crying.  Sometimes longer, and if he's escalating and I don't feel like listening to him cry for an hour I'll have to go into his room and fall asleep with him on the mattress we have for that purpose.

Anyway, for the last week, I will go through our normal bedtime routine where, by the time I am singing him a song, he is drowsy and maybe dozing but not in a deep sleep, but when I put him in his crib, instead of just crying he will scream.  And it will go on for about 10 minutes at which point he'll vomit.  Then we change his bedding, his pajamas, brush his teeth again, and I will sing him another song.  The second time around he'll go to sleep with barely 5 minutes of fussing.

At first I thought he either had a stomach ache, or we were feeding him too soon before going to bed (he usually has dinner between 5:30 and 6, and goes to bed anywhere between 7 and 8.  Sometimes he gets a small snack right before bed).  But last night I tried to be preemptive - after he had cried for 5 minutes, I went in, picked him up, and let him cuddle.  He calmed down until I made to put him back in his crib, then he cried, stuck his finger in his mouth (it didn't look that far to me, but I suppose he could have triggered his gag reflex) and then a couple of seconds later vomited all over me.

Is he doing this on purpose?  What do I do?"

Whoa. Sometimes I think I've heard almost everything, and then I get a question like this one.

If you'll remember back to the idea about tension increasers and tension releasers, the idea is that some kids gain tension by crying, so crying makes them get more wound up and unhappy. (These are the kids that need to be rocked or nursed or soothed to sleep.) You know you have one if leaving your kid to cry for even 20 seconds results in even more crying and having to work even longer to get your child to calm down. (My first son was the classic tension increaser. He sleeps just fine now.)

Tension releasers/decreasers, on the other hand, seem to need to cry to be able to fall asleep. It's as if they're creating a kind of white noise by crying that helps them shut down for the night. You know you have one if rocking or soothing to sleep seems to make them more upset and wound up, and if you leave them to cry for a few minutes and they start to wind down, and then drop off. (My second son was a classic tension releaser. He sleeps just fine now, too.)

But, here's the kicker: Kids can flex back and forth between the way they respond to crying during different stages and phases. (And I've had comments from readers that they have kids who are one way for nighttime and another way for naps!)

So it sounds to me like Jess' son is in a stage of being a tension releaser at night. (Are *any* of us shocked that he's switching sleep patterns right at 18 months?) He's creating the white noise he needs to shut down by crying.

All well and good. Except.

What's with the puking?? Is there some kind of release that he gets from the vomiting? Is it somehow resetting his system?

What payoff is he getting from the throwing up? It canNOT be comfortable to puke on yourself, and then have to get cleaned up. And there are easier ways to get more attention than making yourself throw up.

I'm baffled. Has anyone dealt with this? Anyone with experience with bulemia that can tell us if there's an endorphin rush accompanying vomiting? 'Cause it's just not making sense to me as a straight play for attention.

(I do, however, think that it's likely to go away on its own as part of the 18-month-sleep regression, so I don't think there are going to be long-term worries. It's just the right now that's INSANE.)