If your child has repeated bouts of vomiting, please collect the following information on three episodes of vomiting before you make an initial or follow-up appointment. This information may help your physician reach a correct diagnosis.
Date:
Time of day:
Place (home, school, etc.):
People present:
How much (ounces)?
Food or mucus?
For how long (minutes)?
What did it keep your child from doing?
Thoughts or stresses before the vomiting (within 1 hour):
Feelings (for example, upset or afraid) before the vomiting (within 1 hour):
Activities before the vomiting (within 2 hours):
Food eaten before the vomiting (within 2 hours):
What did you do to help your child feel better?
What do you think caused the vomiting this time?
