I've been thinking about this all day at work :)

Here's the direction I think I would go with my kids. There are tons of issues especially since he's 11. First, I think I would watch him or at least write down which foods he does it with. Is it meats, how about typical foods for an 11 year old such as pizza or fast food. Is the food dry, etc. Does he always spit out the same foods, like for example, does he always spit out chicken but eat pizza? Does it matter what size bite he takes?

I would then ask him more about why he's doing it and tell him that you are concerned and want to help him stop it. I would try (this is the hard part - he is 11 years old :) to keep it as non-judgmental as possible.

After this, I would consider either a behavioral plan or a second opinion. With a behavioral plan you would reward him for getting through a meal without spitting it out. The reward can be something small or it can be a mark toward something bigger. It doesn't have to be something that costs money either. Maybe a treat that he doesn't normally get like extra TV or game time. I would try to avoid punishing him for doing it - accentuate the positive not the negative.

If you try the behavioral plan and that doesn't work then I would go on to definitely a second opinion and/or a nutritionist. The doctors may want to consider looking into other possible causes of him having troubles swallowing. I just recently learned about eosinophilic esophagitis that can cause problems swallowing but has some other symptoms as well that you didn't mention. Dr. Eisner also wrote about dysphagia (difficulty swallowing).

A nutritionist may be helpful to help figure out ways to get the proper nutrients even if he isn't eating certain types of foods.

Finally, did the cyprohepadine help? It's interesting because it is used for cyclic vomiting syndrome but it is also used for allergies so it would seem to me that if there is an issue with EoE that it might be helped by the cyprohepadine???

Stephanie