Description 

A 6-year-old previously healthy boy presented to paediatric clinic with increasing severity and frequency of his gag reflex over the period of 2 months. According to the parents, the child was previously healthy, immunised and no perinatal complications. His initial symptoms were nausea that was worse in lying position, occurred mostly during the night, no abdominal pain, discomfort or other associated symptoms. These symptoms gradually worsened to gagging that is constant and currently interfere with his day-to-day activity. No identifiable stressors at home or school that triggered the symptoms. No dental problems, prosthesis and regularly visits his dentist. His physical findings were normal with stable vitals and soft, non-tender abdomen with normal bowel sounds. His oral examination was unremarkable and the patient was discharged on histamine blockers for 2 weeks despite which he had no improvement. His …