Lorazepam in the treatment of posttraumatic feeding disorder.

Abstract

[Author Affiliation]Murat Kardas. 1 Department of Pediatrics; Department of Pediatric Gastroenterology, Hepatology and Nutrition; and Department of Child and Adolescent Psychiatry, Bezmialem Vakif University, Istanbul, Turkey.Banu Bal Cermik. 1 Department of Pediatrics; Department of Pediatric Gastroenterology, Hepatology and Nutrition; and Department of Child and Adolescent Psychiatry, Bezmialem Vakif University, Istanbul, Turkey.Sema Ekmekci. 1 Department of Pediatrics; Department of Pediatric Gastroenterology, Hepatology and Nutrition; and Department of Child and Adolescent Psychiatry, Bezmialem Vakif University, Istanbul, Turkey.Selcuk Uzuner. 1 Department of Pediatrics; Department of Pediatric Gastroenterology, Hepatology and Nutrition; and Department of Child and Adolescent Psychiatry, Bezmialem Vakif University, Istanbul, Turkey.Selim Gokce. 1 Department of Pediatrics; Department of Pediatric Gastroenterology, Hepatology and Nutrition; and Department of Child and Adolescent Psychiatry, Bezmialem Vakif University, Istanbul, Turkey.Address correspondence to: Selim Gokce, MD, Department of Pediatric Gastroenterology Hepatology and Nutrition, Bezmialem Vakif University, Adnan Menderes Bulvari, Fatih, 34093, Istanbul, Turkey, E-mail: drgokce0007@yahoo.comTo the Editor:Posttraumatic feeding disorder (PTFD) is characterized by acute onset of severe and consistent food refusal following a traumatic event or repetetive traumatic insults to the oropharynx (Chatoor 2009). The children refuse to either drink liquids or eat any solid food, and, in severe cases, refuse all oral feeding. If untreated, food refusal potentially threatens the child's nutritional status, health, growth, and age-appropriate feeding development. Unfortunately, a standard treatment for this condition is not described.Herein, we present a 12-year-old male patient who developed severe food refusal after a choking experience. He was resistant to behavioral therapy. Lorazepam, a benzodiazepine with acute anxiolytic effect, resulted in dramatic improvement.Case ReportA 12-year-old male patient was admitted to hospital for severe refusal to drink or to eat any food, after a choking episode while eating nuts that had occurred 5 days before. He described something stuck in his oropharynx, and was continiously displaying a stereotypic swallowing movement. Past history was unremarkable. Family history revealed a conflicting relationship between the parents, but they were reluctant to give detailed information. Physical examination together with fiberendoscopic evaluation of the throat was unremarkable. Broncoscopic and upper gastrointestinal endoscopic examinations were all normal as well. Psychiatric assesment revealed that the patient was afraid of choking and dying when feeding, and that he diplayed severe anxiety when food presented to his mouth. Behavioral therapy (gradual desensitization method) was started. The patient did not respond to this approach and at the end of first week lorazepam (Ativan p.o.) was added to the treatment regimen. Clinical response was dramatic, and resulted in full restoration of oral feeding within 48 hours. Lorazepam was withdrawn during the clinical course, and the patient was discharged. Clinical symptoms and signs did not relapse.DiscussionPTFD is first described by Chatoor et al. (1988) in latency-age children refusing to eat any solids after they had experienced a choking episode and severe gagging. PTFD was later described in infants and toddlers as well (Chatoor 1991). The children are generally preoccupied with the fear of choking and dying. They display intense anxiety, and sometimes panic when food is introduced into the mouth. It can occur at any age, from infancy to adulthood. A standard treatment for this condition has not been described. Therefore, each child with a PTFD needs to be assessed individually to determine which treatment is most appropriate for the child and the family. …