A 10-Year-Old With Anxiety and History of Asthma
James is a 10-year-old Caucasian male who was brought to the authors' psychiatric mental health outpatient clinic by his parents with the complaint of "he is having trouble swallowing." His parents provided much of the clinical picture and history, since James did not voluntarily offer much conversation during the session. His father stated that James had strep throat about a month or two ago, and he noted that as time went on, James was not swallowing. Further, James was holding saliva in his mouth, only eating soft foods (for example, mashed potatoes, ice cream), and expressing more fears of choking. His father also recalled a past incident when James had swallowed a whole ice cube and feared choking. James will not eat meat, vegetables, or anything that needs to be chewed or that has texture. He repeatedly refers to "that feeling" in his throat and chest. His mother reported that James does not sleep well because he fears "that he is going to die in his sleep from choking."
James has had two "attacks" within four days related to his sense of not being able to breathe and swallow During the first episode, James reported "feeling like I was going to faint." Of the second incident he said, "My heart is pounding, and I am sweaty, and I can't breathe good." His parents described him as making shallow, rapid, panting vocalizations. The use of his rescue inhaler did not relieve his symptoms. Both episodes resulted in emergency department (ED) visits where the physical findings (X-rays, cardiac and respiratory monitoring, pulmonary functions) were all normal. There was no evidence of cranial nerve (II-XII) dysfunction. Complete physical examination revealed no abnormal findings in head, neck, or thorax. The ED physician subsequently referred James to his long-time pediatrician for a follow-up visit, where James' physical findings were again in the normal and expected range. The pediatrician prescribed alprazolam 0.25 mg one tablet three times a day as necessary and referred James to the authors' psychiatric mental health practice for an evaluation.
Abstract and Introduction
Case Presentation
James is a 10-year-old Caucasian male who was brought to the authors' psychiatric mental health outpatient clinic by his parents with the complaint of "he is having trouble swallowing." His parents provided much of the clinical picture and history, since James did not voluntarily offer much conversation during the session. His father stated that James had strep throat about a month or two ago, and he noted that as time went on, James was not swallowing. Further, James was holding saliva in his mouth, only eating soft foods (for example, mashed potatoes, ice cream), and expressing more fears of choking. His father also recalled a past incident when James had swallowed a whole ice cube and feared choking. James will not eat meat, vegetables, or anything that needs to be chewed or that has texture. He repeatedly refers to "that feeling" in his throat and chest. His mother reported that James does not sleep well because he fears "that he is going to die in his sleep from choking."
James has had two "attacks" within four days related to his sense of not being able to breathe and swallow During the first episode, James reported "feeling like I was going to faint." Of the second incident he said, "My heart is pounding, and I am sweaty, and I can't breathe good." His parents described him as making shallow, rapid, panting vocalizations. The use of his rescue inhaler did not relieve his symptoms. Both episodes resulted in emergency department (ED) visits where the physical findings (X-rays, cardiac and respiratory monitoring, pulmonary functions) were all normal. There was no evidence of cranial nerve (II-XII) dysfunction. Complete physical examination revealed no abnormal findings in head, neck, or thorax. The ED physician subsequently referred James to his long-time pediatrician for a follow-up visit, where James' physical findings were again in the normal and expected range. The pediatrician prescribed alprazolam 0.25 mg one tablet three times a day as necessary and referred James to the authors' psychiatric mental health practice for an evaluation.