Anxiety disorder in Children

[reds]

My son has just turned 8. Over the past 8 days he complained that something is in his throat and he is worried that there might be bones in his food therefore he is extremely careful in chewing his food. We took him to see doctors and ENT specialist and there is no problem detected. He seems to be anxious about eating. He is not as happy as his usual self and embarrass going to school.

We have been supporting Ryan by telling him that he is fine and will be fine. Any suggestions or has anyone experience this? Please help!

 

[LittleDudesMom]

Reds,

I cannot help you from personal experience, however one of our mods had a daughter that experienced eating anxiety. I'm sure she will be along later this morning.

You mention that you have taken him to a doctor and ENT. It kinda sounds like to me that his issue is more anxiety based than phsyically based. Has Ryan visited with a psychologist or therapist?

Sharon

 

[smallworld]

Reds, welcome. I'm glad you found us.

My daughter M was a couple months shy of 8 when her anxiety with eating began. She started complaining that it was hard for the food to go down her throat and that she was worried the food would come back up. She frequently said she "felt bad" and that she was "queasy." She also became sensitive to the look and smell of certain foods and couldn't be in the same room when they were served.

Although we suspected anxiety at the root of her behavior, I insisted that all physical causes be ruled out. She had extensive blood work (to rule out ulcer, celiac, thyroid problems, etc) , underwent an upper endoscopy and a swallow study (the latter two set up by a pediatric GI doctor). Everything turned up normal.

M then started seeing a child psychiatrist, who did not prescribe medications originally but worked with her cognitively to deal with her anxiety. Unfortunately, M saw a cartoon on TV that depicted a character choking and became convinced that she would choke and die if she ate. She then gave up certain foods (first all meat, then BiPolar (BP)&j, then pizza, then anything crunchy, etc) as "unsafe" until she got to the point of barely eating anything at all. Because she lost so much weight and was barely keeping herself hydrated, she ended up hospitalized for 5 days, fed via an NG tube for a month and in a day treatment program for 5 weeks of feeding therapy. Medication for anxiety was started just prior to hospitalization, and that coupled with intensive therapy, gradually got M back to eating to sustain herself without tube feedings.

In relating our story, I'm not trying to scare you, but it is important to take Ryan's concerns very seriously so the situation doesn't spin out of control. Have you ruled out all physical causes? If so, are you getting him in to see a psychiatrist, psychologist or social worker? Ideally, this mental health professional will have experience with Cognitive Behavioral Therapy, which will help Ryan overcome his fears by exposing him to the very thing he is afraid of (food). If his anxiety becomes so great that he starts severely limiting his intake, medications will need to be considered. If you end up working with a psychologist or social worker, make sure that professional has a working relationship with a psychiatrist in the event you have to go the medication route.

It's been 2 years since M's eating anxiety began, and I'm happy to report she's a healthy little girl who eats almost normally today. She's still on medications and she still sees her psychiatrist weekly, but she's well on the road to recovery.

Please know that I am here to support you in any way you think I can be helpful. Hang in there.

 

[reds]

Dear smallworld and Sharon,

Thank you both for your advice and especially smallworld for sharing your experience with me. We live in Hong Kong, therefore, the social security and medical system is slightly different from yours. So far his signs/symptoms are very similar to M's. We are currently in touch with one of Ryan's classmate parents who psychologist.

We have been to doctors to rule out the physical causes.

reds

 

[Kjs]

I believe we had this same experience. We didn't realize at the time what the problem could be, now looking back I think we understand why.

When difficult child was 5 he stopped eating. It was June, school just got out. We didn't notice too much at first. He would tell us if he swallowed his food he would choke and die. We told him no, he was fine. Days passed and he would sit in front of his food. Once when we demanded he eat just one bite, he said his good-byes. Said he loves us, cried, was shaking got the food to his mouth and could not do it.

I took him to a psychiatrist. They put him on liquid Paxil. That did nothing. Days and weeks passed. Pediatrician referred him to a pediatric gastroenterologist. They did a scope to ensure nothing in his throat. All was fine. After 6 weeks of no solid food, not even one bite he started to not want to drink. (we were giving him pediasure and ensure).

Finally easy child was going to a concert in a larger town. Told difficult child he could go ONLY if he would eat. easy child took him to a restaurant in the other town. Called us. difficult child ate ONE french fry. Silly to be so excited about one french fry. But, this must of proved to difficult child he would not choke and die. He slowly began eating again.

Looking back at things that happened around that time we found: A neighbor man who has been so nice to difficult child since he was born. A scary looking biker guy with long hair, big full beard. difficult child loved him. He would go watch him work on his motorcycle. The man gave difficult child a ride around the block. When he went to the motorcycle ralley he would bring difficult child t-shirts. Really a nice man. That man died in his sleep. It was in early June. We think that is what caused difficult child to feel that way.

We find when difficult child starts acting strange we look at situations that occurred and have been able to usually tie something in that set him off.

Good Luck.

 

[reds]

Ryan showed improvement the past 2 days. we keep telling him that he is fine and will be fine. We give him lots of encouragement to eat and praise him a lot when he did well. He seems to be responding better. he eats his usual portion of breakfast this morning, the best over past 10 days. It takes 30 minutes but no complain from him. It seems that he is very concern about bones in his food, that's why it takes him a long time. I hope this sign of improvement continues....

Kjs is right. Something must have happened to trigger this behaviour. We tried to ask but he is not telling. Maybe he is shy to tell us.

 

[Marguerite]

Reds, this sounds very familiar to me. If conditions such as overactive thyroid have been ruled out (blood test looking at T3 & T4 levels, as well as sometimes ultrasound of the thyroid to see if it's enlarged at all) then I think you're looking at anxiety.

If you can think of how you have felt yourself, perhaps when you were a child, and you were extremely upset or worried about something, you might be able to sense a little of how your son feels. It's possible that when you were a child you understood better than he does, where the physical feelings were coming from. But a lot of children, especially those with problems, are less in touch with the connections between their feelings and the physical responses to those feelings.

I think you're doing the right things by reassuring him, but if you could find out what in his environment has raised his anxiety to this level it might help even more. He may not know what it is, because he may not have connected in his mind between a triggering event (perhaps a change in teacher at school, or another child teasing him) and the feeling in his throat.

It might not be anxiety. It might be sadness. Has something happened that you know about, that might account for him feeling sad?

Even if you can't find out why you can still help him. If you can teach him to relax, it can help. difficult child 3 had to do an exercise every night where he had to practice taking slow deep breaths while making sure he breathed from his diaphragm. If he had his hands on his tummy he had to feel it push his hands out with each breath in. He had to breathe in for 2 seconds and breathe out for two seconds, repeating this ten times each night.

Other relaxation and/or visualisation can help. Anything which can help him get back the connection between emotions and physical feelings can help.

Do you have access to tai chi? Would he do it? That might also help him focus his thoughts positively and also learn to control his breathing and relax.

Some children with Sensory Integration Disorder (SID) (sensory integration problems) can also have trouble with certain textures in food. But this sounds like a sudden change, and his description really sounds like that feeling you get in your throat when you are really anxious or upset.

I hope he keeps improving. His classmate's psychologist parent sounds like a good way to go.

Marg

 

[reds]

Marg,

We do see progress in Ryan. But, he is eating very slowly as he chewed his food very carefully scared that there might be bones in it. His general conditions is fine. More cheerful than previous week.

We also notice that his mood is sad in the morning, when he prepares for school. I wrote to the teacher and were in touch with her almost on daily basis. He was a bit sensitive at school during playtime last week, which is not his usual self, but in class he is fine. This week is better.

Thanks for reminding me of the relaxation method. I completely forgot about it as all of us in the house is focussing too much on his problem. I will take your advice and practice with him tonight.

reds

 

[Marguerite]

It does sound to me that maybe something in the play time with the other children could be connected to an increase in anxiety. It could be something that happened a week or more ago. Maybe some other child told a story about someone choking on a fish bone and it has made him worried. it could be something so very simple, something you or I wouldn't worry about. But children see things differently.

It is good that you are in touch with the teacher, that will help let you know as soon as there is any change. It also helps for the teacher to be watching.

I am glad he seems to be getting better. That is good.

Is he a good student? Very clever, especially in some subjects? Or is it sometimes very hard for him in class?

I hope the breathing exercise can help him. It could take some time with regular practice.

If he gets anxious a lot about other things too, then maybe the psychologist you know could help.

Marg

 

[reds]

Just want to give everyone an update. Ryan is improving a lot and his eating problem has almost gone. I met his class teacher during parent, student and teacher meeting about 2 weeks ago. Teacher opened up a conversation which indicates Ryan was being bullied by one of his classmate. In addition he finds it hard to cope with one of the boy (different) due to the boy's behaviour (always follow Ryan and do what Ryan wants to do, ie fighting for exact same spot on carpet time, etc).

This meeting opens up his feeling and he talks more now and we can also guide him better. He is happier and almost back to his old self. We are so relieved.

Ryan is very good at school in term of learning ability. He is good in all subjects. However, he needs to work on his social skill.

Any suggestions/guidance would be much welcome.

Thanks again to everyone that responded to my problem.

 

[Marguerite]

I am so pleased he's doing better. I'm not surprised at the reason this problem seemed to suddenly get worse. Have you been able to talk to Ryan about how his emotions and distress were causing the swallowing problem? He needs to get the connection between the feeling he had and the emotions which were causing it, so he can recognise it when it happens again.

And it is going to happen again. So if he is prepared, he will recognise it and hopefully come and talk to you about it.

The social skill problems - he will need help. He isn't going to learn social skills just be being around other children. He will need to role play, to rehearse (with you) and to be supported in social situations so he can practice in safety.

Have you considered the possibility of Asperger's Syndrome? I know a number of children with this, plus I have difficult child 1 with it, plus his sister who is mildly Asperger's. difficult child 3 is more obviously autistic, as he had language delay.

A child with Asperger's Syndrome is often very bright especially on some subjects such as maths and science. Computers especially. As they get older and the work becomes more abstract, they can begin to have trouble with subjects like grammar, creative writing, history - humanities subjects. difficult child 3 is brilliant at grammar and spelling but not doing well when he has to analyse a text.
Asperger's children also have trouble with social skills and can't pick it up easily as other children do.

But Asperger's kids have some wonderful qualities - they are honest (generally). They obey rules. They are loving and loyal, often much more so than others. They often enjoy learning and will value the opportunities to learn.

Have a look at the Pervasive Developmental Disorder (PDD) questionnaire on www.childbrain.com. You can't use this to diagnose, but you can print the results and take it to a psychologist or specialist and ask their opinion.

There are some important people in the world who probably have Asperger's. Bill Gates is believed by some to have it. Einstein. I think Steve Irwin had it. And many more.

I am very happy he is doing so well. He sounds like a very precious child.

Marg