My Child Choked and Won’t Eat! Help!

We recently got a question from a mother whose daughter had a choking episode and is refusing to eat.

“Our six year old had a choking episode two weeks ago, but the food popped out pretty quickly. She is now only drinking Pediasure. Our pediatrician is not concerned since she is drinking Pediasure (“Total nutrition” he said!), but our daughter is panicked about choking again and seems to be getting worse. We called the local eating disorder treatment center, and they can see her- in three months! We don’t know what to do!”

(Assuming her weight is stable or minimal decline, and that her development and eating were typical before the aversive event, and assuming the pediatrician has ruled out any reason behind the choking event…)

A few general thoughts for this mom and others with the same concern:
You are right not to wait three months! Most children in this situation don’t need inpatient or intensive Eating Disorder treatment, but things can get worse quickly. This is not an uncommon event, but scary all around. EARLY support leads to best the outcome. Your doctor isn’t too worried, but you are seeing a dramatic difference and your gut says you need help. The phobia can become more entrenched the longer it goes on. (See case study below we wrote for doctors on Medscape for more. Part of why we are sharing this is for parents to have it to show to the child’s doctor if they need help finding resources, or having concerns taken seriously.) This is a traumatic event, and can take time to heal, but you should see steady progress with support.

• Find a therapist who specializes in children with anxiety and phobias ASAP. Briefly explain the situation, see if you can get a crisis appointment, at least within the next week or so if she truly is only drinking Pediasure and things are getting worse. Sometimes a call from your pediatrician can get you in sooner. Ideally the therapist has experience with “phagophobia” (with children who have choked and stopped eating solids), or with vomiting phobia.
• Cognitive behavioral therapies seem helpful in challenging the thinking process behind the fears. There are a few case studies of hypnosis as well that seem promising.
• A therapist with “somatic” training may be helpful as well since she is young. This is also called an “embodied” therapy, which helps regulate the physical experiences of anxiety after a traumatic event.
• Support nutrition with textures she can take in. Is she taking purees at all? Smoothies? Smoothie pops? Continue with Pediasure. If you can, make nutritious (protein and fat included) smoothies with foods she used to eat, or fruit/smoothie popsicles (think coconut milk, whole fat Greek yogurts, fruit, honey, bananas, nut butters… look online for nutrition boosting pop recipes).
• Reduce anxiety. Try to remain and project a calm, nurturing presence to help reduce her anxiety. Optimize “sleep” hygiene so she gets good rest. Try to help her continue to play with friends and participate in activities that get her mind off her fears. Continue to eat together, and she can join in mealtimes with liquids/foods she can handle. We think our book Helping Your Child with Extreme Picky Eating is particularly helpful around anxiety. We describe this “aversive” experience as a contributing factor to not eating.
• If your daughter is getting worse or begins to drop weight, go back to the pediatrician for urgent help, particularly if you see signs of dehydration. (Avoid a nasal feeding tube if possible, as inserting the tube can traumatize and worsen eating aversions, but it usually doesn’t get to that if you get help early.)
• In general, unless there was a history of difficulty eating and swallowing, or there are any new factors or red flags, swallowing studies are not indicated. Waiting weeks to “rule out” swallowing difficulties can waste time for getting help. If you do pursue swallowing eval, don’t miss out on the other opportunities to help in the meantime.
• Get support if you have more questions. Mealtime Hostage has a wonderful private parent facebook support group. There will likely be other parents with kids who have experienced this. It could prove helpful, and give you ideas and local resources.