Medical Traumatic Stress: A Multidisciplinary Approach for Iatrogenic Acute Food Refusal in the Inpatient Setting

[摘要] Feeding problems in infancy and early childhood are very common. Twenty-five percent to 45% of typically developing children reportedly experience some type of feeding problem. Although many of these issues are temporary, with no significant clinical impact, psychologically traumatic events can result in acute food refusal with serious risk of harm, either necessitating or occurring during an inpatient hospitalization.1 Emerging literature and diagnostic entities are focusing on the ways psychological stress can precipitate avoidant and restrictive food intake. Recent changes in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), have brought renewed attention to psychological trauma in young children that results in disordered eating.2 In the present article, we examine iatrogenic food refusal in the context of medical traumatic stress of a 5-year-old girl to demonstrate diagnostic consideration and treatment strategies.K.G. was a 5-year-old otherwise healthy girl without restrictive or picky eating before presentation who was transferred from a referring hospital pediatric ward at day 13 of her hospitalization for evaluation and treatment of acute-onset abdominal pain and total by mouth (PO) refusal. The patient was in her usual state of health until she presented to the referring hospital with a 3-day history of vague abdominal pain, nausea, nonbloody nonbilious emesis, and 1 episode of nonbloody diarrhea. One sick contact with viral illness was reported before admission. A full review of systems was otherwise negative.The patient’s referring hospital physical examination was notable for a relatively well-appearing, somewhat anxious but talkative young girl with mild diffuse abdominal tenderness most evident at the umbilicus and “feeling like a bubble,” with mild hepatomegaly variably reported by clinical examiners. Transaminitis was noted, with alanine transaminase levels of 139 IU/L and aspartate transaminase levels of 123 IU/L. Results of multiple laboratory studies obtained at the referring hospital reported …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob