Behavioral treatment for aerophagia in a typically developing 3-year-old.

Abstract

Aerophagia is a functional gastrointestinal disorder involving swallowing excessive air, which is associated with gastrointestinal symptoms such as bloating, abdominal pain, nausea, vomiting, and interference with dietary intake most commonly diagnosed among individuals with intellectual disabilities. Aerophagia is less common in typically developing children with gastrointestinal complaints and there is little previous research on successful behavioral interventions with this population. This case report illustrates an integrated behavioral approach to treating aerophagia in a typically developing 3-year-old with aerophagia that involved swallowing of emergent eructation. The family initially presented to an outpatient pediatric gastroenterology clinic. After diagnosis, the pediatric gastroenterologist referred the family to the integrated pediatric psychology service for behavioral intervention. Intake and intervention were brief, occurring over 3 outpatient sessions. Intervention included psychoeducation, selection of alternative behaviors incompatible with air swallowing, parental modeling, and systematic reinforcement. These procedures were feasible and acceptable for the family and referring provider and resulted in symptom remittance after 3 sessions, maintained at 6-month follow-up.

Behavioral Assessment and Treatment of Aerophagia

“…Minimal extant research describes the process of assessment, treatment, and evaluation of the effectiveness of treatment for aerophagia (Cigrang et al, 2006; Flaisher, 1995; Garcia et al, 2001; Holburn & Dougher, 1985; Murphy et al, 2017). Differential outcomes are reported across studies, with no discernable characteristic of one specific treatment to account for an effective reduction in aerophagia, when a reduction occurred.…”

“…Untreated aerophagia results in serious medical complications, such as arrhythmia, abdominal pain, dizziness, nausea, vomiting, anorexia, constipation, and weight loss (Barrett et al, 1987). Approximately 8.8% of adults with developmental disabilities are also diagnosed with aerophagia, and even fewer typically developing individuals (i.e., 1.3-7%; Murphy et al, 2017). Nonetheless, developing effective assessment and treatment approaches for aerophagia is critically important due to the severe health complications caused by the behavior.…”

“…Medical interventions for aerophagia entail dietary recommendations, such as restricting the intake of carbonated drinks. Since the literature suggests that medical interventions oftentimes have little effect on aerophagia, behavioral interventions are recommended (Murphy et al, 2017). Such interventions have been demonstrated to be effective across a wide range of problematic behaviors in individuals with developmental disabilities, including self-injury, aggression, and disruption (Beavers et al, 2013).…”

Development of a pediatric psychology practicum for doctoral trainees in the context of outpatient pediatric gastroenterology.

“…For example, one second-year trainee collaborated with a Pediatric GI Fellow with a specific interest in chronic idiopathic nausea to embed psychosocial assessment tools for a pilot study in her clinic and collaborated on two articles (Russell, Stone, & Walker, 2016, 2017). Another second-year trainee collaborated with a physician on a single case study related to a child with an atypical presentation of aerophagia that required a unique behavioral treatment approach (Murphy, Thomsen, & McLaughlin, 2017). In this way, trainees receive exposure to clinically oriented research and dissemination and knowledge transfer through interactions and research collaborations with physicians.…”