Sudden Onset Anxiety

[Marc Feldesman]

Our 7 year has suddenly developed all the characteristics of an anxiety disorder after experiencing the "embarassment" (her word) of spilling juice all over her school uniform at lunch.  This now plays itself out in her getting "tummy aches" every morning before school, immediately before lunch at school, and in every social setting where she is expected to eat with and in front of other children (i.e. birthday parties, Sunday school snacks, etc).  We've already consulted with her teacher, the school psychologist, and her pediatrician.  The pediatrician has recommended that she carry one Tum(r) in each pocket of her school uniform.  This is, of course, against school policy.  The school is considering waiving its policy, which may prove to be all we need.

In the meantime, she doesn't eat lunch at school, barely eats any breakfast on weekdays and this is, of course, beginning to affect her schoolwork.  She is also beginning to lose a small amount of weight.  She eats ravenously at dinnertime and on the weekends, but I'm not in favor of this kind of "feast and famine" type of eating.

Neither my wife nor I want to make a big production out of her not eating because we fear a worse outcome than we already have - a full fledged eating disorder.

This all began quite suddenly on January 12 with no previous history of eating problems.  School schedules have been erratic all of January.  Tomorrow begins the longest run without days off until Spring Break.

Two questions:

1) Is our sense of taking "little notice" of the problem the best way to go?  (or alternatives?)

2) At what point do we need a different type of intervention?
Counselling?  Medication?

Thanks,

[HFHS M.D.-SW]

Dear Marc Feldesman,

You and your wife appear to be taking the appropriate means in addressing your daughter's concerns.

Your daughter may need a proper evaluation by a child therapist.

The therapist should evaluate your daughter's;
1-History of anxiety and reaction to similar situations.
2-Relationship with family, her comfort in talking out her problems.
3-Details of the school lunch incidence.
4-Perception of how she sees things.

Since the episode occured two weeks ago, you may consider a wait and see approach, this may be a transient reaction. If her anxiety worsens or she losses more weight, see her pediatrician.

Treat your daughter as you normally would, expressing care and concern without "the big production".

Best Wishes,

HFHS M.D.-SW

[marc]

One additional clarification.  The school doesn't have a policy against taking medications.  The school has a policy against children self-administering medications.  This means that anytime a child needs to take a medication, he/she has to be dismissed to the school nurse to receive it.  Our pediatrician is rightly concerned that this makes the problem even more obvious and worsens the situation rather than makes it better.  The pediatrician has gone so far as to refer to Tums as a dietary supplement (calcium) rather than a medication.