Klonopin and Pediatric Air Swallowing

Children under severe psychological duress sometimes develop an involuntary reflex that causes them to swallow large volumes of air. Known as pathologic childhood aerophagia (PCA), this condition leads to a variety of stomach and intestinal problems if left untreated. Bowel distention, malabsorption of nutrients, and abdominal cramping are all potential symptoms of long-term PCA. Treatment of PCA usually consists of supportive counseling and reassurance, along with an attempt to identify and manage sources of stress and worry. Attending physicians may also prescribe anti-anxiety drugs on a case-by-case basis when the first line of treatment fails. Researchers in Korea performed a small-scale test to determine whether the anti-anxiety drug Klonopin (clonazepam) might be safe and effective in treating PCA.

Twenty-two children at a Korean clinic were enrolled in the PCA management study. Fifteen received Klonopin, and the other seven received counseling alone. Parents provided informed consent on behalf of their children, and there was no placebo-controlled group for comparison. Video observation of the children’s esophagus confirmed that abdominal symptoms were a result of PCA and not another condition. Throughout the study, regular observation with a videoscopic device helped clinicians determine the state of the child’s PCA. Children and parents also self-reported PCA symptoms and any potential medication side effects throughout the study.

Researchers dispensed Klonopin to the children at doses far below the normally therapeutic amounts. However, even at these low doses, empirical video evidence confirmed that the muscles controlling the involuntary swallowing action relaxed quickly after administration. The effective dosage of Klonopin in the study was low enough that long-term maintenance treatment presented relatively little risk. Children treated with Klonopin experienced remission of their PCA at a rate of 67%, compared with only 15% for children treated only with reassurance. In the absence of follow-up treatment, however, the likelihood of relapse was fairly high. A combination approach that incorporates both pharmaceutical and behavioral treatments offers the most comprehensive solution.

Except in cases of mental retardation, PCA is nearly always a symptom of psychological distress. Although Klonopin and similar psychotropic medications offer relief from the condition, cognitive therapy is important for maintaining remission and enhancing the individual’s self-confidence and coping mechanisms.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Clonazepam. Retrieved April 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000635/
2. Hwang, J., Kim, J. S., Ahn, B. H., Jung, C., Lee, Y. H., Kam, S. (2007). Clonazepam treatment of pathologic childhood aerophagia with psychological stresses. Journal of Korean Medical Science, 22, 205-208.

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