Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

"Fear of Swallowing" by a 7 1/2 year old girl who choked on a tortilla chip. How can Emma be able to eat again?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

no

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Our 7 1/2 year old granddaughter choked on a tortilla chip on June 2nd, 2012. Over the next week, she gradually stopped eating -- until she would only eat soy chocolate pudding and soy milkshakes. Let me just say, Emma is severely allergic to wheat, barley, rye, eggs, peanuts, tree nuts and milk...she used to be allergic to soy and oats, but has outgrown those allergies. We have taken her to her pediatrician, a psychologist, a speech therapist, back to the pediatrician who put her on a very low dose of Zoloft yesterday and who has suggested another psychologist. Emma initially lost 5 lbs...which she has gained back by eating the soy pudding, soy milkshakes, mango sorbet, OJ. She is anxious about things other than food, since the choking incident. She will not eat anything that has any substance to it. Please consider doing research on this problem.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

We'd like to see Emma able to swallow "real food" --- Emma-safe food again. Emma-safe foods are offered at most meals -- on a separate plate.

Describe any health-related risks, side effects, or harms that you are concerned about.

Emma has not gained in stature or weight in the last year (except gaining back the five pounds she lost since choking)...her health will be compromised by the lack of nutritious food...Emma is very bright for her age in reading, math. She is able to articulate her situation and her desire to eat...she says she is hungry. Moms and Grandmoms are taught to and instinctively know to feed their children and grandchildren. It is very difficult to not be able to help.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

AHRQ Priority Populations

• Children
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

None

Importance

Describe why this topic is important.

Emma needs help to overcome her "fear of swallowing" and nothing has helped yet. Do you have any suggestions that can help?

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

My 7 1/2 year old granddaughter, was born on Christmas Day 2004...she is loved and everyone who knows Emma, loves Emma. Most people don't really know that Emma hasn't eaten much since choking on June 2nd. She would like to be able to eat -- especially before she starts 2nd grade. She voiced that she doesn't know what her friends will think when she only eats soy pudding and soy milkshakes if it isn't "over" before she returns to school. Emma is already "different" because of her severe food allergies. Can you help?

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

no

If yes, please explain:

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

It will help other people whose children choke and "they don't know what to do" to help their children to be able to swallow again.

Describe the timeframe in which an answer to your question is needed.

ASAP

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Children who choke and can't and won't eat food that is good for them...anything with substance to it -- that needs to be swallowed.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

It will help other people whose children choke and "they don't know what to do" to help their children to be able to swallow again.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

Good Housekeeping Magazine - March 2012 (I just read it yesterday)