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Stressors associated with dyspnea in childhood: patients' insights and a case report
1Department of Pediatrics, State University of New York Upstate Medical University, Syracuse 13210, USA. anbarr@mail.upstate.edu
Insights
Pediatric dyspnea (difficulty breathing) can be linked to stress. Self-hypnosis helped resolve breathing issues in most children by reducing stress and providing insight into its causes.
Area of Science:
- Pediatric Pulmonology
- Psychosomatic Medicine
- Behavioral Pediatrics
Background:
- Dyspnea is a common respiratory symptom in children.
- Persistent dyspnea despite medical treatment suggests underlying non-organic factors.
- Psychological stress is increasingly recognized as a contributor to somatic symptoms in pediatric populations.
Observation:
- A cohort of 22 pediatric patients with persistent dyspnea were offered self-hypnosis.
- Hypnosis was provided for both relaxation and to explore potential psychological triggers.
- Patients ranged in age from 9 to 17 years.
Findings:
- Self-hypnosis instruction led to the resolution of dyspnea in 18 of 22 patients within one month.
- Eight patients utilized hypnosis for insight, identifying stress as a cause or avoidance mechanism.
- One case illustrated how understanding the stress trigger resolved vocal cord dysfunction-related dyspnea.
Implications:
- Dyspnea in children may serve as an expression of stress.
- Stress-reduction interventions, including self-hypnosis, show promise for treating pediatric dyspnea.
- Gaining insight into stress-related causes can enhance the efficacy of dyspnea treatment in children.
Objective:
To highlight the concept that stress can be associated with dyspnea in children.
Methods:
A chart review identified 22 patients (age range, 9-17 years) referred to a pediatric pulmonologist, who were offered instruction in self-hypnosis for treatment of dyspnea that persisted despite medical therapy. Patients were offered the opportunity to use hypnosis to gain insight into the causes of their dyspnea.
Results:
The dyspnea resolved in 18 of the 22 patients within 1 month of instruction in self-hypnosis for relaxation and symptom reduction. Eight of the 22 patients (age range, 11-16 years) chose to use hypnosis for insight. Using automatic word processing, they explained that their dyspnea was associated with stressful situations, or that it reduced the chances of having to experience an uncomfortable situation. For example, a girl with dyspnea resulting from vocal cord dysfunction realized during hypnosis that she developed her symptom in order to prevent herself from talking about information that might cause discomfort were it disclosed. As soon as the patient decided that she could trust herself to handle the information appropriately, her symptom resolved.
Conclusions:
Dyspnea may provide patients with a way of expressing their reactions to perceived or anticipated stress. Thus, stress reduction interventions may prove very helpful in resolving this symptom. However, in some cases gaining an insight into the potential cause of the dyspnea may increase the effectiveness of therapy.
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