JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY Volume 17, Number 2, 2007 © Mary Ann Liebert, Inc. Pp. 233–236 DOI: 10.1089/cap.2006.0057 Fluoxetine in Posttraumatic Eating Disorder in 2-Year-Old Twins Gonca Celik, M.D., 1 Rasim Somer Diler, M.D., 2 Aysegul Yolga Tahiroglu, M.D., 1 and Ays ¸e Avci, M.D. 1 ABSTRACT Feeding disorders of infancy or early childhood are relatively uncommon in the pediatric pop- ulation. In posttraumatic eating disorder, the infant demonstrates food refusal after a trau- matic event or repeated traumatic events to the oropharynx or esophagus. We present case re- ports of 24-month-old twin girls, A and B, who presented to our clinic with food refusal and fear of feeding. Several invasive gastrointestinal procedures were performed when they were 3 months old, and they started to refuse all solid food and some liquids soon after hospital- ization. Fluoxetine 0.3 mg/kg per day (5 mg/day) was started to target their anxiety and fear about feeding. In the second month of weekly follow up, the children began to be fed with- out a nasogastric catheter. A significant decrease in anxiety and fear was observed during feeding. Although the use of serotonin-selective reuptake inhibitors (SSRIs) in preschool chil- dren is controversial due to the lack of empirical data in this age group, we observed clinical improvements in anxiety in these two cases. Furthermore, fluoxetine was well tolerated and no side effects were observed. 233 INTRODUCTION T HE TERM “POSTTRAUMATIC EATING DISORDER” was first coined (Chatoor et al. 1988) in an article on food refusal in five latency-age chil- dren who experienced episodes of choking or severe gagging and refusal to eat any solid food following this traumatic event. If left untreated, this condition can impair physical and emo- tional development of the child (Chatoor 1991), but the treatment of this condition has not been well studied. Operational diagnostic criteria in posttraumatic food disorder (PTFD) of infancy and early childhood are: (1) The infant dem- onstrates food refusal after a traumatic event or repeated traumatic events to the oropharynx or esophagus (e.g., choking, severe gagging, vomiting, reflux, insertion of nasogastric or en- dotracheal tubes, suctioning, force-feeding); (2) the event (or events) triggered intense distress in the infant; (3) the infant experiences distress when anticipating feedings (e.g., when posi- tioned for feeding, when shown the bottle or feeding utensils, and/or when approached with food); (4) the infant resists feedings and becomes increasingly distressed when force- 1 Department of Child and Adolescent Psychiatry, Cukurova University, Adana, Turkey 01330. 2 Department of Child Psychiatry, Western Psychiatric Institute and Clinic, Pennsylvania, Pittsburgh, Pennsylvania.