Daniel J McNeil, Deborah L Preston, Maggie Blackwood, Hillary Porter*
Background: Heightened anxiety often is seen in children with trauma histories and complex healthcare problems, and vomiting is a common anxiety reaction. Fluoxetine has demonstrated clinical safety and efficacy in pediatric patients. However, there are no published case examples of the pharmacological management of anxiety-induced vomiting in young children.
Case presentation: Cases involve two 3-year-old females with multiple health conditions and neglect, presenting with anxiety-induced vomiting. Fluoxetine was prescribed due to the anxiety-related gastrointestinal symptomatology and subsequently reduced vomiting and increased nutritional intake benefiting overall health.
Conclusion: Outcomes of these cases suggest the possible efficacy of fluoxetine even in young children with anxietyrelated symptoms, including vomiting. Four justifications for off-label use of fluoxetine for the anxiety component of vomiting in young patients are described, including multifactorial approaches, evidence-based decision making, safety, and severity. Future directions and guidelines will be discussed.