All in Your Mind? New-Onset Dysphagia in a Previously Healthy Adolescent Child

A healthy 11-year-old male develops fear of choking secondary to progressive dysphagia that began in early childhood. No organic cause is found, and the patient is diagnosed with psychiatric oral aversion. The child is eventually transferred to a psychiatric facility, where a month later he has a possible aspiration event and is transferred to the local emergency room for respiratory distress before being admitted to the intensive care unit. Workup is notable for abnormal findings on brain imaging, and the diagnosis of Alexander's disease is made. This case highlights the importance of complete history-taking and examinations in pediatric patients.