Home Esophageal Self-Dilatation in Children

Home esophageal self-dilatation permits greater independence and more frequent treatments than intermittent hospital procedures for patients with esophageal strictures. The article describes an innovative program for teaching esophageal self-dilatation to preadolescent children, using a form of creative visualization. The child focuses on a 2-minute mental image (e.g., video game, a popular song, or swimming a race) from his/her own experience while passing a Maloney bougie. A nasal breathing technique is used, and active encouragement is provided. Topical lidocaine and oral diazepam can be used initially to assist relaxation and are stopped when the child gains confidence with the technique. The authors taught esophageal self-dilatation to three children aged 12 to 13 years with esophageal strictures. All three learned the technique within 1 week and continued it at home for between 4 and 6 months. Two of the children were taught in hospital by a nurse, and the third was taught as an outpatient by a peer who had already mastered the technique. Home esophageal self-dilatation can be successfully taught to children in the preadolescent age group. The teaching program is simple and effective and can be easily applied to other tasks such as pain control, nasogastric tube feeding, and self-injection.