AAP Urges Docs to Screen Kids for Eating Disorders

Hospitalizations for eating disorders in children under 12 years of age increased by 119% from 1999 to 2006, according to a clinical report published in Pediatrics, which estimates that 0.5% of adolescent girls in the US have anorexia nervosa, and 1-2% meet criteria for bulimia nervosa.

The report, written by David S. Rosen, MD, MPH, of the American Academy of Pediatrics’ Committee on Adolescence, states that it is “essential for pediatricians to consider these disorders in appropriate clinical settings, to evaluate patients suspected of having these disorders, and to manage (or refer) patients in whom eating disorders are diagnosed.”

Clinicians need to be familiar with early detection and proper evaluation of patients suspected of having a disorder, states the report, which finds that males now represent up to 10% of all cases of eating disorders, as well as in children of younger ages. Because medical complications of eating disorders can affect any organ system, pediatricians and other physicians need to monitor patients for medical or nutritional problems, and ensure appropriate treatment options including medical care, mental health treatment, and nutritional intervention.

The report outlined the following guidelines for pediatricians:

1. Pediatricians need to be knowledgeable about the risk factors and early signs and symptoms of disordered eating and eating disorders.
2. When counseling families on preventing obesity, pediatricians should focus on healthy eating and building self-esteem while still addressing weight concerns. Care needs to be taken not to inadvertently enable excessive dieting, compulsive exercise, or other potentially unhealthy weight management strategies.
3. Pediatricians should be encouraged to calculate and plot weight, height, and BMI by using age- and gender-appropriate charts and assess menstrual status in girls at annual health supervision visits.
4. Pediatricians should screen patients for disordered eating and related behaviors and be prepared to intervene when necessary.
5. Pediatricians should monitor or refer patients with eating disorders for medical and nutritional complications.
6. Pediatricians need to be familiar with treatment resources in their communities so that they can coordinate or facilitate multidisciplinary care.
7. Pediatricians can play a role in primary prevention during office visits and through school-based and community interventions with a focus on education, early screening, and advocacy.
8. Pediatricians are encouraged to advocate for legislation and policy changes that ensure appropriate services for patients with eating disorders, including medical care, nutritional intervention, mental health treatment, and care coordination, in settings that are appropriate for the severity of the illness.

Finally, the clinical report stated that “efforts to prevent eating disorders can take place both in practice and community settings,” and urged primary care pediatricians to “help families and children learn to apply the principles of proper nutrition and physical activity and to avoid an unhealthy emphasis on weight and dieting.” Pediatricians are also encouraged to screen to detect the early onset of disordered eating and to avoid seemingly innocuous statements such as “you could stand to lose a little weight” that are sometimes reported by patients to have triggered the onset of their eating disorder.

To view the report—“Identification and Management of Eating Disorders in Children and Adolescents”—click here.

Do pediatricians have the tools and knowledge required to screen children for eating disorders and treat the condition? What are the most significant challenges that exist in treating these patients?