Clinical Report—Identification and Management of Eating Disorders in Children and Adolescents

The incidence and prevalence of eating disorders in children and adolescents has increased significantly in recent decades, making it 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. This clinical report includes a discussion of diagnostic criteria and outlines the initial evaluation of the patient with disordered eating. Medical complications of eating disordersmay affect any organ system, and careful monitoring for these complications is required. The range of treatment options, including pharmacotherapy, is described in this report. Pediatricians are encouraged to advocate for legislation and policies that ensure appropriate services for patients with eating disorders, including medical care, nutritional intervention, mental health treatment, and care coordination. Pediatrics 2010;126: 1240–1253 INTRODUCTION Increases in the incidence and prevalence of anorexia nervosa (AN), bulimia nervosa (BN), and other eating disorders in children and adolescentsmake it critically important that pediatricians be familiar with early detection and appropriate management of these disorders. Results of epidemiologic studies have indicated that the numbers of children and adolescents with eating disorders increased steadily from the 1950s onward.1–4 During the past decade, the prevalence of obesity in children and adolescents has also increased dramatically,5–9 accompanied by further emphasis on dieting and weight loss among children and adolescents.10–15 The epidemiology of eating disorders has gradually changed; there is an increasing prevalence of eating disorders inmales16–19 andminority populations in the United States20–23 as well as in countries in which eating disorders had not been commonly seen.3,4,24,25 Of particular concern is the increasing prevalence of eating disorders at progressively younger ages.19,26,27 A recent analysis by the Agency for Healthcare Research and Quality revealed that from 1999 to 2006, hospitalizations for eating disorders increased most sharply—119%—for children younger than 12 years.19 It is estimated that approximately 0.5% of adolescent girls in the United States have AN, that approximately 1% to 2% meet diagnostic criteria for BN, and that up to 5% to 10% of all cases of eating disorders occur in males. A large number of people with eating disorders do not meet the strict criteria set forth in the American Psychiatric Association’s David S. Rosen, MD, MPH and THE COMMITTEE ON ADOLESCENCE