Your child also does not have to meet the criteria for a disorder to benefit from intervention.
Early warning signs of eating disorders may include:
- fear of stomach aches
- aversion to tastes or textures
- excessive bowel movements
- worry about body image
Signs of a more developed eating disorder can include:
- refraining from eating
- reducing food portions
- weight loss
- lack of growth
- thinning of hair
- delay of puberty
- constipation or digestion problems
- hiding or hoarding food
- mood swings
- fine hair growth on the body
AAP Policy Statement: Identifying and Treating Eating Disorders, Vol III, No 1, January 2003
This is the current release of the guideline.
American Academy of Pediatrics (AAP) Policies are reviewed every three years by the authoring body, at which time a recommendation is made that the policy be retired, revised, or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation, or retires a statement, the current policy remains in effect.
For information on screening for eating disorders, please see the AAP Policy Statement.
AAP Policy Statement contains screening questions and possible findings on physical examination in children and adolescents with eating disorders
Screening for adolescents 12-17:
The American Academy of Pediatric Physicians recommends use of the SCOFF questionnaire for this population.
A two-question comprehensive tool that also addresses binge eating disorder and other disordered eating is the ODES-Y.
The medical workup includes a measurement of height and weight (and a calculation of percentile of ideal body weight) and a thorough medical workup including comprehensive metabolic profile, phosphorus, TSH, amylase, a complete blood count, urine toxicology screen, and an EKG. Medical consequences of restriction affect multiple organ systems including: 1) bones (causing osteopenia and osteoporosis); 2) cardiac (bradycardia, hypotension, MVP, CHF (during refeeding) and arrhythmias); 3) brain (low serotonin); 4) skin (dry skin, edema, lanugo); 5) GI (constipation, delayed gastric emptying); 6) hematology (pancytopenia); and 7) endocrine (sick euthyroid syndrome, hypoglycemia, low LH, FSH, estrogen and testosterone). Medical consequences of purging also affect multiple organ systems: cardiac (arrhythmias, bradycardia, orthostasis); dental (caries and enamel loss); GI (tears, gastritis/tears, GERD); lab abnormalities (low potassium, elevated bicarbonate, elevated amylase); or enlarged parotid/salivary glands.
The psychological assessment includes screening for frequent comorbid psychiatric issues (such as depression, anxiety, trauma, and suicidality) and the impact of the eating disorder on functioning at home and school.
Patients with AN or BN must be triaged for the danger zone of low body weight (mortality increases when weight is below 65 percent of ideal body weight), low blood pressure or bradycardia, low potassium, phosphorus or magnesium, prolonged QTC, refeeding, or suicidality. Death from eating disorders is most frequently due to cardiac complications, although a significant number of patients also die by suicide.
Patients who are medically unstable need emergency room treatment or hospitalization. Patients who are acutely suicidal need psychiatric hospitalization.
Patients with AN can be treated at several levels of care. For outpatient treatment, close collaboration is advised between the therapist and primary care physician. If available, a registered dietician, family therapist, and psychiatrist may also be helpful members of a treatment team. It is also important to have an outpatient contract, i.e., a clear agreement to gain weight and a plan to hospitalize if the patient cannot progress in a timely fashion as an outpatient. Weight restoration, the mainstay of treatment, is targeted at 0.5 to 1 pounds a week outpatient to 3-4 pounds a week in the hospital.
Children and adolescents may benefit from Maudsley family therapy, an outpatient treatment approach based on family intervention that avoids hospitalization. In the Maudsley approach, parents are initially very involved in weight restoration. As weight is restored and eating normalized, autonomy over eating is transferred back to the patient, and adolescent issues are addressed.
Many patients benefit from more intensive treatment with inpatient, residential, or partial hospitalization to regain to a healthy weight range, treat the psychological characteristics of their eating disorder and comorbid psychiatric disorders, target family issues, and help a patient get back on their developmental trajectory. There are no psychiatric medications that are recommended for weight restoration or maintenance for patients with AN. On the other hand it is important to avoid medications with potentially deleterious side effects of prolonged QTC, hypotension, appetite suppression, nausea, weight loss or gain.
The treatment of choice for BN is outpatient cognitive behavior therapy with an experienced therapist. Fluoxetine at 60 mg has been shown to be helpful to reduce binge/purge frequently at least in the short term. Other pharmacologic strategies have been utilized as well. Patients who are unable to stabilize with outpatient care, who have serious psychiatric comorbidities, or who are at medical risk may benefit from residential or partial hospitalization.
Parent Information and Handouts
- National Association of Anorexia Nervosa and Associated Disorders
Contains general information about eating disorders and includes a directory of providers
- AACAP Facts for Families - Teenagers with Eating Disorders
Book for Family: Helping your Teenager Beat an Eating Disorder, by James Lock and Daniel Legrange, 2005