Watching out for eating disorders in kids and teens

For many children, eating is merely a way to power the body for all of the activities of life. However, for other children, eating can be a disordered habit than can lead to significant negative health outcomes if left untreated. In his presentation “Identifying and treating disorders in children and adolescents,” Neville H. Golden, MD, chief of the division of adolescent medicine at Lucile Packard Children’s Hospital in Palo Alto, California, shared some guidance with attendees of the virtual 2020 American Academy of Pediatrics National Conference & Exhibition. Initially, he spoke about the shifting epidemiology of eating disorders, sharing that it was becoming more prevalent in younger children, males, and minorities. He also spoke about the sex differences that are noted in eating disorder prevalence, stating that the 9:1 ratio of girls to boys only seems to apply to teenagers and young adults. In children aged 9 to 10, the ratio is 1:1.

Golden then discussed the eating disorders that pediatricians may find in patients. He covered the 2 most well-known: anorexia nervosa and bulimia nervosa. Anorexia is characterized by an intense fear of gaining weight and restricting energy intake and bulimia is characterized by recurrent binge eating and recurrent inappropriate compensatory behavior to mitigate the binge eating. However, those eating disorders made up 48.7% of eating disorders. Other disordered eating included avoidant restrictive food intake disorder, which has no fear of weight gain or body image distortion, but is characterized by avoiding foods for sensory reasons and worry about choking or vomiting.

The medical complications related to eating disorders are myriad and can include:

• Fluid and electrolytes – includes dehydration, hypokalemia, hyponatremia, etc.
• Cardiovascular – bradycardia, dysrhythmias, pericardial effusion, etc.
• Gastrointestinal – parotid hypertrophy, loss of dental enamel, delayed gastric emptying, etc.
• Endocrine – reduced bone mineral density, growth retardation, hypogonadism, etc.
• Neurologic – seizures, structural brain changes, delirium

He also discussed when hospitalization for eating disorders would be indicated. Patients should be hospitalized if there is failure of outpatient treatment; physiologic instability; severe malnutrition; dehydration or electrolyte abnormalities; and electrocardiogram abnormalities. When working on weight restoration in hospitalized patients, clinicians need to be vigilant for refeeding syndrome, which can occur during aggressive nutritional restoration. Recent studies have found that higher caloric intake than recommended by some guidelines can reduce the length of stay, without increasing the rate of refeeding syndrome.

The presentation concluded with a discussion on managing obesity and being careful to avoid messaging that could trigger an eating disorder. When counseling patients on obesity, clinicians should not encourage dieting, skipping meals, or using diet pills. The focus of the counseling should be on healthy habits that can be sustained for a lifetime and should encourage frequent family meals. Clinicians should also closely monitor weight loss in patients who need to lose weight to ensure that the patient does not develop an eating disorder. Patients who aren’t properly monitored could develop anorexia nervosa, which would not present the same way as the stereotypical case.