New guidance on identifying and managing eating disorders in children and adolescents

28 Feb 2021

Eating disorders (EDs) are psychiatric illnesses that influence the physical and psychological development of children and adolescents.1 As one of the current global health issues, EDs were once aggregated among Caucasian adolescents in Western countries and now increasingly prevalent across Asia’s highincome populations since the late 20th century.2 Despite the increasing concern on EDs, guidelines for the care of pediatric and adolescent patients as well as resources for the treatment of EDs have remained inadequate.1 Recently, the American Academy of Pediatrics (AAP) Committee on Adolescence has issued a clinical report in January 2021, reviewing the diagnostic and treatment strategies of EDs in children and adolescents with the aim to provide substantial guidance for pediatricians in managing the diseases.1

According to Hong Kong Eating Disorders Association Limited (HEDA), around 35% of the identified ED cases from 2018 to 2019 were among children and adolescents between 11 to 20 years of age.3 Consequently, pediatricians are in a unique position to identify EDs early and interrupt their progressions.1 Aimed to provide thorough background information, the newly published AAP report not only outlined the latest diagnostic criteria of EDs from the “Diagnostic and Statistical Manual of Mental Disorders”, Fifth Edition (DSM-5), but also reviewed the prevalence of EDs to identify populations at high risk.1 Screening methods and assessment criteria were also discussed in detail, and example interview questions to assess suspected ED patients, notable physical examination features, signs and symptoms, and selected medical complications related to the diseases were listed for reference.1

The later part of the report focused on treatment principles, financial considerations and the prognosis of EDs.1 The role of pediatricians was highlighted in the care of pediatric and adolescent patients with EDs, followed by discussion of various approaches such as collaborative outpatient care, family-based treatment and pharmacotherapy in treating anorexia nervosa, bulimia nervosa, binge-eating disorder and avoidant/restrictive food intake disorder.1 With the introduction of treatment-related financial considerations and prognosis, the report offered a direction for pediatricians to develop treatment plans that suit individual patient needs.1

Finally, the report encouraged pediatricians to actively engage in the prevention and advocacy of EDs in the patient care setting.1 Other AAP clinical reports, in particular the “Preventing Obesity and Eating Disorders in Adolescents”, were recommended for detailed preventive steps including the facilitation of preventive measures with the cooperation from teachers, coaches and athletic trainers.1 Pediatricians were also advised to advocate and support health care reform efforts for improved access to quality treatment services by preadult ED patients.1

Although specialized treatment plans and official statistics on the prevalence of EDs are not yet available in Hong Kong, a specific clinic under the Department of Psychiatry in Queen Mary Hospital was allocated to provide psychiatric services for inpatients, outpatients and day-patients aged under 18 years diagnosed with ED.4,5 Local pediatricians are hence encouraged to recognize potential patients with EDs early by following the screening instructions in this new guideline, to ensure timely referral to the specialized ED clinic with prompt care to the juvenile sufferers.1

Overall, it is believed that with the assistance of this newly published clinical report, local pediatricians, in collaboration with psychiatrists, can acquire adequate guidance on developing the screening strategies as well as management programs for children and adolescents afflicted by EDs.

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