As children grow, their sense of who they are is often influenced by their self-esteem and their acceptance of their body, particularly as it develops and changes. It is fair to say that most people express some dissatisfaction with their body shape or size. However, for many children and adolescents, this develops into a more serious disorder, often baffling the parents who were unaware of the insidious onset of the symptoms. Initially, children or adolescents may receive praise for their weight loss, only for their family to learn that it was the beginning of the eating disorder. The pediatrician is in an ideal role to identify these concerns. Of note, is that overweight or obese youth are encouraged to diet to lose weight. This needs to be done with great tact and skill in order to minimize the risk that the child or adolescent allow this to develop into a serious problem.

Eating disorders are highly prevalent, devastating illnesses that impact both the individual sufferer and those closest to him or her. There is clear evidence that children at increasingly younger ages are expressing concerns about their weight and participating in dieting behaviors. For example, the hospitalization rate for children under 12 years of age has doubled in the past twenty years. Eating Disorders, including Anorexia Nervosa, are associated with serious medical complications and a significant death rate. Eating Disorders have a peak age of onset in adolescence, just at a time in psychological development that leads to greater independence in adulthood.

Family-based approaches to the treatment of eating disorders represent important, empirically supported options for addressing the needs of adolescents with Anorexia Nervosa. Family-based weight restoration treatment for Anorexia Nervosa, in particular, has mounting evidence to support its use with children and adolescents. Family-based treatments encourage participation of the wider family network to support re-nourishment, establish independence around food and weight management, and encourage appropriate developmental gains.

Given that most adolescents remain embedded within a family structure and are dependent upon their parents, it is reasonable to expect that family involvement is viewed by many as a critical component of successful treatment of adolescent eating disorders.

Tips for the Pediatrician

1. Be on the lookout for risk factors for the development of an eating disorder: family history of obesity, family history of anorexia nervosa; dieting behaviors and attitudes in the family; sexual abuse, obsessive compulsive disorder, trauma.
2. Assess protective factors: supportive family, engagement in academics and after school activities
3. If you suspect an eating disorder, ask to see the child or adolescent more often; monitor vital signs (looking for bradycardia); laboratory work (looking for hypokalemia);
4. Refer for a nutrition consultation
5. Request a psychiatric consultation to assess for co-occurring depression, anxiety or substance abuse.
6. Recognize the signs or symptoms that may warrant a higher level of care; when to admit to the hospital medically (bradycardia, hypotension, rapid weight loss, failure to restore weight on an outpatient basis); when to admit to the hospital psychiatrically (suicidal ideation); when to consider a day program (not suicidal or medically fragile, but, not able to restore weight as an outpatient)
7. Project TEACH child and adolescent psychiatrists are available to provide consultation and education on this topic and other mild-to-moderate mental health concerns for children and adolescents, ages 0 to 21.