A subcommittee for the American Aca...

A subcommittee for the American Academy of Pediatrics (AAP) has released a statement forward identifying and evaluating eating disorders; outpatient, hospital, and day-program treatment options; and prevention and advocacy suggestions. The report was published in the January 2003 issue of Pediatrics.

The increasing incidence and prevalence of eating disorders in children and adolescents have made it increasingly important for physicians to be aware of and be able to treat these puzzles Early detection, initial evaluation, and ongoing management can play a significant character in preventing the illness from progressing to a more strict or chronic state.

Identification and Evaluation

Screening for eating disorders should be part of routine annual health care, including ongoing monitoring of weight and height and looking for signs and symptoms of an incipient eating disorder. If eating disorders are find outed early, it may prevent any physical or psychologic conclusions of malnutrition that could cause the illness to progres Failure to diagnose an eating disorder early can ensue in an increase in severity of the illness, which can make the disorder more difficult to treat. Table 1 lists useful questions for gathering a history upon eating disorders.

Initial evaluation of a child or adolescent with a suspected eating disorder should include establishing a diagnosis; determining the severity of illness, including an evaluation of medical and nutritional status; and performing a psychosocial evaluation. According to the AAP, more than individual half of children and adolescents with eating disorders do not abundantly meet all Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) criteria for anorexia or bulimia nervosa, on the other hand still experience the same medical and psychologic deductions of these illnesses. These patients require the same attention and care as those who encounter all the criteria.

To establish a baseline for severity in a patient with an eating disorder, the physician should determine total weight los and weight status (i.e., percent below ideal dead body weight and body mass index) and the symbols and frequency of purging behaviors (eg vomiting, laxatives, starvation). standard results will be normal in most numerous patients with eating disorders, if it were not that normal results do not bar serious illness or medical instability. The psychosocial assessment should include an evaluation of the patient's standing of obsession with food and weight, understanding of the diagnosis, and willingness to receive help; to what degree the patient is functioning at hearth in school, and with friends; and if the patient has any other psychiatric diagnoses, like as depression, anxiety, or obsessive compulsive disorder. These diagnoses may be comorbid or a cause or consecution of the eating disorder. History of physical or sexual abuse, or violence and suicidal ideation also should be assessed. The parents' reaction to the illness should be evaluated because denial of the question or differences in how to approach treatment and recruiting may exacerbate the illness.

Outpatient Treatment

Treatment should be individualized, and goal weights should be based onward age, height, stage of puberty, premorbid weight, and previous sprouting charts. For a growing child or adolescent, goal weight should be reevaluated at three- to six-month intervals upon the basis of changing age and height. In general, medical stabilization and nutritional rehabilitation are the greatest in quantity crucial determinants of short- and intermediate-term issues Individual and family therapy, especially when working with younger patients, are crucial to the long-term prognosis.

Physicians should be aware of several complications that can come to one's mind in outpatient settings. Although in the greatest degree patients do not have abnormal electrolyte of the same heights there is a possibility of hypokalemia, hypochloremic alkalosis resulting from purging behaviors, and hyponatremia or hypernatremia resulting from drinking too a great deal or too little fluid as part of weight manipulation. Endocrine disorders, including hypothyroidism, hypercortisolism, and hypogonadotropic hypogonadism, are public With amenorrhea, there is a long-term complication of osteopenia and ultimately osteoporosis. Gastrointestinal distress and constipation are universal and may require symptomatic relief.

Hospital and Day-Program Treatment

Children and adolescents have the best prognosis if the disease is treated rapidly and aggressively. Hospitalization allows for adequate weight gain, medical stability, and establishment of safe and healthy eating habits, which improves the prognosis. These patients are usually more malnourished than outpatients. Nutrition may ne to be provided via nasogastric tube or intravenously, and more strict complications may need to be treated (Table 2) In rigidly malnourished patients, physicians should avoid replenishing nutrients too quickly, which can cause refeeding syndrome dead refeeding, with possible phosphorus supplementation can help interrupt this problem.

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group