AAP releases Recommendations on management of eating disorders in children
American Academy Of Pediatrics has released a clinical report including a review of common eating disorders diagnosed in children and adolescents, outlines the medical evaluation of patients suspected of having an eating disorder.It presents an overview of treatment strategies, and highlights opportunities for advocacy. The recommendations have been published in the Journal Pediatrics.
Eating disorders are serious, potentially life-threatening illnesses afflicting individuals through the life span, with a particular impact on both the physical and psychological development of children and adolescents. Because care for children and adolescents with eating disorders can be complex and resources for the treatment of eating disorders are often limited, pediatricians may be called on to not only provide medical supervision for their patients with diagnosed eating disorders but also coordinate care and advocate for appropriate services.
Highlighting that an accurate diagnosis of the disorder is an absolute essential before further management of such patients, the article has laid down certain recommendations as follows-
Treatment principles- Because an early response to treatment may be associated with better outcomes, timely referral to a specialized multidisciplinary team is preferred, when available. Normalisisng eating patterns and behaviors so that they establish a healthy relationship with food and their body weight,is the main goal.
Educating young people and their parents about the physiologic and psychological effects of food restriction is an early component of care. Parents are empowered to feed their children regularly (typically 3 meals and 2–3 snacks per day) and adjust portion size and energy richness based on weight progress.
Parent-focused therapy is an adaptation of FBT wherein the therapist supports the parents to renourish the patient and limit weight-control behaviors but, after the initial appointment, meets only with the parents.The patient has brief visits with a nurse or physician for the assessment of weight and acute mental health issues but is not directly involved with a therapist.
Day-treatment programs (day hospitalization and partial hospitalization) provide an intermediate level of care for patients with eating disorders who are medically stable and do not require 24-hour supervision but need more than outpatient care.
Residential treatment typically includes 24 hour per day supervision, medical oversight, group-based psychoeducational therapy, nutritional counseling, individual therapy, and family therapy. The length of stay can be weeks to months, depending on the severity of illness and financial resources. Outcome studies reported by residential programs, generally, reveal improved symptomatology at discharge,but the results at long-term follow-up are mixed.
The most common goal for hospital-based stabilization is nutritional restoration. Nasogastric tube (NGT) feeding may be necessary for some hospitalized adolescents, but opinions vary regarding when they should be initiated.
High-quality studies in which researchers examine the impact of inpatient care are limited, and the best end point for hospital treatment of children and adolescents is unclear.
Pharmacotherapy for AN
Selective serotonin-reuptake inhibitors (SSRIs) have been tried but are not effective in acutely ill, malnourished patients and have not been shown to prevent disease relapse in those who are weight restored. A number of atypical antipsychotic medications have also been studied, including quetiapine, risperidone, and olanzapine. Results have generally revealed little benefit in weight gain or improvement in eating-disorder thinking.Initial studies of augmentation of SSRIs with atypical antipsychotics in adult patients have been promising.
Avoidant/Restrictive Food Intake Disorder (ARFID), oftentimes characterized as "extreme picky eating," is an eating disorder impacting thousands of individuals, particularly children. No medication is specifically indicated for use in ARFID; pharmacotherapy is directed at treating underlying comorbid illness (eg, anxiety) as necessary.
Addressing the role of pediatricians in such scenarios, the article says that "Efforts to prevent eating disorders may occur in clinical practice and community settings. By using sensitive, nonstigmatizing language and demonstrating supportive attitudes toward children and adolescents of all body shapes and sizes, pediatricians create a welcoming clinical setting for discussions about weight and weight-related behaviors."
Simply put, given the lack of resources available to treat and monitor eating disorders in this population, the academy warns that pediatricians could be assuming more of the burden themselves. It further recommends:
Screening for eating disorders during annual visits with the use of age- and sex-appropriate charts.
When a disorder is suspected, performing an evaluation that includes medical as well as psychological aspects.
Referring patients to regional specialists, when available.
Advocating for legislation and policies that support treatment of these disorders.
For full article follow the link: https://doi.org/10.1542/peds.2020-040279