All eating disorders are different, presenting their own range of challenges to a treating clinician. Pediatric eating disorders present even more challenges, as children and adolescents are still developing both physically and mentally. Additionally, the family of a pediatric patient typically plays a large role in the recovery process.
Pediatric Eating Disorders
A 2010 clinical report  by David Rosen, M.D., M.P.H., of the American Academy of Pediatrics reports that approximately 0.5 percent of adolescent females fit the diagnostic criteria for anorexia nervosa, while 1 to 2 percent fit the criteria for bulimia nervosa. He notes that males make up as much as 5 to 10 percent of the total population with eating disorders, a reality that is slowly gaining recognition.
Though there are many biological, psychological, and social factors that contribute to the development of eating disorders in children, adolescents, and adults, there has been a recent emphasis on diet and exercise for children in light of the obesity epidemic within the United States.
As Dr. Rosen explains, “During the past decade, the prevalence of obesity in children and adolescents has… increased dramatically, accompanied by further emphasis on dieting and weight loss among children and adolescents.”
The movement to keep children healthy and fit is well-intentioned, but some argue that the approach being taken is setting children up for a distorted perception of healthy eating and exercise patterns. Demonizing foods most children enjoy, such as macaroni and cheese or candy, instead of teaching proper portions and moderation, might be backfiring in the form of increased rates of eating disorders and childhood obesity.
Differences in Treatment Modalities
There is little research on eating disorder treatments specific to the pediatric eating disorder population. However, some modalities have been tested and proven beneficial. A 2010 article  by James Lock, M.D., Ph.D., of Stanford University School of Medicine explains that including family members in treatment for children with eating disorders can be highly effective.
The only family-based therapy that has been clinically tested for pediatric anorexia nervosa was developed by researchers at the Institute of Psychiatry in London and is “…based on the idea that families make accommodations in feeding their child that initially appear useful in combating [anorexia], but these ultimately become maladaptive, disrupting both the development of the adolescent with [anorexia], and perpetuating the behaviors that maintain the disorder. Treatment aims to identify and help the family modify these accommodations.”
Nutritional therapy for children and adolescents can be controversial in the context of eating disorder recovery. Some believe that, as with adults with eating disorders, nutritional therapy is essential for long-term recovery.
Understanding what the body needs and how to fulfill these needs through nutrition can lay the foundation for a healthy relationship with food and exercise.
However, in some cases, this can increase the pediatric patient’s obsession with food rules and guidelines, thereby increasing disordered behaviors.
The use of prescription medication to manage eating disorder symptoms or those of co-occurring conditions also becomes more challenging when dealing with children and adolescents. For example, fluoxetine (Prozac) has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of bulimia nervosa.
However, this is an antidepressant that carries a black box warning for the potential to increase suicidal ideation and actions in children and teens.
Clinicians treating pediatric eating disorder patients are encouraged to be aware of these issues when treating younger populations. Implementing certain modalities and prescribing medication can be done with this awareness and caution to ensure that the most effective treatment is conducted with the least possible harm to the patient.
The Need for More Research
Many eating disorders in children and adolescents go undiagnosed. A 2012 survey of clinicians in Ontario, Canada, found that “…a large proportion of clinicians do not routinely screen for eating disorders, and when eating disorders are assessed and treatment is initiated, family members are not routinely involved in the process.”
Dr. Lock calls for further action in the field, stating, “Although funding for eating disorder research is a stated priority of the U.S. National Institute of Health, few studies focus on children and adolescents…”
Despite this, some groups are taking measures to work toward prevention and improved treatment of pediatric eating disorders. For example, the National Eating Disorders Association (NEDA) recently introduced the Educating to Prevent Eating Disorders Act of 2015 (H.R. 4153) which, if it passes, will launch a nationwide pilot program for early screenings of eating disorders in schools.
Knowing more about pediatric eating disorders, conducting screenings in youth, and providing effective treatment modalities can benefit children and adolescents struggling with eating disorders while arming clinicians with the tools they need to properly treat this population.
About the Author: Courtney Howard is a Certified Life Coach specializing in eating disorders through Lionheart Eating Disorder Recovery Coaching. As a content writer at the Sovereign Health Group, while writing freelance through Eating Disorder Hope, Courtney is a passionate advocate for recovery and works to fight the stigma surrounding all mental health disorders. She graduated summa cum laude with a Bachelor of Arts (B.A.) from San Diego State University, holds a paralegal certificate in Family Law and is a Certified Domestic Violence Advocate.
References: Rosen, D. (2010). Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics: Official Journal of the American Academy of Pediatrics, 1240.
: Lock, J. (2010). Treatment of Adolescent Eating Disorders: Progress and Challenges. Minerva Psichiatrica, 51(3), 207–216.
: Robinson, A. L., Boachie, A., & Lafrance, G. A. (2012). Assessment and Treatment of Pediatric Eating Disorders: A Survey of Physicians and Psychologists. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 21(1), 45–52.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Reviewed By: Jacquelyn Ekern, MS, LPC on May 7, 2017
Published on EatingDisorderHope.com