title: Childhood eating disorders: British national surveillance study.
abstract: BACKGROUND
  The incidence of eating disorders appears stable overall, but may be increasing in younger age groups. Data on incidence, clinical features and outcome of early-onset eating disorders are sparse.
  
  
  OBJECTIVE
  To identify new cases of early-onset eating disorders (<13 years) presenting to secondary care over 1 year and to describe clinical features, management and 1-year outcomes.
  
  
  METHODS
  Surveillance over 14 months through the established British Paediatric Surveillance System, and a novel child and adolescent psychiatry surveillance system set up for this purpose.
  
  
  RESULTS
  Overall incidence was 3.01/100,000 (208 individuals). In total, 37% met criteria for anorexia nervosa; 1.4% for bulimia nervosa; and 43% for eating disorder not otherwise specified. Nineteen per cent showed determined food avoidance and underweight without weight/shape concerns. Rates of comorbidity were 41%; family history of psychiatric disorder 44%; and early feeding difficulties 21%. Time to presentation was >8 months. A total of 50% were admitted to hospital, typically soon after diagnosis. Outcome data were available for 76% of individuals. At 1 year, 73% were reported improved, 6% worse and 10% unchanged (11% unknown). Most were still in treatment, and seven were hospital in-patients for most of the year.
  
  
  CONCLUSIONS
  Childhood eating disorders represent a significant clinical burden to paediatric and mental health services. Efforts to improve early detection are needed. These data provide a baseline to monitor changing trends in incidence.
authors.affiliation: Department of Child & Adolescent Mental Health, Great Ormond Street Hospital for Children NHS Trust, London, WC1N 3JH, UK. D.Nicholls@ich.ucl.ac.uk
authors.forename: Dasha E
authors.initials: DE
authors.lastname: Nicholls
authors.forename: Richard
authors.initials: R
authors.lastname: Lynn
authors.forename: Russell M
authors.initials: RM
authors.lastname: Viner
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001835:Body Weight / Q000502:physiology; D002648:Child; D015897:Comorbidity; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D008297:Male; D011159:Population Surveillance; D011627:Puberty / Q000502:physiology; D006113:United Kingdom / Q000453:epidemiology