Medical instability and growth of children and adolescents with early onset eating disorders.
OBJECTIVE
Little is known about the physical burden of early onset eating disorders (EOEDs). Most published data on physical instability and growth in malnutrition come from specialist centres, or from the developing world where aetiology differs. The authors present data on physical status at presentation from population-based surveillance systems in the UK and Ireland.


METHODS
Prospective surveillance study.


METHODS
All suspected cases of EOED in children under 13 years of age reported by paediatricians and psychiatrists via the British Paediatric Surveillance System (BPSU) and Child and Adolescent Psychiatric Surveillance System (CAPSS) in the UK and Ireland from March 2005 to May 2006 (15 months).


RESULTS
208 cases were identified (24% reported by paediatricians). Median age was 11.8 years (IQR 1.74). 171 (82%) were female (78% premenarcheal and 60% prepubertal). 74% of males were prepubertal. 35% of cases had medical instability at presentation (60% bradycardia, 54% hypotension, 34% dehydration, 26% hypothermia). 52% of cases required admission at diagnosis (73% to a paediatric ward). 41% of cases with medical instability were not underweight, that is, they had body mass index (BMI) z-scores above -2.0 (2nd centile). Sensitivities for identifying medical instability with BMI z-score <-3 or 70% median BMI were 31% and 15%, respectively. Menarcheal status did not predict risk of medical instability.


CONCLUSIONS
EOEDs present with severe levels of physical instability and frequently to paediatricians. As anthropological indices alone are poor markers for medical instability, clinical assessment is essential. Doctors providing care for children have a central role in both the recognition and management of EOEDs.
UCL Institute of Child Health, General and Adolescent Paediatrics, University College London, 30 Guilford Street, London, UK. l.hudson@ucl.ac.uk
Lee D
LD
Hudson
Dasha E
DE
Nicholls
Richard M
RM
Lynn
Russell M
RM
Viner
D000293:Adolescent; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D001919:Bradycardia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D017281:Cost of Illness; D003681:Dehydration / Q000453:epidemiology; D001068:Feeding and Eating Disorders / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006128:Growth / Q000502:physiology*; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D007035:Hypothermia / Q000453:epidemiology; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008572:Menarche / Q000502:physiology; D011446:Prospective Studies; D006113:United Kingdom / Q000453:epidemiology