title: Eating disorders in children and adolescents: state of the art review.
abstract: Despite their high prevalence, associated morbidity and mortality, and available treatment options, eating disorders (EDs) continue to be underdiagnosed by pediatric professionals. Many adolescents go untreated, do not recover, or reach only partial recovery. Higher rates of EDs are seen now in younger children, boys, and minority groups; EDs are increasingly recognized in patients with previous histories of obesity. Medical complications are common in both full and subthreshold EDs and affect every organ system. No single cause of EDs has emerged, although neurobiological and genetic predispositions are emerging as important. Recent treatment paradigms acknowledge that they are not caused by families or chosen by patients. EDs present differently in pediatric populations, and providers should have a high index of suspicion using new Diagnostic and Statistical Manual, 5th edition diagnostic criteria because early intervention can affect prognosis. Outpatient family-based treatment focused on weight restoration, reducing blame, and empowering caregivers has emerged as particularly effective; cognitive behavioral therapy, individual therapy, and higher levels of care may also be appropriate. Pharmacotherapy is useful in specific contexts. Full weight restoration is critical, often involves high-calorie diets, and must allow for continued growth and development; weight maintenance is typically inappropriate in pediatric populations. Physical, nutritional, behavioral, and psychological health are all metrics of a full recovery, and pediatric EDs have a good prognosis with appropriate care. ED prevention efforts should work toward aligning with families and understanding the impact of antiobesity efforts. Primary care providers can be key players in treatment success.
authors.affiliation: The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Kenisha
authors.initials: K
authors.lastname: Campbell
authors.affiliation: The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania peeblesr@email.chop.edu.
authors.forename: Rebecka
authors.initials: R
authors.lastname: Peebles
mesh_terms: D000293:Adolescent; D001835:Body Weight / Q000502:physiology*; D002648:Child; D003937:Diagnosis, Differential; D001068:Feeding and Eating Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male
keywords: anorexia nervosa; bulimia nervosa; eating disorders; family-based treatment