Eating disorders exist in children of all ages, but recent research suggests that different symptoms should be looked for in children age 12 and under than in older children.
Researchers compared data of children up to age 18 who visited the emergency room for eating disorders over a 20 year period. They looked at the children’s behavior, understanding of eating disorders and physical and medical information.
This research showed that eating disorders in children were much more common in girls, but more likely in boys under age 12 than over age 12.
Eating disorders in children did not involve binging or purging. Teens over age 12 were more likely to use pills, purging and binging to control their weight.
This research was conducted by a team led by David A. Forbes, MBBS, FRACP, from Eating Disorders Program at Princess Margaret Hospital for Children and School of Paediatrics and Child Health at The University of Western Australia in Perth, Australia.
The data for this study was gathered from a larger project called Helping to Outline Paediatric Eating Disorders (HOPE). The HOPE project gathers information on children and adolescents with eating disorders.
A medical assessment and interviews were used to make the diagnosis of an eating disorder. A diagnosis of eating disorder was determined by meeting criteria for a psychiatric illness of eating disorder.
Both the patients and the parents gave interviews.
The patients reported on their attitudes about their weight and shape, their understanding of eating disorders and their eating habits and behaviors. This involved questions on laxative and diet pill use, binging, purging and exercising.
Doctors examined physical features like body weight, body temperature, blood pressure and heart rate. They also compared the patients' body weight when they came to the emergency room with other weight measurements taken earlier in their life to determine amount of weight loss and how fast it was lost.
The researchers compared the interview information given by both the patients and the parents and used both sets of information in their research.
Children were defined as those who were under 13 years old and adolescents were under age 18. The study involved 656 patients with eating disorders — 104 children and 552 adolescents.
Bulimia is an eating disorder involving overeating/binging, then using some method to purge or remove the food that was eaten from the body. It often involves vomiting, but can also include excessive laxative use.
Over 82 percent of the children with eating disorders were girls and over 95 percent of the adolescents were girls. Among all the patients in this study, the researchers were more likely to find an eating disorder in a boy 12 and under than in a boy over 12.
Children were less likely to be concerned about their body weight or shape and showed less understanding about eating disorders than adolescents. Restraining from eating was the main symptom of eating disorders in children under 13.
The results showed that bulimia was much more common in adolescents. Bulimia was found in 10.3 percent of the adolescents with eating disorders, compared to only 1.9 percent of the children.
Adolescents had lost an average of 20.4 percent of their body weight and children had lost 17 percent. Children had lost weight at a rate of 4.1 pounds per months, whereas adolescents in the study lost at the rate of 3.2 pounds per month.
Adolescents had had their eating disorders for about nine months, and children had had theirs for about seven months.
Medications had been used to treat psychiatric illnesses in 19.5 percent of the patients over age 12, whereas only 8.8 percent of the children had been treated with psychiatric medications.
Physical comparisons of blood pressure, heart rate, body temperature and body mass were not different between the children and the adolescents with eating disorders.
Forbes and his team concluded that children who are evaluated by healthcare professionals for eating disorders should not have the same standards applied to them as for adolescents. Children with eating disorders may not have the same symptoms, such as bulemia or the seriousness of symptoms, such as percent body weight lost with their disorder. Children may not recognize their eating disorder enough to be able to discuss it with a doctor.
The authors stated that a limitation of their study was that when the eating disorder interview technique was used in young children, they did not always give consistent responses to similar questions.
This study was published in the January issue of the International Journal of Eating Disorders.
The researchers did not disclose any conflicts of interest.