Unique considerations for the medical care of restrictive eating disorders in children and young adolescents

Plain English summaryEating disorders are affecting increasingly younger patients, with ages of onset that now include children and young adolescents. This brings new risk, as children and young adolescents with eating disorders may develop unique medical complications related to the energy needs for the growth that should occur during this developmental stage. Inadequate energy intake during eating disorders in children and young adolescents can have long-term consequences including negative impacts on final height and bone and brain health. Children and young adolescents with eating disorders may present to care with acute concerns that require medical hospitalization and significant support to begin feeding again safely. Providers caring for children and young adolescents with eating disorders should be familiar with these unique complications and understand critical factors in the initial assessment, medical stabilization, and nutritional rehabilitation of children. The clock is ticking, and the goal of care of children and young adolescents with restrictive eating disorders should be to safely restore normal growth and puberty as quickly as possible. BackgroundThe medical complications of eating disorders are often approached through an age-neutral lens. However, children and young adolescents may have unique medical complications related to the energy needs and timing of growth and development. Providers caring for patients in this vulnerable age range should understand how to identify, approach, and manage these potential age-related complications.ReviewEvidence continues to accumulate that increasingly younger patients are being diagnosed with eating disorders. These children and young adolescents have significant risk for unique and potentially irreversible medical complications. Without early identification and treatment, restrictive eating disorders may negatively impact linear growth, bone development and brain maturation in children and young adolescents. Additionally, due to the energy needs of growth and development, unique considerations exist for the use of acute medical stabilization and the identification of patients at risk for refeeding syndrome with initial nutritional rehabilitation. This review presents an approach to the evaluation and management of children and young adolescents with eating disorders.ConclusionChildren and young adolescents with restrictive eating disorders may have unique medical complications related to the energy needs and timing of linear growth and pubertal development. Significant risk exists for irreversible medical complications of impaired growth, bone, and brain health. Increased awareness of the energy needs for growth and development may improve early recognition, appropriate intervention, and future outcomes for children and young adolescents with restrictive eating disorders.