- Whereas eating disturbances in children are fairly common, the classical eating disorders are observed infrequently. Nonetheless, cases of prepubertal anorexia nervosa as early as age seven have been reliably documented for over a century.
- The existence of bulimia nervosa as a syndrome in children is not well documented except for two possible retrospectively determined cases reported by clinician. Overeating episodes, on the other hand, have been described in male and female children in the course of anorexia nervosa, albeit rarely.
- In point of fact, Few medical practitioners in England are familiar with anorexia nervosa in childhood. A mere 31% among pediatricians and only 3% of family practitioners in a geographical area mentioned a possible diagnosis of anorexia nervosa when they were asked to evaluate two case vignettes of childhood anorexia nervosa.
- The Diagnostic and Statistical Manual, fourth edition, no longer classifies eating disorders under ” Disorders usually first evident in infancy, childhood or adolescence ” as in DSM III-R. Eating disorders occupy now a separate section under disorders in adulthood. This reclassification is unfortunate, since it ignores that anorexia nervosa does occur in childhood, typically has its onset during adolescence and is intricately related to growth and development. Feeding and eating disorders of infancy or early childhood have remained in the childhood section and comprise three syndromes: pica, rumination disorder, and feeding disorder of infancy or early childhood.
- Recent retrospective analyses of hospital records have noted an increase in childhood anorexia nervosa. Whether this finding is due to a true increase in incidence or reflects previous underdiagnosis of childhood anorexia nervosa will require more study.
- Another factor which could contribute to underdiagnosis is the lack of consensus regarding the diagnostic criteria.
- The DSM-III diagnostic criteria as too restrictive and insufficiently specific for diagnosing children. On the assumption that excessive fear of becoming obese in the presence of severe underweight was a universally accepted core symptom, the amount of body weight loss required for the diagnosis was too high, because the smaller percentage of total body fat in children resulted in greater emaciation with less weight loss than in the postpubertal female. These concerns lead to a revision of the weight criteria in DSM-III-R with a reduction of the weight loss requirements for anorexia nervosa to 15% instead of 25%.
- Another symptom typically observed in childhood, deccelerated growth (10-14 years) in the absence of any physical or mental illness. Furthermore, the criteria requiring amenorrhea in females or impotence for males do not apply to children.
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