SAN DIEGO – The presence or absence of body image distortion can help clinicians identify two distinct groups of latency-age children who present with severe food refusal, Robyn S. Mehlenbeck, Ph.D., reported at the annual meeting of the Society for Developmental and Behavioral Pediatrics.
The finding is important because latency-age patients do not fit neatly into categories of anorexia or feeding disorder of early childhood, said Dr. Mehlenbeck of the department of psychiatry at Rhode Island Hospital, Brown Medical School, Providence, R.I.
“There's a lot of confusion about these kids who don't fit [a definition] and we really don't know what to call them, let alone what to do with them,” she said, adding that there are no good estimates on the number of younger children with eating disorders.
She and her associates reviewed the medical charts of 44 patients, aged 6–12 years, who presented with food refusal and restrictive eating habits to a day treatment program at Rhode Island Hospital between 1999 and 2003. The treatment program takes a multidisciplinary team approach, collaborating closely with families and community providers.
At intake, families completed questionnaires about behavioral and family functioning, and quality of life. The mean age of study participants was 10 years, and more than half of the participants were female (67%). Most were white (82%), and 30% were on public insurance. The average length of stay in the program was 21 days.
The investigators divided the children into two groups. The 16 children who presented with body image distortion were called the early onset anorexia (EOA) group, while the 28 who presented with no body image distortion were called the atypical eating disorder (AED) group.
The two groups of children did not differ in terms of gender, insurance type, or program length of stay, but children in the AED group were about 2 years younger than their EOA counterparts (a mean of 9.7 years vs. 11.4 years, respectively).
All eight children from minority backgrounds were in the atypical eating disorder group; the children in the AED group were more likely to come from single-parent households than were those in the early onset anorexia group.
The two groups did not differ in terms of body mass index and most medical factors, but those in the EOA group were more likely to show cardiovascular compromise, exercise excessively, and have a family history of eating disorders, compared with the children in the AED group.
In addition, nearly 90% of the children in the EOA group had recent weight loss prior to starting the treatment program, compared with about 50% of those in the AED group. Of the children who had weight loss, the mean loss was 19.7 pounds in the EOA group, compared with a mean of 8.3 pounds in the AED group.
On the flip side, children in the AED group were more likely than their EOA counterparts to be described by their parents as having a history of picky eating, poor appetite, sensitivity to textures, slow eating, and difficulty swallowing.
Dr. Mehlenbeck said that the treatment implications differ for these two groups of children. “We would treat AED kids more behaviorally, similar to kids with anxiety and behavior disorders,” she said. “Treatment for kids with EOA would be similar to interventions for anorexia.”
Identifying children with food refusal problems early “may help quite a bit,” she added. “Collaboration is key. All of these kids need to be treated with a team format. So even if they're an outpatient, pediatricians should be working with a mental health worker who specializes in feeding or eating disorders, and a dietitian.”