Dull name: exciting contents

What a wonderful thing, the Clinical Report Identification and Management of Eating Disorders in Children and Adolescents FROM THE AMERICAN ACADEMY OF PEDIATRICS

First of all, because it is online, full text. Parents can read it and know what their pediatrician knows (or should). Moms and dads can have a direct peek into the state of the art about the illness and how it is treated.

They can read this line, in particular, that may save years of potential misery: "When an adolescent is referred to a pediatrician because parents, friends, or school personnel suspect the possibility of an eating disorder, it is likely that disordered eating is present." This is critical information. Parents generally report feeling something was wrong, and it is validated by those around them. But they doubt it, and fear it. If the pediatrician minimizes, in an attempt to be reassuring, a long chain of missed opportunities can ensue. The parent needs to know that those worries are usually valid - and ideally their concern should be taken as a strong indicator of a problem.

This line, too, is critical: "Pediatricians must, therefore, not be lulled into a false sense of security if the adolescent denies all symptoms." Amen.

On the other hand, *I'm* critical of this line: "The parents’ reaction to the illness should also be assessed. Parental indifference or denial of the problem or inconsistent views about treatment may affect the course of the illness and recovery." It's true, of course, but could be phrased better. This sounds like "These parents can be obstructive." and fits into general disdain for parents that, while it is certainly true in some cases, is not a great starting point and feeds into lingering doubts about causation. Let me edit it: "Parents are often confused by the symptoms and may harbor unfounded fears and misconceptions that can, if unaddressed, affect the course of the illness and recovery. Your role as physician is to start the process of parent information and support that will lead to a positive outcome."

But this, this line is buried in the middle but could really use bolding, underlining, bells, and whistles: "The pediatrician should identify other potential psychiatric diagnoses (such as depression, anxiety, or obsessive-compulsive disorder), which may be a cause or consequence of disordered eating."

As far as I know, that is the clearest statement in such a publication to draw a connection between the eating and the psychological symptoms that acknowledges that the relationship may be bi-directional. Most recommendations talk about the disordered eating being a consequence of psychological symptoms, but not the cause. I am dismayed daily  at this gap in the literature so cheer for it here.

Bravo, AAP, for a clear and useful and evidence-based review and recommendations. This is a tool we will be using for a while!


  1. Brilliant news! I'm coming from the opposite view on the "cause or consequence" clause, and am mainly just relieved that they are looking for other potential psychiatric diagnoses at all but I'm in agreement with you, this is fantastic although the wording on parents could definitely be tighter.

    My big wish now is to work towards an environment where this is read, not only by paediatricians, but by clinicians treating adults too - let's get rid of the ticking clock which ENCOURAGES clinical teams to say something completely different once the patient reaches the magic age of 18. -

  2. That line at 18 is absurd and dangerous. I can hardly wrap my head around it!!!!

    If anything, patients over 18 need MORE support and engagement from parents NOT LESS. Entering legal adulthood with a potentially life-destroying mental illness that is TREATABLE without the full press of parent and clinician and health system coordination is cruel indeed.

  3. I have no idea what the answer is to that - being a legal adult means that you have the right to refuse treatment, but it makes it so easy to refuse it. I personally keep getting to a point where I don't like what I am hearing, and so just walk away (as I did again 2 weeks ago), which of course leads to relapse. But what can be done about this I have no idea. No one can *make* me more accountable because I'm well over 18.

    I liked your edit btw - why didn't someone consult you on the wording??


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